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 Text by: Leung Hang-yi & Fu Tak Iam Foundation Editorial Board | Translation by: Stacy Mosher

 

"Doctors are not invincible!”

 

Press Conference to Promote Preventive Medicine among Grassroots Workers  photo credit: HIA 

 

Hong Kong’s medical technology is among the best in the world, but not everyone enjoys equally good health. Hong Kong workers are famous for their long working hours. Mr. Cheung, a 60-year-old container lorry driver, worked at least ten hours per day for meagre pay to feed his family of four, putting a strain on his later years; he lost strength in his legs and became prone to falling. His injuries put his driving at risk – “I had three or four collisions in the course of a few months!” – until in 2013, when his right foot was too weak to press the brake in time, he had a traffic accident that cost him his job.

 

Mr. Cheung had been treating his infirmities with breathing exercises (‘Chi Gong’) and acupuncture for years at a cost of thousands of dollars per month. No longer able to afford these treatments, he went to a public outpatient clinic, where a doctor told him that his symptoms indicated degenerative joint disease. “It’s untreatable. They didn’t even give me medication.” He took physiotherapy once a month for two years, but with the source of his illness undetermined, the therapist could only teach him some movements to relieve the pain, and the treatment was not very effective. After muddling along in this way, Mr. Cheung went to the orthopaedic clinic of a public hospital, but he was put on a year-long waiting list for magnetic resonance imaging (MRI) to diagnose his condition. “I had no choice but to stand in line – doing it outside [at a private hospital] would cost more than $10,000.” Just when he believed a turn for the better was at hand, Mr. Cheung reached an impasse on his surgery: The doctor told him that he might have spurs in his cervical vertebrae that would cause numbness in his arms, and he would need another MRI. In other words, he had to wait another year.

 

Since the waiting time at the public hospital was so hard on Mr. Cheung, why not switch to a private hospital? The cost of private treatment was too prohibitive, especially considering that he still had two children in school, and his wife was now the family’s sole support, leaving them in a bind.

 

As Mr. Cheung wended his way through the endless queue for medical services, doctors and nurses were racing from pillar to post in the public hospital. A nurse with more than 20 years’ experience in gerontology handled dozens of cases every day, but clerical work sometimes took 80 to 90 percent of her working hours at peak periods. Staffing was insufficient to begin with, and she was also covering the work of two colleagues who recently resigned. Constant overtime meant she basically worked nonstop from 8 AM to 8 PM, seven days a week. Worried that her gruelling work schedule would undermine her own health, she finally tendered her resignation. Complaints are rife in the public hospitals, which suffer from persistent brain drain.

 


 

New strategies needed for a beleaguered healthcare system

 

In view of this situation, a group of concerned medical professionals established a non-profit organization called Health in Action to be the change they wished to see by eradicating health inequity and promoting “the right to health.” They saw that the main victims of Hong Kong’s healthcare system are grassroots workers, especially the working poor, who typically exhaust themselves to make a living and neglect the physical and mental health of themselves and their families. Since 2015, the Fu Tak Iam Foundation has supported Health in Action in launching a healthy living project for working poor families in Kwai Tsing District. Its distinguishing feature is using outreach to identify people who are potentially most at risk, and then using case management to provide professional medical consultations and services to individuals and families, as well as encouraging preventative medicine to avoid the infirmities that lead to a vicious circle of deteriorating work capacity and poor quality of life. The services include physical examinations, health management planning and subsidies for medical expenses, promoting preventative and timely treatment, and emphasizing the responsibility of the family to work together towards personal health.

 

Dr Fan Ning, one of the founders of Health in Action, has taken part in overseas disaster relief work, and knows about the backwardness of medical resources in refugee areas. “But even such a wealthy place as Hong Kong still has so many people who cannot obtain the medical services they need in a timely manner.” The long-term health problems of the grassroots result from a vicious circle of low income and lack of a supportive community network. “Many live in partitioned flats and don’t even know where they can get free medical services or free medical exams.” Helping disadvantaged groups prevent illness and improve their health is an enormously difficult task.

 

"Their first consideration is adequate food and shelter.” Cheung Wai-ching, who has more than 20 years of experience as an outreach nurse, joined Health in Action as a volunteer three years ago, and has witnessed the many barriers the grassroots face in accessing public health services: inadequate flexibility in clinic hours, meagre quotas for night clinics, difficulty making an appointment and long waiting times for specialist treatment. ‘Blue-collar workers’ don’t get paid sick leave, so they’re unwilling to spend their working hours standing in line for a government doctor. But they can’t afford a private doctor. As a result, when they’re unwell they self-medicate, often at the risk of misdiagnosis and delayed treatment, not to mention the effects on their health five or ten years down the line.

 


 

The Family Health Management Programme

 

Health in Action’s healthy living project in Kwai Tsing District targets the district’s working poor, mostly aged 35 to 64. As of September 2018, the group has benefitted 5,800 clients, including the Family Health Management Programme serving 90 people in 30 families.

 

 

Sharing by participating family of Family Health Management programme – Mr Wu


 

Cheung Wai-ching is a nurse consultant in the Family Health Management Programme, which targets low-income individuals at risk or with a preliminary diagnosis of the “three highs” (hypertension, cholesterol and blood glucose) as well as obesity. Participants are assigned a volunteer nurse who creates a tailor-made health management plan based on work and family requirements, and arranges for family visits and relevant professional support from social workers, nutritionists and physical therapists.

 

A “three high” home and a 60-year-old driver with diabetes

 

Mr. Cheung, the 60-year-old lorry driver mentioned at the beginning of this article, needed surgery on his cervical and lumbar vertebrae, but was on a year-long waiting list for an MRI at the public hospital. At this point, Health in Action subsidised the cost of an MRI at a private health organization, which allowed Mr. Cheung to arrange surgery within a week. He says the subsidy allowed him to get faster treatment: “I didn’t need to waste another year or two waiting.”

 

This subsidy is a service under the Family Health Management Programme. Up to now, 80 people have received the benefit in amounts of up to $8,000. Most of the subsidies cover examinations for relatively urgent medical conditions, as well as meeting the cost of mental health services, health equipment, or prescription medicines.

 

When Mr. Cheung was assessed by a Health in Action nurse, he learned that he was seriously overweight, and was diagnosed with diabetes and hypertension that could deteriorate into chronic cardiovascular disease. These conditions could hamper his recovery from neck and lumbar surgery and increase the risk of bacterial infection and other complications.

 

Nurse Cheung Wai-ching, who has been following Mr. Cheung’s case, says that when she first began making home visits, Mr. Cheung was unaware of his problematic eating and drinking habits. “As soon as I walked in the door, I saw a flat full of beverages and instant noodles – they ate very few green vegetables.” The family suddenly realized where the “three highs” had come from.

 

As is common in the working class, Mr. Cheung’s work hours had been very irregular. He took advantage of short breaks to make up for lost sleep, and spent long hours driving a lorry with little physical movement or change of position. “I would turn on the air conditioning and bend over the steering wheel so I could get some sleep. That’s probably how I developed problems in my neck and back. When I was young and strong, I could take it, so I neglected my health. When I was hungry I’d buy a rice box full of greasy food and MSG. All my friends did the same. No one saw any problem with it.”

 

Mr. Cheung says the nurse warned him that if he didn’t change his living habits, his medical condition would worsen until it could only be controlled with diabetes medication. “Once I start taking that medication, it is for life – there is no turning back.” No longer daring to neglect his health, he began following a personal health management plan that included daily walks, exercise and controlling his food intake. He even broke his nearly 40-year-long smoking habit. In four months, his weight dropped from 220 to 203 pounds, and his family also realized the need to change their eating, drinking and living habits. Mr. Cheung recovered well from his surgery and is now in physical therapy with the goal of regaining 70 to 80 per cent of his mobility.

 

Nurse Cheung says that Mr. Cheung’s progress is inspiring; his blood pressure and blood glucose have dropped back to normal levels, and if he and his family maintain their good living habits, he will not need to take diabetes medication for the next five years.

 

Teaming up to put health in action

 

People go to a doctor to treat their illness, but Health in Action teams up with the people it helps. “Apart from treating his illness, you want him to feel you really care about him.” Nurse Cheung says that making people take their health seriously requires putting yourself in their situation instead of “intimidating” them.

 

“We have to be of the same mind. If they’re most concerned about their son passing an examination, you’ll have to spend half of your one-hour visit talking about their son instead of right away telling them to cut back on salt and sugar. Once you become friends, he’ll listen to whatever you say.”

 

That’s why the Health in Action team spends more time and communicates more meaningfully with their clients than a typical hospital clinic. They carry out at least three or four home visits and meetings, and more complicated cases such as Mr. Cheung’s may involve 16 or 17 home visits. If the client is more “stubborn,” the team will use every opportunity to follow up. They also hold information sessions at community centres.

 

“People love to participate in information sessions, because they’re dissatisfied with the public hospital system, and they aren’t allowed to see a doctor before they actually become sick. They’re not necessarily ignorant – most of them really care about their health, they just don’t have a correct understanding.”

 

Dr Fan Ning refers to an actual case they handled: An elderly woman in her 60s suffered from hypertension. She lived with her husband, son, daughter-in-law and grandchildren, “three generations totalling nine people in a flat of just over 400 square feet.” On top of that, one grandson had attention deficit and hyperactivity disorder (ADHD), and relations were strained between the woman and her daughter-in-law. The older woman had no time to look after her own health, and her blood pressure was elevated because she was always “angry.”

 

The team devised a health management plan for the woman, but her first task was not to see a doctor. “The first thing in fact was to deal with problems in her life and environment.” They referred her to a neighbourhood organization that provided support services for ADHD by giving kids homework help and teaching their families how to handle discipline problems. They also pushed for the Housing Authority to split up the households to improve their living environment. As a result, the boy made progress in school, the woman’s relationship with her daughter-in-law improved, and so did her blood pressure. “None of these things seemed related, but these kinds of cases crop up all the time among Hong Kong’s low-income families.”

 


 

“Doctors are not invincible!”

 

Stretching workshops led by volunteers

 

Nurse-led clinic  photo credit: HIA

 

 

 

The present Health in Action team comprises around 100 volunteers, most of them from various branches of the medical profession. In the Family Health Management Programme, nurses take on the role of overall planning, and ten volunteer nurses follow up on cases and make home visits. Volunteer doctors provide consultation services and help with lectures and training as needed.

 

Dr Fan Ning points out that the doctor’s role in this team is “support, not leadership,” a departure from the doctor-dominated paradigm of the past. In his eyes, “Being a doctor is a role, but the doctor is not God.” He adds, “In fact, Hong Kong doesn’t have enough doctors; even 10,000 more wouldn’t be enough. And the greatest shortfall of doctors is in the public sector. If we keep using the old thinking and old concoctions, we’ll be trapped in a dead-end forever.”

 

Dr Fan compares Hong Kong's public health system to a solid fortress. Many old, weak, ill and handicapped people in the community have trouble pushing open the fortress gate, and how can things continue this way as Hong Kong’s population ages? Primary healthcare is the first layer of the medical system; compared with the interventionist and targeted treatment of specialists and hospitals, it puts greater emphasis on macroscopic and integrated diagnosis, taking the patient's physical, mental and social circumstances into account to provide individualized treatment and prevent a deterioration of his health condition. Hong Kong's primary healthcare is full of gaps, however, so specialist treatment leads the way, and hospitals shoulder much of the burden.

 

"Being healthy doesn't necessarily mean seeing a doctor, not to mention seeing a famous doctor or consulting several specialists. That's an erroneous concept. Doctors have to acknowledge that no matter how clever you are, if you don't have enough time and delays result, will you keep the patient from obtaining the timely attention and health he deserves? When resources are strained, we need to consider how to best allocate them and not waste them." As a doctor himself, Fan Ning thought things over and decided to propose a change.

 


 

The Kwai Tsing Community Health Management Hub* makes Symbiotic Community Health a reality

 

After years of demands by local residents, the Hong Kong government last year proposed in the Chief Executive’s policy address a comprehensive review of primary healthcare services. A first step is preparing for a health centre in Kwai Tsing District, which has a high percentage of impoverished residents, with service scheduled to begin in the third quarter of 2019. Dr Fan hopes that Health in Action’s experience and the health management project can serve as a reference for the government’s primary healthcare reform.

 

In 2018, the Fu Tak Iam Foundation agreed to continue its subsidy on Health in Action to expand the scope of the Healthy Living Project for Working Poor Families in Kwai Tsing District and enrich its service content. Over the next three years, starting in November 2018, Health in Action will establish a community health management hub in Kwai Tsing, just in time to serve as a model for the government’s new measures. Dr Fan Ning says, “We’re very grateful to the Fu Tak Iam Foundation for enabling us to introduce an advanced model of outreach, mobile services and community engagement. Kwai Tsing District has 30,000 low-income households. Our goal for the next three years is to establish contact with one tenth of them, or around 3,000 households.”

 

 

Various services are provided at the Kwai Tsing Community Health Management Hub  photo credit: HIA


 

The new centre, called the Kwai Tsing Community Health Management Hub, will continue Health in Action’s family health management programme, volunteer training, medical expense subsidies and other services, while also launching new services such as a nurse clinic, community pharmacy, pain and occupational health screenings and weight management, as well as adding five outreach health stations to enhance the flexibility and scope of services. The team’s full-time staff will increase to nine, including nurses, pharmacists, social workers, nutritionists and physical therapists.

 

The nurse clinic will provide free health assessments and referral services, especially for assessing the risk of cardiovascular disease, treating and assessing the “three highs,” and weight management. Nurse Cheung Wai-ching explains, “In the past, most public outpatient services were led by doctors, with nurse clinics mainly devoted to specialist referrals. Health in Action’s new nurse clinic will nevertheless provide consultations on primary care and preliminary assessments for low-income families. For example, someone with high blood pressure who consults a doctor will not necessarily be prescribed medicine. The team will provide professional recommendations according to circumstance, and in urgent or serious cases will refer the patient to the appropriate place.” Even more important, the clinic’s hours will suit the working hours of the average grassroots worker, and people will be able to drop in without an appointment. The centre’s service hours will be extended on Monday night and Saturday morning, with plans to extend evening hours further in future.

 

The community pharmacy will have a permanent registered pharmacist who can help diagnose common illnesses, and qualifying low-income households will enjoy preferential pricing on medicines. The pharmacy is scheduled to open in the first half of 2019. Dr Fan says the community pharmacy is expected to help save costs at the local emergency ward. “Many emergencies can in fact be handled by a community pharmacy. A good 40 to 60 per cent of acute cases do not actually require a visit to the emergency ward.”

 

The health problems of lower-income families are by no means unique to Kwai Tsing. After focusing on primary healthcare for five years, Health in Action is seeing results, but there is still a long road ahead. Health in Action will continue to introduce necessary community healthcare services and proposals for stronger policies to reform Hong Kong’s medical system so that it can meet the needs of disadvantaged groups.

 

“It is a challenge, but we will persist,” says Dr Fan optimistically.

 

 

 

* The Kwai Tsing Community Health Management Hub is located at 9th Floor, Millennium Trade Centre, 54-56 Kwai Cheong Road, Kwai Chung, New Territories.

 

 

 


 

Read more Dr Fan Ning: "Health Management x Symbiotic Community Health"

 

 

 Text by: Leung Hang-yi & Fu Tak Iam Foundation Editorial Board | Translation by: Stacy Mosher

 

"Doctors are not invincible!”

 

Press Conference to Promote Preventive Medicine among Grassroots Workers  photo credit: HIA 

 

Hong Kong’s medical technology is among the best in the world, but not everyone enjoys equally good health. Hong Kong workers are famous for their long working hours. Mr. Cheung, a 60-year-old container lorry driver, worked at least ten hours per day for meagre pay to feed his family of four, putting a strain on his later years; he lost strength in his legs and became prone to falling. His injuries put his driving at risk – “I had three or four collisions in the course of a few months!” – until in 2013, when his right foot was too weak to press the brake in time, he had a traffic accident that cost him his job.

 

Mr. Cheung had been treating his infirmities with breathing exercises (‘Chi Gong’) and acupuncture for years at a cost of thousands of dollars per month. No longer able to afford these treatments, he went to a public outpatient clinic, where a doctor told him that his symptoms indicated degenerative joint disease. “It’s untreatable. They didn’t even give me medication.” He took physiotherapy once a month for two years, but with the source of his illness undetermined, the therapist could only teach him some movements to relieve the pain, and the treatment was not very effective. After muddling along in this way, Mr. Cheung went to the orthopaedic clinic of a public hospital, but he was put on a year-long waiting list for magnetic resonance imaging (MRI) to diagnose his condition. “I had no choice but to stand in line – doing it outside [at a private hospital] would cost more than $10,000.” Just when he believed a turn for the better was at hand, Mr. Cheung reached an impasse on his surgery: The doctor told him that he might have spurs in his cervical vertebrae that would cause numbness in his arms, and he would need another MRI. In other words, he had to wait another year.

 

Since the waiting time at the public hospital was so hard on Mr. Cheung, why not switch to a private hospital? The cost of private treatment was too prohibitive, especially considering that he still had two children in school, and his wife was now the family’s sole support, leaving them in a bind.

 

As Mr. Cheung wended his way through the endless queue for medical services, doctors and nurses were racing from pillar to post in the public hospital. A nurse with more than 20 years’ experience in gerontology handled dozens of cases every day, but clerical work sometimes took 80 to 90 percent of her working hours at peak periods. Staffing was insufficient to begin with, and she was also covering the work of two colleagues who recently resigned. Constant overtime meant she basically worked nonstop from 8 AM to 8 PM, seven days a week. Worried that her gruelling work schedule would undermine her own health, she finally tendered her resignation. Complaints are rife in the public hospitals, which suffer from persistent brain drain.

 


 

New strategies needed for a beleaguered healthcare system

 

In view of this situation, a group of concerned medical professionals established a non-profit organization called Health in Action to be the change they wished to see by eradicating health inequity and promoting “the right to health.” They saw that the main victims of Hong Kong’s healthcare system are grassroots workers, especially the working poor, who typically exhaust themselves to make a living and neglect the physical and mental health of themselves and their families. Since 2015, the Fu Tak Iam Foundation has supported Health in Action in launching a healthy living project for working poor families in Kwai Tsing District. Its distinguishing feature is using outreach to identify people who are potentially most at risk, and then using case management to provide professional medical consultations and services to individuals and families, as well as encouraging preventative medicine to avoid the infirmities that lead to a vicious circle of deteriorating work capacity and poor quality of life. The services include physical examinations, health management planning and subsidies for medical expenses, promoting preventative and timely treatment, and emphasizing the responsibility of the family to work together towards personal health.

 

Dr Fan Ning, one of the founders of Health in Action, has taken part in overseas disaster relief work, and knows about the backwardness of medical resources in refugee areas. “But even such a wealthy place as Hong Kong still has so many people who cannot obtain the medical services they need in a timely manner.” The long-term health problems of the grassroots result from a vicious circle of low income and lack of a supportive community network. “Many live in partitioned flats and don’t even know where they can get free medical services or free medical exams.” Helping disadvantaged groups prevent illness and improve their health is an enormously difficult task.

 

"Their first consideration is adequate food and shelter.” Cheung Wai-ching, who has more than 20 years of experience as an outreach nurse, joined Health in Action as a volunteer three years ago, and has witnessed the many barriers the grassroots face in accessing public health services: inadequate flexibility in clinic hours, meagre quotas for night clinics, difficulty making an appointment and long waiting times for specialist treatment. ‘Blue-collar workers’ don’t get paid sick leave, so they’re unwilling to spend their working hours standing in line for a government doctor. But they can’t afford a private doctor. As a result, when they’re unwell they self-medicate, often at the risk of misdiagnosis and delayed treatment, not to mention the effects on their health five or ten years down the line.

 


 

The Family Health Management Programme

 

Health in Action’s healthy living project in Kwai Tsing District targets the district’s working poor, mostly aged 35 to 64. As of September 2018, the group has benefitted 5,800 clients, including the Family Health Management Programme serving 90 people in 30 families.

 

 

Sharing by participating family of Family Health Management programme – Mr Wu


 

Cheung Wai-ching is a nurse consultant in the Family Health Management Programme, which targets low-income individuals at risk or with a preliminary diagnosis of the “three highs” (hypertension, cholesterol and blood glucose) as well as obesity. Participants are assigned a volunteer nurse who creates a tailor-made health management plan based on work and family requirements, and arranges for family visits and relevant professional support from social workers, nutritionists and physical therapists.

 

A “three high” home and a 60-year-old driver with diabetes

 

Mr. Cheung, the 60-year-old lorry driver mentioned at the beginning of this article, needed surgery on his cervical and lumbar vertebrae, but was on a year-long waiting list for an MRI at the public hospital. At this point, Health in Action subsidised the cost of an MRI at a private health organization, which allowed Mr. Cheung to arrange surgery within a week. He says the subsidy allowed him to get faster treatment: “I didn’t need to waste another year or two waiting.”

 

This subsidy is a service under the Family Health Management Programme. Up to now, 80 people have received the benefit in amounts of up to $8,000. Most of the subsidies cover examinations for relatively urgent medical conditions, as well as meeting the cost of mental health services, health equipment, or prescription medicines.

 

When Mr. Cheung was assessed by a Health in Action nurse, he learned that he was seriously overweight, and was diagnosed with diabetes and hypertension that could deteriorate into chronic cardiovascular disease. These conditions could hamper his recovery from neck and lumbar surgery and increase the risk of bacterial infection and other complications.

 

Nurse Cheung Wai-ching, who has been following Mr. Cheung’s case, says that when she first began making home visits, Mr. Cheung was unaware of his problematic eating and drinking habits. “As soon as I walked in the door, I saw a flat full of beverages and instant noodles – they ate very few green vegetables.” The family suddenly realized where the “three highs” had come from.

 

As is common in the working class, Mr. Cheung’s work hours had been very irregular. He took advantage of short breaks to make up for lost sleep, and spent long hours driving a lorry with little physical movement or change of position. “I would turn on the air conditioning and bend over the steering wheel so I could get some sleep. That’s probably how I developed problems in my neck and back. When I was young and strong, I could take it, so I neglected my health. When I was hungry I’d buy a rice box full of greasy food and MSG. All my friends did the same. No one saw any problem with it.”

 

Mr. Cheung says the nurse warned him that if he didn’t change his living habits, his medical condition would worsen until it could only be controlled with diabetes medication. “Once I start taking that medication, it is for life – there is no turning back.” No longer daring to neglect his health, he began following a personal health management plan that included daily walks, exercise and controlling his food intake. He even broke his nearly 40-year-long smoking habit. In four months, his weight dropped from 220 to 203 pounds, and his family also realized the need to change their eating, drinking and living habits. Mr. Cheung recovered well from his surgery and is now in physical therapy with the goal of regaining 70 to 80 per cent of his mobility.

 

Nurse Cheung says that Mr. Cheung’s progress is inspiring; his blood pressure and blood glucose have dropped back to normal levels, and if he and his family maintain their good living habits, he will not need to take diabetes medication for the next five years.

 

Teaming up to put health in action

 

People go to a doctor to treat their illness, but Health in Action teams up with the people it helps. “Apart from treating his illness, you want him to feel you really care about him.” Nurse Cheung says that making people take their health seriously requires putting yourself in their situation instead of “intimidating” them.

 

“We have to be of the same mind. If they’re most concerned about their son passing an examination, you’ll have to spend half of your one-hour visit talking about their son instead of right away telling them to cut back on salt and sugar. Once you become friends, he’ll listen to whatever you say.”

 

That’s why the Health in Action team spends more time and communicates more meaningfully with their clients than a typical hospital clinic. They carry out at least three or four home visits and meetings, and more complicated cases such as Mr. Cheung’s may involve 16 or 17 home visits. If the client is more “stubborn,” the team will use every opportunity to follow up. They also hold information sessions at community centres.

 

“People love to participate in information sessions, because they’re dissatisfied with the public hospital system, and they aren’t allowed to see a doctor before they actually become sick. They’re not necessarily ignorant – most of them really care about their health, they just don’t have a correct understanding.”

 

Dr Fan Ning refers to an actual case they handled: An elderly woman in her 60s suffered from hypertension. She lived with her husband, son, daughter-in-law and grandchildren, “three generations totalling nine people in a flat of just over 400 square feet.” On top of that, one grandson had attention deficit and hyperactivity disorder (ADHD), and relations were strained between the woman and her daughter-in-law. The older woman had no time to look after her own health, and her blood pressure was elevated because she was always “angry.”

 

The team devised a health management plan for the woman, but her first task was not to see a doctor. “The first thing in fact was to deal with problems in her life and environment.” They referred her to a neighbourhood organization that provided support services for ADHD by giving kids homework help and teaching their families how to handle discipline problems. They also pushed for the Housing Authority to split up the households to improve their living environment. As a result, the boy made progress in school, the woman’s relationship with her daughter-in-law improved, and so did her blood pressure. “None of these things seemed related, but these kinds of cases crop up all the time among Hong Kong’s low-income families.”

 


 

“Doctors are not invincible!”

 

Stretching workshops led by volunteers

 

Nurse-led clinic  photo credit: HIA

 

 

 

The present Health in Action team comprises around 100 volunteers, most of them from various branches of the medical profession. In the Family Health Management Programme, nurses take on the role of overall planning, and ten volunteer nurses follow up on cases and make home visits. Volunteer doctors provide consultation services and help with lectures and training as needed.

 

Dr Fan Ning points out that the doctor’s role in this team is “support, not leadership,” a departure from the doctor-dominated paradigm of the past. In his eyes, “Being a doctor is a role, but the doctor is not God.” He adds, “In fact, Hong Kong doesn’t have enough doctors; even 10,000 more wouldn’t be enough. And the greatest shortfall of doctors is in the public sector. If we keep using the old thinking and old concoctions, we’ll be trapped in a dead-end forever.”

 

Dr Fan compares Hong Kong's public health system to a solid fortress. Many old, weak, ill and handicapped people in the community have trouble pushing open the fortress gate, and how can things continue this way as Hong Kong’s population ages? Primary healthcare is the first layer of the medical system; compared with the interventionist and targeted treatment of specialists and hospitals, it puts greater emphasis on macroscopic and integrated diagnosis, taking the patient's physical, mental and social circumstances into account to provide individualized treatment and prevent a deterioration of his health condition. Hong Kong's primary healthcare is full of gaps, however, so specialist treatment leads the way, and hospitals shoulder much of the burden.

 

"Being healthy doesn't necessarily mean seeing a doctor, not to mention seeing a famous doctor or consulting several specialists. That's an erroneous concept. Doctors have to acknowledge that no matter how clever you are, if you don't have enough time and delays result, will you keep the patient from obtaining the timely attention and health he deserves? When resources are strained, we need to consider how to best allocate them and not waste them." As a doctor himself, Fan Ning thought things over and decided to propose a change.

 


 

The Kwai Tsing Community Health Management Hub* makes Symbiotic Community Health a reality

 

After years of demands by local residents, the Hong Kong government last year proposed in the Chief Executive’s policy address a comprehensive review of primary healthcare services. A first step is preparing for a health centre in Kwai Tsing District, which has a high percentage of impoverished residents, with service scheduled to begin in the third quarter of 2019. Dr Fan hopes that Health in Action’s experience and the health management project can serve as a reference for the government’s primary healthcare reform.

 

In 2018, the Fu Tak Iam Foundation agreed to continue its subsidy on Health in Action to expand the scope of the Healthy Living Project for Working Poor Families in Kwai Tsing District and enrich its service content. Over the next three years, starting in November 2018, Health in Action will establish a community health management hub in Kwai Tsing, just in time to serve as a model for the government’s new measures. Dr Fan Ning says, “We’re very grateful to the Fu Tak Iam Foundation for enabling us to introduce an advanced model of outreach, mobile services and community engagement. Kwai Tsing District has 30,000 low-income households. Our goal for the next three years is to establish contact with one tenth of them, or around 3,000 households.”

 

 

Various services are provided at the Kwai Tsing Community Health Management Hub  photo credit: HIA


 

The new centre, called the Kwai Tsing Community Health Management Hub, will continue Health in Action’s family health management programme, volunteer training, medical expense subsidies and other services, while also launching new services such as a nurse clinic, community pharmacy, pain and occupational health screenings and weight management, as well as adding five outreach health stations to enhance the flexibility and scope of services. The team’s full-time staff will increase to nine, including nurses, pharmacists, social workers, nutritionists and physical therapists.

 

The nurse clinic will provide free health assessments and referral services, especially for assessing the risk of cardiovascular disease, treating and assessing the “three highs,” and weight management. Nurse Cheung Wai-ching explains, “In the past, most public outpatient services were led by doctors, with nurse clinics mainly devoted to specialist referrals. Health in Action’s new nurse clinic will nevertheless provide consultations on primary care and preliminary assessments for low-income families. For example, someone with high blood pressure who consults a doctor will not necessarily be prescribed medicine. The team will provide professional recommendations according to circumstance, and in urgent or serious cases will refer the patient to the appropriate place.” Even more important, the clinic’s hours will suit the working hours of the average grassroots worker, and people will be able to drop in without an appointment. The centre’s service hours will be extended on Monday night and Saturday morning, with plans to extend evening hours further in future.

 

The community pharmacy will have a permanent registered pharmacist who can help diagnose common illnesses, and qualifying low-income households will enjoy preferential pricing on medicines. The pharmacy is scheduled to open in the first half of 2019. Dr Fan says the community pharmacy is expected to help save costs at the local emergency ward. “Many emergencies can in fact be handled by a community pharmacy. A good 40 to 60 per cent of acute cases do not actually require a visit to the emergency ward.”

 

The health problems of lower-income families are by no means unique to Kwai Tsing. After focusing on primary healthcare for five years, Health in Action is seeing results, but there is still a long road ahead. Health in Action will continue to introduce necessary community healthcare services and proposals for stronger policies to reform Hong Kong’s medical system so that it can meet the needs of disadvantaged groups.

 

“It is a challenge, but we will persist,” says Dr Fan optimistically.

 

 

 

* The Kwai Tsing Community Health Management Hub is located at 9th Floor, Millennium Trade Centre, 54-56 Kwai Cheong Road, Kwai Chung, New Territories.

 

 

 


 

Read more Dr Fan Ning: "Health Management x Symbiotic Community Health"