14 December 1997

Crisis leading to dire need for Health Care Review
("Letter to Hong Kong", Radio Television Hong Kong)

(Keywords:- infectious diseases, medical blunders, policy review, public health)

          In just two weeks' time, the curtain will fall on 1997. To Hong Kong, it is a unique historic year. It is a year for jubilation to most, at the return of sovereignty. Yet no sooner, to many, comes the dismay of a sharp economic down turn. To health care in Hong Kong, 1997 is far from being a good vintage.

          Let me elaborate. It begins in early summer with the spate of cholera. The near epidemic was fortunately halted by the discovery of the source from some despicably unsanitary food factories and restaurants. This was followed by the detection of life threatening E-Coli contaminated beef, by luck, it has not caused disaster.

          The crunch came with the report of transfusion of wrong blood. Like a domino effect, to the horror of all, lives were lost from transfusion of milk into the blood circulation; from accidental pumping of air, aiming to inflate a pillow, into blood stream; and more. All in the glittering eyes of proper hospital settings. Children were "poisoned" from taking anti-fever medicine adulterated with mouth gargle. The last straw came when one patient following another succumb to a new strain of influenza when, ironically, Government is saying that there is no fear.

          How much more can Hong Kong people take? Is our health care service failing? Are we returning to the dark ages?

          Yet, it would do nobody any good to enter into a trance of panic. Instead, we should take stock of the incidences, overturn every stone, learn from the mistakes and come out a winner.

Medical Blunders reveal Shortcomings in System

          Let us look at those indisputable blunders. Few would disagree that human error exist, for human factor it must be. To the more sinister critics, sadly this could symbolise that our young batch of health care professionals are not giving the devotion, the dedication, the respect in their handling of patients in a way they should. Let us hope that such lassie faire attitude, quite understandable in a political unstable climate, could be easily blown away with the wind now that Hong Kong is no more a borrowed time in a borrowed place.

          To the more understanding analysts, the accusing fingers could easily be pointed at work overload, for work overload it is. Most public hospitals and clinics have reported a 50% or more increase in patient attendance or admission since the Hospital Authority has taken over the public hospital management some six years ago. Yet this has not been matched by corresponding increase in manpower, nor could it ever be.

          Where do we go from here? With the Government mission being that "nobody should be devoid of proper health care because of lack of means" and with the Hospital Authority exhibiting improvement at least in hotel services, public health care is facing the state of a limited budget providing an infinite need. And more is expected to come. In short, our public medical service is a victim of its own success!

          Many have called for an increase in manpower. After all, Hong Kong is flooded with our fiscal reserve. Yet, irrespective of any level of staff topping up, the time will come when the insatiable needs of the public will outstrip any increase in supply.

Health Policy Review a must

          It is imperative that a new policy in health care be established -- a policy to determine when health care is a welfare, for which Government should heavily subsidize; and when health care is a service, for which those who can pay, pay and those who can pay more, pay more. Such payment can be by the public purse for the needy, by digging into one's pocket, by personal medical insurance, or by a territory-wide centrally polled medical insurance. Yet, this is not a professional decision. Instead it is a political determination for which this Government ought to have the clout, the will power and the decision to bring it forward.

          In the early days of his campaign trail, the Chief Executive has not included a good look at the Hong Kong health care scene as an item in his priority list. This is understandable, for praises were then abound with the Hospital Authority and the public health care services. Though with regret, it is hoped that all these recent medical blunders will have awaken him to the fact that all that glitters is not gold. Furthermore, health care is an essential element for societal stability and for our everyday life.

Lessons to be learnt in Public Health

          Let us look at the other health mishaps. Surely the various spates of public health crisis in this year are not all medical blunders. It is taking one step too far to accuse our public health officers for not being active enough because an avian strain of influenza virus is found in human and producing lethal result. It is denigrating the morale of the dedicated staff to say that they are not progressive enough because a deadly strain of E-Coli was found in beef. Instead, the quick actions of the authorities which has led to prevention of an otherwise disaster, should have accorded them full marks.

          Yet have they done enough? Have the Government taken heed of the professional advice and suggestions and moved quick enough? What lessons could be learnt from these incidences such as the Avian Flu saga.

          For a modern metropolis that always would like to assume the role of the hub of South East Asia, Hong Kong has a disappointing lack of disease data --data which are essential for the long term planning of health care; data which are necessary to project patterns of diseases. Our disease reporting systems are also poor. Most are on a voluntary basis, depending on the good will of the medical practitioners without supervisory control. Many doctors do not visualize the importance of such reporting, nor have they developed the habit nor the culture of such reporting.

Re-look of the role of Department of Health

          There is thus a dire need for the consideration of setting up a "Centre for Disease Control" type set-up in Hong Kong. Through this centre, proper epidemiological data and proper disease patterns could be collected, collated and properly assimilated. Through this centre, further disease research could be instigated. We have the brains in Hong Kong -- the discovery of the "avian flu" virus was a Hong Kong first. Let's nurture these brains, support it with all we can and get the most out of it.

          The saga of the avian flu may as yet shown another possible flaw with the authorities concern. The first case was discovered in August. Yet it is only in late November, when more cases were discovered, were apparent actions being taken like the setting up of an expert task force. Three months down the line, the authorities are still unable to tell how many influenza cases in Hong Kong are actually due to avian flu, whether this virus could spread from human to human. The authorities should be sitting on a gold mine but regrettably have shifted to a volcano.

          It is high time that the Department of Health re-examine its role. Should this department be concentrating on and further developing in areas of public health, epidemiology, disease surveillance, disease control, which, when well done, will further improve our health indices? Or, should it still cling to the provision of 15% curative primary health care out patient service where it deserve little credit, while there can be better alternatives to take care of the needy?

          These are the areas that our health policy chiefs must consider!

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