Remembering S'pore's Sars heroes: Gone but never forgotten

SINGAPORE - His was one of the most heart-rending stories to come from the Sars (severe acute respiratory syndrome) outbreak a decade ago.

Vascular surgeon Alexandre Chao, then 37, had rushed back from Los Angeles (LA) where he was meant to be spending a well-deserved vacation with his wife.

The date was April 5, 2003.

"One by one, his colleagues had fallen to the viral attack. He was the only 'clean' surgeon available to run the medical surgery as he had been away; so duty called," his widow, Associate Professor Koh Woon Puay, now 43, tells The New Paper on Sunday.

"Just four days before, he had persuaded me not to travel to Toronto to present a paper. There had been an outbreak of Sars and he was worried for my safety," she says, trying to hold back tears.

"I don't remember ever trying to dissuade him from returning. Not even once."

Before he left LA, Dr Chao had told his wife: "I'll be very careful. I will not put our family at risk."

That was the last time she saw him alive.

Seventeen days later, Dr Chao died from Sars at the Singapore General Hospital (SGH) where he had worked tirelessly.

"As his wife, I always supported his decisions. Then, I felt like the wife of a soldier returning to the battlefront.

" I couldn't tell him not to go, but quietly wished he did not have to."

Prof Koh, then only 33, was robbed of her soulmate; her two young daughters, deprived of their father.

Moving the box of tissue paper closer to her and pulling out a piece to wipe her eyes, Prof Koh continues.

The sequence of events is still vivid in her mind, from Dr Chao's phone call informing her he had a fever to the day he died.

She recounts: "It was April 11 and I had just returned from dinner.

"It was 10pm and as I turned the key in the lock, I could hear the phone ringing in the apartment."

She rushed to pick up the handset, and heard her husband on the other end.

"I remember his exact words: 'Dear, don't be worried. I have a fever... The protocol is to stay isolated at home for 48 hours and if the fever persists, go to the hospital.'"

Not wanting to pass the infection to his young daughters and elderly mother, Dr Chao moved into his godmother's home down the road.

"His godbrother refused to leave the house, saying he would keep an eye on Alex.

"He did, right up to the day Alex drove himself to SGH," she adds.

Prof Koh arrived from LA on Tuesday night, April15. But Dr Chao had checked himself into the hospital that morning.

They would not get to see each other again.

She says: "We spoke on the phone - constantly - to keep me updated on his condition.

"Alex was asymptomatic - he didn't have the usual signs of the infection. His lungs were clear and he wasn't breathless."

But on the morning of the day he died, Dr Chao's voice was very soft and faint, says Prof Koh.

"We had spoken at 8am, but very quickly, things got worse. He became breathless, and had to be intubated before he was pushed to the ICU (intensive care unit).

"The nurses there later told me he was smiling and waving to them, assuring them he was OK. But he wasn't. He died soon after," she says, tears rolling down her cheeks.

Prof Koh was told Dr Chao probably caught the infection from a cancer patient he was treating. The man had a fever, was breathless and was on dialysis at the hospital.

She admits that she was inconsolable but her daughters' resilience helped pull her out of depression.

"When Alex died, I told Beatrice her papa had gone to heaven and would not be back.

"Many people didn't agree with that approach, but I felt then that she was old enough to know the truth."

Now 13, Beatrice, who is in Secondary 2 at Raffles Girls' School, remembers her father as someone who was very obliging.

She recalls: "When I was young, I asked him to read 10 bedtime stories to me before sleeping. He agreed to.

"We were very enthusiastic at first but grew steadily sleepier with each page. Eventually we fell asleep after the seventh story."

Although she was too young to remember her father when he died, younger daughter Berenice, now 11, says that her favourite memory was of her father sitting on the floor in her room, eating a tub of green tea ice cream.

"I would crawl up to him and he would feed me a little bit, using my baby spoon. Till today, one of my favourite ice cream flavours is green tea, and I think it's because of my father."

Prof Koh has since remarried and the girls took to their stepfather, author George Tan, from the start. She says that when Mr Tan proposed, her daughters told her to marry him "not because you think we need a father but because you love him".

She adds that it takes a confident man to marry a woman with children and elderly parents in tow.

"He even had a bromide of an interview I did with Lianhe Zaobao on Alex framed and hung up in the bedroom. He said it was for the girls, that they keep their father's legacy alive," she asays, smiling.

Yet even after 10 years, dredging up the memories was painful.

"But I want this story told. I want our children and their children to know about this period of Singapore's history.

"Wars can be geographically contained. Infectious disease cannot - and is more devastating.

"Our children must learn to be aware of their own hygiene in order not to spread germs," she says, adding that she is glad the legacy lives on in Chinese textbooks.

"People tell me that Alex was a hero who returned when he didn't have to. But he was not the only one.

"All the doctors, the nurses and those in the forefront of Sars ; those who who died in the call of duty and those who survived despite the odds were and are very much heroes."

SARS TIMELINE

MARCH 1, 2003: Two women are admitted to Tan Tock Seng Hospital (TTSH). Both friends, they had stayed at the Metropole Hotel in Kowloon the month before.

MARCH 12: The World Health Organisation (WHO) issues a global alert on a severe form of pneumonia in Hong Kong, Vietnam and Guangdong province in China.

MARCH 14: In Singapore, there are reports of six more cases of atypical pneumonia, two of which involve healthcare workers.

MARCH 15: Seven more cases bring the total number to 16.

MARCH 17: A total of 20 people are down with Sars in Singapore. Portable X-ray stations and a dark room are set up at the Communicable Diseases Centre (CDC) to facilitate Sars screening. Security guards control and register visitors.

MARCH 19: Sars patients now number 23. Face masks fly off the shelves at retail outlets.

MARCH 21: Number of Sars patients: 39, including four hospital workers.

MARCH 22: Number of Sars patients: 44. Of these, 21 are staff members of TTSH, which becomes the designated hospital for the outbreak.

More than 740 people have to stay at home for the next 10 days. Those who disregard the order face fines of up to $5,000.

Both TTSH and Singapore General Hospital (SGH) cancel non-urgent operations, and outpatient operations are scaled down. A Sars hotline - operational from 8am to 8pm - is set up.

MARCH 24: First Sars patient dies. Paediatric Sars ward set up at TTSH, KK Women's and Children's Hospital. A no-visitor rule starts in Sars wards. Intensive care units and triage stations are set up to screen outpatients with fever.

MARCH 25: Second Sars patient, a pastor, dies.

MARCH 26: TTSH's Emergency Department takes over the role of Sars screening. Five more hospital workers are diagnosed with Sars, bringing the total to 74. Nine are seriously ill.

MARCH 27: All schools - from pre-school to junior college - shut. First Sars patients discharged from hospital.

MARCH 29: Of the 86 people hit by Sars, 25 are discharged. Screening of passengers starts at Changi Airport.

MARCH 31: Airport checks on Sars are tightened. Third Sars patient dies.

APRIL 2: Fourth Sars patient dies.

APRIL 3: Fifth person with Sars dies.

APRIL 5: Sixth death: Miss Chong Pei Ling, 29, who had rushed to the hospital from the airport after returning from a trip to Hong Kong and Beijing.

WHO doctor Carlo Urbani, who had warned the public of Sars, succumbs to the virus in a Bangkok hospital. Outbreak of Sars occurs at SGH. Patients and staff are moved to TTSH.

APRIL 7: TSH cardiology medical officer Dr Ong Hok Su dies. Former Prime Minister Goh Chok Tong announces the formation of a Ministerial Combat Unit for Sars.

School closure is extended. Singapore Armed Forces scales down its overseas training, courses and conferences.

APRIL 8: Number of Sars patients: 157, with 37 probable, 74 suspect and 46 observation cases.

APRIL 11: Launch of the Courage Fund, offering financial relief to Sars victims hospitalised or quarantined during the outbreak.

APRIL 14: Secondary schools reopen.

APRIL 16: Primary and childcare centres reopen.

APRIL 17: The Ministry of Health announces plans to convert Ren Ci Community Hospital into isolation facilities in order to handle the next outbreak.

The Government tops up the Courage Fund with $1 million, awarding it Institution of Public Character status.

APRIL 20: Sars outbreak at Pasir Panjang Wholesale Market. It shuts for 10 days.

APRIL 22: SGH vascular surgeon Alexandre Chao dies from Sars.

APRIL 23: All departing passengers at Changi Airport have their temperatures checked by thermal imaging scanners before going through immigration.

MAY 7: First 40 container isolation rooms ready for operation.

MAY 11: Nurse Hamidah Ismail dies on Mothers' Day.

MAY 18: One more Sars patient is diagnosed, dashing Singapore's hope of being taken off the WHO's list of Sars-affected areas. He would be Singapore's last Sars patient.

MAY 31: WHO declares Singapore Sars-free.

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