Singapore's Hidden Medical Conditions Test the Promise of a More Caring Commute

A seat can mean more than a comfortable journey

Singapore's Land Transport Authority (LTA) had distributed more than 10,600 stickers for people with temporary conditions and 20,400 cards for those with lasting conditions by May 2024. Each carries a simple request: May I Have a Seat Please. For passengers whose illness or disability is not visible, that request can make a daily bus or MRT journey less painful and less frightening.

Yet a card does not always bring an offer of help. Vivien Shiw, a 34-year-old university administrative employee with Sjogren's syndrome, vasculitis and arthritis, sometimes squats inside an MRT train when the pain in her legs becomes unbearable. On other journeys, she gets off at the next station to rest on a bench.

Shiw often receives stares instead of assistance, even when carrying the card. A rash is the only visible sign of her condition, and other passengers may not associate it with difficulty standing. Her greatest fear is losing her balance and falling.

Her experience captures the challenge facing Singapore's efforts to support passengers with hidden medical conditions. The transport system has introduced identifiers, expanded assistance schemes and trained thousands of staff. Whether a passenger receives a seat still depends partly on whether another person recognises a need that cannot easily be seen.

For thousands of Singaporeans with such conditions, an ordinary commute can involve pain, anxiety and the fear of being misunderstood. The measures developed by June 30, 2025, address both practical assistance and the harder task of changing public attitudes.

Why someone who looks healthy may need help

Hidden medical conditions are health problems that are not immediately apparent to other people. A passenger may look young and healthy while finding it difficult to stand for long periods, maintain balance or move through a crowded space.

The conditions and circumstances described by commuters cover a wide range of needs:

• Autoimmune diseases, including Sjogren's syndrome and multiple sclerosis.
• Chronic pain and fatigue syndromes.
• Heart disease and arthritis.
• Neurological disorders and conditions, including epilepsy and autism spectrum disorder.
• Ongoing cancer treatment.
• Physical injuries or the use of prosthetic limbs.
• Early pregnancy.

Visible appearance offers little help in understanding some of these difficulties. Someone who can walk into a train may still experience pain when standing through the journey. Another passenger may need help navigating crowds or knowing when to leave the vehicle.

Passengers describe misunderstanding, scepticism and ridicule when their needs are not obvious. Some face uncomfortable stares, whispered comments or a refusal to give up a seat. Others become reluctant to ask, concerned that they will have to explain private medical details to strangers.

How the request for a seat began

LTA launched the May I Have a Seat Please initiative in 2019 to help passengers communicate their needs without repeatedly explaining their conditions. It began with a sticker and later expanded to cards and lanyards for people with lasting conditions, while stickers serve those with temporary needs.

Priscilla Chan, LTA's Deputy Group Director for Public Transport, explained why the authority introduced the initiative:

Commuters have consistently demonstrated graciousness to the elderly or expectant mothers on public transport. However, there is another group of commuters whose conditions are often hidden and yet they need seats just as much.

London and Tokyo provided inspiration through similar visual identifiers. The idea is straightforward: a recognisable message gives other passengers a reason to offer assistance when appearance alone provides no obvious signal.

Commuters can collect the identifiers free at passenger service centres in MRT stations, bus interchanges and selected ticket offices. No medical proof is required. The arrangement reduces the burden on people who feel self-conscious about asking or fear being judged.

The dates show how the effort has developed across transport and other travel settings:

• 2016: The Enhanced Vocational Licence Training Programme began including modules on commuter inclusivity.
• 2017: The Caring SG Commuters movement launched to encourage a national culture of care and inclusion.
• 2019: LTA introduced the May I Have a Seat Please initiative.
• May 2024: LTA reported distributing more than 10,600 stickers and 20,400 cards.
• From August 2024: More than 330 staff across 15 organisations at Changi Airport received training as care ambassadors.

The card brings confidence, but also difficult encounters

Ms Ratnah Hafizah, who has multiple sclerosis, previously used private hire rides to collect her son from kindergarten, even though the trip was only one bus stop. Carrying the card has given her the confidence to use a priority seat without fearing other passengers' judgment.

Shiw's experience is less reassuring. When passengers stare without offering help, she must decide whether to endure the pain, squat or interrupt her journey. The same identifier can therefore bring confidence to one passenger while leaving another feeling conspicuous and unsupported.

Ms Lim, a 21-year-old university student identified only by her surname, described a discouraging encounter while trying to obtain the card. She said a passenger service employee laughed at her request, despite her presenting medical records for conditions including endometriosis and pelvic congestion syndrome.

Lim eventually received the card, but the encounter left her feeling invalidated. Her experience also shows why the scheme's rule requiring no medical documentation matters: access is intended to rest on a person's request for assistance, without a requirement to produce records.

Helping Hand covers more than seating

The seat request card belongs to the broader Helping Hand scheme, an initiative of the Caring SG Commuters Committee. The committee brings together ministries, agencies and public transport operators to make travel more inclusive.

Helping Hand has expanded to address several different situations. Its identifiers communicate practical requests that passengers may otherwise struggle to explain during a busy journey:

• The This is a wheelchair card helps users of paediatric wheelchairs alert staff and other passengers to give way, especially in designated spaces.
• The Please alert me when I am approaching my stop card asks others to notify a passenger near their destination. It supports people with visual impairments or dementia.
• The Universal Helping Hand card lets passengers indicate particular needs, such as help with directions or fare cards.

The identifiers are free and require no documentation. This approach makes dignity and accessibility part of the collection process, as well as the journey itself.

LTA's May 2024 figures show the scale of distribution: more than 20,400 cards for lasting conditions compared with more than 10,600 stickers for temporary needs. Cards accounted for roughly two thirds of the combined total, showing how much of the distribution served people needing continuing support.

Thousands of staff have received training

Singapore's public transport operators have paired visual identifiers with training intended to help staff recognise and respond to different needs. Since 2016, the Enhanced Vocational Licence Training Programme has included modules on commuter inclusivity, with more than 10,455 bus captains completing the programme.

SMRT has trained more than 4,500 staff who work directly with passengers, including station managers, bus captains and service ambassadors. The training often involves social service agencies and special education schools, using role play and practical learning to build skills and sensitivity.

More than 7,000 SMRT staff are also certified as Caring Commuter Champions, equipped to support passengers with disabilities. The training figures cover different programmes and should be understood within their respective roles.

Madam Aileen Goh, a senior assistant station manager at SMRT Trains, described how training has helped her approach passengers who appear unwell or may have dementia:

I look out for those who need help and have the confidence to assist them, such as by slowly approaching elderly passengers wandering around the station and gently checking in on them.

Mr Dalvinder Singh, a bus captain with Tower Transit Singapore, said the identifiers give staff a clearer starting point for offering assistance:

Before the cards were introduced, we would usually rely on visual cues or if the commuter approached us first. Now, with the lanyards and cards, I can take the initiative to offer help more confidently and appropriately.

Both accounts describe a practical change: staff can approach someone gently and offer relevant help, instead of waiting for a passenger to explain a difficult situation.

Recognition remains uneven among passengers

Passengers with hidden conditions continue to encounter the assumption that someone who looks young and healthy can stand. Some cardholders say the identifier attracts attention without producing assistance, leaving them feeling judged rather than supported.

Other commuters hesitate to offer seats because they fear being taken advantage of. When a condition has no obvious outward signs, that suspicion can leave the person needing help to bear the discomfort of asking again or continuing to stand.

A reporter who spent a day wearing the lanyard observed that most passengers either ignored the card or looked away, appearing unsure whether to offer a seat. The experience reflected the uncertainty that some regular users describe.

Posters and announcements have been placed in prominent locations, but public education still faces language and cultural barriers. The card's message is in English, which some older passengers and people from backgrounds where English is not commonly spoken may not understand.

Staff training can improve an encounter at a station or on a bus. A crowded carriage also requires recognition from fellow passengers. The initiative depends on people understanding both the message on the card and the possibility that a need for assistance may be invisible.

People with disabilities helped shape the lanyard

The lanyard's design came from an art competition organised by the Caring SG Commuters Committee for people with disabilities or special needs. The final design combines elements from ten artworks, bringing the experiences and hopes of their creators into an everyday transport item.

Asher, who is on the autism spectrum, contributed an image of five people forming the shape of an invisible heart. The artwork symbolises empathy and care, matching the purpose of an identifier meant to make an unseen need easier to recognise.

Joy, who has Down syndrome and flat foot, explained that her condition is invisible to others, making it difficult to ask for help. Her contribution connects the design to the personal difficulty of requesting assistance when a passenger's appearance gives others little information.

Zer Yinn, a young woman with autism, used her artwork to express her hopes and dreams, highlighting acceptance and understanding. Together, the contributions reflect the variety of people who may use the lanyard and the importance of respecting each person's dignity.

Changi Airport extends support beyond the commute

Changi Airport has adopted related measures for travellers with invisible disabilities. Staff are trained to recognise both the May I Have a Seat Please lanyard and the Hidden Disabilities Sunflower lanyard, a global symbol first launched at Gatwick Airport in England.

Since August 2024, more than 330 staff across 15 organisations at Changi have been trained as care ambassadors. Their role includes supporting passengers with invisible disabilities such as autism, attention deficit hyperactivity disorder (ADHD), Down syndrome or dementia.

Ms Edwina Fan described assistance that helped her son Wallace, who has autism and is distressed by loud noises and crowds. Airport staff provided arrangements including manual immigration counters, early boarding and an early meal service.

Fan also recalled support on the MRT. During one of Wallace's meltdowns, staff formed a protective circle around him, shielding him from onlookers and preventing another passenger from filming. The response addressed his immediate distress while protecting his privacy.

Ms Tiffany Tee described a different set of adjustments for her son Atkins, who has autism. Airport staff allowed him to bring a toy that helped him stay calm on board and did not pressure him to make eye contact during security checks.

For these families, small changes in how staff responded made travel less stressful and encouraged them to venture out more often. Their experiences show how assistance can extend beyond providing a seat to allowing time, reducing pressure and responding sensitively during distress.

Singapore shares a challenge with other transport systems

London's Please Offer Me a Seat badge and Tokyo's badges for expectant mothers and people with hidden disabilities offer comparable ways to communicate a need. Singapore's initiative belongs to this wider effort to make public transport more accessible through recognisable visual signals.

These programmes share a practical lesson: identifiers work best alongside public education and staff training. A card can communicate a request, while an informed passenger or trained employee can turn that request into useful assistance.

Singapore has combined identifiers, training and awareness campaigns in an approach consistent with practices used internationally. The experiences of Shiw, Ratnah and Lim show why public understanding remains central even after a scheme is established.

A national effort depends on everyday responses

The Caring SG Commuters movement, launched in 2017, invites Singaporeans to help build a national culture of care and inclusion. The expansion of Helping Hand and continued staff training form part of that effort.

Transport Minister Chee Hong Tat has stressed the importance of not hesitating to ask for or offer help. LTA and its partners continue to seek commuter feedback and work with social service agencies to refine and expand the initiatives. No specific date has been given for a further expansion.

Singapore's ageing population and the growing prevalence of chronic conditions make accessible transport increasingly important. For an individual passenger, the immediate difference may be a seat that prevents a painful journey, a reminder before a stop, or a staff member who approaches calmly during distress.

The next part of the task lies in making those responses more consistent. The schemes provide ways to request help; the experiences of their users show the continuing need for recognition, trust and respectful treatment.

Key Points

• LTA introduced May I Have a Seat Please in 2019 to help passengers communicate needs that may not be visible.
• By May 2024, more than 10,600 stickers and 20,400 cards had been distributed. Collection is free and requires no medical documentation.
• The wider Helping Hand scheme also supports wheelchair users and passengers needing reminders, directions or help with fare cards.
• More than 10,455 bus captains completed training that includes commuter inclusivity, while SMRT has trained thousands of staff through its programmes.
• Passengers describe both greater confidence and continuing experiences of scepticism, stares and insensitive treatment.
• Changi Airport's care ambassador training extends support to travellers with invisible disabilities, with families describing practical help that reduced travel stress.