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WALKING TOGETHER Journeys of hope from Eastern Singapore

Josephine De Souza:

Lightening my Load A man's health can be judged by which he takes two at a time - pills or stairs.

- Joan Welsh (Member, House of Representatives, Maine, USA)

I remember moving into my Tampines three-room fiat 30 years ago. We had just got married, life was wonderful and I recall laughing merrily even as I carried boxes and plastic bags full of my clothes up the stairs. We didn't have lifts on every floor then.

We're still here in the same fiat but I'm not the same person. We have four children and I have an extra 20 kilograms on me. I can no longer run up and down the four storeys the way I used to.

I I am tired most of the time. My favourite thing used to be cooking for the family. I would turn on the radio to my favourite station and spend hours cooking their favourite dishes like chicken rendang.

Nowadays, even the marketing is tiring. I have not cooked for a long time.

Recently, my daughter got married. I did not recognise the woman in my daughter's wedding photographs! Is that how I appear to others?

Then, my neighbour Madam Cheng gave me a brochure which she had picked up from the community club on something called E C H O , which stands for "Eastern Community Health Outreach".

Cheng teaches tai-chi at the East Coast Park and she can climb 10 storeys without panting. She has been trying to get me to join her for years, but I cannot imagine waking up so early to exercise!

She told me E C H O is a health-coaching programme for people living in the east. She kept asking me to go for the E C H O health screening with her.

Frankly, I am afraid of doctors! And I felt that there was really nothing wrong with me. Isn't it normal for a 53-year-old lady and mother to be a little overweight and feel tired?

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But Cheng was very persuasive, so I registered on the Internet and went with her to Tampines Changkat Community Club, which is just one bus stop away from my place. It was a simple affair - we both took our weight, blood pressure and the nurses drew our blood.

I didn't know what to expect after the screening. Cheng was all smiles after she received her report. She was healthy, but said she would continue going for E C H O health screenings to track her health and continue to join E C H O workshops and activities to learn more about health and lifestyle management. I was happy for her, but when I saw my report, all I saw were the words "obese", "high blood pressure" and "high blood cholesterol", like traffic lights on the page!

I have never gone for a health screening in my life. It felt like a test I wanted to do well in and failed.

I wanted to retreat, hide at home and ignore the results of the health screening.

Instead, because of my results, a coordinator from the E C H O programme called me up and encouraged me to consult a doctor in my neighbourhood.

I was scared, terrified of what the doctor would say.

I will never forget what happened in that consultation room. She was such a friendly and patient doctor, so unlike the fierce doctor stereotypes I had from the past. She calmly and quietly delivered the words which would change my life forever: "Josephine, you have diabetes mellitus."

Have you ever taken a hit in the stomach such that you completely lose your breath? My son once did that to me when he was 10. He head-butted my stomach and I banished him to his room the whole day, it was that painful. You reel with shock, catch your breath and try to deal with whatever caused it. That's how I felt. Like I had been punched.

Only I didn't know how to deal with this. What did I know of diabetes? It only affected 'older people', those who ate too much sugar, those with diabetes running in their family. Not me, surely? I was to understand later that all these are myths. Anyone can get diabetes.

No one in my family had diabetes, but the doctor told me that it was strongly related to obesity. The greater the degree of obesity, the greater the risk of developing the condition. It also commonly occurs after the age of 40.

I must have looked very worried, because the doctor told me something just before I left the room. She looked me in the eye and said softly: "Josephine, you are not alone. We will help you get your health back."

Immediately, my shoulders felt lighter. I was given the worst news of my life in that room, but I actually left with a spring in my step.

There was a nice person who called me a few days later from Changi General Hospital's "Health Management Unit", who told me that she would be following up with me regularly by phone on my condition, and that I could call her with any queries I might have about my condition or medication. I was amazed at this follow-up - that there were people whose job was to help those with chronic diseases (like me) to track and self-manage our illness, and keep it under control.

Knowing that I am taking responsibility for my health is a powerful feeling. I now know that it is not normal to pant when walking up the stairs, it is not normal to be obese and I should not accept it as part of the normal ageing process.

In my journey, the nurses and doctors kept reminding me - it's not the years in your life, but the life in your years. I became determined to conquer my diabetes and live as full a life as I possibly could. Best of all, I would not be alone in the journey.

I remember learning how to do my own finger prick blood test at home, to monitor my own condition.

When the nurses first showed me how to do it, I was horrified. I am afraid of blood and pain! But they were incredibly patient.

The first time I did it at home, I had to call Cheng for support and she was very encouraging. These days, pricking my finger is as routine as brushing my teeth.

My doctor also linked me up with a "Community Health Centre" in Tampines to check my feet and eyes for signs of complications from diabetes, and receive counselling on health and nutrition. It is near my home, and I don't need to go to a hospital specialist clinic for follow-up - very convenient!

Another major change was in my diet. I was told that I had to maintain my blood sugar level to stay healthy and that I should avoid food containing refined sugars.

Now, I love my food as much as the next Singaporean. But you know what? It's just a matter of habit. After two months of eating wholemeal instead of white bread for breakfast, I actually love the taste of wholemeal and find white bread "boring".

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' - j p e n d a few Saturday afternoons go ing 'back to school ' to attend the E C H O Fat Buster workshops to learn h o w to lose weight by eating heal thi ly a n d exercising. W h a t ' s great is that I have persuaded m y h u s b a n d and eldest daughter to start o n E C H O heal th screenings - it's never too early or late to take charge!

C h e n g is del ighted a n d she calls the diabetes a " w a k e - u p ca l l w h i c h was a blessing i n disguise" . I can't t h i n k of a n y t h i n g nice to say to that. B u t I have been j o i n i n g her t a i - c h i classes at the park a n d br isk w a l k i n g regularly. Yes , I drag m y h u s b a n d a long so we can spend healthy qual i ty t ime together!

I have also learnt, f r o m the E C H O newsletters sent to me a n d the workshops I attend, that the aches and pains w h i c h I used to c o m p l a i n of are an excuse to avoid exercise, a n d that the p a i n m i g h t very wel l go away i f I m o v e d . It's t rue ! I w a l k everywhere now.

I have since lost five k i l o g r a m s , m y b l o o d sugar level is under contro l , and y o u k n o w what? I can n o w c l i m b the four storeys to m y place - w i t h m y bags of groceries - no sweat.

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Eastern Community Health Outreach The Eastern Community Health Outreach ( E C H O ) is a community-based chronic disease prevention programme offered in partnership with grassroots organisations. The programme includes health screenings, health coaching and healthy lifestyle activities, which aim to intervene early to delay the onset of chronic diseases such as diabetes, high blood pressure and cholesterol. E C H O has screened and engaged more than 500 residents of Changi Simei since its launch in January 2011. The programme will be extended to Tampines in 2012.

Health Management Unit The Health Management Uni t (formally Disease Management Unit) was set up to assist patients who need help to manage their long-term conditions. These patients receive advice from nurse tele-carers on medication, diet and lifestyle, how to monitor their condition and look out for signs of deterioration, helping them stay healthy for as long as possible. Those who need more help will receive further guidance and support in between medical visits. Currently, C G H has more than 1,500 patients on the programme.

Community Health Centre The Community Health Centre ( C H C ) supports general practitioners by providing services for patients with long-term conditions. Services include eye screening, foot screening, health monitoring and education about diet, lifestyle and medication. The first C H C , located in Tampines, is helmed by senior nurses and allied health professionals with experience in caring for patients with chronic conditions. Currently, the C H C has served more than 1,000 patients.