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Source:
www.moh.gov.sg |
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Official opening of the Children Hospice
International's 18th Congress 07 Sep 2007 By Mr Khaw Boon Wan
Venue: Pan Pacific Hotel |
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An Excerpt |
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Last week, I spent some time in the Japanese
island of Okinawa. It has a population of 1.4 million, largely
concentrated in the capital city of Naha. But it also has a significant
rural sector population spread over 40 small towns and villages. |
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I visited one such village called Ogimi
(“大宜味村”). It has 3,500 villagers. Accompanied by the village Mayor, I
participated in the village life and absorbed the villagers’ attitude
towards life and death. They have much to teach us. |
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The Ogimi village has a reputation as “the
village of long life”. It has the highest number of centenarians,
adjusted for population, in Japan and most probably, in the world. Out
of a village of 3,500, 1,050 are above 65 and 100 above 90. Among them,
16 are above 100: 1 man and 15 women. I have not spoken to so many
centenarians on the same day... |
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I visited Ogimi not to seek the secret of
longevity. But a local University academic who has studied this subject
and observed the villagers for years briefed me on his research
findings. I suppose there is no harm in sharing his conclusions. As
genetic factors are beyond our control, his briefing focussed on
non-genetic factors, of which there are many. But he singled out three
important factors which help explain the villagers’ longevity. |
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First, their traditional diet: they eat more
pork, more tofu (bean curd), more dark green vegetables and more seaweed
than other Japanese. And their salt (sodium) intake is low, about half
of Japan’s national average and many times lower than the Western
countries. |
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Second, they are physically active. They
exercise a lot and keep active all their lives. They work for as long as
there is work available. |
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It is common to see some of the
villagers continue to work into their 70s and 80s, even in
laborious work such as farming and weaving...Even when work is not
available, they are committed to an active social life, in senior
citizens’ clubs, village events and volunteer activities. They
meet friends often and very few isolate themselves at home. |
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Third, their active daily life in turn
benefits their sleep at night. They sleep easily and while they do
not sleep long, they sleep soundly with little interruptions. |
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Live Well |
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So this is the Ogimi secret to
longevity: a healthy diet, an active life and good quality
sleep... |
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Given their diet and regular activity,
the prevalence of diabetes and cardiovascular diseases is way
below their national average. Osteoporosis is also less of a
problem, with the incidence of hip fractures at half of the US
rate. |
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Unlike most elderly villagers in other
parts of the world, the old folks in Ogimi walk with straight
backs. I did not meet any hunch-backed residents. This is not the
result of medications or health supplements, but sheer simple and
healthy diet with plenty of vegetables and physical activities... |
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We talked about the younger
generation. They lamented the erosion of traditional village
lifestyles and worried a lot about the bad influence of fast food. |
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They prefer their “slow food”
tradition - prepared from fresh ingredients and cooked slowly to
carefully remove the animal fat. They also practise “hara hachi bu”:
eating moderately and only to 80% full. The other 20%, they
believe, will only go to enrich the doctors. We did not meet any
who were obese... |
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Ogimi is, of course, not entirely a
bed of roses. Among the 16 centenarians, 3 are bed-ridden,
including the oldest man who, at 108, also suffers from dementia.
I visited several nursing homes where the bed-ridden elderly were
being served. Just like in some of our nursing homes here, many of
the elderly seemed unaware of what was going on around them. The
difference is that their residents are one generation older... |
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Good Death |
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Okinawa reflects the extreme end of a
society dealing with advanced ageing. But the rest of Japan is
heading in that direction. |
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In Tokyo, I had a substantial
discussion with the Health Ministry on a range of ageing issues,
including the morbid topic of where people died. They noted that
soon after WWII, 85% of Japanese died at home, with the remaining
15% in hospitals. They lamented that the reverse is now true. This
is despite regular surveys pointing to the elderly patients’
preference to die at home. |
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The Japanese are not unique. Last
month, NHS London released its review report on "Healthcare for
London: A Framework for Action". It devoted a section to
end-of-life care and lamented the lack of discussion in society
about “what constitutes a "good death". |
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It observed that "most people are
dying in hospital when they would rather die at home". It added
that repeated surveys of the general public have shown that the
first preference for most people would be to die at home. In
practice, only 20% of deaths in London occurred at home, with 66%
occurring in hospitals. |
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We have not done such a survey in
Singapore, but I will be surprised if Singaporeans are any
different from the Japanese or the Londoners. After a full and
meaningful life, I certainly wish to die at home, among my loved
ones, in familiar and peaceful surroundings. |
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We have done a study of where
Singaporeans died, mostly (55%) in acute hospitals. 28% died at
home but I suspect many more would prefer that too. |
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Meeting Preference |
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Why is the modern healthcare system
failing in meeting the preference of the dying? I think this is a
subject worthy of a study. I believe we should try to facilitate
dying at home for the terminally ill if this is their preference. |
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The London report recommends creating
a register to elicit and record patients’ preferences on where to
die. Perhaps we should study this aspect too. |
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While dying in hospitals is natural
for fatalities due to accidents, heart attacks and other
unforeseen events, the terminally ill have time to prepare for
their final moments and express their preferences. |
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The families and the healthcare
workers should strive to meet their final wishes. My Ministry will
study this subject in greater detail and identify the obstacles
and gaps. If need be, we shall change the rules and processes that
currently hinder dying at home... |
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Let's Talk About Death |
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End-of-life issues are deeply
emotional. But at the Ogimi village, I did not find the villagers
squeamish when talking about it. They laughed and joked about it. |
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They realise that treating death as
taboo does a disservice to both the dying and the living, adding
to loneliness, anxiety and stress for all. They are grateful for a
healthy life and pray for a good, dignified and discreet death, a
“pokkuri” moment. |
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It takes humility to acknowledge that
medical science, however advanced, has its limits. For the most
vulnerable group of patients at the close of their lives, for whom
curable treatment is no longer an option -- their last moments
matter. |
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We must use the art and science of
medicine to help them and their families find comfort and meaning
in the last phase of their lives... |
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Full Text of Speech |
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Source:
www.moh.gov.sg News 7 Sep
2007 |
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FrontPage Edition: Tue 11 September 2007
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