Building Ties Through International Collaboration

Hoe Pei Shan

It was a mission spanning four days, six surgeries, two clinics and half a dozen teaching lectures – one that touched numerous patients' lives, and forged invaluable connections between international colleagues-turned-friends.

In May 2023, five orthopaedic surgeons from Singapore General Hospital (SGH) embarked on a trip to the City of Batac, a rural area within the northern province of Ilocos Norte in the Philippines. They were part of an unprecedented collaboration between Singapore's oldest medical institution and the Filipino government-run Mariano Marcos Memorial Hospital and Medical Center (MMMH & MC). One of the mission's goals was the sharing of medical knowledge and skills, from pre-operative management to postoperative follow-up, that would be beneficial to both patients and medical staff.

Led by Dr Darren Tay and Prof Tay Boon Keng, the Singapore team and their Filipino counterparts spent months preparing to take on several complex joint replacement and foot and ankle cases. The surgeries were funded in part by two philanthropists – one from Singapore and the other from Ilocos Norte – as well as a sponsoring vendor of orthopaedic implants. The collaboration between the two hospitals was also supported by Ilocos Norte Governor Matthew Joseph Manotoc, City of Batac Mayor Albert Chua, and MMMH & MC Head of Department of Orthopedics, Dr Marjorie Sierra.

Stepping into a different clinical world

As the minibus of Singaporeans rolled up to MMMH & MC, men were seen lying asleep outside the gates to the outpatient clinic registration booth. Some of these patients had travelled days to get to the hospital – considered the most advanced in the province – and so would rather camp outside to wait for their subsequent appointments post-discharge than make the long commute back and forth. This was a glimpse into the grit of the Ilocanos people, many of whom were used to working under harsh elements in agriculture and putting up with the pain of injuries and degenerative conditions. By the time they sought medical help, it was not uncommon to have significant deterioration.

Conducting surgeries in foreign set-ups with fewer resources was challenging, but through detailed planning and teamwork, all six cases went smoothly. Two knees and two hips were replaced, a torn Achilles tendon repaired, and a deformed foot corrected – all without a single cent paid by the patients, thanks to the generosity of the operating teams and donors.

Teamwork makes the dream work

Closed-loop communication, mutual trust, respect and camaraderie enabled both Singaporean and Filipino colleagues to stay on the same page despite the differences in techniques, language and cultures. The OT became an avenue for picking up new skills and procedures, forging new mentorships and friendships. From medical students to senior surgeons, everyone was welcome to observe, learn and share.

The beauty of collaboration is that it is a two-way street, with potential synergistic effects for all involved. The SGH team, for instance, demonstrated a technique for minimally invasive Achilles tendon repair not often seen in MMMH & MC. Meanwhile, at the head of the table, a Filipino anaesthetist helped create a bloodless field by carefully maintaining a lower blood pressure, such that the team could operate without a tourniquet as is more commonly practised in Singapore.

There was also much to glean from the Filipino doctor-patient relationships and hospital culture that appeared less focused on defensive medicine and litigation, and more attuned to mutual gratitude and trust. Patients were eager to thank medical staff even when they were groggily emerging from anaesthesia, or lying in the sweltering heat of a small, crowded, non-air-conditioned ward.

Promising future of international exchanges

This was but the first chapter in what Dr Darren Tay hopes to be a multi-year, multi-disciplinary project. The eventual goal is for the various SGH departments to send teams of experts to similarly share in areas where MMMH & MC may have less experience with, while also learning from them how institutions with fewer resources can serve patients through innovation, creativity and versatility.

Dr Tay has already envisioned a two-year plan and is looking to rope in other surgeons, doctors as well as allied healthcare partners. Physiotherapists, for instance, are not as widely employed in MMMH & MC, and their emergency department did not have any emergency medicine specialists at the time of visiting, as the discipline is still new to the Philippines. Discussions have also been held to have more regular exchanges with doctors across other parts of Asia.

"It was a wonderful collaboration between our two hospitals, during which we experienced their generous hospitality at the MMMH & MC in Ilocos Norte, Philippines. I am happy to see that both sides were able to benefit from this platform that allowed us to have a fruitful exchange of ideas, practices and experiences. This has been a positive starting point for what we hope will develop into a robust and enduring exchange between our two institutions, widening our scope to encompass a broader spectrum of clinical, academic and administrative services." – Dr Darren Tay

The short but fruitful first mission has already shown the benefits of such cross-border exchanges, with both sides meeting initially as colleagues but departing as friends who have learnt much from each other. Their days were spent working hard together in the hospital and their nights were filled with lively discourse over dinner and supper stops at street food carts.

The Singaporean team left the City of Batac with their hearts full and their suitcases bursting with farewell gifts from their newfound Filipino friends. They had not only helped change the lives of their patients, but also touched a community that had welcomed them with open arms.

A grateful Dr Sierra said: "Altruism is recognising that there is a need to share resources, skills and knowledge beyond one's border, and that is what this mission is all about. The kindness and generosity extended by our friends at SGH has created a ripple of positive impact to the ones directly and indirectly benefitted by this mission–the patients, families and medical staff. We at MMMH & MC are looking forward to building a sustainable and mutually beneficial partnership with SGH in the years to come."

Prof Tay Boon Keng (front left) and Dr Darren Tay (front right) operating together with their MMMH & MC colleagues


OT nurses from both teams working together to prepare for surgeries

Hoe Pei Shan is a former Singapore national gymnast who first studied literature and was a journalist before pursuing medicine. Then a house officer (HO) at Singapore General Hospital Orthopaedics at the time of writing, she is interested in global health and was part of the Singapore team that flew to Ilocos Norte for this surgical mission. (She is currently a HO at Tan Tock Seng Hospital General Surgery!)