Rural Nursing in Singapore 10   Editorial RURAL NURSING IN SINGAPORE Desley Hegney, PhD, RN Editorial Board Member   Greetings to all of you from tropical Singapore. Many of you will not have realised that I moved from Australia to Singapore in March this year. In many ways I could no longer consider myself to be ‘rural’ living in a highly urbanised Asian city of 4.5million people. It is really every rural nurse’s dream – one huge shopping centre. Really there is not much more to do here than shop and eat. Exercise is a challenge as it is hot (about 24C in the morning and gets up to 34C in the evening) and humid. But it does rain a lot (which is a refreshing change from Australia) and everything is green. No drought or water shortage, though they do not waste water either. Of course, we are only a bridge and a causeway from Malaysia or a boat ride to Indonesia. Many Singaporeans go to Indonesia and Malaysia daily to play golf, shop or visit one of the lovely resorts. It is easy to get around. Public transport is great and cheap. Taxis are also very reasonable (though the government has put on a surcharge during peak times and sometimes the surcharge is higher than the taxi meter). Most expats don’t buy a car, but after six months here I decided to buy a second hand one. In Singapore the government sells car licenses for 10 years. That is, you pay to buy a license to buy the car and after 10 years the car has to be scrapped (many are sold into Malaysia I am told). This can range from a low a couple of years ago of about $10,000 to $50,000 (the price is rising as the government is restricting the cars on the road and therefore releasing fewer licenses). Then you buy the car. The new car price is also heavily taxed – so most of the Singaporeans buy second-hand cars. That is what I bought – a second hand Subaru (though one does wonder what one would need an all-wheel drive for in Singapore). Mind you I have seen four-wheel drive cars here. I bought the car because I bought my 3 year old black Labrador dog with me – Angus. Angus has taken some time settling in (ear and skin issues due to the heat) but is doing OK now. Because we live in an apartment (or condo as they call them here), I wanted to take him out. There is an off-lead beach that we go to on the weekends, so he has a great time with other dogs, swimming, chasing the ball and generally getting lots of exercise. During the week the maid – Mira (who is from the Philippines and has 5 children and a husband there) walks him when I am at work or out in the evening). The health system is good here. If I go to the doctor it costs me $5 and that includes prescription medication. The pharmacies in Singapore do not dispense drugs – the dispensing is done at the doctor’s surgery (strange). There are large primary care clinics (about 20% public and 80% private). You don’t make an appointment – rather you just turn up and wait. They have a good system of nurse-led case management of chronic diseases where registered nurses (not APNs) case manage in particular people with diabetes and heart disease. At NUS we have a Masters APN program and we are slowly increasing the APN role in both hospitals and primary care. What do I see as so different? Well, of course it is Asia. It is crowded (especially the trains). Sometimes I find the crowds rather overwhelming and then I escape back to my apartment. The shops are open all week from about 10.30am to 11pm!!! So one finishes work and goes shopping! The people are very friendly. Singapore is very, very safe. While I could not walk around rural Australia at night by myself, I can walk anywhere in Singapore by myself and feel 100% safe. The food is great. Singapore has three cultures – Chinese (about Online Journal of Rural Nursing and Health Care, vol. 9, no.2, Fall 2009 11   Online Journal of Rural Nursing and Health Care, vol. 9, no.2, Fall 2009 80%), Malay and Indian (about 15%), as well as expats. So there is a great range of food and it is mostly very cheap (like $2-3 for a meal from the Hawker stalls). Of course if you want to eat in a top restaurant, there are many, and you pay for that. Alcohol is expensive. Heavily taxed, and most functions are dry (Fanta, Coke, Sprite). Drink driving is really ‘no tolerance’ as if you are below the legal limit but have any alcohol in your blood and are driving erratically they can still charge, cane, imprison you (or all of these options) and take your license away for 12 months. There is no graffiti. No road rage. It is very clean. The toilets are also very clean and are both squat (not for me) or ‘western’ (thank heavens). They don’t eat cats or dogs here either (they may on mainland China, but not in Singapore). As I said it is not far to Malaysia where, of course, there is a large rural population. I have not explored that as yet, but am hoping to once I settle in here as Singapore and Malaysia nurses have many common ties. So you will not hear from me again. Karen Francis will take over the Australian rural nurse section. But in my heart I am still a rural nurse and still working in the area of primary care. I will keep up my international contacts and friendships that I have made over the years that I have been involved with rural nursing. I hope you all have a great Christmas. Even though Singapore is not really a Christian country, they are already putting up all the lovely lights in Orchard Road and there are things Christmassy appearing in all the shops and food places. We have just finished celebrating Deepavali, Hari Raya Haji, Hari Raya Puasa, the Festival of the Hungry Ghost, Vesak Day, and Ramadan – so wonderful the way all these festivals and religions mix so well here. If you are in Singapore look me up here at the Alice Lee Centre for Nursing Studies in Singapore. Best wishes and thank you for all your support over the years.