Singapore nurse shares on how she prepares children for transplant

Photo above: Ms Cing Khan Lian shows six-year-old Muhammad Arhan Ashraf how to clean his catheter to prevent infections.

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Ms Cing Khan Lian

Age: 32

Occupation: Senior staff nurse at the division of paediatric haematology-oncology at National University Hospital (NUH)

Vigilance is key in Ms Cing's job as a blood and marrow transplant nurse looking after very sick children with low immunity.

She is by a patient's side before, during and after a transplant, giving support to him and his family and watching out for signs of an adverse reaction to the transplant. A transplant involves replacing faulty cells with healthy stem cells - immature cells that give rise to all blood cells.

A child having a transplant has to be nursed before his admission into hospital, Ms Cing said. She teaches patients and their caregivers how to minimise the risk of catching infections.

Ms Cing, who is single, graduated from Nanyang Polytechnic with a diploma in nursing in 2003. She completed an advanced diploma in nursing (paediatric) in 2010. She is part of the team which helped NUH achieve internationally recognised accreditation for stem cell therapy last year.

I specialise in caring for children undergoing blood and marrow transplant because...

Seeing them recover and return to school is very rewarding. They grow up to achieve fulfilling lives and are able to contribute to society.

Blood and bone marrow in children are fascinating because...

They are able to regenerate more quickly in a child than in an adult. This is by virtue of young blood and marrow being more robust.

One little known fact about blood and marrow transplant is...

It is not an invasive surgical procedure. A stem cell infusion is similar to a blood transfusion.

It replaces damaged or destroyed bone marrow with healthy bone marrow stem cells, which are immature cells that give rise to all blood cells.

Patients can receive their own stem cells or those from someone else. Stem cells can be collected from the bone marrow, peripheral blood and cord blood in the umbilical cord.

The majority of patients require only a single infusion.

If I were to give an analogy for what I do, I would...

Be a farmer who prepares the land by filling it with fertile soil for the seeds, which are akin to stem cells in the child's body. I tend to the child, just like how a farmer cares for the farm.

I clear away the "weeds" and ensure the environment is optimal for growth of the "seeds".

I watch the human "living tree" grow a bountiful harvest, while I stand in awe and celebrate life.

A typical day for me...

Starts at 7am and ends at 5pm if I am on the morning shift or 1pm to 9pm if I am on the afternoon shift.

My work revolves around patient care. It starts with a comprehensive handover from my fellow nurse. I check my patients physically in the wards and outpatient clinic, attend to their emotional and psychological needs, educate them where necessary, administer medication and prepare for their discharge.

My day ends with a nice dinner cooked by my mother, when we chat about everything under the sun.

The night ends with prayers together.

I have come across all types of cases...

Both malignant and non-malignant. The ages of the patients I nurse range from slightly older than a year to 18 years old.

Those with malignant diseases, such as neuroblastoma (nerve cancer) and malignant lymphoma (cancer of the lymph nodes), require a bone marrow transplant to eradicate the aggressive diseases. These cannot be cured by conventional chemotherapy or radiotherapy.

After high-dose chemotherapy, which can damage healthy cells too, patients also receive their own stem cells to repair the bone marrow.

For non-malignant diseases, such as thalassaemia, the purpose of a bone marrow transplant is to get rid of the inherited disease.

I love patients who are...

Hmm, I love them all. Going into nursing means that one has made the decision to love. Some patients' burdens are so heavy that they feel crippled and become demanding or difficult, but this is our opportunity to love them unconditionally.

Patients who get my goat are...

None actually. I have prepared myself to serve and once I put on my imaginary armour, I can do all things through faith.

Things that put a smile on my face are...

Seeing my patients hang on to hope, faith and trust and eventually recover. There are many moments when I feel very contented and that is why I am still in nursing.

It breaks my heart when...

We lose a child before or after a transplant. This may be due to infection, a chronic lung condition or a very aggressive disease.

I would not trade places for the world because...

I love being a nurse and I am blessed with a great team here of fellow nurses, doctors and allied health professionals.

My best tip is...

Parents and other caregivers should know that children undergoing cancer treatment have compromised immunity.

If such a child develops a fever, caregivers should not give him any medication, as it may also mask the real problem, which could be a bloodstream infection requiring antibiotic therapy.

Caregivers should seek medical help when their children have fever.

joanchew@sph.com.sg


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