In Singapore, and just about anywhere else in the world, there’s a strong and persistent stigma attached to any kind of mental illness. And as patients and their family members struggle to understand and deal with the diagnosis and ensuing treatment of mental illness issues, compassionate, caring and committed nurses stand at the very front line of treatment.
The thought of going back to school was daunting, as Kugan never liked books very much and worried he’d be exposing himself to jeers from friends. But by that time he was pushing 30, and realised he needed a more stable and secure future.
“I was doing a lot of odd jobs when I was young. I was also quite temperamental, impatient and not gentle… and I thought that nursing was only for females… and what would my friends think?” Kugan smiles as he recounts the struggle he went through while at life’s crossroads.
That was 11 years ago, and Kugan – now a senior staff nurse (SSN) at the Institute of Mental Health (IHM) in Singapore – says pursuing a career in nursing was one decision he never regretted, because it changed his life.
“Nursing provided me structure and goals, and IMH is my second home. I’m happy where I am now,” he says.
The road less travelled
The eldest of two sons, Kugan was simply coasting along for most of his youth. After completing National Service, he took on various jobs: rubbish collector, cleaner, magazine deliveryman and dishwasher, later becoming a pest control officer and then working for a logistic firm.
“I had a lot of dream careers (in mind). I wanted to be an army officer. I wanted to become a flight steward,” says the 39-year-old Registered Mental Nurse. But those dreams did not quite pan out the way he imagined.
His mom, now retired, has dedicated more than 40 years of her life in the nursing service at the KK Women’s and Children’s Hospital. But Kugan insists that never in his wildest dreams did he imagine following in his mother’s footsteps. If anything, he witnessed the long hours she put in and presumed that all nurses are women.
Putting his preconceptions aside, Kugan was 28 when he took a two-year Enrolled Nurse Course at ITE East College in 2004 that was sponsored by IMH, Singapore’s first mental hospital with a comprehensive range of psychiatric, rehabilitative and counselling services for children, adolescents, adults and the elderly.
“I started enjoying the job towards the end of my ITE (programme). I learned a lot. When I saw patients who I needed to nurse… I realised these are the same as people in my house, like my late grandparents,” he says. “I slowly adapted and now I understand: if nurses don’t take of you, who will?”
A couple of years later, IMH provided him with an opportunity to pursue a Diploma in Nursing at Parkway School of Health – despite his less-than-ideal GPA (Grade Point Average) score. It was challenging but he persevered.
The experience Kugan gained during his clinical attachments in various hospitals while a student was invaluable. He was determined to improve himself, and after receiving his Diploma in Nursing in 2011 the IMH posted Kugan to its acute psychiatric ward, which became a pilot for the 40-bed Mood Disorder Unit (MDU) a year later. This unit specializes in the treatment of patients suffering from mood disorders and co-morbid anxiety disorders, depression, obsessive-compulsive disorder, bipolar disorders and stress and adjustment reactions.
Kugan feels gratified, even though caring for mental patients can often be challenging and unpredictable.
“When patients are not well, they can become very aggressive. They try to bully you and abuse you both physically and verbally,” he says of his early impressions on the job. “As time went by, I started to understand that these patients are not well and need help – that’s why they’re here. And when they got well, they come by for a visit, sometimes treat us to some snacks, and apologise to us (for their previous behaviour). They thank us for taking care of them. I feel very good when this happens.”
In 2013, Kugan was sponsored for an Advanced Diploma in the Mental Nursing Programme at Nanyang Polytechnic. After graduation, he was posted back to MDU. Last year, he completed the BCLS (Basic Cardiac Life Support) Instructor course. He describes himself as someone average in academics who “doesn’t like to study,” but Kugan has so far managed to finish three courses in less than 10 years.
The numerous professional upgrading courses have equipped him with the necessary knowledge and skills to manage mental patients. His job is challenging and can sometimes be emotionally draining.
“It’s natural,” he says. “Mentally ill patients are fragile and carry the stigma of being ‘different.’” And in many ways, Kugan also has to manage family members who feel miserable and helpless when they see their loved ones suffering.
“I feel sad and bad for them (both patient and family). As nurses, we need to educate them about the illness and dispel misconceptions about the stigma that’s attached to mental illness,” he says. “When we see them get through this period, when they’re able to go back to their lives, when they drop by (IMH) to show us their gratitude: that’s the most rewarding part of being a nurse.”
Kugan points out that other medical professionals, including doctors, respect nurses’ opinions. And there is plenty of room for improvement and expansion within the medical community, like going on further studies and participating in outreach programmes, all of which will help make you a better nurse.
“Doctors are willing to accept our ideas and suggestions because we’re the ones looking after a patient’s day-to-day health welfare. There’s a great improvement in team work,” says Kugan, who is currently pursuing a part-time Bachelor of Science (Nursing) degree with Queen Margaret University. It will be the fourth course he’s taken, and he hopes to graduate this year.
“Nursing is a good choice,” he says. “But whatever you do, don’t join nursing for the money or as an excuse to get a job overseas, because you’re dealing with human life.”
Personally, nursing has provided Kugan a solid grounding. Although his family teases him of still being “short tempered,” he insists he has more control over it now.
“That character is gone. I have not erupted in a very long time. My work changed me, and I have learned a lot from our patients,” Kugan says. “Some are very hot-tempered and aggressive, but I realise they have bigger problems than me… and I learn how to cope, too, from them.”
Outside the hospital wards, Kugan de-compresses by taking long and quiet walks, exploring places like parks where he can have some peace, and swimming.
“I’m more of a nature guy, and I love to travel. My wife and I are both nurses so we have busy schedules,” he says. “Whenever we have a chance to do a short trip together we take it, mostly to nearby countries, about six or seven short trips a year.”
Kugan met his Filipino wife Jocelyn, who is a staff nurse at Gleneagles Hospital Parkway’s Medical & Surgical Centre, while they were both doing their diploma studies in 2008. They’ve been married for four years.
Kugan’s is not a rags-to-riches tale. Rather it’s a turning-point story of a man who once did odd jobs for a living but made a choice to turn his life around: “It’s been 10 years since I started working here at IMH and I am enjoying it.”
But old habits die hard, and sometimes Kugan finds himself washing dishes, tidying up and throwing out rubbish at the hospital. He has no intention of forgetting where he came from.
Not all dreams come true. But even if they don’t, the ending could still be just as happy. Siti Suhana Abd Rahman once dreamt of becoming a teacher. Instead, she studied to be a nurse… and never looked back.
Siti has her persuasive mother to thank for nudging her to take this path. The obedient daughter, who has healthcare professionals among her relatives, certainly considers her career choice the correct one for her.
“My mother believes that nursing is a noble job, and she wanted to see one of her children in a medical profession. I was reluctant at first but I followed her wishes (and) enrolled in the School of Nursing at Singapore General Hospital, which used to be located near Singapore General Hospital, when I was 17,” recalls Siti, who is the second child and the only girl of four siblings.
She eventually fell so in love with nursing that she furthered her studies by taking advanced nursing diploma programmes.
“As a nurse I’m helping other people. I become an adviser, advocate, caregiver, a teacher to my patients… so I am able to do what I’ve always dreamed of,” says Siti, who is a Senior Staff Nurse II at the Acute Female Ward of the Institute of Mental Health (IMH) in Singapore, looking after patients aged 21 to 77.
Caring for mentally ill patients was not her first choice as a nurse but upon graduating in 2001 she was assigned to IMH. At that time, graduates were assigned postings based on their residential location.
“At first, I never thought I’d be working at IMH for long. But seeing the patients here, some without family care or support, made me think: ‘If we nurses don’t stay, who will take care of them?’ So I stayed, and mental healthcare became a field of interest,” Siti says.
Now, the 34-year-old finds so much fulfilment in her work: when patients and their family members lean on her for counsel and support.
“Despite the chaotic environment at times, it is a pleasant feeling when I am able to see patients walking out of the ward mentally stable. I feel satisfied when patients are able to recognise me after their discharge,” she smiles. “Some family members also appreciate the extra mile that I tried to do for them.”
People often forget that the patients had a normal life before they were diagnosed with mental disorder. They had a home, attended school and engaged in social activities. They have parents, many have spouses and children, some have pets. Siti looks at a patient as a person first, to help her understand them better. Her approach makes it easier to break down walls, and it works: patients open up and let her in.
“It’s when I talk to patients that I learn more about them, like the things they did or their interests. You see, I have seen some patients who were brought and just left here by their parents or by their children. They did not return to visit the patient,” she says. “Even when social workers try to reach the families, they couldn’t.”
Since she joined the Acute Female Ward in 2014, Siti’s work has revolved around the prevention, evaluation, diagnosis and treatment of mental and emotional disorders. Acute conditions include schizophrenia, bipolar disorder, depression, psychosis, personality disorders and self-harm (suicidal tendencies), among others.
“Acute patients in our ward may or may not respond to medication. If they’re still not responding to medication, doctors may suggest ECT (electroconvulsive therapy) when the patient’s family agrees. If they do well after ECT then they can be discharged.
“Some patients will forget their activity of daily living and will be referred to the rehabilitation ward, which provides a comprehensive programme to assist persons with severe and persistent mental illness. These persons have deficits in social functions due to their cognitive impairment. The recovery process focuses on their ability to use alternative strategies to cope with their illnesses, to maintain social relationships and to be gainfully employed,” says Siti, whose particular unit usually attends to about 43 patients.
In an ideal world, Siti would want to see patients recover so they can be discharged to their families and communities, or at least to a less restrictive environment like a home for the aged.
Outside work, the mother of three spends all her free time with her children (aged four, six and 11), her husband and her live-in mother. Once a year, the couple makes sure to go on a “honeymoon” trip to celebrate their wedding anniversary.
“Despite my shift hours, I always manage to be with my family,” she says. When her children fall ill, her nursing skills come in handy. “I know how to manage them. There’s no need for me to be anxious since I can monitor them and will know when it’s time to go to hospital.”
Siti applies the same tender loving care to her 61-year-old mother, who was diagnosed with autoimmune disease last year. For two years, she noticed her mom had become lethargic and was losing weight. Siti brought her to see a few doctors, but none of them could diagnose what was wrong.
It took one year, during which Siti’s mother developed hyperpigmentation on her face and body, to finally pinpoint that she had an autoimmune disease. (If you have an autoimmune disease, your immune system attacks healthy cells in your body by mistake; it can affect almost any part of the body, and no one is sure exactly what causes autoimmune diseases.)
It’s a wise choice to go into the nursing profession, Siti advises, but you must maintain a balanced work-life. Between taking care of her patients and her family, Siti doesn’t have much time left for herself. But she says she doesn’t mind, and enjoys catching up with friends via social media.
“My husband and my mother are my best friends,” she says. “And my indulgences are my kids.”
Looking back, she doesn’t regret following her mother’s wishes. She may have not achieved her dream of becoming a teacher, but she certainly fulfilled her mother’s wish to have at least one child in in the medical profession.
“I feel blessed to have a mother like her, who pushed me to be a nurse,” says Siti, her voice trailing off as she tries to hold back the happy tears.
This article first appeared on ‘Yahoo News’ on 22 March 2016.