'Starting and ending well'

Lien Foundation CEO Lee Poh Wah wants all Singaporeans to start life with a quality pre-school education, no matter what their means, and to enjoy a good death with nothing left unsaid. He tells Susan Long how staring death in the face changed him and got him to change the deal for others.

The Straits Times, 11 Jan 2013

LIFE is but a short dash, so Mr Lee Poh Wah is wasting no time making his as dashing as possible. He tries new things, forgives readily and has fun, thanks to how his life has informed his work.

It was at the age of 35 that the former national dragon boater with washboard abs found out he had Stage 3C colon cancer. He had just joined the Lien Foundation and was hoping for a baby with his wife of seven years.

Barely three years before that, his younger brother, aged 30, had died of a sudden unexplained cardiac arrest while watching TV at home.

His parents grieved anew as their remaining child, Mr Lee, had three-quarters of his colon removed and went through six months of chemotherapy.

But the episode had a happy ending for Mr Lee. His intense, muscular brows furrow as he reflects: "A plausible impending death powerfully concentrates the mind. I had a personal awakening.

"For me, cancer cured my blindness. It also enhanced my creativity and empathy. You realise that you don't really have a lot to lose. You're no longer shackled by fear, you trivialise the trivial, you dare to push the envelope."

Now 42 and free from cancer for the last seven years, the Lien Foundation chief executive's skirmish with death has helped him conceive some 30 fresh initiatives to improve care for the dying.

His Life Before Death campaign - featuring unconventional ideas like a coffin design competition, a "Last Outfit" photo project to get people to think about going in style and the making of "Emotional Wills" to close any unfinished matters - helped people to face their mortality. He also aggressively promoted palliative care to help people die less painfully.

Mr Ng Kok Song, 64, outgoing chief investment officer of the Government of Singapore Investment Corporation and former chairman of the Lien Centre for Palliative Care, credits Mr Lee's "positive impatience to change the status quo" and his intelligent use of research and the media to influence public policy.

In 2010, Mr Lee commissioned the Economist Intelligence Unit to produce a global Quality of Death Index, which ranked Singapore 18th out of 40 countries surveyed, suggesting more ought to be done. It led to the Government tasking the Lien Centre to develop a coordinated national strategy for palliative care, which was released last year.

This year, Mr Lee will be helping to develop palliative care systems in four other Asian countries.

Much remains undone for the agnostic, who sees his lifetime's work as "changing the culture and zeitgeist on death and dying" and making sure as many as possible "die with peace of body, peace of mind, peace of spirit, with nothing much left unsaid or undone".

"Society needs to enhance its death knowledge. All of us need to improve in thinking about and discussing end-of-life issues in a climate of honesty. Death still comes like a stranger. Many of us don't know how to respond or what to say in front of the terminally ill," he intones urgently.

This year, he is trying to bring new stakeholders, such as funeral houses, insurance firms and designers to the "die-logue table" to improve the final send-off. For starters, he's looking into redesigning hospices to make them more hospitable for the terminally ill and their families.

Starting line

THREE years ago, after 15 years of marriage, he and his wife, who works as a director at a technology company, welcomed their first-born. They named her Xeloda after a cancer drug, "not so much to remind her what her dad has gone through, but my personal belief that you can be small and toxic but make sure you are potently useful to society", he says.

Before she was born, pre- schools weighed heavily on his mind. Since 2005, his first project at Lien was to integrate pre-schoolers with mild learning difficulties into 11 YWCA pre-schools.

In 2009, he worked with KK Women's and Children's Hospital and the PAP Community Foundation (PCF) to pioneer a community-based early detection and intervention programme for pre- schoolers with mild developmental needs in 25 PCF kindergartens. It brought specialist care - paediatricians, psychologists and therapists - out of hospitals and right into the pre-schools. This was so successful it was recently scaled up nationally by the Government to the tune of $30 million.

He also brainstormed many IT projects to scale up capacity in the pre-school sector - which he dubs Cinderella for playing second fiddle to mainstream education and suffering from "under-investment, neglect and incoherent policy" - such as introducing cloud computing, iPads and interactive IT as part of teaching in non-profit pre-schools. But over the past seven years, he noticed the sector "regressing".

To find out how Singapore stacked up against others, he commissioned a study last year which ranked Singapore 29th out of 45 countries in standards of early childhood education, highlighting affordability and quality as weak areas. That eventually led to a new statutory board being set up to oversee pre-school education.

He sees his role as "opening the gate and nudging people with the authority and responsibility to drive through themselves".

Since the Government has confirmed it will come through, he's embarking on Phase 2 this year - to help pioneer new models of non-profit pre-schools with better quality teachers in poor areas, where children need the most help but often receive the least. A team of social workers and educational therapists will rally around these children, who are largely from single-parent families or who live in rental flats.

He is devising a campaign to elevate the status of pre-school teachers, who have low pay and high turnover. He also wants to enhance parents' literacy in early childhood development and the role they can play to complement their children's learning experience. "I think all parents start with good intentions. But some push their children into an academic arms race that may inflict toxic stress."

His end goal, he says, is the day "when whether you're a child of a toilet cleaner or tycoon, you have access to the same high-quality pre-school programme".

It is more than a rosy ideal to Mr Lee, who is convinced a good pre-school programme is the most "cost-effective tool" available to a state. He cites studies that show about 50 per cent of US prison inmates have some form of learning difficulty. In Britain and Sweden, the figure is about 30 per cent. "It shows that everything can be traced back to pre-school days. Some of those who can't keep up with the system will go to the dark side. There's a cost to society if you don't intervene early enough," he warns.

Walking the talk

RECENTLY, work and life converged for him again when his 76-year-old father, a retired tyre salesman, had a near-fatal infection of the aorta from a stent implanted years earlier.

Drawing lessons from the dying well campaigns he had staged, he made sure his interactions with his typically Chinese, "emotionally uncommunicative" family were "honest and intimate". He made sure his dad and housewife mum knew the full diagnosis and risks. He did not dodge difficult conversations. He took the opportunity to ask about his dad's life in detail, thanked him and reaffirmed him as a father.

"What I learnt from this episode itself was that the end of life phase is charged with potential for growth. It should be a shared social experience to be supported as a final passage," he reflects.

In the end, his father survived the various operations. But it helped them close the wound of his brother's sudden death, which had left a "protracted complicated grief" in 2002.

That incident brought about a U-turn in the life of the alumnus of PCF, the now defunct-Jervois East Primary, Gan Eng Seng Secondary, National Junior College and National University of Singapore, where he studied mechanical engineering on a government-linked company scholarship.

Upon graduation, he worked two "unexciting" years in property investment, then won the Raffles Scholarship to Manchester University to do his Master of Business Administration from 1997 to 1999, returning to found a failed technology start-up during the dot.com boom. His brother's death jolted him into asking if he was "climbing the right mountain and doing work that fed my passion".

At that time, the then Ministry of Community Development, Youth and Sports was looking to start a social enterprise fund. Despite being a "non-profit virgin" who had done "zero volunteer work", he was hired as business development manager. It was "a wonderful primer to the non-profit sector" for three years, till the Lien Foundation, the first grant-giving organisation to professionalise here, hired him as senior programme manager.

His brief in 2005 was to look at the foundation's core interests in education, elder care, environment and families at risk. But he avoiding giving out giant cheques and putting name labels on edifices, and sharpened its focus to advocacy work on pre-school education, palliative care and water and sanitation issues - "large intractable issues shunned by others" where he felt he could make a small difference.

He refused to be seen as a "walking ATM" to the social sector but as the foundation man who brought with him - beyond money - fresh ideas to "kick ass" and challenge norms.

Mr Laurence Lien, 42, chairman of the Lien Foundation, hails Mr Lee's "entrepreneurial, bold and trailblazing" spirit for helping to "transform the foundation from a passive grantmaker to one that is strategic and making an impact".

Ask Mr Lee what his own lifetime wish is and it is far more modest. It is, simply, to outlive his parents, he confides. "I don't want them to go through losing another son. Because of my condition, there's always this Sword of Damocles hanging over me," he says. Pausing, he then quotes his hero, martial artist Bruce Lee: "But the key to immortality is to live a life worth remembering."

Mr Lee on...

What he worries about most for Singapore

Inter-generational immobility and transmission of poverty. Look at our Gini coefficient. I don’t think you can put the genie back into the bottle – 400,000 people on Workfare is an alarming figure. There is something sinister happening if you look through the pre-school lens; it’s becoming very obvious that family income is a strong predictor of academic achievement, which is a strong predictor of adult earning abilities in the future. These two trends conspire to create a more economically polarised society. Income inequality has led to inequality of opportunity.

Philanthropy and charity

I look upon philanthropy as problem solving rather than just playing Santa Claus. To me, there’s a distinction between charity and philanthropy. Charity is about pure and simple giving. It’s food for the human soul. Philanthropy, if done right, reduces the need for charity. We all need to apply ourselves to give imaginatively, constructively and systematically to solve problems, not just simply assuage symptoms.

Successfully pushing for pre-school sector change

Sometimes the best way to gain leverage is to influence the Government to focus funding on a cause or to change its priority. That’s why we embarked on our advocacy efforts, research and surveys. We pointed the direction to observe, the analysts provided the telescope, the media provided the sustained spotlight and the political leaders responded decisively.