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This year, Senior Nurse Clinical Nagalingam Saraswathi turns 70. Affectionately known to many as ‘Sister Sara’, she is Singapore’s first Breast Care Nurse (BCN). Thanks to her, all public hospitals here have a BCN.

An Adventure into the Unknown

Sister Sara (Second from left, back row) starting out as a young nurse

At the tender age of 20 in 1972, Sister Sara started as an Enrolled Nurse, in the Intensive Care Unit. A Registered Nurse a decade later, she specialised in Oncology, and was a member of the Bone Marrow Transplant team. In 1992 when she was approached to be sent for training in the UK to become a specialised Breast Care Nurse, to care for patients who had a mastectomy, she hesitated, unsure of what this entailed but in the end said yes. She had never stepped foot outside of Singapore and when asked if she was nervous or afraid, she replies with a twinkle in her eyes, ‘No, I wasn’t nervous at all! In fact, I was so busy with my handover before leaving that I fell sick. When I arrived, the senior nurse was extremely kind and caring. She told me to rest for a few days and then come in when I felt better.’ This first encounter in the UK inspired her, ‘I wanted to be like this to my staff’.

Those six weeks in the UK ignited a spark. Sister Sara excitedly describes how much she learnt from her training and attachments, together with nurses from Australia and other parts of the UK. ‘I was so inspired! Every bit I learnt, all my ideas, plans and notes – I wrote them down in a little notebook which I still have!’

The Birth of BCNs in Singapore
On her return from the UK, she was brimming with ideas, and plans and on a mission. It was a lot of work. Sister Sara had to start her own training, teaching, establish new processes and procedures as well as develop a rehabilitation programme for patients recovering from mastectomies. She even presented a research paper every year. As the first BCN in Singapore, she was very enthusiastic to establish Breast Care Nursing in Singapore. ‘I conducted my own 6-week training course for nurses from other public and even a few private hospitals. The idea was that these nurses would go back to their hospitals and start a Breast Care Nursing service.’

The Importance of being a BCN
Many of us have little idea of what a BCN does. Sister Sara offers a bigger and complete picture of what being a BCN entails. BCNs have clinics where they see breast cancer patients before, during and after treatment where they give medical guidance and advice.

A very important element is helping patients through their crisis to recovery journey. ‘When a patient is diagnosed with breast cancer, she is shocked, confused and at a loss. We see them immediately upon their diagnosis and 90% of the time, patients can’t recall or recall wrongly what the doctor told them. We counsel them, assess what’s their main concern, reassure them and give them hope and then they start to come out of the crisis a bit. We provide a number they can call so they have a resource. We also look into their emotional, mental and financial states as well.’ To do this, BCNs build close and supportive relationships with patients. After their surgery, the nurses continuously stay in touch. Sister Sara adds, ‘When patients recover and are fitted for prosthesis; when they are happy and call me to say they are coping well – this is the best reward!’ 

Besides educating patients and their caregivers, the BCNs train nurses as well. They also conduct evidence-based research and work on projects to improve processes and procedures, even policies. An example is how they are working to standardise the Well Women Programme for staff across all SingHealth institutions.

Blossoming in the community
Sister Sara started the Breast Cancer Support Group ‘Blossoms’ in 1992. ‘I realised patients were very frightened, and had many questions. I got together a small group in the beginning and worked with contacts in the Singapore Cancer Society to form Blossoms. In time, we groomed our own volunteers from among our patients and their caregivers.

A Blossoms year end party before the pandemic with Blossom members & their families, the BCN team and volunteers. Sister Sara is in the centre, in blue.

Another area she is passionate about is education and outreach programmes in the community to raise awareness of breast cancer. ‘Today we are even visiting secondary schools,’ says Sister Sara. Their work is paying off as the team is starting to see a rise in early detected cases.

‘I have been leading a team of Speciality Nurses in overseas mission work since 2008 and collaborated with overseas partners for training of BCNs.’

The Future of BCN
There is a joyful glow as Sister Sara recounts her 30-year journey as a BCN nurse. Although hitting 70, there are no indications in her appearance and enthusiasm. ‘As long as I can do BCN work, I would love to carry on. Our team is like a family – they treat me like their mum. My role is to nurture, support and motivate them, and create an environment where improvements and patient safety are possible. When it comes to my people, I believe in working with my heart, not by the book. And of course I have to keep up to date as well, especially with technology. But my girls help me get started with online shopping, ibanking etc…

The success I have is due to the people around me. My late husband was very understanding and supportive during the early years when I put in many long hours. At work, the Nursing Division, the doctors, surgeons and allied health colleagues have all been so supportive – always open to collaborating with me and open to ideas and suggestions. This is the case even today and I believe it will continue as we journey into the future.’

Did you know?
• Besides being the first BCN nurse in Singapore, Sister Sara was also SGH’s first winner of the President Award for Nurses in 2001.
• In 2012, she was awarded the National Day Award for The Long Service Medal
• She has also been recognised for her contributions to the community by the Hindu Endowment Board – Excellence Award in 2022.

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