© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
DOCTOR FOR SOCIETY
A consultant surgeon on-call 24/7: an interview with Dr YK Au
Brian YO Chan, Adrian HK Yu, Selene SW Yu
MBChB 2013-2015, Faculty of Medicine, The Chinese University of Hong Kong
Have you ever been on-call 24/7 for more than a month? Performing operations belonging to six different specialties? Have there been any life-threatening moments in your work such that emergency evacuation within minutes is needed? Meet Dr Au Yiu-Kai, a consultant surgeon of Kwong Wah Hospital, the founder of Hong Kong Wheelchair Aid Service, and an all-time medical volunteer of the Hong Kong Red Cross and Médecins Sans Frontières (MSF).
With three decades of medical humanitarian experience, both locally and beyond, Dr Au is a vivid example of constant commitment and dedication to underprivileged populations. As a young man, he had great concern for societal issues. Unmet medical needs were widely prevalent in the 1980s in Hong Kong. Since 1987, he has been providing free medical services to retired old miners and their families in the Ma On Shan village on a monthly basis. In 1997, he set up the Hong Kong Wheelchair Aid Service with his colleagues, with a mission to protect wheelchair users from unnecessary injury and enable them to perform activities of daily living more independently. In 2002, Dr Au became a medical volunteer of both Hong Kong Red Cross and MSF, two major global humanitarian organisations that aim to protect life and advocate importance of human dignity. Through his work with these organisations, he served populations affected by wars and natural disasters in Liberia, Indonesia, South Sudan, Thailand, and Mainland China.
Great things start simple. Dr Au’s heart for charity work dates back to his early education with a Catholic background, which emphasised the importance of contributions to society. This simple yet key message planted the seed for volunteer service during his adolescent and medical school years. In 1978, when he was a first year medical student, following the Wah Fu Estate tragedy, where two children were orphaned following their parents’ death from liver cancer and suicide, he initiated a fundraising campaign to provide financial support for the children. This incident impressed upon him the importance of community care, and the fact that simple tender loving care can be very reassuring to the sufferers even if it appears as a small contribution in the big picture. It encouraged him to launch more extensive and daring programmes to help the community. After his graduation, Dr Au initiated the “Community Health Development Programme”, wherein junior medical staff provided simple physical checkups to the public every Sunday. In 1987, Dr Au initiated a monthly outreach service to residents in Ma On Shan, which provided free consultations for a duration of nearly three decades. To date, he and his team have made up to 300 visits to that area, delivering quality primary health care.
The call to go global reached Dr Au shortly after the end of the second millennium after Jesus’ birth. Having reached a certain peak in his career, Dr Au started having a heightened awareness of the global condition, as well as reflecting upon his future contributions to the society. He noticed the natural disasters and anthropogenic hazards as well as the unmet medical needs which could benefit from the knowledge and skills of medical doctors. It was also the boom of laparoscopic surgery, not only in Hong Kong but also in Mainland China. In Hong Kong, junior doctors became more interested in manipulating sophisticated laparoscopic equipment as opposed to mastering traditional and basic surgical techniques. In China, the fervent for advanced technology was equally strong, yet rural areas remained in absolute poverty. With these considerations in mind, Dr Au embarked upon humanitarian projects organised by the International Committee of the Red Cross, with the hope of finding a position whereby he could contribute to the needy and the deprived, whilst, simultaneously, testifying to the value of traditional surgical skills. He later realised that he was the first doctor in the Hospital Authority to join such mission trips.
The year 2001 marked an important milestone. For the very first time, international borders no longer limited Dr Au’s service. Spending three and a half months in the world’s largest war hospital at Lokichokio, northern Kenya, Dr Au dedicated himself to saving victims of the civil war in southern Sudan. At times, there were operations that needed skills beyond the usual practice. Basic surgical principles became crucial in these situations and became pivotal in the surgical theatre. This phenomenon was fondly described as the ‘Surgical Bible’: despite encountering an operation that you have never performed before, you can read it up, and quickly apply the new knowledge in performing any operation. This was the reason why Red Cross preferred general surgeons to highly specialised surgeons who only operate on a specific body part or who can only operate with sophisticated technology. Some unusual surgeries that Dr Au performed included partial penectomy, caesarean sections, eyeball debulking, craniotomy, and even groin flaps. In this primitive land where state-of- the-art technology was not available, Dr Au gained confidence in his skills. These experiences served to establish the fact that basic surgical principles are most important. The lack of resources and danger did not daunt him from returning; rather, it encouraged him to serve more people.
There was still one more hurdle to overcome. As a consultant surgeon, he could not leave the hospital and serve in a foreign area miles away from Hong Kong for a prolonged period of time. When he expressed his concerns to Dr Yip Wai-Chun, then Chief of Service at Kwong Wah Hospital Department of Surgery, Dr Yip’s response was: “How can I not help you for such a noble cause?” Hence, he assigned a senior surgeon to cover for Dr Au’s duties while he was away. This enabled him to embark on yearly relief work for the next 12 years.
Colleagues’ support proved vital in Dr Au’s endeavours, and it was something he treasured very much. One of his fondest memories was mastering the skill of performing caesarean sections, which was an essential obstetric operation in war zones and poverty-stricken areas. Under the enthusiastic arrangement of Kwong Wah Hospital, he was allowed to rotate with obstetricians and observe multiple caesarean sections. Numerous senior obstetricians taught him the essentials and special tricks of the surgery so that he could master it in a short time.
As you can imagine, however, unpredictable security concerns do exist while working in war zones. In 2008, just days before departure to Somalia, an MSF team was attacked, resulting in the killing of three persons including one surgeon. Fear shrouded over Dr Au, and he started making preparations to face the worst situations. During his 2012 outpost to Pakistan, two Red Cross workers were kidnapped by Taliban troops and executed weeks before departure. Vigorous security meetings were put into place, with constant updates regarding the latest intelligence. Despite all that, an emergency evacuation within 5 minutes was activated, with none of the team allowed to make contact regarding their evacuation route and timings, until they departed safely to Islamabad.
Looking back, Dr Au feels that his participation in humanitarian medical work, both locally and globally, in large- and small-scale operations has served to provide him with a unique perspective towards life. A heart for charity work and enthusiasm for adventurous opportunities were naturally fundamental for his achievements, but Dr Au also remarked that all milestones in life that progressively led him to global operations were incidental. He sincerely thanks his colleagues and supporters for helping him throughout the years. Entering his 50s, he feels rejuvenated by these annual missions, and continues to look forward to more. On the one hand, he was driven by the unmet medical needs around the world; on the other hand, he wanted to retain the precious skills of basic surgical techniques, which he felt were irreplaceable despite the impact of evolving medical technology. Another important task at hand was heritage—passing on these important messages to the next generation. For this reason, he has been actively sharing these experiences with all those who were interested in humanitarian work, including medical students. For future doctors-to-be, Dr Au has two important messages: (1) do not be confined to Hong Kong, and (2) avoid over-dependence on high technology and overlooking the importance of basic surgical skills.
It is hoped that Dr Au’s spirit will be passed on to the future generation, and that his story inspires youngsters to think ahead, look globally, and contribute more to society!