Living in the Twilight Zone

December 6, 2013

Shortage of mental health care resources impacts quality of care received by patients

By Tracy Chan and Cindy Ng

She always felt there were people stalking her and plotting to harm her. She could hear a man’s voice persuading her to kill herself. She constantly talked to herself out loud. Her mother took her to a hospital and she was diagnosed with schizophrenia.

That was more than 30 years ago and now Florence, who does not want to disclose her full name, has regular follow-up consultations in public hospitals and takes antipsychotics to control her schizophrenia symptoms. Although the prescribed drugs have significantly relieved her symptoms, she suffers from some side effects, such as slightly trembling fingers and occasional eye-rolling.

Florence, who is in her mid-50s, is one of the 44,850 diagnosed schizophrenic patients in Hong Kong who are in contact with public hospitals’ psychiatric services. According to the Hospital Authority, there are 195,000 people in Hong Kong who have been diagnosed with mental illnesses and have used the authority’s psychiatric services.

Mental illness includes a wide range of conditions that diminish one’s ability to cope with the ordinary demands of life – disrupted thinking, feelings, moods, relationships and daily functioning. In Hong Kong, common mental disorders are affective disorders like anxiety and depression and severe mental illness such as schizophrenia.

Seeing the prevalence of mental illness in Hong Kong, the Hospital Authority has increased mental health expenditure from 8.2 per cent of total health expenditure in 2007 to 8.7 per cent in 2012. But the ratio of mental health professionals to mental health patients remains low, far behind that found in other developed economies.

The shortage of personnel has a knock-on effect on the time allocated to each patient. Dr Arthur Mak Dun-ping, associate professor in the Department of Psychiatry at the Chinese University of Hong Kong, says doctors have to meet nearly 30 patients in an afternoon on a daily basis.

Mak says that when he describes this situation in meetings with psychiatrists from other countries, no one believes him. “They think this is India. It is only acceptable to have 30 cases if this happens in a third world country,” Mak says. He says doctors in the United Kingdom only deal with five cases in one afternoon.

Ignored in Plain Sight

December 6, 2013

Mental health problems and suicidal thoughts are common but often overlooked in the elderly

By Charlene Kwan and Katrina Lee

The sound of laughter and song travel along the corridor from a spacious room decorated with handicrafts and colourful collages. Tables with mahjong and chess sets have been set up, awaiting players to take their places. Walking closer to the cheerful sounds reveals a group of elderly people singing and listening to Cantonese opera.

Except for being livelier, this scene could resemble those found in most elderly homes. From the happy faces of the elderly people here, it might be hard to guess it is a centre providing hospital day services for elderly people diagnosed with mental disorders. Indeed, the Psychogeriatric Ambulatory Care Centre (PACC) of Kwai Chung Hospital is the only centre of its kind in Hong Kong.

The Psychogeriatric Ambulatory Care Centre at Kwai Chung Hospital has a homely setting to ease the tension of hospital wards

Mental health problems are common among the elderly aged 60 or above in Hong Kong, some 30 to 40 per cent of whom are believed to have some sort of psychiatric disorder. Despite such a high prevalence, the care and attention they receive from society is far from satisfactory and there are unique challenges facing the mentally ill elderly that present obstacles to recovery.

Depression is one of the most common mental illnesses found in older people and affects up to 15 per cent of the elderly population. If left untreated, it can lead to suicide. According to the Institute of Mental Health (IMH) at Castle Peak Hospital, deaths from suicide are three times higher among the elderly than in the general population and 90 per cent of elderly suicide completers suffered from depression.

Unfortunately, many elderly people tend to hold back their feelings and needs, which can make it hard to identify depression. Rufina Au, a registered nurse with more than 10 years’ experience in taking care of elderly patients, says older people are often already grateful that their children are willing to live with them; they dare not ask for much from them. “Those who were born in the 1920s and 1930s have pretty good endurance, they do not want to cause trouble for others,” she says.

At the same time, family members can easily neglect signs of depression in their ageing parents and grandparents. Au says those who live with their parents, often have the perception that the elderly are fine as long as they can still eat and sleep. They tend to belittle the potential significance of older people suffering from bad moods and losing their appetites.

Who Cares for the Carers?

December 6, 2013

Relatives who devote their lives to those with mental health problems are themselves vulnerable and neglected

By Elaine Tsang & Jeffrey Wong

Mico Chow Man-cheung remembers the times when he would stare at the ringing phone on his office table, his heart pounding and his hands clammy with sweat. At times like these, Chow would be filled with dread. He feared it would be a call from the police or a hospital. His wife, who suffered from depression, had previously threatened to end her life. He was afraid the call would bring bad news.

Eventually, Chow left his job of 25 years so he could devote his time to looking after his wife. What he did not realise was the pressure at home would threaten to drag him into depression too.

Mico Chow Man-cheung sought help from the Hong Kong Familylink Mental Health Advocacy Association by attending their workshops for carers

“Actually there was not much I could do to help because I didn’t have the knowledge to and I couldn’t see any ways through which I could help my wife,” says Chow. “At that moment, I was worried about whether I could handle my own moods and emotions.”

Adding to his concerns about how he would handle his own emotions were his fears that saying the wrong thing could further antagonise his wife. He took extreme care over his choice of words and avoided negative criticisms that might harm their relationship.

Chow’s wife is stable now and he has gone on to become the chairman of the Hong Kong Familylink Mental Health Advocacy Association. But he fully understands what it is like to be one of the many carers who are walking an emotional tightrope while taking care of family members living with mental illness. According to a survey by the Baptist Oi Kwan Social Service (BOKSS) in 2010, 70 per cent of such carers – most of whom are middle-aged women – exhibit various levels of depression symptoms.

Tim Pang Hung-cheong is a community organiser at the Society for Community Organisation, (SOCO) who advocates for the rights of the mentally-ill and their families. Apart from the emotional strains, Pang says carers also have to shoulder great financial pressures. Like Chow, some carers quit their jobs to become full-time carers. Without a stable source of income, the demands of medication and therapy become a constant headache.

Treatment is available through the public system but the median waiting time for public hospitals is around seven weeks and the longest waiting period can be up to 100 weeks. Once a patient gets an appointment, consultations may last just a few minutes. Therefore many carers prefer to send their family member to private hospitals or clinics which they believe can provide better services. However, these services can cost thousands of dollars a week.

Another reason families may prefer to seek private treatment is to avoid having medical records in the public system which could affect the patient or their family members’ future career.

“A patient’s family member applied for a job as a civil servant in the Hong Kong Customs and Excise Department, but he was rejected because of the family record of mental illness,” Pang says.

Stigma and discrimination surrounding mental illness are still widespread in society and can be an obstacle to family members’ acceptance and understanding of people with mental illness. Yet it is essential for carers to have an understanding and knowledge of their family member’s illness.

Unequal before the Law

December 6, 2013

Sexual harassment law protects customers from goods and service providers but not the other way round

By Vanessa Cheung and Natalie Tsoi

Leung is a 58-year-old worker in a care home. She has been doing this work for 18 years. One day, as she carried out her daily routine helping an elderly man with his shower, he stretched out his hands and tried to touch her breasts while she was towel-drying his body. Leung was shocked, she covered his body immediately to stop him attempting to touch her.

This may seem like a blatant case of sexual harassment but, under existing law, Leung cannot sue the elderly man. As a service provider, she can be sued but has no right to sue the service receiver for sexual harassment under the Sex Discrimination Ordinance (SDO).

“It is absolutely unfair…Why can you complain about me on sexual harassment but I cannot complain about you?” she asks.

The SDO was enacted in 1995 and is implemented by the Equal Opportunities Commission (EOC). Under the terms of the ordinance, “It is unlawful for a person to sexually harass another person in the course of offering to provide, or providing, goods, facilities or services to that other person.” But sexual harassment by customers and clients against service providers is not covered, leaving 3 million service providers outside the scope of the ordinance.

According to the EOC, sexual harassment occurs when any person makes unwelcome sexual advances, or unwelcome requests for sexual favours, to another person. Conduct of a sexual nature which is likely to offend, humiliate or intimidate another person or creates a hostile environment is also considered sexual harassment.

In 1999, the EOC proposed to amend the SDO by making it unlawful for a customer to sexually harass the service provider in the course of seeking, or receiving, goods and services. Although the government indicated it would not object to such an amendment in 2000, nothing happened until the EOC proposed it again in 2011.

And it was not until October this year, that the administration tentatively announced it would introduce the Sex Discrimination (Amendment) Bill to the Legislative Council by the second half of the current legislative session.

Human rights lawyer Chong Yiu-kwong believes one reason why it has taken so long is the lack of controversy over the issue, pushing it to the bottom of the government’s agenda. Since sexual harassment by customers against service providers is not covered by the SDO, the EOC cannot follow up on any complaints or maintain relevant statistics, and subsequently victims might not bother turning to the EOC. Therefore, there is a lack of data showing how serious the problem is and reflecting the necessity to amend the ordinance.

“Issues will never be prioritised if the government does not feel the pressure,” Chong says.

Tapping into the Future

December 6, 2013

What do Hong Kong developers need to thrive in the mobile app development?

By Emily Chung and Silvia Li

It is eight o’clock in the morning and the MTR carriage is filled with commuters flocking to work and students travelling to school. Apart from the station announcements and the sound of music leaking out from passengers’ headphones, the carriage is eerily silent.

People keep their heads down, their fingers tapping away at their smartphones and tablets. Some of them are reading the morning news, some are searching for bargains and others are fighting intergalactic battles – all on mobile apps.

After the dot-com bubble burst at the turn of the century, the rise of smartphones in recent years has spurred a revival in the innovation-technology domain.

This new IT boom started when Apple launched its mobile apps distribution platform, Mac App Store in May 2008. Later that year, Google launched a similar platform, now known as Google Play. Since then, developers have been able to sell their products in a global marketplace by paying just US$25 a year for Google Play or US$99 for Apple’s App Store.

Rick Woo Man-yuen from Four Directions showing their app for wedding photos — Rick Woo Man-yuen from Four Directions
showing their app for wedding
photos

Seizing on the opportunities these developments presented, some young developers in Hong Kong are creating start-ups specialising in apps. Four Directions, run by Rick Woo Man-yuen and his partners, is one of the most successful examples.

Woo recalls that the four partners chewed over their plans in an upstairs cafe in 2010. Apart from creating apps, they also handled digital projects for clients. Woo says the partners did not earn a salary for the first six months.

A year later, they developed AppGreen, a web-based service that allows subscribers to create their own mobile apps without the need for any programming knowledge and at low cost. AppGreen was Four Directions’ breakthrough product and won a Top 100 Asia award from the leading innovation magazine, Red Herring, which is known as the “bible of the Silicon Valley”. Woo’s company was the only one in Hong Kong to win the internationally recognised technology award that year.

With the award came recognition from clients and Woo says the company became more and more successful in pitching their business. Later, they also joined the Small Entrepreneur Research Assistance Programme (SERAP) run by the Innovation and Technology Commission and obtained extra funding of HK$1.26 million to carry out research and development.

The future seems promising for Four Directions, which currently has a team of 38 staff. But Woo points out that it has become exceedingly hard for apps to fare well, as thousands of new competitors enter the market each day.

Making the Cut

December 6, 2013

Hong Kong lacks proper tree management and planning, say experts

By Yoyo Chan and Tommy Lee

A tree aged 20 to 30 years, its trunk measuring about 40 cm in diameter, sits dead in an inappropriately small planter. The trunk has become home to various fungi families, the canopy is gone due to over-pruning and topping. Sadly, this is a common sight that greets arborist Theresa So Fung-chun in the course of her work. Certified arborists, also known as tree surgeons, treat sick trees and take care of tree safety.

In this and in many other similar cases, improper tree management is probably the culprit. According to the former Civic Party legislator Tanya Chan Suk-chong, who is also a certified arborist, improper tree management stems from inadequacies in the government’s urban planning.

As an arborist certified by the International Society of Arboriculture, Chan says choosing the right location for trees is crucial in tree management. Trees need to have sufficient space for their roots to grow underground and their crowns to spread out above ground. The distance between trees should also be taken into consideration when planting them.

As an example of how not to manage trees, Chan cites the case of the heritage banyan trees in Tsim Sha Tsui’s Park Lane Shopper’s Boulevard that had to be cut down after they were killed by root rot. The growth of the trees’ roots had been restricted by the size of their planters. “Maybe they [the trees] were not suitable to grow there,” says Chan.

Inadequate planning is common in land-squeezed Hong Kong. Sometimes, trees are even transplanted from one location to another. Chan compares this to a person undergoing small-scale surgery. It hurts. She emphasises the importance of planning. “You need to have the right locations. Once you have that, the burden of caring for the trees is less.”

As Hong Kong does not have a centralised department overseeing tree management and the risk assessment of trees, Chan has drafted a tree ordinance proposal.

Under the proposed tree ordinance, there would be a committee that includes frontline professionals such as arborists, as well as experts on trees, landscaping and urban planning, along with citizen representatives. All members on the committee would have the chance to provide opinions on tree species, policies, and conservation.

At the time the ordinance was proposed, in 2011, the then Secretary for Development, Carrie Lam Cheng Yuet-ngor, pledged to seriously investigate the feasibility of legislation. It seems the investigation is still ongoing because we are no nearer to having an ordinance.

Leading the Way

December 6, 2013

Hong Kong last saw guide dogs on the streets in 1970s now they are back with a new generation of puppies in training

By Cherry Wong

On a sunny day, a labrador retriever leads its handler through the crowds while the handler follows, holding onto the handle that is attached to a snugly fitted harness on the dog. On their short journey from the handler’s home in Wong Tai Sin to the MTR station, many pedestrians stop to look and whip out their cell phones to take photos. The dog’s name is Rally and she is not an ordinary pet dog, she is a guide dog.

Rally’s everyday work is to lead her owner, Trada Yip Man-yee through her daily routine. Yip became blind around 10 years ago after developing glaucoma. She used to rely on a white cane to help her get around. However, the cane is only useful as a mobility tool up to a maximum height or distance of 2 ft below waist level. Whenever she went out, Yip had to be extremely cautious, or else she would end up bumping into passers-by or other obstacles.

The elderly people living in her building used to shout at her to warn her against accidentally hitting them with the cane. But around six months ago Rally came and brightened her life.

A young guide dog learns to use an escalator in Hong Kong

It took 26 days for Yip to master communication with Rally. Handlers communicate with their dogs through a variety of signals using voice, body gestures, and collar gestures. Now, with Rally’s assistance, Yip can walk much faster and further than before. “I’ve become happier, as all my neighbours like Rally a lot. After these six months, Rally gives me the confidence to get around,” Yip grins.

Yip finds she is now welcomed by strangers as people are often curious about Rally. She attracts attention and her presence starts conversations.

The history of guide dogs in Hong Kong can be traced back to 1975 when a German Hong Kong resident sponsored two guide dogs which received training in Australia to the territory. Unfortunately, due to a lack of local support and experience in handling guide dogs, one eventually died of disease and the other was killed in a car accident.

The guide dog service in Hong Kong was subsequently suspended as Hong Kong was not ready to produce guide dogs locally. Puppies chosen to be trained as guide dogs must have descended from at least seven generations of selectively bred guide dogs.

Guide dogs made a return to Hong Kong two years ago after two guide dogs were imported from Taiwan. At present, there are six guide dogs serving in Hong Kong and another six are receiving training provided by two local guide dogs organisations, the Hong Kong Guide Dog Association (HKGDA) and Hong Kong Seeing Eye Dog Service (HKSEDS).

Covering the Community

December 6, 2013

A sense of community returns with the revival of local newspapers

By James Fung

Inside a public housing estate in Shek Kip Mei, several volunteers are distributing a thick pile of district newspapers to passing residents. The single sheet of paper contains articles covering social issues and district matters and is the latest incarnation of Voice of Tai Hang Tung, one of Hong Kong’s earliest community newspapers.

The early 1970s saw a boom in Hong Kong community newspapers with a total of 15 published across the territory. The original Voice of Tai Hang Tung was launched in February 1973 by the resident committees of Tai Hang Tung Estate and Nam Shan Estate, the precursors of the current Sham Shui Po Community Association.

The current version of Voice of Tai Hang Tung is a bi-monthly free newspaper which has been published since the end of 2010 with funding from the community association. Lau Cheuk-kei, one of the publishers, explains that the original paper emerged as a direct result of the Tai Hang Tung Estate’s history. The estate began as a resettlement area, built by the government to house more than 50,000 people made homeless by the Shek Kip Mei squatter area fire two years earlier. It was redeveloped in the 1970s and the newspaper was started as a means of delivering vital information to the large population there. “At that time, when the internet, WhatsApp and Facebook did not exist, the circulation of messages relied on either verbal communication or text written in black-and-white,” says Lau.

The first few issues of the newspaper addressed problems of overcrowding, poor hygiene and lack of security in the Tai Hang Tung community. Before the establishment of the district councils, the resident committees used the Voice of Tai Hang Tung to bring people together to bargain with the Housing Authority and the government on district affairs.

When the plans to redevelop Tai Hang Tung were discussed in the 1970s, the schedule for the works and proposals for resettling residents were announced through the district paper. This shows how important local papers were for disseminating information.

By the end of the 1980s, the Voice of Tai Hang Tung and many other district papers had ceased to operate. Lau attributes this to the improvement of Hong Kong’s overall living conditions – the function of community papers became less important.

A Playwright for Our Time

December 6, 2013

Candace Chong Mui-ngam captures the social and political issues facing Hong Kong for the stage

By Sharon Lee

As the applause finally subsides in Kwai Ching’s Black Box Theatre, a dozen audience members soon surround a casually dressed woman in her thirties. She graciously accepts the compliments and answers the questions with smiles, standing next to a banner that reads, “Freedom is like wind, nothing can block it”. The banner is a prop in this student production of Candace Chong Mui-ngam’s acclaimed 2012 play, The Wild Boar, a work about media censorship.

Chong, 36, is one of the city’s most promising playwrights and a four time winner of the Best Script of the Hong Kong Drama Awards. Her winning scripts, Alive in the Mortuary (2003), Shall We Go to Mars? (2005), The French Kiss (2006), Murder in San José (2010), have been staged over and over again.

Chong is surrounded by members of the audience after a performance of the Wild Boar

When extra performances for The Professor, her new play to mark the 50th anniversary of the Chinese University of Hong Kong, were announced, tickets for staff and the general public sold out within a day.

Ticket sales for Chong’s plays are no indication of their themes. Unlike some other popular dramas, her work addresses serious issues that might be expected to bore mass audiences.

For instance, The French Kiss (2006), examines religion, the law and moral judgement. The whole play takes place in just one setting and is basically a conversation between two people. However, it won the Best Script prize at the Hong Kong Drama Awards, has had three re-runs, and even been translated for performance in a Korean theatre.

While most of her previous works focus more on individuals struggling with human nature, her 2012 play The Wild Boar looks at society from a more macroscopic level by taking on the subject of media censorship.

In 2010, Chong read a newspaper report about a small drama troupe that had received threatening phone calls about a drama they were going to stage on the June 4 crackdown. Chong was extremely troubled that the reach of censorship could extend to theatre, as she believed drama was of limited influence in Hong Kong.

Nevertheless, she was glad that media censorship was not so prevalent that she was unable to read the news of the incident. The sense that something important was being threatened and the need to protect it drove her to write The Wild Boar.

Galaman and the Armpit Revolution

December 6, 2013

Animator Johnee Lau Kwun-yiu finds human spirit in the ugly, unloved and discarded.

By Louie Cheng

He is the most unlikely of superheroes – a man with a sprout growing out of his armpit that turns into a caped crusader when he lifts his arm. But then, his creator is an unlikely cartoon talent.

Galaman, the name is a play on the Cantonese word for armpit, stormed into public consciousness during the 17th Incubator for Film and Visual Media (ifva) Festival last year. Galaman’s brave deeds and outstanding looks earned his creator, 25-year-old Johnee Lau Kwun-yiu a Silver Award in the ifva Animation Category.

In a city where people like their cartoons cutesy, Lau’s drawings are unconventional. Galaman is a crude outline of a human figure although his transformation into the muscular square-jawed superhero is preceded with that most classic of superhero gestures, the lifting of an arm.

Normal things in real life can be monsters in the Galaman series, including a pork chop and nose.

The Galaman episodes are characterised by outlandish, even absurd storylines, with heavy doses of toilet humour and wordplay-laden conversations; the cosmetics brand Max Factor, for instance, is sent up as “Gas Factor”, and one episode features a sex-changing robot called “Transgender”(變性金剛), a parody of the “Transformers” (變形金剛).

All these ideas originate from the talkative young animator who is keen to share even his unused jokes and one-liners. Thin, with long limbs and a pale complexion, Lau has as much an air of a 19th-century writer as he does of a 21st-century animator. “Actually, I planned to study Chinese language [at university] and be a writer or reporter,” he says.

As a secondary school student, Lau was into Chinese literature rather than art and so he studied the subject at A-level. He was expected to do well in the exam, but a piece of writing he submitted for his assessment probably changed the course of his life.

The essay, titled “Mourning a Pimple”, told the story of an acne pimple growing on the nose of a sleeping youth. In the story, the pimple is a martyr, doomed to die only to be replaced by another pimple – the reason for its existence to remind people they must wash. The tale would seem to be an allegory on futile sacrifice but the examiners were not impressed. Lau got a D for the subject, which crushed his confidence in his writing abilities and killed his dreams of being a writer.

“I had been studying for so many years, still, the exam result wasn’t good. And all the things I had learnt might not even be useful for work,” he stops and sighs. “I felt I had wasted my time.”

But Lau did not remain depressed for long. Soon he realised he actually liked creation, so he chose the two-year Higher Diploma in Multimedia Design and Technology at the Hong Kong Polytechnic University. His aim was to “start something fresh or regain my confidence in creation,” he says.

Although he was now interested in drawing and determined to learn animation, Lau did not manage to register on any relevant course. But this only drove him to teach himself. He managed to produce animated videos for his final year project for the Higher Diploma. “I bought reference books to learn how to use Flash on my own,” he recalls.