KK Women's and Children's Hospital


The KK Women’s and Children’s Hospital has a history that stretches back to 1858 as the fifth general hospital established since Stamford Raffles set up a trading post in Singapore in 1819. The hospital officially became a maternity hospital on 1 October 1924. Today, KK Women’s and Children’s Hospital is the largest medical facility in Singapore, specialising in obstetrics, gynaecology, neonatology and paediatrics. It is also the only integrated women’s and children’s hospital in Singapore.

History
The origins of KK Women’s and Children’s Hospital can be traced to the general hospital opened around 1860 in the Kandang Kerbau district.1 Located at the junction of Bukit Timah and Serangoon roads, this general hospital was the fifth to be constructed in Singapore since Raffles landed in 1819. The hospital was built to provide medical care for the population, which had by then grown to over 50,000. The hospital was divided into two sections: Seaman’s Hospital for the Europeans, and Police Hospital for the locals.2 This general hospital was popularly referred to by the locals as the Kandang Kerbau Hospital because of its location. A buffalo pen or buffalo shed (kandang kerbau in Malay) owned by the colonial government’s Department of Transport was believed to have been located there. The Hokkiens and Teochews referred to the hospital as Tek kah (zhu jiao in Mandarin), or Hokkien for “foot of the small bamboos”, as bamboo plants used to grow on the hillocks below which the hospital was located.3


In 1865, the hospital started admitting women for childbirth and other gynaecological conditions.4 In 1870, the Contagious Diseases Ordinance was enforced to curb the rise of sexually transmitted diseases. Under the ordinance, all brothels in Singapore were registered and prostitutes subjected to regular health checks. The infected prostitutes were then admitted into the hospital’s women’s ward for treatment. In 1872, the women’s ward became known as the Lock Hospital and was equipped with 20 beds.5

After an outbreak of cholera in the neighbouring Lunatic Asylum in 1873, patients from the general hospital were evacuated to Sepoy Lines, while those from the Lock Hospital were transferred to a rented house. The latter returned to the general hospital when the outbreak was contained. In 1884, the Lock Hospital began providing treatment for licensed prostitutes suffering from all diseases other than venereal diseases, and four years later, it became a voluntary institution. However, after admissions fell and the number of venereal disease cases increased, an outpatient department was started at the hospital for women who needed treatment but did not want to be admitted.6

In 1905, impoverished female patients from the Tan Tock Seng Hospital were transferred to the Kandang Kerbau Hospital. Subsequently, the hospital also admitted female lepers and poor children. Thereafter, it became known as the Pauper Hospital for Women and Children.7

Free Maternity Hospital
Over time, women became aware of the higher standard of maternity care at hospitals, and more chose to deliver their babies in hospitals instead of at home. As a result, there was a pressing need to provide more hospital beds for these women. When it became apparent that the existing Free Maternity Hospital on Victoria Street and the Maternity Block of the General Hospital (now Singapore General Hospital) at Sepoy Lines were unable to meet the increasing demand for maternity services, the authorities approved a proposal to convert the hospital at Kandang Kerbau into a maternity hospital.8


The hospital closed for renovations in December 1923 and opened as the Free Maternity Hospital on 1 October 19249 for the poor who could not afford medical fees. The hospital, which had 30 beds and 12 children’s cots,10 was headed by Dr J. S. (Joseph Sandys) English, a professor of midwifery and gynaecology at the King Edward VII College of Medicine.11 

The hospital came to be known as the Kandang Kerbau Hospital or KK Hospital.12 Five babies – three Malays, one Japanese and one Chinese – were born in the hospital on the first day it opened.13 By the end of its first year of operation, the hospital had admitted 714 patients, taken care of 688 deliveries and performed 48 gynaecological operations.14 During this period, three other hospitals were also involved in deliveries – the General Hospital at Sepoy Lines, the Cantonese Kwong Wai Shiu Hospital and the St Andrew’s Mission Hospital. Nonetheless, many babies were still delivered at home, sometimes by untrained midwives. KK Hospital was therefore a welcome service for Singapore which had a high birth rate then.15 In 1934, its 10th year as a maternity hospital, there were 2,826 admissions and 2,579 deliveries.16

As early as 1936, a decision had been made to construct a new block at KK Hospital. Plans for the extension were passed in 1937. In this year, there were 5,214 deliveries, partly due to the admission of all third-class patients, who did not have to foot hospitalisation bills, into KK Hospital. First- and second-class patients were admitted into the General Hospital’s Maternity Block. The new $275,000 extension was completed around the end of 1939. The three-storey building housed labour wards, isolation wards, lecture rooms for medical students of the King Edward VII College of Medicine, staff offices, flats for resident medical officers and a laboratory.17

Japanese Occupation and postwar developments
When the Japanese Occupation (1942–45) began, the KK Hospital – then equipped with 500 beds – was converted into an emergency general hospital for treating war casualties. During the war, Prof English was interned in Singapore and the hospital was renamed Chuo Byoin, which means “Central Hospital”. It became a general hospital where patients included Japanese civilians and the local population. The hospital was then headed by medical superintendent Dr Tanaka with Benjamin Henry Sheares (who later became the second president of Singapore; 2 January 1971–12 May 1981) as the deputy medical superintendent.18 In 1942, Dr Sheares introduced and performed the lower-segment method of the caesarean section operation on patients at the hospital. This technique significantly reduced the risks to mothers as well as improved wound healing so that the wound was less likely to rupture in a subsequent pregnancy.19


After the war, from 1 July 1946 onwards, KK Hospital resumed its function as a maternity hospital. Following a reorganisation at the three government hospitals, gynaecological and obstetric services were centralised at KK Hospital, serving both free and paying patients. It thus became the main maternity hospital in Singapore, as well as a specialist in women’s diseases. The General Hospital at Sepoy Lines became the principal hospital for acute medical and surgical cases, while Tan Tock Seng Hospital admitted convalescing patients from the General and KK hospitals.20

1950s to 1980s
KK Hospital became very popular over the years and grew from strength to strength. In 1950, the average number of births per month was 1,000 (13,328 for the year), and this increased to 1,200 a month in 1952 (15,321 for the year).21 To meet the demand for maternity beds, the foundation stone for new extensions to the hospital was laid by then Governor John Nicoll on 6 October 1953.22 Although the opening of the new wing on 10 August 1955 increased the number of beds from 240 to 316, it was still insufficient due to the postwar baby boom. An all-time record of 2,180 babies were born in KK Hospital in October 1955.23


In another attempt to alleviate the bed crunch, the Domiciliary Aftercare Service was initiated in May 1954 for normal cases without complications. These women were discharged and sent home by ambulance 24 hours after their babies were born. Midwives visited these women at their homes to provide postnatal care and reported any abnormality to the hospital. In August 1955, the Domiciliary Delivery Service was introduced where mothers could choose to deliver at home. The normal cases who had received antenatal care at the hospital were interviewed and assessed for their suitability. The first baby was delivered under this service in September that year. Both services were discontinued in 1968 when birth rates declined and more women chose to have their confinement in the hospital.24

In 1956, a nursery on the second floor of the new wing was converted into a special area for premature babies. The use of incubators for the first time in the latter half of 1958 helped to reduce infant mortality rates. In the 1920s, infant mortality was about 250 for every 1,000 births; by the late 1980s, this had dropped to below 10.25

The period from 1960 to 1968 saw more than 36,000 deliveries each year. KK Hospital earned a place in the Guinness Book of Records with 39,856 deliveries in 1966, a record it held until 1976.26

Singapore’s birth rate declined as a result of a series of family planning campaigns launched by the government in the 1960s and 1970s.27 In 1970, the number of deliveries at KK Hospital fell below 30,000 and further declined in the 1980s, dipping below 20,000 in 1986. Another reason for the decrease was attributed to the opening of obstetrics and gynaecology units at the Thomson Road General Hospital (later known as Toa Payoh Hospital and now Changi General Hospital; 1969), Alexandra Hospital (1971), National University Hospital (1986) and Singapore General Hospital (1986), as well as a growing pool of obstetricians and gynaecologists in the private sector.28

Restructuring and relocation
KK Hospital was restructured on 1 April 1990 and it began operating as a private company though still owned by the government.29 Following the restructuring, the obstetrics and gynaecology departments and neonatology units at Alexandra and Toa Payoh hospitals were relocated to KK Hospital.30

In March 1997, KK Hospital moved to 100 Bukit Timah Road, opposite its former site on Kampong Java Road. Renamed KK Women’s and Children’s Hospital, its new building was equipped with more than 800 beds, a children’s emergency department and a 24-hour women’s clinic.31 The paediatric medical services at the Singapore General, Alexandra and Tan Tock Seng hospitals were centralised at KK Hospital.32 It was officially opened by then Prime Minister Goh Chok Tong on 10 October 1997.33 In March 2003, the old hospital site was designated a historic site by the Preservation of Monuments Board (now known as Preservation of Sites and Monuments).34 The old KK Hospital building has served as the headquarters of the Land Transport Authority since 1997.35

Description of hospital building
The KK Women’s and Children’s Hospital, which is spread over 4.8 ha, features two six-storey towers on a four-storey podium.36 The building was designed by architect Tay Kheng Soon and constructed at a cost of S$393 million. The wards are arranged in a “race track” layout to allow for better lighting and ventilation.37


Centennial in 2014
In 2008, KK Women’s and Children’s Hospital celebrated the 150th anniversary of its founding, and in 2014, it will celebrate its 100th year as a maternity hospital. As part of the centenary celebrations, a time capsule buried in the hospital’s forecourt by then Minister for Health and Environment Yeo Cheow Tong on 30 July 1997 was unearthed. The capsule contained hospital records and medical equipment such as a foetal scope dating back to the 1950s and a set of forceps used in assisted deliveries. It also includes the 1966 certificate from the Guinness Book of Records which was awarded to the hospital for delivering the most number of babies that year.38


Timeline and major milestones
1858: The fifth general hospital is opened in the Kandang Kerbau district.
1 Oct 1924: The Free Maternity Hospital (also referred to as Kandang Kerbau Hospital) is opened.

1942: KK Hospital is converted into an emergency general hospital during World War II and renamed Chuo Byoin.
11 Sep 1961: Singapore’s first pair of conjoined twins, Karen and Kate, are born at KK Hospital.39
1963: KK Hospital is accredited by the Royal College of Obstetricians and Gynaecologists as a postgraduate training centre.40
1966: KK Hospital is listed in the Guinness Book of World Records as the world’s busiest maternity hospital with 39,856 deliveries in 1966.
1982: The In-Vitro Fertilisation (IVF) and Embryo Replacement Programme is introduced at KK Hospital.41
19 May 1983: Southeast Asia’s and Singapore’s first “test-tube baby” (born via the IVF procedure) is delivered at KK Hospital by Prof S. S. Ratnam.42
1 Apr 1990: KK Hospital is restructured to operate as a private company, though still wholly owned by the government.
1993: The first intrauterine blood transfusion in Singapore is performed on an anaemic baby at KK Hospital while it was still within its mother’s womb.43
1995: KK Women’s Clinic, the hospital’s first outpatient branch, is opened in Ang Mo Kio Central.44
1997: KK Hospital is relocated to Bukit Timah Road and renamed KK Women’s and Children’s Hospital.
Sep 1999: The microwave endometrial ablation procedure is used to treat heavy menstruation, the first hospital in Southeast Asia to do so.45
Mar 2003: The old Kandang Kerbau Hospital site is designated a historic site by the Preservation of Monuments Board.
2005: Southeast Asia’s first Cleft and Cranofacial Centre for children is opened.46
2008: The hospital celebrates its 150th anniversary.47
2013: The hospital commences art therapy.48



Authors

Veronica Chee and Naidu Ratnala Thulaja



References
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38. Ho, D. (1997, July 31). A & E clinics just as cheap as general practitioners. The Straits Times, p. 33. Retrieved from NewspaperSG; KK Women’s and Children’s Hospital: 150 years of caring (1858–2008). (2008). Singapore: KK Women’s and Children’s Hospital, p. 98. (Call no: RSING 362.19820095957 KK) 
39. Separated in 1961: S’pore’s own Siamese twins. (2003, June 8). The Straits Times, p. 26. Retrieved from NewspaperSG.
40. KK Women’s and Children’s Hospital: 150 years of caring (1858–2008). (2008). Singapore: KK Women’s and Children’s Hospital, p. 69. (Call no: RSING 362.19820095957 KK)  
41. KKH milestones. (2002, November 20). The Straits Times, p. 6. Retrieved from NewspaperSG.
42. Chong, G. P. (1983, May 20). It’s a boy. The Straits Times, p. 1. Retrieved from NewspaperSG.
43. KKH milestones. (2002, November 20). The Straits Times, p. 6. Retrieved from NewspaperSG.
44. Yap, E. (1995, April 23). KK Hospital branches out to cut delays. The Straits Times, p. 5. Retrieved from NewspaperSG.
45. No incision and pregnancy, though not advisable, is possible. (2001, July 15). The New Paper, p. 12. Retrieved from NewspaperSG.
46. Yadav, S. A. (2004, October 23). NKF opens new centre at KK Hospital. Today, p. 8. Retrieved from NewspaperSG.
47. Kesava, S. (2008, July 28). Milestones over the years. The Straits Times, p. 24. Retrieved from NewspaperSG.
48. KK Women’s and Children’s Hospital. (2014). Milestones: KKH in the 21st century. Retrieved from KK Women’s and Children’s Hospital website: http://www.kkh.com.sg/AboutUs/Overview/HospitalMilestones/Pages/Home.aspx



The information in this article is valid as at 25 January 2016 and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.

Subject
Health and medicine>>Health services
Women's hospitals--Singapore
Children--Hospitals--Singapore
Politics and Government>> Health
Public buildings
Hospitals--Singapore
Architecture and Landscape>>Building Types>>Civic and Administrative Buildings
Public health

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