From the beginning, doctors, nurses and many healthcare professionals are taught to do everything they can to save their patients’ life. I know this because I was a combat medic who had a small but impressionable experience in resuscitation and treatment. I also know this because I recently caught up with a close friend of mine, who recently graduated from medical school and is doing her housemanship at different hospitals, and we touched on the limitations of the healthcare system.
If anything, the Covid-19 pandemic has revolutionised the practice of medicine, including shaking up this fundamental imperative; patients down with Covid-19 are advised to practice self-isolation and home recovery, while telemedicine or teleconsultation have helped offset the workload of hospitals.
“In the early days, (many healthcare professionals) faced some form of social stigma,” says Dr Dinesh Visva Gunasekeran, the Vice Chairman of GP+ Co-operative Limited (GP+ Co-op), on the emotional challenges healthcare professionals had to deal with. “There was a small group of people, who acted out of fear and character, when they saw us from afar.”
The co-operative that he, along with many healthcare professionals, is part of, happened to be a hub of solace and support. “GP+ Co-op is meant to be a partnership between different healthcare providers, not just doctors, who are aligned on wanting to help improve care (within the healthcare community),” he says. “We could lean on one another.”
He emphasised: “We are not profit-motivated, but rather impact motivated.”
On being a co-operative, Dr Dinesh thinks that the co-operative model is “very interesting”. He says: “We are talking about an organisation that is very democratic and different from a Private Limited company or a Limited Liability company. Co-ops have proven to be an effective form of governance, especially when working on non-profit works or community engagements.”
SNCF recently caught with Dr Dinesh who shared more about GP+ Co-op, how Covid-19 has affected the medical landscape and the influence youths have to do good.
SNCF: What is GP+ Co-op and what do you do there?
Dr Dinesh Visva Gunasekeran: GP+ Co-op is a voluntary organisation. We work primarily with healthcare professionals who are aligned on the mission of improving qualitative care for the broader population. My role involves volunteering at conferences or creating partnerships with digital health companies.
In 2021, I was appointed as the co-op’s new Vice Chairman. I’m working on improving collaborations and engagements among our members, who are healthcare professionals, and partnering digital health companies to reach out to more Singaporeans.
SNCF: Last October, GP+ Co-op celebrated its third birthday. As a fairly new co-operative in Singapore, how has Covid-19 impacted GP+ Co-op and its members?
Dr Dinesh: It was extremely challenging at the start. Many of us are frontliners and, inevitably, some of us contracted Covid-19. It was a very stressful time for us and our families. The way the pandemic panned out was really a test of our resilience.
Not only were we facing a very real health threat, we were also facing some form of social stigma too. There was a small group of people, who acted out of fear and character, when they saw us from afar. It was an emotional challenge because we felt that we were putting our lives on the line to support the people that we serve, but many did not quite support us.
Fortunately, GP+ Co-op turned out to be the safe space we needed. We had opportunities and virtual platforms for healthcare professionals, including our own general practitioners (GPs) and optometrists, to share our challenges and lean on one another.
SNCF: Covid-19 has changed the way medicine is practised. What are you seeing on the ground?
Dr Dinesh: Telemedicine entered the public consciousness some five years ago, but it wasn’t until the pandemic that accelerated its adoption and brought it to the forefront.
We noticed that there were patients who can be managed remotely and safely, and many of whom are patients that we are familiar with. For teleconsultation to work, it’s important to have established a good patient-doctor relationship; GPs need to be able to build rapport and trust so that our patients will be comfortable enough to let us in on their illness.
SNCF: What are the challenges with telemedicine?
Dr Dinesh: The challenge with telemedicine is that the patient is not physically in front of you. There is no one to make a physical assessment on. GPs cannot palpate areas for tenderness, feel for masses in the tummies, or listen to the lungs for phlegm or infection. All these make diagnosing medical conditions challenging.
Because of how quickly we had to adopt this during the pandemic, the main challenge was really operationalising it safety and identifying the right patients. By that, we mean identifying patients who can manage the technology or have the ability to understand the things to look out for.
SNCF: In an interview with The Straits Times, Dr Leong Choon Kit, the Chairman of GP+ Co-op, mentioned how patients prefer conferring with their family doctors, or GPs, for support. Are people receptive to telemedicine?
Dr Dinesh: Many patients do not like (telemedicine); they prefer having direct physician contact or traditional in-person care. This is fine because healthcare is a very personal thing. For GPs, it is important to filter the right patients for telemedicine.
But if you ask us, we do prefer in-person care because we get to connect with our patients and examine them properly. However, there is still a growing group that prefers remote care. They could be the single mothers or the young, middle-aged caregivers, who are very time-pressed. For them, telemedicine is a lifesaver as it gives them access to care that they might not have otherwise had time to pursue.
SNCF: From the last public health crisis, we have all grown to become more resilient and raise our level of preparedness. Do you think Singapore was prepared for Covid-19?
Dr Dinesh: Relative to all the other countries that responded to Covid-19 earlier on, I think we were at the forefront of this battle. There was plenty of international coverage on how Singapore was nimble in responding to the crisis. We have been a relatively forward-looking society and have invested resources in capacity building and crisis management, which was why we were able to pull through relatively quickly when Covid-19 hit.
SNCF: Let’s talk about you. Why start a career in healthcare? Why did you join GP+ Co-op?
Dr Dinesh: I entered healthcare because I wanted to make a difference to others. When I first met Dr Leong, who was the original founding Chairman of the co-operative, I was taken away by his plans and his mission of the co-operative. Joining GP+ Co-op was a natural thing; I can volunteer some of my time to improve care from the ground up and drive change.
SNCF: Being in your 30s, we would say you are one of the younger co-op members in Singapore. How can we get more youths to join a co-op or be involved in the co-op movement?
Dr Dinesh: What I really like about youths of today is how well they can organise themselves around a mission. I've seen many ground-up charity projects that were led by youths. Many of them have used social media, such as TikTok and Instagram, and these missions are so diverse in terms of mandates which run the gamut from sustainability to gender equality.
We should perhaps consider giving youths basic support – such as educating them on the legal ramifications of running a co-op or the accounting processes required – as well as access to scalable means to run their projects. Youths who want to champion certain social missions can benefit from becoming a co-operative, which provides them with governance, scalability, and sustainability, instead of just relying on social media.
SNCF: Speaking of being a youth, you were one of the 30 nominees in Forbes Asia’s 30 Under 30s back in 2018. Tell us about that experience!
Dr Dinesh: To be honest, that was quite a surprise! I was nominated for being part of the initiative that uses Augmented and Virtual Reality to facilitate the early detection of eye diseases. My team and I didn't expect that level of recognition for the work that we had done. In fact, I was a bit embarrassed because I was the only face that was put on there. It wouldn't have been possible without each and every one of those involved.
SNCF: You used to volunteer your time at neighbourhoods, such as Chinatown and Little India, to conduct health screenings for the population there. Tell us more about what you did.
Dr Dinesh: When I was an undergraduate, my classmates and I would volunteer at local health screening programmes. Some of the residents may not have access to or afford traditional healthcare services. What we did was to create programmes around health education, linking these residents up with financial support, and even bringing doctors and nurses to their neighbourhoods to do some basic screenings.
SNCF: What did you glean from those experiences?
Even when you lower all these barriers to health care, many are still hesitant. It could be because of a lack of understanding about the illnesses, the stigma of seeking treatment, or even the fear of finding out that something is wrong with them. This made me realise that we had to educate and highlight the importance of going for screenings.
SNCF: As someone who wears many hats, what empowers you at your work and what keeps you going?
Dr Dinesh: Healthcare is such a massive, heterogeneous sector; it's very easy for initiatives to get lost in different segments of this sector. I deliberately take on these roles to get a sense of things that are going on, both from the academic point of view and where things are in their early stages, as well as to get a view on how these can impact medical practice.
As an educator, I realised my students are very interested in innovation and I want to make sure I can give them insights that are not solely academic and research oriented. And that’s where my interactions with my colleagues from GP+ Co-op helped.
SNCF: What is your personal end goal then?
Dr Dinesh: I’m trying to develop a system for healthcare that is more scalable and less costly to provide basic care services. I'm following the interests that I have and receiving guidance from my mentors, such as Dr Leong. We are looking at how we can improve things overall for our patients. It's very hard to see a specific direction because a lot of these initiatives are new and difficult to predict.
SNCF: Assuming we don't get any more curveballs, what can we expect from a GP+ Co-op in 2022?
Dr Dinesh: I guess you will have more visibility of us, beyond our established existing practices. We'll be looking at more digital approaches to connect with patients to promote healthy lifestyles.
By Sng Ler Jun
Interview has been edited for clarity.