The Hong Kong Paradox: Poor Air Quality & Longevity.

We all know about the French Paradox by now and basically, by right the French for what they eat should have the highest heart disease rates despite their fondness of cheeses and dare we mention Foie Gras. At least we now have some idea that it was the trans fat that is the culprit. Then there was a hint that it could be the red wine and when a programme was shown in the US, within a year, red wine sale went up 44%. The rest as they say is history.

What about the Hong Kong Paradox?

No, I am not talking about SIDS, yes, it was a bit of a paradox. Nor am I talking about the low infant mortality rate of 1.3 per thousand. That would be seen as a paradox from the point of view of countries like US or UK. Well the paradox is that the doctors used to be trained in specialism in the UK.

But unlike red wine, I doubt if anyone is going to take up this paradox.

On a good day in Autumn© 2013 Am Ang Zhang

As China is now the main manufacturing country for the rest of the world, it is only obvious that its factories pump out all sorts. Hong Kong in the autumn and winter months suffer from serious air pollution. Every medical research would confirm your suspicion, it is bad for health. But wait:

South China Morning Post:

Hong Kong’s women and men enjoy the longest life expectancy in the world, according to data released by Japan’s health and welfare ministry on Wednesday.

The average lifespan for women in Hong Kong is 87.32 years, and local men on average can expect to live to 81.24. Japanese women took second place at 87.05, while Icelandic and Swiss men shared the second position in the men’s category at 81 years.

The overall life expectancy gap between women and men fell by 0.07 year last year, compared with the previous year’s figures.

Polluted air anyone? Good for longevity.

The famous new bridge in Autumn © 2013 Am Ang Zhang

By the way, there is no tax on wine in Hong Kong. Perhaps that is why!!!

Norway & Hong Kong: Drunk Or Art Nouveau!

Democracy Or Alcohol?

Ålesund ©2012 Am Ang Zhang

In 1904 fire destroyed most of Ålesund.

It was rebuilt in Art Nouveau style and is arguably the most beautiful city in Norway without the City Hall.

Democracy: Voted against joining EU in 1972 and 1994.

Telegraph:

Norway is one of the richest and most contented nations on earth, with a GDP per capita of £40,000 – compared to £23,000 in the UK, and an EU average of £21,150.

Unemployment is at 3.25 per cent, while GDP is growing at 2.75 per cent per year – as it has on average over the last 40 years.

It also regularly tops the UN's survey of quality of life, with a generous welfare system – women receive 46 weeks maternity leave at full salary, compared to Britain's six weeks on 90 per cent – and free education (incl. universities) is provided for all.

The country funds this through its huge reserves of oil, timber and fish which it manages prudently, stashing away large percentages of its oil revenues to fund the future healthcare needs of an ageing population.

Alcohol:

Do we ever learn that prohibition never did anything to alcohol consumption nor would price control? 

With the millions spent on Cocaine in Wall Street and The City, when will we wake up to the fact that these are Tax Free perks?

©2013 Am Ang Zhang

Hong Kong Scraps Wine, Beer Duties on Record Surplus

By Wendy Leung - February 27, 2008 05:37 EST

In a place without democracy!

Feb. 27 (Bloomberg) -- Hong Kong's government abolished taxes on wine and beer after posting a record surplus, boosting efforts to turn the city into a wine-trading hub.

The tariffs will be abolished immediately, costing the city government HK$560 million ($72 million) in annual tax revenue.

Tax was 80% before 2007 then 40%

The rest of Hong Kong Tax:

No sales tax

No capital gains tax

No VAT

Maximum salary tax of 20%

Profit tax maximum of 16%

Inheritance tax or estate duty has been abolished since             11February 2006. 

Yet, my doctor friends told me that there is no binge drinking problem like they have in Norway where there is high taxation and much difficulty in buying alcohol.

Strange: A drink too many!

Ålesund Norway©2012 Am Ang Zhang

Drunk and disorderly

Solveig Torvik 

December 16, 2010 

Weekend binge drinking is a perplexing feature of Norwegian cultural life to many visitors.

The role of alcohol in Norway often appears to be to consume it until you’re senseless, and alcohol commonly is accepted as an excuse for indulging in antisocial behavior. Binge drinking seemingly isn’t regarded as aberrant behavior in Norway, even by sober citizens who, generally speaking, uncomplainingly tolerate the ensuing brawls and other unpleasant results.

But why do so many people who do live in the “world’s best place” drink until they’re comatose? And why are many of them prone to violence and aggression when drunk? No one knows.

Dr Ole Johan Hoyberg, formerly a hospital-based psychiatrist in Ålesund, told newspaper Sunnmørsposten: “There’s a great deal more drunkenness in the communities that I got an insight about as a hospital doctor. Alcohol abuse is on the point of becoming a national sickness.”

Which seems an odd state of affairs indeed for a nation that’s billed as the world’s best place to live.

Perhaps no tax on alcohol beats democracy!

Norway: Hello Summer!

Aug 16, 2012

Norway: Democracy & Disaster!

Health Care Class Struggle: NHS & Hong Kong!

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Vacation: Bird Photography

Fun with Photoshop

House M.D. : Canon 5D Mk II

WPPI Las Vegas: Digital Photography & Art

Photography: Old & New
Photography: Best lens for portrait & landscape!

Photography: The Vatican

Fun with Photoshop

Photography: Point & Shoot!

Photography : Best & Free!

Photography: Bokeh & Multiple Night Shots!

Photography: Spring Tulips.

Photography: Pictures at an Exhibition

Sleeping on Duty: Bed 1 & The Moon!

Recent Junior Doctor discussions on sleeping on duty brought back memories for this retired Child Psychiatrist. When I did my first House Job (residency) in Internal Medicine I was on for two nights out of three and three weekends out of four as it is busier weekends and more of us would be needed. 

We have three Internal Medicine Units and I am in Medical C for want of a creative name or a rich donor. We need to be on after acute take as these were our patients. It provided for continuity and training. Then we are off for one night when, if we do go to the cinema, it would be a waste of money as we fell asleep within minutes. We have 36 beds and bed 1 is with bed 36 behind the nurse station. Nurses tried not to use bed 36 so that the Houseman could catch some sleep. I once fell asleep on one of the those rare nights when everything went quiet at about 2 am. I was catching up with history from a wife at the nurse station. The wife stood across the highish station and the next I knew was that an hour or so went by. I fell asleep holding my pen. 

The wife of the patient just said: You must be tired, doctor. 

No complaints and she did not walk off either. I was so grateful. Medicine the way it should be. In Hong Kong.

©2013 Am Ang Zhang

Then I remember my Bed 1 patient: 

The Cockroach Catcher  Chapter 47  Going To The Moon

T

 ime and again I have been asked why I decided to pursue child psychiatry as my career. This question was often posed by my juniors who were at the point of their life when they had to choose their career path. It would have been dishonest of me to tell them that I knew exactly why. In life certain events seem to just happen and hopefully they gel together well enough so that one does not have to say at the end of one’s working life that a wrong decision was made.

         After passing my finals, I did my internship in Internal Medicine and Obstetrics and Gynaecology.

         In our final year the first reports came through of cures in Leukaemia.  People’s hopes were rekindled and Medicine moved into a new era.

         Needless to say cancer touches every family in more ways than one can imagine and especially when it hits at one’s prime in life it is a highly emotive thing. In other words, no one is immune, not even if you are a doctor. At the time of my internship we had to deal with all those over the age of twelve and a number of inpatients were young Oncology cases. One of the boys I can remember was having the full VAMP treatment. Someone had a dry sense of humour to borrow from the word Vampire and with good reasons. Blood samples had to be drawn often and it was years later that I appreciated the work of some psychiatrists who recommend the limiting of daily blood drawing to before 10 A.M. every morning. This simple enforceable rule greatly reduced the emotional stress of the children involved. Patients were by and large compliant and they knew that the blood drawing was important.  When they were able to work out that it would not happen after 10 A.M. they had at least a good ten hours of relative peace.

         I had this highly intelligent boy on the ward with Leukaemia on treatment. He was barely thirteen and looked nine-ish. He was my most helpful assistant and would follow me on the lab trolley when I was doing my blood sample rounds. He would fill in the forms and match the numbers on the sample bottles. He never made a single mistake as far as I can remember.  Most of my contemporaries had some pet patient like that. How else could we have got through the day’s work? Most sisters and matrons turned a blind eye and the consultants and professors had been there so they did not mind either. Considering that we were then spending the major part of our waking life on the ward, we got closer to these patients than to anyone else in our life at that point.

         This boy was beginning to show the effect of VAMP and he had some of the most frightening nightmares when he would scream in the middle of the night and nothing much would comfort him. He would sit up and say something about going to the moon and that was probably the only thing of which anyone could make some sense. The regular night nurse who had children of his age was most fond of him and would give me detailed reports of the timing of such occurrences. At other times I could see her playing her mother rather than nurse role and just holding him while he sobbed.

         He had the Number 1 bed which was right by the nurse’s station and it was a rather cosy one as the bed opposite was generally the last one to be used. If I had not been on call, he would give me a quick run down on who was new and who was unconscious and who had insecticide poisoning from suicidal ingestion. In any case, one could smell the insecticide as one walked in as these survivors breathed it out.

         We all so hoped that the cure would extend to him and he would certainly make a good doctor or a good nurse.

         One day when I returned from weekend leave – the one in four weekend that we got to catch up with our sleep, our romance and our family – I could smell something but it was not Malathion[1]. Something was wrong. All his things were gone and the bed was now stripped bare. Night nurse was still around, waiting for me to turn up.

         “He has gone to the moon,” she said.

         Oh no. He had a massive bleed in the brain and passed away during the weekend. His last words were: I am going to the moon.

         I more or less decided at that moment that although we were brought up on the first day of Medical School to confront death, this just might be too much for me. Dealing with the death of a good friend’s father following a cerebral haemorrhage was hard enough but the passing of a young thirteen year old was going to leave its mark and I did not want too many of those.

The Cockroach Catcher
Review on Amazon

The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US

Can it be that it was all so simple then

Or has time rewritten every line

If we had the chance to do it all again

Tell me - Would we? Could we?

                                                                      The Way We Were

     

A Chapter on Anorexia Nervosa,  


Anne of Green Gables

---

[1] Malathion – an insecticide often ingested in attempted suicides at the time.

Health Care Class Struggle: NHS & Hong Kong!

I have always maintained that we were distracted into talking about GPs and ignore the most important aspect of Health Care in most countries: specialist care. We are fast heading towards a new class struggle: Health Care Class Struggle: Private & Dumped Public.                                 

©2013 Am Ang Zhang

In most western and not so western countries the demand for Hospital Specialists (Consultants in England) has never been higher.

Check out the Mayo clinic.

A friend had a STENT procedure In Hong Kong (like the one Prince Philip had) for a reasonable US $ 50,000.  I worked out that his cardiology specialist is earning a humble $10 million a year.

You begin to get the picture that for a long time, NHS is extremely good value.

When there are not enough specialists to go round in any country money is used to ration care. Just look at Canada.

There is unfortunately little realisation that soon, a large number of consultants would no longer be working in NHS Hospitals.

Stent, Hips and others

They will be working for Private Hospitals that initially will be offering services to NHS patients. But because of shortage of the said consultants, those that are concerned that at 78% obstruction, their heart and life may not last the wait and they will pay for the job.

My friend thought it was a bargain at US$ 50,000.

What about your painful hips, the CCG may decide to impose a wait time to limit cost. So you too will pay for it. That is what my golfing friend did in Florida for a bargain US$90,000 as he paid a co-pay of 25%.

So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in CCGs arguing about the price of Stents or Hips.

Soon with changes in the amount of private work FT Hospitals may do, what successful, skillful and sought after Consultant would want to stay within the NHS only to have his pension contribution increased and ultimate pension reduced.

Why not be 100% private and where are FT Hospitals going to find consultants for the phantom private patients.

Private hospitals will continue to provide NHS work but more to fill in their money making gaps. Very smart management indeed.

Consultants in private hospitals are generally extremely well treated, not like the way CEOs of old NHS Hospitals used to sideline them.

In Hong Kong, private Consultants work with several private hospitals and all private hospitals knew that these are the geese that lay the golden eggs. All hospitals provide excellent facilities for them including free valet parking as time is precious.

Could this be why so few consultants are objecting to the changes? I remember one such Private Hospital in Sheffield where there is no charge for parking and there was even free Cappuccino!

What about the quality of work?

Remember, in England, NHS or Private, they are the same consultants.