When corporate pilot Cyril Letzelter gets the chance to fly to the United States every three months, he stocks up on clothes for himself, his wife and his two children.

“Children’s clothing at a Walmart in the US can cost US$3 (S$4.10) a piece but in Singapore, it’s at least US$15,” said the 48-year-old American, who is not surprised that Singapore has been found the most expensive city in the world for expatriates. He moved here in November 2013 with his wife Jennifer, a 35-year-old engineer.

They have two young daughters who are three months and 23 months old. Their maid is paid $1,000 a month.

Said Mr Letzelter: “We’re adventurous people and we were looking for a place to raise kids that could provide them with a unique culture.

“The pay was good and the math worked out well.”

The couple earn about $29,000 together, but even then, it meant making adjustments to their lifestyle.

Mr Letzelter’s previous house near Denver, Colorado was 610 sq m, while his wife had a house near Boston that was about half of that size. Now, their apartment in Thomson is about 150 sq m.

Mr Letzelter said: “Housing is crazy expensive here. We’re paying $4,400 in rent.

“For that amount, we can get two cars and a very big house in the US.”

They have also chosen not to buy a car despite owning two in the US.

Having bought their cars at about US$20,000 each there, they baulk at having to pay at least $80,000 here. But they like the relatively cheap public transport here.

Mrs Letzelter said: “Taxis are very cheap and public transportation is amazing. In other countries, we would have to have a car, but here, we have no problems.”

While they can adjust to a smaller home and public transport, getting used to local food has been a lot harder, so they pay extra for imported foodstuffs.

At $2,400 a month, their grocery bill here is triple what they usually spend in the US.

Mrs Letzelter said: “Grocery shopping is shockingly expensive. We try to shop at FairPrice because it’s cheaper, but oftentimes we pay a lot of extra money to get products that make us comfortable.”

While the family had initially planned to live here for a decade, they have recently started to contemplate a move back to the US.

Mr Letzelter has noticed a significant attempt by the Singapore Government and firms to hire more locals rather than expats since 2014.

“Far fewer expats are getting expat contracts, with many getting only local contracts, and the salaries are not as high,” he said.

His wife was only able to find work as an engineer on a local contract. She said she felt compelled to work as the high cost of living here meant that the couple could not meet their financial goals – saving for retirement and their children’s college funds – just on Mr Letzelter’s salary alone.

The couple said other American expats are thinking of moving out or have already done so.

Mrs Letzelter, a member of the American Women’s Association of Singapore, said the association used to have significantly more members. The improving US economy and a strengthening US dollar also make it tougher to stay here.

When Mr Letzelter first joined his company here in 2013, he was getting paid about 40 per cent more than he was in the US. But this has since narrowed to 20 per cent.

He said: “We really do like it here, but if the math doesn’t work out, we’ll go back earlier,” he said.

THE LETZELTERS’ AVERAGE MONTHLY EXPENSES

RENT: $4,400

GROCERIES: $2,400

PUBLIC TRANSPORT AND TAXIS: $800

EATING OUT: $500

EDUCATION: $1,000

HELPER: $1,000

UTILITIES: $350

ENTERTAINMENT: $200

TOTAL: $10,650 (all in Singapore dollars)

*Also spends $15,000 a year for travel back to the US

domteojy@sph.com.sg

This article was first published on March 27, 2016.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

The cost of high-end housing, private schools and cars may be sky high in Singapore, but for many expatriates, going “local” makes living here quite affordable.

And that means eating at hawker centres, buying groceries from wet markets and eschewing private transport for trains and buses.

This is what many of them told The Sunday Times when asked about Singapore’s thrice-awarded title of being the most expensive city in the world for expatriates.

The Economist Intelligence Unit (EIU), the research and analysis division of British media firm The Economist Group, produces the worldwide cost of living survey to help firms come up with compensation packages and allowances for expatriates and business travellers.

It takes into account more than 400 individual prices across 160 products and services in calculating its cost of living index.

Singapore has placed top since 2014, and was ranked first again in the latest report earlier this month, ahead of Zurich and Hong Kong, which shared second place, with Geneva coming in third.

The Singapore Government responded to this with a detailed post on its gov.sg website to explain why the country was top of the chart.

A key reason was the Singapore dollar’s strong appreciation against the United States dollar in the last decade, and the type of upmarket goods that the survey takes into account, such as filet mignon and international newspapers.

It also reported that the prices quoted by the EIU for many products and services were far more than what Singaporeans typically pay.

Expats whom The Sunday Times spoke to said the cost of living depends on the lifestyle they choose.

Italian Joe Galeotti, a 48-year-old hairstylist, added: “You can either have a meal for less than $10 at the foodcourt or $200 at a restaurant… I choose the former as it makes more sense to me to eat Asian food when I’m in an Asian country.”

Many said they have fallen in love with Singapore’s public transport.

Said Mr Paul Burton, a 41-year-old director at IHS, a firm that provides defence analytics: “We now spend less in a month on train tickets in Singapore than in a week back in London.”

For psychology lecturer Aoife McLouglin, 30, getting around by taxis is also relatively affordable. She said: “It is easily a third of the price compared to my country, Ireland.”

Dutch expatriate Emile Leus, 43, simply takes advantage of the weather here. The owner of TVworkshop Asia, an events company, said: “I cycle everywhere I go and it’s great.”

The EIU has named Singapore the most expensive place in the world to get a car because of its certificate of entitlement system and, for some expats used to driving, this takes some getting used to.

Said Dutchman Charlie van Eeden: “I used to drive a BMW but it’s just too expensive here. Now, I’m paying $1,400 for a rental Hyundai. For the same price, I could probably rent a BMW 5 Series in Amsterdam.”

If not for his two young children, aged three and five, the 39-year-old head of Asia at a creative agency added that he would rely on public transport or cabs to get around instead.

Rental rates here also require adjusting expectations.

Instead of paying $6,000 a month to rent a new condominium unit in Novena, Mr Galeotti chose to live in a nearby 10-year-old condominium instead, paying almost half the price in rent. He said: “I don’t mind that it is an old condominium. It still has great facilities.”

Experts caution against reading too much into the EIU survey.

Dr Yvonne McNulty, who specialises in expatriation and global mobility research, said it is aimed at a niche group of highly paid foreigners on “expatriate” contracts, which tend to offer housing and car allowances, and that these expats hope to replicate how they live back home here.

The associate lecturer at RMIT University Singapore and founder of Expat Research added: “The survey does not consider ‘localised’ expats, who are here on local terms, even though we’re seeing more of them now.”

Private school fees remain a bugbear. Frenchman Eric Balanca, 50, is here on a local contract with his wife, 18-year-old son and toddler.

His son studies at the French School of Singapore, costing him about $25,000 annually. “It’s definitely a high price because in France, education is free.

“There are local schools, but it’s difficult to get in and I would prefer my son to attend the French school,” he said.

Expatriates also find ways to get around the high costs of certain goods in Singapore.

“Baby items are much cheaper in the UK because they are discounted, so we used to ship prams, baby chairs and other baby items from there,” said Mr David Brotherton, a 39-year-old lawyer from Britain.

Despite earning the title of costliest city for the third year running, all the expatriates whom The Sunday Times spoke to said that they would definitely recommend Singapore as a place to live and work.

Said Mr Balanca: “The people are great and I like the vibrant economic environment… My advice is to take care of your income by budgeting.”

nghuiwen@sph.com.sg

domteojy@sph.com.sg

This article was first published on March 27, 2016.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

When one of her patients began to throw a tantrum – shouting and banging her head against the walls – 31-year-old nurse Nur stepped in to try and calm her down.

But the hysterical woman kicked her in the chest, leaving her winded and shaken for the rest of the day.

Incidents like these are not uncommon, said Ms Nur, who declined to give her full name.

In her 14 years as a nurse, she has seen colleagues bitten, slapped and punched at work – both by patients and their family members. “This is something we didn’t talk about at school, and it can be quite traumatising for young nurses,” she said. “Even verbal abuse just spoils your day and lowers your morale, but you still have to carry on with the shift.”

Worryingly, nurses who spoke to The Sunday Times said they felt such incidents of verbal and physical abuse are on the rise.

All of them said they had been on the receiving end of such abuse before, and that roughly four in 10 patients are likely to raise their voices against healthcare staff.

Last November, local medical journal Annals Academy of Medicine also published an editorial estimating that seven in 10 healthcare workers have faced physical abuse, and that there is generally “significant under-reporting” in this area.

Those at greater risk tend to be young and female, as well as front- line staff who come into contact with patients more frequently.

Accident and emergency departments (A&E), intensive care units, and other places where emotions run high tend to be where many abuse cases occur. “In the A&E, sometimes patients have to wait for two or three hours,” said Madam Brenda Lee, 58, who has been a nurse for more than 40 years.

Those with fractures, for instance, may be in pain but are still considered Priority 2 – behind those with critical conditions such as heart attacks. And those with relatively minor injuries, such as sprains, headaches and animal bites, are considered Priority 3.

“Naturally there’s a lot of frustration because they all want treatment immediately,” Madam Lee said.

Mr Abdul Hadi Kamarolzaman, a former nurse who now teaches healthcare staff how to protect themselves in such tense situations, said simple techniques can help calm patients down. He himself was once attacked by a psychiatric patient wielding a drip stand.

“For many (patients), what they really want is for someone to listen to them,” he said. “Show them that you are able to empathise, and allow them to ventilate.”

However, he also teaches his students how to handle situations that threaten to become violent – for example, breaking free of grabbing hands or chokeholds without hurting the patient. He, too, has been hearing that the number of abuse cases has been going up, although he is not sure why. However, he stressed the important role that hospital managements play in preparing their staff for this part of their work.

“The management needs to be aware that this is an important part of nurse training,” he said. “If you get it right, you can preserve morale and prevent attrition.”

Ms Sue W, 29, who has been working as a nurse for five years, added: “Verbal abuse cases are rarely escalated to the police because of pressure from the management.” She typically keeps her eyes peeled for tell-tale signs of aggression and calls for backup or tries to de-escalate the situation before anything happens.

Veteran unionist K. Thanaletchimi, who has been president of the Healthcare Services Employees’ Union for 20 years, said hospitals should encourage their staff to report such incidents. At the very least, patients can be made to realise they could have handled the situation better. “It’s about the ‘heartware’ – whether other people feel they should treat other human beings with basic dignity and respect,” she said.

Hospital staff trained to handle difficult patients

Public hospitals say that staff are taught how to deal with difficult situations involving patients, including when to call for backup.

At the National University Hospital (NUH), there were 155 reported cases of abuse last year, down from 162 the year before.

Said an NUH spokesman: “We understand that patients can get abusive because they are unwell and some may display different behaviour because of their illness.

“Family members may be anxious for their loved ones.

“However, we do not tolerate abuses against our staff and will take action to protect them.”

At Tan Tock Seng Hospital (TTSH), there are surveillance cameras and alarm buttons to call for security guards if needed.

Said a TTSH spokesman: “In a potentially difficult situation, our staff are trained to try and understand the cause of any aggression.

“This allows them to respond more appropriately.”

Khoo Teck Puat Hospital has seen an increase in the number of reported abuse cases, from 25 in 2011 to 41 last year. However, a hospital spokesman added that these numbers are “very much under-reported”. He said: “On a daily basis, many of our healthcare workers are subjected to disrespectful and unkind treatment by the public that goes unrecorded.”

He added that front-line staff are trained to manage abusive behaviour, including when to escalate the matter to their supervisors or rope in other colleagues for help.

Nanyang and Ngee Ann polytechnics, which offer nursing diplomas, said students are taught to handle such difficult patients through role play in class. Hospital staff also guide them during attachments.

A Nanyang Polytechnic spokesman said: “They are taught how to diffuse the situation by first trying to understand the patients’ concerns.” A Ngee Ann Polytechnic spokesman added: “In recent years, we have heightened students’ awareness on how to deal with stressful situations at the workplace, such as bullying behaviour, sexual harassment and physical and verbal abuse from patients.”

linettel@sph.com.sg

This article was first published on March 27, 2016.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

Stricter checks at MRT stations may soon become part of everyday life in the face of increasing terror threats. Security experts say Singaporeans should ready themselves for inconveniences such as bag checks and screenings at key installations, especially transport hubs.

Associate professor Bilveer Singh of the National University of Singapore said terror attacks over recent years at metro or train stations in London, Madrid and Brussels show that these have become a target of choice. “We have to make these installations tougher to crack. Security checks will create inconvenience, but there is no choice, and people will have to understand this,” Dr Singh said.

While there are already security checks at MRT stations, these are random and sporadic. Since the Brussels attacks, The Sunday Times understands patrols have been stepped up at key installations such as transport nodes, and security enhanced at checkpoints.

Experts said attacks on other “soft targets” such as shopping malls, schools and hawker centres are also worrying because these are “impossible to fully protect”.

Mr Toby Koh, managing director of Ademco Security Group, suggested that random checkpoints be set up as a “visual deterrence”.

This could mean circulating security checkpoints around the different MRT stations or transport hubs at random.

“It would remind citizens that security is important and to keep it in mind,” he said, adding that complacency was Singapore’s greatest weakness.

“We are a victim of our good policing, we always think this is not going to happen to us.”

He added that commercial building owners could do more, noting that less than 10 per cent of such buildings were designed with security considerations in mind. Law and Home Affairs Minister K. Shanmugam flagged this concern on March 18, and revealed that the government would be asking developers of large projects to factor in security considerations at the design stage. Building owners could also be asked to install CCTV cameras.

Mr Paul Lim, chief executive of Secura Group, said buildings could be designed such that CCTV cameras could reach larger areas, and have fewer chokepoints to reduce the risk of stampedes in the event of an attack.

“How buildings are designed can also mitigate the after-effects of a terror attack, for example, if you have shatter-proof glass or pillars that withstand certain levels of explosive. In buildings that are badly designed, the damage can be 10 to 100 times greater,” said Mr Lim.

Security studies academic Antonio Rappa from SIM University said more stringent checks should also be carried out on foreigners after they enter the country.

He pointed out that in the 1920s and 1930s, Japanese tourists who travelled to Malaya would take pictures of beaches, installations and utility pipelines. These later became part of an intelligence trove when the Japanese invaded.

In calling for vigilance, Dr Rappa said: “The security situation in Singapore is under control but the fact that arrests have been made recently, and more arrests are likely to occur, in my view, show the number of supporters for overseas terror networks is growing.”

Tampines GRC MP Desmond Choo, who is on the Government Parliamentary Committee for Home Affairs and Law, said much of the “counter-terrorism work is done behind the scenes for obvious operational secrecy reasons”.

“Singaporeans can be assured that the HomeTeam and security agencies are silently protecting our homeland,” he said.

dansonc@sph.com.sg

This article was first published on March 27, 2016.
Get a copy of The Straits Times or go to straitstimes.com for more stories.