MARY, MARY QUITE CONTRARY

Mary Ann Tsao left behind a highly successful career as paediatrician in New York City—one that took several years of hard work to build—and returned to Singapore to start her family’s own foundation. Now she looks back to years of being the new girl on the block, of building a foundation from ground up, and dealing with the success that finally came as a reward for hard work and unwavering faith that she was doing the right thing.

It wasn’t too difficult to pick out Mary Ann Tsao in a room full of familiar, smiling faces that graced a charity community event in Singapore—a feat considering that she walked in casually and without fanfare, cellphone pressed against an ear, sunglasses concealing her eyes, and a chic, no-logo leather handbag hanging from the crook of her arm. She calmly picked her way through the crowd, occasionally nodding hello to people she knew, and walked straight to a quiet corner where she deposited her bag on an empty chair and continued talking for a few seconds more. She managed her entrance with the knowing confidence of a stage veteran who has rehearsed the scene a few times and has decided to ‘own’ the direction by adding a few ad libs until it was all natural and even interesting. By the time she hung up, some people were already waiting to plant ‘air-kisses’ on both her cheeks or to shake her hands. And she obliged them easily and casually, without artifice or reservation. No one, it seemed, has not heard of Dr Tsao, principal builder of Tsao Foundation, recipient of Public Service Medal in 2000 and Public Service Star in 2004 both for her work on ageing in Singapore, and a thought leader in the field.

She’s what most of us would like to imagine a New York woman to be, if by that we mean that she’s aware, passionate, articulate, and always in the moment. And we will not be way off the mark as she studied and practiced medicine in New York, eventually building a successful practice there. The scion of a prominent shipping family and president of Tsao Foundation, Mary Ann is at once familiar and little known. What is her story?

The Tsaos, as most bullet-point histories point out, originated from Shanghai and made a fortune in transportation, banking, and a handful of other businesses. The paterfamilias, Tsao Wa Chang, built a successful transportation business in Pudong in the 1900s. His son Tsao Ying Yung, Mary Ann’s grandfather, established a bank following his employment with a major chemical company also in Shanghai. But like many wealthy families whose fortunes became casualties of World War II and the subsequent civil war, the Tsaos had to migrate to Hong Kong to start anew. Mary Ann’s father Frank Tsao, being the eldest son, assumed leadership of the family as Chinese tradition dictated. He proved himself capable of restoring the family fortune, however, and in 1949 laid the foundation for the family’s principal business by acquiring his first ship and co-founding the Great Southern Steamship Co Ltd.

Learning the Values
Mary Ann was born and raised in Hong Kong, the second of four children, in relative affluence. The family has recovered to a certain extent what it had amassed and lost in Shanghai; misfortunes were behind them and the prospects of a peaceful, prosperous life in plain view. But typical perhaps of people who have gone through hardships and reversals, Mary Ann’s parents raised her and her siblings with emphasis on values. Within the family, indulgence was tempered with discipline, and privilege was explained as an outcome of hard work, fairness and responsibility. She believes that her social streak comes from her mother who taught them compassion and social responsibility through example since they were very young children. “When I was a little girl, maybe four years old, I remember fussing about a pair of socks with lace. My mother got upset and she pointed to a girl who collected pig slop from houses in the neighbourhood, her little sister strapped on her back as she went around without even a pair of shoes. That was my first great lesson in social responsibility. I always remember my mother giving away our old clothes to children of poor families. We learned early to share whatever we have with others.
“But my mother is also a very fun person and very creative and artistic,” she says.
Another woman who had tremendous influence on Mary Ann’s character was her grandmother Tsao Ng Yu Shun, founder of the Tsao Foundation, who taught her grandchildren that a woman must be a master of her own destiny—a revolutionary idea given the role women were generally handed in traditional Chinese society. Although Mrs Tsao’s dreams of becoming a nurse were thwarted by circumstances, she did not give up leading the life that she wanted. She learned the rudiments of investing and managing her money by herself, eventually acquiring a jewellery shop on Nanjing Road with what she has saved up. “That was unheard of,” marvels Mary Ann, “given her education and background. But she had this knack for doing things her way, which always turned out to be the extraordinary.

“When she came to live with us in the US—I was in eighth grade—she made a sandwich for me to bring to school. But what did she know about sandwiches? So she took a piece of bread and filled it with leftover food, some honey and pickled peas. Everyone in my class was curious about my sandwich but I told them that it was very special and that you could only get them from a special place,” says an amused Mary Ann. “From then on I realised that it was okay to be different. My grandmother taught me that matter-of-fact confidence.”

Meanwhile, her father taught them prudence, integrity, far-sightedness, and diligence, as well as care and respect for others, especially those with whom we work. He also drove home the importance of strategic money management, both personally as well as in business—lessons that would serve her well in setting up and running the foundation.

Ties That Bind
As I stand in the hallway of Tsao’s home while waiting for the pictorial to commence, I peer into a few framed chinoiserie prints depicting country fairs that were hanging on the wall. “It’s amusing how the Europeans saw the Chinese,” Tsao says as she approaches me, adding how people mostly see things only through their own eyes. Tsao, who is a major supporter of contemporary arts centre and venue The Substation, is conversant on the subject of the culture, able to discuss the works of Damien Hirst and arts funding with equal substance. “I don’t collect art,” she says as I look around her home, “I feel that they belong in museums where people can look and discuss them.”

By any standard, the place that Tsao calls home is luxurious. It is a
sprawling structure with pleasant if almost unprepossessing facade, and an interior made impressive by vastness, simplicity and remarkable crafts-manship. Bespoke and designer furniture, in dimensions that match the space, are arranged symmetrically. It is a house that does not announce its grandeur. “Our house speaks of the personality of our family,” she volunteers. It is a renovated bungalow that appears modest from the outside but reveals surprising depth and soaring roof inside. I decide against asking if it were the work of her brother Calvin. Mary Ann never drops names or gives any details that could easily be misconstrued as boatful that it seems inappropriate to ask. (Renowned architect Calvin Tsao, who won first prize for 2009’s White House Design Award, is Mary Ann’s older brother. His other brother, Fred Chavalit operates the family’s shipping and other businesses, while her sister Cheryd runs a very innovative events company.)

Tsao is no longer practicing paediatrics. “I sold my practice in New York in 1992, four years after coming to Singapore and it became clear that my commitment to the foundation is such that my absence from New York and my practice will be indefinite.”
In that regard, she admits that she gave up a very successful practice that took years of hard work to build. However, she also knew all along that one day she will leave the practice behind as her interest was always in community service over private practice. “As much as I love my practice and my patients, I have no regrets as I knew that I would have to leave it behind one day if I want to make a real impact on the wellbeing of the community.”

Tsao was trained in a very unique social medicine program in New York, which was designed to train physicians to work in disadvantaged communities and developing countries. “Many of us were trained additionally in public health or community health planning.

“My mentor was a wonderful woman who eventually became a prominent figure in Health policy in the US, and she always warned us that while our commitment should always be to our community and the people we serve, one day we will have to give up clinical practice if we want to make a bigger impact as, inevitably, it would policy/advocacy and work that would take us away from our patients.
“And good clinicians really need to practice full time and be available to their patients at all times.”

The four siblings have joined forces to develop social enterprise projects to address the negative impact of globalisation, population ageing, and climate change. “We have a project in China but it’s very early days yet,” reveals Tsao.
“So far it has been wonderful working with my siblings,” she concludes. “I am extremely fortunate and grateful for the good fortune of having my family.”

A Measure of Success
Success to Tsao rests between inverted commas not because she denies or ignores its existence, but because she would rather focus what it takes to get there. “I don’t even know what it means to be successful these days,” she confides. “It’s hard enough to be good. The real challenge is to be your best self.”
If Tsao Foundation were the measure of Tsao’s achievements, she would have earned the right to brag about it.

“I pretty much built Tsao Foundation from scratch,” she says candidly, by way of describing what was there when she started out. “As it was, when I first arrived in Singapore, there were almost no players in the field of aged care and there was really no one for is to give grants to anyhow. Additionally, my grandmother—the founder—also believed that good work must come with effort, and that giving funds alone is not enough. This way, the funds are also 100 percent accountable.
“Firstly, perhaps I should explain that the Tsao Foundation is a little different from other foundations here in that it is an operational foundation, which means that it is not primarily a grant-maker, but we fund and run our own programmes.”
Secondly, because of its programming side, Tsao had to develop, in addition to establishing the legal philanthropic entity, a long term strategic plan, starting with assessment of needs, networking with agencies, and implementation of programmes. Until 2007, when she stepped down as CEO, she designed and implemented all its programmes.

Tsao used to hang around void decks of housing facilities where old people hang out so she could talk to them and find out what their issues and needs are. “Those days were wonderful,” recalls Tsao. “Now I have less opportunity to do so and spend most of my time pencil pushing.”

“I would say that programme implementation was challenging as community-based aged care was non-existent in those early days, and the kind of trained staff was not available in Singapore, and our models of care appeared totally foreign to everyone. I had to bring in American staff to train my local team. Today, my local staff is absolutely top notch and we are now considered thought leaders in the field of community geriatrics. But it really took years to get here!”

The foundation began with a team of eight; today it has a little shy of 60.

Rolling Out A Plan
Until 2007, Tsao was president and CEO. Now, as president, she has less operational responsibilities, but remains head of strategic planning, policy advocacy, new programme development and innovations, regional development, and clinical input for continued quality improvement.

Through team effort, Tsao Foundation in Singapore and the region is now synonymous with “ageing-in-place and in community”. The notion that older people should be supported and enabled to maintain control of their destiny, make decisions for themselves, and live at home for as long as they desire – as long as it is safe for them to do so. “We innovate in the areas of community-based health and social care caregivers can be supported in their care-giving role in the community, and older people can be as independent as they can be – even when they are living with disability and frailty. We believe in person-centred/Eden Alternative approach to care and self-efficacy.”

This principal idea was crafted by Tsao’s grandmother, who said “I know what it is to grow old, and I feel the desperation of those who face old age alone, who cannot get to a doctor, and whose families cannot or do not know how to care for them. The pain of poor health is so much worse when you are old and frail.”

Heeding her grandmother’s advice, Tsao has pioneered numerous innovative programmes, including Hua Mei mobile clinic that delivers home-based medical and social care to homebound older people; Hua Mei Care Management, which helps to build a
stable social support system for people who are disadvantaged and have disability, and who have poor social support, such as those who are single and older, and had a stroke.

The foundation has also set up the Hua Mei Seniors Clinic, a WHO pilot site for age-friendly primary care specialising in care for mature and older adults aged 40 years old and above. Another project is the Hua Mei Acupuncture and TCM Centre, which works closely with practitioners of Western medicine to provide complementary care.

The foundation is also active in other fields, such as skills development training. The Hua Mei Training Academy, a WDA-certified (Singapore Workforce Development Agency) training centre offers programmes for seniors, professionals, caregivers and policymakers. Meanwhile, related programmes help develop knowledge that advocate for the wellbeing of older women, such as the Citi-Tsao Foundation Financial Literacy Programme for low income mature women.

The foundation’s latest programme, the Hua Mei Centre for Successful Ageing, provides a one-stop centre for mature adults to access a range of services such as those mentioned as well as a Learning Room, where people can come to master skills in areas such as healthy ageing, financial management, relationship management, fitness, etc., in order to age successfully.

“My involvement in these is in programme planning. I also drive the implementation,” says Tsao.

A Varied Life
Although Tsao’s days do not always run like clockwork, she has adopted a schedule that allows her to switch roles smoothly. “My typical day is not unlike many working mum’s,” Tsao says candidly, “even though as a single mother (Tsao’s husband passed away a couple of years ago) my life tends to be a bit more hectic.”
She claims it’s “not very exciting”, but given the long hours she puts into her work, her family and herself, it is at the very least, productive.
Tsao rises early, a habit that she developed as part of her childhood discipline and doubtless reinforced by her realities as mother and professional. By 5.45am she wakes up to start meditating. She then proceeds to review her day and prepare for whatever is on the agenda. By 6.30am, she prepares her children, aged six and 10, for school, drops them off and “hangs around a bit to see kids play, touch base with teachers or get the ‘scoop’ on whatever might be happening in class or school from other parents”.

Time spent with her children is precious for Tsao. Although she has not slowed down, she is able to manage her time much better. Recently, she ended a seven-year term as Executive Committee member of the Conference of Asian Foundations and Organisations, during which she was involved in regional work on the development of philanthropy and civil society in Asia. Travel—for speaking engagements and conferences—takes her away from home. She was recently in Sydney on a study trip with the Singapore Ministry of Health.

Her office workday begins around 8.30, like most executives. During this time, she runs between meetings and the offices of the Tsao Foundation, attending to family-related business, as well as the demands of some agencies on whose boards she is a member. “It’s all good stuff; it’s all the things that I love to think about and work on,” she adds.

In the evenings when she does not have functions to attend, she eats dinner at home in the company of her children, reviews their homework, talks about their day and finally tucks them into bed. She then returns to her mediation, tries to clear her email, and catches up on her reading.

For all these she achieves a balance. “I do try to live my life fully, positively and with no regret. And squeeze in some humour and laughter whenever I can.” She keeps in touch with her parents in Hong Kong by phone and even manages a twice weekly session of Pilates.

Just as she strives to help the elderly improve the quality of their lives, Tsao is also keenly aware that she needs the same: independence and self-determination, health and access to healthcare, and opportunities to continue leading a fruitful life. As she spends time helping , she is also discovering her own needs.

“I can proudly say that I was able to fulfil my grandmother’s wishes (for the foundation). That is an accomplishment for me.” When I ask her who she else answers to, she pulls back for a moment. “I was a well-brought up Chinese girl. Although I value the opinion of my family, and I am interested in the views of my peers and colleagues, I don’t necessarily seek approval from anyone. I behave myself.”


THE TSAO FOUNDATION BRIEF
A not-for-profit organisation, the Tsao Foundation seeks to alleviate the hardships of ageing through a range of community health services; promotion of successful ageing; and pioneering new approaches to ageing and eldercare throughout Singapore and the region. It also aims to be a catalyst for constructive change by addressing ageing and eldercare issues at policy level. Service, education and collaboration are the pillars of the foundation that guide the fulfilment of its mission.
It was the wish of Mrs Tsao Ng Yu Shun, founder of the Tsao Foundation, to foster a society for all ages that supports active ageing and values the contributions of older people. Today, the same wish is finding fulfilment in the works of the foundation by advancing services, skills and knowledge of cilitating older people’s participation in society; and by promoting their views for policy planning.

The foundation believes that older people, regardless of their conditions, have a strong desire to continue living independently in their own homes and communities.
It also believes that older people can remain active participants of society if they can obtain access to sufficient care, and opportunities to participate.

The foundation constantly seeks new ways to improve the eldercare landscape and quality of life for older people in Singapore. Two of its innovative care programmes are the Guided Autobiography and the Age-friendly Primary Health Care Clinic.
The foundation also seeks to maintain a high professional standard that its set for itself, and for the services it provides the people serves. It also promotes scholarly research on ageing issues; invites distinguished scholars to come and share their expertise with local eldercare professionals; and supports policy planners with ground feedback and constant dialogue.

The foundation develops synergistic partnerships with local and regional aged care organisations in order to develop a network of professional carers who are committed to promoting the cause of older people.

It promotes the exchange of information and collaboration on projects that addresses ageing issues and needs of older people. The Foundation has formed the Interagency Division in 1996 to facilitate its efforts in this area. The division also seeks to contribute to eldercare policy planning and development by engaging policy makers in constructive dialogue; providing research information and feedback from the ground; and participating in relevant government committees.