Random Food Pics 3

During my time off...

I thought shark nuggets (see below) would taste different or have a different texture, but it just tastes like a white fish.  Oh and water chestnut juice might look like sewer water but it is so good!

Kaya Toast, Soft Boiled Egg, Milk Tea

Pork Bugolgi

Cha Siu Wonton Mee

Water Chestnut Juice - delicious!

Lor Mee with Fried Shark Nuggets

"Volcanic Beancurd" (w/fried shrimp)

 

Am Care in Singapore

Yesterday I was able to briefly visit the am care clinics at SGH, more specifically the warfarin clinic.  It is very similar to what happens in the US and is done in person.  The clinic is run by a pharmacist working under protocol as it is in the States.  Patients perform a typical INR test and when the result is in, they are called into the room for evaluation.  The most important difference from the classroom for me at SGH was pharmacogenomic.  It has been well studied and taught to us, but usual American dosing and management of subtherapeutic INRs are too extreme for a predominantly Asian population.  As I learned yesterday, increasing the total weekly warfarin dose by 5% (instead of 10%) is normally sufficient to get the increase you want in the INR.

Warfarin only comes in 3 doses in Singapore so with my first patient I thought I had caught noncompliance with the pill coloring but the patient was actually accurate with the dosing!  1 mg = brown, 3 mg = blue, and 5 mg = pink.  The other pharmacists here were amazed that we have so many doses of warfarin in the US!  Another interesting thing here is that the clinic never gives refills on warfarin.  They always only prescribe just enough to make it to the next clinic visit to ensure the patient returns, and for the most part, the patient does come back for their appointments, which is not always the case in the US.  Otherwise, the practice here is similar to the US since they also follow the CHEST guidelines.  Next week will be the MTM clinic!

Tourist for a Day

My preceptor gave me the day off today to be a tourist so I took advantage of it and marked a lot of things off my list.  First up was the Singapore Botanical Gardens.  Normally plants are just plants to me but most of the guides say to check it out since it's famous so that's how I started the day.  It was extremely hot and humid though as I walked around the park and got uncomfortable pretty quickly.  Good thing today it was unexpectedly free for students!

Lunch was at a nearby English cafe but the food seemed pretty American to me.  It wasn't bad and good value for a 3 course meal:

Mushroom Soup

Salmon, Chicken, Beef Combo Platter

Tropical Fruit Jelly

Following lunch was a trip to the Asian Civilizations Museum which was interesting because it touched upon the pasts of all the major ethnic groups that live in Singapore, showing the diverse cultural backgrounds of the residents here.  A bonus was that this museum also offered student discounts today so admission was only $2 USD!

Then a quick snack break with a sweet corn ice cream sandwich that was only 82 cents USD!

Transiting through Chinatown with a stop at the hawker centre here I made it to the Helix Bridge, constructed to look like DNA (quite appropriate for my area of studies!)

Dinner was very tasty and interesting.  So this was one of the 10 things you must try in Singapore from the best restaurant that makes this item.  It is called Bak Kut Teh and it's actually just a simple soup made from a blend of spices, pork, and pork bones.  The flavor is very peppery from the spices and the broth is very rich from the bones.  The only downside is I think I consumed 3 days worth of sodium in one sitting! 

I ended the day by visiting Gardens by the Bay, another man made park near the edge of the waterfront which is colorful and distinct at night when lights illuminate the trees.

It was a very long day but well worth the time - a good break from the demanding schedule at the hospital but now it is time to get back to work!

Partaking in the National Pastime

Most guidebooks will tell you that life in Singapore is all about 2 things: eating and shopping.  Having been here 2 weeks now and making some new friends, I set out yesterday doing just that.  A few of the other pharmacists and pharmacy students from the National Cancer Centre took me out to dim sum today and we were not shy with the ordering!

The dim sum was fantastic but I'll wait and see how it compares to Hong Kong at the end of my adventure.  After lunch, one of the students (a local) took me and my co-student from Western all around the main parts of the city.  In a span of 12 hours, we went to 9 different malls and 1 museum!  One of the stops was the Peranakan Museum which (lucky for us) was free admission when we visited.

This museum is dedicated to the history and culture of the Peranakans, a mixed ethnic group that came into existence when traders from China settled on the Malay peninsula and Singapore and adapted into the local society and culture about 200 years ago.

One mall in particular was enormous beyond measure.  Mustafa Centre is open 24 hours and I can only describe it as a 6 story Wal Mart mega-ultra-supercenter.  On the 3rd floor, there are 50+ aisles of snacks alone!

I probably spent 2 hours inside and haven't seen everything yet but we got hungry and since we were already in Little India, of course we had to get some Indian food:

Chicken Tikka and Garlic Naan

All in all, a long, exhausting day but I did see a ton of stuff!

Random Food Pics 2: Starbucks and others

Starbucks is outrageously expensive here when you consider that you can get a full lunch or dinner for $3 or $4.  A tall latte costs $5.50 and the cheapest thing on the menu, brewed coffee, still costs $3.70.  That's even more expensive than lunch for some people.  Yet many people still choose to spend their hard earned cash here.  Just like in the US I guess.  On the plus side, they have really unique food items here that trump what you can eat at Starbucks in the States.

Some other random foods or items I've come across so far in my second week here:

Almond and Sesame Paste Dessert

Lamb (Mutton) Murtabak

Drink in a bag...so weird (but only 70 cents)

Laksa

Chicken Curry

Chicken Curry with Roti Prata

 

Thanksgiving Dinner

My preceptor as well as a few of the other pharmacists at SGH did their studies in the US and all of them agree that Thanksgiving was the best US holiday they missed.  Since both I and my co-student from Western would be missing Thanksgiving, my preceptor apparently decided way in advance that he would take us to Thanksgiving dinner.  The funny thing is it turned out to be a buffet style dinner at a bar/restaurant and there were a TON of expats who had the same idea we did.  I miss mashed potatoes the most over here so this dinner came at the right time!

Pumpkin Soup, White Cheddar Mashed Potatoes, Creamed Spinach, Mashed Sweet Potatoes, Bacon Green Beans, Brussel Sprouts, Ham, and Turkey with Gravy

Pumpkin Cheesecake

  All in all a good dinner and a piece of home.

Outpatient Pharmacy and NUS

Yesterday I met up with my original preceptor who had some time to take me around to the other pharmacy operations in the hospital.  Singapore General Hospital is part of a health network called SingHealth and the best analogy to the system here is that it is like a Kaiser system.  There are six different health networks in Singapore and when patients see doctors at the hospital or clinics attached to the hospital, they will usually go to the outpatient pharmacy at that hospital campus to pick up their medications before going home.  That is why retail pharmacy is really more of an afterthought here, meaning very few people actually use a retail pharmacy to get their meds.  As you can imagine, the outpatient pharmacy at SGH gets pretty chaotic.  They have over 30 full time pharmacists who verify medications and perform clinical checks.  The really cool thing about this pharmacy is that they have a whole barcode, conveyor belt, robotic system that will take the script, count the number of tablets, packages, etc., and fill the prescription.  It is entirely automated and the strange thing here is that everything is in unit dose packages which is usually more expensive, but for some reason here it is cheaper.

Later on in the day, my actual preceptor took me over to the pharmacy school at the National University of Singapore to see the campus.  In a way, the pharmacy part of NUS is like UCSF or UCSD; it is only 2 buildings dedicated for pharmacy.  The class size is similar as well with 150 students or so per class.  The main difference is that these students will graduate with a BPharm.  Unlike at UCSF, the school of pharmacy here is an undergraduate program so students can start right after high school.  The PharmD program is another 2 years afterward and currently only has 9-10 students.  There is a lot more labwork in the NUS pharmacy curriculum so my preceptor took me to one of the labs where they learn compounding as well as what we would consider undergraduate chemistry lab:

Other than the fact that the NUS campus is so large there are 3 Starbucks on campus, it is just like any other college campus. 

Food Courts

When it comes to eating here, arguably the quintessential Singaporean dining experience is the hawker center.  There are many of these hawker centers spread throughout the city and each of them is more or less like a giant food court with many independent stalls.  The key thing about hawker centers is that they're dirt cheap and amazingly delicious at the same time.  Oh and it's cash only so make sure you have enough of that (but honestly a few bucks is more than enough.  It took me a week and a half to find out I live 2 blocks from one, but better late than never!  This particular hawker center (Tiong Bahru Market) takes up the entire 2nd floor of the shopping complex and has 80+ stalls that sell different things:

Many of the individual dishes here are about $2.50 USD meaning if you usually spend about $10 in the US for lunch, you can get 4 different good sized meals here!  I had a local specialty called Char Kway Teow which is a soy sauce noodle based dish.  Very flavorful with sweet chinese sausage, eggs, soft fishcake, and clams:

Along with the large sugarcane juice with lemon, the total damage was $3.85USD.  You can bet I'll be a frequent visitor here!