Meet ‘Viper Doc’: He flew in F-16s to learn how to care for pilots

In this new series, people from all walks of life offer an inside, often unfiltered, take on their livelihoods and what keeps them going. In this instalment, hear about Dr Robin Low’s work in aviation medicine, a speciality field that includes ensuring the health and safety of pilots, as told to The Straits Times.

I am 56, and I focus on caring for aviation professionals in my job at Changi General Hospital (CGH).

The most memorable moments are when I visit my patients at their “office” – in an aircraft, cockpit or air traffic controller’s console.

The thrill of exposure to different settings – that’s my personal favourite aspect of the job.

In my early years of practising medicine, I found that the daily running of clinics and even working in the operating theatre had become routine.

But aviation medicine is unlike most other fields of medicine in that it requires the doctor to go beyond the clinic or bedside. I interact with the pilots and air traffic controllers in their workplaces.

Like other doctors, we also have clinic consultations with patients, just that they are primarily aviation personnel.

The earlier part of my career was with the Republic of Singapore Air Force (RSAF), where I had the opportunity to fly on military aircraft, from helicopters to fighter jets. I also had to learn how to operate the systems on a fighter aircraft, including flying a mission in a fighter simulator, which is meant to simulate real-life scenarios in an actual plane.

I have also sat in the back seat of fighter jets as part of actual flying training missions, where the aircraft is simulating an attack on a ground target or fighting an adversary in the air, and experiencing low-level flying during a night training session.

Even for transport aircraft, the missions go beyond just transporting people or goods from place to place. They include conducting parachute training at night and flying low level over terrain. Experiencing what the pilot experiences first-hand is always a thrill for me.

These experiences have enabled me to better understand the challenges and health considerations aviation professionals face in their work, which I now apply in my current role at CGH. To me, this is one of the most enjoyable aspects of the practice.

I decided to specialise in aviation medicine because it offers an atypical experience.

I was one of the first doctors in Singapore to be sent for a two-week course which the US Air Force conducts for flight surgeons – the American name for aviation medicine doctors – to learn how to be a “fighter pilot” doctor.

Conducted at the Luke Air Force Base in the US, the course teaches flight surgeons the essentials of flying and operating the F-16 Fighting Falcon fighter jet, one of the plane types operated by the RSAF.

In addition to understanding the elements of fighter flying like flying with night vision goggles, I learnt how to operate the flight controls and radars in a simulator. In the second week, I flew operational flights in the back seat of an F-16 jet, and was exposed to what I had studied. By the end of it, we were officially called the “Viper Docs” – “Viper” is the nickname for the F-16 Fighting Falcon.

The course really made us better doctors as it gave us a better understanding of our patients and their working conditions.

Just like every kid who loves airplanes, I had considered becoming a pilot. But that ambition was quickly quashed when I found out I had myopia at the age of 10. In those days, pilots had to have perfect eyesight.

Today, it is possible for someone with myopia to qualify as a military pilot under the RSAF Corneal Refractive Surgery Programme.

My father was probably the one who sparked my love for military aircraft in a big way. One of our favourite spots was the old Paya Lebar Airport, back when it was still a commercial airport with a viewing gallery.

I remember the mushroom-shaped counter and the mosaic art piece in the terminal building vividly. Years later, I was thrilled to begin my career in the RSAF at the Paya Lebar Air Base. I was working inside that very terminal building, and I could share that with my old man.

This is why aviation medicine is a speciality. My job seeks to reduce the medical risks for pilots and air traffic controllers.

If an office worker has coronary artery disease, he may have no problems being cleared to work. If he starts having chest pains, he can be taken immediately to the emergency department.

While aviation personnel face the same ailments as other people, they have heavier responsibilities in keeping others safe while operating in vastly different work environments.

A pilot who develops chest pain mid-flight may not be able to access immediate medical care, and at the same time, could endanger the entire flight. Such conditions must be treated – surgically, if required – before the pilot can be cleared to fly again.

But my work is not just about caring for pilots. Practising aviation medicine also involves ensuring that passengers who have medical conditions are fit for a flight. For example, a passenger recovering from recent abdominal surgery may not be fit to fly, as the lower cabin pressure may result in gas expansion, negatively affecting wound stitches.

Also, patients with chronic renal failure may have low blood levels and may require a blood transfusion prior to flying, or some patients may need supplementary oxygen when on board.

In such cases, consulting an aviation medicine specialist is necessary, especially if the patient needs to travel shortly after surgery or medical treatment.

Additionally, aircrew need to have good eyesight to look at things at a distance, as well as be able to see details close-up when reading their instruments and flight charts.

My job includes caring for air traffic controllers too, where potential safety implications during flight or air traffic control duties have to be considered. Similar to health considerations for pilots, these include coronary artery disease, kidney stones and musculoskeletal issues such as slipped discs.

A key concern is the risk of being incapacitated while on duty, when conditions like a heart attack or kidney stones could be severely disabling. Even milder symptoms like persistent discomfort or pain may affect concentration and performance, which are critical in these safety-sensitive roles.

In my job, I sometimes get involved in aviation incident investigations. This can mean visiting an aircraft or the airfield to understand the environment and events that resulted in the incident.

In the earlier days of my career with RSAF, I was activated for an overseas mission on the day of the SilkAir MI185 plane crash. All 104 people on board died when it crashed into the Musi River in Sumatra on Dec 19, 1997.

I was part of the first wave of search-and-rescue flights, conducting intense recovery and support missions. My colleagues and I looked after the pilots and aircrew in that operational environment to ensure they remained healthy and fit to perform their tasks.

We eventually ended up being based in Indonesia for the subsequent days and weeks. We also sat in on the briefings to observe if anyone was ill or fatigued, or needed mental support.

I conduct physiology training sessions for pilots and aircrew, which involve lectures and practical training in aviation physiology simulators that CGH undertakes for the RSAF.

This means I also work closely with the RSAF aviation medicine specialists who oversee the aviation physiology training programme and develop aeromedical policies, research and innovation. To elevate aviation medicine, CGH and RSAF opened the Singapore Changi Aeromedical Centre in February 2025.

Aviation physiology training covers core topics such as hypoxia, spatial disorientation and acceleration forces, which the pilots may experience during their flying career.

Practical training on the simulators includes using the hypobaric or altitude chamber, the spatial disorientation trainer, the ejection seat trainer, and the pinnacle of aviation medicine training simulators – the high gravitational force (high-G) human centrifuge.

Hypoxia is a condition that occurs when the body experiences symptoms due to insufficient oxygen at high altitudes. In my classroom lectures, I remind pilots to recognise the symptoms, and how to prevent and manage the condition. They are then exposed to a high-altitude scenario in the hypobaric chamber to train themselves to recognise and address the symptoms experienced.

We also use an advanced disorientation trainer to demonstrate the dangers of being disorientated in flight.

Additionally, the high-G human centrifuge is used to teach pilots how to cope with high-G forces, which fighter pilots could experience when they execute some of the manoeuvres and sharp turns during a dogfight – an aerial fight between fighter jets at close range.

In these scenarios, fighter pilots may be exposed to up to nine Gs pressing against their body, which means experiencing up to nine times the force of gravity.

Military pilots face a little more stress than commercial ones as military missions are more unique, varied and carry a higher risk owing to the flight profiles, manoeuvres and, in real operations, the unknowns.

For example, military pilots train for situations where the enemy’s aircraft tries to shoot their aircraft down. To prepare for high-stress conditions, they push their bodies and their aircraft to the limits during training while engaging in manoeuvres, which would not be usual for a commercial airliner.

These risks include losing consciousness owing to high-G forces during high-G manoeuvres such as making tight turns in a fighter jet, becoming disorientated during night flights or flying in severe weather conditions.

So I conduct physiology training for pilots to teach and condition them to the limitations of their bodies in relation to these flight profiles and the high-altitude, high-speed environment they operate in.

As the stresses faced by military pilots are greater than those faced by commercial pilots, the fitness requirements are necessarily more stringent. During training sessions, my colleagues and I expose them to these situations in a safe environment.

While commercial pilots may have more predictable operations, they face other challenges such as long working hours, time zone changes and fatigue. The impact of the Covid-19 pandemic on the airline industry has also contributed additional stressors for the pilots.

Exposure to the actual aircraft and flying environment helps me to understand what our patients experience at work, which then enables us to make informed decisions about their fitness to fly when they have certain medical conditions.

When pilots or aviation professionals see their doctor making the effort to understand their workplace and work environment, it fosters a level of trust that is highly important in the doctor-patient relationship.

For instance, understanding how a pilot exits an aircraft when there is a ground emergency helps me to assess if a patient is able to return to work while recovering from a lower-limb injury.

Similarly, knowing the cabin altitude is crucial when evaluating cases of in-flight hypoxia, a condition that occurs when the body experiences symptoms due to insufficient oxygen at high altitudes.

This is in line with the principles of occupational medicine, where understanding the workers’ environment and how they perform their job is essential to addressing any potential challenges or risks to their health.

The most meaningful and satisfying aspect of my job is using my medical expertise to help pilots – whether it is something significant like getting them back to flight status or maintaining a certain level of health to be certified to fly, or just helping them to understand their medical condition and alleviating their concerns.

We teach pilots that they need to be in an excellent physical and mental state whenever they go to work. This includes looking at long-term illnesses such as diabetes and short-term conditions such as upper respiratory tract infection, toothache and fatigue from insufficient sleep, among other things.

I also help the pilots understand the limitations of the human senses in flight, prevent risky situations and train them to quickly adapt to and rectify a situation while remaining safe.

This is to ensure safety during flight when they are exposed to the flight environment. Ultimately, we have to ensure the safety and well-being of both pilots and passengers.

Got an interesting job to share? Write in to us at ssharon@sph.com.sg.