Expatriate Health: More Than Medicine

Relocating to a new country means learning the local culture and parlance and settling into a new home, schools and lifestyle. But when it comes to the family’s overall health finding a good doctor and dentist is more than about medical care. It goes beyond the merely curative to the forming of community and connections.

Moving to Singapore is an exciting prospect for many expatriate families. But it can also be quite an upheaval to daily life and routines. Often, securing placement for children in school, getting familiar with the neighbourhood’s supermarkets and eating places form an important anchor. Just as essential is finding a family doctor and dentist to ensure everyone in the family keeps healthy.

Dr Roger Pang at The Ming Clinic has seen to the medical and healthcare needs of countless families – both local and expatriate – for over 35 years. A good number of patients are from overseas, including a large proportion from the diplomatic service. Usually patients live in Holland Road, Farrer Road and other city-fringe areas, so there is a “good catchment” for the clinic at Camden Medical.

He noted a growing trend of female expatriates where the husband is the ‘trailing spouse’ and takes on more family duties. Regardless, the needs of the expatriate community have not changed, he said. Apart from coughs and colds, fevers and flus, the practice also sees to other preventive health checks and procedures.

Vaccinations, for instance, are an important aspect of moving to Singapore and a requirement for a dependant’s pass. Diphtheria and measles vaccination are mandated by law. In addition, a child must have BCG, pertussis, tetanus, poliomyelitis, mumps, rubella and hepatitis B jabs to register for a Singapore primary school. “We often help families with the paperwork even before they arrive in Singapore,” Dr Tan Hooi Hwa, also of The Ming Clinic, said. Although Singapore is generally safe, infectious tropical diseases still exist and are prevalent in the region. “Vaccination is just as important as air-tickets and accommodation.” This is especially important in light of the large amounts of travel that people do, whether for work, for school trips or when heading for overseas university.

The Ming Clinic also undertakes a lot more preventive health efforts. “Expatriates are especially conscientious about annual screening,” Dr Pang shared, “A large number also send their helpers in for additional health checks apart from the ones required by the Ministry of Manpower.” Beyond screening for diabetes, cholesterol and blood pressure, they have recently introduced colorectal screening (Colonoscopy) that can be done conveniently within the clinic by a colo-rectal surgeon. The clinic has been renovated and approved by MOH for such procedures to be done.

Screening efforts, Dr Pang explained, are not the only way to pick up diseases and monitor health. “As family physicians, we built a relationship with patients over time.” Especially for expatriates, this forms an important connection. Often, they ask about local quirks. One of the most common, Dr Pang said, is the notion of ‘heaty’ and ‘cooling’ foods, a concept rooted in traditional Chinese Medicine. These seemingly inconsequential questions and conversations can actually become important. “When patients are comfortable, they will open up. Sometimes they mention something which they think is trivial but we might take note of because it could significant.” Dr Pang himself has urged further investigations into moles and skin anomalies that have led to early diagnosis of skin cancer.

At Smilefocus, this form of relationship-based care and rapport with their largely expatriate patients is also an important characteristic of their clinic. Dr Brendan Gin – originally from Melbourne and has worked in Singapore for 19 years – shared how the dentists and clinic staff often become part of expatriate families’ social network. As expatriates themselves, they inevitably become a touchpoint to share the expatriation experience. Familiar accents and backgrounds aside, having a dentist from one’s own home country can add a comforting familiarity. “It is in how treatment is being presented and catering to the patient experience that is similar to that in the home country.”

They can also identify with some of the concerns and questions asked. “Some of the most common questions is about fluoride in the water and if it’s safe to drink,” Dr Gin said. He added with a laugh that another popular one is: “Can I use chewing gum?”

These queries aside, the needs of patients are largely the same as that of locals. “More and more are also aware about the link between dental health and general wellness, especially the link between dentistry and illnesses that involve inflammation, such as cardiovascular disease, diabetes.” This underscores the importance of good daily care and twice-yearly dental checks and cleaning.

“People are also conscientious about taking bitewing radiographs and orthopantomogram (OPG). Bitewing X-rays helps detect decay at the crown portion and contact point between two teeth, Dr Gin explained. “It highlights potential problem areas that are usually not obvious to the naked eye.” An OPG is a panoramic X-ray of the upper and lower jaws, including the teeth and can monitor bone levels around the roots of the teeth. These scans should be done once every two and five years, respectively. “Frequency of screening helps to address gum disease which is linked to inflammatory disease,” Dr Gin said. As more people understand the link between oral health – especially gum disease – and inflammation, more are taking steps to address it. The take up rate of dental screening is rising as people adopt a more proactive stance towards health.” And it is by asking these questions, understanding their options and taking action that patients become more empowered participants in their own health. “It creates an enhanced two-way communication between doctor and patient – and this drives better oral health in the long term.”