Skip Ribbon Commands
Skip to main content

Healing the community beyond the hospital

Changi General Hospital’s (CGH) Correctional Health care team provides a unique side of healthcare for inmates.

Dr Poon Beng Hoong, Senior
Consultant and Director,
Department of Correctional
Health, CGH

Since 2022, CGH has been developing expertise in correctional medicine and providing quality primary and specialist care to inmates in prison, in partnership with SingHealth Polyclinics and the Singapore Prison Service (SPS). A dedicated, multi-disciplinary care team consisting of doctors, nurses, allied health professionals and administrative and operations staff from various fields oversees the holistic healthcare delivery to inmates based on their healthcare needs.

In providing the continuity of care for those who need medical care after their release, inmates are referred to CGH’s specialist outpatient clinics for follow-up treatment. “The provision of correctional health differs from that of our general population as it involves security and social-economic factors,” says Dr Poon Beng Hoong, Senior Consultant and Director, Department of Correctional Health, CGH. “As effective reintegration into society requires good health, CGH’s correctional medicine programme aims to professionalise the practice, achieve evidence-based and quality care, and helps ensure the continuity of care post-release.”

Living healthier lives

A specialist in the areas of gastrointestinal and liver conditions, Clinical Assistant Professor Eugene Wong from the CGH Department of Gastroenterology and Hepatology is part of the CGH team that cares for inmates with gastrointestinal and liver diseases. Some of the more common conditions among inmates include hepatitis C and liver cirrhosis, but they are often asymptomatic. If not treated, these patients may develop liver cirrhosis, liver cancer, vomit blood (variceal bleeding), confusion (hepatic encephalopathy) or water accumulation in the belly (ascites).

Clinical Assistant Professor Eugene Wong provides care for inmates with gastrointestinal and liver diseases at CGH.

The quality of care provided to inmates is no different from others. Inmates who require more specialised care will receive the treatment required, and when other subspecialties are involved, Clin Asst Prof Wong works closely with the SPS and other care team members to ensure inmates receive the care they require for complex conditions.

“Trust is a very important element in the doctor-patient relationship to achieve the best outcomes for these patients. Physicians generally have no direct access to inmates’ family members. This may pose a challenge when we need to manage patients with terminal illnesses, such as advanced-stage liver cancer,” shares Clin Asst Prof Wong. “Our role as physicians is to always advocate for the best interests of our patients.”

Clin Asst Prof Wong and the CGH care team focus on improving the health of the inmates, with the aim of subsequent rehabilitation to facilitate the reintegration of these patients into society. “For many inmates, being in prison is temporary. After they are released, they become another one of our patients in the community setting,” says Clin Asst Prof Wong. “It is heartening to learn that many of our patients are integrating well into society, as they continue to follow up on treatment with us after their release. Most inmates are appreciative of the medical care we provide because there is an understanding that we are there to help them.”

Senior Nurse Manager
Jeremy Sng provides care
for inmates at Changi Prison.
(Photo: Singapore Prison Service)

Nursing inmates to better health

As a Correctional Health nurse, Senior Nurse Manager Jeremy Sng goes to the Changi Prison Complex daily to provide medical care for the inmates. “I oversee the day-to-day nursing operations at the Changi Prison Complex to ensure that the inmates receive quality medical care for their conditions, which range from psychiatric conditions to chronic diseases, such as hypertension and diabetes, and heart conditions,” he explains.

Mr Sng also plays a key role in the planning, development and implementation of operational policies and procedures to provide holistic and coordinated care for patients in a correctional health setting. This includes revising medical standard operating procedures for various conditions, and implementing them appropriately on the ground. Mr Sng also carries out ward rounds at the medical centres and assists with consultation services at the prison clinics. These provide him with clearer visibility of ongoing clinical operations, allowing him to allocate available resources optimally.

In this unique care setting, there is a need to balance caring for the inmates with the need to follow security protocols. “We need to have mental resilience and be able to think quickly in order to swiftly adapt to the dynamic nature of the work,” says Mr Sng. “As correctional health nurses, we are trained in diverse skillsets to identify issues, handle challenging situations, and provide nursing care to inmates with complex medical conditions.”

There have been occasions when Mr Sng and his colleagues faced inmates who exhibited reactive or aggressive behaviour. “In such instances, we remain professional while showing empathy and respect to the inmates,” he shares. Despite these unique challenges, Mr Sng recognises that the inmates deserve the same amount of respect as any other patient. “It has been a rewarding journey alongside our inmates, as we provide care for them to help them integrate back into society with good health,” he says.

Dr Chew Zhihong, Consultant,
Department of Orthopaedic
Surgery, CGH

Leveraging telehealth for continued care

The pandemic has accelerated the hospital’s use of telehealth to provide care for patients from the hospital to the community. These are offered across a range of medical services — one of which is teleconsultation sessions for inmates, which are conducted by CGH Departments of Orthopaedic Surgery, Respiratory and Critical Care Medicine and Otolaryngology — Head and Neck Surgery (ENT).

CGH began planning for teleconsultation sessions for inmates in the first quarter of 2021. This was partly driven by the COVID-19 pandemic, which made physical clinic visits challenging. Since then, the CGH Department of Orthopaedic Surgery has provided teleconsultation sessions for close to a hundred inmates. “Teleconsultation has brought about increased efficiency with the eliminated need to transport the patients physically to and from the hospital,” says Dr Chew Zhihong, Consultant, Department of Orthopaedic Surgery, CGH.

Teleconsultations are conducted similarly to physical consultations — clinicians record a patient’s clinical history, identify the problems affecting patients and go through the results of clinical investigations performed at a previous visit, Dr Chew adds. “There is a specific set of inclusion criteria to determine which patients are suitable candidates for teleconsultation, but all first-visit consultations are conducted in-person as the clinicians need to perform a complete physical examination of the patient.”

CGH’s doctors carry out teleconsultation sessions for inmates. (Photo: Singapore Prison Service)

Prescriptions are written electronically just like in a physical clinic and mechanisms are in place to ensure patients receive their medication prescribed via teleconsultation. If there are any new developments in the inmates’ conditions, new clinical complaints, or if the condition requires surgery or further investigations, the clinicians will assess accordingly and conduct a physical consultation instead.

“Most inmates appear to be receptive to teleconsultation,” says Dr Chew. “Teleconsultation sessions are more light-hearted, and the patients appear to be more willing to share their troubles with our doctors. Once, an inmate remarked to me that our teleconsultation session felt like a tele-visit session from a friend!”

Healing the community beyond the hospital