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 It is therefore essential for us to work closely with top overseas medical centres, and to learn from them in order to stay abreast of new medical knowledge and advances. 


It is with great pleasure that I warmly welcome all of you to this, the tenth Ministry of Health – Cleveland Clinic Foundation Update. To our three guests from the Cleveland Clinic, Cleveland Ohio, I hope you have found during your few days here that it is not just our weather that is warm, but that Singaporeans are equally warm too. 

More than 10 years have passed since the signing of the Memorandum of Understanding between the Ministry of Health and the Cleveland Clinic Foundation. Both parties recognise the importance of excellence in the pursuit of academic and clinical education, in research and in the delivery of patient care. My Ministry is of course committed to achieving this in Singapore. We are therefore very fortunate and grateful, that we have in this endeavour, a partner in the Cleveland Clinic Foundation. 

Our relationship with the Cleveland Clinic started way before the signing of the MOU. In 1980, Dr Floyd Loop, now the Chairman, Board of Governors and Executive Vice-President of Cleveland Clinic, visited Singapore together with a Cardiologist and Cardiac Anaesthetist. The purpose of their visit was to help us set up our Department of Cardiothoracic Surgery. Today, 17 years on, the Ministry of Health is host again to experts in Cardiology & Cardiothoracic Surgery. 

Since the MOU was signed, 49 Cleveland Clinic doctors have been to Singapore. They helped develop medical education programmes, conducted lectures and courses and demonstrated new skills. Over the last decade, we also had annual updates like this, and today, we celebrate the 10th Update. 

Just as these Cleveland Clinic doctors have come to know us, our practice, our society, our people, so too, many of us have been privileged to be visitors at the Cleveland Clinic for short and for long periods. The Ministry has sent 43 doctors, 31 nurses and 2 paramedical staff for training at the Cleveland Clinic. I would like to place on record our gratitude to the Cleveland Clinic Foundation for the tremendous help in the training of our doctors and nurses both here in Singapore and at Cleveland. 

My Ministry places very great importance on continuing ties with overseas medical centres. As a small country, Singapore does not have the resources to stay at the cutting edge in all fields of endeavour, be it in science, engineering or medicine. It is therefore essential for us to work closely with top overseas medical centres, and to learn from them in order to stay abreast of new medical knowledge and advances. This will enable us to provide excellent medical services to our people and to remain ahead of regional competition. 

The population in Singapore is fast greying. This will lead to a consequent rise in cardiovascular diseases, affecting both the heart and the brain. Unfortunately, we also have a high prevalence of diabetes at 8.6% and of hypertension at 13.6% in Singapore, and this contributes significantly to cardiovascular disease. The picture of amputations done on diabetic patients over the 5-year period from 1991 to 1995 is indeed a gloomy one. Lower limb amputations rose from 262 in 1991 to 352 in 1995; single toe amputations from 191 to 230 and multiple toe amputations from 32 to 65. 

In matters of the heart, we seem to fare no better. Age specific incidence rates for acute myo-cardial infarct among Singaporeans aged 20 to 64 years rose from 76 per 100,000 in 1988 to 79 in 1992 before decreasinq to 71 in 1994. 

Males fared worse than females, 115 per 100,000 compared to 26.4 in 1994. Among the different ethnic groups, the Indians fared worse than the Chinese and the Malays. 

The Ministry is sparing no effort in combating these diseases. This is particularly important, because an ageing population will surely increase these rates. But the impact of our Healthy Lifestyle Programme will take some years to be felt. Consequently, coronary heart disease and other cardiovascular disease will continue to remain a major health concern. 

It is towards this aim of strengthening our medical service for the prevention and treatment of heart diseases that my Ministry set up an 11-Member Committee chaired by Dr Charles Toh, an eminent Cardiologist, to review the policy direction for the development Cardiology and Cardiothoracic Surgery in Singapore. 

The Committee has submitted its report. The two main recommendations of the Committee are: 
       Firstly, that the present Ambulatory Heart Centre should be upgraded and expanded to a comprehensive Heart Centre, including inpatient, operating theatre and outpatient facilities. Secondly, that a Coordinating Committee, consisting of representatives from the Heart Centre, the University and the private sector, be formed to advise the Ministry on the directions and development of Cardiology and Cardiac Surgery, and to co-ordinate the development of such facilities, as well as educational and research programmes. 

My Ministry has accepted their recommendations. 

Our 3 guests today from the Cleveland Clinic Foundation have been here this past week interacting with our staff. I hope that our clinicians have taken full advantage of the team’s stay here to learn about the recent advances that have been made in their fields of medical expertise. 

At the same time, it is also important for our clinicians to analyse and understand the cost effectiveness of new procedures or treatment regimes. This will then enable us to stretch our limited funds while providing Singaporeans with an affordable, high level of medical care. 

0ur affiliation with the Cleveland Clinic Foundation has helped us reach where we are today. I thank Cleveland Clinic for all its support and assistance, and l look forward to continuing this partnership with them in the years ahead. With that, it is now my pleasure to declare the 10th Ministry of Health – Cleveland Clinic Foundation Update open.