From hellhole to centre of excellence
Hong Kong is today one of the healthiest places on earth and a leader in medical research - but it's been a long, tough road to get there
"Not all the wealth of the East would have lured us thither." This was what friends of British vice-consul Henry Charles Sirr told him in the 1840s, when the scourge known as "Hong Kong fever" was engulfing the territory, its settlers and new colonists.
In 1843, an estimated 24 per cent of the British garrison in Hong Kong and 105 European residents died of the fever.
Sirr, in his book China and the Chinese, published in 1849, called Hong Kong "the most unhealthy spot in China".
If Sirr and his friends had lived to see today, they would likely be both shocked and proud. Hong Kong is now not only one of the healthiest places in the world - judging by its life expectancy and low infant mortality rates - but also a significant contributor to global developments in medical care and research.
"Hong Kong is a world leader in many areas of high-end medical research," says Professor Irene Ng Oi-lin, head of the department of pathology at Hong Kong University's Li Ka Shing Faculty of Medicine.
The "recent and remarkable achievements" that Ng highlights include pioneering research into emerging infectious diseases such as avian influenza (H5N1 in 1997 and this year's H7N9), swine flu and the Sars coronavirus, in terms of pathogenesis, clinical features, diagnostic tests, virus ecology, transmissions and treatment.
Hong Kong has also made notable contributions in the areas of spinal surgery, in-vitro fertilisation, endocrinology and transplantation. The city is also among the leaders in research on, and treatment of, diseases like lupus nephritis, a kidney disorder; leukaemia; liver cancer; nasopharyngeal cancer, which develops in the back of the throat; and hepatitis B. The latter two diseases are of particular significance because of their higher incidence rates in this part of the world.
Research findings of Hong Kong-based scientists on the blood disorder thalassaemia, viral hepatitis and nasopharyngeal cancer were chosen as the city's top medical breakthroughs by Emeritus Professor Rosie Young Tse-tse, honorary clinical professor at the Li Ka Shing Faculty of Medicine's department of medicine.
"Among the many achievements in medicine in Hong Kong, I have chosen three which have the greatest impact on the health of Chinese in this part of the world," she says.
"The research findings and the translation of these findings into clinical practice have enabled us to prevent these diseases from occurring or to treat them successfully. I hope that these horrible diseases will disappear completely in Hong Kong in the foreseeable future."
Looking ahead, the territory is poised to become a biotechnology centre following the launch of the Hong Kong Institute of Biotechnology in June 2010. Researchers there are now reportedly engaged in an unparalleled DNA sequencing project. The institute is the Hong Kong arm of China's leading genomics company the Beijing Genomics Institute (BGI), which has the same research capacity as the top three laboratories in the United States.
Most recently, on July 1, HKU, in collaboration with non-profit organisation Asian Cancer Research Group and BGI, reported new evidence on the genetic basis of a common form of liver cancer, hepatocellular carcinoma, one of the most deadly cancers worldwide. Published in the journal Genome Research, the study surveyed 88 patients in Hong Kong to better understand the molecular basis of the cancer and provide new clues to improving the diagnosis and treatment of liver cancer in the future.
Evidently, Hong Kong's medical research and standards of health care have come a long way since Sirr's days, but ironically this progress perhaps has the past to thank. The city's experience of dealing with infectious diseases have built up a strong body of expertise at its two medical schools - one at HKU, which opened in 1887, and a school at Chinese University that began operating in 1982.
Hong Kong was still on a par with some of the world's poorest economies in terms of its health profile up until 1941.
In 1968, it was instrumental in containing the H3N2 virus, which was termed "Hong Kong flu" by the World Health Organisation in recognition of its discovery at the Government Virus Unit at Queen Mary Hospital.
Following the July outbreak that year, other outbreaks were reported around the world. About 15 per cent of the Hong Kong population were affected, but fortunately the symptoms were mild and the death rate low.
"The early discovery of the Hong Kong flu virus may have been instrumental in preventing a much deadlier pandemic," say the authors of the book Plague, Sars, and the Story of Medicine in Hong Kong.
When the bird flu virus H5N1 emerged as a threat in 1997, HKU microbiologists played a pivotal role in identifying it.
A similar situation was seen when Sars was first detected in Hong Kong in March 2003. The HKU medical team was the first to identify the Sars coronavirus, which was critical in the fight against the pandemic. Similar viruses in civet cats and Chinese horseshoe bats were also discovered, enriching the understanding of the origin of the disease.
This year, with the emergence of the H7N9 avian influenza virus, Hong Kong scientists have again been at the forefront of research. According to HKU, the university is the second-highest cited institution globally for research on avian influenza, and is one of the WHO's eight H5N1 reference laboratories.
A benchmark of Hong Kong's success is the quality of the publications that carry the city's research findings, including top medical and scientific journals such as Science, Nature, the New England Journal of Medicine and The Lancet, among others.
"As a clinician-scientist in Hong Kong," Ng says, "I hope and am confident we will see more medical breakthroughs from our medical community in the near future for patients in need."
A CENTURY OF GETTING BETTER
The Hong Kong College of Medicine for Chinese, founded in 1887, is renamed the Hong Kong College of Medicine. It was established to train Chinese people in Western medicine and to deal with outbreaks of diseases such as cholera, smallpox and typhoid. One of its most illustrious first graduates was Dr Sun Yat-sen. The college became the medical faculty at the University of Hong Kong in 1911.
HKU orthopaedic surgeons gain a worldwide reputation by pioneering the anterior approach for surgical treatment of spinal tuberculosis, a procedure dubbed "the Hong Kong Operation".
Hong Kong surgeons are the first to conduct an adult-to-adult right-lobe, live-donor liver transplant - providing a new option in the face of a severe shortage of deceased donor organs.
The bird flu virus H5N1 was detected in Hong Kong and HKU microbiologists played a crucial role in identifying the virus, thanks to the medical faculty's development of expertise in influenza since the 1960s.
The world's first intervertebral disc transplant is carried out by HKU jointly with the Navy General Hospital in Beijing after 10 years of research. Compared to conventional treatment (removal of the disc and fusion of the spinal segment), this approach opened a new horizon for treatment of many spinal disorders without sacrificing spinal mobility.
HKU discovers the Sars coronavirus - a milestone in the fight against the disease.
Chinese University revolutionises the method of checking foetus health through a non-invasive prenatal diagnostic test. This approach is based on the discovery of circulating foetal nucleic acids in the plasma of pregnant women.
HKU develops an oral preparation of arsenic trioxide - the first patented prescription drug developed entirely in Hong Kong - to treat acute promyelocytic leukaemia. It is poised to become the standard formulation globally. HKU's hepatology team also revolutionised the treatment of chronic hepatitis B by pioneering the first oral antiviral therapy that has been shown to provide potent viral suppression, reversing liver fibrosis and reducing the risk of liver cancer.
Researchers from the University of Science and Technology discover the protein Pax3/7BP, which plays an influential role in skeletal muscle stem cells. This could lead to more effective stem-cell treatments for various muscle diseases, including muscular dystrophy. Another team from the university discover the signalling mechanisms in brain development, identifying a protein called a2-chimaerin as a key regulator of neuronal migration and brain function.