Wednesday, December 10, 2014

WHEN CARING TAKES A TOLL ON THE HEART...

Feature article in The Straits Times 7 Dec, 2014. Click here to read the original and other related stories.

It is 8am on a Tuesday when I report for work at the Touch Seniors Activity Centre in Geylang Bahru, dressed in polo shirt, jeans and sneakers.

The 16-year-old centre is at the void deck of Block 61, one of two blocks of one-room rental flats in the ageing Housing Board neighbourhood.

About the size of two five-room HDB flats, it has a common area lined with potted plants and rows of tables and chairs, where eight women and three men, all Chinese, are having breakfast of kaya-on-bread and Milo. In one corner, an Indian man is reading The Straits Times.

Three women are in the kitchen preparing breakfast. Everyone is dressed casually, two of the women in their pyjamas.

I am here as an untrained "programme assistant" to help the centre's six staff members run daily programmes for the elderly.

"I hope you can speak dialect," says centre director Julia Lee, 52, taking me to her tiny office. "Speaking dialect is a job requirement." The centre serves 740 people who are over 60 years old. Four in five are Chinese who speak either Hokkien or Cantonese, and the rest are Malays and Indians.

About half live in the rental blocks. One in five lives alone, and half live with their spouses and children. One in 10 is on public assistance. "Most are not working, either living off their savings or their CPF (Central Provident Fund) and they get financial help from the Government and VWOs," says Julia, referring to voluntary welfare organisations.

She introduces me to the staff - Betty Lee, Richard Chia, Yong Yin Hoong, James Lee and Carol Oh - all in their 50s, except for Carol, who is 32. Julia hands me a dark red polo shirt like the one all the staff are dressed in. "Wear this," she says. "You are one of us."


The dialect test

My first assignment was to man the general inquiries counter. And I realised quickly I was crippled because I speak only English and Mandarin, and just a smattering of Hokkien.

A Hokkien-speaking woman in her 60s came along, asking how to apply for the Community Health Assist Scheme card which will get her higher subsidies when she sees the doctor. I explained, then stumbled over the Hokkien word for "polyclinic".

From about 4m away, a woman having breakfast called out loudly, without even looking our way: "Peh soon chu!"

My client chuckled and said: "Her ears tokong (very good)!" I learnt then that I need not worry, because help was always near.

Almost all the elderly folk at the centre were tucking into the free breakfast. Most were chatty and cheerful, but there were some loners and quiet ones too.

Two men sharing the same copy of The Straits Times began bickering. "You did not put it back properly, every morning like this!" snapped one, stomping away.

Although this is an activity centre, dishing out meals and running exercise and games sessions take up only a fraction of the staff's time. What needs most time and effort are home visits. There are about 50 frail elderly persons living alone in the area, and the staff visit every one at least once in two days, if not daily.

My colleague Betty Lee, 56, took me under her wing as she set off after lunch on her rounds.

The Ministry of Social and Family Development requires such centres to visit frail seniors weekly. "But one week is too long," said Betty. "If something happens, we don't want to find out only from the smell." I knew she meant old people dying alone - since 2007, more than 50 have been found dead alone in their homes.

We headed first to the ninth floor at nearby Block 62. Betty knocked on the door of 77-year-old Madam Chew Pui Siew's flat but there was no answer. She knocked again and again, calling out for Madam Chew. "She was discharged yesterday after being hospitalised for a fall, so I want to see how she is doing," she said.

The next thing I knew, Betty was down on her hands and knees, squinting as she peered into the flat through the tiny gap below the front door. "Previously we could climb and peep through the louvres on top but now they are covered up," she said, miffed at not being able to make out anything indoors, disregarding the film of grey dust her hair had picked up.

"Never mind, we'll come back later," she told me. "We must see how she is doing today."

Over the next two hours, we visited four elderly people, spending about 30 minutes with each.

There was Madam Koh Ai Teng, an 84-year-old widow with failing eyesight who lives alone in an eighth-floor flat. She has four sons and two daughters, but prefers to live alone. She gets about with a walking stick and is usually at the centre every morning.

"She is an independent woman," said Betty. "If we don't see her in the morning, it means something is wrong."

Betty glanced quickly into a wooden food cabinet to see if there was enough food, checking the expiry date of two cans of sardines. "Why didn't you finish your meal?" she asked, pointing to a half-eaten styrofoam pack of rice, chye sim and tofu.

"I am keeping the other half for dinner," replied Madam Koh.

We then walked to the next block to visit Madam Neo Gek Hui. "She can be quite grumpy," Betty warned me as she knocked on the door.

The 87-year-old woman opened the door and let us into a dark, dingy flat with shuttered windows that reeked so terribly of urine and stale cigarette smoke that I almost gagged, but Betty appeared oblivious to the odour.

The widow has a daughter who is working as a professional, but they are not on good terms.

A heavy smoker, the old woman wasted no time in asking if I would help her buy cigarettes. She lost interest in chatting when she gathered we would not be supplying cigarettes. "I'm going to rest now," she said, hinting that we could go.

Outside, Betty said: "She's okay, except for her smoking, but at 87, what to do? Her flat is still neat, but she doesn't open her windows, that's the problem. Most of them are like that, they are afraid of dust."

A pile of soiled clothes

We went next to the 11th floor to see retired taxi driver Seah Keng Oon, a 73-year-old who had just undergone brain surgery. The divorcee has two sons and a daughter but lives on his own on $450 monthly public assistance.

His one-room flat had a wooden sofa, some tables and chairs and a bed so untidy I began straightening out the bedsheet. That was when I noticed the bed bugs, dead and alive, as big as grains of barley. Two landed on my arm.

Betty said softly: "Do not sit on the wooden or rattan chairs because the bugs hide there, and you need to shake yourself afterwards and make sure you don't take the bugs home." My arm seemed to itch right away.

On the eighth floor, we dropped in on Mr Boey Seng Tee, 71, who has early-stage Parkinson's disease. The unmarried retired cleaner lives alone on public assistance. His flat was an awful mess, with clothes piled nearly a metre high on the floor. His bed was untidy, with the pillow and some towels thrown over the crumpled bedsheet which was stained badly and stank of urine. Betty shook her head and said: "We just gave him a new bed and bedsheets last month."

We spent more than 30 minutes sorting out his soiled clothes, separating urine-stained underwear and singlets from clean clothes. He protested when we put a pair of trousers into the pile of dirty clothes, saying: "Still can wear, only wore for one week."

We threw the soiled bedsheet and pillowcase down the rubbish chute, swept the floor and picked up dead bed bugs. Mr Boey nodded off while we worked.

"It is a matter of time before he will have to be admitted to a nursing home," said Betty. "We'll just have to try and keep him here for as long as we can."

We headed back to the centre and washed our hands thoroughly with Dettol soap, but Betty wasn't done yet with our home visits.

We returned to our first stop, to check on Madam Chew Pui Siew. This time, her 55-year-old odd-job labourer son opened the door.

Seated in her wheelchair, Madam Chew told Betty: "I heard you knocking just now, but I was too weak to get up from the bed."

Betty spent 30 minutes talking to the son, explaining that some things needed to change now that his mother would be in a wheelchair for some time. Among other things, they would need a water heater, ramps from the kitchen to the toilet and adult diapers.

Betty told me: "It is very stressful for the son to look after the mother, so we'll try to visit her for 30 minutes every other day and give him a break."

My routine over the rest of the week was the same - manning the counter and helping with group activities at the centre, before visiting homes in the afternoons.

Memorable among the old folk I met was Mr Lee Ah Tong, a 67-year-old retired odd-job labourer who has no family and lives alone in his 11th-floor flat.

I visited him with another colleague, Richard, the only one Mr Lee allows into his home, which is chock-full of countless items he hoards.

"You'll have to buy something from him," whispered Richard as he knocked on the door. "Otherwise he won't let you in."

Inside, we had to make our way along a 30cm-wide path between piles of everything from bicycles to television sets, fans, lights, hi-fi sets, countless plastic bags and boxes, and the hammock Mr Lee sleeps in. I asked if he was a karung guni man and he seemed to take offence. "My things all good quality," he retorted.

I bought two torchlights for $8 and that improved his mood. He even agreed to pose for photos, putting on a shirt and cap. "You will help me to advertise?" he asked.

Richard said as we left: "He is a bit eccentric, but harmless. My only worry is that he smokes in the flat and things might catch fire. And he drinks too."

By Day Four, I realised that most of the elderly at the centre are helpless, lonely and illiterate, and need help even for simple chores. The staff help to fill in forms, read letters, change light bulbs.

That week, I ran a bingo session, conducted a quiz flashing photos of landmarks to test their memory, joined in a dance class and morning exercises, visited and cleaned homes, checked blood pressure, pushed wheelchairs, and delivered food and medicine.

Programme assistant? I was a dialect-speaking jack-of-all-trades, just like everyone else.

Seniors activity centre? It was more a seniors services centre.

The brown box

I did not find the job tiring, but it became emotionally draining.

The frail elderly need a lot of care and attention. But those who are well want to be occupied and to be outside their flats with other people instead of being cooped up at home staring at the walls.

Julia said the staff have to draw the line and learn when not to get too close. "We don't give handphone numbers," she said. "There is an emergency system installed by the HDB which they can call if they need help, even at night."

But this is a job that demands a lot, especially as the seniors grow older, sick, more frail, and die.

One day I spotted a large brown box tucked away in a corner labelled "Last Office". It contained three sets of clothes: a white dress and two long-sleeved shirts.

Three people had left their clothes with the centre for safekeeping until their funerals.

"Their photographs are in our computers," said Julia. "We do this by special request. It is the last service we provide."

Death comes calling about twice a month - more than 90 have died since 2010. One in four is 80 or older.

On my last day, Betty spotted me slumped in a chair after we visited four homes and guessed it might all be getting to me.

"Let's take a break by getting out of the centre," she said. "We'll take Madam Koh to see her son."

She meant Madam Koh Ai Teng, the widow I had met on Day One.

Her 63-year-old son had been living in a nursing home near Moulmein for the past three years because of his diabetes and poor health. Madam Koh had not visited him all this time, but recently began saying she wanted to see him.

Taking seniors on such visits is not the job of the centre, but Betty, who is married with two grown-up children and a mother about Madam Koh's age, said: "I try to do these extra things where I can."

Madam Koh looked fresh and was dressed in a brown blouse and dark pants for her outing. I could smell the pleasant scent of talcum powder as she walked to my car, holding a paper bag tightly. I drove her and Betty to the nursing home,

We found her son lying in bed and as soon as Madam Koh saw him, she took out a packet of Khong Guan biscuits from her bag.

Her greeting to him was in Hokkien: "Are you hungry?"

He said: "Ma! You are here. How did you come?"

The old woman ran her fingers tenderly down his face, arms and legs, all the way to his feet.

"The skin is so rough," she said with a sigh.

His eyes welled up.

Hers too.

I stopped taking photos to leave mother and son alone and they spent over an hour speaking softly.

When it was time for us to leave, the son wheeled himself to the door, stood up unsteadily from his wheelchair, held on to the railings at the corridor and said: "Look Ma, I can stand, don't worry."

Madam Koh was silent on the ride back. But as soon as we reached the void deck of her block, she clasped my hand and Betty's for almost a minute.

"So sorry to have inconvenienced you," she said in Hokkien, and I understood every word. "Thank you for taking me to see my son."

I replied in Hokkien: "No need, no need."

And I looked away quickly, afraid they would see the tears in my eyes.

(The article above is posted here to raise awareness of the plight of the elderly not only in Singapore but also elsewhere. It is also a call for more volunteers to provide care for the elderly.)


If you would like to find out how you can help, go to http://www.touch.org.sg/touch_seniors_activity_centre