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Reflections on 33 years in the public sector

Dr Yeoh Eng-kiong, who is stepping down as Secretary for Health, Welfare & Food, took a break from a whirlwind of visits and meetings to reflect on past and present health and welfare issues - and his future - in an interview with news.gov.hk.


"Having spent 33 years in the public sector - and like most of us in Hong Kong, our work drives and determines our lives - I thought it was time that I gave myself some time to rediscover myself and to see what other things I'm interested in beyond my work," he said.


His early experiences in the public hospital system had a significant impact that is reflected in his current policies. Upon his graduation from the University of Hong Kong in 1971, he worked as an intern in Queen Mary Hospital, then as a junior doctor. He qualified as a specialist and went to Queen Elizabeth Hospital.


"The public sector in the days of the '70s was very problematic. We had large numbers of patients in the public hospital system and the quality of care was very variable. That has shaped the terms of my own thinking and philosophies and understanding of why you need a good public system," he said.


"Every day, you had patients who were stacked, in camp beds, three stacked next to each other. To get into see the third patient, I had to move two beds to get in there. Can you imagine the environment? How can you even nurse that patient? Or give them the right medication? Or take blood pressure? Do the simple medical tasks? You couldn't. We had only one resident nurse at night who had to deal with all 100 patients."


If the public sector healthcare system is a shambles, he said, "people have no choice. People will beg, borrow or steal to get private care. This is what happened in the old days when our public sector was even worse in the 1950s. I remember as a kid, I was looking at Hong Kong movies in Malaysia and there were always these sob stories about people who had to borrow money to get private care."


His own experience highlighted the problems with poor quality public care. "This had a very strong influence on me in making sure the public sector must improve."


Because of this, some people labeled him a socialist. But he rejects that outright. "As a government, what should you provide to the community? The UK and Canada are not socialist systems but they have to provide some of these fundamental social services to the public and healthcare is one of them. It's really each government's decision as to what social services you should provide, to whom and how you share the costs," he said.


Public, private healthcare systems have complementary roles


A good public sector healthcare system is the greatest assurance to quality and to cost containment, Dr Yeoh stresses.


"For middle income people, when you have a good public sector, you know it's available and can be called upon. You know that it's there when you have major problems, major illnesses, when financially you have pressures on your own resources, then you can always call on the public sector. And that's a good and steady influence, that sets benchmarks for the private sector."


The private sector will always play a critical and complementary role, he says, because the public sector can never provide everything to everyone. For example, it cannot provide a choice of physicians, nor the same level of convenience the private sector can due to the large volume of people the public sector must accommodate.


Centre for Health Protection to take integrated approach


Of his bureau's many accomplishments in recent years, Dr Yeoh seems most pleased with the establishment of the Centre for Health Protection - a direct result of last year's SARS outbreak which highlighted the vulnerabilities of the public health system.


"We had quite a good health system that was able to deal with the known infectious diseases, but SARS was an entirely new infection, where nobody had any idea what was the cause. We didn't even know what the organism was, let alone what were the appropriate treatments, appropriate controls," he said.


SARS also pointed up the inability to handle the size and impact of a major outbreak. In response, an expert committee comprised of public health experts from all over the world provided Hong Kong with policy recommendations, including the setting up of the centre.


"We are now able to deal not just with SARS, but we are much better prepared to deal with any other new or existing infectious disease if it hit us with the size and magnitude of SARS. Right now, we have the facilities to cope with that because we built these infection control wards, with 1,400 of these new isolation beds," Dr Yeoh said.


It's not just the centre itself which is important, but the approach to infectious disease and the expertise. In the past, infectious disease was predominantly the realm of doctors and nurses. But other skill sets, including sociology, behavioral sciences, health education and research, are also key.


"The Centre for Health Protection will have to look at a more integrated approach in looking at health problems," Dr Yeoh said.


Research paramount in early recognition system


The centre also has a research focus and will commission local universities to provide answers to specific questions. Since new diseases often mimic existing ones - as SARS did, resembling atypical pneumonia - having good research is critical to provide early warnings.


It will also aid in scenario planning, to ensure adequate facilities, sufficient stocks, and swift and effective responses.


Social Welfare requires tripartite approach


Since Dr Yeoh took up the post of Secretary for Health, Welfare & Food, there has been a shift in thinking in the welfare area, too. The emphasis, he said, is to take an investment approach to welfare.


Some people see welfare as a handout. He would like to change that view by investing in direct services - such as family services, youth services and child services - to provide resources to be used for individuals, families and social networks. This would help individuals to cope with challenges.


"Many problems like child abuse, unemployment, poverty, suicide, domestic violence, have the same roots," he said. "Because people have not been able to adapt, to manage their problems, pressure, so we're looking at building individual capacity so people are better able to withstand the stresses or strains of life or changes, strengthen families so they provide that support to the individuals, and then building support systems for families."


He notes that individuals who have social networks are able to deal with their problems more effectively. "They can call upon neighbours, friends. If you're depressed you can talk to someone."


Time for reflection, self-discovery


In the past three months, Dr Yeoh has reviewed the policy areas in his portfolio, to take stock of work progress and to record what he has learned so the knowledge will not be lost.


It is up to the future secretary to decide on how much of the work should be continued, when and the priority, he says. Meanwhile, after more than three decades of dedicating himself to his work, he will find time to pursue personal interests.


"I enjoy reading, I like music. I like to read about a lot of things outside the medical arena. There's a whole range of topics and subjects and things in life that I have put aside and ignored and I'm looking forward to having time to look at those and, as some people say, smell the roses and listen to the birds."


Ends/Sunday, September 26, 2004

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