Written by Dr Tom Buckley, excerpted from HUNG CT (Editor-in-chief), et al. Ten Years and Beyond. Published by The Hong Kong College of Anaesthesiologists, 1989-1999, pages 88-92.

About the author: Dr. Tom Buckley is currently Director of Intensive Care at Princess Margaret Hospital and Yan Chai Hospital.

 nethersole_old

The old Alice Ho Miu Ling Nethersole Hospital in Bonham Road, Hong Kong.

Prior to the introduction of Intensive Care Unit's (ICUs) in 1967, critically ill patients in Hong Kong were treated in the general wards with the emphasis being on crisis management.  Hong Kong was a slow starter, with regard the development of intensive care facilities and once introduced, development proceeded in a sporadic and fragmentary fashion over the next 20 years.

 

General Development of Intensive Care in Hong Kong

The first ICUs were established at Nethersole Hospital on Hong Kong Island and Kwong Wah Hospital in Kowloon in 1967.  These were officially opened in 1968 and an ICU was also opened at the Grantham Hospital.  In 1970 an ICU was opened at Queen Mary Hospital and over the next decade many hospitals established their own ICUs.

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Patients were managed in these ICUs with increased monitoring and nursing care but without dedicated medical care.  Doctors attended to ICU patients as part of their regular patient rounds and junior doctors working in other wards were assigned to respond to calls from the ICU whenever medical attention was needed.  Patients in these early ICUs remained in the care of their original admitting doctors and other specialties would be consulted as required on an ad hoc basis.  Besides ICUs, hospitals in Hong Kong also provided 'High Dependency Care', with ventilatory support in satellite areas scattered among specialist wards.  This practice with the notable exception of the Prince of Wales Hospital persists today in many hospitals.  Before the opening of separate Coronary Care Units (CCUs), the ICU in many hospitals provided care for patients who were suffering form coronary heart diseases.  Some general hospitals established separate CCU's only as late as 1992.

 

In 1983, the Hong Kong Society of Critical Care Medicine (HKSCCM) was established.  After attending the Inaugural Meeting of the Western Pacific Society of Critical Care Medicine (WPSCCM) in Tokyo in 1979, Hong Kong delegates brought back ideas of creating their won Critical Care Society which had doctors, nurses an allied health professionals as members.  In 1983 the HKSCCM was accepted as an Associate Member of the Federation of Medical Societies of Hong Kong and as a Full Member of the World Federation of Societies of Critical Care Medicine.  Amongst its earlier activities were the training of ambulance personnel and others in cardiopulmonary resuscitation (CPR) and Basic Life Support (BLS).  It also played host to a number of leaders and experts in the field of intensive care medicine who visited Hong Kong and addressed its scientific meetings.  The current (1999) Chairperson of the HKSCCM is Dr Florence Yap, an intensivist at the Prince of Wales Hospital.  The Society has been active in providing an academic program for its members and liasing with the Hospital Authority in establishing guidelines, for example brain death certification.  It has also helped to bring together doctors from varying medical backgrounds, who practise intensive care medicine.

 

The next major development in intensive care occurred in 1984 with the opening of the ICU at Prince of Wales Hospital, the teaching hospital of the newly established Faculty of Medicine of Chinese University of Hong Kong.  This led to the development of intensive care as a definite entity.  The Department of Anaesthesia was entrusted with managing the intensive care resources of the hospital.  A historical first in Hong Kong as anaesthetists were finally empowered to administer and manage critically ill patients in the ICU.  The other notable feature was that there was to be no ventilation of patient's on the general wards.  In patients in whom mechanical ventilation was indicated transfer to the ICU was required.

 

In 1987 Professor Teik E Oh was appointed to the Chair of the Department of Anaesthesia of the Chinese University of Hong Kong .  During the 10 years Professor Oh was in Hong Kong significant progress was made in the development of intensive care as a specialty.  This included the administrative, clinical, and academic aspects of intensive care medicine that had not been evident previously.  One of his early significant accomplishments was to change the academic and clinical title of his department to the "Department of Anaesthesia and Intensive Care" in 1989.

 

This had some influence on subsequent development of Intensive Care Units in new hospitals of the Hospital Authority (e.g. Tuen Mun Hospital, Pamela Youde Nethersole Eastern Hospital and Tai Po Nethersole Hospital) being under the Department of Anaesthesia.

 

In 1988 the establishment of the proposed Academy of Medicine was being looked into and deliberated by a Committee under the chairmanship of Professor Keith Halnan of U.K., at the invitation of the Hong Kong Government.  The Committee produced a report which stated that ‘... Intensive Care was a relatively new specialty ... both specialist physicians and anaesthesiologists are involved and take part in training ... anaesthesiology is a major well-defined specialty ...'.  In Hong Kong, the situation in respect of training and general management of ICUs (by anaesthetists/intensivists) had not yet gained the widespread recognition that many experts here and elsewhere considered it deserved.  There was a consensus in many countries that intensive care medicine should assume a definite identity of its own.

 

IN 1993, the 7th Congress of the Western Pacific Society of Critical Care Medicine was held in Hong Kong and demonstrated what remarkable progress intensive care medicine in Hong Kong and demonostrated what remarkable progress intensive care medicine in Hong Kong had made.  The convenor of that Congress was Professor Teik Oh and the hosting organizations were the WPSCCM, the Chinese University of Hong Kong (CUHK) and the HKSCCM.

 

In 1996, Princess Margaret Hospital (PMH) established that first independent Department of Intensive Care with its own Chief of Service (COS), followed by the United Christian Hospital.  Physicians trained in intensive care medicine headed both of these Departments.

 

Training of Medical Personnel in Intensive Care Medicine in Hong Kong

In the 1970's doctors obtained Intensive Care experience by simply being posted to the ICU.  Few doctors were specifically trained in intensive care medicine because structured training was not available anywhere in the world at that time.  In the USA certificates in Critical Care were developed under various specialty Boards. As the American qualifications were not recognized in the purely British system at that time no local medical graduate undertook that pathway of training.

 

From the early 1980's onwards, the Central Training Committee of the Hong Kong Medical and Health Department (and later the Hospital Services Department) placed an emphasis on intensive care training for anaesthesia vocational trainees.  This resulted in the mandatory exposure to intensive care by anaesthetists going on overseas study leave for the next few years, irrespective of their other training requirements.  For non-anaesthetists, training in intensive care still remained the initiative of the individual doctor who needed to find an attachment in an intensive care unit overseas in order to gain experience.  In reality, any doctor who was not specifically trained for an intensive care qualification could not expect to receive more than three to six months of concentrated intensive care experience at one time.

 

Australia and New Zealand organized their own structured training programme in late 1970's .  The Faculty of Anesthetists of the RACS awarded the first Fellowship Diploma specifically in Intensive Care in 1980.  The first local doctor specifically sent to Australia for Intensive Care training was Dr Ronald Lo who obtained the Fellowship in Intensive Care from the RACS in 1981.

 

With the arrival of Professor Oh in the late 1980s the Faculty of Anaesthetists of the RACS recognized the ICU at the Prince of Wales Hospital for the two-year core vocational training period.  The result was that Hong Kong could now offer a recognized intensive care training programme without the need for "budding" intensivists to travel overseas.  The first trainee was Dr Tom Buckley who obtained his Fellowship in 1990.  He subsequently became Director of Intensive Care at the Prince of Wales Hospital.  This programme added impetus to the local training of anaesthetists in intensive care such that anaesthetists in training could now undergo their three months of intensive care training in Hong Kong whilst doctors could now also train in the specialty of intensive care.  The first local doctor to train locally was Dr So Hing Yu, who is now the Chief of Service of the Department of Anaesthesia and Intensive Care at Tai Po Nethersole Hospital.  The Prince of Wales Hospital has employed many highly qualified intensivists over the years and has continued to train and certify doctors from a variety of backgrounds.  Over ten doctors have now passed through the training programme of the Prince of Wales Hospital.  Most have remained in Hong Kong and now occupy fulltime intensive care posts in other hospitals.  Subsequent developments have seen further development of the ICUs of both Queen Elizabeth Hospital and Pamela Youde Nethersole.  They are now recognized by the Faculty of Intensive Care of the Australian and New Zealand College of Anesthetists for core vocational training in intensive care.

 

The Hong Kong College of Anaesthesiologists (HKCA) created the Intensive Care Committee in 1994.  This was initially chaired by Professor Teik Oh and subsequently by Dr Tom Buckley.  Fellows in Intensive Care were admitted ad eundem in mid-1996.  The major achievement over the past three years has been the development of a structured programme in intensive care training for local doctors.  This has been based on the Australasian training programme with its suitably qualified doctors in the specialty of intensive care.  This will lead to a final examination and a Fellowship in Intensive Care under the HKCA.  The inaugural examination occurred in 1997 and the first doctor admitted to the HKCA (IC) by examination was Dr Cheung Po Wa.  In 1998, Dr Claudia Cheng was admitted to Fellowship by examination and in 1999 Dr Victor Yeo having passed the final examination will be admitted to Fellowship.  There are now over 20 Fellows of the HKCA who are endorsed in Intensive Care.

 

Training of Nurses in Intensive can Critical Care Nursing in Hong Kong

Senior nursing positions in ICU's are limited while experienced nurses seek career promotions.  There is therefore a continual drain of ICU-trained nurses to other nursing areas, such as nursing education and administration.  This is likely to remain a significant issue in intensive care nursing in the years to come.

 

Senior nurses were sent overseas, mainly to the United Kingdom for training in Intensive Care Nursing in the 1960's.  On their completion of training and returning to Hong Kong, they helped to set up the local ICUs. But it was evident that this nucleus of expertise was not sufficient to satisfy the rapidly expanding need for intensive care nursing.  To meet the demands, a local post-graduate certificate programme was developed and initially run by the Medical and Health Department in the late 1970's.  Subsequently, the Hospital Services Department and the Hospital Authority became involved.  In 1995, the first tertiary level Diploma Course in Critical Care Nursing was run by the Critical Care Nursing was run by the Chinese University of Hong Kong.

 

In conclusion, while the initial development of intensive care proceeded slowly, over the past ten years there has been rapid progress coinciding with the development of the Hong Kong College of Anaesthetists and the arrival of Professor Teik Oh.  His drive and enthusiasm have enabled Hong Kong to catch up and in some cases surpass the development of other intensive care programmes around the world.  Challenges for the future involve increasing resource allocation to intensive care so that intensivists manage intensive care; reducing mechanical ventilation on the general wards; and increasing the medical profession's and Hospital Authority's knowledge of the value of Intensive Care.  Finally, it is important to ensure that doctors and nurses interested in intensive care continue to be offered a high quality training programme that enables them to care for the critically ill patient.

Copyright - Hong Kong College of Anaesthesiologists (HKCA). Permission for transcription has been obtained from HKCA and Dr Tom Buckley in 2009.