April 28, 2017

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by Khairunisya Hanafi

WHEN buying a property, it’s all about location, location, location. When seeing a GP, it turns out, it’s all about timing, timing, timing.

It doesn’t matter if your GP clinic is in a shopping mall or in an HDB block. When it comes to how much your consultation fees will cost, it boils down to how long is the visit, whether it’s during the day or night, and whether it’s a weekend or a weekday. There is really no standard to how much a GP can charge – and get this, some doctors might even charge more if you’re being difficult.

Over the past week, we went to 40 clinics all over Singapore to check how much consultation fees cost. We tried to see if clinics in shopping centres would cost more than those in HDB flats. We also wanted to know if consultation fees would cost more at different times of the day.

We found that location really doesn’t matter. Instead, time plays an integral part in the pricing of consultation fees. Patients are typically charged differently depending on the duration of their consultation. Doctors may also charge patients with extended fees should they go beyond the length of a long consultation.

For many clinics that we visited, we were told that the clinics’ consultation fees were ultimately determined by the doctors on duty.

 

Diagnosing the problem

We wanted to know what this range was, after new guidelines came out saying doctors must be reasonable in determining how much to charge their patients. This seemed to be an important point in the report as it noted the number of complaints over the past decade regarding poor communication between doctors and patients about the cost of fees.

Recently, a patient, finance officer Ms Adeline Kang, made a complaint to the Ministry of Health (MOH) that she had been overcharged at a family clinic. The 41-year-old was told that she had to pay $80 at Wee’s Family Clinic & Surgery in Whampoa for two medical conditions- stomach pains and a sore throat.

Dr Wee Chee Chau then clarified the matter in a forum letter to The Straits Times stating that there was a “miscommunication between the patient and the clinic assistant” and that a separate billing for two ailments was “definitely not the case”.

MOH investigated the matter and found that the consultation fee did fall “within the range of charges displayed there”. It however advised the clinic to review the way it communicates its charging practice to patients.

The updated guidelines had another point to make: It reminded doctors that because they’re performing a service, how much they charge must be equal to the amount of work done, or in the words of the report: “the fees that you charge must be fair and reasonable and commensurate with the work actually done”.

This updated code and guidelines will come into effect on Jan 1 next year.

 

Our findings

From the 40 clinics we visited, we found a wide range of consultation fees: From as little as $14 to more than seven times, as much: $110 per visit. Here’s how it works out:

  1. Duration of consult

Of all the variables we found related to timing, this was the best indicator of how much a consult will cost. Shorter consults cost less, and longer consults more, obviously.

However, there was also a lot of variation as to how “short” exactly was a short consult. As many as 18 out of 40 clinics determined this duration to be about 10 minutes. But there was one clinic, Silver Cross Medical Centre at Holland Avenue, which felt that a consultation just under 30 minutes could still be considered short. Most other clinics would consider 30 minutes too long – even for a long consult.

As many as 18 out of 40 clinics determined a “short” consult was about 10 minutes.

As for long consultations, most cost $30 on average and was roughly pegged at 11 to 20 minutes. Again there was some variation, though not by much. Long consultations can go up to $50 for Greenlife Clinical Surgery in Sembawang and Kao & Tan Family in Jalan Membina. Patients’ complaints and medical assessments carried out are other considerations when pricing consultation fees.

We also found a handful of clinics which charged extended fees beyond the span of a long consultation. First Medical Centre in Stirling Road charges about $15 per 10-minute blocks for consultations exceeding 20 minutes.

At Tiong Bahru Medical Centre, $25 is charged for every additional 15 minutes. Phoenix Medical Group at Paya Lebar Square similarly charges $1 for every minute beyond a long consult.

There were also clinics which set fixed prices no matter the duration. Shenton Family Medical Clinic at Jurong Gateway Road charges $22 for both short and long consultations.

Raffles Medical at Causeway Point charges $36.35 and has not changed its price for two years. For Yim Medical Centre in Admiralty MRT, consultation fees are fixed at $25.

2. Weekday or weekend?

Another factor of timing that we found was whether it was a Monday-Friday consult, or a Saturday-Sunday consult. While many clinics we visited did not make this distinction, others went into the nitty-gritty of breaking down the timings of each day, pricing the fees at different rates.

For instance, the Singapore Family Clinic & Surgery situated at Woodlands Drive 70 charges patients from $23 in the day and about 10 per cent more in the evening. On weekends, patients can be charged as much as 22 per cent more than what they would pay on a weekday.

Other clinics, such as Healthway Tampines Central Clinic, charges about 7 per cent more for weekend consultations. Its weekend consults are about $28 and weekday consults are about $26 during office hours.

Think 7 per cent is too high? Well, we found that Raffles Medical in Sembawang increases its fees by more than 40 per cent during the weekends, going at $40 and above.

3. Other special hours 

We also found that there are several doctors who impose surcharges on their patients after usual office hours. At Kao & Tan Family, its midnight surcharge is $50 on weekdays, while during the weekends it charges $76 for consultations after midnight. At Central 24-Hr Clinic in Clementi, patients are charged $110 for midnight consultations.

 

It’s ultimately up to the doctor

Apart from timing, to our surprise, we found that there was another factor: basically how much the doctor likes you.

Dr Siah Kim Bin from Teng Clinic in Stirling Road said some doctors also consider the “attitude of patients” when charging them. If a patient is “stuck up” or “rich”, chances are he or she will have to pay more. The clinic’s fees start at $20 for both short and long consultations. Previously priced at $15, Dr Siah said he raised prices mainly due to inflation.

Dr Lee See Chung from Shenton Family Medical Clinic, on the other hand, prefers to keep his fees affordable. His patient service officer, Madam Alice Cheah said: “Dr Lee doesn’t like to charge his patients too expensively… because he doesn’t like his patients to pay so much in medication and consultations.”

“Even though 11 minutes and above is a long consultation, so far we don’t charge patients that expensively,” the 34-year-old added.

The clinic, located at Tampines Street 21, charges its patients $18 for a short consultation. It last reviewed its fees in January this year, previously charging patients $15.

And of course, all these can be done because it’s really up to the doctors how much they wish to charge their patients – which is exactly the issue the medical council has been trying to address for years.

 

A chronic issue?

The sheer number of different ways a GP can charge is problematic as it gives no direct indicators for patients to gauge their consultation fees.

Actually, this issue has been in scrutiny for a while. In 2007, a guideline on fees was withdrawn due to concerns that it was infringing competition laws. Additionally, the Competition Commission of Singapore removed the listing of fees which doctors should charge in 2010 as they viewed the action as anti-competitive.

While pricing guidelines have since been removed, the Singapore Medical Association does have a recommended fee guideline for private doctors on its website. Nonetheless, general practitioners and family doctors are still empowered to set their own fees.

 

Additional reporting by Iffah Nadhirah Osman

Featured image by Sean Chong.

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Moneylending

by Daniel Yap

CONGRATULATIONS on the double gold! Paralympic backstroke queen Yip Pin Xiu brought home her second gold medal early on Friday, Singapore time, for the 50m backstroke S2 category. Blood, sweat and tears (maybe not blood) have paid off for Yip, and I am 100 per cent proud of her.

She will qualify for a yet-undecided sum of prize money. Not under the Tote Board/Singapore Pools-funded Multi-million dollar Award Programme (MAP) funded by the Singapore National Olympic Council (SNOC) but under the Singapore National Paralympic Council’s (SNPC) donor-funded Athletes’ Achievement Award instead.

The loudest voices on the Internet now are trying to convince everyone that she deserves $1 or $2 million. I disagree. It’s emotional nonsense, and while I’m a big fan of emotional, it’s the nonsense part I can’t stand.

(By the way, Olympic Gold medalist Joseph Schooling would not have been given $2 million if he had two gold medals in the Games. SNOC limits the prize to one per Olympic outing.)

Uplifting or condescending?

A good teacher once asked me whether it was uplifting or condescending to measure a disabled person by a different standard and not hold them to the standards required of able-bodied people. I still don’t have the answer to that question.

While I spend the rest of my life pondering the answer (I suspect the answer is both, and empathy), the reality that hits me is that not every competition is equal in monetary terms. It can’t be so, nor should it be. It’s not even about able-bodied versus disabled. Everything has categories, and these categories are seldom equal, especially financially. Is a preschool teacher worth less than a crane driver? Is art less worthy than finance?

When it comes to judging someone’s worth, it bears reminding that neither Yip nor Schooling are the medals nor the money they win.

Vonnegut’s Handicapper General

If we’re all about equality, how about we cut Schooling’s prize money to match Yip’s? That would make it equal, wouldn’t it? And it would cost a heck of a lot less money, which can be used for talent development of other athletes. This should appease the agents of equality.

But this kind of equality strikes us all as innately unfair. A Paralympic medal is not an Olympic medal. It is not less than an Olympic medal, but neither is it more.

I mean that in the same way that a disabled person like Yip is not less than an able-bodied person, and she is also not more. And they are certainly not exactly equal. That’s why the Paralympics exist.

You get what you raced for

But promises are promises, and Schooling has been promised a million. But on the same note, Yip has never been promised a million, and always knew what she was getting into. She doesn’t do it for the money. She said so herself.

What campaigners are trying to say when they want to give Yip a million bucks is that you can somehow campaign to twist the G’s arm to twist SNOC’s arm to somehow fish a million dollars out of a non-existent budget (G got a lot of money, right?) to give to whoever we feel good about at that moment.

Campaigners want to twist the G’s arm to twist SNOC’s arm to somehow fish a million dollars out of a non-existent budget (G got a lot of money, right?) to give to whoever we feel good about at that moment.

I don’t understand how that makes sense, and certainly don’t want this to be a precedent for how society works.

Kiddolympics, old-lympics

If Yip deserves the same amount of money as Schooling, then the same reasoning should apply to the Youth Olympics as well. Why not award a million dollars to gold-winning youth Olympians? And Special Olympians?

And why not have an old-lympics or a kiddolympics while we’re at it? I’d like to see a bunch of children try the clean and jerk in the under-8-years-old category. Some of them can do it. Is it condescending if I gave them a million bucks, or should I force them to compete in the same category as 20-yearolds?

We don’t put the same stock in the Youth Olympics as we do in the Olympics because we understand that people are different. And with that, financial incentives for different sports are different. And even within MAP, team sports are rewarded differently from individual sports. Don’t believe me? Look it up.

Measure the man by the money?

And so it comes down to this fact of life: money, and the value attached to it, is a matter of economics. That means that people are willing to put in money (or demand someone else pay) because they derive utility from watching a feat. But there are other “currencies” besides money.

But money isn’t everything and shouldn’t be everything. Both Schooling and Yip know this and living with this knowledge is what has enabled them to do what they’ve done.

Some sports are more profitable than others. But some careers are more fulfilling. Schooling’s family took great risks and while I’m glad they will be financially rewarded, I know that this is not the main reason why they sacrificed so much. To make a big deal about money is missing the point.

But if you’re in it for the money

Can’t run to save your life? Here’s one word for your sporting future: E-sports. There’s $8.3 million in prize money for the winning team of the next Dota tournament. You still have to train like a dog. You still have to make sacrifices. You’ll still need to be born with all the right variables – the physique, the sharpness of mind, the ability to stare at a screen for 12 hours a day. You’ll also get scoffed at by sports purists, but at least you could be really, really rich.

The Singaporeans (Jeng “NutZ” Yih Wong and Daryl “iceiceice” Koh) in medal (okay, top-three) contender teams MVP Phoenix and Team DK won’t be getting any money from SNOC anyway, even if they become the best in the world.

But they’ll still be getting a million dollars if they win. And I’ll still be 100 per cent proud of them – even if they don’t.

 

Featured image from TMG file.

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Airline passengers walk past a banner about the Zika virus shortly after landing from Singapore at Soekarno-Hatta airport in Jakarta, Indonesia August 30, 2016. The banner reads "Careful mosquitos spread Zika." Picture taken August 30, 2016. REUTERS/Beawiharta - RTX2O6SQ

by TMG Visuals

THE Indonesian Health Ministry said yesterday (Sept 15) that it has installed larvae traps around its airport terminals as one of the measures to prevent the spreading of Zika virus amid an outbreak in Singapore.

At the Soekarno-Hatta International Airport in Jakarta, one of the busiest airports in Southeast Asia, authorities prepared about 1,000 larvae traps, placing them in the garden, arrival and departure hall, offices, toilets and all public areas across three terminals.

The trap provides an artificial ground for mosquitoes to lay eggs and the chemical in the container will kill the larvae in it. Health officials hope this will effectively reduce the population of mosquitoes.

This is the latest measure carried out by the Indonesia air transport hub following a Zika outbreak in Singapore. It has also enforced thermal scanning on all passengers arriving from here since last month.

Singapore reported its first locally-infected Zika patient on August 27 and since then, the number of reported infections has soared to more than 300. Thailand has recorded about 200 cases of Zika since January, increasing fears that Indonesia, a country of 250 million population, could be exposed to the virus.

“There are about 6,000 passengers arriving from Singapore almost everyday. We monitor and check the body temperature of arrival passengers with thermal scanners, no one so far has been detected (as a possible virus carrier),” said Mr Susanto, a health official who goes by only one name.

“Apparently, not all of them show overheating symptoms like dengue, some of them could be suffering from fever that is under 38 degrees. So the most important thing to do is not let mosquitoes spread around the airport area, therefore we installed these larvae traps in the whole airport area.”

The installation is part of the Indonesian government’s disease prevention programme called “3M”.

Said Mr Oscar Primadi, head of the communication department of Indonesia’s Health Ministry: “The airport, as the entrance (to the nation), is important when it comes to protecting us from Zika. This method can help. We will continue the effort because it is part of the government’s ‘3M’ prevention measure.”

“This is one of the methods that is effective in eradicating the population of mosquitoes. So, I would like to reiterate that, we will advocate this method to the public as it has been proven to be an efficient technology. We will do anything we can to curb the growing of the mosquitoes,” he added.

The Zika virus, which has spread through the Americas and the Caribbean since late last year, is generally a mild disease but is a particular risk to pregnant women. It has been linked to microcephaly – a severe birth defect in which babies are born with abnormally small heads and underdeveloped brains.

 

Featured image by REUTERS.

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Washing hand
Flickr User: U.S. Department of AgricultureImage title: 20120106-OC-AMW-0074Flickr link: https://www.flickr.com/photos/usdagov/7008315603/in/photolist-bFis4D-6V9shs-gcGgqB-3hmjdh-6WpAcE-fgjY6V-dirESM-o2eiPa-8S3bep-pSCRK4-bUcL5p-qPMDbA-8XDc-4rqSw2-bFir5F-a6ksm6-qS1aFo-hGzkT-bUcPvt-nmL2zk-ahhTkt-9GG7C8-9j79jG-6PLtGt-j1NS1Q-qRVikR-pHsymG-biN2hx-dfS1Hv-p4Gcnv-caWBuQ-9PTueN-dfS1Bk-qMzoGo-r55z1u-4GEU1z-q8nnDZ-omhhMu-qzvcwh-oEx2mK-fQ5BzU-dfS1DM-omhEid-cbz4vw-9uhiCj-6grA7Q-5Qk3Wy-7vs9K5-qzwf2Y-qzwbvQ

by Wan Ting Koh

TRICLOSAN and triclocarban may sound alien to many of us, but it is a common ingredient in many antibacterial hand soaps and body washes available in Singapore.

Both chemicals have now been banned by the US’s Food and Drug Administration (FDA). The FDA did so after manufacturers failed to demonstrate that the ingredients are both safe for long-term daily use and more effective than plain soap and water in preventing illnesses.

When TMG checked the shelves of a local supermarket chain, six in 10 brands of antibacterial wash contained at least one of the banned substances as an active ingredient. This included popular household brands such as Lifebuoy, Ginvera and Follow Me.

Triclosan and triclocarban are just two of 19 ingredients highlighted by the FDA for the long-term health risks they pose to people who use them. The other 17 ingredients are cloflucarban, fluorosalan, hexachlorophene, hexylresorcinol, iodophors (Iodine-containing ingredients), iodine complex (ammonium ether sulfate and polyoxyethylene sorbitan monolaurate), iodine complex (phosphate ester of alkylaryloxy polyethylene glycol), nonylphenoxypoly (ethyleneoxy) ethanoliodine, poloxamer—iodine complex, povidone-iodine 5 to 10 per cent, undecoylium chloride iodine complex, methylbenzethonium chloride, phenol (greater than 1.5 percent), phenol (less than 1.5 percent), secondary amyltricresols, sodium oxychlorosene, tribromsalan, triple dye.

The FDA made its final ruling on Sept 2, banning over-the-counter consumer antiseptic wash products containing the 19 ingredients. A statement released on the same day said that manufacturers in the US would be given a year to comply with the rule. They would have to remove affected products from the market or replace the antibacterial ingredients in the products.

The reason for the rule? There is no scientific evidence that antibacterial washes are more effective than your normal hand soap in preventing the spread of germs, according to the FDA. In fact, their harmful effects might even outweigh their benefits.

Antibacterial soap refers to soap containing ingredients with active antimicrobial activity, that is, the ingredients destroy or inhibit the growth of microorganisms. Plain soap, on the other hand, contains no such ingredients. Soap is usually made by action of alkali on fat or fatty acids and consists essentially of sodium or potassium salts of such acids.

Dr Janet Woodcock, the director of the FDA’s Center for Drug Evaluation and Research (CDER) said in the statement: “Consumers may think antibacterial washes are more effective at preventing the spread of germs, but we have no scientific evidence that they are any better than plain soap and water.”

The CDER had issued a proposed ruling three years ago suggesting that long-term exposure to active ingredients used in antibacterial products could pose health risks, such as bacterial resistance or hormonal effects. This means that using the products could promote drug-resistant infections or interfere with important hormone functions. A report by the US Natural Resources Defense Council said that triclosan disturbs thyroid, testosterone and estrogen regulation, which can create a host of issues including early puberty, poor sperm quality, infertility, obesity and cancer.

Back in 2013, antibacterial hand and body wash manufacturers were required to provide the agency with additional data on the safety and effectiveness of certain ingredients if they wanted to continue marketing products containing them, but they did not provide the data.

This is what the FDA said in its recent statement: “Companies will no longer be able to market antibacterial washes with these ingredients because manufacturers did not demonstrate that the ingredients are both safe for long-term daily use and more effective than plain soap and water in preventing illness and the spread of certain infections.”

While this ban does not currently apply to Singapore, we visited a branch of a popular supermarket chain to check out whether the hand and body soap marketed as “antibacterial” contain the active ingredients, and here is what we found:

Products containing triclocarban:

Dettol bar soap

Lifebuoy hand soap

Protex shower gel

Lifebuoy bodywash

Products containing triclosan:

Ginvera 2-in-1 hand liquid soap

Follow me hand soap

Follow me shower foam

EverSoft shower foam

Ginvera shower foam

Products free from the ingredients:

Dettol hand soap

Dettol body wash

Kirei Kirei hand soap

Kirei Kirei body foam

Shokubutsu body foam

SilkBath body soap

HomeMaster fruity hand soap

News of the FDA ban earlier this month has sparked off reviews of the antibacterial ingredients in hand wash products in other countries. Canada, India and Israel are considering whether to follow in the US’ footsteps.

TMG has asked Health Sciences Authority in Singapore for its comments. It had said in 2013 that it was closely monitoring international developments concerning the review of active ingredients found in antibacterial products, and would take appropriate action based on the outcome of the FDA review.

In the US, some of the largest companies behind the antibacterial products have already started removing the banned chemicals. Johnson & Johnson and Procter & Gamble (P&G) announced their intention to phase out the chemicals in their products before the rule was made final, according to the CDER. Johnson & Johnson expressed its intention to phase out triclosan in its products by 2015 while P&G said on its website that it has eliminated triclosan from “more than 99 per cent of the products where it was used”.

The American Cleaning Institute (ACI) however, insisted that antibacterial soaps and washes continue to be safe and effective products for consumers. In a statement responding to the FDA rule, it said antibacterial soaps are “critical to public health” due to the importance of hand hygiene in the prevention of infection.

“Washing the hands with an antiseptic soap can help reduce the risk of infection beyond that provided by washing with non-antibacterial soap and water… Consumers can continue to use antibacterial soaps with confidence as they have for decades in millions of homes, offices, schools, daycare centers and other commercial settings,” it said.

Featured image 20120106-OC-AMW-0074 by Flickr user U.S. Department of Agriculture (CC BY 2.0)

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Chiara Micheletti helps her mother Marisa Vesco take a shower in Cossato, Italy, June 7, 2015. Marisa suffered from incurable liver cancer and in the last months of her life she was not able to bathe herself. Her daughter Chiara cherished the time she was able to help her mother. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY - RTSMMRJ

GAIA SQUARCI/ REUTERS

Marisa Vesco eats ice cream in her bed in Cossato, Italy, June 30, 2015. Marisa suffered from liver cancer and a loss of appetite during the last months of her life; eating ice cream was one of her few pleasures. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. - RTSMMRF
LIFE PLEASURES: Marisa Vesco eats ice cream in her bed in Cossato, Italy, June 30, 2015. Marisa suffered from liver cancer and a loss of appetite during the last months of her life; eating ice cream was one of her few pleasures. (Photo by REUTERS/Gaia Squarci)

 

MY GRANDMOTHER’S life and mine overlapped for 27 years. I always called her “Nonna.”

Our age difference and profoundly contrasting values and way of thinking did not prevent us from developing a strong bond and a relationship punctuated by mischievous games and moments of tenderness and humour. We were amused by our differences.

“You know, I was still young when you were born,” she told me a few weeks before she died. “It’s a little like we grew up together.”

At a lunch table a few months earlier in Milan, I learned from my mother, her daughter, that Nonna, 85, suffered from incurable liver cancer. Years before, she had already survived two bouts of breast cancer.

 

Old family photographs are seen on Marisa VescoÕs bed as she works on creating a family album with her granddaughter, the photographer Gaia Squarci in Cossato, Italy, July 1, 2015. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY - RTSMMSH
PHOTOGRAPHIC MEMORY: Old family photographs are seen on Marisa Vesco’s bed as she works on creating a family album with her granddaughter, the photographer. (Photo by REUTERS/Gaia Squarci)

 

Nonna would tell me time and time again that the news of my birth had given her the strength to fight.

When I learned that she was sick again, I had just landed in Italy, where I would be for only three days before flying back to New York.

Even more heartbreaking than the fear of saying goodbye to her was the fact that my grandmother did not know how sick she was. My mother and aunt believed she could not bear the thought of a third bout with cancer, this time, affecting her liver. Nonna was told by family members that her liver was ill.

 

Chiara Micheletti helps to bathe her mother Marisa Vesco in Milan, Italy May 21, 2015. Marisa suffered from incurable liver cancer and in the last months of her life needed assistance. Her daughter Chiara cherished the time she was able to help her mother. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. - RTSMMS3
MOTHER AND DAUGHTER: Chiara Micheletti helps to bathe her mother Marisa Vesco in Milan, Italy May 21, 2015. Marisa suffered from incurable liver cancer and in the last months of her life needed assistance. Her daughter Chiara cherished the time she was able to help her mother. (Photo by REUTERS/Gaia Squarci)

 

No one ever mentioned the word “cancer.”

Because of this, one question haunted us until the day she died: Did we have the right to know the truth about her condition when she did not?

Nonna spent most of her last months at home, surrounded by family. She reconciled with the idea of death and said she could slowly feel it coming.

Doctors felt that surgery and chemotherapy would be pointless.

 

Marisa VescoÕs perfume bottles, almost all of which were empty, sit on the edge of the bath at her home in Cossato, Italy, February 5, 2015. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. - RTSMMSD
A WHIFF OF THE PAST: Marisa Vesco’s perfume bottles, almost all of which were empty, sit on the edge of the bath at her home in Cossato, Italy, February 5, 2015. (Photo by REUTERS/Gaia Squarci)

 

In the midst of all this, I realised my mother was losing her mother.

After moving back to Italy for a few months, I witnessed the range of my mother’s emotions and the energy she devoted to the time they had left together.

Nonna’s world shrank to a few walls and fewer streets. In this narrow existence, every detail and daily act took on deeper meaning.

 

The pills taken by Marisa Vesco to alleviate the symptoms of liver cancer are photographed on her bed in Cossato, Italy, June 23, 2015. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. - RTSMMSF
DAILY SUSTENANCE: The pills taken by Marisa Vesco to alleviate the symptoms of liver cancer. (Photo by REUTERS/Gaia Squarci)

 

One of the things my mother treasured most was giving her mother a bath. She did not hesitate to touch her old body, and she did not want others to do it on her behalf.

I joined my mother and grandmother in the bathroom to quietly observe them with my camera.

 

Marisa Vesco reaches for a magazine in a bedroom of her apartment in Cossato, Italy, June 7, 2015. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY - RTSMMR1
REQUIRED READING: Marisa Vesco reaches for a magazine in a bedroom of her apartment. She joked about the photos taken by the photographer appearing on the magazine covers. (Photo by REUTERS/Gaia Squarci)

 

As I experienced those precious moments, I imagined myself at an older age and thought about how time changes one’s perspective on being a woman.

As my grandmother faced my lens, completely naked, her body bearing the signs of past and present illnesses, she did not show the slightest bit of shame – only trust and pride.

 

Marisa Vesco embraces her nephew Luca Squarci during a visit to Cossato, Italy, June 22, 2015. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY - RTSMMSQ
HUGS: Marisa Vesco embraces her nephew Luca Squarci during a visit to Cossato, Italy. (Photo by REUTERS/Gaia Squarci)

 

If you spoke with people in Nonna’s town they would say she never left the house without being enveloped in a cloud of perfume, her white hair perfectly coiffed and her face tinged with makeup.

I was surprised by the way she confronted being ill without losing her femininity. She was able to poke fun at herself. More than once she asked me, “Am I going to end up on Vogue or Marie Claire?”

 

Chiara Micheletti embraces her mother Marisa Vesco in her room at a hospice where she stayed for a month and a half before her death in Biella, Italy, August 21, 2015. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. - RTSMMR5
BY HER SIDE: Chiara Micheletti embraces her mother Marisa Vesco in her room at a hospice where she stayed for a month and a half before her death in Biella, Italy, August 21, 2015. (Photo by REUTERS/Gaia Squarci)

 

On October 11, 2015, the day Nonna died in Biella, Italy, I was across the world in Brooklyn, New York. I had spent five months with her, celebrating her life instead of mourning her death.

I remember taking a walk through the Greenpoint neighbourhood of Brooklyn and staring for a while at kids competing in a race. I was unable to come to terms with the fact she was no longer a part of the world around me.

I struggled with the concept of death and the abstract emotion we call grief. I found peace only when I returned to Italy to spread Nonna’s ashes.

 

Marisa VescoÕs ashes are spread by her nephew Luca Squarci at her favourite location where she grew up near Cossato, Italy, December 16, 2015. REUTERS/Gaia Squarci SEARCH "ITALY CANCER" FOR THIS STORY. SEARCH "THE WIDER IMAGE" FOR ALL STORIES. - RTSMMRC
FAREWELL: Marisa Vesco’s ashes are spread by her nephew Luca Squarci at her favourite location where she grew up near Cossato, Italy, December 16, 2015. (Photo by REUTERS/Gaia Squarci)

 

My family and I walked to Nonna’s favourite place in the mountains not far from Cossato in northwestern Italy, the town in which she had grown up.

Her ashes felt heavy in my hands. I threw them far up into the air, and they fell all over the grass, and all over me. My mother, brother and aunt did the same, again and again.

In the end, we were covered in Nonna’s ashes and so was the field around us.

Months later, my mother sent me a photograph of that field. It was completely covered in flowers.

 

Featured image by Gaia Squarci/ REUTERS.

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ZIKA is here. We’d rather not say “finally”, since we’ve been warned about it so many times that it seemed like a bad mantra. That exotic word by the way, refers to a disease spread by that dratted Aedes mosquito, the type which also spreads dengue.

We’ve been warned that we’re vulnerable because we have so many people going through Singapore. In May, Singapore reported its first imported case, a 48-year-old who travelled to Sao Paulo. It had seemed like something so far away, in Brazil, where pregnant women could pass the infection to the foetus who would be born with birth defects.

But Singapore’s latest Zika patient, a 47-year-old female Malaysian who resides at Block 102 Aljunied Crescent and works in Singapore, hasn’t travelled to Zika-affected areas recently. This means she was probably infected in Singapore which makes her the first case of local transmission.

MOH is also screening others living and working in the area who have symptoms of fever and rash. At this point, two members in a family who live in the Aljunied Crescent area and an individual who works there, had preliminarily tested positive based on their urine samples.

Don’t start panicking.

According to MOH: “Zika is generally a mild disease. It may cause a viral fever similar to dengue or chikungunya, with fever, skin rashes, body aches, and headache. But many people infected with the Zika virus infection do not even develop symptoms.” But pregnant women who live or work in the vicinity and who have a fever or rash should see a doctor.

The Malaysian, who developed fever, rash and conjunctivitis on August 25, is recovering well.

As for precautions, we should just do what we’ve always known we should do – wipe out the mosquito population. That might just rid us of the dengue fever scourge as well. Dengue has claimed seven lives so far. By the way, the Malaysian isn’t living in an active dengue cluster but there are two other clusters nearby.

 

Featured image from TMG file.

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by Andrea Wang

IN HIS update on PM Lee’s condition following his ill spell during last night’s National Day Rally (NDR), Minister for Foreign Affairs Dr Vivian Balakrishnan, who is also a doctor, revealed that “PM Lee had a vasovagal episode”.

A “vasovagal episode” may sound quite scary, but Dr Balakrishnan assured us that PM Lee is okay. In fact it’s relatively common and is one of the major causes of fainting.

Essentially, a vasovagal episode like the one PM Lee suffered from is a feeling of discomfort caused by the overstimulation of the vagus nerve. The vagus nerve is the longest of the 12 cranial nerves, which emerge directly from the brain. It is linked to major organs such as the heart, lungs and oesophagus. When you sweat and digest food, it’s the vagus nerve that sends the right signal. It’s also in charge of keeping your heart rate constant.

So when this nerve is overstimulated, it can cause your heartbeat to pause or slow down, lowering blood pressure and temporarily slowing the blood supply to the brain. This is known as a vasovagal attack, or vasovagal episode.

As Dr Balakrishnan said in his post, PM Lee showed the classic symptoms of a vasovagal episode, “sweatiness, low heart rate and low blood pressure”.

Common triggers include seeing an unpleasant sight (like blood), heat exposure and standing for long periods of time.

When the overstimulation of the vagus nerve leads to a loss of consciousness, it’s known as a vasovagal syncope, one of the most common types of fainting.

Other, less common, types of fainting include situational syncope, which is when sudden sneezing or coughing puts pressure on the autonomic nervous system which regulates automatic body functions (such as heart rate or blood pressure) and cardiac syncope, which is fainting caused by heart problems (for example coronary heart disease) that interrupt the flow of blood.

If you happen to have such an episode, you can try asking your doctor for a week off – PM Lee is on medical leave until August 29.

 

Featured image taken from Elson Soh’s Facebook Page.

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by Glenn Ong

BAK KWA – or barbecued meat – is a favourite among many Singaporeans, especially during festive periods like Chinese New Year.

However, health concerns are popping up, with a report, released last month by the Thai Consumer Protection Association, saying that many brands of bak kwa from Bangkok contained high amounts of sodium nitrite, a carcinogen (cancer-causing). These brands had failed to clearly label the bak kwa’s expiry dates too.

Processed meat products in general can be cancer-causing too, according to a report by the World Health Organisation published last November.

But what exactly is sodium nitrite, and how is it harmful to us?

 

What is sodium nitrite?

Its scary name notwithstanding, sodium nitrite is actually a type of salt and anti-oxidant used in curing meats like ham, bacon, and sausages. Cured meat cannot be made without sodium nitrite, which also gives such meats their distinct flavour. This means that you have probably been unknowingly consuming it your entire life.

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Image Bacon! by Flickr user Didriks (CC BY 2.0)

Consuming sodium nitrite purportedly has benefits for your body. It prevents the growth of a bacteria that causes botulism, a potentially-fatal disease that causes weakness in the limbs and breathing difficulties. Also, the use of nitrite prevents the growth of a bacteria that causes listeriosis, a serious infection which can lead to miscarriage. As a preservative, sodium nitrite also increases the shelf life of food and prevents spoilage.

Yet, cured meats are not the largest source of our daily nitrite intake. According to the American Meat Institute, 93 per cent of nitrite intake is from tubers (like potatoes), vegetables, and even our own saliva.

The nitrate to nitrite conversion process from eating vegetables makes up 85 per cent of the average human dietary nitrite intake.

In fact, the amount of nitrate in cured meats is significantly lower than in vegetables. Spinach contains around 500 to 1900 parts per million of nitrate, whereas US food regulators allow “no more than 156 parts per million” of nitrite for cured meat.

 

Why is sodium nitrite bad?

Ms Gladys Chu, a lecturer from Nanyang Polytechnic’s (NYP) Diploma in Food Science and Nutrition programme, said: “According to the International Agency for Research on Cancer (IARC), processed meat is classified as carcinogenic to humans, based on sufficient evidence that consumption of processed meat can cause colorectal cancer.” She added that “one of the chemical preservatives present in processed meats is sodium nitrite”.

So what makes sodium nitrite cancerous? Ms Chu said: “During meat processing, carcinogenic chemicals including N-nitroso compound are formed.”

To what extent is this chemical compound harmful? According to an academic paper titled “N-Nitroso compounds in the diet“, published in the scientific journal Mutation Research – Genetic Toxicology and Environmental Mutagenesis, “N-nitroso compounds have been shown in animal experiments to be the most broadly acting and the most potent group of carcinogens”.

The article also said that the “widespread exposure to N-nitroso compounds in food provides one link [to finding the cause of cancers] that should not be ignored”.

 

Does Singapore bak kwa contain sodium nitrite?

TMG reached out to local bak kwa producer Lim Chee Guan, which said that its bak kwa does not contain any sodium nitrite.

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Lim Chee Guan bak kwa. Image from Lim Chee Guan’s Facebook page by Facebook user Ong Hoey Siang.

“Our food processes comply with HACCP standards, and are thus safe for consumers,” said the spokesperson. When asked about what preservatives go into its bak kwa, the spokesperson said that the company only uses “sugar and common table salt”, which are natural preservatives.

On how long its bak kwa can last before expiring, the spokesperson said: “Our bak kwa are freshly made and packed upon purchase. Therefore, it is best consumed within ten days.”

 

Regulations in Singapore

Sodium nitrite is a permitted additive in Singapore. According to the Agri-Food and Veterinary Authority of Singapore’s (AVA) food regulations, the maximum amount of sodium nitrite allowed in cured or preserved meats is 125 parts per million.

Conversely, it appears that Thailand, which generally follows the United States Food and Drug Administration (US FDA) and the Codex General Standard for Food Additives (GSFA) as a benchmark, presumably holds itself to stricter standards. The GSFA mandates that food products containing sodium nitrite cannot contain more than 80 parts per million.

On shelf life and expiry dates, AVA told TMG that for now, only products with limited shelf-lives need to be labelled with expiry dates. These products are:

  1. Perishable/short shelf-life products (such as tofu, pasteurised milk and some other milk products)
  2. Products whose quality may deteriorate over time (such as vitaminised drinks and cooking oil)
  3. Products such as raisins and breakfast cereals that are susceptible to contamination (such as insect infestation, after prolonged storage)
  4. Infant food

In addition, the AVA does not permit any form of meat from Thailand to be imported into Singapore. For more information on which countries are on the permitted list, you may refer to AVA’s website here.

An AVA spokesperson said to TMG: “Thailand is not an approved country to bring in meat products (for personal consumption) in view of its animal disease status.” The spokesperson said that these measures are necessary “to prevent introduction of diseases into Singapore which would have an impact on Singapore’s animal population and trade status”.

 

Safety for our bodies 

“Every 50g of processed meat eaten daily increases the risk of colorectal cancer by about 18 per cent.”

– Ms Chu quoted “studies”

NYP’s Ms Chu said that food products that keep to the 125 parts per million limit are generally safe for consumption. Said Ms Chu: “The food additive sodium nitrite may be safely used in processed meat in accordance with this recommendation.”

However, she cautioned against overconsumption of processed meat. “Studies show that every 50g of processed meat eaten daily increases the risk of colorectal cancer by about 18 per cent. Even a small amount of processed meat can increase cancer risk,” she said.

 

Featured image by Natassya Diana.

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by Andrea Wang

ABOUT a year after MediShield Life (MSHL) replaced MediShield, Integrated Shield Plan (IP) users could see an increase in their premiums as soon as October this year.

Such policyholders could see their premiums increase by more than 20 per cent due to “ballooning medical costs and worsening claims experience”, reported The Business Times (BT) on Wednesday (August 10). The rise would also tie in with the expiration of the IP insurers’ promise to hold off premium increases for a year since the launch of MSHL last November.

A few assumptions (based on past industry data) were made here when calculating this figure – such as claims going up by 5 percentage points a year. According to the BT report, insurers will have to raise premiums by 21 per cent if they are to break even over the next three years.

How much exactly an individual’s premiums will rise will still however depend on other factors, including age, the type of insurance policy, and its coverage.

Apart from rising medical costs, other pressures facing insurers include making money. In a separate report yesterday, BT said three out of these five IP insurers incurred losses last year.

These insurers, Aviva, NTUC Income and Prudential, have chalked up losses due to the skyrocketing cost of claims that have gone up at a faster rate than anticipated, BT said.

AIA and Great Eastern were the two insurers that recorded profits. A sixth insurer AXA Life also offers IP, but because they only started offering plans in May this year, they were excluded from the report.

If there’s a silver lining for insurers, it’s that Singaporeans are increasingly recognising the value of health insurance, and in particular, IP. The Life Insurance Association (LIA) said that there has been a 25 per cent rise in new premiums in the first half of the year, with a sizeable portion coming from IPs.

Back to the premium increases. It is too soon to say how the expected increases may influence individuals, but available government grants could mean that you may not need to pay out-of-pocket costs – something which the BT report left out.

These subsidies are the Premium Subsidy, Transitional Subsidy, Pioneer Generation Subsidy and Needy Subsidy. To find out more about these subsidies, click here. Or, contact your insurance provider for more information on how the upcoming premium increases will affect your policy.

 

Featured image Health Insurance Premiums by Flickr User Sharon Sinclair(CC BY 2.0).

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by Andrea Wang and Vir Chiniwala

AFTER the abrupt closure of California Fitness, some of us will now have to find a new gym. Others just want to get in on this whole exercise thing, but are unsure of where to start.

Consider boutique gyms. More of these smaller gyms, many of which specialise in a specific type of workout or machine, are popping up.

Here’s why (and where) you can get in on this trend:

 

They offer more unconventional methods of exercising 

No, your options are not limited to running, the elliptical and weight training. Find the workout that’s perfect for you, and in the process, you might also find a like-minded community of people.

 

Upside motion

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Image taken from lululemon athletica Singapore‘s Facebook page

If you’re looking to shake things up, Upside Motion is a good place to go. With a focus on three main programmes – Pilates, Xtend Barre, and Aerial – Upside Motion offers a unique range of workouts.

That coveted dancer’s body can become a reality with Xtend Barre, a fast paced exercise that taps into ballet and Pilates to sculpt a leaned and toned body. Aerial, on the other hand, is a low impact workout that uses a silk hammock to loosen your joints and strengthen your core.

Location: 36 Armenian Street, #02-03, 179934 / 321 Orchard Road, #04-05, 238866

 

SURFSET Singapore

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Image taken from SURFSET Singapore‘s Facebook page

Ever dreamt of living on the beach and surfing the waves every day? SURFSET gets you halfway there with a workout that is done on top of a surfboard. Designed to mimic what it’s really like on the waves, the surfboard is on an unstable base, which helps build core strength and balance.

SURFSET gets you moving with a fat-burning, muscle-toning cardio work out that will have you ready to hit the beach in no time.

Location: 454B Joo Chiat Road, 427667

 

Work out in a gym that doesn’t look like a gym

There’s no need to confine yourself to an overly bright room – or even a room at all. Switch it up with a change of environment, and you won’t even feel like you’re working out.

UFit

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Image taken from UFIT‘s Facebook page

You have a dilemma – you like the idea of getting out to exercise but you don’t like running, are terrible at conventional sports and want something a little more intense than just talking a walk.

Develop your fitness and strength with UFit by doing crossfit – outdoors. If crossfit isn’t your thing, it’s not the only outdoor activity that UFit offers. Yogafit, Hiitfit, and Boxfit are some of the many activities that you can get involved with while being in some of Singapore’s most scenic locations.

Location: Multiple locations

 

7Cycle

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Image take from 7Cycle‘s Facebook page

If the one thing you really hate about going to the gym is how boring it is, try out 7Cycle. It’s indoor cycling that will get your heart pumping. With their self-proclaimed “pulsating soundtrack and party-like atmosphere”, it’ll feel less like exercise and more like being at a dance club.

Whether you want to enhance your cycling, you’re looking for an intense conditioning class, or if you’re just doing it for fun, 7Cycle has a range of classes to fit your needs.

Location: 19 Anamalai Avenue, #01-01, 279987

 

You won’t be just another face in a sea of faces

For those who are worried about getting lost in a group, these gyms look after every member with a specialised personal touch.

The PIT

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Image taken from The PIT Singapore‘s Facebook page

For those who are serious gymming enthusiasts, look no further than The Pit. It has personal training classes ranging from metabolic conditioning to cardio boxing classes – this gym really isn’t for the faint of heart.

The Pit trainers or “Pitmasters” have a no-nonsense attitude and will put you through a gruelling schedule that might make National Service look like a piece of cake. Its methods are exclusively tailored for each individual, with exercises involving kettlebells and clubbells. Plus, if you remain devoted, you might even get a chance to flip tyres or push sleds as part of Pit’s strength workout.

Location: 123 Devonshire Road, 239883

 

Breathe Pilates

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Image taken from Breathe‘s Facebook page

Breathe Pilates (BP) might seem like a run-of-the-mill aerobics gym but it is refreshingly different. It provides rehabilitative physical training for a range of issues, from headaches to larger problems like muscle pulls. BP also offers special classes for mothers and expectant mothers in order to ensure their health and fitness levels remain high.

Moreover, its unique class “Zen.Ga” is the first of its kind that combines science, yoga, and relaxation – sounding more like a fascinating science experiment than a sort of workout.

Location: Four branches islandwide

 

Instead of shifting your schedule to accommodate them – they’ll accommodate you

For those who require a gym that can work around a hectic work schedule and can be completed quickly, look no further – these gyms will allow you to lead a healthy lifestyle without wrecking your daily calendar.

 

Ritual

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Image taken from Ritual‘s Facebook page

Ritual calls itself “the world’s most efficient gym” – it focuses on high intensity training (HIT) utilising kettlebells and bodyweight, so that you can get in and out of the gym in a guaranteed 30 minutes. To further ensure that you don’t put your timetable in a jam, Ritual holds a workout session every 20 minutes from 6.30am to 9pm daily.

Furthermore, it provides gym clothes and amenities such as towels along with protein shakes in case you feel the hunger pangs after the intense workout – how’s that for convenience? To quote the gym – “All you need to do is show up.”

Location: 11 North Canal Road, #03-01, 048824

 

Club Insignia (GYMM BOXX)

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Image taken from Club Insignia‘s Facebook page

Club Insignia was recently acquired by GYMM BOXX – a rapidly growing chain in the gym market, but Insignia’s style of working out will remain intact. What sets this gym apart from others is that no session is identical – in each workout, the exercises and routine are unique, making it ideal for those who get bored of doing the same repetitive exercises.

The gym is also accessible for the elderly, with its trainers holding specialist classes reserved for senior citizens. These “aqua fit” classes use cardiovascular exercises to ensure that even the aged are able to maintain a healthy lifestyle.

Location: The Oasis #03-02, 87 Science Park Drive, 118260

 

Featured image from UFit’s Facebook page.

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