Chat with a Community Care Veteran: Social Work and Beyond (Part 2)

Siew Li was presented with Outstanding Social Work Award in 2014, the highest honour for social workers.

mosAIC talks to Ms Cheung Siew Li, a social worker with over two decades of experience, on her journey in the sector and her path beyond it.

In this second of a two-part story (Click here for Part 1), mosAIC talks to Siew Li about the cases that impacted her and how she continues to grow in the social work profession.

mosAIC: Siew Li, over your extensive career, what kinds of people were you particularly drawn to helping?

SL: Social Workers get to work with people from all walks of life and encounter many issues (financial, psychosocial, health, employment issues, just to name a few). However, in the past 13 years at St Luke’s Hospital (SLH), I have developed interest in and passion to better support persons with dementia and their caregivers because of how the disease affects the individual, their families and caregivers. Dementia is not an acute condition that goes away with treatment, but a chronic condition that you grapple with for life. Worsening cognitive impairment over time can lead to vulnerability. Therefore, persons with dementia need advocates within the family and the community to ensure that their needs are met, and they are safe, comfortable, valued, and supported.

mosAIC: What are some cases involving such vulnerable individuals and how have they made an impact on you?

SL: One particularly challenging case had elements of abuse. It involved a patient with moderate stage dementia, her daughter who was the caregiver, and another disabled family member. The caregiver had dedicated many years taking care of both of them. When I met the three of them at SLH, I realised something was wrong. The disabled family member had visible bruises and wounds on her, both fresh and old, and the patient with dementia seemed anxious around the caregiver. While the patient with dementia stayed safe in SLH, we worked with other agencies on long-term care arrangements to ensure future safety of the person with dementia and her disabled family member. We suspected that prolonged caregiver stress and burnout was a possible contributing factor in the abusive situation.

This case taught me that if caregivers lack the necessary support and resources; things can potentially escalate into a negative situation. I also learnt the importance of inter-agency cooperation as it can require many helping hands to create safety and support for patients.

mosAIC: Is it always so intense?

SL: Oh, no. There was this other case involving an elderly gentleman with Hansen’s Disease (also known as leprosy). He had contracted leprosy in his youth but was very independent, supporting himself with a factory job and cycling everywhere even up to the time he was hospitalised! He had been discharged well but was later readmitted; cognitive impairment, together with worsening vision and the loss of some fingers from leprosy, had led to him scalding himself while preparing his meals. Nevertheless, he was adamant about going back home, so we bought him a kettle tipper and a bed, and installed a water heater for his home.

Unfortunately, he still could not cope and got readmitted into the hospital. I suggested a residential facility where he could be safe and cared for, but having been self-reliant his whole life, he was afraid to lose his independence in an unknown place. To allay his fears, I got in contact with SILRA (Singapore Leprosy Relief Association) Home, a home for persons with leprosy, and when we took him there to visit, his eyes just twinkled. He said, “I didn’t know there were other people like me”, and eventually agreed to stay with them. He’s an example of people who are forgotten – he must have been about 80 years old by the time he came to us.

mosAIC: Speaking of people who are “forgotten”. Were there cases that eluded you, and how did you deal with them?

SL: I remember patients who used to live in wet markets, showering in public toilets, and sleeping on chairs or cardboard when no one was around at night. Sometimes they don’t want to be found because they fear they will “lose their freedom” in a residential facility.

In social work, you have to know that you can’t solve every problem. Sometimes, you just have to wait for the next opportunity or their next encounter with the healthcare system. Sometimes people are just not ready to be helped, so you just do what you can to let them know they can trust you.

mosAIC: How has your career transitioned since social work?

SL: About seven years ago, I realised the impact can be small if I focused on one case at a time. To better deal with patterns and trends, I wanted to analyse problems, develop appropriate solutions, run programmes more widely and train other social workers to bring about greater impact. My job scope grew and allowed me opportunities to do just that.

My organisation provided me many opportunities to help me grow in my leadership journey. One was to read a postgraduate diploma in healthcare management and leadership, through the Health Manpower Development Programme. After receiving the Outstanding Social Worker Award in 2014, I also gained exposure to social work leadership through an eight-week attachment to Mount Sinai Hospital in New York. There, I learnt how social work services were delivered and how Obamacare (Affordable Care Act) was implemented. I also learnt about specific programmes for palliative patients, renal patients in the marginalised communities, and patients with HIV and AIDs. Recently, I also attended a leadership programme under the Healthcare Leadership College with sponsorship from the Ministry of Health.

From 2014, I gradually moved from medical social work into leading care integration efforts at SLH. I currently oversee five units – the referral team, social workers, care coordinators, community partnership, and counselling and care unit. I also co-lead the dementia care services.

mosAIC: How has your ability to address social problems changed?

SL: My training as a social worker helps me to look at the spaces between well-defined services and touchpoints; this is where people “fall through the cracks”.

In my current role, I’m sharpening my ability to suss out partnership opportunities to improve patient care and better integrate care. To me, integrating care means joining up care and services for users. I’m learning to leverage what another provider can do that my organisation cannot, while finding ways in which SLH can bring value to them, be it providing follow-up care or helping them navigate the medical landscape.

mosAIC: Do you miss direct social work?

SL: Of course! I “grieved” a little in the beginning because I was interacting less with patients and doing more project work, admin, and management tasks. However, the transition went well overall. Instead of managing cases directly, I tell myself that I can empower others who will each see many patients on their own!

mosAIC: Thanks so much for taking the time to talk to us, Siew Li! To wrap up this interview, how would you sum up your guiding principles in your career?

SL: Two come to mind. First, is my personal mission statement: To serve and support the lost, the last and least. This refers to those who are vulnerable, disadvantaged, uncared for, forgotten, and pressed down by life’s problems.

Second, I believe leadership is about moral courage: don’t have to be popular but must do the right thing. This is a key principle in leading others.