An old woman asked for her

Award-winning occupational therapist talks about the woman who started her thinking about eldercare, and how to bring meaning back to seniors' lives

By Wong Kim Hoh, The Sunday Times, 2 Feb 2014

When Lim Hwee Er was in her 20s, she was convinced that she had her career and life all mapped out.

It took a chance meeting with a complete stranger to change that.

Their paths crossed nearly 20 years ago at Alexandra Hospital. Ms Lim, now 42, was then a final-year occupational therapy student interning at the hand therapy unit, which provides rehabilitation services for those who have injured their hands and upper limbs.

One day, she tagged along as her supervisor went on her daily rounds of the hospital's geriatric ward.

The very next day, a nurse from the ward telephoned to say that a woman patient had been asking for Ms Lim.

"I didn't know who the woman was and I didn't know why I left an impression, but the nurse told me she had asked specifically for me. The nurse also said the patient was not eating and would have to be put on the drip that day if she continued refusing her food. She asked if I could persuade her to eat," she recalls.

She went to the ward, and visited the elderly woman. "She didn't say much but looked really sad and skinny. I looked at the food and then I looked at her, and I thought to myself, 'If I were her, I'd probably not want to eat it either'."

She asked the woman if she would like some ice cream instead and she nodded. Ms Lim bought a small cup of vanilla ice cream and the woman polished it off.

After that, Ms Lim continued dropping in on the woman. Even after her internship ended, she would pop by occasionally to visit her elderly friend.

"There was hardly any conversation but she was just happy that I was there. I probably fed her more than I talked to her," she says.

That episode did not go unnoticed. Ms Lim's supervisor and the hospital's full-time occupational therapists told her to consider going into eldercare.

"I'd never been interested in old people before that. I had always wanted to work with mental patients," she says.

But she took their advice. Today, the founder of Goshen Consultancy Services is an award-winning occupational therapist specialising in eldercare, and is especially respected for her work with dementia patients.

Last year, her company conceptualised and produced an award-winning DVD which was presented at the National Council of Social Service Members Conference. Called Spending Time With You, the video, which comes in English, Malay and several Chinese dialects, engages dementia patients through an actress who talks and sings to them.

"Working with the elderly has stabilised me so much as a human being. It makes you take your eyes off yourself, which is one of the best things I could have done," she says.

Cool and serene, with an affectingly calming presence, it is hard to imagine this woman having a less than firm grip on who and what she is.

But she confesses to having once been a troubled teen with a self-destructive bent.

She is the elder of two daughters of a printing technician and an administrative clerk. Life hummed along until she was about 10, when her parents started bickering. They divorced when she was in her late teens.

"My father was largely absent after I turned 10. My mother was the one who raised us," says the former CHIJ St Theresa's Convent student.

"As a kid, I was studious, independent and responsible. My mother and my school expected that of me," she says.

But something snapped after the O levels. "I realised I did not want to live a life so predictable."

She turned rebellious.

The first radical thing she did was to march into the befuddled principal's office at Catholic Junior College to ask for a transfer to Jurong Junior College, which was not as well regarded.

"I just wanted to experience life on the other side. When you come from a convent school, you tend to mix with the same kind of people, very English-speaking and a bit pretentious, from my perspective. I wanted to meet some regular kids."

She found them at Jurong JC, where she played truant and hung out in snooker parlours and at tea dances.

"I flunked my first year," she says with a laugh. In fact, after three years there, she still did not get her full A-level certificate.

She had academic woes and relationship problems - she once strung along three boyfriends. Frequent fights with her mother brought things to a head. She was also beset by gastritis, listlessness and depression.

Fortunately, she came to her senses. She resat her A levels as a private candidate and did well enough to get into the health sciences diploma programme at Nanyang Polytechnic, specialising in occupational therapy.

The course took her on attachments that let her work with stroke patients, children and the elderly, but by her second year, she was convinced she wanted to work with mental patients.

"I guess I'd always been interested in psychological stuff," she says simply.

All that changed after her encounter with the elderly woman patient at Alexandra Hospital. She joined the hospital's geriatric ward as an occupational therapist.

"There, I became convinced that eldercare was the thing for me because there was just so much to do," she says.

She recalls fighting with doctors over some of the elderly patients. "In those days, there were many old women who lived alone and would come into hospital after a fall. Sometimes they were sent to a home because they could not use the squatting toilets in their own homes.

"All they did was have a fall and suddenly they could not decide how or where they wanted to live? I couldn't stop thinking about it."

She stayed at Alexandra for a few years, during which she took study leave to get her degree in occupational therapy from Teesside University in the United Kingdom.

In 1999, Dr Oon Chiew Seng - who founded Apex Harmony Lodge, the first nursing home for dementia patients in Singapore - bought out her bond so she could start rehabilitation programmes there.

The new job gave her a free hand to build her skills in dementia treatment in a creative, non-medical way.

She remembers a cantankerous Hainanese woman who was referred to the home for day care. "She would always come in scolding, before wandering around and then locking herself in the toilet for eight hours. Apparently she always looked in the mirror when she did this. We could not get her to eat or drink," she says.

Ms Lim solved the problem by setting up an old dressing table with a threefold mirror in the living room of the home.

"We worked out that she talked to the mirror because the person in it looked familiar and spoke the same language. We then put food on the dressing table, and she would eat her food and talk to the person in the mirror.

"After a while, we would even put bean sprouts on the dressing table and she would pluck them as she carried on her conversations," she says.

Solving such problems, she says, is hugely satisfying.

"It forces you to look at everyone as an individual. If we think hard and look hard enough, we can meet a lot of their needs even if we do not solve all their problems."

She left Apex after two years to do locum work for a whole string of institutions - from St Luke's ElderCare to Peace Haven. "I was one of the few professional occupational therapists to come out on my own. It was tiring work but I had a really steep learning curve."

She started working mostly with patients, but realised that she needed to move into planning in order to effect change.

This awakening came about after a particularly interesting project she initiated at Peace Haven, a nursing home for the sick, frail and elderly run by the Salvation Army.

The pilot project required the elderly residents, many with dementia, to navigate lifts and stairs to go to different floors for meals and other activities.

The building even had a swimming pool.

"Even though out of the 30 patients, only five could go into the pool, we would park the others around it in deck chairs, sunglasses and hats and serve them mocktails. It was amazing to see what this did for their well-being and how well they could manage," she recalls.

"I realised that a lot of challenges need not be solved in a medical fashion, they just need a bit of common sense."

In 2000, she registered Goshen Consultancy Services. It was pretty much a one-woman show until about three years ago, when she got two partners on board.

"Someone told me, 'Hwee Er, you are a craftsman but a terrible businesswoman. We need people who can replicate you and make you more useful to other people'," she says.

Today, her outfit provides consultancy services and training in eldercare for various organisations and agencies; it also develops products such as the Spending Time With You DVD for dementia patients and their caregivers.

Society, she says, needs to have a mindset change about ageing.

"People should see it as not a deterioration, but a development. It's entering another stage and people should prepare for it, just like they prepare for adulthood and marriage."

"We keep wanting to change old people. If they can't walk any more, we keep wanting to make them walk again. We should create more acceptance of ageing, then we can function around old people in a more enlightened way."

With a tinkling laugh, Ms Lim - who is in a relationship - confesses that she has her fears about ageing too. "But I tell myself: it is inevitable, it will happen. Because I work with old people, I get to deal with the issues first. I won't get a rude shock when my time comes."

Getting a head start

"We should start working with the elderly early. If we treat them only when they are sick and dependent, it's a bit late. If we work with them early, we can encourage them to take better care of themselves, eat more healthily, find meaning, and let go of grievances instead of letting them affect their lives."

Ms Lim Hwee Er, on how we should cope with ageing

Uplifting experience

"Why is it depressing working with dementia patients. I see it as looking after someone who is forgetful but who, if I introduce something resonant, can suddenly be talking to me normally. That, to me, is not depressing, it is miraculous."

Ms Lim, on working with dementia patients