Newsletter No. 109

2 No. 109 4th June 1997 CUHK Newsletter Visit by Presidents of Teaching Hospitals in China Prof. Sydney Chung, associate dean of medicine (left 4 ), introducing the Shaw Endoscopy Centre at the Prince of Wales Hospital to the Chinese delegation. A delegation f r om the National Association of Presidents of Teaching Hospitals of Me d i c al Un i v e r s i t i e s, China, headed by f o rmer director of the Drum Tower Hospital of Nanjing, Prof. Tao Yin, visited the University from 5th to 11th May 1997. Du r i ng their visit, the delegation participated in 'Challenges for Teaching Hospitals', a seminar organized by the Un i v e r s i t y 's Faculty of Medicine. Challenges faced by teaching hospitals, including those in administration, finance management, teaching, and research were discussed in depth. The delegation then visited the Faculty of Medicine and its teaching hospitals, including the Prince of Wales Hospital, Sha Tin Hospital, and the Hong Kong Eye Hospital. They also toured the newest hospital in Hong Kong, the Alice Ho M i u Ling Nethersole Hospital in Tai Po. Seminar on Child Abuse T h e CUHK Department of Psychiatry held a seminar on child abuse on 10th May at the lecture theatre in Shaw College. Experts f r om Monash University and many local organizations such as the Hong Kong Social Welfare Department, the Correctional Services Department, the Hong Kong Police Force, the Hong Kong Baptist University, and Against Ch i ld Abuse shared their experience on a wide range of issues, which ranged from the l ong - t e rm effects of c h i ld abuse, the assessment and treatment of c h i ld molesters, to women as abusers. Law Professor Examines Relevance of Basic Law to Business P r o f . Frankie R L. Leung, adjunct professor of law at Loyola Law School and lecturer in law at Stanford University, gave a lecture at the University entitled 'Is the Basic Law Good for Business?' on 17th May. The lecture was organized by the School of Accountancy. Prof. Leung reviewed the underlying assumptions of the Basic Law with special reference to articles therein dealing with interpretation rights, the relationship between the Hong Kong SAR government and Beijing, Article 23, and nationality issues. The emphasis was on the pertinence of the Basic L aw to the business community. Prof. Leung obtained his BA from the University of Hong Kong, his M.Sc. from B i r m i n g h am University, and his law degrees from Oxford University. He was a visiting scholar at Harvard Law School and practised as a barrister in Hong Kong for eight years. Currently a partner at a 200- strong law firm in Los Angeles. Prof. Leung is also the correspondent on Hong Kong for the International Legal Materials of the American Society of International Law. Medical Students Help Measure Physical Fitness of the Elderly Y e a r 4 medical students attached to the Department of Community and Family Medicine conducted two community health projects from 3rd February to 17th March: 'Body Measurement and Physical Fitness of the Elderly in Tsuen Wan' and 'Physical Activity and Fitness of Institutionalized Elderly in Sha Tin'. The projects gave the students the experience of conducting a field survey and serving the community's senior citizens. Department Update TheLargest O & G Unit in Hong Kong They d e l i v e r 7 - 8 , 0 0 babies a y e a r , teach the s p e c i a l i t y of o b s t e t r i c s and g y n a e c o l o g y at the u n d e r g r a d u a t e l e v e l , and t r a i n s p e c i a l i s t s a the p o s t g r a d u a t e l e v e l T h e i r p r o g r a m m e s coverp a r e n t o l o g y , r e p r o d u c t i v e m e d i c i n e , n d o c r i n o l o g y , u r o g y n a e c o l o g y , and g y n a e c o l o g i c a l o n c o l o g y . . . From Birth to Maturity When Prof. Allan Chang first arrived in the territory in 1982 to join the University's new Faculty of Medicine, the immediate task was to develop a Department of Obstetrics and Gynaecology at the Prince of Wales Hospital (PWH) that could provide quality service to its patients and be worthy of ateaching hospital. In the 3-4 years that this took, the department also established its undergraduate teaching. Thereafter, emphasis was put on research and postgraduate training. With increasing experience and expertise, the department has since 1991-92 been engaged in more basic research, such as the study of menopause and its chemistry, the use of sophisticated drugs, numerical processing, medical engineering, and molecular biology. Staff members are now part of an international research team for the identification of tumour suppression genes that can block the development of gynaecological cancers. 'Such developments alter the medical profession's perspective of how to care for people; they may not be major shifts, but they are significant and represent our contribution to the knowledge in our speciality,' says Prof. Chang. On the Research Side The bulk of the department's research is however clinically based, and concerns better diagnostic and treatment methods. These include numerical processing, i.e. designing ways to detect the well-being of the foetus by applying certain logic and algorithms using the computer; studies on how physical and mental decline and progressive arterial degeneration that accompany menopause can lead to strokes and heart attacks; research in female urinary control problems, which affect not only Western but also Chinese women; new treatment of miscarriages that does not require operative procedures; and issues like foetal distress and postnatal depression. Service Delivery In 15 years, the department has established itself as the largest such one in the local community. Its deliveries record is due not only to the fact that the PWH is the only hospital in its area, and that Sha Tin has a very young population, but, as Prof. Chang says, the fact that the unit has established areputation for being very friendly. 'We have made a great effort at making it easy for pregnant women to talk to us and explain their problems. I am sure this makes a big difference.' It, however, also means a considerable service overload, and makes teaching and research much more difficult. As the department head, Prof. Chang compliments all the staff members for havingmanaged to teach so well and achieve so much in research despite severe understaffing and excessive clinical workload. While this overload problem is faced by all the departments of the medical faculty, Prof. Chang believes it is especially urgent for his department because, 'When a woman has a baby, everything else must wait.' In other areas of community service, mainly to upgrade and improve the profession as a whole, Prof. Chang is currently the Hong Kong Academy of Medicine's vice-president for education and examination. He has just completed three years as the president of Hong Kong College of Obstetricians and Gynaecologists, with Prof. Christopher Haines, a senior lecturer in the department, as the secretary in 1993-94. Prof. Haines is presently an adviser to the WHO on menopause. Quality Assurance Prof. Chang points out that in general, the O&G departments in the world have had quality assurance programmes far earlier and far ahead than any other speciality in medicine. Hence, a quality audit was introduced as soon as the department was established. What was also quickly established was a weekly meeting to evaluate cases with unexpected outcomes. They also have what very few units have internationally — visits to the paediatric department nurseries to see all the babies with problems and to analyse whether belter service could have been rendered during either pregnancy or childbirth. He says in a matter-of- fact manner, 'We don't talk about quality assurance because it is very much a part of our job. In our field, we have been doing it for the last 30 years.' Any Achilles' Heels? 'Yes, we have considerable weaknesses,' is the frank and forthcoming reply from Prof. Chang, who evaluates weaknesses as readily as strengths. The first weakness is that traditionally obstetrics does not attract serious researchers. The problem is related to the discipline worldwide rather than to the efforts of individual O&G departments. It has thus taken the department very long to establish itself in research.' And then in Hong Kong, Prof. Chang points out, the speciality of obstetrics has for many years been neglected. The government has failed to provide many needed services like prenatal counselling or universal assessment of babies in early pregnancy. According to Prof. Chang, these are services that are available in any 'civilized' Western country. Requests for these services and additional resources from the Hospital Authority have long been ignored, and hence Hong Kong's clinical service and care in this area is sometimes not on a par with that of Western countries of comparable wealth. The quality of our care is sometimes poor because the manpower, space and resources at our disposal are only adequate for one-third or one- fourth of the cases that we are currently looking after,' says Prof. Chang. 'It is shortcomings such as these that constitute the more unfortunate moments 一 moments when ababy is bom damaged or dead, and moments when you have to tell certain patients that, because we do not have enough resources and their condition is not life- threatening, we cannot look after them any longer. These are all moments that I would much rather not have, but they concern us as doctors.' He concludes by saying, 'Being adoctor is like being a general — you win some battles, you lose some, and when you lose, you feel traumatized. But statistics being what they are and biology being what it is, you can never guarantee a successful outcome to every case. We can only try our best.' S h a l i nB a h a d u r