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Facilitating paradigm shift: Story of an occupational therapist in the community


St Luke's Hospital Occupational Therapist Joseph Chua knows for a fact that geriatrics and dementia care are where his passion lies.

Witnessing how my grandaunt struggled whilst living with dementia and how it affected the people around her, I realised the importance of providing therapeutic intervention and support to persons living with dementia and their caregivers.

Spending the past six years in the dementia ward at St Luke's Hospital (SLH) has further strengthened my resolve to provide quality care for these patients and their caregivers. Typically, I spend half of the work day in the inpatient dementia ward, working with patients and engaging them with therapeutic interventions. I also educate their family members on post-discharge care.

I spend the rest of my day visiting my patients at their homes and helping them enhance their quality of life, by engaging them in daily occupational therapy activities within the comfort of their community or helping to manage their behaviours of concerns.

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Joseph works with a multi-disciplinary team, including physiotherapists, speech therapists, music therapists, art therapists, nurses, medical social workers, doctors and care coordinators, to provide appropriate care and support to his patients.

I enjoy taking my patients through the full spectrum of care as it allows me to see the impact of the work we do. Another exciting part of my role involves working in a multi-disciplinary team to review how we can further improve our work across the different healthcare settings.

Small gestures with a deep impact

As an occupational therapist, I face new situations that challenge me every day, and it is partly why I enjoy doing what I do. I recall a patient who left a very deep impression on me – let's call him Mr L. Mr L was a headstrong, independent and introverted person who often kept to himself. He was living with dementia and often exhibited behaviours of concern towards the end of the day. In the evenings, Mr L would often be found wanting to go home, and he would pace up and down the ward looking for an exit.

Often, I would offer my help to assist him and calm him down. There were times when this proved challenging and a stand-off would ensue. Imagine the scene, where Mr L would be demanding to be "brought home", waving his walking stick at the surrounding staff while leaning against a wall. I could see the distress and anxiety etched on his face.

These incidents taught me the importance of entering the world of persons living with dementia and understanding their perspectives. I would try various methods to connect with Mr L — newspapers, coffee, his favorite music or his favorite foods (char kway teow and watermelon). It is interesting to find that the same intervention may not always work on every occasion. At times, just expressing empathy for his distress was the best remedy. 

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Joseph guiding a patient on a therapeutic activity

Another memorable relationship with a patient was one that stemmed from the interaction I had with him and his sole caregiver. I remember that the caregiver was feeling burnt out from taking care of her loved one. So my colleague and I made a point to visit them during festive seasons, even after the patient was discharged. This really brightened their mood, especially for the caregiver. These occasions hold a special place in my heart.

The caregiver ended up volunteering at St Luke's Hospital to give back to the community, after getting to know the work we do. It was something significant because many of our programmes at SLH benefit from the help of volunteers. In addition, she would send periodic updates on how the patient was doing as she knew that I was keen to follow up on the progress of my patients. She brought even more joy to everyone on the days that she came to volunteer, as she would often bring snacks! Ultimately though, what was most touching was the friendship that blossomed from improving the lives of persons living with dementia. From this, I learnt the importance of extending care to the patients' loved ones who toil, often unseen and unappreciated. 

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Making the best out of it

As an occupational therapist, I see myself facilitating paradigm shift – helping my patients change their mindsets and learning to do things in a different way. Despite living with dementia, these patients continue to exist as unique and special individual. It is important for me to look past their lost abilities and understand their hobbies and interests, in order to adapt them into meaningful activities for them to engage in.

My patients and their caregivers are my greatest source of motivation. Journeying with them brings me a sense of satisfaction and they reinforce the certainty I have in working with them. I believe that my work is meaningful as it brings value to the persons living with dementia and their families.

I am Joseph Chua, an Occupational Therapist at St Luke's Hospital.