2019-07-07 05:00:00 2019-07-08 04:59:00 SPH 2 Steel magnolia is an evocative term to describe a woman who exemplifies graceful femininity and indomitable strength.

Steel magnolia is an evocative term to describe a woman who exemplifies graceful femininity and indomitable strength.

It is also an apt description for Professor Cynthia Goh, a youthful 69-year-old with gentle manners, an instinct for kindness and an unwavering belief in human dignity.

She recognised a need for hospices and palliative care in Singapore long before others did, and resolutely set out to improve the quality of life for the terminally ill. "I was told there was no need for such services when I first started in the 1980s," she says.

She started out as a volunteer and over the past three decades, surmounting many obstacles, she steadily laid the groundwork to help the dying live out their days as comfortably and with as much dignity as possible.

Her many achievements include setting up palliative care services at the National Cancer Centre Singapore and Singapore General Hospital (SGH), and founding HCA Hospice Care, Singapore's largest home hospice care provider.

"I'm tremendously fortunate to live long enough to see some of the fruits of my labour. Not all of us are given that gift," she says modestly over coffee at a hotel in Orchard Road.

Like the best in the medical profession, Prof Goh has a soothing voice and a reassuring bedside manner. Born in Hong Kong, she comes from a family of doctors.

"My maternal grandfather was a doctor and a Chinese patriot who was very influenced by Dr Sun Yat Sen," she says, referring to the physician, philosopher and politician who played a key role in overthrowing the Qing Dynasty. "Dr Sun had always told the Chinese to learn technology from the West and bring it back to the East."

Prof Goh was medical director of Assissi Hospice for five years, from 1994. Under her watch, Assissi became a comprehensive hospice provider. ST FILE PHOTO

Her grandfather did just that by getting his medical degree in Edinburgh and was one of Hong Kong's first Western-trained doctors.

Prof Goh's mother wanted to be a doctor too, but World War II put paid to that ambition.

"So she married a doctor instead. My father, too, was a Chinese patriot and was born in Johor. He was very anti-British and didn't want to go back to British Malaya," says Prof Goh, who has two younger brothers, one of whom is also a doctor.

Educated in both English and Chinese, she had "quite a privileged middle-class childhood".

When the chaos of China's Cultural Revolution spilled over into Hong Kong, causing riots and demonstrations, her parents sent their children abroad.

"Even though he was anti-colonialist, my father was old-fashioned and thought the British had the best education system. So he said: 'The boys have to go to the UK. You have a choice, you can go to America as well.'

"A lot of the girls in high school actually ended up in Wellesley and Radcliffe," she says, referring to two famous American liberal arts colleges for women.

But having grown up on a steady diet of Enid Blyton books about English boarding schools such as Malory Towers, she ended up in Malvern, a boarding school in Worcestershire.

Her social conscience was shaped in large part, she says, when she was doing her medical studies at St Bartholomew's Hospital, University of London. Founded in the 12th century, it is the oldest hospital in Britain still providing medical services on the site it was originally built on.

"I ended up there because of a very romantic story," she says, as she chronicles how the hospital was built by Rahere, a court jester turned monk, after Saint Bartholomew - one of the 12 apostles - appeared to him in a dream.

"The story goes that he had nothing, so he cleared the field with his bare hands and the children of the city came out to help. And during Holy Days - now holidays - their fathers came and helped him clear the land too."

Her days at St Bartholomew's were formative in more ways than one. "I was trained in the era of free healthcare. We gave the best to our patients; it didn't matter whether the patient was a duchess or a beggar. We treated them exactly the same way. That was how I was brought up too."

Her mentors also left a lasting impression. One of them was the late Sir Ian Todd, a world-famous colorectal surgeon who was also president of the Royal College of Surgeons.

When she was a houseman, Dr Todd told a patient he was sending her to another doctor at another hospital because that was the best person to deal with her condition.

"Here was a world-famous surgeon telling a patient in front of junior staff like me that there was someone else who was better."

Prof Goh married a fellow medical student, a Malaysian Chinese from Sarawak. After 11 years in London, during which time she had two children, she and her husband set up home in Sarawak.

In East Malaysia, she mixed with folk from different backgrounds including the Hong Kong wives of timber tycoons and English and American missionaries.

Because her sister-in-law was from the Iban tribe, she also made friends with members of the different indigenous tribes in Sarawak.

In 1981, she and her family moved to Singapore.

Prof Goh, who took about six years off to be a full-time mother, went back to work when her nanny from Hong Kong came to Singapore to help her mind her children.

"I started from scratch, as a junior officer at the A&E department in SGH," she says.

Deciding on a speciality after getting her membership of the Royal Colleges of Physicians of the United Kingdom was not easy.

Bent on whole-person healthcare, she decided on palliative medicine, which did not exist in Singapore then. She was advised to join a university instead so that she could pursue a Doctor of Medicine in her spare time.

"I said no. If I'm going to have an academic career, I need a PhD and I need to be properly taught how to do research," she says.

As luck would have it, an opportunity to join the Institute of Molecular And Cell Biology came along. She earned her doctorate six years later.

But she did not forget her palliative dreams. "People were just dying on their own and in pain."

In 1986, she volunteered her services as a doctor with St Joseph's Home in Jurong, which was the only place in Singapore which had set aside 16 beds to care for those who were dying. She was joined by Dr Anne Merriman.

"I was trained as an internist, she, a geriatrician. Both of us were looking after patients we were not trained to look after. But we read books and articles, and called people up in the UK, asking: 'What do we do now?'"

The patients, she added, were great teachers and taught them a lot about using drugs to manage their pain.

Not long after, serendipity gave them a helping hand.

Dr Tetsuo Kashiwagi, a Japanese psychiatrist who started a hospice in Osaka, was in Singapore to attend a psychiatric conference when he heard about the hospice at St Joseph's Home.

He went to visit it, accompanied by former journalist Irene Pates, who wrote a piece, A Peaceful Place To Die, for The Straits Times.

"The piece, which came out in July 1986, attracted 144 letters from the public," Prof Goh says, adding that they were mostly from caregivers who wished they had help when their loved ones were dying from terminal illnesses.

With the spotlight trained on such a resonant issue, Prof Goh and like-minded volunteers decided it was time for concrete action.

The association with "death houses" was hard to shake off and it took much persistence and determination before Prof Goh and company got themselves affiliated with the Singapore Cancer Society.

"We had no beds, no doctors, no nurses, nothing. What we had were lots of people coming to us and saying: 'My father's dying, he's in severe pain. Nobody can do anything. Can you do something?'"

"As it happened, there were quite a few doctors, a few nurses and lay people in that first group of volunteers. So we formed little teams and looked after patients in their own homes, inadvertently starting Singapore's first home care service."

In the first year, they had 70 referrals. The following year, that number jumped to 140.

A generous donation from the Cheng Kim Loke Foundation enabled them to hire a nurse whom they sent abroad to be trained as a coordinator.

The learning curve was steep.

"We could manage the physical pain but what we couldn't manage was the emotional and spiritual pain," she says.

"People with no families, people who have lost their families, people who want to unite with their families, men with several wives, none of whom would visit," she says.

She remembers a dying woman whose mother-in-law forbade her children to visit her for fear that they would also be infected with cancer.

"Those soap operas you see on TV are not an exaggeration; they are actually watered down," she says. "There were so many human struggles we experienced through our dealings with the patients."

That group of volunteers grew and eventually became, in 1989, the HCA, a charity which now looks after more than 3,500 terminally ill patients a year.

Prof Goh went on to do more.

She was medical director of Assissi Hospice for five years, from 1994. Under her watch, Assissi became a comprehensive hospice provider.

She then set her sights on making palliative care a speciality.

"The only way you could create a speciality was to get into the public sector," she says.

Her next stop was at National Cancer Centre Singapore (NCCS), where she started the department of palliative medicine, a first among public hospitals. This led to other developments: the establishment of palliative medicine as a recognised medical subspeciality in Singapore, and a Chapter of Palliative Medicine at the College of Physicians Singapore.

Prof Goh currently serves as the deputy chair of the advisory board for the Lien Centre for Palliative Care, Asia's first palliative care research and training centre at the Duke-NUS Medical School.

She is also still a senior consultant at NCCS, where she sees clients a couple of times a week.

Her work has won her multiple awards, including a Public Service Medal in 1997.

The grandmother of two, aged three and five, has not slowed down.

With a grant from the Lien Foundation, she is now focused on setting up a palliative care framework for developing countries such as Myanmar, Bangladesh and Sri Lanka.

As chair of the Asia Pacific Hospice Palliative Care Network, and co-chair of the Worldwide Palliative Care Alliance, she is also active in palliative care training and education in the Asia-Pacific region.

And she still volunteers at St Joseph's, where she first started.

"I need to keep myself up to date. If I want to teach, I need to be practising and I need to have my store of stories to tell.

"And I will continue to do this for as long as my health allows me to."