Women leaders: She leads 130 healthcare workers at the Home Nursing Foundation to care for the sick and frail

More than 20 years ago, a young medical student followed a nurse to a bedbound patient’s home during her posting to the Home Nursing Foundation (HNF).

Dr Christina Tiong, CEO of Home Nursing Foundation, was that student, and it’s a scene she still vividly recalls today.

“He couldn’t speak and was lying in bed all day, quite lonely. He was on diapers, and there was a kind of urine smell in the house.

“It was a very dismal setting. There is a hopeless feeling that this person is going to just spend the rest of his life lying on the bed. What is the family going to do? You feel very sorry,” the 47-year-old said.

But as the nurse carefully proceeded to dress the patient’s wound, speaking gently to the patient and his spouse, the young woman saw a glimmer of hope.

On the surface, this practical help, caring touch and emotional support may not seem as heroic as work at the emergency department but there was a quiet heroism and deep compassion that spoke to her.

Today, Dr Tiong leads a team of around 130 nurses, doctors and therapists at the foundation who care for close to 5,000 frail and homebound patients yearly – people who might otherwise fall between the cracks. They make home visits to patients every day, rain or shine.

HEALTHCARE BEYOND HOSPITALS

The majority of these patients suffer from debilitating conditions such as cerebral palsy, intellectual disability, autism, stroke, neurodegenerative diseases, heart failure, respiratory conditions, osteoarthritis and cognitive impairment.

The healthcare professionals often work under stressful conditions because some are unable to clean their home, which may be cockroach- or maggot-infested. Some also suffer from dementia or other mental health conditions, and may be angry and combative during these home visits. 

“In the hospital, if someone is not well, you are very much in control of what this person undergoes. You can do surgery, prescribe medications… When I was a young medical officer… we kind of took things for granted, and expected that when [patients] get discharged, everything is just going to go back to normal.

“But the minute that this person goes home, it’s a different world altogether. Simple things like getting out of bed, having a meal, walking to the toilet and having a bath will be very challenging.

“How should they take care of themselves? What aspirations and roles in their own family or in society do they wish to have with their state of health? How do they adapt back to their role, if they were a mother or a working professional?” she said.

“As this person continues in his life, [it is important that] there are people who can help and support him, and the family finds reason to carry on. That to me is just as important as the work that is being done in the hospitals and clinics,” she added.

HOLISTIC COMMUNITY CARE SUPPORT

One of HNF’s patients is a 30-year-old cerebral palsy patient who cannot feed himself and relies on a nasogastric tube to carry food from his nose to his stomach. He is cared for by aged parents. So when his father was diagnosed with cancer, there was a sense of hopelessness.

To ease the family’s burden, HNF assists the patient with nasogastric tube changes, and helps to gather donations to subsidise his equipment, milk feeds and diapers.

Social workers also helped the patient’s father connect with befrienders so that he could have a support network while receiving treatment for cancer.

Shortly after joining HNF in 2018, Dr Tiong spearheaded the launch of two senior daycare centres in Hougang and Buangkok for seniors with dementia and impaired mobility who need daytime supervision.

She also launched an active ageing centre in Buangkok to engage seniors with exercise and activities such as an angklung club.

“We need to realise that there is a desire for meaning, purpose and contribution in each of us. So how do we empower [patients] to live purposefully?” she said.

“YOU ONLY LEAVE ONCE”

More recently, Dr Tiong and her team began offering end-of-life support to patients who choose to pass on in their own homes.

“Close to 40 per cent of our patients are at the end of life,” she said. “Many of them may have been repeatedly admitted to hospital. Sometimes, they feel that that is not what they want. They want to pass on at home. We have that conversation and provide them with a deeper level of support.”

This includes house visits to provide palliative care and pain management, as well as 24/7 telephonic support when patients feel “desperate or lost”. The healthcare team also shares information with caregivers on the end-of-life symptoms and how to provide comfort to patients.

In 2023, HNF supported around 50 such patients, including an elderly woman who suffered from dementia and chronic kidney disease, and passed away peacefully at home surrounded by family members who held her, prayed for her and sang to her.

“When I was younger, I thought, you only live once. But now as I grow older, I realise you only leave once.

“Having a good end-of-life experience gives [patients] peace of mind, a sense of closure… It is also important for the family to feel well supported – that it wasn’t so rushed that they didn’t have the ability to fulfill their loved ones’ wishes,” she reflected.

EVERYONE IS A LEADER

Such work takes a physical and emotional toll on the healthcare workers. As CEO, Dr Tiong’s primary role is to support her team so that they have enough in their tank to care for others.

She prioritises staff welfare programmes such as weekly exercise, Family Day, and family-life workshops, so that staff who are parents also learn how to take care of their own families well.

She also ensures that there are training programmes that support her staff’s professional growth.

“Everyone is a leader in their own aspect. My role is to bring out the leadership in them. It is not just one person having a dream or a vision but a group of people coming together to shape how we are able to make a difference.

However, Dr Tiong noted that at crucial moments, leaders need to act decisively without waiting for everyone’s input. Women leaders sometimes come across as indecisive because they tend to be more accommodating than male counterparts, taking everyone’s voice into consideration.

“In my sector, as it goes higher up, there is much more male than female representation. So it is important to have a female voice. And I think the female leaders need to learn to get to the point. [Otherwise], their voice becomes a bit diluted,” she said. “That is actually my advice to self.”

That said, Dr Tiong never set out to be a leader.

Having started her career as a frontline doctor working during the highly infectious SARS outbreak while pregnant with her first child, she saw the value of backend administrative roles to plan for infectious diseases and an ageing population.

As a young mother at the age of 27, she also realised frontline work, night shifts and gruelling hours would make it difficult for her to care for her young children.

“When I was working in the emergency department, when I got home, even if I was physically there, I couldn’t be there mentally, for the kids. 

“I was just happy to find a role that I could contribute meaningfully to while having the mental space to see them grow up and be involved in their lives and their struggles. Titling wasn’t important,” said the mother-of-three.  

When asked about her best advice for other young people at the crossroads of their career, she laughed.

“My advice is nobody wants to listen to advice,” she said. “Maybe just be yourself and be comfortable about how you want to contribute. I think that makes it sustainable and enjoyable for ourselves.”