Tuesday 11 June 2013

Father said, No, you mustn't be a nurse

'Mother of Nursing' defied parents, proved the profession is not about bedpans and lowly work
By Wong Kim Hoh, The Sunday Times, 9 Jun 2013

It was two days to Chinese New Year. Associate Professor Lim Swee Hia had planned to be at the supermarket with her husband and young granddaughter, shopping for festive goodies and ingredients for the reunion dinner on New Year's Eve.

Instead, they ended up in her office at the Singapore General Hospital (SGH) where she worked the phone and sent off a letter to Deputy Prime Minister Teo Chee Hean and Health Minister Gan Kim Yong.

As president of the Singapore Nurses Association (SNA), she wanted to register the fraternity's objection to a footnote in the Population White Paper, released earlier that week, which labelled nursing a low-skilled job.

"We had to correct that perception. Nurses have many roles, and we are highly skilled," says the director of special projects at SGH and the National Heart Centre.

She should know. The woman many call the Mother of Nursing in Singapore has been at the forefront of the push to raise the profile of the profession for the last three decades.

A paediatric nurse who rose through the ranks to become SingHealth's group director of nursing, she is an advocate of innovative care and patient safety and is the first nurse in Singapore to be appointed adjunct associate professor by Australia's Curtin University in 2008.

Ironically, if she had heeded her late father's wishes, nurses here might not have such a nurturing leader and champion.

He had objected strongly to her joining the profession in the 1960s, as nursing was then seen as a lowly job which involved changing bedpans and turning over patients.

"He loved his children a lot and didn't want them to have a tough life," says Prof Lim, 63, who has a twin brother, and is the eldest of six children. Labour chief Lim Swee Say is one of her siblings.

Their parents were immigrants from Swatow, China.

Born in 1950, she spent the first couple of years of her life in an old shophouse in Johor Road.

"My parents rented a small room under a staircase where we lived with our grandmother. When we were babies, our parents would put my twin brother and me in hanging sarong cots so that we would not get bitten by rats which used to gnaw at my grandmother's toes. Apparently when one of us wet ourselves, the pee would drip from the cot above to the one below," she says, eyes crinkling with laughter.

Life was not easy but hit a particularly rough patch when she was 12.

Her father, a sales assistant in a goldsmith shop, had to make a trip to China to see his mother. He passed some jewellery to a friend so that the latter could help to peddle them to kampong folk.

"The friend took even more jewellery from the goldsmith in my father's name. When my father returned, his friend had run away," she says, adding that her father not only lost his job but also owed the shop a lot of money.

Fortunately, a cousin from China came to the rescue, giving her father the formula to make incense and joss sticks.

By then, the family had expanded and moved to a one-room rental flat in Petain Road.

"My father started a small cottage industry to make and sell incense in our little flat. I can still remember the fragrance. Every day, after school, we would come home to help make and roll joss sticks. Each one was made by hand," she says.

The joss sticks would then be taken to a big carpark next to the now-defunct New World Amusement Park for drying.

"We'd take a bunch, and when we took our hands away, they would spread on the ground like flowers. We took our books with us and would study there while we jaga the incense so that the cats and dogs would not mess them up," she adds, using the Malay word for "guard".

As the eldest, she had to prepare meals for her siblings from a young age and remembers having to stand on a stool while cooking because she was not tall enough for the stove.

"We understood hardship but in those days, there was hardship all around. We were so poor I had to share books with my twin brother. He was in another school but sometimes during recess, he would run over to my school to pass me the book I needed," says the former student of Griffiths Primary and Cedar Girls' Secondary School.

"He was very good and resourceful. He knew how to apply for bursaries, and would always apply for me as well."

Although she was a good student, she left school after completing her O levels. With six children to feed and educate, her parents found it hard to cope.

"My twin and I are very close. He talked to me and asked if I could start work first. I didn't mind. He was a very good student at Raffles Institution," says Prof Lim, whose twin completed his A levels and later became a pilot.

She became a nurse by accident, she says.

She had applied to join the civil service. Asked to list 10 choices in her Public Service Commission application forms, she had put "clerk" for each, but with different ministries.

"The interviewers noted that I did maths and biology for my O levels and asked me to consider nursing as one of my choices," she says.

She put it down as the last choice on her list although her parents had already told her it was not a job they approved of.

"When I told my father, he said, 'I'm not going to let you take it up if the letter comes. No matter how hard, we'll struggle through.'"

The letter did arrive, and it took a lot of persuading on the twins' part before their father relented.

"I told him to at least let me try and that I would quit if I didn't like it," she says.

Her starting pay was $190 and she was posted to the paediatric ward in SGH after her training.

What she saw really impressed her. There was more to nursing than changing bedpans and turning patients.

"When you give a bedpan, you have to observe skin conditions. Sometimes a patient's blood pressure drops when you turn them, so you have to be careful. Others have spinal injuries. What a nurse does is not so simple."

She also did not see the bullying and yelling senior nurses who were supposed to rule the profession. Instead, she came into contact with thinking professionals who understood diseases, diagnoses and medication.

"I decided nursing was what I wanted to do. I could have earned more as a clerk but I learnt a lot and enjoyed what I did. You have to like what you do," says Prof Lim, who handed over her entire pay packet to her parents at the end of each month.

Her father, meanwhile, kept asking her to quit.

"But after I finished my third year, he stopped. My brother said, 'She's done three years, she's passed her exams, she doesn't complain when she comes home and she's still so cheerful. Why don't you just let her continue?'" recalls the warm and chatty woman, who completed her nursing diploma in 1971.

The old man, however, could not be persuaded when she wanted to pursue her advanced nursing diploma in neuro-care in Britain.

"He was afraid I would not come back," she says with a laugh.

She got her advanced diploma in critical care in Singapore instead.

"I wanted to specialise and I'd been told the ICU was very good; it was about holistic care. I waited three years to take the course because the queue was very long," she says.

She was 28 when she married a lab technician then working at SGH. They have a son, 34, who is a chemical engineer, and a daughter, 26, a doctor.

Over the next two decades, Prof Lim worked not just at SGH but also at Tan Tock Seng Hospital and the National Heart Centre. She rose steadily through the ranks and was made SingHealth's group director of nursing in 2004.

She retired from the post last year but remains the senior director of SingHealth Alice Lee Institute of Advanced Nursing (IAN) and director of special projects at SGH and the heart centre.

Her decades of service have seen her in the thick of action as Singapore grappled with some of the darker episodes in its history.

She was the chief nurse at SGH's ICU unit when the New World Hotel collapsed in 1986, killing 33 people.

When Sars broke out in 2003, she was deployed from the heart centre to SGH where she oversaw the needs and workflow of nurses at the Outram Campus. At the command post, she tackled issues ranging from food and accommodation to welfare and infection control.

"We were fighting an enemy which was unknown. What places to lock down and isolate, who to quarantine, what sort of training for our workers and nurses," she says, recalling those long, dark days. She received a Sars Commendation Award for her work in 2003.

There were other honours, including the President's Award for Nurses in 2002 and the National Day Public Administration Silver Award in 2008.

She is a great advocate of innovation and actively encourages nurses to improve processes and participate in research initiatives to push the boundaries of patient care.

"I have to try to better the lot of nurses. I must see happy nurses because when I have happy nurses, I will have happy patients," she says.

That is why she lobbies for nurses to constantly upgrade themselves.

She led by example when she earned her master's degree in nursing at Curtin University in 2008 and became its Faculty of Health Services' first international adjunct professor.

She also holds academic appointments at the University of Manchester and China's Xiamen University and Heilongjiang Nursing College.

She has left deep imprints in other areas.

She played a key role in establishing the SingHealth Alice Lee IAN, which offers specialisation programmes and practice-based training for nursing and health-care support staff. The institute is the first in Asia to be accredited by the American Nurses Credentialing Centre (ANNC).

Accreditation by prestigious bodies, she says, is a great morale booster. "It benchmarks where we are in terms of international nursing standards."

That is why she is so proud that in 2010 SGH became the first hospital in Asia to gain the Magnet status, the highest institutional honour for nursing excellence and leadership.

Bestowed by the ANNC, the accreditation places SGH among the elite group of top 5 per cent of hospitals in the world to have achieved this prestigious recognition. Others include internationally renowned hospitals such as the Mayo Clinic, Johns Hopkins Hospital and Duke University Hospital.

"This tells our staff, 'You're fantastic, you are doing so well, you are world-standard.'"

Dr Png Hock Hock, deputy director, division of nursing administration, Singapore General Hospital, has known Prof Lim for more than 10 years.

She says of Prof Lim: "She has given a lot of her time and her life to nursing in Singapore. Nurses love and respect her, they call her the Mother of Nursing. She's always thinking ahead. She started so many programmes here; she doesn't just start, she maintains and improves these programmes over time."

With a tinkling laugh, Prof Lim says that her father - who died more than 20 years ago when she was an assistant nursing director - had no idea of the strides she had made in her career.

"My 85-year-old mother still doesn't; she just thinks I'm a nurse. She asks me why I don't report for work as early as I used to," she says.

Seeing death and illness at such close range for so many decades has made her see life differently.

"Life is really unpredictable so it's best not to take things too seriously. We should all just learn to forgive and forget."

Humbling experience

"Nursing has humbled me a lot. I've seen so much - healthy people who become vegetables, young people who become paraplegics. We should learn not to take things too seriously, we should all be humble and learn to help each other."

ASSOCIATE PROFESSOR LIM, on how nursing has changed her perspective on life

Being understanding

"We have rules and policies but as nurses, we can be humane. We do not allow family members to stay overnight, but sometimes with very ill patients, we just pull the curtain and let their loved ones stay behind the curtain. The patients feel safer and may recover faster. It's nice to see patients recover."

PROF LIM, on nursing and humanity

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