Coming from a humble background, Dr Yu-cheung Ho experienced first-hand the struggles confronted by a community in poverty, which were so common to many of those brought up in those days. The poverty issue, compounded by the many other problems that an impoverished community suffers, exacerbate the difficult situations most of the then residents faced. Because of his upbringing in a challenging environment, Dr Ho developed an interest in helping others, and this was an influential factor in his future work.

Having decided that medicine is one of the better ways to make a direct and positive impact on society, and being interested in the subject matter itself, Dr Ho committed to studying medicine and later graduated from The University of Hong Kong medical school in 1982. With a particular interest in hands-on procedures, he found that surgery was a natural fit and later pursued specialisation in urology. After graduating, he served in the public healthcare sector, and after many years of service, he continued his work in the private sector.

The First Rotary Club in Hong Kong, The Rotary Club of Hong Kong, was established in 1931. Since then, Rotary International District 3450 (https://rotary3450.org/) has expanded so that it now encompasses 105 Rotary Clubs throughout Hong Kong, Macau, Mongolia, and Guangdong. The Rotary Club endeavours to bring together local business and professional leaders to provide humanitarian work. Over the past few decades, the demands of humanitarian work have broadened in scope, and the challenges have become increasingly global, from pandemics affecting third-world countries to food crises afflicting war-torn regions. To cope with these changing times, the Rotary Club has expanded rapidly across regions, building goodwill for global and local communities and following its motto ‘service above self’.

Dr Ho, who has a keen interest in humanitarian work and a passion for helping others, was introduced to be a member of the Rotary Club of Peninsula South by his friends and colleagues. ‘It was its hands-on nature, and the emphasis on being non-political, non-religious, and non-commercial that intrigued me at first,’ Dr Ho stressed when explaining his interest in Rotary. ‘We can leverage the strong bonds among various Rotary Clubs worldwide, allowing us to reach out and go further both globally and in local communities.’ Dr Ho holds polio eradication as an example of a global campaign that Rotary has been involved in, where efforts at the local level are supported by coordination internationally, humanitarian issues are best solved with a global framework with devolved local execution.

Since becoming a Rotarian in 1994, Dr Ho has been involved in implementing and delivering various service projects locally and internationally in collaboration with local and overseas Rotarians. One of the more memorable projects that Dr Ho recalled involved providing better surgical care in acute hospitals in Mongolia. Owing to the outdated facilities and equipment and lack of funding, the hospitals were ill-equipped to serve the growing demand of surgical patients. Leveraging expertise from Hong Kong, and coordinating help from doctors from India, Rotary revamped both the laparoscopic instruments and facilities and the surgical skill training of the local surgeons over there. Another project in Mongolia that Dr Ho was involved in was improving a hospice care centre in Ulaanbaatar to cope with the increasing demand of cancer patients.

In 2018-19, Dr Ho served as the District Governor of the Rotary International District 3450. While serving as District Governor, Dr Ho was particularly enthusiastic about broadening the opportunities for the young and providing a better future for the neglected and disenfranchised groups in local society. He also oversaw a ‘pair-up project’—jointly hosted with the Salvation Army—to provide career and life planning for marginalised secondary school-leavers who were failing in further studies. By pairing students with Rotary Club members from a variety of professions and backgrounds, the project offered the school-leavers guidance on career pathways and opened up new possibilities in their employability.

More recently, the COVID-19 pandemic has been a focus for Rotary Clubs, and Dr Ho’s expertise has been invaluable in vaccination drives and health-related campaigns. He has assisted a local Rotary Club which provided COVID-19 vaccinations to children and older or disadvantaged adults in throughout Hong Kong, including Tai Po, Kwun Tong, Lok Fu, and Yau Tsim Mong districts. The magnitude of the pandemic extends far beyond a healthcare issue, and it has also had a huge impact on the economy. Because of the linkage between poverty and poor medical outcomes, it is vital to target poverty and healthcare together in hopes of ensuring equity in medical services and improved health outcomes.

“Being proficient in medicine does not make one a good doctor,” Dr Ho explained. “A good doctor has to cater for the psychological needs of a patient. In order to do so, they must connect with the community and the wider world.” Dr Ho emphasised that participating in charity work and joining service groups provides a unique perspective on the social and psychological needs of patients.

In addition to improving the lives of those in the community, volunteering allows for deeper connections with patients. Through decades of service, Dr Ho is encouraged by the progress that the Rotary Club and other organisations have made so far. He hopes the younger generation can take up the mantle and continue helping those in need and serving the community.

Prof Chak-sing Lau, the Immediate Past President of the Hong Kong Academy of Medicine (HKAM), and a renowned clinician and professor with a storied career, was invited by the Hong Kong Medical Journal to reflect on his career and share some thoughts for the future.

Prof Lau doesn’t like to see himself as a leader; despite being Chief of Service at the Department of Medicine at Queen Mary Hospital, he sees himself as a member of the team, no more important than any doctor under his team. Everybody has a role to play in the community, and he only seeks to do his job to the best of his ability.

Prof Lau has inevitably experienced many of the challenges that the recent COVID-19 pandemic has brought upon the Hong Kong community, and especially the healthcare system. He still firmly believes that increasing vaccination rates are imperative to reduce morbidity and mortality from this pandemic. However, while he remains optimistic, he admitted underestimating the difficulty of city-wide vaccination, and also overestimating the ability of the healthcare profession to persuade people to get vaccinated.

While the sentiment towards COVID-19 in the hospitals has not changed significantly, Prof Lau’s personal views about the strategies that people employ to cope with COVID have seen some changes. Doctors have learned to live with COVID-19 on a daily basis; although no single strategy is superior (in Hong Kong, or internationally), the important thing is for everyone in the community to work together to return the world to some normalcy.

One of Prof Lau’s key concerns is the ageing population in Hong Kong. He remarked that there are few incentives for new doctors to train in geriatrics, along with a lack of manpower in nurses, allied health professionals, and caretakers within the public system. Hong Kong’s COVID-19 situation has only exacerbated issues; for example, some of the current restrictions mean that many elderly inpatients cannot have visitors, which may exacerbate mental health issues that are already prevalent in this demographic.

Despite the added strain that COVID has placed on the public healthcare system, Prof Lau expressed admiration for his colleagues’ staunch hard work during the pandemic. He felt touched that even colleagues who work in the private sector have reached out and volunteered to help the strained public services. In this way, he remarked that COVID has driven people apart, but in some ways it has brought people together through adversity.

Another pressing problem facing public healthcare services that concerns Prof Lau is the high attrition rate among doctors. Many departments are understaffed, and the only source of manpower is fresh graduates. Many of these junior colleagues are overwhelmed by the workload, and the steep learning curve can also be extremely discouraging. Ultimately this is detrimental for both doctors and patients, resulting in a poor impression of public healthcare services from both perspectives. Prof Lau thinks that a key way to correct this is to show doctors that they are appreciated; having a say in what happens and seeing the results is a great way of improving morale. By building a culture of belonging and fraternity, doctor retention and satisfaction will certainly be helped.

Prof Lau has much to say on the past, present, and future of medical education. He lamented that medical students these days have too much to learn; he recognises that it is impossible for students to know everything, and teachers’ expectations might need to be regularly revisited in this context. He thinks that the key to effective education is training teachers to assess students reasonably, which he notes is a far cry from his own medical training. He recalls that his medical school professors were top clinicians or researchers, but did not know how to match expectations with students’ abilities. Over his own time as an educator, he has noted a shift towards mindful consideration and realistic expectations of students, but there is still a disparity between teachers’ expectations and reasonable ability.

Regardless of the limitations in the education system of his time, Prof Lau said that he paradoxically misses the stresses of it. He fondly recalled frantically copying notes from professors’ lectures and trying to memorise everything possible. However, he cautions students that this is not the optimal way to learn, and now encourages students to understand rather than rely on rote memorisation. He also expressed disappointment that the pandemic meant many medical students were deprived of clinical teaching hours and patient exposure and stressed the importance of patient interaction, emphasising that everything he knows was learned from his clinical encounters. He sympathises with new graduates who may find it extremely tough to begin practice.

The level of burnout among healthcare workers has reached an all-time high in recent years. The key to preventing burnout is to “love what you do”, says Prof Lau. When interviewing candidates for medical school, Prof Lau always tries to work out whether they will love medicine, and he hopes to nurture a love of medicine in his students during their time in undergraduate medical education. Passion for the profession has helped Prof Lau’s motivation persevere; he recalls how despite the overwhelming workload, he drew inspiration and ambition from his colleagues. Despite loving what he does, he knows that burnout is unavoidable and there are still times when he feels stressed. Therefore, Prof Lau places a great emphasis on finding a good work-life balance. Outside of work, he enjoys long distance running, playing basketball, spending time with his friends and family, and he never misses watching any of Liverpool’s matches.

Dr Ching-choi Lam, a dual specialist in paediatrics and community medicine, is a man who wears many hats. He is the current Chief Executive Officer of the Haven of Hope Christian Service, a non-official member of the Executive Council, Chairman of the Elderly Commission, and Chairman of the Council for Sustainable Development. Dr Lam has served two terms as a District Councillor in Sai Kung, and now advises the Hong Kong SAR Government on primary healthcare development. In addition to these varied roles, Dr Lam remains tirelessly active as a community paediatrician, serving the underprivileged population in the community clinics of the Haven of Hope Christian Service.

Dr Lam has engaged in public service throughout his career, reflecting his ardent desire to improve the lives of all those in need, from young children to vulnerable older adults; from patients in his clinic to the wider public in Hong Kong. Motivated by concern for those in need outside the traditional confines of a medical career, Dr Lam has extended his career into the realm of policy making. Dr Lam’s dedication to public service was recognised with a Silver Bauhinia Star in 2019 and he was appointed as a Justice of the Peace in 2003.

After graduating from medical school, Dr Lam trained and practised paediatric medicine for many years before taking up his current role as the CEO of the Haven of Hope Christian Service. Dr Lam is often asked about his surprising change in direction from paediatrics to elderly health care and palliative care. Although children and elderly people occupy opposite ends of the age spectrum, in his eyes, they are both vulnerable populations deserving of care and attention. Dr Lam traces the beginning of his work with the elderly to his paediatrics training. He recalls that while a paediatrics trainee he read the first chapter of the Textbook of Paediatrics, titled “Community Paediatrics”. The chapter highlights the role of the environment in shaping a child’s development, sparking his belief in the importance of community work as a means of health promotion. While promoting the Healthy City Initiative, he further learnt about the “New Public Health” concept, which states that effective health promotion is based on a recognition of the interdependence of the health of people and the environment. When the government invited him to join the Elderly Commission in 2003, he embraced the opportunity gladly, considering it a natural direction to take.

One of Dr Lam’s most eminent projects is the Elderly Service Programme Plan, which proposes a new direction of “Ageing in Place”. In Hong Kong, as in many other regions of the world with an ageing population, demand for residential care services for the elderly is outpacing existing supply. Although international and local research has demonstrated the benefits of ageing in place, that is, providing care for the elderly people at home rather than moving them to a dedicated residential care facility, the concept has faced much resistance and even protests from the Hong Kong community. The government was accused of proposing this policy to try avoiding its responsibility to provide adequate residential care places for the elderly with long-term care needs. In the face of dissent, Dr Lam sought to understand more deeply the perspectives of the patients, so he spent months listening to local older adults through personal meetings. His research revealed that 80% of older adults in Hong Kong prefer to age in place. Dr Lam realised that, despite resistance from many sectors, most older adults did not object to the idea and even wished to remain in the community. Determined that the challenges and worries of the elderly people should not be ignored, Dr Lam led the Elderly Commission to formulate the Elderly Services Programme Plan and proposed strengthening community care support to boost confidence in “Ageing in Place” among the elderly people and their families, and help them see community care as a desirable alternative to residential care.

Dr Lam rises to confront challenges with the humble and caring heart of a physician. This approach, which he also applies to his role as a community health advocate, strikes a parallel to his days as a paediatric trainee at the neonatal intensive care unit at Queen Elizabeth Hospital. At that time, he often faced the empathic reproval of parents who had very recently lost their newborn child despite the best treatment. Dr Lam admits that he often shed tears, even before the parents, showing them the depth of his sincerity and his care. Now, when he is communicating with the elderly protesters, he evokes their empathy in a similar way. He whole-heartedly believes that humility and sincerity of spirit speak louder than words, or any objective facts he may hold. The elderly individuals who attend the rallies against his policies are often moved by his sincerity and sometimes reconcile by shaking his hand and taking photographs together.

One might question how it is possible for a doctor to fill so many roles. Dr Lam says that, despite rarely taking a day off from work, he avoids burnout by maintaining a balanced lifestyle and keeping his body and mind healthy. As a Christian, Dr Lam names integrity as one of his core values. He believes in the importance of consistency in one’s professed beliefs, which bridges the gap between theory and action. As a doctor, he advocates exercise as a form of preventive medicine, and he practises what he preaches; Dr Lam is an enthusiastic recreational cyclist who covers more than 200 km per week.

In his trans-disciplinary career, Dr Lam brings medicine from the clinics into the wider community, demonstrating how to “go beyond”, as he likes to put it. Ultimately, health is a multidimensional concept. Applying his range of clinical experience creatively in his many roles, Dr Lam combines the art and the science of medicine as a true advocate of community health.

The severe acute respiratory syndrome (SARS) outbreak in Hong Kong in 2003 and the more recent coronavirus disease 2019 (COVID-19) pandemic have impacted many people’s lives. Few people, however, have had their careers so profoundly transformed by these events as Dr Emily Chi-wan Hung.

After graduating from The Chinese University of Hong Kong (CUHK) in 2000, Dr Hung initially pursued specialty training in paediatrics, as she believed in managing diseases in early life and making a lasting impact on patients’ lives.

However, during the SARS outbreak in 2003, Dr Hung’s career took its first major change in course. While studying for an undergraduate degree at the University of Cambridge in the United Kingdom, Dr Hung had completed a year of training in pathology and virology, with special research focus on human papillomavirus. Because of this background in virology, Dr Hung felt that she could contribute to the effort against SARS, and joined the SARS molecular sequencing team at CUHK. This opportunity led to her to join academia after the completion of her specialist training in paediatrics, and she spent several years researching serum circulatory DNA until she returned to clinical practice as a paediatrician in 2010.

Giving back to the community Dr Hung firmly believes in the importance of giving back to society, and throughout her clinical career, she has maintained passion and commitment to such contributions. A major focus of Dr Hung’s charitable efforts has been the Little Life Warrior Society (https://www.llws.org.hk/). The Little Life Warrior Society organises various activities and support groups for paediatric oncology patients and their families, including in-patient ward visits, out-patient activity groups, schoolwork tutorials, and even haircuts for patients. “After my rotation to the Children’s Cancer Centre of the Prince of Wales Hospital Department of Paediatrics in 2004,” recalls Dr Hung, “I was saddened by the unpredictable disease course of childhood cancers, and the devastating effect it had on young patients and their families.” Dr Hung became a medical advisor for the Little Life Warrior Society in 2004, and participated in various activities, including its Youth Group, which supported children cancer survivors who have grown up to become teenagers. She served as a medical advisor for the Society from 2004 to 2012.

As a paediatrician, Dr Hung is a firm believer in disease prevention. In 2016-17, the overall influenza vaccination coverage rate for school children aged 6 to 12 years was only 16%, whereas school-initiated outreach vaccination activities achieved a coverage of about 50%. Therefore, the Department of Health established the School Outreach Vaccination Pilot Programme and the Enhanced Vaccination Subsidy Scheme in 2018-19 to further increase participation of schools. Dr Hung participated in these schemes and has run outreach influenza vaccination events at different primary schools and kindergartens in the past few years. “The outreach events are important to me because they are instrumental in increasing flu vaccine coverage in children,” says Dr Hung, “This helps to minimise outbreaks, severe complications, and deaths due to influenza in children.”

In addition to her busy clinical work and charitable contributions, Dr Hung also strives to promote medical development in Hong Kong. In order to nurture the younger generation, she holds teaching sessions in her clinic for medical students at CUHK, and she works as a regional trainer for neonatal resuscitation. She is currently an honorary clinical associate professor of her alma mater. In 2015, Dr Hung was selected for the Ten Outstanding Young Persons award in Hong Kong in recognition of her exemplary contributions to medical education and healthcare promotion in Hong Kong. “It was a very humbling and rewarding experience to be selected for this award,” said Dr Hung.

Similar to the SARS epidemic in 2003, COVID-19 brought about another major career change for Dr Hung. She is once again at the forefront of battling the pandemic, but this time she has adopted her innovation and skills into a new venture. The COVID-19 pandemic caused a sudden surge in demand for surgical masks. In the early days of the outbreak, mask shortages were causing panic in Hong Kong. While procuring masks for her outreach vaccination programmes in January 2020, Dr Hung found that many companies were unable to provide masks or even shipment dates for deliveries. In order to help meet this demand, Dr Hung decided to develop a surgical mask manufacturing and production line in Hong Kong with her husband, who has a background in engineering. Throughout the endeavour, Dr Hung and her husband had to overcome many challenges. Owing to worldwide demand for the raw materials needed for mask production, supplier delays were frequent, and some suppliers even raised their prices to increase profits. Setting up a clean room for mask production also proved difficult, requiring high-quality renovation work and revisions to meet international standards. There was even trouble sourcing qualified technical support staff, owing to the travel restrictions at the time, so Dr Hung’s team had to self-study to get the mask production machine up and running. Despite the challenges, the mask production line finally began operation in July 2020. In addition to supplying masks to public hospitals, Dr Hung’s company partnered with philanthropists in Hong Kong to donate masks to charitable organisations including The Salvation Army, St James’ Settlement, and Refugee Union. Dr Hung is adamant that quality must be maintained over quantity, and takes pride in providing high-quality masks for medical professionals and the public.

When asked about her future goals, Dr Hung reiterated the importance of altruism: “We have to do the right thing to change the world and make it a better place.”

Dr Susan Fan served The Family Planning Association of Hong Kong as executive director for 25 years, until her retirement in early 2021. We recently sat down with Dr Fan as she reflected on the evolving role of the organisation in her years of service. “The deferral in marriages and fertility decline in Hong Kong has required diversification of our services,” said Dr Fan, “but our mission has always been to advocate planned parenthood and sexual health.”

Established in 1950, the Association began its work as a charitable voluntary organisation via individual contacts in its early days. “Our volunteer doctors and nurses were pioneers in promoting birth control amid the traditional beliefs of expanding the family lineage,” said Dr Fan. Their efforts were later much amplified by the organisation’s successful “Two Is Enough” campaign in the 1970s. That decade also saw the gradual incorporation of the Association’s 32 birth control clinics into the Department of Health’s Maternal and Child Health Centres. Although the Association is best known for its contraceptive and abortion services, the Association’s very first clinic, established in 1956, also specialised in investigation and management of subfertility. “We did not tell people to simply avoid getting pregnant; we advised couples to plan their childbearing early and wisely. The same can be said today, as we see an upturn in demand for fertility treatment due to advanced parental age,” explained Dr Fan.

The Association’s scope differs from the conventional obstetrics and gynaecology specialty in that its services transcend genders and age-groups. The Association ran the only semen bank in Hong Kong before other technologies were developed for treating male factors in infertility. The organisation also runs a men’s health clinic and supports the exploration of sexuality in youth and LGBTQ communities with school-based education and a mobile classroom. Because sexual activity is still a relatively taboo topic in Chinese culture, discussions on youth sexuality must be conducted with sensitivity. “Pre-marital sex is often misconstrued as being synonymous with ‘promiscuity’. We had to work around prevalent social norms by calling sex education ‘family life education’, and using subtle language in educational television in order to introduce issues of sexual identity and orientation.“ Yet the Association also benefits from Hong Kong’s unique cultural milieu, as Dr Fan explained “Our community is very pragmatic. Unlike some countries and cultures where abortion remains highly divisive, our organisation has not faced outright opposition from conservative or religious sectors.”

When Dr Fan joined the Association in the 1990s, the issue of population ageing was gaining attention. In response, the Association began to introduce services for older members of society, such as opening the first menopause clinic in Hong Kong, offering hormone replacement therapy, and commencing an osteoporosis clinic for women and men. Through these health services, the Association aimed to prevent and reduce age-related conditions while enhancing the quality of life of Hong Kong’s ageing population.

Dr Fan stated that sexual health is an issue common to everyone in society, regardless of their background. She stressed that the Association’s services are entirely confidential and professional, and staff are not there to chastise or discipline people. Under Dr Fan’s leadership, the Association actively reached out to certain groups that are often overlooked; for example, male sexual and reproductive health is often neglected. In the past, men were simply advised to use condoms or get vasectomies. However, the Association not only emphasises the male role and responsibility in family planning, but also provides sexual health services for men including management of sexual dysfunction, erectile dysfunction, or premature ejaculation. To minimise patient embarrassment or reluctance, these services are usually delivered by male doctors, nurses and counsellors.

The Association also extended services to other under-served members of society, marginalised groups, and ethnic minorities. Despite the best intentions, these are not always successful, as Dr Fan illustrated by recounting efforts to run a mobile clinic for foreign domestic helpers, in public areas where helpers gather on Sundays. It turned out that parking the mobile van in an open public space was counterproductive, as helpers feared being noticed and stigmatised for visiting it. There have also been successes; the Association was entrusted to roll out a programme to provide free or subsidised human papillomavirus vaccines for more than 30 000 young girls from low-income families. Dr Fan reflected that there are always ways to improve the effectiveness and accessibility of these services, to dispel misconceptions and to reduce public hesitation to seek sexual health services, and to reach as many people as possible.

Youth sex education is another important focus for the Association. Dr Fan thanks the Hong Kong Jockey Club for their support in opening a Youth Zone for introducing sexual health to young people. The Association also runs three Youth Health Care Centres throughout the city. Dr Fan explained that the locations of these Centres in commercial buildings in busy districts were carefully selected so that they were readily accessible but also discreet. The Association<s dedication to empowering the youth is impressive; Dr Fan noted that 20% of their Council membership is comprised of youth representatives nominated from the Association<s youth volunteers by themselves. Furthermore, the Association<s longstanding efforts in sex education have contributed significantly at all levels of education in Hong Kong, nurturing a future generation that is more aware of their sexuality and sexual health.

Looking into the future, Dr Fan hopes that Hong Kong people, particularly young couples, will proactively plan their families earlier. She understands that factors such as the city’s demanding work culture and high living costs exacerbate people’s reluctance to have large families, but she hopes family planning will allow people to fulfil their dreams of parenthood, while avoiding problems caused by age-related effects on fertility. The Association offers pre-pregnancy check-ups, in which prospective parents can be screened for common hereditary conditions or to simply learn about preparing for childbearing. She also hopes to see more support for men playing a more active role in parenting.

Dr Fan looks back fondly on the past 25 years at the Association. She credits all her achievements to the incredible staff and the doctors who volunteer their time at the Association, without whom her ideas would simply be unattainable. She is also grateful to the government and many donors who have provided the Association with sufficient funding to allow it to provide affordable services to the Hong Kong population. “I found working with the Association immensely satisfying, and I sincerely hope my successor, Dr Mona Lam, will do so too”, remarked Dr Fan with a smile. The Association has tirelessly worked to improve the quality of life of families across Hong Kong, but Dr Fan acknowledges that challenges remain in social policy, community perception and cultural values, and notes that there is always room for improvement. The continued promotion of proper family planning and education in enhancing the overall sexual and reproductive health of all people in Hong Kong cannot be over-emphasised.