Boy who was operated on in the womb

When Ms Jeannette Seah and her husband learnt they were expecting twins in 2011, they were ecstatic. It was her second pregnancy. Their older son, Jayden, was then aged three.

Ms Seah, 38, head of marketing in a life insurance firm, says: "We even thought of names for them, Joash and Josiah."

But about 18 weeks into the pregnancy, she was diagnosed with a rare condition called twin-to-twin transfusion syndrome, said to occur in one in 1,600 pregnancies.

The condition happens in identical twins when there is transfusion of blood from one twin to the other through connecting blood vessels in the placenta which they share. The recipient twin, who is usually born larger, may have too much blood and may develop heart failure. The donor twin may have too little blood to grow well in the womb.

Ms Seah says: "The doctor in private practice told me straightaway he could not help me any further."

The couple sought help at KK Women's and Children's Hospital.

There, Professor George S.H. Yeo, head of maternal foetal medicine, told them laser surgery was needed to seal the blood connections between the twins to increase their survival chances.

While the procedure is now done at KKH and National University Hospital, at that time, it had never been done in Singapore. The alternative was for Ms Seah to seek treatment overseas.

She and her husband decided to go ahead with the procedure here.

During the successful two-hour operation, a keyhole was made in her abdomen over the womb and laser applied through it.

During a scan at week 29, however, the heartbeat of the smaller twin, Josiah, could not be detected.

Ms Seah says: "I told Prof Yeo I wanted to deliver Joash immediately to preempt any likely complications.

Joash was delivered via C-section at week 30, way before a full term of between 37 and 40 weeks.

While rejoicing over his birth, Ms Seah grieved the loss of Josiah. The doctors placed Josiah on her chest. With her husband, 39, a senior lecturer in a private tertiary institution, she held the baby and talked to him. Doctors found that he had died from an overly twisted umbilical cord, which had cut off his oxygen and nutrient supply.

Meanwhile, Joash, 1.5kg at birth, was often sick in his first year, but by 11/2, had caught up with his peers in height and weight. Today, the four-year-old weighs about 15kg and is 1.05m tall.

Ms Seah gave birth to another son, Julien, seven months ago. She says: "We see him as God's gift to us, to replace the one we have lost."

Island- hopping midwife

Whenever one of the three midwives stationed on Pulau Brani or St John's Island went on leave, Ms Sumitera Letak, then a new midwife in her 20s, would be called upon to replace them.

"Nobody wanted to go to the islands even though you got paid an extra $1 a day," says Ms Sumitera, 73, who never married and lives alone in a three-room HDB flat. "You had to stay there for about three months during which you had to do home deliveries on your own. If anything happened, you would be responsible."

One of the few surviving midwives who used to work on the islands, she says: "I went not because of the extra money, but because my father told me it was part of my job to go."

She could not swim, but had to take the sampan, which did not have life vests then, to islands such as Sentosa and Lazarus to do home deliveries.

One of her most heart-stopping moments was when, after helping a woman deliver a baby, she realised with a shock that it was a twin pregnancy and another baby was on the way. What was worse was when the second baby's hand emerged first, instead of the head.

She says: "The woman's water bag had burst, she needed to go to a hospital immediately, otherwise both the mother and the second baby would be in danger."

A villager alerted the coast guard who got a sampan for Ms Sumitera and the pregnant woman. The sampan took them to Jardine Steps (formerly at the foot of HarbourFront), where an ambulance was waiting to take them to the then Kandang Kerbau Hospital. The woman had a successful forcep delivery.

Thankfully, Ms Sumitera says, nobody died on her watch.

Trying to persuade pregnant islanders to go to the hospital when they had complications such as high blood pressure or bleeding was another challenge. She says: "The islanders loved to deliver their babies at home and were reluctant to go to the hospital."

By 1990, Ms Sumitera had delivered hundreds of babies, so much so that to this day, she still gets women coming up to her to say she had helped deliver their child or grandchild.

In 1993, she joined an outpatient clinic at the then Kandang Kerbau Hospital, where among other things, she counselled women before abortion and those newly diagnosed with gynaecological problems, including cancer.

She enjoyed the job so much that she volunteered to join the hospital's newly set-up Women's Cancer Support Group.

After she retired from the hospital in 2006, she continued to volunteer there with the group, the only former KKH employee to do so. She visits cancer patients at home and accompanies them to doctor's appointments.

Some of the patients have become friends. "I give them my cellphone number and we can chat for up to an hour," she says.

Today, she keeps herself busy by teaching religious classes and briskwalking three times a week.

The oldest of 10 children, she is close to her siblings and takes care of a younger sister, who suffers from various medical conditions including diabetes.

"My siblings ask me to go and live with them, but I don't want to. It's enough that they visit me often, with their children," she says. "I am very happy and contented with my life. I have good health. What more can I ask for?"

74-year-old doctor who can't stop working

But Professor Phua, now 74, shrugged it off. "Some parents find it hard to hear such news and will scold me, but I just keep quiet and listen. I know they need to voice their frustration and sadness. Sometimes, there is nothing more we can do medically, but we can be there to support the family."

Now the senior consultant in gastroenterology service at KK Women's and Children's Hospital's department of paediatrics, he is regarded as an expert in disorders of the digestive systems. Prof Phua, who has two children and two grandchildren, is also considered a senior to many young paediatricians, who often go up to him and say he was their teacher.

After graduating from University of Queensland, he worked at Singapore General Hospital in 1967.

He says paediatrics has changed a lot since then. "Then, parents treated doctors as kings and hardly asked questions or challenged our decisions. Now, we spend more time talking to parents, who come with a list of what the Internet says."

In the past, doctors had to rely largely on physical examinations to diagnose and treat patients. Now, they have the help of new medical imaging technologies such as CT (Computed Tomography) scan.

The types of conditions he sees have also evolved. In the old days, there were more cases of malnutrition, intestinal worms and infections such as diarrhoea, pneumonia, tetanus and chicken pox.

These days, thanks to Singapore's vaccination programme, he does not see any tetanus cases and only a few cases of measles and chicken pox. But he is seeing more cases of obesity, diabetes, asthma and inflammatory bowel disease.

In 1997, he joined the newly opened KKH.

A tragic incident happened in 2000, when his team was caring for a pair of young siblings suffering from hand, foot and mouth disease. That year saw more than 2,000 cases of the disease, one of the worst outbreaks since the virus was first identified here in 1972.

He says: "We knew the virus could affect the brainstem and there had been a few deaths in the region, but medicine to stop the virus didn't exist then or even now."

After one child died and the other's condition was worsening, someone had to tell the parents. He says: "As I was the most senior in the team, I had to do it. It was a traumatic experience for everyone involved." The children died within hours of each other.

Thankfully, more than 95 per cent of his patients do get well and seeing them recover is one of the most rewarding parts of his job.

He is particularly close to children with chronic conditions such as hepatitis, as he has been treating many of them since they were babies. Many become so attached to him that they are reluctant to transit to the care of adult medicine doctors when they reach 18.

One of his oldest patients is in her 40s, with children. He is still in touch with her and her parents.

He has never thought of leaving for the private sector. "You get to see more difficult cases in the public sector. You also get to teach and do research," he says.

He was involved in clinical trials of the rotavirus vaccine, which showed that the vaccine was effective in reducing the severity of the virus in immunised babies and young children. Rotavirus infection causes severe diarrhoea and, in extreme cases, can be fatal if left untreated.

Despite his age, he has no plans of slowing down, although his workload is heavier now than 10 years ago. His workday starts before 7am and ends around 6pm. He sees patients four afternoons a week, does ward rounds and is heavily involved in teaching and mentoring

He says: "My wife teases me for spending more time in hospital than at home and it's true."

•Dear KKH, Hope In 50 Letters, which costs $50, is available from KK Women's and Children's Hospital, Patient Education Centre, Level 1, Women's Tower, Tel: 6394-1268; and Woods in the Books, 3 Yong Siak Street, Tel: 6222-9980. It can also be bought online from Epigram Books at shop.epigrambooks.sg. All proceeds will go towards the KKH Health Endowment Fund