She loved her work as an emergency physician in one of the busiest emergency departments in Singapore. But in 2022, Dr Tiah Ling left her stable consultant job at Changi General Hospital to pursue a nomadic life of providing healthcare in various low-resource areas, prepared to hop from passion project to passion project while earning a fraction of her then specialist pay.
"Although I have enjoyed a satisfying career in emergency medicine (EM) with very supportive bosses and colleagues, there are other things I have always wanted to pursue, and I realised I might regret not giving myself the chance to try them," said Dr Tiah. "As my 50th birthday approached, I saw it as a good time for me to 'step off the train' and pause after spending nearly 20 years working within institutional settings. This pause would hopefully allow me to reassess my priorities and decide how I want to move forward in the next chapter of my life."
She had no fixed destination when she left and chanced upon a job opening soon after that brought her to Mae Sot, a Thai town at the Myanmar border. Having been there since mid-2023, Dr Tiah is currently the technical consultant for an upcoming emergency care unit (ECU) under the Mae Tao Clinic (MTC), a community-based organisation that has served the migrant community and displaced populations for more than 30 years.
She rents a single room in an apartment shared by several other international staff and volunteers at MTC, getting around on foot or driving a beaten jeep lent to her by MTC founder and director Dr Cynthia Maung, a pioneer Burmese physician. It is not uncommon to hear gunfire around Mae Sot, particularly closer to the Moei River separating Mae Sot from Myawaddy, Myanmar, where the strains of Burmese civil unrest remain.
"Most were surprised that I had left institutional practice without any concrete plans, but they were largely supportive of my decision. I think when I shared about the longer-term deployment at MTC in Mae Sot, they were naturally concerned about security and general living conditions since the town is along the Thailand-Myanmar border and sounded quite ulu (Malay for remote)," said Dr Tiah.
Venturing into global health
Dr Tiah's foray into global healthcare began as a junior EM trainee when she joined a medical mission to Malang, Indonesia, helping to develop a new system of triage and EM at Dr Saiful Anwar Hospital and launch an entirely new ambulance service.
"It illustrated to me vividly that optimising patient care goes beyond clinical work," said Dr Tiah. "A well-functioning healthcare system that serves patients optimally requires multiple sectors working together with multi-pronged approaches. Medical expertise is just one piece of the bigger picture in improving health outcomes."
She went on to further hone her knowledge and skills in humanitarian aid and development assistance through the International Emergency Medicine Fellowship programme at Johns Hopkins Bloomberg School of Public Health. Armed with a Master of Public Health degree, Dr Tiah took on a variety of fieldwork spanning Africa and Asia between 2009 and 2010, including helping to strengthen emergency care delivery at a district hospital in Ghana.
Subsequently in 2014 and 2015, she was a facilitator in a hospital management training workshop in Afghanistan, and a consultant for the joint World Health Organization-International Labour Organisation Project in Lao People's Democratic Republic. In the latter role, she designed and implemented quality assurance mechanisms to support the establishment of the National Health Insurance Scheme in the Vang Vieng district, Laos.
Dr Tiah noted that global health bridges service delivery, education, research, innovation, capacity building, policy development and programme implementation, and hence she found it valuable to build relevant skills and experience in these fields.
"Time commitment is another prac¬tical consideration. For professionals in Singapore, short stints of one to two weeks for on-site support with potential follow-up visits are often more feasible," she added. "Regardless of the nature of the projects, essential 'soft' skills include strong work ethics, effective communication, adaptability, resourcefulness, and the ability to work independently."
Singapore's support for refugee healthcare at MTC
Since 2023, healthcare professionals from Singapore have been supporting MTC. The clinic provided over 100,000 consultations in 2023, more than twice the number in 2021, as the community of displaced persons grew after a political coup. The clinic is only staffed with ten doctors, mostly from Myanmar, and relies heavily on medics and nursing aides who have not gone through formal medical training.
The clinic provides and facilitates life saving procedures, active surveillance of communicable diseases, and helps ensure adequate nutritional needs and food safety for its patients. In recent years, the clinic has seen an increase in war casualties, emergency obstetric cases, incidence of malaria and patients in need of continued HIV treatment. In early 2023, MTC identified the need for an ECU to support their 200-bed inpatient and outpatient departments.
Around that time, former Singapore ambassador to Myanmar Mr Robert Chua and Prof Tay Boon Keng of the Singapore Health Services (SingHealth) International Collaboration Office came up with an initiative to provide support from Singapore for MTC's needs, which Dr Tiah described as "pivotal".
Working together with a team led by Singapore General Hospital's Prof Venkataraman Anantharaman, Singapore collaborators have provided valuable input for the design of the new ECU space, scheduled to open in 2025. The team is also helping to develop a structured ultrasound curriculum for emergency contexts and contributing to refining clinical workflows. Ultrasound is a crucial diagnostic and procedural tool in resource-strapped MTC, where the only other imaging device available is a small tabletop unit donated by a veterinary service, which was designed to take X-ray scans of animals but is being used to image small human fractures and locate foreign bodies in trauma cases.
Simultaneously, Prof Tay started an orthopaedic programme to deliver free injectables targeting joint and tissue degeneration, and has been working with industry partners and philanthropists to help raise money and to donate supplies to MTC. Prof Tay has also been in discussion with Mae Sot General Hospital, the nearest Thai public hospital to MTC, on their support for border health issues.
Another aspect of healthcare in MTC that the Singapore team is assisting with is nursing. Prof Lim Swee Hia, Senior Director of Special Projects and the former Group Director of Nursing at SingHealth, led the designing and inauguration of a Bachelor of Nursing Science programme that started training its first batch of students in 2023.
A continuing journey
For the immediate future, Dr Tiah Liang remains committed to the MTC ECU project till at least 2026, and is focused on designing and setting up a dedicated space for delivering emergency care services for the displaced community. It has been a journey filled with challenges and a "steep learning curve" navigating unique sociopolitical dynamics along the border.
Beyond that, Dr Tiah has "no concrete plans yet" but knows where her heart lies, saying that she "hope(s) to continue contributing to regional development work, particularly in strengthening border health services."
Dr Tiah Ling, pictured outside the consult and ultrasound imaging rooms of Mae Tao Clinic