Tuesday started off slow with an “anti-jet lag” massage and an early lunch of satay, then off to deliver Part II of my dementia talk to a largely similar group of 200 health professionals from all care environments.
I was honored by the presence of Marie-Louise Ansak, founder of On Lok, the premiere PACE program in America, in 1970s San Francisco.
After officially retiring from the work, Marie-Louise began sailing her boat around the Pacific, finally tying up at Sentosa Cove here in S’pore, and registering her craft as the “S. V. Dessert First”.
At 82 she swims and reads daily, and often attends medical talks as well. She is also mentoring the Tsao folks on the ins and outs of starting a PACE program here. She’s using a cane, due to a “bad knee”, but feels that the lack of flexion that would result from a replacement would make living on the boat too much trouble to bother with, so she makes do. Wai Chong told me she still scuba dives, inspects the hull for damage, and can make welding repairs. She sails periodically, with the aid of professional or volunteer crews.
Marie-Louise felt my talk was very sympatico, and that many of my principles could easily be applied to older people without dementia as well.
Then, after dropping Marie-Louise at the Metro station, Wai Chong, Mala and I drove across to the north, arriving at the newly opened Khoo Teck Puat hospital, for a tour of the geriatric ward and outpatient clinic by Dr. Philip Yap and members of his medical and nursing team.
While retaining some of the institutional trappings of rows of beds in large wards (in the publicly funded section), there was a spacious and clean feel to the wards nevertheless and the nursing staff wore a warm, calm demeanor. There was much use of landscaping, including a lazy river through a small park area, and lots of terraces and rooftops growing various flora.
The outpatient clinic is state-of-the-art, with many rooms and facilities designed with the particular needs and limitations of the elders in mind. There is a first rate urodynamic lab, and a great PT/OT section with a dynamic balance machine to combat unsteady gaits and falls. How successful has this S$100K machine been found to be, and can people with dementia implicitly learn better balance after standing on the machine for several sessions? The jury’s not totally in yet.
Dr. Yap has been using my book in a reading circle, and thrilled me by ranking it with Kitwood’s tome as essential reading in dementia. He is also a champion of person-directed care and sent a staff member to Denver for June’s Eden Alternative International Conference.
I had a lovely discussion with the medical team, who were all watching an Eden video when we arrived, (How cool is that??) He is very interested in bringing Eden principles to the acute care and outpatient settings, as well as helping champion any local nursing homes that would be keen to try it. (More job security and good eats for Al down the road…?)
We had a good discussion of first steps for a transforming organization: a leadership retreat to assess and work toward leadership buy-in, and I introduced Joe Kenney’s Change Readiness curve with all its lessons and implications. We also talked about aging in community and our Community Green House Project plans (which continue to move forward).
Finally, I emphasized that culture change is rarely a shift in staffing ratios, but rather a new way of harnessing the strengths the organization has. I reminded them that if the staff of a care environment continue to see people living with dementia as tragic, broken people, incapable of meaningful contribution to the community, and if they disempower the elders, view their distress as a “problem behavior”, and ignore unmet needs in favor of adding psychotropic drugs, then you could have 1:1 staffing and still not improve the care. After some curried buns, wonderful jasmine iced tea and some gifts from the hospital staff, I came back to my hotel with Jenny (Tsao Foundation’s Marketing guru), to connect with well-respected journalist Radha Basu of Singapore’s Straits Times. Ms. Basu is preparing a large supplement article for early October on long-term care trends in Singapore, and possible solutions to the aging trends they see. Ill post the article when it arrives.
After the interview, I decided to recognize the month-long Taiwanese festival around the river in a special way. I remembered that Singapore is the home of what Anthony Bourdain boldly proclaimed to be the best dumplings and steamed buns anywhere in the world – at the renowned Din Tai Fung on Orchard Road. Being such a toursity area (see below), I went up there to test the hype, fully expecting (1) high prices (2) mile-long queues (3) overrated dumplings and (4) a tourist hell. Luckily for me, Dun Tai Fung failed to disappoint on all four fronts.
There was only a 5-minute wait for a nice table where I could see all the action. The food, promptly prepared, was exceptional. Best in the world? I couldn’t judge that, but by far the best ones I have tasted.
I had 6 steamed crab dumplings, which had pasta so soft it drooped when you hoisted it with the chopsticks, like a fabric purse. The explosion of buttery crab and herbs when you plop them into your mouth is a true joy to behold. Not fishy–perfectly balanced flavors.
I chased those half dozen dumplings with jasmine tea and then received two large steamed pork buns: a marinated chunk of seasoned pork (lots of ginger) inside a slightly sweet, also soft but “cakier” mix, to which I added soy sauce, julienned ginger strips and just enough hot pepper oil to keep my lips burning after the meal ended. It too was delectable.
As for my fears of a “tourist hell”, nearly everyone I could see outside of my table was speaking a Chinese dialect. The only “gringo” I spied appeared to have a Taiwanese boyfriend in tow. And the total price for 6 of the best dumplings and 2 of the best pork buns I’ve ever eaten (with tea, tax and tip)? Just under US$12.
Many travelers extol the cities where they spot the most beautiful and glamorous women, strolling the boulevards while dressed to the nines. I am sure many cities delight, but Orchard Road in S’pore must be on that list somewhere near the top. During the day it is packed, primarily with women who are either professionals or professional shoppers, hitting the likes of D&G and Gucci. As the evening wears on, the composition starts to shift toward, well…a different kind of professional woman.
Not that you can tell at first blush. Cheap and tacky clothing appears to be illegal around here. Black mini-dresses are mostly the uniform of Orchard Road. About the only way one can tell the difference among the parade of beauties is to see what happens if you manage any brief eye contact with one. A warm smile and a hello in return means the hook is being set. The regular shoppers are all too cool to acknowledge the growing ranks of guys that come out in the evening to gawk. (sorry folks, no photos this evening…)
It’s a strange mix of class and kitsch, with a Louis Vuitton store right across the street from “House of Condom”.
Those who know about such things say that those beautiful women can be very deceptive, and that if you find yourself getting into a round of serious fee negotiations, it pays to move in close enough to notice whether an Adam’s apple is visible on “her” slender neck, or else you might buy your own personal “Crying Game”…
I would have enjoyed watching the show as it got more colorful in later hours, but with a long Wednesday ahead, hot pepper oil remnants on my lips and a satisfied belly, I headed back to the MRT station, have filled my quota of buns for the night…