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The article that follows is a collection of reflections and observations by Peter (British) and Nathan (Singaporean) living and working in each other’s countries.

 

Peter Cackett

 

“Best thing about this place is it’s not still full of pompous ex-colonials who think they were born to rule the world. That’s what I love about Asia, anyone can make it, it doesn’t matter which stupid school you went to.”

In this scene from the film Rogue Trader (1999), Nick Leeson (Ewan McGregor) describes Singapore to his wife, shortly before he singlehandedly brings about the collapse of Barings Bank (one of England’s oldest merchant banks) from a series of unauthorised and risky trades resulting in losses of a billion dollars.

I felt the same degree of excitement about Singapore as Nick Leeson when I bounced on to the plane at Heathrow headed for SE Asia to commence my medical retina fellowship at the Singapore National Eye Centre (SNEC) in the summer of 2007.

I must also mention that on the plane I had my three kids under four years old in tow. Following a 13-hour flight, much of which was spent pacing up and down the aisles trying to shush my six-month-old daughter to sleep, whilst trying to operate the inflight entertainment system for my two and four-year-old sons, I shuffled wearily into the arrivals hall.

I marvelled at the space! The cleanliness! The efficiency! And to top it all, I am convinced it was Brian Eno’s Music for Airports playing in the background. How uber cool! Or “sick”?! as my kids would now say.

Then we stepped out into the open to get a taxi and I felt the delicious warmth. I had finally arrived at the tropical paradise I had dreamt about. No more de-icing the car, no more shivering in the poorly heated clinic rooms in Scotland. In my quest for a career in ophthalmology I had relocated to Scotland from London and still had never fully acclimatised to the much colder weather.

However, I realised very quickly that Singaporeans love their air-conditioning. And SNEC had exceptionally good air-conditioning. The retinal laser clinic suite was the coldest, and I nicknamed this the Planet Hoth (frozen planet, Star Wars). I would have worn a fleece to the laser suite if I had not left all my cold weather clothes in storage back in Scotland. The fleece would also have been useful for a trip to the cinema in Singapore as here it is almost as cold as the laser suite, and something to bear in mind if you ever visit.

“Sit down uncle,” Ian, my mentor, said to a patient in the first medical retina clinic I joined him at. Over the subsequent month he seemed to have a steady stream of relatives attending his clinic. “Ian, you have a very extended family with many eye problems,” I finally observed. He then explained that, as mark of respect, in Singapore it is customary to address an older person as auntie or uncle. This can, however, create problems as a female colleague at SNEC complained to me that she had recently been addressed as “auntie” and didn’t believe her relatively young age warranted the polite term! In Scotland, in a similar fashion, a patient occasionally addresses me at the end of a consultation “Thanks, son”, although with the onset of a few grey hairs this happens far less so. But when it does, I am on a high for the rest of the day and gloat to my partner when I get home “I got called son today!”

 

Lantern festival 2007. Pete’s kids learn to seize on an opportunity at a young age. 

 

SNEC valet parking. A potential NHS initiative.

 

The food in Singapore was another bonus for me doing my fellowship there. Tin, another mentor, at lunchtimes would take the international fellows out to various hawker centres and restaurants to try the different cuisines. The food was always delicious, although sometimes it is better for me not to know what I am eating as I have always been a little squeamish, especially of offal. “Mmm, this soup is lovely, is it chicken?” I enquired at a Chinese banquet. “No,” Tin replied cheerfully, “it’s pig’s lung soup”. Is that a thing, you have got to be kidding me? I thought. Apparently, though, it is a delicacy and notoriously difficult to prepare, but something my brain and stomach could not process and left me feeling a little queasy. In a similar fashion on a recent trip to Romania, my partner Smaranda delightedly informed me, midway through a bowl of soup which I was wholeheartedly enjoying believing again to be “chicken”, that it was in fact tripe soup.

“海克伊玛” or rather “hai ke yima,” I proudly asked the nurse as I handed her some paperwork which I had completed in the clinic after a couple of months of being in Singapore. A puzzled look crossed her face. “Hai ke yima,” I said again. Again, a confused look on the nurse’s face. “You know,” I insisted in English, “is it ok?” “Oh,” she laughed, “you mean hai ker yima”. Believe me, to my untrained ear, the difference was very subtle, but it was clear that learning to speak even basic Chinese Mandarin, which I was taking lessons in, was going to be challenging and entertaining for the staff! I then gradually discovered that whilst the young Singaporeans were all pretty much fluent in both English and Chinese Mandarin, the elderly were not. They spoke a variety of different Chinese dialects (Cantonese, Hokkien etc.) and then there were the patients that spoke Malay, Tamil, Hindi etc. Unfortunately, in the medical retina clinics, most of the patients were elderly. Oh dear. Luckily the nurses all seemed to be fluent in many of the languages, and collectively in the clinics covered them all, so I always had my very own equivalent of a Babel fish (a small fish in Hitchhiker’s Guide to the Galaxy that can be placed into someone’s ear to enable them to hear any language translated into their primary language) on hand to help.

Throughout my time at SNEC, the unwavering dedication and commitment to the department by the staff and their work ethic never ceased to amaze me. This is epitomised no more so than in an event that took place shortly after I arrived on fellowship. The annual SNEC doctors’ group photo comprising almost 90 doctors. At 7am. On a Saturday morning. Almost everyone turned up at the appropriate time outside SNEC. By 7:05am the photo had been taken and many of the doctors then headed into SNEC to get on with some work. Meanwhile, I sloped off home to help with the kids building Lego and watching the Wiggles on DVD. If I attempted the same photo at the Eye Pavilion in Edinburgh at 7am on a Saturday morning I am sure it would be just me and some tumbleweed, and I would end up taking a selfie and driving home again.

I also discovered that the Singaporeans are a very kind and generous nation. On one occasion on a Sunday afternoon, I had tried to entertain my two boys at the Ancient Civilizations Museum. I think we had already done the Singapore Zoo and the Jurong Bird Park that week and we (or rather I) needed some variety. On leaving and heading along the footpath opposite Boat Quay, the heavens opened in true tropical style. We were getting soaked, I was unprepared and the afternoon was going pear-shaped. A man walking towards us then stopped and, after much insisting, handed us his umbrella, smiled, and happily went on his way, getting very wet but leaving us dry. A much-welcomed random act of kindness and, as mentioned in a previous article, it is these acts that are most likely the secret to happiness and the meaning of life.

The year was rewarding and helped me make the transition from fellow to consultant, but although there were career opportunities in Singapore (not in collapsing banks but in medical retina) I chose to return to the UK. This decision was mainly based on the proximity of family (parents) and is one of the main considerations if one is thinking about relocating to another country. However, hopefully one day in the latter stages of my career, like the Terminator, “I’ll be back” and return to work there again. But I’ll remember to pack my fleece and woolly hat for the laser clinic.

 

 

Nathan Ng

 

In the summer of 2017, I waved goodbye to my parents at the departure gates of Changi airport and boarded a plane to the UK. I was headed to Edinburgh to pursue a medical undergraduate degree. Having never been to the UK before this, I could hardly contain my excitement and spent the 13-hour journey there drifting between rewatching classic movies and making grand ambitions about the adventures I would embark on.

SHIOK Lah! (Singlish terms added to the Oxford English dictionary in 2016), I proclaimed as I felt the cool breeze stepping onto the Edinburgh airport tarmac. Growing up in tropical weather, with 37 degree temperatures, alternating between scorching sun and pouring rain, I was really looking forward to having four seasons! The weather in Scotland can be unpredictable and I know people complain about gloomy, wet weather, but I am a fan of the drizzle here. It is cool, and you never end up feeling humid and sticky. In Singapore, during a rainy day, you might have to worry about your carpark getting flooded!

 

Nathan enjoying a warm and cosy breakfast in cold Scottish weather.

 

A friend of mine picked me up from the airport. Jay was a few years my senior and had just graduated from Edinburgh Medical School. Akin to handing over a baton, he passed on to me the tips and tricks of surviving university in the UK as we drove to dinner. As my ears absorbed the wealth of knowledge, my eyes feasted on the beautiful sights the city had to offer. Arthur’s Seat! Calton Hill! The Pentlands! I loved how nature and city living was so intertwined. Despite great plans for trying new things, being a cliché Singaporean in a western country, the first meal I had was Chinese hotpot.

Singaporeans really love their food, maybe a little too much. Anticipating that I would struggle to source food I was used to from home, 70% of my luggage was food items. I figured I could just buy everything else locally (Poundland and Primark were my saving grace). I recalled on my first day of clinical attachment, at the lunch table, I whipped out a bento box containing some black pepper fried rice, crispy wanton, and stir-fried beef. I had gone on a cooking spree the night before and was feeling pretty proud of my prepared meal. I glanced around the sitting table and noticed in contrast to my very over the top meal, some had sandwiches, others had some salad and fruits. By this time, the overpowering smell of my dish had consumed the room, I felt like a sore thumb and quickly finished up. I soon learnt the ins and outs of acquiring food in hospital, such as waiting till near closing time at M&S for some good discounts, getting meal deals and the rotating menu at hospital including “Fish and Chips Friday”.

 

View from Carlton Hill, Edinburgh, UK.

 

“Get me a scoop of chocolate ice cream,” I placed my order at the popular local gelato shop. Zain, a good friend and colleague of mine, gasped in horror. “That’s…not the most polite,” he whispered to me underneath his breath. I looked up at the waitress, who might indeed have taken offence at the choice of my language. He explained patiently to me that although I never meant to be curt or rude, that was how it came across. I was devastated! In Singapore, I was considered polite by all measures! From then, any request I made used more ‘English etiquette’. Ironically, I experienced reverse culture shock when I went back home for summer break. “You alright? Can I please have a cup of iced coffee?” or “I beg your pardon” got me weird looks from the aunties in the hawker centres back home, who were much more used to “Kopi beng” and ‘huh?” Overall, people are really friendly and polite in the UK. Strangers strike up interesting conversations with you and daily interactions such as these put me in a good mood. The people are one of the things I love most about the UK and I am grateful for the bonds I have formed.

A big part about being a healthcare professional is good communication with patients and other members of the team. Although I still have to make a conscious effort not to speak in “Singlish”, English is my first language and clear communication is not usually an issue. However, there are times I find my brain working a little harder to process what my UK counterparts are trying to say. “Just had my tea!” meant “Just had dinner!”. “Ya ken?” means “You know?” and “Ya alright?” means “Hi!”. Interestingly, locals also tell the time differently, and I am still trying to figure out why you wouldn’t just say 12.40, instead of 20 to 1?

Working in the UK and the National Health Service (NHS) has been an absolute privilege. My co-workers are dedicated, compassionate and great company. My supervisors are great mentors, who take time to teach and train. Although shifts and rotas can be tough, there is a prevailing culture of protecting staff and promoting work-life balance. Most importantly, the NHS serves as an avenue for providing great and free healthcare and I am thankful to be a part of it.

 

 

Ophthalmic Aid to Eastern Europe (OAEE)
As a consequence of the war in Ukraine, the need for ophthalmic medical supplies in Eastern Europe has never been greater. The charity OAEE aims to deliver donations to the Ophthalmology Department of Lviv Hospital and to St. Spiridon Hospital in Iasi, Romania, where displaced Ukrainian refugees are arriving. We are seeking donations of new or ‘used but usable’ ophthalmic equipment and any short-coded consumables. Surgical instruments, slit-lamps, direct and indirect ophthalmoscopes and operating microscopes are particularly needed.
If you have anything that may be of use, please contact Peter Cackett by email at pdcackett@hotmail.com . Thank you for any support that you can provide.

 

 

COMMENTS ARE WELCOME
Would you like to comment on the topics raised within this article?
Email chris@pinpoint-scotland.com and, once approved, your comment will be published here.

 

 

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CONTRIBUTOR
Peter Cackett

Princess Alexandra Eye Pavilion, Edinburgh, UK.

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CONTRIBUTOR
Nathan Ng

NHS Lothian, UK.

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