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    " Undersea & Hyperbaric Medicine "

Untested trail

Joining the SAF and the Navy was an important milestone decision – I had to forgo the tried-and- tested route of mainstream clinical specialty training in the hospital (at least for the initial years) and embark on a somewhat untested trail. However, with the support of my wife, family and some friends, I decided to do what my heart has always told me to do – to serve my nation beyond National Service liability.

At the onset, the SAF offered a dual specialty career ie. a military operational medicine specialty (I opted for undersea & hyperbaric medicine) and a mainstream clinical specialty to complement our military training. The programme is arranged such that there is built-in flexibility to cater to the needs of individual as well as the organisation. At the organisational level, trainees are expected to undergo training in their respective fields of operational medicine during the first three years. At a later time, they will continue their hospital training in a chosen mainstream clinical specialty.


First-hand experience

Undersea medicine comprises diving and submarine medicine, and deals with the physiological and operational aspects of medicine and human performance in the high-pressure underwater milieu. One of the challenges in the course of training is to experience first-hand the working conditions in the operational environment.

As a trained diver, I was able to better understand the needs of our naval divers and the physiological and psychological demands of their occupation. Unlike recreational divers, military divers do not have a choice on where to dive. A good example is the search and rescue/recovery mission for the SilkAir MI 185 air crash off Palembang into the Musi River in December 1997. Biological hazards, poor visibility and unforgiving underwater conditions were some of the common problems encountered.

With the recent acquisition of submarines, the medical support for our submariners in training and operations has opened up a whole new dimension of medical practice. Good medical fitness and mental endurance are required as working in a submarine environment under less-than-optimal conditions with limited personal space can be a potential source of stress especially during prolonged periods of operations.

Both divers and submariners are highly trained personnel working under exacting environmental conditions, it is therefore essential that the health needs of these servicemen are well taken care of to optimise their operational capabilities. Our concern starts with the selection of these men to ensure that only those with a high level of medical fitness are enrolled. After recruitment, the training of these personnel frequently involves high-risk activities and it is important that they remain in good health to undergo such strenuous training. The working environment and training methods are also closely monitored to avoid unnecessary injuries.


Developing directives

An important part of our work involves the development and revision of safety/training directives and medical support doctrines to better support our operational forces during peacetime training and in war. Conduct and participation in operational or medical exercises further sharpen our situational awareness in managing the constraints imposed by naval battles.


Hyperbaric medicine

In our Naval Medicine & Hyperbaric Centre (NMHC), the practice of hyperbaric medicine involves the application of hyperbaric oxygen therapy as an adjunctive treatment modality in the management of clinical conditions such as chronic non-healing wounds, osteoradionecrosis, refractory chronic osteomyelitis, and many other medical conditions approved by the Undersea & Hyperbaric Medical Society (UHMS, based in United States). Many years of research and clinical trials have proven the value of adjunctive hyperbaric oxygen therapy in obtaining better clinical outcomes when used judiciously under the care of trained physicians.


Operational medicine

The rationale of starting our career with operational medicine and training revolves around the need to immerse ourselves in the military environment at an early stage and have a firm understanding of the issues at hand. It is also thought that it will be easier for us to undergo the various strenuous military and physical training when we are relatively young. Part of our training is done overseas. For myself, I underwent the United States Navy (USN) programme for their undersea medical officers and several other related courses and conferences in diving and hyperbaric medicine. The Swedish submarine escape training which I completed last year and a training stint onboard a USN fast-attack submarine earlier this year were the other highlights.

In our career, there are more than adequate opportunities for us to learn and be exposed to new ideas and foreign cultures. Through our work and interaction with foreign military personnel during exercises or while on course, I have come to see things in a much broader perspective and view diversity as a complement and strength. The job also demands that we acquire both leadership and management skills, to be an effective leader and manager. This, in turn, has contributed positively to my overall development as a clinician, a manager and a military officer.


Not a bed of roses

Like all jobs, this one is not a bed of roses. Problems and crises do occur periodically. Taken positively, this enhances our skills in problem-solving and crisis-management and we emerge from it stronger. In addition, this also provides good operational training as such occurrences are not uncommon in the battlefield.

As I come towards the end of my first three years training, I look back with fond memories and great satisfaction. There were trying times as the physical demands and mental stress can be daunting and the task at hand sometimes may seem insurmountable. Thankfully, there are always seniors and colleagues to lend a helping hand and give valuable advice. The Navy family culture has also made the working experience much more pleasant.


A calling too

Just like practising medicine itself, serving in the military should be a calling, with the commitment to safeguard our future and that of our children. The main drawback of this system (if any) is the delay in completing my mainstream clinical specialty training. This may not be a significant issue as the organisation does make provisions for us to complete our clinical specialty training. Recognition from our peers may be hard to come by as they may not fully understand our training requirements and commitment to the organisation and national defence. Financial remuneration is also not as lucrative as that of our colleagues in private practice.


Give it some serious thought

At the end of the day, one has to be honest with himself and understand his station in life and most importantly, be at peace with himself in whatever he is doing, be it career, family or friends. For those of you who are thinking of joining us or have not decided on your career path, do sit back and give military career some serious thought. Like most clinical specialties, this may not be everybody’s cup of tea, but for those who dared, it will be a challenging, balanced and rewarding career.


CPT (Dr) Kang is a regular SAF doctor. He joined the SAF in Jan 96
and is currently in the Moic Submarine Medicine branch in Sembawang Naval Base.
His specialty is Undersea and Hyperbaric Medicine