Monday 26 May 2014

Tan Phaik In: Nurse mother to kampung dwellers

As a nurse in the 1960s, Mrs Tan Phaik In trudged up dirt tracks into Singapore kampungs to check on mothers and their newborn babies, and to give the babies immunisation shots. She also advised wives to use contraceptives during Singapore's "Two is Enough" family planning campaign, which sometimes led to hilarious results as some couples were clueless as to how to use a condom. Now 81, Mrs Tan, who was the chief nurse in primary health care from 1983 to 1990, also tells Goh Chin Lian how she kept going at her job for nearly 40 years.
The Straits Times, 24 May 2014

Why did you join nursing?

I wanted to get out of the house. I was living in Penang and my mother had died when I was 11/2 years old. I was the youngest of three children. My father remarried a widow who brought with her five children.

My stepmother was cruel to me and my sister during the Japanese Occupation. Rice was rationed. In my family, only the boys ate rice. The girls ate sweet potatoes and porridge.

When I finished secondary school at 16, my father wanted me to train in midwifery, to help my stepmother, who was a midwife.

My brother told me: "You'd be a slave to them. Your money would go to your stepmother."

With nurse training, I'd get a place to stay in the hospital quarters, he said. With other types of work, I'd still have to go home.

What was the training like?

I did general nursing for three years and four months, followed by midwifery for a year.

In general nursing, we did shift duty: 6am to 2pm, 2pm to 9pm, or 9pm to 6am.

We did 14 nights straight, then five days off. We were obedient. They set the routine, we followed.

Why did you come to Singapore to work?

Because of my husband, who was a friend of my colleague.

I met him in 1954, when I came to Singapore for a holiday. After that, we wrote to each other. Practically every day I received a letter from him. After two years, he came to Penang and asked my father for my hand in marriage. In 1957, I resigned from my job and came to Singapore.

Your first job in Singapore was at a maternity and child health clinic near West Coast Road. What was work like?

I took three buses in the morning from my rented room in River Valley Road to the clinic, and the same when I returned home.

As I came from Penang, my Hokkien was different. I had trouble talking to people. They said "thng si" (for soup spoon) while I said "thau kiong". They called coconut "kelapa" (a Malay word), while I called it "nyok".

The doctor, who alternated between two clinics, came in only three times a week. Each clinic had a staff nurse, an assistant nurse and four midwives.

Many mothers came to the clinic to immunise their babies against small pox and diphtheria.

Describe the physical conditions at the clinic.

It didn't have electricity as it was a new clinic. Although new, it had no electricity. We got it only four or five months later when the electrical cables were laid.

When headquarters wanted to get me, they called a shop nearby. The shopkeeper would come: "Missy, Missy, you have a telephone call!" I then had to go to the shop to receive the phone call.

We didn't have disposable equipment. We re-used everything. We had to check whether the injection needles were blunt each time after use. If they were, we had to sharpen them the way we sharpen knives, and boil them.

We didn't have autoclave for sterilising equipment with steam. So we put them in a pot of boiling water over a kerosene stove.

We didn't have a pharmacy. The assistant nurse dispensed the medicine.

We didn't have a refrigerator, so I'd put ice cubes in a small container and place the vaccines for diphtheria and tetanus, and small pox in it to keep them cool. I'd take the vaccines home to put in my fridge. The next morning, I'd put them in the container of ice again and take them to the clinic.

You went to the kampungs to visit new mothers. Why?

KK Hospital had a post-war baby boom in the late 1950s, so mothers had to go home the day after they delivered. Nurses did the follow-up with the mother and bathed the baby.We checked whether the mother's breast had milk and whether the baby's umbilical cord was infection-free.

The area we covered included Pasir Panjang, which was muddy and prone to floods because of the sea nearby. We asked for the high tide times so that we would leave before it flooded.

One time, in 1959, I slipped when crossing a wooden bridge to reach a house and fell about 1m down to the muddy ground. The mud came up to my chest.

The patient's husband pulled me up and cycled to a nearby clinic to borrow a uniform for me. I changed and started working.

I was then four months' pregnant with my first child, Kenneth. Nothing happened to him. (He is now 54, working as a corporate communications consultant.)

What obstacles did you face getting to the homes of the new mothers in the villages?

It was all rubber plantations and vegetable farms where these mothers lived. The villages also kept pigs. We walked 10 to 15 minutes from the main road to reach the attap houses, which were scattered.

Also, the Chinese would give their children one name for the birth certificate and a nickname at home, like ah gao (Hokkien for dog). They had many children in those days. When we used the proper names, nobody knew who they were.

Some were cheeky: You'd have found them but they'd tell you to walk further down the dirt track.

We walked a lot and worked hard, but we were happy because the people were kind and respected us. When they saw us from afar, they ran to us and called: "Missy! Missy!" The children who spoke Hokkien called us "Missy Bu!" which means nurse mother.

Many parents were reluctant to immunise their children. Why?

Most kampung people were farmers. The mothers had to work in the farm. But after immunisation, the child would have a fever and the mother had to take her child to the clinic. Because of that, they didn't want to immunise their child. So we started the kampung immunisation service. A van went to the kampungs to give injections. We also gave them paracetamol tablets for the fever.

What were some of the post-natal practices followed by the new mothers?

During the one-month confinement, the Chinese women would wrap their head with a scarf and close all the windows, because they believed you must not be exposed to wind, or you'd get a headache.

But the poor would return to work in the farm a week or so after the delivery. If they breastfed, they'd go home every two to three hours a day to feed the baby and then went back to work.

The husbands were usually working elsewhere, so the wives took care of the farm.

What were the common afflictions of the mothers and children?

One problem was worms. The women went around barefooted. We gave pregnant women worm medicine. Some worms could suck their blood and they would become anaemic. Once in a while, the doctor ordered worm treatment for the children.

The children developed septic sores because of poor nutrition and hygiene. They would scratch mosquito bites on their foreheads or leave wounds on their legs unattended, which then got infected.

On July 21, 1964, race riots broke out between the Malays and the Chinese. These lasted five days and left 22 dead and 454 injured. There was daily curfew until Aug 2. How did it affect you?

I was seven months' pregnant with my second child. I was a staff nurse at a clinic in Buona Vista. The phone lines were jammed and I could not get through to the nursing sister in charge of the clinic to ask what should be done.

I told the staff to go home. The midwives stayed in the clinic in case they were needed at night.

The curfew was from 2pm till the next morning, and there were no buses during this period. I had to walk from Buona Vista to my home in Margaret Drive. It took about an hour because I was pregnant.

Once, after walking for about half an hour, someone in an army truck saw me and gave me a lift to a corner of Alexandra Road. I then walked home, via Dawson Road.

The moment I reached home, I broke down and cried, because I felt so relieved to be safe at home. I watched TV to know when to return to work. I went back to work less than a week later.

How did the riots affect the work of the midwives?

Most of the midwives in the clinic were Malay. They still went to the Chinese kampungs. They were not scared because they knew the kampung families well.

They were scared of people from other parts of Singapore attacking the clinic at night because they stayed overnight there. So they put a big wooden stick under their bed to protect themselves.

Later, they stopped having midwives stay overnight in the clinic because at Sembawang Maternal and Child Health Clinic, a midwife was raped (by a group of armed men on Oct 16, 1968).

How were you involved in family planning later?

In the countryside, they didn't care how many children they had.

We told them: "If you give birth every year or once every two years, you'll become weak because you don't have good nourishment. How will you look after so many children? You've no money. How will they go to school?"

Most of the Chinese were willing to go for ligation. The Malays preferred using condoms or taking the pill. They would say, "If my husband were to divorce me, my future husband may want his own children".

Did your nurses have to teach them how to use the contraceptives?

The men never came to the clinic to buy condoms. It was always the wives. When a woman was buying a condom for the first time, the nurse would demonstrate using her finger. The wife would then ask the husband to do the same - to cover his finger with the condom. She then would ask us why she got pregnant.

What values should a nurse possess?

The important thing is that you feel for the person you're looking after, and you feel satisfied that you've done everything possible for him.

If the patient needs you, you must sacrifice some time and do it willingly. I used to sponge patients in the morning. If I knew I had too many to do, I would start work at 5am instead of 6am.

What do you hope the younger generation would learn from yours?

Most important are your parents. Mothers, even when they have no money, will always think of their children first. But the children, when they have money, will spend it on themselves first.

I set aside more than $100 of my $400 to $500 salary for my father. Nowadays, children give their parents what's left.

Once in a while, you should have a chit-chat with your parents. Even if you can't visit, you can call and talk. Then they know you still remember them. If you keep quiet, your parents also dare not contact you.

Satisfaction from making life better for others

CLEANING cold and stiff corpses is part and parcel of nurse training.

But the experience hardly fazed Mrs Tan Phaik In.

"I would talk to them. I'd say: "Uncle (or Auntie), I'm going to clean you. Please be soft," she recalls with a laugh about her days as a trainee nurse in the 1950s.

"We used a big basin of hot water to wipe clean the cold body."

Trainee nurses today still perform this "last offices" on dead patients to make them clean and dignified before the bodies are sent to the mortuary.

The task is among her treasured memories of her three years and four months of training in Penang. She did well enough to win book prizes and a silver medal.

She qualified as a nurse in 1955 and completed a midwifery course the following year.

In love with a Singaporean, she took the train south of the border and arrived in Singapore in 1957.

She landed a job at a maternal and child health clinic and a year later, married Mr Tan Kong Wee, a telegraph operator, whom she had known for four years.

Like many in her generation, she stayed put until asked to move, which happened in 1972, when she was posted to the Health Ministry as a nursing administrator in the primary health division.

She led a team of 520 nursing officers and nurses working in maternal and child health clinics, school health services, doing training and health education.

Twice, she was given National Day honours: an Efficiency Medal in 1983 and a Public Administration Medal (Bronze) in 1989.

She retired in 1990 at age 58.

A year later, she took up a job running a home for children with intellectual disabilities, set up by Thye Hua Kwan Moral Society. In 1996, she left to be with her daughter Karen, now 47 and a stage actress, who was about to give birth in London.

Mrs Tan also has two sons - Kenneth, 54, works as a corporate communications consultant while Kelvin, 49, is an arts school lecturer - and two granddaughters, Rachel, 18, and Olivia, nine.

Now 81, she does volunteer work and accompanies her 84-year-old husband for his hospital appointments and when he goes out. He cannot see clearly and is hard of hearing.

In a profession that struggles to attract today's young, Mrs Tan says the reward in nursing lies not in the tangibles but the satisfaction of helping the sick get well and seeing the joy of a mother holding her newborn child.

"I became a nurse because I wanted to leave home.

"But it has brought me immeasurable satisfaction. When I'm given a job, it does not matter how many hours I have to put in. I just want to do it until I'm satisfied, then I go.

"The best part is that I feel happy doing it - making life a bit better for others."

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