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November 1997 - May 1998
Philippe Roure
Department of Orthopaedic and Reconstructive Surgery (Head: Prof. AC Masquelet),
Hôpital Avicenne, Bobigny, France
Just before the final stage of my specialty training, I was given the opportunity to spend 6 months (from November 1997 to May 1998) in Hong Kong, working as a research associate at Queen Mary Hospital, in the Department of Hand Surgery headed by Prof. S.P. Chow.
You may wonder why I should have gone to Hong Kong, of all places, to continue my training - why not go to the States, or to some European country?
Of course, people have all sorts of preconceived ideas about what used, until quite recently, to be a British colony: Chinese people in rags, living in rabbit hutches; planes coming in at rooftop level; streets teeming with people - Chinese in traditional garb, like something out of a Tintin book, Jackie Chan lookalikes in Levis, British yuppies, etc.
In actual fact, it is all quite different, but Hong Kong (which means ‘perfumed harbour’ in Cantonese) remains a fascinating and mysterious place for the French, because of this mixture of British and Chinese culture, which come together on one common ground: business.
Photo 1 : The many faces of Hong Kong SAR: the New Territories
As regards medicine, and especially orthopaedics, hand surgery is flourishing in Hong Kong, where it benefits from a range of advantages: Chinese microsurgery, excellent surgeons who have spent some of their training years in Britain or in the States, and a wealth of experience that was provided by historical events.
Hong Kong developed vigorously, both in demographic and in economic terms, after the Communists came to power in China, in 1949, and later as a result of the Cultural Revolution, which led to a massive influx of Chinese refugees, capital, and entrepreneurs.
Industry and the building trade were then able to employ a vast labour force, who were working under difficult conditions, without any proper labour legislation. Not surprisingly, there were numerous industrial accidents, many of them involving hand injuries.
This is how Hong Kong surgeons came to be involved in the treatment of this large patient population. The management of hand injuries was an important issue, since the accident victims would be off work for long times, at great cost to the community and to themselves, since they had no social security cover. As a further remedy, the surgical profession developed rehabilitation, so as to allow these disciplined and hardworking people to return to work even sooner. No slackers in Hong Kong!
It was against this background that I found myself one November morning at Kai Tak International Airport, after the plane had come down, in the time-honoured way, skimming the rooftops of Kowloon.
Travellers going to Hong Kong nowadays no longer experience this daredevil approach: in June ‘98, the airport was transferred to Lantau Island, where planes come in over the sea, the way they do elsewhere in the world.
Among the crowd of Chinese brandishing name boards, I managed to discern my name, followed by “French doctor” - just in case there was someone else of that name on the flight.
Of course, the number of Chinese surnames is fairly limited; so the initials of a person’s given name or names will be used for identification. Thus, the professor hosting my training period has to be referred to as Prof. S.P. Chow, rather than just Prof. Chow, else no one would know who I was talking about.
Chinese names written in Western characters are, of course, only phonetic transliterations used for communication with Westerners; however, these names have their own, often very poetic, meaning. Thus, there may be a Mr. Prosperous River or a Mr. South Wind That Brings Prosperity, while ladies may be called Ms. Fertile Bird or Ms. Sunset on the Shore. Among the men’s names, anything involving Prosperity is a winner.
Having spotted the right name board, it was not difficult to find the nice microsurgery lab technician just beneath the board, who had been sent out to meet me.
No sooner were we out of the arrivals building and heading for the taxi queue than I was hit by the sweltering heat of the place. It was still morning, but very hot and humid - not at all like Paris in November!
Then came my first impressions of Hong Kong: an enormous tailback at the entrance to the Eastern Harbour Tunnel that runs under Victoria Harbour to link the Kowloon peninsula to Hong Kong Island.
Photo 2 : The many faces of Hong Kong SAR: Hong Kong Island seen from Victoria Harbour
The scenery was not very attractive: brick or concrete buildings blackened by air pollution; no buildings higher than ten floors, because of the nearby airport; washing hanging on lines in front of grimy windows; and, everywhere, an air of quite dreadful squalor.
However, all around us people were driving the latest Mercs, BMWs and Ferraris, with hardly a bicycle in sight. This departure from the customary Far Eastern transport pattern came as a surprise.
Once we had got to the northern shore of Hong Kong Island, the traffic started moving more smoothly, and I got my first sight of the typical picture postcard sights of Hong Kong: huge skyscrapers, glass towers, pavements teeming with people, some buildings left over from colonial times.
Fortunately, we were only passing through this metropolis gone mad, to get to the other side of the island, a district called Pok Fu Lam, which is much more residential, and where the University campus and Queen Mary Hospital are situated.
Queen Mary’s is a large hospital, the second in the SAR in terms of size, but apparently the most famous. It has several buildings linked by covered ground-level or overhead walkways - after all, who wants to be blown away by a typhoon? The central building has more than 20 floors. It is a modern white block built against a hill, overlooking the South China Sea, which is less than a kilometre away. On the other side, there are green hills, without any buildings, which give one the impression of being in the country. What a luxury in Hong Kong!
The time had come to meet my new Chief, Prof. S.P. Chow, the Head of the Department of Hand and Reconstructive Surgery. His office was in the administrative wing of the Department, together with the labs, the secretaries’ office, the surgeons’ rooms, and the departmental library.
I was impressed by the library: coffee and tea-making machines; china cups that get washed up by tea ladies; two comfy armchairs and a coffee table with the day’s newspaper; a good-quality fitted carpet; a large conference table made of pleasant-looking wood, at the back of the room - all very cosy, very British; all very unlike the utility look of similar facilities in our French public hospitals.
Of course, the walls are lined with shelves filled with Chinese and English-language textbooks and journals, with publications by surgeons at the Department very prominently displayed.
After a short wait, the Professor came to meet me. He is an elegant man, with a pleasant smile - and I was surprised how young and dynamic he looked. That was not what I had imagined a Chinese professor to look like!
He was obviously happy to have a French honorary research associate, instead of the usual Far Eastern or British ones. A Frenchman is something out of the ordinary that one can show off to one’s colleagues; someone that can come to one of those wine tastings that are getting so fashionable in the Far East; and someone who will be bound to have some original ideas.
I had to do two projects on hand surgery or microsurgery during my stay; I was also invited to take part in the surgical and other activities of the Department. How I would structure my time was entirely up to me.
I was given a free run of the Microsurgery and the Biomechanics laboratories, with full technician support.
My accommodation was in the Duchess of Kent Children’s Hospital. This is a more modest-looking facility, about 20 minutes’ (downhill) walk, or a 5-minute minibus ride, from Queen Mary’s. It is right by the seaside, surrounded by trees that are inhabited by some monkeys, and next door to the University stadium and swimming pool. It’s like being on the Côte d’Azur - or it would be, but for the container ships crowding round the entrance to Victoria Harbour, and the fact that there is not the least little bit of beach or even access to the water, anywhere.
My room (rented for an exorbitant sum) was on the ninth floor of an office and housing block. It was 10 m2 in size, with kitchen facilities and a common-room shared with the nurses and the foreign doctors working at the hospital; a Chinese-size bed (meaning that my feet would stick out even if I was lying diagonally across); and a bathroom shared with my next-door neighbour.
This was to provide me with one of the more exotic impressions of my stay, because the foreign doctors were all army medical officers of the People’s Republic of China, who had been posted to Hong Kong for a few months. In keeping with Chinese tradition, they would “cleanse” themselves every morning, making a lot of body noises that are not very pleasing to delicate Western ears.
Having got all these things sorted out, I was ready to start my life in Hong Kong.
November is one of the better times of the year for going to Hong Kong. The sky is cloudless, the temperature does not rise above 26-27°, and the weather is dry. Winter is a short season in Hong Kong, lasting from January until March; for 3 weeks, the temperature will be around 10°. Summer, however, is hot and humid, and brings such unwelcome visitors as typhoons and sharks: the people of Hong Kong consider this the ideal time of year for going abroad.
Cars are an expensive means of transport in Hong Kong, because of high tax levels. Getting around without a car is made easy by an extensive public transport system. The MTR, buses, and minibuses are very cheap.
Photo 3 : Lamma Island, 30 minutes by ferry from Hong Kong Island
From the Duchess of Kent Children’s Hospital, the only option was to take the minibus. These vehicles are stretched Japanese estate cars that seat 15 passengers. Minibuses are hailed like taxis - and will stop if there is enough space. Fares are placed in a small box behind the driver. Passengers have to pay the correct fare: no change will be given; there are no tickets, and no inspectors. It is difficult to see how such an honour system would work in France....
Once everybody is seated, the 20-minute ride along the race-track can commence. Since the driver is paid per head of passenger, he wants to make as many round-trips as possible. So he puts his foot down along the winding, busy streets of the island. Beneath the windows, a rail is provided for passengers to cling to as the minibus tears around corners.
On my first outing, going nowhere in particular, I found myself in Kennedy Town, one of the less ritzy Chinese districts, with rows of little shops selling every conceivable ingredient used in Chinese cooking; with general stores; and with odd-looking and dodgy-smelling restaurants.
What chiefly struck me was that people were giving me funny looks. I soon realized that I was the only Westerner around!
After that, I was able to discover Hong Kong (or - as it should be called since the handover in 1997 - the Hong Kong Special Administrative Region of the People’s Republic of China) at greater leisure.
Hong Kong is situated in south-east China, east of the Pearl River delta. It consists of Hong Kong Island, with the hospital and the famous skyscrapers; and Kowloon, the mainland part facing Hong Kong Island, with the New Territories extending into the hinterland. The New Territories were leased by Britain from China a century ago, for a period of 99 years; hence the hand-back last year.
Hong Kong is surrounded by a fringe of outlying islands, most of them unspoilt and little built-up, where one can spend a peaceful weekend.
Facing Hong Kong across the delta is Macau, notorious for its gambling dens (and its women). This Portuguese enclave will be returned to China next year. The journey from Hong Kong can be made in 50 minutes, by single-hull or catamaran jetfoils.
While foreigners tend to think of Hong Kong as an intensely built-up area, only 20% of the land surface is, in fact, covered by buildings. Hong Kong is really a big rock sticking out of the water, and while the coastal fringe can be used for building, the centre is unsuitable for such activities - which is why the real estate, crowded along the seafront, is so exorbitantly expensive.
Photo 4 : The double-decker tram - 100 years old, still going strong!
The remaining 80% of Hong Kong’s land area is hills covered in grass and shrubs, criss-crossed by trails, where the locals go hiking in their spare time.
Kowloon and the northern shore of Hong Kong Island are separated by Victoria Harbour. To get from A to B, one may use one of three road tunnels, the MTR, or the famous ferries that have been plying across the harbour since the start of the century.
Along the waterfront, there are ultramodern high-rises, luxury hotels, headquarters of multinational companies and of Chinese billionaires (the tycoons), as well as hundreds of commercial centres offering the world’s most renowned brands.
Hong Kong is a land of contrasts, where the Chinese and Western civilizations co-exist without actually blending; where modernism meets traditionalism; where poverty and flashy wealth are cheek by jowl.
Thus, a glass-fronted skyscraper may have been built next door to some squalid hovel; the tycoons in their big Mercs drive past wizened old men pushing heavy carts; and everyone observes Chinese rites and rituals that go back thousands of years.
Thus, it is thought fitting to place an altar in one’s shop, to honour the spirits of the place; or to put a pair of lions flanking the entrance to a bank, to bring good luck and prosperity.
Even on Hong Kong Island, there are great differences between different neighbourhoods. A tram that first started operations a hundred years ago runs along the northern side, from Chinese Kennedy Town to the commercial heart at Central, which is still quintessentially British; to notorious Wan Chai, with its bars and night clubs; and to Causeway Bay, with its shopping centres.
Everywhere, however, the pavements are lined with dark little restaurants, where nothing is written up in English; tiny outlets, filled with stacks of hi-fi equipment or computers; and herbalist’s shops that exude a heady scent of exotic herbs and spices. And everywhere, but everywhere, there are throngs and crowds and masses of people.
The people one sees in the streets are mainly Chinese. Westerners tend to confine themselves to certain areas such as Central or the tourist spots.
The Chinese have mainly come from the surrounding provinces, especially from Canton (Guangdong). Most of them arrived in 1949, when Mao came to power; and after the massacres during the Cultural Revolution. They brought with them their muscle and their skills, their capital and their business acumen, which helped to produce the city’s present-day affluence. With Beijing’s blessing, Hong Kong has become China’s only opening onto the capitalist world.
Today, the sons and daughters of those who came as refugees constitute the population of modern Hong Kong - which now numbers 6.5 million.
Many immigrants now living in Hong Kong come from other Asian countries, such as India or Pakistan. Numerically, the largest group is undoubtedly that of Filipinos (or rather Filipinas), who work as domestic servants and tend to gather for huge Sunday picnics in the middle of the road in Central, where Sunday has been dubbed “Filipina Day.”
What strikes one first, when walking through the city, is, admittedly, how dirty everything is; equally though, one is struck by the vitality and dynamism of a place where people seem to be constantly on the move, in a hurry, night and day. In Hong Kong, anything seems to be possible.
As Westerners, we seem to be invisible to the Chinese - they do not see us. They ignore us, and if one speaks to the man in the street, he tends to be pretty gruff. We are also known as gwailo, which is Cantonese for “white ghost.”
However, one never feels in danger. There are no signs of delinquency, no graffiti on any of the buildings, which is quite something for a city that size.
Another major feature of Hong Kong is the variety of scenery. The southern side of Hong Kong Island, quarter of an hour’s bus ride from Central, is much less densely built up, and has sandy beaches lined with restaurants, at such places as Deep Water Bay, Repulse Bay, Stanley Bay, or Shek O.
These places have a holiday atmosphere. One can go for a swim inside the shark-netted areas. However, the water is rather polluted, which may not be good for the skin.
In the New Territories, too, there are almost entirely deserted sandy beaches that can be reached only by boat or after several hours’ walking. There, the last place one would think of being at is Hong Kong!
This is, in fact, the magic of the place: everything is concentrated in a small space. One can go from beaches to skyscrapers via lush green hills, all in the space of half an hour or so.
It took me 6 months to find out how big Hong Kong really is; and even then there were aspects that had escaped me.
My work at the hospital started at 8 a.m. - no A&E meeting to review the patients admitted overnight, but a ward round for the junior doctors, before going to theatre.
I would first have breakfast in the canteen: dim sum (steamed dumplings), congee (sticky rice served in the broth it was cooked in), or sticky rice and chicken (when the latter didn’t have the ‘flu!). And, of course, chopsticks with everything.
After that, my timetable would be pretty flexible. The only requirement imposed on me was that I should finish my projects, as agreed in my contract.
I therefore spent some time in the Microsurgery lab with my rats, or with my cadaver hands in the Biomechanics lab, to examine the mechanical properties of different absorbable intramedullary fixation devices in an experimental model of a comminuted fracture of the first phalanx.
The laboratories were superbly equipped, with modern hydraulic and computer systems for the biomechanical tests; excellent microscopes for microsurgery; an animal house; a photo lab; and staffed with IT advisers and a dozen or so technicians to help the research associates or doctors from the Department who wanted to do some research.
Funding, quite obviously, was not a problem. Hong Kong University is rich. This is because Hong Kong is a wealthy city, but also because the Government has been investing in education and science for a large number of years. The Government knows that the future of the territory is uncertain, given the way in which it is surrounded by the mighty Communist neighbour, and that its financial power may weaken. Therefore, giving young people an excellent education, obtaining know-how, and reaching a high level in the sciences, are seen as the best investment in the longer term, and as a means of safeguarding Hong Kong’s rights and freedoms, and keeping open the door to the outside world.
By the same token, any papers published by members of the Department assume a much greater importance than would be the case in France. These publications are not just concerned with different scientific subjects, they also have an important political function: they allow their authors to travel, to be heard, not to be swallowed up by Hong Kong’s big neighbour.
I was also struck by the staffing figures, as compared with levels in France. The reason is a simple one: in Hong Kong, charges are low, while there is an abundant supply of educated and disciplined manpower. Unemployment is about 3% of the active population, and economic growth is vigorous (or at least it was that, until a few months ago).
Prof. S.P. Chow would meet me fortnightly, with his assistant, Dr. W.Y. Ip, to review the progress of my work.
And this is where I started to learn how the Chinese think....
The thing is that, instead of being direct and making me work on subjects that were of interest to them, they would ask me first to work on my own subjects - thinking perhaps that this might produce ideas that they could then appropriate and exploit to their own ends.
However, they obviously did not think much of my self-selected subjects, and waited patiently for two months, skilfully suggesting in the process that it might be better for me to take up such and such a subject, which happened to be one of the main concerns of the Department.
Eventually, I suggested to them that I should work on those subjects rather than the ones I had had in mind. This earned me a big smile, and the remark that I had had an excellent idea.
That was a somewhat convoluted way of approaching one’s objective; and I certainly was not used to it.
Another principle important to the Chinese is not to lose face. Nobody, least of all a university professor, would risk asking me to do things, for fear that I might say no.
What one has to bear in mind, of course, is that these Sino-British people have a somewhat warped picture of us French: to them, we are a people that guillotines its kings, protests at the drop of a hat, and makes a profession of coming out on strike. A French person might, therefore, refuse to do what his or her superior tells them to do - something quite unthinkable in Hong Kong.
I took great care not to disabuse them entirely, which allowed me to spend my time without being unduly troubled by requests to work.
Prof. S.P. Chow is an important personality in Hong Kong. He is Head of the Department of Hand Surgery, and Dean of the Medical School, as well as being well received in government and executive circles. He is respected by his peers and his students, who, as is usual in China, are devoted to him. He is also a very charming person. Throughout my stay, he treated me with great kindness and perfect civility.
On the second day of my stay, he took me to the supermarket next door to the hospital, and insisted on offering me the contents of my trolley as a welcoming present. I must say that none of my chiefs back in France had ever treated me to such a present when I first joined them.
Throughout my stay, Prof. S.P. Chow regularly invited me to home to dinner, or took me out to restaurants, with his friends, or to lunch at the Yacht Club.
He loves wine, and is a true connoisseur. (Wine is becoming a fashionable drink in Hong Kong and in China in general, taking the place of cognac, which the well-to-do would previously down in large quantities at dinners. It has become very with-it to belong to a wine tasting club, so as to distinguish oneself from those who drink wine only because it’s the smart thing to do and cannot tell the difference between Chateau Cardboard plonk and a Saint Emilion.) He invited me to several tasting sessions, organized by the University or in the big downtown hotels.
These tastings are quite an elaborate ritual, but I was amazed to see so many Chilean, Australian, New Zealand and American wines there.
As a Frenchman, I was automatically considered to be a great connoisseur, and only had to praise, with great assurance, our national produce. After all, that’s what one is French for!
Prof. S.P. Chow’s other hobby is hiking. While outsiders would not normally associate Hong Kong with hiking, this sport is, in fact, very popular and also very readily practised, since 80% of the land area is hills with properly laid out tracks.
Photo 5 : A Sunday hike in the New Territories, with Prof. S.P. Chow (on the right)
This way, on one or two Sundays a month, and even on odd weekday afternoons, Prof. Chow would take me hiking in the hills, with a rucksack containing a snack and a nice bottle of wine that would be ceremoniously consumed on the last hill of the day.
Our hikes took us through Hong Kong Island, the New Territories, and the outlying islands.
The views one gets can be superb, and the whole picture verging on the surrealist. Imagine yourself standing on some wild hill, with, on one side, modern office towers at the foot of the hill, and, on the other, sandy beaches, and, in yet another direction, container ships waiting to get into the harbour.
I would never have thought that Hong Kong could offer all these different sights; nor that I would come across an academic like Prof. Chow.
Doctors in general enjoy higher social prestige than they do here in France. The people certainly respect them, and have faith in their diagnosis.
Most of the hospital doctors are Hong Kong Chinese; over the past 20 years, the British heads of hospital departments have been replaced by Hong Kong residents of Chinese origin.
From the junior level onward, they go to conferences world-wide, with all the costs involved borne by the hospital.
Doctors’ salaries reflect their status: a junior gets the equivalent of 60,000 to 80,000 French francs a month, while a senior registrar may earn up to 110,000 francs a month, and a professor may get up to 200,000 francs; in addition, there are substantial benefits in kind.
In the private sector, the picture is less clear; however, earnings are higher - and there is no social security to pay, and income tax is 15%!
As you may imagine, it was not easy explaining the French system to them....
What I was trying to say is that, in Hong Kong, doctors are still on a pedestal, and are only just beginning to be viewed more critically as the economic climate is becoming harsher.
The medical education and training system is patterned on the British one. All undergraduates spend at least one semester abroad, usually in the UK, the US, Canada, or Australia. After 5 years’ undergraduate studies, they spend one year as Medical Officers, and then become Senior Medical Officers for an average period of 5 years. There is no competitive exam of the kind that has to be sat in France to get access to specialty training. However, throughout the training period, there are exams at regular intervals. Most of the doctors will stay and work in hospitals in the territory, since the salaries are high enough not to force them immediately into private practice.
Since the handover, doctors from the People’s Republic of China (in common with all PRC inhabitants other than party apparatchiks) have been forbidden to go and work in Hong Kong; this ban has, indirectly, provided some ring-fencing for the Hong Kong medics.
Health care is, in principle, free of charge. While emergencies receive the immediate attention they require, there is a waiting list for elective cases.
Most of the well-to-do will go to private clinics for surgery, unless there are special needs in terms of equipment or skills that can only be met at a public hospital. It is customary for patients who are satisfied with the treatment they have received to make a donation to the department, to obtain the favour of the gods, and also of the doctors, should there be problems later on.
These donations may run into the equivalent of several million French francs. Anybody that generous will be entitled to having the institution thus endowed named after him.
Another interesting way of financing health care is through gambling. Horse racing is controlled by the Jockey Club, which is a totally non-profit-making body. Through its Charities Trust, the Club is a major source of donations to a large number of charitable projects and other good causes, including hospitals, clinics, and rehabilitation centres. Facilities that are funded in this way often have “Jockey Club” as part of their name. Since the Chinese love horse racing and betting on horses, this system provides an elegant and lucrative source of funding for medicine and health care.
So what about traditional Chinese medicine?
This age-old form of medical practice is still very much alive today. Outside the hospital sector, it is present everywhere. Unlike the People’s Republic of China, Hong Kong does not provide traditional Chinese medicine in the hospitals.
As a rule, people will go and see a “traditional doctor” first, and take all manner of herbal remedies, before going to see a “modern doctor.” Even professors in medical schools will first try traditional remedies when they have got ‘flu.
The most frequently sought treatment is for impotence, which is obviously one of the major preoccupations both in Hong Kong and in mainland China: the herbalists offer umpteen medicinal plants and decoctions for the restoration of potency.
In addition to my research activities, I took part in the general work of the Department - ward rounds, clinical meetings, outpatient clinics, and operations.
The professor does two rounds a week, on Wednesdays and on Saturdays, after the clinical meeting. Everybody is smartly dressed under their white coats. The doctors, nurses, and physios are there, some 20 people in all, from the entire Department.
Once more, I was the only Westerner; and what is more, I was not a Brit!
There were, in fact, very few Westerners working at the hospital. The majority of the ones that were there were British, and most of those were anaesthetists.
In surgery, there was only one European, a Brit; he was a senior registrar, with only one ambition: to get out into the private sector, to treat ... European expats.
In common with all medical and university instruction, the ward rounds were held in English. This was lucky for me, though perhaps less lucky for the patients, most of whom speak only Cantonese. This is because the greater part of the population are from the border region of Guangdong, where the language is Cantonese and not Mandarin Chinese. Only 20% of the people of Hong Kong have some English, while only 2% have perfect mastery of the language.
The doctors would thus discuss among themselves at the patient’s beside, without the patient being able to understand a dicky bird. The patient would get a translation from a nurse, afterwards.
Photo 6 : Ward round at Queen Mary Hospital
Another difference between Hong Kong and French hospitals is that, over there, patients are accommodated in large wards, with beds arranged in blocks of six; if there is a major influx of patients, camp beds will be provided as well. There are a few two-bed or single-bed rooms; these are for special cases, or for private patients.
There were curiously few Western patients in the public hospitals: they prefer to go to private clinics, where they get greater privacy and are fed Western food.
Outpatient sessions are held in the same room, at the same table. Several doctors are seated side by side along this table, with the secretaries and physios also present. The patients then file past the doctors, saying, within earshot of everybody else, what is wrong with them, and comparing their complaints with those of their neighbours in the queue. Not quite like the way we do things in France!
The wards have all the latest equipment; the nurses in their pink or blue uniforms (according to rank) do as they are told by the doctors, without questioning or answering back. The pecking order is well established; surgeons are highly respected.
The in-patients suffer mainly from trauma, or the sequelae of trauma. Industrial accidents, burns, a lot of reconstructive surgery using flaps. Compared with France, there is a higher rate of free flaps, with fewer local ones. The underlying reasoning is “Why do a local flap when one can do a free flap? In our hands, the free ones are just as reliable.”
There are always some cases of Mycobacterium marinum infection, mainly in fishermen or fishmongers; these infections are a “local speciality” - they were first described in the Department back in the 70s.
After the ward round, the doctors would go and have elevenses in the canteen: another lot of dim-sum, noodles with sesame seed oil, sticky rice and chicken. Enough to keep one going!
Food, of course, is something sacred in Hong Kong, in all strata of the population. The streets are lined with restaurants, from the pokiest to the poshest; and one of the most striking things to the newcomer is that, at all times of day or night, one will always see someone eating.
At work, Hong Kong people always have a cup of tea parked beside them, with sweet or savoury snacks for more solid sustenance.
Eating is a second religion, firstly because the Chinese love good cooking, and secondly because the forebears of Hong Kong’s present population were refugees, who had not had enough to eat. The starvation of the past is still deeply ingrained in their memories.
The clinical meetings were held in a lecture theatre of the Department. All the doctors, the students, the senior nursing staff, and the physios would be there. The three units of the Department of Orthopaedic Surgery (Hand, Joints and Trauma, Spine and Paediatric) would take part on a rota basis. The middle level would present one or two clinical cases that would then be used for teaching.
These meetings involve much audience participation. A microphone is handed round, and the speaker questions the medics, starting with the most junior members. Everything is done in English, even though not everyone has a perfect command of what is not, after all, their mother tongue.
I was sometimes astonished at how tough some of the seniors were with the junior surgeons - but, then, our Paris chiefs don’t exactly excel at being nice to their juniors, either.
I was regularly asked my opinion. Undoubtedly, they thought that I might provide some exotic answer. However, I tried to tread carefully, and avoid the traps set for me, more in jest than in order to show me up. Also, I held the ultimate trump card in this game: I could always say that I had not really understood the question, “because my poor English, of course.” However, the general feel of these meetings was friendly; and even though the professors drew a clear line between themselves and the students and trainees, the atmosphere was an almost family one.
The theatre is very well equipped, and amply staffed. Aseptic techniques are similar to ours. No disposable pyjamas, but woven operating gear: Chinese laundries are cheap.
One room is very important in the surgical suite: the dining room. It always provides ample supplies of tea, coffee, cakes, and sweets of all kinds; and it is there that lunch is served.
The senior nursing officer was very sociable; this was somewhat unusual, because, while the staff were helpful and smiled readily, they tended to be cold and stand-offish. It would appear that this is part of their culture.
Another curious feature: in all the theatres, there are cameras installed in the light fittings, looking down on the operating field. However, I was told that they are not always on.
Surgery was done in the same way as in our practice. I would assist the surgeon, who would sometimes let me do a bit myself. Things would get complicated when they got excited about something and started jabbering away in Chinese.
At this centre, they love flap surgery, and were very proud to demonstrate “Masquelet flaps” to me. They were quite keen to perform “all-time firsts”, and to try out new ideas.
Members of the medical profession are much respected here. Nobody would dream of suing a medic; everybody trusts their doctor implicitly.
To the Chinese, anybody educated is a figure of great respect; and many of the Hong Kong people of today react like the refugees of old: they are happy to have access to high-quality health care, especially when comparing what they can get with what is available only 30 kilometres away, in the People’s Republic.
Surgical technique is sound, especially in microsurgery. However, we in France need not be ashamed of our standard - it’s perhaps just that we are somewhat more limited in what we can do with our patients.
Unlike the situation in some of our hospitals, I saw no problems on the A&E side: there were enough theatres, and enough surgeons to staff them. The system of being on-call for two or three days on the trot is unknown in Hong Kong. So why does everybody keep telling us that, in the Far East, they work harder than we do?
At the hospital, I never found that the doctors or the rest of the staff worked harder than we do in France; however, they always looked very busy, even when they were doing nothing. That is the difference - only, it took me a few months to rumble that.
In business, and in the private sector, things are obviously different. There, nobody is clamouring for the 35-hour week....
My Hong Kong colleagues always were very kind to me, although, initially, they were somewhat indifferent. They were, in fact, warmer and more cordial than we tend to be towards foreign trainees in France.
My colleagues did not go out much, and practised little sport. The Chinese tend to marry early, and the family is very important. My colleagues, therefore, spent their leisure time at home. There is not much entertaining at home: home is a haven from the outside world; also, flats tend to be tiny.
On the other hand, there is much dining out, with family or friends. This way, I was able to attend several departmental dinners, which were always very liquid and very nice. One of the traditions at the hospital was that any doctor who had had a promotion would invite the entire department out to a meal at a restaurant.
For such occasions, the restaurants provide a private room; guests can bring their own drinks; and etiquette prescribes that one should tuck noisily into the food provided.
Photo 7 : Christmas at Queen Mary Hospital - Meet the Department!
After the meal, it’s karaoke, at the table, with all electronic mod cons provided: the microphone is handed round; the songs are in Cantonese (“Canto-pop” - grrreat!) or in English; and everyone joins in happily.
Karaoke is a favourite entertainment in Hong Kong, and generally in the Far East; to me, it was one of the pains I had to put up with during my time in Hong Kong.
Quite generally, the Chinese do not socialize much with Westerners. They practise peaceful co-existence. Every ethnic group has its own favourite haunts: the Chinese go in for karaoke; the white population frequents the pubs and night spots.
In the centre of Hong Kong, at Central, there is an area called Lan Kwai Fong, which is packed solid with bars, restaurants, and yuppie clubs. There, the golden boys meet on weekday evenings, and most of the Westerners congregate at the weekend. Rock bands, beer, techno music, everybody out on the pavements clutching a pint, in the best old Brit tradition.
Another part of town much frequented by Westerners is Wan Chai. This former red-light district of Hong Kong still has many hostess bars, with mainly Filipina bar girls and a formidable “Mama San” at the entrance; as well as all sorts of saunas and massage parlours.
Among the many pubs and night spots that have mushroomed in the area is Joe Bananas - another bar with a “very British” atmosphere.
I had not expected to find so much entertainment in Hong Kong. However, people work hard all week, and need to relax at the weekend.
There is obviously no apartheid in Hong Kong: in the entertainment districts, too, Orientals mingle with the Westerners, although most of the Chinese one sees there are Americans, Canadians, Australians, or Europeans of Chinese origin - nicknamed “bananas” by the native Chinese (yellow on the outside, white inside).
The French are not very much in evidence in these parts of town, but easily recognizable by their “so lovely” accent, which serves as a badge of recognition.
Photo 8 : The tea ceremony among colleagues
The French expat colony is quite large, numbering between 5,000 and 10,000; it matches the German colony for size, but is very much smaller than the British one.
Many French expats work in finance, in the building trade, and above all in the luxury goods industry, selling wines and spirits.
Like expats from other countries, they come in different patterns. Young people without prospects back home in France come here to find a job and climb the social ladder - something that is much easier to achieve in Hong Kong, where the very open capitalist system allows a hard worker to get to the top. Then there is the French executive who has been sent out, with his family, to spend a few years in Hong Kong. He will have an excellent salary, a large flat with domestic staff, and membership of a leisure club (the level of which will depend on that of his job); his children will be privately educated at a French or British school, and the missus will be a member of a ladies’ club.
Between these two patterns, there is that of the young, dynamic managerial type at the start of his career, who has been sent out here by his company for a few years’ hard work, in return for which he has been promised major promotion when he is back in his own country again.
These people tend to have little contact with the Chinese, but co-exist peacefully with them.
Hong Kong is also important as a stepping stone to Asia, and to China in particular.
The comparison with China is interesting, because people there have a different mentality, and are often nicer, more natural, not so “nouveau riche” and “show-off” as the people of Hong Kong (who will describe themselves in these terms).
However, the difference may not last much longer: Shanghai is becoming increasingly like Hong Kong, and is obviously destined to be the new economic pole of this region.
However, that’s another story.
My 6 months in Hong Kong just flew by without me noticing it. Hong Kong is a fantastic place that will fascinate anybody that goes there; and complete immersion in a foreign culture has also brought me personal enrichment that is deeper and wider than I can tell right now.
The only part of me that found time to be dragging was my stomach.
With many thanks to Prof. Masquelet,
who made it possible for me to go on
this trip.
(Transl: KRMB)