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Today’s China is something like

this impossible animal with two heads facing in opposite directions.TERRY LAUTZ • 14

TODAY • TUESDAY 31 MAY 2016

Recent initiatives such as the launch of a new Wellness Centre by the Stroke Support Station (S3), are important in improving community access to therapy for stroke patients. TODAY FILE PHOTO

Family, community support key in stroke recoveryI was 30 and working as an assis-

tant head at the Economic Devel-opment Board when I had a stroke

in 2011. One Sunday morning, as I was washing my motorcycle, I felt a sud-den pressure in my head and collapsed in the car park. That was where the security guard on duty found me and immediately called for an ambulance.

I had suffered a sudden haemor-rhage in the brain from an arterio-venous malformation — an abnormal tangle of blood vessels — that had, until then, shown no symptoms. The bleeding occurred within the parietal lobe of the right hemisphere of my brain, severely affecting movement and sensation on the left and domi-nant side of my body.

In my journey through the medical establishment since, I have had many opportunities to talk to doctors, ther-apists and fellow stroke patients. But one particular conversation has stuck with me.

An occupational therapist from the wonderful team at Tan Tock Seng Hospital explained to me that in his professional experience, disability was seldom a purely physical phenom-enon. Much depended on the patients’ own reactions to their new physical realities and their willingness to par-ticipate in rehabilitation and to devise coping strategies.

Looking back, my fellow patients who approached their rehabilitation journey with positive attitudes had one thing in common. They were op-timistic about their future at the same time that they accepted their new physical disabilities.

Later on, I discovered that there is a psychological term for this sense

THEIR ROLE IN REINFORCING A PATIENT’S POSITIVE ATTITUDE IS VITAL

Hawyee Auyong is the founder of the Rehabilitation Assistance to Cure Heal and Enable Lives (Rachel) Fund administered by Tan Tock Seng Hospital Community Charity Fund and that provides assistance to low-income families for stroke rehabilitation therapy. He is also a research associate at the Lee Kuan Yuan School of Public Policy.

HAWYEE AUYONG

of optimism tempered by realism. It is called the “Stockdale Paradox”, named after Admiral James Stock-dale, who was the highest-ranking American soldier to be held prisoner during the Vietnam War.

He and his fellow prisoners of war who survived kept each other going, while maintaining a realistic assess-ment of their chances of rescue.

Faced with a challenge or trauma, the Stockdale Paradox defines those who are willing to accept the realities of their situations and yet are confi-dent enough to believe that they will somehow prevail.

IMPORTANCE OF FAMILY AND COMMUNITY SUPPORT

Although attitude and effort may make the greatest difference in how

stroke patients approach rehabilita-tion, family and community support are vital in reinforcing this.

Trauma can be just as hard for fam-ily members and loved ones to come to terms with as it is for those directly affected. But mutual understanding and encouragement can keep every-one grounded and positive.

Family members need to be pre-pared to be flexible to help patients regain a sense of normalcy. Being able to regain some independence in daily routines early on can be a huge boost to self-esteem and encourages further effort.

While family members should provide help where needed, the line between being supportive and being patronising needs to be constantly negotiated.

One of the hardest things for both patients and their immediate relatives to cope with may be negative moods and emotions, which may be a direct cause of the brain injury itself as much as a normal psychological reaction to trauma.

For me, one of the most noticeable mood changes after my stroke was a quicker temper. In the years since, I have learnt to cope by detecting early signs of anger and quickly acting to calm myself down.

Even if both patients and their fam-ilies are invested in the rehabilitation process, the larger social support and healthcare infrastructure must facili-tate the journey.

A 2012 study by the National Uni-versity of Singapore showed that ad-herence to post-discharge therapy in

Singapore was dismal, at less than 40 per cent.

The direct cost of therapy aside, even those with access to subsidies of-ten find the cost of transport prohibi-tive, especially specialised transport such as ambulances, which can cost many times the therapy itself.

Recent initiatives such as the launch of a new Wellness Centre by the Stroke Support Station (S3) this month by Minister for Health Gan Kim Yong are important in improv-ing community access to therapy.

Mr Gan recognised the importance of such community-based efforts in helping stroke survivors “re-inte-grate into society and return to their normal activities as soon as possible”. However, in my opinion, still more can be done to address “last-mile” issues such as travel to and from therapy.

In the United Kingdom, where the National Health Service pays for both post-discharge rehabilitation as well as ambulance transport, therapy ad-herence rate is around 90 per cent, more than twice that in Singapore.

It is imperative that Singapore improves on its rehabilitation adher-ence rate as our population ages. Al-ready, there are more than 10,000 new stroke patients every year, two-thirds of whom suffer moderate to severe physical disabilities.

Community support can help pa-tients take advantage of the crucial one-year recovery window, and stop them from getting trapped in a self-reinforcing cycle of reduced mobility and exclusion from society.

In fact, faster social re-integration may help the country save on long-term healthcare costs by reducing associated chronic illnesses.

Dealing with trauma is never easy, but a positive attitude, encouragement from family and friends, and support from the wider community can great-ly ease the road to recovery.

Five years after my stroke, I still cannot move my left hand much or walk without aid.

But if you ask me if I would trade what I have gained since then in terms of new friendships and life experienc-es for the ability to move normally again, I would be really hard pressed to give you an answer.