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Back to the Future – HKU Med Magazine

The Faculty’s re-engagement with Mainland China is consolidating our position as a bridge between China and the world and opening a multitude of new paths and opportunities.

“Life can only be understood backwards; but it must be lived forwards,” wrote Søren Kierkegaard. This is an apt description of today’s Faculty (and of Hong Kong). We have spent much of the past 132 years traversing colonialism, war, economic upheavals and reunion with the Mainland, to come full circle to our past and future destiny. Under the influence of our deep re-engagement with the Mainland, the Faculty is contributing to healthcare in the Mainland at higher levels than ever before and, in turn, welcoming unprecedented opportunities to advance our teaching, research and health leadership.

The 2000 bed HKU-SZ Hospital is located in the Futian District in Shenzhen.

This re-engagement has brought new horizons to all our areas of activity. For instance, we are collaborating on co-teaching and co-learning activities with the best medical schools in the country as a member of the China Consortium of Elite Teaching Hospitals, which we were invited to join in 2017. Our HKU-Shenzhen Hospital (HKUSZH) has introduced transformative changes in the public health system. And our research excellence has been advanced through collaborations with Mainland partners, such as our work with Shantou University on emerging infectious diseases.

Re-engagement has not happened overnight but the pace has been remarkably rapid nonetheless, in step with the country’s historic progress in improving medical care and education and adapting technologies to advance society. While there is still much work to be done, reflected in the Central Government’s Healthy China 2030 blueprint to optimise health and healthcare across the entire country, the Faculty is in an optimal position to make meaningful contributions. We are a leading institution that has a long history of engagement with both East and West, and we are also geographically well-positioned to contribute to the Belt and Road Initiative (BRI) to develop and deepen China’s connections with the region and the world and the Greater Bay Area (GBA) vision to integrate the Pearl River Delta region into an innovation and economic powerhouse.

“We are coming full circle to the original vision of our forerunner, the Hong Kong College of Medicine for Chinese, which was founded in 1887 to serve the nation as well as Hong Kong,” said the Dean, Professor Gabriel Leung — an aim that was articulated by the Viceroy of Canton, Li Hongzhang, who became patron of the College in 1888. “There is no doubt that when your admirable project is achieved it will be appreciated and imitated, and that it will through your students be a blessing to China,” he said.

Hong Kong College of Medicine for Chinese, established in 1887 and renamed the Hong Kong College of Medicine in 1907, was the territory’s first institution of higher learning. In 1911, when the University of Hong Kong was founded, it was amalgamated into the Faculty of Medicine as the University’s premier faculty. This photo was taken in 1908 with Dr Ho Kai, one of the founders of the College of Medicine (sixth from right, front row).

The blessings work both ways, for the Faculty also has much to gain from its deepening ties with the Mainland — provided it acts with urgency, added Professor Leung. “By the time we reach 2047 — by the time the Greater Bay Area vision is at maturity, by the time the Belt and Road Initiative re-ignites a new sense of globalism — we must make sure that we are very well prepared. This preparation is imperative for research and development, for Hong Kong’s health sector, and, most importantly, for tomorrow’s practitioners, i.e., the students of today.”

Dean Professor Gabriel Leung (left) with Dr Yin Li (right), Governor of Sichuan Province, in 2017 when the governor and his team visited HKUMed, where they received a presentation on research projects in the Faculty and visited the Wet Laboratory. A collaboration agreement was signed between the two parties.

The process of the Faculty’s re-engagement with the Mainland has been unfolding since the late 1970s, when Deng Xiaoping initiated the open-door policy which just celebrated its 40th anniversary. In the early years, the Faculty acted as a bridge between Mainland and overseas counterparts, sharing technology and skills to help build up competencies. From around 1997, the capacities of Mainland medical educators and healthcare professionals began to advance at a very rapid pace and our relationship transformed into a two-directional transmission of knowledge and understanding. More recently, our interactions have entered a new era of greater scope and ambition.

Healthy China 2030, which was launched by President Xi Jinping in 2016, is a major milestone in the country’s healthcare reform. Under the theme “cobuilding, sharing and health for all”, the strategy aims to rapidly improve the health of all sectors of society by improving healthcare access, service quality, public education and many other areas, including the education and training of healthcare professionals. For the Faculty, all this means there are many opportunities arising for innovation and collaboration, which are further multiplied by the GBA and Belt and Road initiatives. The latter also aims to fortify and forge connections on the New Silk Road and promote economic development and innovation, including in the field of healthcare, which plays to the Faculty’s strengths in international relations. (There is also an international dimension to Healthy China 2030 because it dovetails with the 2030 deadline for the United Nations’ Sustainable Development Goals and the World Health Organization’s universal health coverage, which both seek to improve healthcare for everyone on the planet.)

Professor Leung is keen for the Faculty to be both a participant and a leader in the national health-sector reform movement, a role for which the Faculty has already achieved recognition. In 2018, Queen Mary Hospital was ranked the top hospital in the GuangdongHong Kong-Macao Greater Bay Area and three other teaching hospitals were named in the top 50: Hong Kong Sanatorium & Hospital (5th), Gleneagles Hong Kong Hospital (26th) and HKUSZH (45th). The latter is particularly notable because of its pioneering work as a role model for many other hospitals on the Mainland.

HKUSZH was endorsed as a “National Residency Training Centre” by the National Health and Family Planning Commission and the Ministry of Finance in China in October 2017

“We started the HKUSZH even before there were equivalent big political narratives, like the GBA. We experienced growing pains and came in for a lot of criticism. This is to be expected at the beginning when you venture into something new — you are often derided as a fool because what you are doing is not received wisdom, otherwise everybody would be doing it. Yet now we are an innovator and trailblazer. And that is the point of a university: to be at the frontier,” he said.

HKUSZH is the physical embodiment of the Faculty’s re-engagement with the Mainland. It was opened in July 2012 to apply HKU’s clinical governance practices in a Mainland hospital and contribute to healthcare reform. It has pioneered online appointment booking, banned “red packets”, ended indiscriminate IV therapy, and made its fees and charges transparent, among many other reform initiatives. It took people time to get used to the new protocols but by mid-2018, the hospital has treated over six million patients in the past six years, providing clinical services in 21 specialties and providing clinical training for over 600 HKU students every year. Its latest initiative is to start carrying out living donor liver transplantation from 2019, a speciality in which HKU academics have been world leaders, including the Hospital Chief Executive of HKUSZH and Chin Lan-hong Professor in Hepatobiliary and Pancreatic Surgery, Professor Lo Chung-mau.

The hospital’s consistently high standards amid rapid expansion have brought it fame and recognition. Its achievements have been reported extensively in Mainland, Hong Kong and international media. In 2015 the hospital was accredited by the Australian Council on Healthcare Standards Committee (ACHS). In November 2017 it gained 3A Hospital Accreditation, the highest level possible. In 2018 it was selected as one of Guangdong’s “Project Summit” hospitals, which are being provided with funds to develop their potential in integrating medical service, teaching, research and management. Each Summit Project hospital receives funding of RMB300 million from Guangdong and an additional matching fund of RMB900 million from Shenzhen city. HKUSZH has also been a recipient of funding under the Sanming (Three Famous) Project of Shenzhen, with six projects receiving a total of RMB 70 million in such areas as liver transplant, breast cancer treatment, radiotherapy and oncology, and spinal disease.

Professor Lo said while there is still much work to do, there was also much to be proud of. “We are at the vanguard of local healthcare reform and it is not always easy. We have to endure patients’ disappointment and worse because we do things differently than what they have been used to. And we have had to slowly change the culture and attitude of both staff and patients. But it has been worth the pain because we have introduced modern, evidence-based measures,” he said. “If I were working solely as a surgeon, I could only save one life at a time. But here we have the potential to save millions of lives by helping to reform and improve the whole healthcare system.”

Professor Lo Chung-mau and one of his Hepatobiliary and Pancreatic Surgery team members at HKUSZH

HKUSZH may have the highest-profile of the Faculty’s contributions to the Mainland’s healthcare reform, but we are also making valuable contributions through our “software”: our people and expertise, connections across continents, and determination to improve health for everyone.

The new building of the Shantou University-The University of Hong Kong Joint Institute of Virology

Individual academics have helped to boost medical research in the Mainland by establishing centres where they can share their expertise. Professor Guan Yi, for instance, who is one of the top virologists in the world, spearheaded the Joint Influenza Research Centre at Shantou University (STU-HKU) in 2001, which evolved in 2016 to become the Joint Institute of Virology (STU-HKU). The institute is a major national and international base, with more than 70 researchers from Asia, North America and Europe. In 2017 it was awarded the Grand Prize of the State Scientific and Technological Progress Award in health and education for its work on preventing and treating Avian H7N9 infections in humans. A team led by Professor Guan was also
awarded RMB 25 million under the Peacock Programme of the Shenzhen Municipal Government in 2012 to conduct joint research on emerging infections through the State Key Laboratory on Emerging Infectious Diseases (Shenzhen Base), which was jointly founded by HKU and the Third People’s Hospital of Shenzhen.

Another example is Professor Xu Aimin, Chair of Metabolic Medicine, whose research has focused on discovering and characterising the factors that lead to obesity-related cardiometabolic complications and developing diagnostic, screening and other tools into applications for use with patients. Professor Xu has been involved in collaborations and clinical trials with scholars in various countries, including Mainland China, and he is the Director of the State Key Laboratory (SKL) of Pharmaceutical Biotechnology. The work of Professor Xu and his colleagues helped to propel the formation of a joint Innovations Platform between HKU and Guangdong Pharmaceutical University (GDPU) in 2018. This platform will leverage on HKU’s research excellence and cutting-edge technologies and GDPU’s expertise in translating biomedical discoveries into applications and operating an incubation facility. It will also house a satellite branch of the SKL. The Innovations Platform will be based in Zhongshan and is expected to incubate at least 10 HKU technologies within five years and be a significant centre of innovation in the GBA.

Professor Xu Aimin, Chair of Metabolic Medicine, Professor in Pharmacology and Pharmacy, HKUMed, and Director of State Key Laboratory of Pharmaceutical Biotechnology.

The SKL designation is important because it indicates that the work of the laboratory is nationally important and is eligible for national funding. The Faculty is in fact home to four SKLs. The SKL of Emerging Infectious Diseases was established in 2005 alongside the SKL of Brain and Cognitive Sciences, and they were the first SKLs established outside mainland China. The SKL of Liver Research was established in 2010 and the SKL of Pharmaceutical Biotechnology in 2013.

Other national recognition has been accorded to highly-esteemed individual scholars who are based in the Faculty, including three scholars named to the Chinese Academy of Sciences (CAS) (Professor John Leong Chi-yan, Professor So Kwok-fai and former HKU ViceChancellor Professor Lap-Chee Tsui), and two named to the Chinese Academy of Engineering (CAE) (Professor Fan Sheung-Tat and Professor Yuen Kwok-yung). They have each made important contributions to science and medicine and are contributing their expertise to the development of the GBA through the new Bay Area academician alliance in Hong Kong, which is promoting participation by CAS and CAE academicians.

Among the achievements of the CAS and CAE academicians is Professor So’s globally pioneering work in axonal regeneration of the visual system and his subsequent work in tackling axonal regeneration of the spinal cord. Professor So is also Director of the Guangzhou-Hong Kong-Macau Institute of Central Nervous System Regeneration based at Jinan University in Guangzhou, which has produced numerous high-impact publications since its establishment in 2012. Another example is the work of microbiologist, physician and surgeon Professor Yuen Kwok-yung, who is world-renowned for his discoveries pertaining to infectious diseases such as H5N1 and SARS. Professor Yuen and his team at the Department of Microbiology recently have collaborated with Hainan-Medical University (HMU) to establish the HMU-HKU Joint Laboratory of Tropical Diseases, which has set its sights on oft-neglected diseases such as viral hepatitis and parasitic infections. In just two years, the lab has already translated its research into new diagnostic tests and therapeutic options.

Professor Tsui Lap-chee, the 14th Vice-Chancellor and President of HKU, is also a member of the Chinese Academy of Sciences.

Professor Tsui is another nationally-and internationally-acclaimed scientist. He was HKU’s Vice-Chancellor from 2002 to 2014, and he now chairs the Scientific Advisory Board of the Faculty’s School of Biomedical Sciences, is Director of the Qiushi Academy for Advanced Studies at Zhejiang University and Founding President of the Hong Kong Academy of Sciences, among many other achievements. He believes there is potential for Hong Kong to be a world-class biomedical technology centre, especially with recent allocations from the Hong Kong government.

In November 2018 the government earmarked HK$30 million to support 22 laboratories jointly founded by the CAS and local universities — good news that also coincided with five joint CAS-HKU labs being rated “distinguished” or “good” in the Fifth Assessment of the Hong Kong-Chinese Academy of Sciences Joint Laboratories. Two of these labs are connected with the Faculty: the Joint Laboratory for Biomaterials of SIATHKU-CUHK, involving Professor William Lu Weijia, was rated “distinguished”; and the Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, involving Professor Tse Hung-fat, was rated “good”.

“Hong Kong has an edge in biomedical technology and HKUMed has contributed to that edge. Its impact will be even greater when it collaborates with more partners, especially from Mainland China,” Professor Tsui said.

Professor Yuen Kwok-yung and his team at the Department of Microbiology recently collaborated with Hainan-Medical University (HMU) to establish HMU-HKU Joint Laboratory of Tropical Diseases with sights on oft-neglected diseases such as viral hepatitis and parasitic infections.

Our academic contributions to the Mainland are by no means confined to research. The Faculty also has valuable experience in education and training that it is now sharing through the China Consortium of Elite Teaching Hospitals that was formed in 2015 to support the healthcare reform drive. The Consortium includes eight top teaching hospitals in the country plus HKU, and its job is to set standards, define competencies and serve as a national role model of residency education for the country.

HKU has special expertise in this regard, given that Hong Kong has had its own training system since 1992 overseen by the Hong Kong Academy of Medicine, whose founding President was the late Professor Sir David Todd.

“We have a quarter century of experience under our belt and we’re now contributing that expertise and our successes, but also our failures, to inform the national dialogue,” Professor Leung said. “There is also self-interest in our involvement because we will be able to ensure our training system is compatible with the national standards of professional qualification.” As an example of this engagement, HKUMed and the Academy co-hosted a training workshop at HKUSZH in December 2018 with the Chinese Medical Doctors Association on best practices in postgraduate medical education.

The Elite Consortium has also been a vehicle for higher-level exchanges and engagement, such as the PUMC Hospital’s International Conference on Residency Education in 2018, where the Consortium Consensus on Core Competency Framework for Residency Education was released. All members, including HKU, collaborated to produce goals in six key areas: professional accomplishments, medical knowledge and expertise, care for patients, communications and co-ordination, teaching capacity, and lifelong learning.

New developments are happening in undergraduate education, too. In July 2018, a pilot programme was pioneered with MBBS students and students of the Peking Union Medical College (PUMC) to learn more about poverty alleviation through health, as first proposed by President Xi Jinping himself. Recently the National Health Commission asked HKU to participate in this project as a trailblazer.

Students guided the participants to do fitness exercises which can improve their health.

The 10-day programme was an eye-opener. Students of both institutions jointly visited the PUMC Hospital, which was ranked the top hospital in the country from 2009 to 2017 and has about 5,000 medical staff, then headed to Yonghe County in the southwest of Shanxi province, one of the four poorest in the country where hospitals and clinics struggle with resource challenges and staff shortages.

“We are two of the very top medical schools in the country and this was an opportunity to deepen our integration,” Professor Leung said. The success of that goal was reflected in comments by Tsui Yat-yan (Medic ‘22): “This trip showed me the less glamourous side of China and the genuine relationship between the land and the people. I was also grateful to meet top-notch medical students from the Mainland and I was pleasantly surprised by their humility and the similarities that we share as medical students. Visiting villages and local medical facilities side by-side with them allowed us to grow closer as a community and enriched our understanding of each other.”

Students visited the homes of impoverished villagers in Yonghe county, Shanxi.

The Faculty’s early role as a bridge between the Mainland and the rest of the world still endures and it is ripe with possibility, particularly through the Elite Consortium. For example, members of the Consortium were invited to join our Summit of Global Health Leaders in December 2017, which attracted more than 600 leaders from around the world. In November 2018, the Dean led a delegation of Consortium members to visit hospitals and institutions in the UK and attend the Women Leaders in Global Health conference in London, where he was also a speaker. The Faculty also sent 38 young scientists to the 2018 World Life Science Conference in October, which was organised by the China Association of Science and Technology and the Ministry of Science and Technology at which six Nobel Laureates and more than 200 academic and scientific leaders made presentations

The level of activity in all areas, including teaching, research and clinical activity, is only expected to intensify in the coming years. This is good for all parties involved as we share expertise and contribute to the greatest healthcare reform in human history — one that is improving the lives of more than one billion people.

“Our deep re-engagement with the Mainland is opening new opportunities for us to contribute to the nation’s development while also leading the advancement of healthcare in Hong Kong,” Professor Leung said.

“It is difficult to overstate how exciting these changes are, and how exciting it is for the Faculty to be able to contribute to these changes through our professional contributions. We have a multitude of connections and a multitude of interests and we will continue to enhance our ability to be a bridge to the Mainland and back, and to the rest of the world — this is a role HKU plays very well.”

In November 2018, Professor Gabriel Leung led a delegation of the Consortium members to visit hospitals and medical institutions in the UK.

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