© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
DOCTOR FOR SOCIETY
Re-making the system: founding an inspirational model for humanitarian aid. An interview with Drs Vincent Leung and KL Cheung
Philip Ko, Khin-Shwe Eu
Year 4, Faculty of Medicine, The University of Hong Kong
As the great Pliny the Elder once said, “Fortune favors the bold.” Cocooned in our comfortable bubble that is Hong Kong, it is easy to forget that many are not so lucky, mired in poverty, and deprived of the chance to live healthy, fruitful lives. Many of the children in the poverty-stricken areas of the world are at a severe disadvantage the moment they are born, denied the medical care they need to grow and thrive.
In a similar vein, it is sometimes easy to forget that despite the significant advances China has made over the past three decades, the growth has been uneven, with some regions remaining underdeveloped and yielding largely agrarian economies. In particular, Yunnan province has remained one of the poorest regions, with weak infrastructure and virtually non-existent health care, especially in the remote hilly areas occupied by ethnic minorities.
In 2006, Dr Vincent Leung and Dr Kam-lau Cheung, well-respected paediatricians, decided to form a joint venture, working towards building a solid health care foundation for the paediatric population of Yunnan. They are no strangers to giving humanitarian aid, having already participated in numerous humanitarian missions abroad, such as Cambodia. This time, they envisioned something different, a grand plan that would contribute to decreasing the infant mortality rate by over 30% in the next 4 years.
On their first visit to Yunnan, the two paediatricians and their respective teams carefully assessed the paediatric care needs in this impoverished area of the country. Truth be told, in the beginning, there was not much to assess. In contrast to the medical system in Hong Kong and in most other developed areas of the world, the state of China’s medical system is not far from that of a living fossil, with severely underpaid physicians who are largely concentrated only in the urban areas. In fact, most of the ‘physicians’ remaining in rural Yunnan are not true physicians from universities, but rather vocation-trained ‘barefoot doctors’ with basic training.
Upon inspecting the paediatric wards in a rural health clinic, the first thing they noticed was a complete lack of medical supplies: even the beds had no mattresses. Patients would simply be examined on what appeared to be a wire net with four legs. Drs Leung and Cheung knew that this would be an uphill battle, but did not realise that they would essentially be starting from ground up.
Undeterred by the challenges ahead, they returned home to formulate a local neonatal resuscitation programme (NRP): rather than simply giving these folks a handout like in some humanitarian missions, they wished to distil key knowledge and experience in newborn resuscitation by taking classic NRP powerpoint and multiple choice questions and translating them into simplified Chinese. Armed with hundreds of copies, together with essential training mannequins and other equipment, they invited local health care providers to a hotel in Xundan, Yunnan, to take a 2-day NRP course, conducted in Putonghua. The first NRP course in 2006 was welcomed with open arms by the local health ministry. Collaborating with the Kunming City Maternal and Child Health Centre and the Hong Kong College of Paediatricians Foundation, the two physicians organised annual NRP courses for more than 100 local paediatricians and obstetricians, as recommended by their respective hospitals. The joint teaching programme involved more than 20 experienced paediatricians and nurses from Hong Kong to teach hand-in-hand with local teachers. Every successful participant was awarded a medical kit filled with resuscitation equipment that included resuscitators, laryngeal mask airways, endotracheal tubes, meconium aspirators, and suction catheters to equip them properly upon returning to their health institution. The NRP is currently supported by over 20 Fellows of their College, and it has since evolved into an annual programme. In numerous provinces throughout China, they have set up NRP training centres to ensure continued success—whilst the Foundation continues to give support through the provision of equipment such as resuscitators and subsidies.
Of course, starting any venture, philanthropic or otherwise, requires significant capital. Through their networking and leadership skills, they managed to raise a significant sum from colleagues and private donors, kickstarting the first phase of the project. Unlike many other international humanitarian aid services, they wished to produce something more self-sustainable and long-lasting. It is this major focus on teaching neonatal resuscitation to health care workers that has made all the difference: this has ensured that babies are given all the necessary care during the most vulnerable moments of childbirth. Throughout this process of knowledge transfer, the Chinese doctors were carefully assessed, nurtured, and encouraged to be trainers, hence helping to pass on the essential knowledge and skills in NRP. This has exponentially magnified the educational effect, and effectively cut down the mortality and morbidity of birth asphyxia in the neediest areas of China.
In addition to organising fundraisers, Drs Leung and Cheung also carefully navigated the complex bureaucratic process, and managed to secure official support from all of the local health ministries in Yunnan, Kweizhou, Guangxi, and Sichuan. Throughout the years, they managed to successfully establish local training centres, fully equipped and expertly staffed, which has also helped to raise the standard of child health in western China. They are firm believers in the philosophy that rather than giving fish already caught, one should instead teach how to fish. Translating this philosophy into practice, teaching NRP to local doctors has proven to be the most effective means to raise the health care standards by a significant margin. It is no accident that the neonatal mortality rate of Yunnan dropped by over 30% over 4 years, after the project was launched in 2006. No doubt this is in large part due to the fact that over 1000 Chinese doctors have received hands-on training to date.
Perhaps it is this key aspect that differentiates their humanitarian endeavour from all others: their ability to coordinate with various levels of the Chinese government, and the coordination among the various levels of leadership has been unsurpassed, allowing them to achieve a level of success not seen in other humanitarian missions across the country. In 2014, the leader of the Chinese Communist Party awarded Dr Leung an extremely prestigious “Model Citizen” award for his outstanding contributions, and for spearheading the movement towards improving the health care system in rural China.
On their most recent trip back to Yunnan, Drs Leung and Cheung met one of the health care workers who thanked them profusely for empowering him with knowledge and equipment: if not for this generosity, countless lives would have been crushed, and the children would never have had the chance to grow and bloom. Knowing that they were able to make such a huge difference is one of the major reasons why the two physicians have gone beyond their comfort zone to help the needy.
As for their future plans, Drs Cheung and Leung emphasised their commitment to sacrifice time every year to various other humanitarian missions, and hopefully replicate the system that has been so successful in Yunnan. “Anything is possible,” they say, “Perhaps we will even turn this into a global endeavour beyond Asia in the years to come, replicating this very successful humanitarian aid model to other impoverished nations.”
Our lives are a lump sum of all our choices. We can take the easy route, huddling in the safety of our homes, and living the model life, oblivious to all of the suffering around us. Or we can take the red pill, and know that we have done all we can to ease the suffering of the world, bit by bit.
To those physicians in Hong Kong wishing to go above and beyond in helping others, but are still cautious of stepping outside the comforts of home, Drs Cheung and Leung impart to them this pearl of wisdom, “Only by stepping out of your comfort zone will you empower yourself: by helping those who are most in need, you will transform the way you view the world, and give your own life an entirely new meaning.”
(left) Student reporters and Dr Vincent Leung (far right) and Dr KL Cheung (second from right) at Prince of Wales Hospital in Shatin (right) Major award by the Chinese Communist Party for their sacrifices and humanitarian contributions