Today a group of the partners went ice skating! I really haven’t been in quite a while so it was a little intimidating but worth a try 😛 We went to Fuji Ice Palace in Jurong East. There were people there having lessons which included little kids under 5 years old. Those little kids were good! But then I guess they do have a lower center of gravity so it’s not as easy for them to fall.

It was slow starting with lots of wall hugging but eventually I got the hang of skating again. I don’t like going fast and it’s kind of dizzying to go around and around and around so we only stayed for an hour and a half before heading back to INSEAD for lunch.

In the afternoon we also had a talk which we were invited to called Business Etiquette and Living in Singapore. The talk was given by a relocation expert to help us settle into Singapore lifestyle. It was a 3 hour talk but well worth the time, she gave us a lot of background on Singapore and also current events.

Some highlights:
1. Singapore has 4 official languages: English, Malay, Mandarin, and Tamil
2. “Salamat Datang” is “hello” in Malay
3. “Vanakkam” is “hello” in Tamil
4. Singapore hs 42km by 23 km (26mi by 14mi)
5. 4.3 million people with approx 1 million tourists per month (!)
6. Singapore has grown larger in size due to reclaimed land. The land was originally taken from its own mountains but now it’s being purchased from Thailand and Vietnam
7. Singapore actually has rainforests!
8. Sir Stamford Raffles purchased part of Singapore in 1819 (you see a lot of buildings named after him and many historic momuments)
9. Lee Kuan Yew was the first prime minister, 1959 through 1990!
10. Singapore’s independence day is September 8, 1965
11. Use your right hand for everything, the left hand is the “dirty” hand
12. Don’t show people your feet, it’s disrespectful (ie, crossing your legs and the soles of your feet are showing)
13. “Tipping is not encouraged”
14. Residents are required to put money into their central provident fund (CPF) for their retirement.
15. It costs approx S$30-40,000 to get a “Certificate of Entitlement” (COE) in order to buy/have a car (you still have to buy the car!)
16. “Kiasu” means “afraid to lose” in Hokkien, you say it to people when people are being pushy without realizing it (ie, pushing their way into the MRT without letting people get out who want to exit)

That’s just a taste of what she talked about with us. She also gave us a great list of places we should visit while living in this area.

Today I visited the practice site that I hope to be working in. The head of the pharmacy dept Prof Chan, Joyce, and I visited Tan Tock Seng Hospital. We met with two other pharmacists, Annie and Yee-May to talk about the opportunities in their hospital.

It sounds like I’ll likely be doing inpatient and/or outpatient anticoagulation. In the inpatient setting, patients who have previously been on warfarin therapy, new starts, and some heparin patients are monitored. The service seems very similar to UCSF in that a patient roster is generated each morning who were ordered warfarin the night before and each patient’s chart is reviewed for notes, medication orders, and resulting AM lab values. Recommendations are made only when necessary and notes are written in the chart. If no recommendations or notations needed then no note is left. The pharmacist is in charge of providing warfarin counseling and setting up outpatient follow-up. The only major difference is that pharmacist can order lab draws for the patient, the PT/INR. Pharmacists cannot write medication orders, they do not have prescribing rights in Singapore.

The outpatient setting is different than UCSF in that they do not use point of care tests, all patients require a lab draw. Also, prescriptions must always be co-signed by a physician. Things like verbal orders do not exist here in Singapore and there is a national clinical pharmacy anticoagulation protocol which is located here if you are interested. Also, patients are not followed for their lifetime even if they require lifelong anticoagulation, these patients can “graduate” from clinic and be seen by their primary doctor less frequently if they become stable on their warfarin dose.

Oh, and there are only 3 strengths of warfarin here: 1mg (brown), 3mg (blue), and 5mg (pink)! So any pharmacists out there reading this blog, keep a watch out for patients from Singapore and them saying the take a brown warfarin tablet, there is a potential for medication error!!

It’s all very different but very interesting, I don’t think I’ll ever get bored.

Now I just have to work on getting my application into the Singapore Board of Pharmacy which I hope to complete soon so I can start my “pre-registration” training, sounds like I’m going to be an “intern” for at least 3 months.

After our visit, Prof Chan treated me and Joyce to coffee and snacks at Starbucks. TTSH is a very different hospital, it houses approx 1200 patients but it’s building is so large that is also houses a large outpatient pharmacy, outpatient clinics, a huge food court, shops (like Starbucks, McDonalds, 7-eleven), and probably lots of offices. It’s also across the street from a mall and right across the street from the Novena MRT station. It’s almost hard to tell that it’s a hospital.

I’m sure I’ll have plenty more to share once I start working, I can’t wait!