The day after the Legislative Council released its Sars report, I sat in a KCR carriage watching a woman opposite me diligently clean out both nostrils with her index finger. With all the fastidiousness of a pedigree show cat, she examined the contents then flicked them, piece by piece, on to the floor of the train. Three reports and two resignations later, have we learned nothing about hygiene and infection control? With bird flu knocking on our door again, are we going to go through the same nightmare, only with different faces to point fingers at later? To date, much of the focus has been on revenge. But forcing resignations and removing staff does not help us prepare for the next and - many experts predict - worse epidemic. Some suggestions made in the expert committee report into Sars have already been put in place. Most important is the setting up of the Centre for Health Protection, which departing health minister Yeoh Eng-kiong rightly cites as his most important recent contribution. But, something very similar was proposed and implemented 100 years ago. This was the Institute of Bacteriology, set up after the plague swept through Hong Kong and rapidly got out of control. People escaped quarantine, took to boats, and officials competed, squabbled or failed to take effective action. And where is that institute now? It is a museum. While you can change structures, remove personnel, set up new institutes, construct flashy buildings, what the fate of the institute demonstrates is that unless you change culture, and the way people think and act, nothing will be different. And it is here that the Legco report is a most valuable tool for moving forward. Its pages are full of blow by blow descriptions of how people who encountered problems assessed them and dealt with them. Certain things stand out. Arrogance is one, exemplified by Chief Executive Tung Chee-hwa refusing to appear publicly before the inquiry. If the boss says he does not legally have to explain what went on, why do his underlings have to? Rigid thinking is another. The chance to contain the epidemic was missed in February last year when Tse Lai-yin, head of the disease prevention and control section of the Department of Health, decided not to check the Metropole Hotel, where the first Sars patient had stayed, because she believed 'residence is not significant in respiratory infection'. Very little was known about this disease when it first emerged. To decide that the transmission pattern was the same as other known infections was rigid to the point of foolishness. Having pointed out Dr Tse's failings, would anyone else have done better? Yes. The report is full of action taken by individuals that did make a difference. Early in January, Yuen Kwok-yung, head of microbiology at the University of Hong Kong, sent two staff to Guangdong to learn about the disease and collect samples for analysis. It is no accident that it was Professor Yuen's department which later identified the infective agent - a new corona virus. Another example worth learning from was that of Kwong Wah Hospital. It came out ahead because it was proactive. Watt Chi-leung, director of the intensive care unit, happened to be walking past the nurses' station when they took a call requesting admission of a mainlander with severe respiratory distress. He did not wait to be officially informed that it might be atypical pneumonia, and immediately told nurses to put him in isolation. The examples go on and on. What it means is that we do have many good people in the system who were unafraid to take quick, effective action. If we can but learn and apply those lessons permanently, we may be proud, not angry, next time. Margaret Cheng is a Hong Kong-based medical writer
