HK health system

HONG KONG: HEALTH SYSTEM, HEAL THYSELF The city's hospitals have witnessed a spate of medical mishaps	ASIA	March 30, 1998 VOL. 151 NO. 12
Prescription: Don't Get Sick A series of medical blunders puts Hong Kong's ailing health-care system under the microscope By Ajay Singh/Hong Kong t was the thin, yellowish layer at the bottom of the liquid that sent doctors into a panic. On the morning of March 9, dispensers at a Hong Kong government health clinic noticed that large quantities of the potentially lethal chemical chloroform had been mixed into two bottles of a cough formula. An investigation revealed that a staff assistant had accidentally added four times the recommended dosage of the anesthetic to the mixture. By the time doctors began contacting the 36 patients who were to take the medicine, it was too late. Eight reported abdominal pain; two were untraceable. The cough syrup caper is just the latest in a string of medical foul-ups that are dominating Hong Kong's headlines and causing citizens of one of Asia's richest cities to wonder why their public health services seem to be deteriorating to Third World levels. Last April, an 82-year-old woman died when a laundress-turned-operating theater attendant pumped air into her bloodstream instead of into her inflatable pillow. In January, a senior surgeon at the Caritas Medical Center operated on the wrong eye of a five-year-old boy. And last month, a 79-year-old man whom doctors had pronounced dead suddenly came to life as police photographers were taking pictures of his body. Public outrage reached a high point last August with the case of Tsui Wai Ming, 20, a car-crash victim who died at Queen Mary Hospital after receiving the wrong type of blood. There are as many plausible explanations as there have been debacles. Health officials point to 1992 budget cuts that have led to staff shortages at the territory's 44 public hospitals. Nurses are overworked, the officials say, and doctors, who now spend 40% of their time on management duties, are unable to pay proper attention to their patients. Meanwhile, the state-run system faces a growing burden: more than 90% of Hong Kong's 6.6 million people now rely on public hospitals for in-patient needs, a 39% rise over 1992. Private practitioners face pressures as well. Many are so busy trying to make money-partly to pay the territory's astronomical rents-that they don't have the time to examine patients properly. "It's absolutely horrible," observes Dr. Margaret Cheng, a former clinic worker who now writes on medical issues. "You spend a bit of time with a patient and the nurses are knocking on your door. They run the business." In one recent case, a doctor at a top private clinic misdiagnosed Nicola Ellis' pregnancy, with almost tragic results. "I was literally on my way to the operating theater," says Ellis, for the removal of what her doctor believed was a dead fetus. Ellis, a British marketing executive, demanded another test: sure enough, the baby turned out to be alive and kicking. ... And if You Do Feel Ill, It's Probably Only Cholera he wavelet of panic that swept hong kong last week had less to do with cholera than with culture. The territory-where the acute diarrheal illness is endemic-had already recorded 15 confirmed cases of cholera this year, most caused by contaminated seafood. But when health officials announced that they had identified 25 new victims-and that the patients had all just returned from holidays in Thailand-the problem quickly assumed the overtones of a pandemic. Doctors and nurses rushed to meet every flight from Thailand, warning passengers to be on the lookout for vomiting and "watery stool." Authorities issued instructions on how to avoid falling ill and fanned out across the city to inspect restaurants and seafood markets. (The disease, while not contagious, can be transmitted by food handling, and in up to 50% of cases, kills if left untreated.) By week's end there were seven more confirmed victims, bringing the total for the year to 47, compared with 14 in all of 1997. In Thailand, officials seethed. "There have been no cholera cases here for 20 years," insisted a government spokesman. "Hong Kong authorities are trying to undermine Thailand's tourism industry." Indeed, the kingdom, whose battered currency has helped boost Hong Kong tourist arrivals 125% compared with a year ago, suffered a wave of flight cancellations as some travelers switched destinations to Malaysia and Singapore. Worried Thai officials quickly toned down their rhetoric, admitting that a mild strain of the cholera bacterium could be contributing to an outbreak of "severe diarrhea," and pledging to track down its source. But they still sought to shift some blame onto the culinary culture of the visitors. Asked one petulant tourism official after a damage-control meeting: "There are many more tourists from Europe and North America-why are they not affected? Unlike the Hong Kongers, they don't go around eating all kinds of food from the roadside." -By Nisid Hajari. Reported by Kim Gooi/Bangkok and Isabella Ng/Hong Kong
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A series of medical blunders puts Hong Kong's ailing health-care system under the microscope

By Ajay Singh/Hong Kong

t was the thin, yellowish layer at the bottom of the liquid that sent doctors into a panic. On the morning of March 9, dispensers at a Hong Kong government health clinic noticed that large quantities of the potentially lethal chemical chloroform had been mixed into two bottles of a cough formula. An investigation revealed that a staff assistant had accidentally added four times the recommended dosage of the anesthetic to the mixture. By the time doctors began contacting the 36 patients who were to take the medicine, it was too late. Eight reported abdominal pain; two were untraceable.

The cough syrup caper is just the latest in a string of medical foul-ups that are dominating Hong Kong's headlines and causing citizens of one of Asia's richest cities to wonder why their public health services seem to be deteriorating to Third World levels. Last April, an 82-year-old woman died when a laundress-turned-operating theater attendant pumped air into her bloodstream instead of into her inflatable pillow. In January, a senior surgeon at the Caritas Medical Center operated on the wrong eye of a five-year-old boy. And last month, a 79-year-old man whom doctors had pronounced dead suddenly came to life as police photographers were taking pictures of his body. Public outrage reached a high point last August with the case of Tsui Wai Ming, 20, a car-crash victim who died at Queen Mary Hospital after receiving the wrong type of blood.

There are as many plausible explanations as there have been debacles. Health officials point to 1992 budget cuts that have led to staff shortages at the territory's 44 public hospitals. Nurses are overworked, the officials say, and doctors, who now spend 40% of their time on management duties, are unable to pay proper attention to their patients. Meanwhile, the state-run system faces a growing burden: more than 90% of Hong Kong's 6.6 million people now rely on public hospitals for in-patient needs, a 39% rise over 1992.

Private practitioners face pressures as well. Many are so busy trying to make money-partly to pay the territory's astronomical rents-that they don't have the time to examine patients properly. "It's absolutely horrible," observes Dr. Margaret Cheng, a former clinic worker who now writes on medical issues. "You spend a bit of time with a patient and the nurses are knocking on your door. They run the business." In one recent case, a doctor at a top private clinic misdiagnosed Nicola Ellis' pregnancy, with almost tragic results. "I was literally on my way to the operating theater," says Ellis, for the removal of what her doctor believed was a dead fetus. Ellis, a British marketing executive, demanded another test: sure enough, the baby turned out to be alive and kicking.

... And if You Do Feel Ill, It's Probably Only Cholera

he wavelet of panic that swept hong kong last week had less to do with cholera than with culture. The territory-where the acute diarrheal illness is endemic-had already recorded 15 confirmed cases of cholera this year, most caused by contaminated seafood. But when health officials announced that they had identified 25 new victims-and that the patients had all just returned from holidays in Thailand-the problem quickly assumed the overtones of a pandemic. Doctors and nurses rushed to meet every flight from Thailand, warning passengers to be on the lookout for vomiting and "watery stool." Authorities issued instructions on how to avoid falling ill and fanned out across the city to inspect restaurants and seafood markets. (The disease, while not contagious, can be transmitted by food handling, and in up to 50% of cases, kills if left untreated.) By week's end there were seven more confirmed victims, bringing the total for the year to 47, compared with 14 in all of 1997.

In Thailand, officials seethed. "There have been no cholera cases here for 20 years," insisted a government spokesman. "Hong Kong authorities are trying to undermine Thailand's tourism industry." Indeed, the kingdom, whose battered currency has helped boost Hong Kong tourist arrivals 125% compared with a year ago, suffered a wave of flight cancellations as some travelers switched destinations to Malaysia and Singapore. Worried Thai officials quickly toned down their rhetoric, admitting that a mild strain of the cholera bacterium could be contributing to an outbreak of "severe diarrhea," and pledging to track down its source. But they still sought to shift some blame onto the culinary culture of the visitors. Asked one petulant tourism official after a damage-control meeting: "There are many more tourists from Europe and North America-why are they not affected? Unlike the Hong Kongers, they don't go around eating all kinds of food from the roadside."

-By Nisid Hajari. Reported by Kim Gooi/Bangkok and Isabella Ng/Hong Kong