A New Kind of Hospital and a Different Way of Viewing Diabetes

Can you imagine a hospital where the floors are carpeted, so you feel soothed and protected? Where the doors open silently so as not to jar your nerves? Where vending machines are filled with fresh fruits, and the healthier the meal in the cafeteria, the less it costs? How about elevator doors covered in exotic floral motifs, or a diabetes center where you never wait more than ten minutes to be seen?

I saw them with my own eyes in Singapore at the Alexandra Hospital during a five-week trip that I took through Asia and Australia in December 2008. Partly a gift to myself after completing a book last year, the trip was also an opportunity to learn about diabetes care on the other side of the world.

I was introduced to the CEO of the Alexandra hospital, Mr. Liak, by my husband, who had previously worked with him. But once Mr. Liak heard that I worked in diabetes, his interest was captured. As my husband said, “He paid me no attention; his eyes were focused on you.”

This amazing hospital is a product of the vision of Mr. Liak and his passionate staff. It is their mission to create a place of healing where people are helped to make healthy choices, even if it’s just taking the stairs instead of the elevator.  Stairways are easily accessible throughout the hospital, not hidden behind locked doors, and they are marked by big red wooden hearts that say, “Please give your heart a lift: Use the stairs.”

Mr. Liak and I discussed the state of healthcare and the treatment of diabetes in Singapore and the U.S. for almost three hours. He shared what some would call a contrarian view: Give diabetes patients a year of treatment and education at Alexandra Hospital. If they improve and own their management, he encourages them to become peer-mentors who help the hospital provide services to even more patients. If they don’t take responsibility for their care after a year, they are free to seek help elsewhere, leaving space for new patients at the hospital.

To say the least, it makes one think. In the U.S., the healthcare system does not particularly motivate patients to become self-reliant and responsible for their own care, although we know that is paramount in managing diabetes. In fact, I once heard a critical tone from my own endocrinologist when I hadn’t been there for a year. But why would I need to come every three months? I am a well-informed patient who manages my diabetes daily. I have an A1c in the 5s, and I get the necessary tests regularly. I can easily discuss my test results with my doctor over the phone and make any necessary adjustments. In fact, I am doing exactly what medical professionals say they want patients to do, managing my own diabetes.

After explaining to Mr. Liak the work I am doing to help patients bring a more positive attitude to managing diabetes, I gave Mr. Liak five copies of my book, The ABCs Of Loving Yourself With Diabetes. As he thumbed through it, his face lit up page by page. He loved it. “This is what we need, a more cheerful and optimistic attitude about managing diabetes!” he said. And with that, he asked us to meet his staff at the hospital’s diabetes center.

I was introduced to the Diabetes Centre staff, and two copies of my book were handed to the Centre’s Director and diabetes nurse. I was shown the book that the diabetes nurse uses with patients and was asked my opinion about it. The first thing I noted, besides its outdated layout and pictures, was that although the book included tabs for medicine, food, exercise, and such, there was no tab for dealing with the psychosocial aspects of living with diabetes. Talk began of translating my book into the Malaysian language, Malay, for the hundreds of thousands of people who live in Singapore and the surrounding region.

Thank goodness my head had not grown so large that I could not fit it through the door to the cafeteria where our tour ended. Over a bowl of vegetables and tofu, Mr. Liak asked me about the presentations I deliver to patients across the country and told me that he’d like to employ someone such as myself to help inspire and encourage other patients. Can you imagine going to a diabetes center to give a talk and having a well-educated patient there to help you? In Singapore, it’s already on the drawing board.

While on my trip from Australia to Japan, I met with two mothers in Sydney whose children recently developed type 1 diabetes. They described their difficulties in getting a school nurse into their children’s’ school. In Japan, I learned that diabetes is a growing problem, but not talked about openly, so you won’t see TV commercials for meters or celebrities talking about having diabetes.

But it was while leaving the Alexandra Hospital that I thought, “If I ever need to be in the hospital, maybe I’ll consider hopping a flight to Singapore.” Meanwhile, upon leaving Mr. Liak that morning, I did what most people in Singapore who are not in the hospital do-shop! 

Riva Greenberg is the author of the book, The ABCs Of Loving Yourself With Diabetes. Her new book, 50 Diabetes Myths That Can Ruin Your Life: And the 50 Diabetes Truths That Can Save It, will be published in July 2009.

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