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SINGAPORE : The Ministry of Defence (MINDEF) has stressed that its health screening process for pre-enlistees is comprehensive and is of international standards.
It has also explained why there is no need for additional tests, specific to heart conditions.
The comments came as MINDEF gave the media a tour of its health screening facility, after two servicemen died during training about a month ago.
Second Lieutenant Clifton Lam Jia Hao died during jungle training in Brunei, while recruit Andrew Cheah Wei Siong died after fainting during a two-kilometre walk at Pulau Tekong.
Pre-enlistees are given an almost head to toe examination, including blood tests, eye-sight tests, dental examination and chest X-rays.
Over the years, regular external reviews have led to some changes to MINDEF's screening process. Its Medical Classification Centre has a total of seven screening stations.
One of the latest to be introduced in the year 2000 for all pre-enlistees is the electrocardiogram (ECG) screening station. MINDEF said it has been successful in detecting some cases of abnormal heart conditions.
For example, over the past three years, the ECG was able to detect 89 cases of pre-enlistees with rapid heart rhythm, and 8 cases of potential recruits who have problems with their heart muscles. This is a condition known to be associated with Sudden Cardiac Death in young adults.
MINDEF said its screening protocols are more comprehensive than those used by other established armed forces. The ECG, for example, is not considered a feasible tool for routine screening by the American Heart Association, but MINDEF introduced it anyway.
Chief Army Medical Officer, Colonel Dr Benjamin Seet, said: "There's no 100 per cent foolproof test that will pick up every single medical condition. When we look at a pre-enlistee, we will evaluate him from head to toe, literally.
We look at various factors and try to best match and put him in a customised BMT (Basic Military Training) programme that meets his medical training status."
That is why MINDEF thinks it is not feasible for pre-enlistees to be screened more comprehensively for heart conditions.
Dr Terrance Chua, head of the SAF Cardiac Screening Advisory Panel and also the Deputy Director of the National Heart Centre, said: "It gets a lot more complicated when you are looking at (a medical condition that's) not so common and the test has limited accuracy.
"In that situation, you would have to perform the test on a large number of people to pick up the disease. Then you have to think about the unintended effects of that testing.
"For instance, some of the tests - like the CT (computed tomography) scans or treadmill tests - there may be a very small risk involved because of radiation and other effects. Ultimately, you will find that the adverse effects will balance off the advantage of picking up the small number of people (with cardiac problems).
"The other consequence is when you are dealing with a test that is not so accurate, you tend to have a lot of false 'positive' results and that false positive patient will become anxious. He needs further testing as well. That test may involve an angiogram or CT scan or a nuclear test which will also involve radiation."
Dr Chua said cost is not an issue as MINDEF pays for the entire process, which could cost nearly S$500 if a specialised test is required.
The ministry screens up to 27,000 pre-enlistees each year. Of these 850 are found with abnormal heart conditions and sent for further testing.
MINDEF said the incidence of sudden cardiac death for Singaporeans aged 35 and below is relatively low - at 1.3 to 1.7 persons per 100,000 persons annually. - CNA /ls
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