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A Parkway Pantai Quarterly JULY - SEPTEMBER 2014 COVER STORY Parkway Pantai grows its footprint in Malaysia and China PAGE 8 Life Renewed at Gleneagles Hospital renews vision PAGE 20 MAKOplasty in Mount Elizabeth Novena Hospital PAGE 39 july to september 2014 PARKWAY PANTAI TEAM Editor-at-large Lim Bee Ling Editorial Advisors Ahmad Shahizam Janet Low Copy Editor Angeline Ang DESIGN ENTELECHY CONTRIBUTORS Writer Thava Rani Photographers Terence Tan Lim Yao Hui editor s note We all know the benefits of synergies at work. That s why we share best practices knowledge and ideas and standardise our processes. The pursuit of synergy represents an opportunity to create value and boost our bottom line. This benefits all of us. At the Group level Parkway Pantai and our parent company IHH Healthcare Berhad (IHH) have also embarked on a corporate reorganisation to realise internal synergies at the same time provide for succession planning. Key group functions between the two are now integrated to enhance information flow and management clarity. These include Legal and Company Secretarial Investor Relations & Corporate Communications Risk & Medical Affairs Strategic Planning & Business Development Finance and Human Resource. Since 1 July 2014 Parkway Pantai s Singapore and Malaysia hospital operations have also been realigned into Parkway Operations Division and Pantai Operations Division structure reporting helmed by Dr Lim Suet Wun and Mr Ahmad Shahizam respectively. Going forward we expect more synergies between our various business entities and functions as the Group sets out to expand its footprint in the region and beyond (see cover story on page 8) and raise the bar on the delivery of quality healthcare through enhancements in facilities and services (page 34) as well as procedures (page 36 38 and 39). EDITOR S NOTE Mosaic is published quarterly by Parkway Pantai Limited and printed by A&D Printhub Pte Ltd. All rights reserved. No portion of this publication may be reproduced without the written permission of the publisher. We take every care and precaution to ensure that information published in Mosaic is accurate at the time of publication but Parkway Pantai cannot guarantee its accuracy and we may change the information at any time without prior notice. The information contained in Mosaic magazine is not an invitation to invest in the shares or any other products or services or otherwise deal in these or enter into a contract with Parkway Pantai or any other Parkway Pantai Company. 1 Parkway Pantai Limited TripleOne Somerset 111 Somerset Road 15-01 Singapore 238164. Tel ( 65) 6307 7880 Fax ( 65) 6738 7341. Parkway Pantai Limited 2014. This publication and information contained herein is strictly for internal use only and contains Parkway Pantai proprietary information which is restricted to Parkway Pantai employees and within the Parkway Pantai Group. Access to use or copying by non-Parkway Pantai employees in any form or other is strictly prohibited. For information about Parkway Pantai visit www.parkwaypantai.com. All information correct as of date of print. Parkway Pantai Limited Company Registration No. 201106772W MCI (P) 111 02 2014 WE WANT YOUR FEEDBACK Do you have story ideas or comments to share with us Write to grpcorpcomms parkway.sg or Group Corporate Communications Parkway Pantai Limited 15-01 TripleOne Somerset 111 Somerset Road Singapore 238164. 04 34 08 36 16 38 22 40 30 CONTENTS 04 NEWS BITES Bite-sized health news and tips 34 AT YOUR SERVICE Gleneagles Hospital upgrades its delivery ward 08 COVER STORY Parkway Pantai further cements market leadership with expansion 36 SPOTLIGHT Mount Elizabeth Novena scores with complex endoscopic procedures 16 CORPORATE CITIZENSHIP Gleneagles Kuala Lumpur bolsters CSR efforts with events calender launch Enabling women with disabilities to inspire change Gleneagles Hospital helps elderly women gain clarity of vision 38 NEW SCIENCE Advanced laparoscopic technique in colorectal surgery Alternative to total knee replacement for osteoarthritis patients 40 TAKE 5 Learn to run right 22 SNAPSHOTS Through the lens around Parkway Pantai 30 PROFILES Dr Natalie Chua on how she became an O&G specialist grill with beer Researchers from the University of Vigo in Spain and University of Porto in Portugal have found that marinating meat in beer helps to lower the amount of potential carcinogens in cooked meat. Pork marinated for four hours in beer black beer ale or non-alcoholic beer were grilled to welldone with black beer yielding the most significant results. It effectively lowers the levels of eight major polycyclic aromatic hydrocarbons (PAHS) by more than 50 per cent. The consumption of grilled meat has been associated with a higher risk of colorectal cancer. This is due to PAHs that form when meats are cooked at very high temperatures. The researchers said that the intake of beermarinated meat could be a suitable mitigation strategy. Source Indian Express NEWS BITES 4 smart sun screening We all know that the sunscreen is a must-have item to prevent premature aging of the skin and skin cancer from prolonged exposure to the sun. But are you choosing and using your sunscreens correctly Dermatologist Ross Perry recommends micronised-titanium-dioxide and micronised-zinc-oxide-based creams as they sit on the skin and block rays. Facial specialist Linda Meridith also suggests looking for a formula that is free of para-aminobenzoic-acid which may cause allergic reactions and reminds us that sunscreen should be reapplied every two hours for maximum coverage. While protection against sun rays may be vital don t forget to expose some skin to the sun for about 15 minutes once or twice a week to ensure your body is getting sufficient Vitamin D Source The Telegraph a sweet start Many healthy diets advocate cutting out sugar but researchers from the Tel Aviv University say that having a sweet treat such as pudding with breakfast might help one lose weight instead. Their study showed that over an eight-month window dieters who indulged in a serving of dessert with breakfast lost about 17kg more than those who had the same calorie intake with a smaller low-carbohydrate menu. Having dessert in the morning when metabolism rates are at their peak as compared to indulging after dinner allows the extra calories to be worked off through the day. Source The Daily Mail peach to curb cancer cell Scientists have found that compounds in peaches inhibit the growth of breast cancer cells. In lab tests mice were fed with substantial amounts of peach polyphenols which are said to act as antioxidants and prevent damage to DNA. The mice had tumours that grew less and without much of the blood vessel formation that is essential for the cancer cells to spread to other parts of the body. Researchers say that a regular 60kg person can obtain sufficient amounts of the compounds by eating two to three peaches a day or through the use of peach polyphenol extract powder as a supplement. Source Indian Express NEWS BITES 5 drink tea to improve eczema Research by the Shiga University of Medical Science in Japan has shown that oolong a delicately flavoured tea helps relieve itching and other symptoms of eczema. In a study conducted by the university 63 per cent of 118 patients condition improved after drinking oolong thrice a day over a period of one to two weeks. Source National Eczema Association painkiller a heart risk for older adults Painkillers are commonly prescribed to help relieve pain and reduce inflammation for a variety of conditions including headaches toothaches and even arthritis. However a study on 8 400 people in the Netherlands with an average age of 68.5 has associated the use of such non-steroidal anti-inflammatory drugs (NSAIDs) with the development of atrial fibrillation (AF) a common heart rhythm disorder in older adults. Irregular heartbeats can cause symptoms such as dizziness and heart palpitations and is associated with more serious health conditions such as heart failure and stroke. Compared to people who have never taken such medication current users of NSAIDs are 76 per cent more likely to suffer from AF. For recent users within the last 30 days the risk is even higher at 84 per cent. Professor Colin Baigent of the University of Oxford said Although NSAIDs are very effective for the treatment of pain it is important that both risks and benefits are considered carefully before they are prescribed. Source The Telegraph NEWS BITES 6 muscle power Some people say laughter is the best medicine but recent findings suggest that muscles make effective medicine as well. Our muscles are said to release hormone-like chemicals called myokines when we exercise. Myokines are known to be effective in reducing the inflammation in our bodies associated with heart disease Alzheimer s and type 2 diabetes. Studies have also found that blood from people who exercise showed signs of slowing down cell reproduction when added to cancer cells in a test tube. Exercising also stimulates our bodies to create more mitochondria the energy factories in our cells. We are actually creating more energy in the long run with regular adequate amounts of well-balanced aerobic exercise and strength training. So claiming exhaustion from the daily grind may not be a valid reason to stop going to the gym Source The Sydney Morning Herald time to wake up If you are one of those people who have difficulty waking up in the morning here s a tip. A psychology professor Richard Wiseman at the University of Hertfordshire advocates a 90-minute rule that is said to help you wake up on time and feeling great. The rule is based on our sleep cycle of entering light sleep then progressing to deep sleep otherwise known as REM. Each cycle typically takes about 90 minutes and the cycle is repeated several times throughout the night. If your alarm tries to jerk you out of dreamland during REM sleep you ll probably find it difficult to peel your face off your pillow. However if your alarm wakes you while you re in light sleep it will be much easier to get up feeling fresh and alert. The trick is to plan your sleep according to the 90-minute rule. If you have to wake up naturally at 8am simply count back in 90-minute intervals to find your ideal bedtime which would be around 11pm or 12.30am to get about seven to eight hours of solid rest. Source News.com.au NEWS BITES 7 lower smoking risk Studies have shown that youths with attention deficit hyperactivity disorder (ADHD) are two to three times more likely to smoke cigarettes than their peers. In addition 40 per cent of adults with ADHD smoke regularly more than twice the rate among adults without ADHD. According to a recent analysis led by researchers at Duke Medicine this smoking risk may be reduced by treating ADHD with stimulant medication especially when medication is taken consistently. Source Duke Medicine COVER STORY growing our 8 FOOTPRINT Step by step Parkway Pantai is expanding its healthcare network in Asia and further cementing its market leadership. In this issue of Mosaic we look at how the business has grown in its home market of Malaysia as well as in China a key market. OUR HOSPITAL NETWORK IN MALAYSIA COVER STORY MALAYSIA Parkway Pantai is the second largest private healthcare provider in Malaysia with over 2 000 beds across a network of 12 multi-disciplinary hospitals branded under Gleneagles and Pantai . It also operates ancillary healthcare services through Pantai Integrated Rehab and Pantai Premier Pathology one ambulatory care centre and one primary care centre. Demand for quality private healthcare in Malaysia has been growing due to an increasing number of people using private medical insurance as well as a growing middle and upper income segment. In tandem with the Malaysian government s efforts to grow medical tourism the country is also seeing more medical tourists because it provides quality care at good value it costs about 50% less to receive treatment in Malaysia compared to the United States Europe Australia and Hong Kong. Parkway Pantai s Malaysia hospitals alone saw about 14 400 medical tourists last year. And there is room to do more as the current number of beds in Malaysia is still catching up with the increased demand. 9 GKK marks the Group s maiden entry into East Malaysia. The hospital will have 200 beds 100 medical suites and six operating theatres when it starts to see patients in the early part of next year. Pantai Hospital Manjung opens On 19 May 2014 Parkway Pantai opened Pantai Hospital Manjung (PHM) its 12th hospital in Malaysia. Members of the public were treated to a host of activities organised by the hospital including free health screening children s colouring contest cooking demonstration dietary and health talks as well as a tour of the hospital s cutting-edge facilities and medical technologies. Situated in Jalan Pusat Perniagaan Manjung Point an hour s drive from Ipoh city the new 108-bed hospital provides the up-and-coming Manjung community with a spectrum of essential specialties which include general medicine internal medicine ophthalmology general surgery ear nose and throat surgery orthopaedics and obstetrics and gynaecology. It also complements the government hospitals and district health facilities in the provision of quality healthcare services. The opening of PHM is expected to boost medical tourism in Perak. COVER STORY 10 Gleneagles Kota Kinabalu tops out By early 2015 Parkway Pantai will open another greenfield hospital Gleneagles Kota Kinabalu (GKK) in Sabah. GKK marks the Group s maiden entry into East Malaysia. The tertiary hospital is built in accordance to the standards set by the Malaysian Society for Quality in Health (MSQH) and the international accreditation body Joint Commission International (JCI). A topping up ceremony was held for the hospital on 8 April this year officiated by the Y.B. Datuk Seri Panglima Masidi Manjun Minister of Tourism Culture and Environment of Sabah. The establishment of GKK will offer exciting career opportunities for healthcare professionals in Sabah and help retain local medical talent. The hospital will have 200 beds 100 medical suites and six operating theatres when it starts to see patients in the early part of next year. In addition it will also have a 24-hour Accident & Emergency Department with Trauma and Intensive Care Centre. COVER STORY Gleneagles Medini to commence sale of medical suites Yet another exciting hospital development for Parkway Pantai lies in the special economic zone of Iskandar where Gleneagles Medini is now under construction. The first phase of Gleneagles Medini will open in early 2015 with 150 beds. It will eventually expand to its intended capacity of 300 beds. Future plans for the development include a rehabilitation centre a nursing home a hospital residency and other healthcare facilities. 11 Yet another exciting hospital development for Parkway Pantai lies in the special economic zone of Iskandar where Gleneagles Medini is now under construction. Subject to the necessary approvals the sale of Gleneagles Medini s medical suites will commence in the second half of 2014. With state-of-the-art facilities the hospital is set to make Medini an attractive medical health destination in the region spurring the growth of medical tourism and setting the benchmark for high quality healthcare in the country. The construction of new roads in the Iskandar region will also make the hospital easily accessible to medical travellers from Singapore and patients coming from other parts of Malaysia. Expansion projects in the pipeline To meet the growing healthcare needs of Malaysia Parkway Pantai is also expanding its existing Malaysia hospitals to increase the bed count at Gleneagles Kuala Lumpur Pantai Hospital Kuala Lumpur Pantai Hospital Klang Pantai Hospital Batu Pahat and Pantai Hospital Ayer Keroh. All in this would add another 300 beds to the existing system. At the same time the Group is exploring opportunities to expand its presence in the east coast of Peninsular Malaysia. OUR HEALTHCARE NETWORK IN CHINA COVER STORY CHINA 12 In China Parkway Pantai operates under the ParkwayHealth brand. It is one of the major foreign-owned private healthcare operators with a network of 11 medical centres across the People s Republic and Hong Kong six in Shanghai two in Suzhou and one each in Chengdu Beijing and Hong Kong. This year marks the 10th anniversary of Parkway Pantai s presence in China. The Group first ventured into China s healthcare business in 2004 with the setting up of a representative office. In 2005 it entered into a joint venture to develop medical and surgical centres clinics and hospitals. In 2007 Parkway Pantai opened its first clinic in Shanghai Gleneagles Medical and Surgical Center. Separately it acquired a majority interest in the World Link Group which operates an expatriate-focused outpatient network of clinics in China. 2011 was another landmark year for Parkway Pantai with the opening of its first medical centre in Central Hong Kong. The Group also entered into a consultancy and hospital management agreement to manage the Shanghai International Medical Center a 450-bed tertiary hospital in the Pudong district of Shanghai. Over the years Parkway Pantai has established a reputation in China for providing quality primary and specialist care attracting patients who are insured by corporations as well as the affluent urban and expatriate communities. Over the years Parkway Pantai has established a reputation in China for providing quality primary and specialist care attracting patients who are insured by corporations as well as the affluent urban and expatriate communities. A wide range of specialties and relationships with over 20 private insurance companies help to increase its competitive edge. In recent years China has liberalised its healthcare investment regulations in favour of private healthcare providers and foreign entities. Leveraging more than 30 years of experience in running world-class hospitals and existing primary and secondary care network Parkway Pantai is now ready to bring quality healthcare to the tertiary care segment in China and Hong Kong. Joint venture hospital in Hong Kong In a landmark achievement Parkway Pantai won the Hong Kong government s tender to build a private hospital at Wong Chuk Hang in March last year. This will be the first private hospital to be commissioned in Hong Kong since 1995. Parkway Pantai is the majority owner in this 60 40 joint venture with NWS Holdings. The 500-bed Gleneagles Hong Kong Hospital will provide high quality healthcare services that are accessible and affordable to the Hong Kong community. It will offer a comprehensive range of clinical services spanning more than 15 specialities including general medicine general surgery orthopaedics and traumatology and gynaecology. Construction of the 500-bed hospital is expected to finish by end of 2016 with the opening scheduled for early 2017. COVER STORY 13 Primary care network continues to grow Meanwhile the Group continues to expand its network of clinics to provide more patients with access to international standard healthcare. Last year it set up its first clinics in Beijing and Suzhou. This year a second clinic in Suzhou began operations. The official opening for the two Suzhou medical centres located at Suzhou New District (SND) and Suzhou Industrial Park (SIP) was held on 24 June 2014 officiated by Ms Xu Ping Deputy Director of SND Administrative Committee and Ms Xia Fang Deputy Director of SIP Administrative Committee respectively. Similar to the setup of other Parkway Pantai clinics in China the SND Medical and Dental Center offers family medicine services for the whole family and is staffed by multi-lingual and highly qualified physicians. The clinic is also equipped with on-site pharmacy and laboratory services. In the third quarter of this year Parkway Pantai will open its second clinic in Beijing. Around the same time it will ramp up and expand two clinics in Shanghai namely Shanghai Centre Medical and Dental Center and Jin Qiao Medical & Dental Center to cater to increased demand. COVER STORY 14 Parkway Pantai continues to expand its network of clinics to provide more patients with access to international standard healthcare. Introducing new service lines As a leader in healthcare Parkway Pantai constantly innovates and develops new services to meet the needs of its patients. In June the Specialty & Inpatient Center at Luwan launched a first-of-its-kind maternity programme in Shanghai. In this unique model of care a team of midwives are empowered to complement obstetricians in providing a continuum of personalised maternity services to new mothers. These range from consultation with midwives prenatal courses assistance during delivery to postnatal home visits. The professional care and advice will provide much comfort to these mothers-to-be during their pregnancy and birthing journey as many of them come from different parts of China and from all over the world to seek work in Shanghai and have no immediate support from their families. Shanghai International Medical Center opens In March this year the 450-bed Shanghai International Medical Center (SIMC) which Parkway Pantai is managing via a hospital management agreement (HMA) opened its door to patients. Located in the Shanghai International Medical Zone in Pudong SIMC is Shanghai s first high-end general hospital. This project demonstrates how Parkway Pantai leverages its hospital management and planning expertise to bring world class hospitals to countries like China Vietnam and United Arab Emirates via HMAs. Apart from providing consultancy and management services Parkway Pantai also provides training to the SIMC s healthcare workers through Parkway College. Doing so would ensure that the level of care provided at SIMC matches up with the high service standards that are synonymous with Parkway Pantai hospitals. 15 COVER STORY sincerely GLENEAGLES KUALA LUMPUR Gleneagles Kuala Lumpur strengthens its corporate social responsibility efforts with the launch of a calendar of events. CORPORATE CITIZENSHIP 16 In the last 15 years Gleneagles Kuala Lumpur (GKL) has successfully changed the lives of less fortunate children and individuals from various backgrounds across Malaysia through its corporate social responsibility (CSR) initiatives. To ensure the continuity of its CSR activities and to garner greater participation from both the public and the underprivileged GKL has introduced Sincerely Gleneagles Kuala Lumpur . Launched by social activist Tan Sri Lee Lam Thye in conjunction with the hospital s Chinese New Year celebration Sincerely Gleneagles Kuala Lumpur is a special calendar that lists all CSR activities planned for 2014. The calendar has over 30 activities double the number in 2013. About 1 000 copies of the calendar were given away at the launch. GKL also plans to raise funds through the initiatives and channel the funds to various charitable organisations. Dato Amir Firdaus Abdullah Regional Chief Executive Officer of Gleneagles Hospitals and Chief Executive Officer of Gleneagles Kuala Lumpur said that Sincerely Gleneagles Kuala Lumpur is not just a programme but a testimony of GKL s commitment to its CSR activities. We want to ensure that our CSR campaigns are carried out consistently with greater involvement and participation from our stakeholders. Sincerely Gleneagles Kuala Lumpur represents a unique opportunity for us to work closely with the public the media our hospital guests and patients as well as our staff and consultants. Through the years we have carried out many CSR activities such as Fund Raising through Fashion for Breast Cancer A-Heart-for-A-Heart campaign for children with congenital heart disease Gleneagles Festive Relief free medical checks for the underprivileged and orang Asli community and many more. In 2013 alone we raised about RM 250 000 through our many CSR campaigns with the generous help from the public In his speech Tan Sri Lee Lam Thye commended GKL for its initiative which clearly demonstrates the hospital s serious commitment to CSR. I trust and believe that Sincerely Gleneagles Kuala Lumpur would help contribute to a more caring society in Malaysia. Members of the public are given the opportunity to make monetary contributions through each of the activities hosted by GKL. This would enable funds to be collected for the benefit of those in need he said. The Sincerely Gleneagles Kuala Lumpur calendar includes the Glen Festive Relieve Campaign which helps fulfil the dreams of orphans during festive seasons the Glen Schoolkid Campaign which seeks to heighten awareness among school children on non-communicable diseases the Glen Buddy Campaign which gives both hospital staff and the less fortunate exposure to field activities A Heart for A Heart programme that has given a new lease of life to more than 500 children born with congenital heart complications and Continues Medical Education which provides the forum for medical specialists to discuss the latest trends in medical technology. CORPORATE CITIZENSHIP I trust and believe that Sincerely Gleneagles Kuala Lumpur would help contribute to a more caring society in Malaysia. Tan Sri Lee Lam Thye social activist 17 CORPORATE CITIZENSHIP 18 WOMEN with disabilities INSPIRE CHANGE Gleneagles Kuala Lumpur leverages corporate social responsibility to provide a platform for women with disabilities to share their experiences. 50 women with disabilities shared their successes in various fields and inspired able-bodied women and students of private higher learning institutions at a forum organised by Gleneagles Kuala Lumpur on 12 March 2014. The forum themed nspiring Change was held in conjunction with this year s International Women s Day celebrations. Regional Chief Executive Officer of Gleneagles Hospitals and Chief Executive Officer of Gleneagles Kuala Lumpur Dato Amir Firdaus Abdullah said We have decided to provide a platform for women with disabilities to speak up and share their experience so as to inspire other women who have just experienced disability and even those without any disability. These fascinating ladies have inspired me personally and we at Gleneagles Kuala Lumpur are proud to fulfil our corporate social responsibility by celebrating their success and contribution. Our hope is that when these students step into the professional world and become employers they would be more sensitive to the needs of this group and not marginalise them just because they are PWDs Amir continued. Among invited persons with disabilities (PWD) who made up the panel at the forum were Ida Nerina local actress Senator Bathmavathi Krishnan Norisah Bahrom national Paralympics athlete Christine Lee PWD activist and Dr Naziaty Mohd Yaacob lecturer at the University of Malaya. Besides the 50 PWD women student representatives from several local universities were also present at the forum which was officiated by Raja Puan Besar of Perak Tuanku Zara Salim. We at Gleneagles Kuala Lumpur are proud to fulfil our corporate social responsibility by celebrating their success and contribution. Dato Amir Firdaus Abdullah Regional Chief Executive Officer of Gleneagles Hospitals and Chief Executive Officer Gleneagles Kuala Lumpur A lecture presented by Gleneagles Consultant Specialist on Rehabilitative Medicine Datin Paduk Dr Tunku Taayah Tunku Zubir looked at the Health and Well-being of Women with Disabilities . Dr Taayah spoke on the increasing number of individuals with disabilities each year and the need for more to be done at the community and the workplace levels in order to make it easier for the PWDs to go through a PWD-friendly life. She cited that nearly 80 per cent of patients experiencing disabilities are still not readily accepted by community members especially at the workplace. Life becomes more challenging to them not only in performing their daily activities but also when they have to face health complications such as diabetes high blood pressure heart condition and cancer. Insensitive communities and employers would only make it worse for them she said. As such we hope activities such as this platform would raise the awareness of the public that the PWD group does not need public sympathy but more of their understanding that the PWDs do have the ability to bring about change and make contributions to the country. CORPORATE CITIZENSHIP 19 the GIFT of CLEAR SIGHT The ability to see is an essential part of one s wellbeing. Gleneagles Hospital in Singapore embarks on a quest to help elderly women refresh their vision. To commemorate its 55th anniversary Gleneagles Hospital (GEH) in Singapore has pledged to provide free cataract treatment for 55 needy women from the pioneer generation of Singapore. This is one of its corporate social responsibility (CSR) efforts under the Life Renewed initiative that hospitals under the Parkway Pantai umbrella participate in. CORPORATE CITIZENSHIP 20 Cataract is a condition in which the clear lens of the eye becomes cloudy preventing sufficient light from entering the eye. Vision is impaired as a result. It is the most common cause of blindness and it usually occurs in the elderly due to ageing. The first sign is usually a blurring of vision. Other common symptoms of cataract include glare where lights seem too bright or have a halo effect and poor night vision. Life Renewed Gleneagles aims to screen and provide cataract surgical treatment for all 55 eligible beneficiaries this year. GEH is working closely with the Community Chest through its network of voluntary welfare organisations to identify and assist financially-challenged elderly patients. Gleneagles Hospital celebrates 55 years of delivering quality healthcare and wants to pay tribute to the pioneer generation for their relentless contributions to Singapore. We identified cataract removal as an area to help improve their lives since close to 80 per cent of the elderly patients here are afflicted with cataract said Dr Vincent Chia Chief Executive Officer. Timah Bte Hamet 76 years old Patients have the assurance that our team of doctors and colleagues are fully committed to providing the best medical care with the Gleneagles Touch. Dr Vincent Chia Chief Executive Officer of Gleneagles Hospital Singapore This is particularly meaningful for a hospital well known for its expertise in eye treatment. Patients have the assurance that our team of doctors and colleagues are fully committed to providing the best medical care with the Gleneagles Touch. Dr Chia added Up until the end of May 14 beneficiaries had been identified of which 10 have successfully undergone treatment at GEH. This CSR initiative is made possible by the Khazanah IHH Healthcare Fund. The RM50 million fund was established at IHH Healthcare Berhad s initial public offering in July 2012 to provide partial and fully sponsored medical treatment to patients who qualify for financial assistance in IHH s home markets of Malaysia Singapore and Turkey. The Fund covers the entire spectrum of treatment from surgery to post-surgical therapy such as physiotherapy speech therapy or counselling. Details of Life Renewed and the Fund can be found at www.khazanah-ihhfund.com. CORPORATE CITIZENSHIP Vision of Hope Beneficiaries of the free cataract renewal service by GEH 21 Lim Sek Hong 79 years old Foo Shiong Thay 74 years old you are very SPECIAL SNAPSHOTS 22 From themed festivities and appreciation dinners the Pantai nurses certainly had a good time letting their hair down and bonding among colleagues during Nurses Day celebrations held in in May. At Pantai Hospital Ayer Keroh all nursing units and departments received flower baskets from the management in appreciation of their contribution. A carnival was held later in the evening in tribute to the nurses joined by the hospital consultants and the management team where all were treated to a feast. Pantai Hospital Ipoh held a lavish dinner at Tower Regency Hotel. Themed Bollywood Night it was attended by 250 nurses consultants and management. Gleneagles Penang held the celebratory dinner in its auditorium for staff s easy access. There was also a special Nurses Wishing Board set up in the hospital lobby one week prior to the celebration dinner. Words of encouragement and praise for the nurses were written on small cards by patients and their families consultants and nursing colleagues themselves which were then placed on the Wishing Board. Nurses at Pantai Hospital Kuala Lumpur celebrated with talent performances and a fashion show put together by staff. For Pantai Hospital Klang nurses no celebration is complete without cake-cutting and staff performances. Pantai Hospital Cheras nurses enjoyed their appreciation tea. Literally standing out from the crowd Pantai Hospital Sungei Petani nurses had a mass exercise to commemorate the occasion SNAPSHOTS 23 SUZHOU celebrations Within China ParkwayHealth s Medical and Dental Center in Suzhou Industrial Park celebrated with a group of special guests. Nurses from four international schools in Suzhou were invited to join the ParkwayHealth team for some fun-filled phototaking a tour of our Suzhou clinic followed by a networking session with the clinic s doctors. NURSES DAY also a community affair here Pantai Hospital Ayer Keroh (PHAK) Pantai Hospital Cheras (PHC) and Pantai Hospital Ipoh (PHI) turned Nurses Day into a heartwarming community affair as they remembered the less privileged and gave back to society in a myriad of ways Within PHAK on 12 May 2014 there were counters selling flowers and souvenir items and all proceeds went to the Florence Nightingale Fund. The public also received complimentary basic screening from the nurses. PHC nurses prepared a hearty breakfast for the residents of Pusat Jagaan Orang-Orang Tua Wawasan old folks home in Cheras on 14 May 2014. They also gave out sundry items such as biscuits milo and instant noodles while sharing advice on healthy eating and exercise tips. At PHI the nurses organised a blood donation drive appealing to staff and public at Dahlia Utama on 10 May 2014. SNAPSHOTS 24 thanks its consultants PHAK Pantai Hospital Ayer Keroh (PHAK) held its inaugural Consultants Appreciation Night 2014 on 26 April 2014 at Casa Del Rio Melaka. The event was organised to thank its consultants for their continuous support and contribution in making PHAK a leading hospital in the southern region of Malaysia. 42 consultants and their spouses attended the event which saw a strong turnout from the Pantai management team. SNAPSHOTS 25 MALAYSIA town halls SNAPSHOTS 26 Dr Tan See Leng Group Chief Executive Officer and Managing Director of Parkway Pantai held his inaugural staff engagement town halls in Malaysia in April and May this year. Dr Tan expressed his heartfelt appreciation to the staff for their hard work and commitment and updated on the organisation s corporate development across Asia. Wrapping up the town halls was a Q&A segment in which staff were encouraged to provide feedback and raise questions about their work and environment. The active participation offered clarity to what staff valued and considered important in their daily work. This was a major step forward to help the management improve and strengthen both work processes as well as culture. MID-YEAR reports Where are we now Dr Lim Suet Wun Executive Vice President of Singapore Operations held a series of mid-year town halls to update staff on corporate performances and developments. He drew special attention to the potential siege caused by the Middle East Respiratory Syndrome stressing the importance of hand hygiene as well as the need for pandemic emergency planning to test hospitals readiness and resilience. But it was not work-only announcements. He also spotlighted the upcoming Parkway s Family Day on 16 August 2014 for staff families to get together and have fun the first of its kind in 10 years. SNAPSHOTS Lim teh (drinking tea) with the big bosses may sound like a fantasy or a nightmare. But the nine of our Singapore colleagues who had tea in a cozy corner of Mandarin Gallery with Dr Lim Suet Wun Executive Vice President of Singapore Operations can testify that it was a very enjoyable experience. Delicious food aside the staff also relished the opportunity to share their feedback candidly on how life at Parkway has been and the areas that can be improved for a better working environment. Every comment that staff shares has the potential to seed a difference. For example an innocuous question at this tea session on why only some male nurses uniforms has back pockets had led to an investigation whether the uniform fabric could be too thin causing staff s discomfit. A committee has been tasked to review this and come up with the best solution to this problem as we want our staff to wear our uniforms with pride and in comfort. Staff from all levels and facilities who are interested in coming for future tea sessions can email their contact details to grpcorpcomms parkway.sg The next tea session is in July 2014. TEATIME t te t te 2014 27 doctor WRITERS Medical articles are often deemed boring and difficult to understand. To help our doctors write engaging and reader-friendly articles Parkway Pantai Group Corporate Communications and Parkway Doctor Partner Programme co-organised a Writing Clinic on 12 April 2014. Ravi Veloo an award-winning veteran journalist was invited to share writing techniques with the participating doctors on how to write like a journalist and capture readers interest. Nine doctors from across Parkway Pantai s hospitals in Singapore attended this cozy and interactive writing clinic where they were challenged to adopt new writing styles. SNAPSHOTS 28 LEAN go Every step counts towards trimming the excess to save resources and up productivity To imbue our staff with an ethos of creating value for customers through making small continuous improvements on our work processes close to 30 staff attended either a 2-day Senior Leaders workshop or a 5-day Train-the-Trainer workshop in Mount Elizabeth Novena Hospital on Lean Thinking between 28 April to 9 May 2014. These workshops were conducted by representatives from the Lean Healthcare Certification programme from the University of Michigan. little DOCTORS First introduced in Mount Elizabeth Novena Hospital the well-received Doctor For A Day (DFAD) programme has now come to Parkway East Hospital (PEH) On 26 and 27 April 2014 kids 5 to 10 years old roleplayed as doctors complete with scrubs and stethoscopes and learnt how doctors work in the Accident and Emergency department Operating Theatre Nursery Room and General Practitioner s clinic. The two-day event saw overwhelming response with 370 sign-ups and more on the waiting list. The next DFAD PEH will be held on 5 and 6 July 2014. SNAPSHOTS BEARY good Can you do 300 worth of good with just 15 With Life Renewed Parkway East Hospital (PEH) you can For every teddy bear that you purchase at PEH the Khazanah IHH Healthcare Fund will up the amount by 20 times to give 300 worth of medical assistance and make a real difference in the lives of the needy. As part of its corporate social responsibility initiative PEH will use these funds to sponsor 15 Total Knee Replacement surgeries to help the elderly get back on their feet. Every 100 teddy bears sold will provide a life-changing total knee replacement surgery costing up to 30 000 Grab your PEH bear by 31 October 2014 to do your part 29 doctor RIDERS Gleneagles Hospital (GEH) got together a team of cycling enthusiasts to participate in OCBC Cycle 2014. Comprising six doctors and GEH s Chief Operating Officer Phua Tien Beng the team proudly wore GEH scrub tops for the 27km Community Ride. The top was specially embossed with the hospital logo as well as its 55 years anniversary logo for the event. That was fun We ll probably do a 40km one next year. said Dr Roland Chong GEH Orthopedic Surgeon of the memorable experience. PROFILES 30 THE accidental doctor A string of random events gives birth to O&G specialist Dr Natalie Chua The obstetrics and gynaecology (O&G) fraternity has a series of random events to thank for getting Dr Natalie Chua Weilyn into its folds. If not for these fortunate accidents as she refers to them Dr Chua may have become a dentist or an endocrinologist. PROFILES When she didn t get into the Medicine faculty and was accepted into her second choice of Dentistry instead she took it in stride. She declined her mother s offer to read medicine overseas with a stoic mentality so as not to burden the family financially and went ahead with the Dentistry orientation programme. I like to be a friend giving professional advice. With some patients you get off on the right note and the rapport is fantastic. Then I received a call. Apparently there was one last spot in Medicine and I was second on the waiting list. I was told a few days later that I d got in. I was already quite comfortably settled in Dentistry at that time. But I always believe things happen for a reason so I accepted the offer says Dr Chua. Her childhood dream of helping people with diabetes which stemmed from watching her grandmother going in and out of hospital for the various complications of the disease was later superseded by her new interest in O&G. That was also by accident. I missed the O&G exams because I had dengue fever and had to be hospitalised. Consequently I had to redo my O&G posting while juggling another posting at the same time. It was very challenging but it renewed my interest in O&G and here I am now O&G fits Dr Natalie Chua s hands-on personality like a glove as it had both medical and surgical aspects. It is one specialty where you can follow a patient throughout her life from adolescence to teenage years to adulthood when she gets married and has a family of her own to her golden years. I feel really privileged being part of that journey. Of her medical school cohort Dr Chua was among the first to become a specialist in private practice not too bad for someone the faculty let in last. 31 PROFILES Seeing a pregnancy through 32 I m quite open. I will hear them out and then I will say let s talk about it . So there s a shared understanding and I find that quite satisfying. Working with mothers-to-be and providing professional care and even emotional support to ensure the delivery of healthy babies are what Dr Chua thrives on at her clinic in Parkway East Hospital (PEH). Dr Chua entered private practice in the middle of last year. She was feeling apprehensive at first not because of a lack of confidence in skills but because some patients commented she looked too young. That hardly bothers her now as her patients both local and foreign certainly have no qualms about her youthful looks. Her clinic is kept busy throughout the day but nonetheless she still manages to give each patient the amount of time they deserve. Presently she delivers about 10 babies each month but is confident of increasing this figure. Despite the hectic and unpredictable nature of O&G practice Dr Chua loves what she does. For her the draw lies in building relationships with the ladies or couples who step into her consulting rooms. I like to be thought of as a friend giving professional advice. With some patients you simply hit it off on the perfect note and the rapport is fantastic. The time she spends with her patients often evolves into friendship. It doesn t seem like work when it s something that you enjoy. Dr Chua believes in getting patients to be as involved in their pregnancy as possible. Some may come in with preconceived ideas especially in this Internet era and Dr Chua does not brush them off. I m quite open-minded. I will hear them out first and then I will say Well let s talk about it . So there s a shared understanding and I find that quite satisfying. While Dr Chua is a strong believer in natural and time-honoured vaginal birth she keeps the options open for her patients and is always game to entertain suggestions. Dr Chua believes in investing time to carefully explain the available options so that her patients can have confidence in their decisions. Just like home Dr Chua is the newest and youngest member of a relatively new group of O&G practitioners which has a clinic within PEH run by the very experienced Dr Heng Tung Lan. I think we complement each other rather well because our personalities are quite similar and we have a good synergy. It s also good for me in that I can learn a lot from her years of experience shares Dr Chua. While Dr Chua s disposition exudes energy and ambition the proof is in the pudding and Dr Chua has indeed put her fair share into the mix. Her lively demeanour has brought in a vast pool of contacts and this has enabled her to contribute to the business development aspect of this O&G group. Her experience in organising events has similarly been invaluable towards the group s inaugural public forum this year. In the immediate term she has her sights set on becoming a partner in the group. While she could potentially work at any of the other hospitals where the group has a clinic she is not likely to let go of PEH so easily. It s near home and I like that kampong feel. You really feel like you know everyone here because it s such a cozy place and you can get to know people on a personal basis. Everyone is very forthcoming and easy to approach. PROFILES Life outside work Dr Chua s easy-but-steady nature extends into her personal life as well. Her husband of nine years is an engineer and they have known each other for more than half their lifetime. 33 As working in O&G can be physically demanding Dr Chua feels most fortunate to have an understanding other half who supports her in what she does and helps her find the energy she needs. When it comes to maintaining a work-life balance Dr Chua believes in this mantra When something is important there is no such thing as too busy you find time. And so couple time for Dr Chua and her husband means watching television shopping and spending time with family and mutual friends. Occasionally on the weekend Dr Chua enjoys cooking dinner for her family when they visit. Describing herself as a fun-loving easy-going but driven person Dr Chua lives in the moment looking forward to tomorrow and never looking back in regret. I believe in fate. Somehow fortunate accidents happened and things have fallen into place for me. I couldn t ask for more. a boost for DELIVERY Gleneagles Hospital in Singapore upgrades its delivery ward and introduces an OB TraceVue Web Remote Access system that enables doctors to monitor their patients remotely. AT YOUR SERVICE 34 The Delivery Suite in Gleneagles Hospital (GEH) was given a thorough facelift last year as part of the hospital s ongoing refurbishment plans. The four-month renovation process covered nine delivery rooms the 4-bedded first-stage-oflabour (FSOL) room extending to the nursing station equipment rooms and even changing rooms. Wooden paneling and feature walls have been added to the delivery rooms to stimulate a warm and homely atmosphere while FSOL room comes with televisions to distract would-be mums from birthing anxieties. Clinical care has also been given a significant boost with new thoughtful designs that aid efficiency. Sinks cupboards and lighting fixtures are changed to more ergonomic ones. Surgical lights in the delivery rooms are replaced with new LED lighting to enhance visibility without generating ambient heat. Instrument cupboards now have see-through sliding doors for faster and easier retrieval of items. The preparation room layout has been modified to improve the efficiency of work processes and a report room was specially created to allow nurses to pass reports without compromising patient confidentiality. Remote monitoring As part of the upgrading GEH also brought in the OB TraceVue Web Remote Access system to its delivery ward. With this system in place doctors gain access to Continuous Cardiotocographic (CTG) Monitoring of their patients from remote areas. Remote monitoring allows doctors to manage their time more efficiently and respond quickly when the situation calls for it. At GEH the system is unique to its delivery ward where quick and accurate decisions concerning babies at high risk could be required. AT YOUR SERVICE 35 How the OB TraceVue Web Remote Access system works Doctors login via an iPhone iPad or an Android smartphone or tablet with an user id and password. The system allows for multiple users to login at the same time. SPOTLIGHT 36 making HISTORY with ENDOSCOPY Mount Elizabeth Novena Hospital lives up to its tagline It s Possible. by performing highly complex endoscopy on not one but two patients. This landmark procedure took place at Mount Elizabeth Novena Hospital s (MNH) Endoscopy Centre in March this year. Since opening in July 2012 the advanced facility has performed more than 6 000 endoscopies. The centre is equipped with cutting-edge video endoscopy systems with advanced imaging technology. Its team of dedicated nurses works hand in hand with specialist doctors to push the limits of what can be achieved in the realm of advanced endoscopy. Endoscopic retrograde cholangiopancreatography (ERCP) is one such example. The operation combines endoscopy and X-ray to treat problems of the bile and pancreatic ducts and is considered the most technically difficult endoscopic procedure. Performing ERCP on cancer patients who had their stomachs fully removed makes the procedure all the more challenging. To some it is considered impossible. This procedure has only been performed by a handful of top-notch specialists from world-renowned medical centres in recent years with a success rate of between 60 to 70 per cent. As there is only one doctor doing the procedure the nurses play a crucial role. Split seconds tiny angles and millimetre distances make the difference between success and failure. Consultant gastroenterologist Dr Jarrod Lee On 1 March 2014 MNH made history when it performed the first ERCP in Singapore using a prototype colonoscope on a patient with his entire stomach removed. The 44-yearold Sri Lankan had his entire stomach removed a year ago due to stomach cancer but subsequently developed cancer recurrence. ERCP was required to clear the blockage to his liver and bile duct so that he could receive chemotherapy. Describing the complexity of the procedure Consultant gastroenterologist Dr Jarrod Lee says Think of ERCP as trying to score a goal from the penalty spot but with a very good goalkeeper. Doing ERCP on a patient without a stomach is like trying to score from the corner flag. To make it worse you have to do it without boots because the usual equipment cannot be used. Also you are not told which goal is the correct one. Plus you still have to get past the good goalkeeper Dr Jarrod and the endoscopy team took two hours to complete the procedure. It was very intense as everyone had to give their full concentration for the entire duration. Dr Jarrod adds As there is only one doctor doing the procedure the nurses play a crucial role. Split seconds tiny angles and millimetre distances make the difference between success and failure. Following the successful procedure another patient flew in a week later for another challenging ERCP. This cancer patient had his duodenum (the first part of the small intestine) removed but now required the ERCP. He had seen many doctors around the region and was told it was impossible to do the procedure. That is until he came to MNH and consulted Dr Jarrod. The ERCP was performed successfully the very next day. With this MNH adds another notch to its list of proud firsts. It is this determination to explore every option and exhaust every possibility that puts the Mount Elizabeth brand at the forefront of medical excellence. SPOTLIGHT SPOTLIGHT 37 From left to right Dr Teoh Tiong Ann Dr Ooi Boon Swee Consultant Colorectal Surgeons Mount Elizabeth Hospital next frontier in less-incision COLORECTAL SURGERY An advanced laparoscopic technique in colorectal surgery called Natural Orifice Specimen Extraction (NOSE) now offers selected patients undergoing laparoscopic colorectal surgery faster recovery and less pain. NEW SCIENCE 38 The standard surgical technique to resect (remove) the colon always requires a long incision between 15 and 20cm to gain adequate access to the entire colon and abdomen. Over the years advances in technology and expertise have made laparoscopic (keyhole) colorectal surgery a reality and it is now widely performed. With the laparoscopic technique colon surgery can be performed safely and efficaciously with a much smaller incision. Even then an incision of at least 4 to 6 cm is still required to retrieve the colon. This incision although smaller than open surgery is often the most painful and is deemed unavoidable in most if not all laparoscopic colorectal surgery. With NOSE the requirement for this additional larger cut is eliminated. Using the laparoscopic NOSE technique the resected specimen is removed via the rectal stump through the anus. No additional incision is required other than those used for the instruments which range from 5 mm to about 12mm. This makes the incisions used to perform a colon resection with NOSE almost similar to those for laparoscopic removal of gall bladder and appendix. The NOSE technique results in less and smaller incisions which translate to less pain less painkillers required faster recovery lower risk of wound infection and better cosmesis for patients. There is little increase in time taken and cost for the surgery and little or no additional risk when compared to conventional laparoscopic surgery for colorectal disease. Colorectal Surgeons from Mount Elizabeth Hospital Dr Teoh Tiong Ann and Dr Ooi Boon Swee have used the laparoscopic NOSE technique on 15 selected patients with good results. Notably two patients had their entire colon removed using only four small incisions. No additional incision was required to remove the large intestine. Dr Teoh says We offer this advanced technique to carefully selected patients. We believe that the laparoscopic NOSE technique can be carried out safely fairly easily and cost effectively by experienced surgeons who are well versed with advanced laparoscopic techniques with good results and obvious benefits to the patient. In Singapore more than 1 500 new cases of colorectal cancer are detected every year making it the most common cancer here. Dr Ooi adds Surgery remains the primary treatment for colorectal cancer and the NOSE technique can be offered to patients with benign colorectal diseases left-sided colon cancers and early or small cancers. The laparoscopic NOSE technique increases the armamentarium in the fight against colorectal cancer while reducing the trauma and pain associated with surgery. SAFER less invasive KNEE SURGERY The new MAKOplasty partial knee resurfacing procedure at Mount Elizabeth Novena Hospital gives adults who suffer from osteoarthritis an alternative to a total knee replacement. We believe the MAKOplasty partial knee resurfacing procedure will improve our patients quality of life. Dr Kevin Loh Chief Executive Officer Mount Elizabeth Novena Hospital Mount Elizabeth Novena Hospital (MNH) continues to make available new treatment options to patients by introducing the MAKOplasty partial knee resurfacing procedure. Powered by the RIO Robotic Arm Interactive Orthopedic System this innovative treatment allows adults with early to mid-stage osteoarthritis in just one or two compartments of the knee to opt for a partial knee replacement surgery which is more targeted and less invasive instead of a total knee replacement. Previously partial knee replacement surgeries were highly difficult to perform as surgeons were required to cut the diseased portion of their patient s bone and fit the implant accurately free hand. With the MAKOplasty robotic system surgeons get real-time visual tactile and auditory feedback during surgery to facilitate optimal joint resurfacing and implant positioning. Compared to traditional knee replacement surgery this procedure results in a more naturalfeeling knee said Dr Kevin Lee a consultant orthopaedic surgeon at Mount Elizabeth Hospital. It also increases the life expectancy of the implant minimises scarring due to a smaller incision and promotes faster recovery and hence a shorter hospital stay. A retrospective review done in the United States of 406 patients who had total knee replacements showed that 47 per cent would have benefited from replacing just one or two of their knee compartments. Because very little bone is removed during the procedure the implants can be replaced with another procedure such as total knee replacement in the future if the osteoarthritis disease spreads. Total knee replacement surgery is not always optimal for patients with early to mid- stage osteoarthritis and so this new system allows us to better cater to the specific needs of those patients. We believe the MAKOplasty partial knee resurfacing procedure will improve our patients quality of life as those who suffer significant pain but have not reached late-stage osteoarthritis can now seek appropriate treatment said Dr Kelvin Loh Chief Executive Officer of MNH. According to the American Academy of Orthopaedic Surgeons osteoarthritis is the most common form of arthritis and a leading cause of disability worldwide. In Singapore seven in 10 people are at risk of knee osteoarthritis. Early to midstage osteoarthritis patients typically share characteristics such as knee pain with activity usually on the inner knee and or under the knee cap start up knee pain or stiffness when activities are initiated from a sitting position and inability to respond to non-surgical treatments or non-steroidal antiinflammatory medication. NEW SCIENCE 39 run RIGHT Anand Sivayogam Physiotherapist Rehabilitation & Homecare Services Mount Elizabeth Hospital TAKE 5 40 Running is one of the most common forms of exercise recreation and sporting activity worldwide. Although research suggests running enhances physical fitness coordination and mental health there are concerns over the incidence of injury in runners and joggers. The good news is the majority of running injuries are due to recurring factors that the runners can often prevent or avoid themselves. It has been reported that up to 70 per cent of runners (defined by experts as a person running a minimum of three days a week covering a distance of at least 3 km per session) sustain an injury requiring medical treatment. They are most vulnerable to injuries duringtheinitialtraining(firstfourmonths) uponreturningtorunningafteraninjuryorprolongedrest whendistanceorspeedofrunningisincreased whenrunningsurfaceischanged muscle soreness and stiffness. To reduce the risk of injury it is advisable to periodically increase the weekly mileage and or speed by no more than 10 per cent per week and ensure adequate rest (at least two days) after a hard session of running. Running equipment Training errors Running injuries are primarily caused by training errors such as running too far too fast or too soon. Lack of warm up cool down exercises inadequate stretching insufficient nutrition insufficient restoration and ignorance of disease or previous injuries are also reported in 60 to 80 per cent of injuries in runners. Warming up allows time for the body to prepare mentally and physically for running. A good warm up followed by stretching will increase blood flow to the muscles and improve flexibility which in turn reduces the risk of injuries. Cooling down after running allows gradual return of heart rate to normal and may help to reduce post-run Shoes are important in the prevention of running injuries. Every runner is different and the type of shoes needed depend on the individual s biomechanical and training needs. In particular people with flat foot high-arched foot unstable ankle or foot problems may need special orthotic shoe inserts (commercial off-the-shelf or custom made) to prevent injuries. A perfect shoe should have good arch support shockabsorbing properties and fit comfortably. When a shoe s mileage exceeds 800km it should be replaced. Running surface The ideal surface for running is flat smooth resilient and reasonably soft such as the all-purpose track in stadiums and schools that are developed specifically for running and jogging. Avoid running on concrete or rough road surfaces which can cause injuries due to increase in ground reaction force. Beginners should avoid hills or upslope jogging because of the increased stress placed on the knee and ankle. Abnormal biomechanics Running injuries can also be caused by internal factors for example lack of flexibility and weakness in key muscles and biomechanical instability such as over-pronation (tendency of foot to tilt toward the middle of the body) or over supination (tendency of foot to tilt outward). Hence it is important to include strength and flexibility training as part of the regular running routine. The key muscles for running and jogging are buttocks (gluteus) front thigh (quadriceps) back thigh (hamstring) and calves as well as the core muscles which provides good stability and balance. It is also advisable to wear proper knee and or ankle guard while running to prevent injuries related to joint instability. Weather Avoid running when the temperature is over 30 degree Celsius and air pollution levels are high. Increase fluid intake when the weather is warm and humid. It is also advisable to wear lightweight and breathable clothing while running jogging to prevent perspiration and to enhance body heat regulation. Exercising when the body is dehydrated increases the risk of developing an overuse injury as the body tissues do not absorb the stress well enough. Weigh yourself before and after running on a hot humid day one litre of water should be consumed for every kilogramme of weight lost. Common injuries in runners and joggers INJURY Plantar fasciitis heel spur DESCRIPTION CAUSE Inflammation of fibrous connective tissue in the sole of the foot caused by abnormal foot biomechanics and tight Achilles tendon. SYMPTOMS Pain in the sole of foot and or heel bone that results in difficulties in weight bearing TREATMENT Activity modification ice massage calves and foot stretching intrinsic foot muscle exercises aided by a physiotherapist optimisation of shoe insole with the help of a podiatris may also be needed Rest ice massage Achilles stretching and eccentric strength training aided by a physiotherapist shoe orthotics such as heel lifts Rest ice massage patellar tendon stretching and eccentric strength training aided by a physiotherapist Modification of training aided by a physiotherapist patellar taping quadriceps strength training lower limb stretching exercises foot wear modifications ITB stretching and release (using form roller) modification of running technique aided by a physiotherapist proper strengthening exercises Rest icing stretching physiotherapy intervention Achilles tendonitis Inflammation of the tendon which connects the calf muscle to the heel bone caused by repetitive overuse of Achilles tendon due to uphill running or too rapid increase in mileage Inflammation of the tendon connecting the kneecap to the shinbone caused by repetitive overuse of the patellar tendon and lack of flexibility over quadriceps and hamstring Repetitive stress in the patellofemoral joint caused by complex interaction between the intrinsic anatomy and external training factors Repetitive friction of distal portion of ITB a thick band of fibrous tissue that extends from the pelvis and runs on the outside part of the thigh until it attaches to the shinbone caused by poor running technique and overuse Inflammation of muscles tendon or bone covering caused by imbalance in calf muscles and shin muscles Fracture (hairline or complete) due to fatigue or stress from frequent repeated physical activity Pain in the back of the heel with or without swelling over the Achilles tendon Patellar tendonitis Pain between the kneecap and shin bone while jogging or just after the workout stair climbing and jumping Patellofemoral pain syndrome Pain below the kneecap usually provoked by jogging stair climbing squatting and sitting with bent knee for a long period of time Pain in the outside of knee joint particularly when the heel strikes the ground while running jogging and snapping or popping sensation during knee movements Illiotibial band (ITB) friction syndrome Shin splints Pain along the inner side of the lower leg while running jogging Localised pain over the affected bone (tibia fibula or metatarsal bone) Stress fracture Rest immobilisation resume running gradually after six weeks