Shoulder to Shoulder: Why Partnership Matters in Times of Crisis

Digital Edition Issue 06, Jun 2020

Over dinner one evening, not long after the first locally-transmitted clusters of COVID-19 patients came to light, my father reminded me of how afraid I had been, years ago, when he told us that he would have to enter the SARS wards. “Do you remember?” he recalled, his voice breaking a little. “You asked, Pa, can you please don’t go? That was one of the most difficult decisions of my life.”

At that time in 2003, my father was a psychiatrist at Tan Tock Seng Hospital, and—with thousands of fellow healthcare professionals and hospital workers—had been called to the frontline of the national SARS response.¹  Many others (including my mother, a general practitioner), stayed at their posts despite the heightened risk, ensuring that clinics stayed open and all who sought help could be treated.

Then in Primary 3, I understood little of national and global developments, but caught the grave note in my father’s voice when he explained what he would have to do. I knew it would mean time away from us: beyond the long shifts, one of the options we considered was for him to move to a hotel for the duration of the crisis, to avoid any possible transmission to the rest of the family. But I knew that it could mean worse, too. Then, as now, the idea of losing him was unthinkable.

Nearly two decades on, I write this at the end of the first week of our government’s enhanced “Circuit-Breaker” measures.²  Across the island, a sense of the fear I felt as a child: deep unease about the evolving COVID-19 pandemic, coupled with uncertainty about the future, remains palpable. Unlike my parents during the SARS epidemic, and the brave teams in our hospitals who are now working round the clock to test and treat patients, I am not at the frontline of the current crisis. But I do have some reflections to share, as a policymaker at the Ministry of Health (MOH), as well as a volunteer with several ground-up initiatives engaged in the COVID-19 response.

1. Keeping the ship afloat

Since late January, some of us have been designated as “Concurrent Appointment Holders”, taking on additional responsibilities as part of the pandemic response in addition to our regular portfolios. With the fight against COVID-19 taking on more and more dimensions, these responsibilities have expanded: in the past week alone, various members of my immediate team have helped with contact tracing, preparing the Singapore Expo site as a community isolation facility, monitoring the situation at migrant workers’ dormitories, and supporting the work of the Multi-Ministry Task Force.

Others have also volunteered to work directly on the COVID-19 response, and will be assigned such responsibilities as the needs arise. But in the meantime, there is plenty to be done in adapting our healthcare system to the needs of the moment, and keep it running to serve our regular caseload. All the work that goes into keeping our polyclinics, nursing homes, community hospitals and other facilities open during “peacetime” remains necessary, even as contingency plans are rolled out and ever more stringent precautions are adopted. While longer-term projects may be temporarily shelved, immediate challenges take their place, and new solutions are born in record policymaking time.

Faced with a pandemic, necessity can be the mother of transformation. As safe distancing measures kicked in, for instance, my colleagues in the Healthcare Finance Division worked within days to extend two of our schemes—the Community Health Assist Scheme (CHAS) and MediSave—to cover video consultations on an exceptional basis during the COVID-19 period for the first time.³  By removing a cost barrier for such consultations, patients who suffer from some chronic conditions can now stay home and avoid transmission risk. Other fine-tuned policy decisions at each stage of the COVID-19 response have helped Singaporeans adapt to the changes brought about by the pandemic, even as three ambitious Budgets have extended much-needed financial relief to many families.

None of these changes come easy: each one is the product of many late nights and robust discussions. Although they do not take place on the frontlines, I am grateful to have seen how those who fight to maintain a sense of “business as usual” exercise more creativity and courage than meets the public eye. These are qualities which, I trust, will not fade from policymaking when normalcy returns.

2. Partnering with civil society

Outside of work, I volunteer regularly with some of our less privileged communities, including low-wage migrants in construction and domestic work. Friends in the non-profit sector often express a wish for government to recognise them as equal partners in community-building, and on that basis to work more closely with them to address gaps in social provision. Their vision is that shared by then-Acting Minister George Yeo in 1991—of “pruning the banyan tree” of state institutions to provide more space for local initiative, and allowing civic institutions to thrive.⁴

Mutual trust and openness cannot be built overnight—but it can, it seems, be catalysed by a crisis. Many have praised the government for its transparency thus far,⁵  highlighting how this has empowered citizens to act calmly and responsibly. Equally worth noting is how the timely provision of accurate information has allowed NGOs to mobilise efficiently, complementing the government’s efforts. When infection clusters began to emerge in migrants’ dormitories, for example, advocacy groups created a visualisation dashboard based on data in official press releases, to help track developments and coordinate the provision of essential supplies to affected dormitories. Two weeks later, Minister-of-State Zaqy Mohamad led engagement sessions over the Zoom video conferencing app to gather feedback on the challenges faced by a select group of NGO representatives, while other teams in government worked discreetly with NGOs to respond to shifting ground needs.

If engagement is pursued in good faith, it will have longer-term benefits for both sides. The government builds up its store of goodwill, while civil society actors gain real-time exposure to the processes and considerations that guide policymaking even in “peacetime”, allowing them to advocate for change in more constructive ways. Friends in need become friends indeed.

3. An ethos of humanitarianism

Singapore’s self-image as a prosperous nation can lead to an assumption that humanitarian assistance is something only others elsewhere require. When we think of such aid, the stories that come to mind—such as of Singaporean doctor Tan Lai Yong’s work in the villages of Yunnan, China—fall easily into this mould. Such a view of humanitarianism is too narrow. Canadian global health expert James Orbinski, who served as Head of Mission for Médecins Sans Frontières (Doctors Without Borders) in Kigali during the Rwandan genocide of 1994, has seen his fair share of faraway need. Yet as he would later write, the spirit of humanitarian concern arises from something more universal: a “feeling of shared vulnerability with the victims of preventable suffering”.⁶  As we are now all too aware, such preventable suffering can easily occur anywhere, including on our own doorstep.

Our response to COVID-19 has shown that a humanitarian spirit can and should be a guiding ethos for Public Service. With its far-reaching impact, the crisis has brought to light the interdependence of different sectors of society. It has also demonstrated that vulnerability is not confined to certain segments of the population, and cannot be blamed solely on a lack of individual effort. All of this provides a rare policy context in which state and society can rally effectively around the awareness of shared vulnerability that humanitarianism entails. This forms a common starting point for us to achieve progressive and equitable outcomes that can effectively reduce human suffering.

Since the start of the crisis, confidence in the government’s response has generally been high,⁷  with citizens applauding our proactive steps to support healthcare workers and frontline staff. Subsequently, public support has remained strong⁸  for our urgent redistributive measures, including what the International Labour Organisation has described as a “quasi-Universal Basic Income”,⁹  on a time-limited basis. And despite some initial uncertainty, community groups have welcomed¹⁰  more radical moves as well, such as the relocation of dormitory residents to heartland HDB neighbourhoods.

Many of these changes are likely to be scaled back once the economy begins to stabilise. But it is worth considering how applying a humanitarian perspective in our own backyard might help us address vulnerabilities that remain latent for so many citizens, even without the imminent pressure of a crisis.

4. It takes a village

I began these reflections with a fragment of a memory: of the choice my parents made, seventeen years ago, to put themselves willingly in the line of fire when they were needed most. Such decisions—which our healthcare workers and essential staff make every day, virus or no—are worth celebrating. Other personal sacrifices are also laudable: suspending meals with extended family, donating one’s Solidarity Payment to a cash-strapped charity, or picking up groceries for a neighbour in need.

But beyond these individual choices, we should not forget that the heavy lifting required to overcome any crisis depends on collective action. In their study of the fight against tuberculosis in the 1950s,¹¹  epidemiologist Hsu Li Yang and historian Loh Kah Seng have shown how it could not be “left solely to healthcare practitioners and public health officials”: it also took effective advocacy on the part of the public, the press, and the private sector to deliver lasting results. Working with community partners such as the Singapore Anti-Tuberculosis Association (SATA), Singapore’s then-British administration eventually took decisive action to reduce malnutrition, improve housing and hygiene, and promote vaccinations.

So popular and successful was this collective movement to overcome tuberculosis that founding Prime Minister Lee Kuan Yew, speaking after his electoral victory in 1963, used it as a metaphor¹²  for how to “unite the people [and] build a prosperous and equal society”, among other nation-building objectives. Taking a leaf from his book, perhaps what is worth celebrating, at this time—and commemorating, when we look back later on this trial—are not acts of individual courage, nor the initiatives of any one institution, but moments of genuine and effective cooperation forged in the heat of crisis between citizens and those who serve them. Already, we are seeing such partnerships in efforts to house the homeless¹³  and feed the hungry.¹⁴  When we emerge from this crisis—as I have no doubt that we will, and stronger for it—this will be a triumph that we can all share.

NOTES

1. Y. C. Chee, “Heroes and Heroines of the War on SARS”, Singapore Med J 44, no. 5 (2003): 221–228, http://www.smj.org.sg/sites/default/files/4405/4405e1.pdf.
2. “What You Can and Cannot Do during the Circuit Breaker Period”, April 11, 2020, accessed May 11, 2020, https://www.gov.sg/article/what-you-can-and-cannot-do-during-the-circuit-breaker-period.
3. “Time-limited Extension of CHAS Subsidy and Use of MediSave for Follow Up of Chronic Conditions through Video Consultations in View of COVID-19”, Ministry of Health, May 5, 2020, accessed May 11, 2020, https://www.moh.gov.sg/covid-19/vc.
4. George Yeo, "Civil Society—Between the Family and the State” (speech, the NUSS Society Inaugural Lecture, Singapore, June 20, 1991), accessed May 11, 2020, https://www.nas.gov.sg/archivesonline/data/pdfdoc/yybg19910620s.pdf.
5. Mohit Sagar, “How Singapore Government’s Communication Keeps Nation Moving Forward in Crisis”, OpenGov, March 16, 2020, accessed May 11, 2020, https://www.opengovasia.com/how-singapore-governments-communication-has-kept-the-nation-working-through-crisis/.
6. James Orbinski, An Imperfect Offering: Humanitarian Action for the Twenty-first Century (Toronto: Doubleday Canada, 2008), 392.
7. “Singaporeans Are Confident in Government amidst Fears of the COVID-19 Outbreak”, IPSOS, March 16, 2020, accessed May 11, 2020, https://www.ipsos.com/en-sg/singaporeans-are-confident-government-amidst-fears-covid-19-outbreak.
8. “Over Half of Singaporeans Are Satisfied with the Solidarity Budget”, Blackbox, April 13, 2020, accessed May 11, 2020, https://blackbox.com.sg/?news-feature=singaporeans-satisfied-with-solidarity-budget-support-and-are-extraordinarily-confident-that-circuit-breaker-measures-will-halt-the-spread-of-covid-19.
9. “Social Protection Responses to the Covid-19 Crisis: Country Responses in Asia and the Pacific”, International Labour Organisation, March 25, 2020, https://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/documents/briefingnote/wcms_739587.pdf.
10. Yuen Sin, “Campaign to Make Workers Feel Welcome in Housing Estates”, The Straits Times, April 20, 2020, accessed May 11, 2020, https://www.straitstimes.com/singapore/campaign-to-make-workers-feel-welcome-in-housing-estates.
11. Loh Kah Seng and Hsu Li Yang, “The Disease that Divides, and Unites”, TODAY, March 24, 2018 accessed May 11, 2020, https://www.todayonline.com/commentary/disease-divides-and-unites.
12. Quoted in K. S. Loh and L. Y. Hsu, “Tuberculosis in Singapore: Past and Future”, Annals of the Academy of Medicine Singapore 48, no. 3 (2019): 72–74, http://www.annals.edu.sg/pdf/48VolNo3Mar2019/V48N3p72.pdf.
13. Tee Zhuo, “Parliament: 300 Homeless Seek Help from MSF Peers Network during Covid-19 Circuit Breaker”, The Straits Times, May 4, 2020, accessed May 11, 2020, https://www.straitstimes.com/politics/parliament-300-homeless-seek-help-from-msf-peers-network-during-covid-19-circuit-breaker.
14. Nigel Chin, “How Society Staples and Debra Lam Ensure Vulnerable Communities Are Not Forgotten during Circuit Breaker Period”, Youth.SG, May 6, 2020, accessed May 11, 2020, https://www.youth.sg/Spotted/People/2020/5/How-Society-Staples-Debra-Lam-ensure-vulnerable-communities-are-not-forgotten-during-circuit-breaker.