For the last two decades, SingHealth has been involved in various global health initiatives that are at different levels of maturity. Many existing collaborative programmes were initiated with the establishment of the SingHealth Duke-NUS Global Health Institute in 2018.

Against the backdrop of the burgeoning interest in global health programmes comes the launch of the Centre for Global Nursing (CGN). CGN emerges as a nexus for collaboration and joint research worldwide, and nurses are invited to be part of the journey to advance healthcare excellence on a global scale.

“The projects that we currently have gave us a very strong reason to ringfence all of them under one entity as CGN,” said Associate Professor Sabrina Koh, Head of CGN. With the pooling of resources and nursing expertise, the centre serves as a central body for curating and delivering bilateral nursing programmes for regional and international nurses.

CGN will build collaborative, long-term relationships to co-create meaningful, pragmatic and sustainable nursing solutions.

This opens opportunities for SingHealth nurses to make a difference beyond their local context, enriching their perspectives on different healthcare systems and the impact of the sociopolitical- cultural environment on health and the nursing workforce of the country. CGN will serve as platform to engage with nurses who are interested in international work. “With CGN, nurses have access to the world to make a difference with their knowledge and expertise,” said Sabrina. “They can bring the skills of patient care delivery that they have developed over the years and apply them in global settings, collaborating with our counterparts in the region to raise the standards of nursing care.”

CGN’s vision is to set up systems that are sustainable for the host countries to run and develop. “Our focus is on mutual empowerment and not just short-term, unidirectional learning,” said Sabrina.

The virtual centre will organise training programmes covering topics specific to global nursing. Cultural awareness elements will be embedded in different modules. For instance, in the areas of research and innovation co-development, participants will explore frugal innovation that is sustainable for the country.

Associate Professor Sabrina Koh, Head, Centre for Global Nursing;Deputy Director, Nursing, Sengkang General Hospital

By her second year of nursing studies, Sabrina knew that she wanted to be an educator. “I like education so much that I never once felt disheartened or regretted my choice. That’s something that I feel heartened about,” she said.

When she was undergoing clinical training as a student, Sabrina recalled that she wanted to see how anaphylaxis, a severe life-threatening allergic reaction, looked like. But, of course, there will never be an anaphylaxis case to study at leisure while the patient is in danger. “Simulation provides a realistic environment for learning without harm to the patient,” she said.

Simulation is one area that Sabrina’s team is helping to build capacity for a regional counterpart. They have created fellowship programmes that prepare trainers to design scenarios for students and conduct debriefing after the simulation exercise.

As an active simulationist, Sabrina’s education-related activities include developing and training in clinical workflows, patient safety, teamwork and communication. Another area of passion is simulation faculty development, which can cost up to US$2,000 for a three-day programme in the United States. Many nurses in the region cannot afford to attend these courses, so she volunteers in countries like India, Malaysia and China to deliver such courses.

“Through CGN, we now have a stronger base to build global partnerships and create programmes that build nursing capability and capacity, and strengthen health systems through education, research and innovation,” she affirmed.

Pham Thi Ngoc Anh, Institutional Global Nursing Lead, KK Women’s and Children’s Hospital Campus; Advanced Practice Nurse & Senior Nurse Clinician, KK Women’s and Children’s Hospital

Having worked as an oncology nurse for more than 19 years, Advanced Practice Nurse (APN) Pham Thi Ngoc Anh has been involved in numerous educational exchange programmes that support nursing education, with nurses from different parts of the world — including Vietnam, Myanmar and the Philippines — coming to Singapore for training.

Her journey in global nursing started in 2018. The University of California, San Francisco, worked with the Haematology/ Oncology Service at the KK Women’s and Children’s Hospital (KKH) — which it already had ties with — to develop a programme for training doctors and nurses to be implemented in Vietnam.

Appointed project lead for the nursing track, Anh, together with her American nursing counterparts, developed the educational programme for basic oncology nursing based on wellestablished global practices.

Initially, Anh used her personal time for this. Since the formalising of the global nursing framework, her supervisors have provided her dedicated time to pursue this project. She also translated the training materials into Vietnamese.

When COVID-19 struck, face-to-face training sessions went virtual, which has continued to this day, and is usually conducted once a month. 13 nurses from cancer centres across Vietnam attended the first training session; these virtual meetings are now attended by 100 to 200 nurses per session in Vietnam.

“It takes a lot of time and effort to build up this programme, but I am very happy with the progress that we’ve made. We are witnessing the difference that we have made for the Vietnamese nurses and patients as well,” said Anh.

To build something sustainable requires funding. The Singapore team has been assisting their Vietnamese counterparts to tap on non-governmental organisations (NGOs) for funding and supporting them to present their work at international conferences to increase their visibility. “I see myself more as a mentor nowadays. Instead of us doing the teaching, we redesigned our programme to schedule case-based presentations, which will be delivered by the Vietnam nurses,” shared Anh.

Anh came to Singapore at the age of 18 and took up nursing because she happened to see the course offered. She has stayed on because she finds meaning in her work. She also feels fortunate that new opportunities opened for her at the right time, allowing her to progress from being an inpatient nurse to a nurse specialising in childhood cancer, to an APN and, subsequently, a transplant nurse. “Every day, when I come to work, I see myself making a difference. That’s the most important thing because, no matter what, I know the meaning of what I’m doing,” she said.

Anh views global nursing as new and exciting. While a good day of work used to mean ensuring her patients were well taken care of and seeing them recover, she can now see patients beyond her care getting better, which drives her to do more. “As experienced nurses, it’s up to us to elevate the profession and take nursing care beyond Singapore. I am very confident that Singapore’s nursing standard is among the top in the world. It’s up to us to put Singapore on the healthcare map.”

Clinical Assistant Professor Ng Wai May, Cluster Global Nursing Liaison Person; Director of Nursing & Advanced Practice Nurse, National Neuroscience Institute 

When Clinical Assistant Professor Ng Wai May was approached by neurologist Professor Umapathi N Thirugnanam of the National Neuroscience Institute (NNI) for nursing volunteers to help build up neuroscience capacity and capability for medical workers, nurses and allied health professionals in Yangon, Myanmar, she was quick to sign up.

As the interest level was high, a team of similarly passionate colleagues was formed soon after. Not only were the team members willing to volunteer their time and expertise, they also decided to foot their own travel expenses and use their annual leave for the project trips in the early stages as there was no formal agreement for this initiative. “It’s really about the heart, as we see meaning in this project,” said Wai May.

This is just one of the global nursing projects that Wai May is actively involved in. Her current project is Project BRAIN – Building nuRses cApability In JaffNa. This project was inspired by Clinical Assistant Professor Jai Rao, who wanted to improve neurosurgery care in Jaffna Teaching Hospital. As part of their work in Jaffna, Sri Lanka, the team roped in a physiotherapist to develop videos on how caregivers can help to mobilise their loved ones to prevent complications and hasten recovery.

“Caring for patients is a team sport; it’s not just physician-focused or nursingfocused. This is interdisciplinary work that we are doing together to improve patient care,” added Wai May.

On-site needs assessment is crucial, Wai May noted, as conditions in different countries vary widely. In some cases, the training needs indicated by the partners were found to be unfeasible as the nursing care had to be strengthened first. In contrast, some other countries were quite advanced and sought support in innovation and research. “We need to cater to the different countries’ needs and work out an individualised plan for the specific country because infrastructures are different, resources are different, everything is different. We have to collaborate, innovate and work within their available resources,” said Wai May.

Witnessing vastly different patient care situations is also an educational experience for the visiting nurses, with abundant, bidirectional learning opportunities. Each country’s unique challenges present opportunities to develop innovative solutions. For example, thickeners and cans of milk are readily used in Singapore for patients who need tube feeding, but nurses in Sri Lanka use cow’s milk for tube feeding and yogurt for patients with dysphagia.

For Wai May and her teammates, it was very exciting to experience new things. “I love it because we start to see different perspectives. These countries have very enthusiastic nurses; I love their attitude, their can-do spirit,” she shared.

Apart from neuroscience training, other topics such as nasogastric tube feeding, tracheostomy care, and skincare are also very much of interest.

Plans are underway for the BRAIN project team to work with the University of Jaffna to develop short courses on stroke and head injury, which are two areas of need identified by the university’s Dean, Professor Surenthirakumaran, and Senior Nursing Lecturer, Jegapragash. The team is also working closely with partners at Jaffna Teaching Hospital, Professor Sathiya and Chief Nurse Malar. Team BRAIN will be training selected members of the Jaffna nursing team at both the university and teaching hospital to equip them with the essential skill set to train other nurses there.

Among the multiple hats she wears, Wai May is Co-Clinical Director of the SingHealth Duke-NUS Institute for Patient Safety & Quality. But global health is something that she will still make time for. “It’s the passion and the satisfaction, the love that you have, that will drive you to do work,” she said. “You don’t see it as work; you see it as really helping others.”

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