From medicine to politics

York Y N Chow 周一嶽

HK Pract 2007;29:282-284

Dr Andrew Ip, honoured guests, friends and colleagues, ladies and gentlemen,

I feel greatly honoured to be invited to deliver the eighteenth Sun Yat-sen Oration this year, as 2007 marks the 10th Anniversary of Hong Kong returning to China, and 121st anniversary of Dr Sun's birth. In order to prepare for this important task, I had to read Dr Sun's history, his achievements, and paid a visit to the Sun Yat-sen Museum, which is well hidden in the Mid-levels, and which I strongly recommend all of you to do.

Dr Sun Yat-sen was educated in the Government Central School, the predecessor of Queen's College, in 1885 and 1886. He first pursued his medical education in Guangzhou at the Canton Hospital Medical School under John Glasgow Kerr. By virtue of his excellent English, he was also employed to assist with translation and interpretation, in return for which he received free tuition, room and board. The following year in 1887, Dr Sun returned to Hong Kong where he studied at the newly established College of Medicine for Chinese, the predecessor of the Medical Faculty of the University of Hong Kong, as one of its 12 students. Half of those students were also from the Government Central School. (It seems even up to now graduates of Queen's College are still well accepted by the Medical Faculty.) His teachers included Dr Patrick Manson, the famous physician and infectious disease expert, and Drs Ho Kai and Chung Bun Chor. He helped to attend to patients in the outpatient clinics as well as the dispensary and in the wards of the Alice Memorial Hospital. He also acted as an interpreter for his westerner teachers and assisted in surgeries. It must have been quite an exciting life for medical students then.

Dr Sun was one of four students (i.e. four out of the original 12) who sat the graduation examination in 1892, but only Dr Sun and Jiang Yinghua passed. I am glad the examiners in medical schools are more lenient today. He also received Honours for a total of 10 subjects. On 23 July 1892, Dr Sun attended the first graduation ceremony of the College of Medicine held at the City Hall. He was presented with a diploma, "Licentiate in Medicine and Surgery of the College of Medicine for Chinese, Hong Kong" by Sir William Robinson, the then Governor of Hong Kong. The irony, however, was: Dr Sun's medical diploma was not recognized by the then colonial Government, and he had to go to practice medicine in Macau, at the Kiang Wu Hospital, and later in Guangzhou. With his compassion and aspiration to save the people and country, he soon gained an excellent reputation as a skilled and kind doctor. Five months after settling in Macau, he borrowed 2000 silver dollars from the Kiang Wu Hospital to set up a dispensary, giving free consultations and medicine to his patients. (One can imagine what a risk taker he was). Because of his popularity, he incurred the jealousy of the Portuguese doctors and he had to relocate his practice to Xiguan, Guangzhou, in 1893. After another year, he closed his practice in order to concentrate on his revolutionary plans.

It was the general view accepted by scholars of history that Dr Sun conceived his strongest revolutionary ideas when he was in high school and university, while he was in Hong Kong. Indignant at the weakness and corruption of the Qing Dynasty Government, and witnessing the unfair treatment of Chinese people by their Colonial masters, Dr Sun gave up his promising medical career and devoted himself to overthrowing the rule of the Qing Dynasty. His subsequent struggle, failures and successes are well known to all of us, so there is no need for reiteration.

I attended the same high school and medical school as Dr Sun, but obviously our similarities stopped there. Dr Sun was a determined and visionary statesman, and he embraced his political ambition, saw the opportunity, and gave up medicine for politics two years after his graduation. The striking fact was, unlike someone who changed career due to various obstacles, he was an excellent student, and a popular and promising doctor, which guaranteed a bright future by the standards of any day. Such a level of confidence is so hard to find today.

As someone who only entered politics 33 years after leaving medical school, I felt totally dwarfed when I reviewed Dr Sun's life story. However, his achievements inspired me to choose today's subject. Furthermore, my experience of two and a half years as a principal official in the HKSAR Government has given me an intensive exposure to issues that will affect us all in the coming years, and I would like to share with you some of my thoughts on these.

China Today

Unlike the Qing Dynasty, the world and China are very different today, and we need to know what has brought about these changes, what are the critical factors, and to where does it all lead us. China is still considered a developing country, albeit a fast developing nation, and a rising power in international affairs, due to its size, population, and economic influence in world trade and industry. Generally considered friendly and non-aggression in its policy, China has gained much foreign support, as demonstrated by the election of Dr Margaret Chan to head the World Health Organization. China is also opening up for foreign investment, attracting more tourists, visitors and foreign workers and students. Putonghua is now being taught in almost every country as a popular foreign language, and Chinese Medicine is also gaining popularity. No doubt China will be a political focus, and as the biggest factory for the world in the coming decades, economic growth will continue. Whereas such changes in small countries can be well adjusted to, changes in a huge country like China will pose a lot of challenges, including sustainability, economic inequity, and their social effects. The current policies by the Central Government of cutting tax on farmers and giving free education and healthcare reform in rural areas are considered steps in the right direction, but their positive effects may take time.

Hong Kong Today

Hong Kong's position has changed a lot in our day. As a British colonial outpost after the Second World War, it first became the settling place of Chinese immigrants after the Revolution and during the following years of hardship, then a fast developing industrial city, and now a major international financial and services centre. Over the past ten years, we have served as a showcase of "One country, two systems". We continue to uphold freedom, justice and social values to the envy of others. The Central Government also gave as much support as possible to ensure that is so. Many countries watched us with surprise and interest. On the other hand, we also served as the international window of China, building bridges for those countries which do not have much understanding of China. This status is likely to be the same for our near future.

Our Future

Unlike some pessimists, I firmly believe our future lies with ourselves. There are however, pragmatic steps that are necessary to influence and build trust with our own community, the Mainland government and communities, and our neighbours and partners. As part of China, we are guided by the Basic Law for decisions on constitutional matters, which include our political system, our constitutional reform, and the development of universal suffrage. However, as a Special Administrative Region with a high degree of autonomy that are unparalleled compared with our colonial past, Hong Kong enjoys advantages in many areas. We must put this autonomy into best use. For example, apart from the better known areas with a high degree of autonomies such as our legal, judicial, and monetary systems, we also have our own welfare and healthcare systems, and set standards for those services. We can determine our food safety and hygiene systems and standards, independent of others. We can objectively assess our own needs and evaluate the scientific evidence, and come to agreement with countries and territories concerned. With our expertise and resources in these fields, there is every possibility that we can have the most appropriate systems for the Hong Kong community, and it can be bench-marked for other cities of a similar status.

Healthcare Services & Professions

With this audience, I would like to take the healthcare services as an example. Hong Kong currently can boast of enviable vital statistics, such as its longevity figures and low infant mortality rates. With heavy government subsidies and strong public healthcare organizations such as the Hospital Authority, Hong Kong enjoys mostly positive feedback from the public and users of those facilities. Yet, if one looks closer at these services, there are many areas that need improvement in order to measure up to other developed countries. Hardware-wise Hong Kong's hospitals and clinics can offer more choices of better accommodation and facilities, and they need extra funding for their upkeep. Service-wise there is an urgent need to strengthen primary care so that citizens can choose and stay with a single primary care provider (or provider group). Long-term care, chronic care and elderly care will also be priorities, followed by further development of community care in mental health, Chinese medicine and dental services. The Health, Welfare, and Food Bureau has prepared a draft work plan for the longer term which will be passed to the next term's Government for consideration. Its highlights will include implementation of the healthcare financing options and territory-wide electronic health record systems, areas that I have mentioned publicly earlier.

Healthcare Professions, politics and leadership

There is one aspect that would make reform (I mean healthcare reform in this context) a success or failure : People and Leadership. In leadership I refer to the professional leaders, many of whom gathered here today. Although it is often quoted that changes are made through resources, time, and people, there are never sufficient resources nor the perfect time for reform. It is people who create both the right time and resources. Successful reform requires unity and support from stakeholders and also non-stakeholders, critics and, nowadays, the public and media. The experience of enacting the Smoking and Health Ordinance and its implementation since 1 January 2007 can verify the process, complexities, and challenges involved. Despite the difficulties overcome, and the time and effort spent, positive changes in public policy and their successful implementation provide tremendous satisfaction and fulfillment for all concerned. Successful reform of Hong Kong's healthcare system therefore require leadership at all levels, people who embrace the core philosophy of patient-centred care, cost-effectiveness, partnership and teamwork, professional ethics and public accountability.

The medical profession in Hong Kong traditionally enjoys a much envied reputation within the community. Hong Kong's medical schools are the most popular institutions for university applicants and entry is extremely competitive. Doctors are still well respected in the community, and the professional standards of our medical services and medical research are well recognized internationally. Such a social status and public recognition cannot be taken for granted. Cases of medical professional misconduct or negligence always attract media coverage and public criticism, and there is always a community demand for a broader representation in monitoring of professional practice and for increasing transparency of the Medical Council. Such demands cannot be ignored if the trusting relationship between the profession and the public is at stake. There is also a demand for the government to regulate professional medical services outside the Medical Council. I must point out that the Government is open to suggestions and ideas on the Medical Council as long as they are compatible with the public interest. Like most well developed countries, Hong Kong empowers professional groups to uphold their professional autonomy and self-governance as long as public trust is maintained.

Ladies and gentlemen, with my modest experience in politics, I would not be qualified to advise or talk in depth on political participation. All I can share with you is: Hong Kong needs unity and collective leadership for its healthcare modernization reform in the coming years, and we need devoted and committed people with a good professional background. Hong Kong also requires people with team spirit and a strong compassion for community participation in the government and its political institutions. In Charles de Gaulle's words, "Politics is too important to be left to the politicians.

In summary, Hong Kong needs people with integrity, ability and a strong sense of public accountability. I know Hong Kong is not short of such talents, particularly within the medical profession. I therefore appeal to those interested to serve to consider coming out of their individual comfort zones, to create a much bigger and more sustainable comfort zone for all.