Health and Social Work
During the post-war colonial period in the late 1940s through the 1960s, social workers in Singapore were confronted with a large segment of the population whose standard of living was characterized by malnutrition, poverty, underemployment, illiteracy, and exploitation. It is therefore no wonder that the first professionally trained social workers were employed as 'almoners' in the hospital settings dealing mainly with financial assistance and other welfare provisions under the then Social Welfare Department (Vaithilingam, 1980).
Malnutrition of children and its consequential long-term physical and mental damage meant that the work of the medical social workers was mainly focused on working with the doctors to ensure that parents understood and followed through on recommendations regarding the nutritional requirements for the children. In addition to knowing the theory and process of working with the families, medical social workers also needed an understanding of basic dietetics.
Even then the medical social workers were engaged in work that in presentday terms could be defined as 'systemic' and ecological. For example, if parents were not able to care adequately for their children (such as being in ill-health or unemployed and lacking in means), the medical social workers sought fostering arrangements for the children. Readmission of malnourished children to hospitals was frequent, and medical social workers engaged in service development tasks such as galvanizing a voluntary welfare organization to provide convalescent care and helping to establish convalescence facilities for such children.
In the course of organizing foster and convalescent care, the medical social workers unearthed other social needs. Many children with intellectual disabilities (then labelled 'mentally retarded') also needed social care after being abandoned by the parents, and the medical social workers again had to work with community sponsors to provide residential and training facilities for these children. Medical social workers recognized that much of their tasks could not be fulfilled without the support and cooperation of the wider community outside the hospital setting and without influencing policymakers. Special education was recognized as an essential aspect of long-term care of children with intellectual disabilities by the Department of Education after a number of projects conducted by the medical social workers demonstrated its value. The role of the social worker in advocacy then as well as now must be based on evidence from the field and not on rhetorical statements about social needs. Today there are special education programs for children with different types of disabilities, with options for integration into mainstream education programs for children who are able to benefit from them.
Medical social workers have moved on from addressing challenges arising primarily from poverty and poor living conditions such as tuberculosis, leprosy, and malnutrition in the early years to challenges faced by demographic changes and rapid urbanization. Medical social workers now form part of a multidisciplinary professional team in health-care facilities such as hospitals and hospices to address issues arising from a rapidly ageing population, family challenges arising from health issues, and work-life stressors. Collaborating with a host of social service agencies outside the hospitals, medical social workers also address needs related to post-hospital care such step-down rehabilitative care in the community, domestic violence and child abuse, issues of death and dying, palliative care and bereavement, mental health, and illness.
Medical social work is therefore an important aspect of the seamless transition from health care in the hospital setting to community care and vice versa providing psychosocial support as well as practical resources to patients and their families. There are ample opportunities for training in medical social work, firstly from the perspective of a generic social worker and eventually specialization in specific areas of medical social work practice. Currently, close to 40 per cent of medical social workers have postgraduate training in social work practice and the sector enjoys firm support from the government as well as the employing agencies.
Fig. 8.2 Model for Reviewing Agency Intervention
Indigenous models of health and mental health are constantly being examined for differences in health and mental health constructs and preferred responses to health issues in the local context as a consequence of the multicultural mix among patient groups that are being documented.