1st Combined KKH Annual Scientific Meeting

08 Jul 2005

By Prof Satku, Director of Medical Services

Venue: KKH Auditorium

Prof Ivy Ng CEO, KKWCH,

Dr Tay Eng Hseon CMB,

Drs Irene Chan and Sheila Loh, Chairpersons of the Organizing Committee,

Colleagues,

Ladies and Gentlemen

It gives me great pleasure to join you all here today, at the opening of the First Combined KK Women's and Children's Hospital Annual Scientific meeting.

I applaud KK Women's and Children's Hospital for organizing this meeting to advance the knowledge and practice of obstetrics and gynaecology and paediatric medicine in Singapore. I would also like to commend the organising committee for putting together such an impressive programme

Obstetricians and gynaecologists and paediatricians by virtue of their practice, play a key role in safeguarding our future by taking care of the health of women and children.

You have helped Singapore achieve one of the world's best maternal and child health outcomes. For this, I would like to congratulate all of you for a job well done.

However, we can barely rest on our laurels. Like most developed countries in the world today, Singapore faces the problem of low birth rates. The roots of this lie in the rapid urbanization of our society and changes in the family dynamics.

Ever since in vitro fertilization was possible, three decades ago, advancements in the science of assisted reproduction have created new opportunities for persons who otherwise would not have had children.

With advances in genetic testing, we have also been able to detect genetic and chromosomal abnormalities and act to reduce risks of infants with genetic abnormalities being born.

I hope all this success of seemingly being able to turn the biological clock back is not influencing our young couples today to delay having children.

The median age of women at the birth of their first child was 24 years in 1970 and over the years has steadily risen and reached the age of 29 years in 2002. The proportion of women who have their first child when they are over 35 years was 2% in 1970 and rose to 9% in 2002.

My attention to this issue was drawn by the comments of a colleague from another Ministry who noted that sometimes while assuring the older couple that there is still hope for them to have children and the process is safe we may unwittingly be also assuring the younger couples that delaying child bearing is a physiologically acceptable option.

It appears that there may still be a gap in matching societal expectations and the realities of every day living with the advances in science and technology.

To address this, perhaps we ought to make more information available on this issue.

In order to adequately communicate the price of reproductive freedom to them, we may need to give them an insight into the life of a 36 year old first time mother.

They need to understand the anxiety and the stress that she endures while waiting for the results of her triple test or worse still, when having to make a choice to abort a 4 month old fetus and cope with the loss.

Young couples also need to be told more frequently and clearly about the proportion of unsuccessful attempts behind every successful assisted pregnancy and the costs associated with such procedures.

Many of you might say that telling people when to have children is a societal rather than medical concern. However, the potential for physical and mental harm to the mother and unborn child associated with late pregnancies alone warrants a need for educating the public just in the same way as we would talk about healthy eating or exercising regularly.

In addition, at a personal level if our unique influence on society due to our knowledge and professional standing can serve as a catalyst for positive change, we ought to take on that responsibility.

As doctors, we may be able to convince people of the value of having children early. We can help them to understand the facts and accept the arguments so that they do not shrug off our persuasion as "just another piece of government propaganda".

As many of you in the audience would remember, the O&G doctors in Singapore were in the forefront of the "STOP at TWO" family planning crusade during the 70s and what a success it was!

The profession almost worked itself out of the job!

Now that the tide has turned, it will almost be continuance of a tradition, if the O&G specialists join the effort to inform the public about the importance of timely pregnancies and perhaps also to have more children. Needless to say, this time around you would not be at risk of working yourself out of the job.

A word of caution. While we need to ensure that ART does not become a lifestyle choice of "reproductive freedom", this needs to be done without discouraging the older mother-to-be from using the current technology to have a child safely.

It is also equally important to promote ART's original intention of treating medical infertility. I am certain the O&G fraternity would be able to do this with the necessary sensitivity.

On a different note, I am happy to observe that you have chosen a theme which emphasizes the maternal and child health and not disease.

Since health precedes disease, both in importance and in time, we ought to consider first how health may be preserved, and then how one may best cure disease.

In today's era of lifestyle related diseases, the real test of maturity of the medical service in a country is when it moves from merely fighting the diseases to preventing them.

Two among the diseases ailing the women in Singapore today are breast and cervical cancer.

Early detection and treatment of these cancers can save lives. To this end, we have put in place National Breast and Cervical cancer screening programmes.

Unfortunately, a significant proportion of women continue to underestimate their risk and thus avoid going for screening. The National Health Survey 2004 showed that less than 40% of women in the target age group had gone for a mammogram within the last 2 years while only 50% had a pap smear done within the last 3 years.

Once again, we must step forward and take every opportunity to encourage our patients to receive preventive services and improve their health risk profile.

Now moving on to our future, the children. Children are the most sensitive barometers of development in a country.

In the words of Mr. Kofi Anan, Secretary-General of the United Nations and I quote "To look into some aspects of the future, we do not need projections by supercomputers. Much of the next millennium can be seen in how we care for our children today. Tomorrow's world is already taking shape in the bodies and minds of our children." Unquote.

Over the years changes have been made to the way we run paediatric practice. The clinics are less intimidating for our "little" patients. The standard of care has also evolved and I can quite confidently say that in most areas we have achieved excellence.

However, there is a group of "children" to whom we need to pay more attention. Adolescence is one of the most critical periods in shaping a child's future course in life. It is during these years that young people develop a definitive sense of self as they adjust to new social roles and achieve biological and psychological maturity. Adequate development of the adolescent is central to preventing depression, eating disorders, drug abuse, teenage pregnancies, HIV/AIDS, and many other problems.

The foundation of unhealthy lifestyle habits is laid early in life. The recent National Health Survey showed that as many as 18.2% of young men and 6.6% of young women in the 18-29 age group smoke regularly. Most of them reported that they tried their first cigarette when they were 14 to 15 years of age.

Only 4% of male smokers and 10 % of female smokers started smoking after their twenties.

The significance of this is that if we manage adolescence well we can in fact drastically reduce the prevalence of smoking and other undesirable, unhealthy habits.

We therefore need to develop programmes to manage adolescence well.

The question is who is responsible for doing this? And do those responsible have adequate resources to engage our adolescents effectively?

This question is not new. It has been asked a hundred times before, even at the time when I was a house officer in Prof Wong Hock Boon's days.

We may not have all the answers, but we have to start making some changes. We have to recognise adolescents as a distinct population group with particular health needs, and work towards addressing them.

Today there are about half million children in Singapore in the 10-18 age group, and another half a million under 10, who would be crossing over to the adolescence in the next few years.

Just as we have become very good in handling the early childhood diseases, it is time that we allocate sufficient resources and develop our health services to offer care and support to the older children. It will be one of the better investments we will make.

It will be most appropriate if paediatricians interested in adolescence, take up this challenge.

Summing up, prevention of diseases in women and children is an important public health priority. We may not have all the solutions as yet nor will they come easily. But meetings like this will serve as a great opportunity and platform for continuous learning and development in this field.

I wish you all a stimulating and enjoyable learning experience.

Thank you.