June 26, 2017

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by Wan Ting Koh

IF YOU’VE been frustrated by the lack of transparency in private hospital fees, you can now visit the Ministry of Health’s (MOH) website to look for prices of procedures ranging from a Caesarean to circumcision.

We did a cursory analysis of the 141 procedures listed and found that the difference in prices for the same procedure varied widely. We picked out the ones with the biggest price differences for each body part and found that a heart surgery topped the list with a $16,638 difference between its lowest and highest price.

The cost of an eye procedure was three times more than its lowest price point.

MOH started listing private hospital operation fees two weeks ago on its website. Even though individual private hospital fees aren’t revealed, fees are displayed as a range, with the lower amount reflecting the 25th percentile charged and the higher amount, the 75th percentile. Operation fees are split into three components: the surgeon’s fee, the anaesthetist’s fee and the cost of the facility.

The release of fees suggests a greater move towards transparency for the G. In 2013, when Parkway Pantai, the medical group which owns four hospitals, including Mount Elizabeth and Gleneagles, published its prices for 30 procedures for each of its hospitals, some were worried that the act might contravene anti-competition laws.

However the Competition Commission of Singapore said that compiling information from patients already billed, which was what Parkway Pantai did, was not illegal, unlike medical fee guidelines which determine the cost of a procedure. That was something that the Singapore Medical Association had to scrap in 2007 for fear of infringing the competition act.

With escalating healthcare costs in the recent years however, there have been more calls for transparency and the G began publishing total operation fees for public hospitals in 2014.

 

The biggest differences

But is this move really beneficial, given that the range of some procedures can be as much as three times the lowest price?

This was the case for an eye procedure – a lens implantation surgery after a cataract surgery. The operation fee can cost from as low as $3,605, to a high of $11,014 which is three times the lowest price point.

Delving deeper into operation fee components showed that both facility fees and surgeon fees contribute to the wide range as the highest price for each is nearly three times the lowest price. No anaesthetist fees were given for this procure as there were fewer than 30 cases.

Similarly, a procedure to remove unhealthy skin tissues in a wound measuring more than 3cm, ranges between $3,243 and $6,295, with the highest operation fee pegged at nearly twice the price of the lowest. Surgeon fees are the culprit for this wide range as the highest cost more than twice the lowest price.

In terms of numerical value, the heart and coronary artery bypass graft surgery had the widest range, from $35,566 to $52,204, which makes a difference of $16,638.

 

Body PartMost expensive procedureSurgeon feesDifferenceAnaesthetist feesDifferenceFacility feesdifferenceTotal operation feesDifference
AbdomenRepair of hernia (ventral/incisional/recurrent hernia)$4,815-$9,095$4,280$1050-$1,875$825$2,679-$6,294$3,615$9,297-$16,398$7,101
Blood vesselsVein, imaging guided laser treatment for varicose vein (1 leg)$4,120-$10,165$6,045--$1,336-$2,730$1,394$8,312-$11,659$3,347
Bone/jointsHip, total hip replacement$8,560-$16,050$7,490$1,750-$2,500$750$4,193-$6,479$2,286$14,040-$25,036$10,996
ChestHeart, coronary artery bypass graft$18,413-$26,857$8,444$3,000-$4,500$1,500$13,578-$22,175$8,597$35,566-$52,204$16,638
EyesLens implantation after previous lens/cataract surgery$3,000-$8,239$5,239--$830-$2,416$1,586$3,605-$11,014$7,409
Female reproductive systemOvary, removal of both ovaries, uterus, fallopian tubes with further cancer$9,257 - $15,034$5,777$2,000 - $3,500$1,500$3,554 - $9,099$5,545$17,110 - $27,139
$10,029
Hand/fingerCarpal tunnel release (single)$2,400 - $4,280$1,880$500 - $900$400$861 - $1,859$998$3,499 - $6,106$2,607
*HeadRepair of jawbone (simple)--------
*Lymphatic systemCervical lymph node, removal/biopsy of cervical lymph node$2,140 - $3,745$1,605$600 - $875$275$1,426 - $2,962$1,536$4,289 - $6,390$2,101
Male reproductive systemProstate, removal of tissue$4,280 - $5,783$1,503$1,000 - $1,500$500$3,370 - $4,822$1,452$9,191 - $11,819$2,628
*MouthRepair of gum tissue--------
Neck/throatThyroid gland, complete removal$6,634 - $11,400$4,766$1,500 - $2,675$1,175$4,534 - $6,502$1,968$13,226 - $20,606$7,380
NoseRemoval of sinus bones$6,420 - $10,980$4,560$1,500 - $2,200$700$3,357 - $6,661$3,304$11,148 - $20,384$9,236
Skin/soft tissueSkin, removal of unhealthy tissues in a wound >3cm$1,819 - $3,745$1,926$500 - $1,000$500$1,094 - $2,135$1,094$3,243 - $6,295$3,025
Urinary tractUreter, non-invasive shock wave therapy for stones$3,000 - $4,173$1,173$750 - $1,000$250$1,876 - $3,332$1,456$4,000 - $7,309$3,309

*Body parts with only one procedure available

 

What’s in your operation fee?

But why do prices vary across private hospitals?

For many, many reasons. Each of the three components has a number of variables factored in. Surgeon’s fees take into consideration the surgeon’s skill level and experience and the techniques they use. A reputable private surgeon may charge higher prices than a lesser-known counterpart.

The prices charged also reflect the complexity of the operation involved, said Dr Gerard Chee, a specialist Ear, Nose, and Throat surgeon in private practice. “If I open only one sinus, I will charge $X for a procedure that will last about 20 minutes to half an hour. If I open all eight sinuses, I will charge about three times more for a three-hour procedure,” he said.

A difficult surgery might have a wider price range as compared to a straightforward one, like a tonsillectomy, he added. The difference in the range of prices listed for a tonsillectomy – which is the removal of tonsils – is $2,929.

According to Dr Chee, an anaesthetist’s fees is usually about 25 per cent of the surgeon’s fees in private hospitals. The surgeon would bill the fee for them, he said. However, there are other ways that anaesthesia fees may be calculated.

The price may vary according to the type of anaesthesia used, whether regional – which only numbs a specific part of the body – or general anaesthesia, which renders the patient fully unconscious.

There is also a lower level of anaesthesia known as sedation which keeps the patient awake, though unable to remember the operation. Anaesthetists may also charge more for a longer operation as they will have to monitor the condition of the patient throughout.

How the anaesthesia is applied may also be a factor, whether it is topical, injected through an IV drip, or given through a gas mask. Special equipment may also be needed for certain anaesthetic procedures, such as those that deal with complicated nerve blocks.

Then there are the facility fees which include the cost of the operating theatre, which varies according to each hospital’s rental rates, the quantity of disposables used, and the type and quality of equipment.

 

Will the list work?

The lack of guidelines means that surgeons determine how to charge their patients.

Most, according to a 2012 ST report, refer to fees drawn up by public hospitals and MOH’s rating of complexity of procedures as a benchmark before adding premiums such as the surgeon’s level of experience. Others refer to how much their peers charge by sending spies to rival surgeons’ prices.

But listing the range of fees may have a limited effect on the fees themselves. Plus, it is still possible for private surgeons to overcharge, since there is no hard-and-fast rule for charging patients. Furthermore, the operation fees listed on MOH’s website are only what 50 per cent of patients here pay.

Having the fees listed doesn’t mean that surgeons cannot charge above the norm, said Ms Tin Pei Ling, who is on the Government Parliamentary Committee for Health.

“But then they will have to give patients a full and proper explanation,” she added.

Though there is a possibility that surgeons who charge higher than the 75th percentile might lower their prices, surgeons who have fees which fall below the 25th percentile may also increase their prices. Said Dr Chee: “For example, if I charge $1,000 for a tonsillectomy and I find out that the lowest price in the range is $3,800, I might raise my fee.”

“Surgeons don’t want to look like they are ‘cheap’. If a doctor charges less than his or her peers, some patients might think that the doctor is not good, or that he doesn’t have enough business, or that he is desperate. This is human nature.”

Listing private hospital fees may be a step in the right direction, but more data may be needed to make the list more robust. Can we look forward to more procedures, including non-surgical ones, being added to the list too?

 

Additional reporting by Li Shan Teo.

Featured image by Natassya Siregar.

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An elderly man makes his way back to his room along one of the numerous aisles in the single-storey elderly home.

by Wan Ting Koh

AT LEAST they agreed on this one point: It’s high time we made our nursing homes better.

But how? That part of the problem has now sharply divided two groups of industry experts and professionals, who each believe they hold the answer to the future of nursing home care in Singapore.

On one side is the Lien Foundation and Khoo Chwee Neo Foundation, who say the “medicalised” model with its dormitory beds needs to be thrown out. They want to build more “home-like” environments, with single- or twin-bedded rooms that give the elderly more privacy.

On the other side: Representatives from six of the nation’s best-known nursing homes, who say that is a waste of money and by the way, some old people actually prefer to share a big room because it makes them feel less lonely.

Said S. Devendran, Chief Executive of the Sree Narayana Mission (Singapore) in a Straits Times Forum letter today (Oct 13): “While there may be a need for more eldercare options, our experience has been that not everyone prefers single rooms … As charity organisations dependent on public donations, we need to be prudent.”

The letter was signed by representatives from five other nursing homes: Kwong Wai Shiu Hospital, Lions Home for the Elders, Man Fut Tong Nursing Home, Moral Home for the Aged Sick, and Singapore Christian Home.

“While there may be a need for more eldercare options, our experience has been that not everyone prefers single rooms.”

The argument comes after a new 131-page industry report was released last week by the two foundations, put together with input from academics, policy-makers, the residents themselves, their family members, and more than 50 nursing home operators.

Titled Safe But Soulless, it argued for an urgent overhaul of how nursing homes are designed and operated, given the expected boom in Singapore’s elderly population by 2030.

Currently, two-thirds of the nation’s nursing homes are run by charity groups, which suffer from a lack of resources as they rely primarily on donations and G subsidies. The remaining third are privately-run: They are more comfortable, but can cost up to $6,000 a month for a single-bedded room.

Some people interviewed for the report likened nursing homes facilities to jails because of its barred gates and locked doors. Also, as many as one in three residents that suffer from mental illnesses are tied to their beds. They require constant supervision, which the nursing homes cannot afford.

Yes, these are all part of the difficulties of running a nursing home, but many improvements have been made over the years, Mr Devendran said.

“Being branded in one sweep as “soulless” in the Safe But Soulless study on nursing homes… despite our collective efforts to improve the quality and standard of nursing homes – is difficult to accept,” he wrote.

Instead of building new homes that prioritise personal space, the group believes resources can be put to better use by recruiting more volunteers, or organising more activities such as music and art therapy sessions.

These programmes help the elderly feel less lonely, which they say is the real problem.

“Many of us can share stories which affirm that loneliness is one of the biggest fears for the elderly,” said Mr Devendran. “This can strike regardless of generation or accommodation type.”

“Many of us can share stories which affirm that loneliness is one of the biggest fears for the elderly.”

One way or the other, both groups agree more resources are needed – and much of it will come from the G. But which side of the argument will it agree with more?

The G is keeping an open mind for now, it seems.

Last year, it declined to provide subsidies to a project that favoured the foundations’ vision of single- and twin-bedded layouts, saying it would be tantamount to subsidising a private or A-class hospital ward.

But since the release of the new report, the Health Ministry has said it would review the report’s findings, adding that it held some “interesting ideas”.

In the meantime, it will continue to do what it can to help the situation. The first G-run nursing home, Pearl Hill’s Care Home, was opened in Chinatown last month. Pearl Hill’s Care Home is a three-storey buildings with 130 beds.

 

Featured image from TMG file.

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by Li Shan Teo

IF YOU’RE a die-hard foodie, you would have probably caught wind of the country’s latest food trend: poke bowls.

No, they have nothing to do with Pokemon. Instead, poke is a colourful bowl of fish salad that is both Instagram-worthy and fast becoming a favourite for the health conscious.

Since the opening of the first restaurant here that focuses solely on poke bowls (pronounced “poh-kay”) in early October last year, many other places that sell poke bowls have since sprung up. The bowls come in various colours and textures that are bound to whet your appetite – from those that stay loyal to their Hawaiian roots to bowls that are more adventurous on the taste buds.

 

What is it? 

Poke is the Hawaiian verb for “section” or “to slice or cut”. The dish is essentially a Japanese-inspired raw fish salad, originating from the streets of Hawaii. It consists of cubes of raw fish, usually Ahi tuna (yellowfin tuna), served with a bed of salad greens and topped with sauces.

Although it’s commonly served as an appetiser in Hawaii, the poke available here tend to be served as a main course with rice and other options such as quinoa. It’s a style that is similar to the bara chirashi, which is a Japanese dish that features diced sashimi on top of rice. If you’re wondering why there are similarities between the Hawaiian and Japanese dishes, it’s because a sizeable portion of the Hawaiian population has Japanese roots – 16.7 per cent of Hawaii’s population is Japanese, forming the largest group of Asian-Americans.

The dish has also been adapted to cater to the Singaporean palate. Instead of sticking to the traditionally used Ahi tuna, poke bowls here offer a wide selection that range from salmon to chicken.

We’ve compiled a short list of the different types of poke bowls you can find. So dive right in!

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Aloha Poke

The first poke restaurant to open in Singapore in October last year, Aloha Poke is the one to go to for a more traditional take on the salad. The restaurant claims to stay true to its Hawaiian heritage, with its fish seasoned “to perfection”.  This is true, with its fish options more on the side of traditional poke bowls – you can choose between tuna and salmon.

The poke bowls come in three standard sizes: the Lil’ Swell that comes with one scoop of poke (75g), Standard Nalu with two scoops of poke (150g) and Big Kahuna with three scoops of poke (225g). They’re priced at $11.90, $15.90 and $19.90 respectively.

Every bowl is typically served with rice (white or brown) and salad, your choice of poke, and topped off with scallions, pineapple and lime. You may also choose two complimentary add-ons and one superfood from their selection.

To spice things up, Aloha Poke offers three flagship sauces – original, wasabi mayo and spicy.

Image from Aloha Poke’s website. 

 

Marina Bay Link Mall, 8A Marina Boulevard, #B2-46, Singapore 018984
Opening hours: 11:30am – 8pm (Monday to Friday), 11:30am – 2:30pm (Saturday)

92 Amoy Street, Singapore 069911 (Telok Ayer MRT)
Tel: +65 6221 6165
Opening hours: 11.30am – 2.30pm, 5.30pm – 11pm (Monday to Saturday), Closed on Sunday

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Rollie Ollie

For a more Asian-inspired bowl, head down to Rollie Ollie, which is touted as an “Asian fusion restaurant with a touch of California style”.

The poke bowls are available in unique Asian flavours such as Seoul Surfer ($13.95) and Thai Twist ($13.95). If you’re craving for some Korean food, the Seoul Surfer will be able to satisfy your appetite with its inclusion of seaweed, sesame seeds and a Korean spicy sauce. If you prefer Thai food, the Thai Twist has Asian ingredients such as mango, coriander, and Thai fish and lemon sauce. The restaurant’s Japanese-inspired bowls are Yuzu Bliss ($14.95) and Wild About Wasabi ($14.95).

To complete your meal, you select your rice preference –  sushi, brown or tea infused rice.

Do note that the poke bowls are only served at the Suntec outlet, and not at Star Vista.

rollie-ollie-2

Image from Rollie Ollie’s website. 

 

Suntec City Mall Pasarbella #01-K42, North Wing 3 Temasek Blvd Singapore 038983
Tel: +65 8188 1531
Opening hours: 10am – 10pm

 

A Poké Theory

If you’re more of a free spirit, then A Poke Theory would be perfect for you. The bowls are fully customisable, giving you the freedom to have the salad you really want.

You get three options for the base: sushi rice, romaine lettuce or lemon herb quinoa. Then you choose from four different flavoured cuts – original shoyu tuna, spicy garlic sesame tuna, spicy mayo salmon or avocado miso salmon.

A regular bowl (100g) of tuna will cost you $11.50, while a large bowl (150g) costs $15. For the salmon, a regular bowl costs $12.50 while a large bowl is $16.50.

The restaurant is also big on “premium” toppings such as kimchi and kale chips, so if you’re craving for something more atas (“high class”), A Poke Theory is the place to be.

a-poke-theory

Image from A Poke Theory’s Facebook page.

 

27 Boon Tat Street, Singapore 069623

Opening hours: 11am – 6pm (Monday to Friday), 11am – 4pm (Saturday), Closed on Sunday

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Katto

Poke bowls can be pricey, especially when many poke restaurants are located in town. So for something a little easier on the wallet, head down to Katto.

Unlike the other poke restaurants, Katto offers an option for a mini size bowl ($7.90). It contains one portion of 70g fish, one base of 250g of white rice, brown rice or salad, and a vegetable side. If you have a bigger appetite, opt for the main size bowl ($12.90), which includes an additional serving of fish and side.

It doesn’t hurt that Katto also offers some fun flavours – entice your tastebuds with chicken rice chilli salmon, creamy goma tuna, tangy thai tuna, classic shoyu salmon and California unrolled salmon.

katto

Image from Katto’s Facebook page

 

1 Fusionopolis Place, Galaxis Building, #01-21/22, Singapore 138522
Opening Hours: 11am – 8pm (Monday to Friday), 11am – 2pm (Saturday), Closed on Sunday

 

Featured image Poke Bowl by Flickr user Michael Saechang. (CC BY 2.0)

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By: Gabriel Crispinohttps://www.flickr.com/photos/ciriloman/8222747688/in/photolist-dwBJpS-fB95SP-fB7fsM-fBmB8W-fBmA2S-egM3in-fB7cBM-fBozGY-fB9aU8-fBo93N-oC3Uht-bwFUqT-dkCMf1-r64Dxf-fB8NaK-fBn6eA-bBpoaA-fBmxSb-fBoiJA-fBmAHb-fBmBzj-fBosTd-fBoALL-fBmCim-fBoxX5-75maqD-fBoweA-fBow6G-aAXFHD-fBonE7-fB9hBt-oNPwv8-fBo8VJ-fB7hM4-fB9dUe-bBEHMj-dkCJvR-cXditU-aAW388-9qVTdL-axN9ek-7Whtnb-4Ukpmr-fBoxuf-aAYHL3-9rNWMT-fB7n8t-fB9dEz-fB7ggP-Jf2MaQ

by Wan Ting Koh

ARE your fruits and veggies clean enough to eat if you run them under running water? Probably. Are there better ways to clean them? Absolutely.

From powders to machines, these solutions claim to help you remove the pesticides from your fresh produce.

 

Most farmers use pesticides on their produce to keep the pests away. Even organic fruits and vegetables may accumulate bacteria on their surfaces in the process of being transported to markets – never mind what organic actually means.

About 3 to 5 per cent of fruits and vegetables imported from overseas were rejected last year for containing too much pesticides. This was a rate that has remained constant over the years, said the Agri-Food and Veterinary Authority of Singapore (AVA).

The authority sampled 8,000 consignments of imported produce for pesticides and rejected about 300 batches of vegetables and fruits.

Of course, this doesn’t mean that pesticides will kill you – though, it’s probably not a good idea to consume it in large amounts.

To reduce your intake of potential pesticides, AVA recommends rinsing your produce with water for 30 seconds, followed by a 15-minute soak. Then, give them a last rinse. Peeling the skins of fruits will also help to remove any pesticides found on its surfaces.

If, however, you feel like you need something stronger than tap water, here are four other solutions you can consider adding to your counter-top.
1. ETL No. 9 All Purposes Green Formula
Bottle of vegetable and fruit wash
Image from ETL No.7 l 9’s  website.

Made of ingredients such as coconut extract, aloe extract and lemon extract, this multipurpose product claims to remove up to 98.6 per cent of pesticide residue from the surfaces of fruits, vegetables, tea leaves, legumes, beans and rice grains.

Amazingly, apart from being a fruit and veggie wash, this product is so strong that it can also be used for hand washing, dish washing, cleaning baby milk bottles and even laundry washing. If that doesn’t bother you, you can get the formula, which comes in a 1-litre bottle, for $35 on ETL No.l 9’s website.

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2. Bacoff Organic Fruit & Vegetable Wash

bottle of veg and fruit wash
Image is a screenshot from RedMart’s website.
This fruit and vegetable wash, which is from Australia and contains octanoic acid, claims to be able to remove wax and pesticides from fruits and vegetables safely. Also known as caprylic acid, octanoic acid is a fatty acid which is found in coconuts and breast milk.
According to the instructions, wash fruits and vegetables thoroughly with a diluted solution and “apply pressure” to ensure all “wax and pesticide” is removed. For “tough” wax and pesticides, allow fruit to soak for up to 10 minutes before applying pressure. Not sure why there would be wax on the produce – maybe it’s an Australian thing. This product comes in a 500ml bottle and is available at RedMart for $10.90.
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3. Safeguard Fruit & Veggie Wash
bottle of vegetable wash
Image by Esther Au Yong

Another product from Australia, this wash claims to “safely and effectively” remove “up to 100 times more contaminants” than if you rinse the fruits and vegetables with water alone.

According to its company website, the solution uses ingredients which are natural and organic, such as aloe vera, citrus essential oils and olive leaf extract. A few drops of the solution in half a sink full of fresh water is enough to clean your fruits and vegetables. Safeguard comes in a 750ml bottle and sells for $10 at Cold Storage.

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4. Zairyo natural sea fruit and vegetable wash 

bottle of powder for washing vegetables
Image from Zairyo website.

According to Zairyo, this fruit and vegetable wash is made of natural scallop shells that get rid of pesticides, chlorine, wax and bacteria. The wash, which comes in a powder form, was imported from Japan and is apparently highly popular with households there.

The multipurpose solution can also be used to disinfect cooking equipment and utensils, for laundry and to deodorise rooms when used as a spray. Each bottle contains 90g of powder and is currently retailing on Zairyo’s website for $19.90.

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5. Dew Vegetable Washer D818

hyflux
Image from Hyflux Shop’s website

At $319, The Dew Vegetable Washer D818 is the most pricey of the bunch here. It resembles a glass bowl with a lid and requires electricity to operate.

Place your fruits and vegetable in the machine, fill the bowl with no more than four litres of tap water, close the lid, then select either the 10-minute or 15-minute wash mode. Bubbles will be emitted from the base of the 1.65g machine. If money isn’t an issue for you, you can order it from Hyflux Shop’s website.

 

Featured image SPLASH by Flickr user Gabriel Crispino. (CC BY 2.0)

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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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