1387 students or housemen, the difference being that with no supervision they had no-one to correct them or to rescue their patients. Examining patients, they would fail to notice the tachypnoea of a child with pneumonia, wading in instead with their stethoscopes, just as I did years ago. Carefully taking the pulse and blood pressure, they would miss the cold clammy peripheries of a patient going into shock. Worse still they would succumb to the temptation to close the skin neatly over a dirty wound or compound fracture. The error surely lies with us their teachers. "First teach the students not to do harm" should be our dictum. Either the Russians may withdraw or the war will drag on. In any event, Afghanistan will continue to pose a great challenge to those who are working to improve their health. It will prove expensive and difficult, but the West has already sent them Stinger missiles and the know-how to use them, so why not heat-stable vaccines? 24 Glen
Southampton SO2 3GG
passport holders and about its reluctant and niggardly help with the Vietnamese refugee problem. Only a little less audible is the concern over a nuclear power station being built in China at Daya Bay, no great distance from Hong Kong’s New Territories. Reassurance about safety became less convincing recently when quite a few of the steel reinforcing rods were left out of the station’s foundations while the site foreman was on holidav. Somewhat
but still significant additions to the general the discussions on some medical matters. If the recommendations of an Australian firrn of management consultants are implemented, administration of hospital medical services will change appreciably-to something not all that different from the pattern in Britain. The suggested changes look fairly benign on paper, but those who have been victims of that other British disease, recurrent NHS reorganisationitis, will cross their fingers and wish Hong Kong the best of British luck.
Hong Kong AN ACADEMY OF MEDICINE AMID THE VEHICULAR POLYCYTHAEMIA?
Queen Victoria’s "barren island with hardly a house upon it" has long ago become a fertile jungle of alleyways, freeways, fly-overs, underpasses, tunnels, and high-rise and low-rise buildings of assorted shapes, sizes, and functions. The undergrowth is jampacked with 5 million or so legal, illegal, and refugee residents, and armadas of trams, buses, and taxis, which share the traffic jams with 700 or so Rolls Royces and myriad other automobiles of lesser breed-most wearing a Japanese smile in remembrance of the days when the British were able to sell ordinary workaday cars in their own colony. The scene is dressed overall in scarlet and gold, and shaken once a day by the noon-day gun and every few minutes by the jumbo-jets which roar down to within a chopstick-length of the tenement washing lines before landing at Kai Tak on a runway so near to a parallel Kowloon main street that at first shock it seems to be one half of a dual carriageway shared by cars on the other half. At the side of the sea in Central the few surviving rickshaw men sit languidly on the shafts of their archaic conveyances, willing to leave their noodles and San Miguel beer to pose for photographs for one tael of gold, and for two to pull their client a few reluctant yards. On the water the Star Ferry fleet chugs eternally between Hong-Kongside and Kowloon-side, playing chicken with the rest of the maritime miscellany of one of the world’s busiest ports. "Fragrant Harbour" ("Hong Kong") is now something of a misnomer, since the once ozone-perfumed breezes now bear, here and there, the distinct whiffiness of sea pollution; but visually it is as exciting as ever.
The Lion Rock toll tunnel from Kowloon to the Shatin district of the New Territories, notorious for vehicular polycythaemia with traffic clots that tail-back miles, is now subject to an intriguing therapeutic trial. In the hope of achieving effective anticoagulation, the toll has been abolished for the journey from Shatin to Kowloon, but doubled for the return trip. As an unkind Englishman remarked, it is lucky that there are fewer Scotsmen in the New Territories than one might imagine from the skirl of the bagpipes (the pipers are Gurkhas not Highlanders), for otherwise most New Territories cars would migrate to Kowloon and stay there forever.
Hong Kong looks like nothing so much as a gigantic beehive. It sounds like a dozen, and the noise has been increased of late by a number of new buzzes. The loudest, at least until the recent stock-market shambles, concerns a possible advance in democracy to a point most citizens of the far-distant mother country would regard as still not much removed from feudalism. A kind of referendum has been held, but the phrasing of some of the questions had been criticised and doubts cast on the authenticity of some of the returns; and the whole exercise is clouded by the shadow of 1997-when the Union Jack comes down and the Red Flag goes up. Running joint second on the decibel scale are protests about perfidious Albion’s refusal to grant rights of UK residence, to HK
Primary medical care is also under scrutiny, as well it might be. Now shared between private GPs, Government community clinics, and hospital casualty departments, it leaves much to be desired. Lack of continuity of care is the norm. Patients shop around between doctors from illness to illness or even during a single illness, so that even the best kept primary medical care record file must be pretty thin, and certainly not fattened much by letters from hospital doctors about hospital outpatient attendances or admissions, for such missives seem few and far between. Another serious inadequacy in communication is the lack of labelling on drug containers; unidentifiable medicaments are another norm. And confusion is compounded by the popularity of the mixtures of plant and animal extracts, of obscure pharmacological and toxicological properties, obtained from "traditional" practitioners or from Chinese medicine shops or the sections (large) devoted to the sale of these potions in "Western-type" pharmacies. How often orthodox diagnosis and treatment is confounded by recent or concurrent use of unidentified Chinese medicines is anybody’s guess. These shortcomings are well recognised locally. Recently the President of the Hong Kong College of General Practitioners appealed to the Government for a primary health care system in the British style, but whether his plea will be answered remains to be seen. And the Colony’s medical and pharmaceutical journals complain repeatedly about unlabelled drugs (even though their readers are to blame), but there are hopes that the Pharmacy and Poisons Board will take appropriate action within a year or so.
As for medical training, there are no problems at the undergraduate level. There are two excellent medical schools whose degrees are recognised by the UK General Medical Council as well as by the Medical Council of Hong Kong. One of these, the medical school of the University of Hong Kong, was founded in 1887 as the Hong Kong College of Medicine and incorporated into the University in 1911. The other school, the faculty of medicine of the Chinese University of Hong Kong, began to take students in 1981. Nor is there any difficulty in obtaining "general professional training" to the level required by those British and Australasian Royal Colleges, who hold examinations for their postgraduate diplomas locally, or by the Hong Kong College of General Practitioners. But what are not yet available in Hong Kong are organised and structured programmes for higher training in the hospital-based specialties, and it was to study this problem and advise on how best it might be solved that a working party chaired by Dr Keith Halnan, from Britain, was set up in 1986. The working party has recently issued an interim report, in which it recommends the formation of an Academy of Medicine composed of Colleges of the main professional disciplines. The Academy, which will have its own diploma of fellowship, will accredit trainees in each specialty on satisfactory completion of recognised training programmes and success in prescribed examinations. It seems likely that these and the final recommendations will be accepted, possibly with minor amendments, by the profession and the Government. All in all, there’s island!
quite a lot happening on and around the barren