Hong Kong Med J 2014;20:170–1 | Number 2, April 2014
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
Ripples for Her—Interview with Dr Lowina Tse Hei-yee and Dr Mona Lam
Louise Tsang, Luke Yiu
Year 3, Faculty of Medicine, The University of Hong Kong

Members of Hong Kong Women Doctors Association, with Dr Tse (5th from left) and Dr Lam (6th from left)
Most of us know Hong Kong as a metropolitan, vibrant city that boasts one of the highest living standards in the world. In recent years, evidence of social stress has increasingly surfaced, resulting in the organisation of community events through the collaboration of non-governmental organisations and professional bodies that aim to provide support for high-risk communities. One such event is the Ripples Action. It was founded in 2008 as a collaboration between the Hong Kong Women Doctors Association (HKWDA), Association of Women Accountants, the Hong Kong Federation of Women Lawyers, women nurses, social workers, and the International Social Service (Hong Kong Branch). Ripples Action assists women from marginalised ethnic groups and new immigrants from China by providing specialised care and services. We were fortunate enough to meet with Dr Lowina Tse Hei-yee, Vice-President of the HKWDA and Dr Mona Lam, Chairman of the Community Services Committee at the HKWDA. Dr Tse currently works in private practice and Dr Lam at Tseung Kwan O Hospital; both are in Obstetrics and Gynaecology and extremely dedicated to their cause.
Every year, Dr Tse and Dr Lam spearhead several community events targeting women’s health services. From planning and setting up to deliver cervical smears for testing, these two doctors together with other volunteers do it all. Despite the constant struggle recruiting volunteers to maintain a steady workforce, Ripples Action always managed to pull through, in the hope that their dedication would benefit women from less-privileged backgrounds.
For the past five years, with the sponsorship of the Dr Ellen Li Charitable Foundation, Ripples Action has performed more than 900 free cervical smears for women from the age of 22 to 77 years. This specific service was chosen as a symbol of female health awareness. The painstaking recruitment process involves social workers spreading the word, and the women bringing their friends and family from similar backgrounds. According to Dr Tse’s records, 50% of the women from ethnic minorities had never had a cervical smear and the smear positivity rate of 13%, which is significantly higher than the 8% reported for the Screening Programme from the Department of Health. All smear results were sent back to the respective women and those with positive smear results were referred for further management to the Hospital Authority Specialist Clinic or the Family Health Service of the Department of Health. Since funding is limited, it appeared unrealistic for the target groups to rely solely on the efforts of Ripples Action for long-term cervical screening.
Dr Tse and Dr Lam recount a particularly rewarding experience at a home visit in Sham Shui Po last year, where they were able to get in touch with a lady who benefited from one of their first community events in 2008. Back then, the lady received a free cervical smear that came out positive and was confirmed as CIN III (cervical intraepithelial neoplasia grade 3). She was then referred back to the Specialist Clinic for treatment and is now in good health. Dr Tse explains that it is very difficult for them to keep track of all the women who attend their community events, and in the rare occasion where the social workers are able to stay in contact, it allows all the volunteers of Ripples Action, herself, and Dr Lam to witness the fruits of their labour.
In addition to free cervical screening, Ripples Action distributes leaflets on community resources and invites women to complete a stress test. Those who have a high score are assessed by a volunteer psychiatrist and then referred to a specialist psychiatrist or social worker for follow-up. Stress tests reveal that some women suffer from depression and anxiety, and both doctors consider dealing with mental health aspects to be a crucial part of their contribution to the community. To assist the women and their families to blend into the Hong Kong community, Ripples Action organises special mentorship programmes, field trips, concerts, and holiday parties to connect women and widen their social exposure.
Dr Tse and Dr Lam also explained that a lot of the time, women from ethnic minorities and new Hong Kongers are not adequately exposed to health awareness, especially in the area of sexual and reproductive health. It is common for them to perform an exclusively domestic role in their marital relationship, in which such topics are usually left unexplored. To expand awareness of sexual violence, the HKWDA collaborated with Rainlily (the association concerned with sexual violence against women) and formulated talks that target women from ethnic minorities who (due to their cultural background) might well endure a lower status due to their gender. At these health talks on cervical cancer, free cervical screening services were readily available on site. Translators were present at the talks to ensure that participants understood the inexcusable nature of sexual violence. It should be emphasised that education makes up a big part of the community service led by the HKWDA, and the rest of their mission lies in providing a safe and warm environment to welcome and care for women from marginalised communities.
In association with the Ray of Hope Charity Foundation, the HKWDA extends its services to the rural areas of Butuo County in Sichuan Province, China. A child sponsorship programme was set up to support the education of young Yi tribe girls, as most women in these tribes are illiterate and have a very slim chance of escaping hard labour in the villages. Supporting their education for 9 years gives the girls hope that one day, they will lead a better life. The sponsors are also linked to the students they support, and there are plans to visit the village school where the girls are studying.
Both Dr Tse and Dr Lam admit that their work with Ripples Action and other community services differs from their daily jobs. It is hard for them to gauge their work based on cost-effectiveness, so instead they focus on reaching out to women who are new immigrants or from ethnic minorities and raise awareness for women’s health. They may never hear from the women they have helped, but what matters most is the women in question become aware of the need to care for themselves. Drs Tse and Lam recall the long hours of meetings and tedious moments of planning that goes into preparation of any event. We can hardly imagine how much effort and energy must be devoted to community services, not to mention their already demanding daily work. This all but leaves us in awe, and helps us to realise their passion to serve and hearts to give. The name, Ripples Action, cannot be more apt. Through Ripples Action, HKWDA’s work in the community touches the lives of women, in the hope that they will touch others and spread the message. Just like a ripple; the start is modest, but knows no end. In a sense, this article has become a small part of the ripple; Dr Tse and Dr Lam shared their flame, and now we hope to pass it on.

Flyer for Ripples Action

Set up for performing the cervical smear

Members of Hong Kong Women Doctors Association in preparation