Towards the end of Sep 2021, the government announced that the home recovery programme (HRP) would be the default mode of management for children between the ages of five and 11 who had been diagnosed with COVID-19. I thought about the plight of the many kids with COVID-19, trapped at home on quarantine orders, waiting for more guidance on HRP, while others were waiting for medical staff to reach out to them.
As a paediatrician, I could not ignore the cry for help from all their parents and, for days, I had been thinking of ways on how a lone paediatrician, who was not a part of the Ministry of Health (MOH) or the Singapore Armed Forces (SAF), could contribute to the national effort to keep these sick kids safe at home. To me, it was ironic that they were so close (on the small island of Singapore) and yet so far (they were all on quarantine orders and could not leave their homes).
Children’s Day is a reminder to me, as a paediatrician and a father, to celebrate the joys of childhood, but this pandemic has severely affected “normal” childhoods. So, on the evening of 1 Oct (which to me is traditionally “Children’s Day”1), I felt I had to do something. A chance conversation—in retrospect, I realise it was God playing a part in connecting us—that evening with a medical colleague who was involved in the telemedicine platform led me to being linked up to a mutual doctor friend who was directly involved in HRP. We spent a frantic 20 minutes on the phone that night, rapidly exchanging ideas on how a paediatrician in private practice could reach out to all these families stuck at home.
We worked out an idea to augment the HRP telemedicine workforce with paediatricians from the private sector to reach out to the kids on HRP via telemedicine consults. This helped to optimise the accessibility and speed at which families could get in touch with a paediatrician in their time of need, so that kids could quickly be assessed to ensure that they would be safe at home while recovering from COVID-19. Those who were unwell could be evacuated to hospital and admitted in a timely manner.
A flurry of online meetings, conversations and emails ensued, this time also involving my colleagues from KK Women’s and Children’s Hospital (KKH) and the National University Hospital (NUH).2 Originally, children had to be brought to and from these two hospitals for physical examinations, which consumed a huge amount of resources. A strategy was developed that involved my team of paediatricians assessing the children via telemedicine consults and only bringing to hospital the ones who were at high risk of complications or those who were unwell.
Needless to say, that week was not only intense but fairly stressful as I had promised a workforce that as yet didn’t exist. How was I going to convince my fellow paediatricians to “sign up”? It was a purely volunteer effort and I had not yet worked out what hours we would be working nor what kind of protocols we were adopting! I turned to the Scriptures for reassurance and after all those years of memorising Bible verses in Sunday School, a few promptly surfaced: “I can do all things through him who strengthens me” (Phil 4:13); and “So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand” (Isa 41:10 NIV).
The first miracle began the day after I reached out to my colleagues scattered across Singapore. Steadily, over next seven days, I had paediatricians volunteering until I had a team of 45! We started operations on 8 Oct and my eyes nearly popped out of my head when I saw the long list of COVID-positive children given to us on day one.
But then next miracle happened—the team took the long name list in stride and we managed reach out to all the kids by the next day. This went on and on, day and night, on weekdays and weekends. Every day, I witnessed little miracles—the volunteer force of paediatricians, despite all our day jobs, managing to cope with the numbers handed to us, all while meeting our mandate of trying to reach out to families within one to two days of getting the name list.
I wrote and frequently updated the standard operating procedures (SOP) to keep pace with the countless issues we faced on a daily basis to overcome the problems encountered along the way. My team got used to my midnight debriefs that came in the form of one- to two-page documents to keep them up to date. Moreover, I also had to maintain team morale and keep the team going in the right direction, as with time, fatigue was sure to set in. Whenever that happened, I turned to the Scriptures for sustenance and again, thanks to years of Sunday school, yet another verse came to mind: “Those who hope in the LORD will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint” (Isa 40:31).
I felt re-energised whenever I mentally pictured eagles soaring in the sky. Moreover, feedback from grateful parents about the teams effort also kept all of us going, despite the tiredness.
Reaching out to all these kids at home is really the culmination of “one kampong” working together to keep them safe during their HRP journey. Our fellow paediatricians in KKH and NUH are an integral part of the kampong for when we have to send kids to the Children’s Emergency (CE) for further evaluation or for admission when they are too unwell to be managed at home. Then there is the rest of the kampong—the operations and admin staff who work tirelessly behind the scenes to keep all of the gears and cogs turning smoothly.
Looking out for kids during the pandemic
Most of the kids we assess have mild symptoms and can be managed at home. My team of paediatricians reaches out to them to firstly ensure they are not too ill to be recovering at home. We despatch medication when needed and pulse oximeters if they have not already been delivered. If the child has a chronic pre-existing medical condition like poorly controlled asthma that could be exacerbated by a COVID-19 infection, we get them in for a physical examination at CE.
A few other symptoms we look out for are a persistent high fever, respiratory symptoms that are severe or prolonged, significant chest pain or persistently raised heart rates. We send in a medical transport to evacuate these children to CE but there have been a few occasions when we had to advise parents to call 995 for a quicker evacuation. We are also ever vigilant for multisystem inflammatory syndrome in children (MIS-C) that has recently cropped up locally. We advise parents to be wary of symptoms similar to Kawasaki disease and also watch out for it during our telemedicine consults.
While physical symptoms in most kids may be milder compared to those experienced by adults, mentally and psychosocially, this pandemic has disrupted social norms for kids, especially the younger ones. It is difficult for kids who are self-isolating at home and stuck in their rooms, and they also don’t get to enjoy their usual evening meal with their families. Some of the older kids are mature enough to get stressed and worried about passing the infection to the caregiver in isolation with them, or even to the rest of the family.
Some younger children who have rarely left the house during the pandemic have much stranger anxiety. Others who do not get to run around outdoors with other kids like they normally do after school miss their usual social circles and don’t get enough exercise. As such, we do need to be aware of the mental and psychological health of kids during this time.
Looking out for parents during the pandemic
We have encountered some families with kids who have special needs and I take my hat off to their parents for being able to cope with their child alone while self-isolating in a room. For these kids, the home environment is familiar to them and would be preferable to sending them to a hospital or community isolation facility (CIF). Still, the mental stress can be substantial and as paediatricians, we fully empathise with them and while it may be a little more challenging to assess these kids, we do the best we can. I am also very fortunate to have on my team a few paediatricians familiar with kids who have special needs or developmental issues and they have been an invaluable resource to such families.
After a month of operations, my team empathises with the mental stresses that parents have to go through while isolating with their kids. We try our best to spend a little time to give them some reassurance even after the medical assessment has been completed. Even though we are separated by a phone screen, many kilometres apart, the “human touch” (albeit virtually) is still very much of value to keep spirits up for parents and kids isolated in a room at home for an extended period of time.
Love God by loving our neighbour
As an ACSian, I recall an ACS boy who had COVID-19 earlier this year, resulting in him and his classmates being isolated at home or in hotel rooms. I saw how an entire Christian community—their schoolmates and their parents, their teachers, old boys and more—rallied around to reach out to the affected kids confined at home. This inspired me to lead this effort to bring a kampong together—to medically support all the kids stuck at home.
I thank God for bringing to mind MCS’s motto for the quadrennium, to “love God by loving our neighbour”. When Bishop Dr Gordon Wong was consecrated as Bishop last December, he said in his sermon: “There are many different ways God works with us in all things to bring about good in this world of groaning. In so doing, we obey the greatest commandment in Scripture which is to love God by loving our neighbour.”
I felt God speaking to me the night of 1 Oct—to find a way to “love our neighbours” by reaching out to all the kids who were isolated in their homes. Over the past 20 years, I extensively trained in Children’s Emergencies, led countless medical outreach programmes and worked with medical charities like Club Rainbow and Operation Smile. All this training and experiences seemed to have culminated in this huge community paediatric effort, the largest one I have ever embarked on.
1 Children’s Day was celebrated on 1 Oct in Singapore until 2012, when the Ministry of Education decided to move it to the first Friday of October.
2 These are the two hospitals that care for children who have been infected with COVID-19 who require hospital admission.
Darryl worked with (coincidentally also Methodist) children’s author Emily Lim-Leh (Barker Road MC)3 and illustrator Josef Lee (Foochow MC) to produce a free illustrated e-book, I Can Recover at Home! to help children and parents understand what the home recovery programme and telemedicine consultations will be like for them. It also includes answers to frequently asked questions, as well as links to useful websites for parents. Scan the QR code or download from https://mummumstheword.files.wordpress.com/2021/11/i-can-recover-at-home-e-book.pdf
3 Emily shared her story in the December 2020 issue of Methodist Message at https://message.methodist.org.sg/finding-my-new-voice
Dr Darryl Lim is a paediatrician in private practice who attends to children with acute emergencies at all hours of the day and night. He spent his formative years in the ACS family—from primary school to secondary school and junior college—and grew up attending Wesley MC. / Photo courtesy of Darryl Lim. Book visuals used with permission.