As Hong Kong’s population ages, medical services on outlying islands struggle to keep pace

HONG KONG: Hilly Cheung Chau, one of Hong Kong’s outlying islands, makes for a scenic getaway from a bustling urban life.

But for its residents, life can be less than ideal as they grow older.

The elderly make up at least 40 per cent of the 20,000 residents on the island. With their homes built on slopes, journeys to and fro can be quite a trek.

Constrained by narrow and steep lanes, residents have to either walk or cycle to get around.

"Even if they’re 80 or 90 years old, they still must walk home. Some journeys take minutes, while others, due to the island's topography, can span over an hour,” said the island’s district councillor Kwok Wai Man.

One resident, who wanted to be known by her surname Au, said: “My knee has degenerated as I get older. I used to hike a lot, but now it hurts more as I walk. The doctor said the bones are wearing down, so I can only walk on flat ground.

Another resident, who also wanted to be known by her surname Kwok, said she has to climb more than 140 steps on the way home from the village centre. While she enjoys the exercise, a fall down the steps has left her scarred.

“It was very scary. I was very afraid of not being able to go home. Then I slowly crawled home and applied medicinal ointment,” she said. Overall, there are more than 195,000 people living on outlying islands in Hong Kong.

As of 2023, over 15 per cent were above the age of 65, up from 14 per cent in the previous year. Their numbers are set to rise.

In the next 25 years, more than one in three Hong Kong residents will be above the age of 65.

MEDICAL SERVICES FOR RESIDENTS

Gaps in medical services on Cheung Chau mean that help from outside the island is needed.

St John’s Hospital on the island, which is a 40-minute ferry ride from the city centre, provides emergency services. Residents with mobility issues can also tap on medication delivery and telehealth services.

But for more complex cases, the Government Flying Service (GFS), which handles search and rescue operations and medical emergencies, steps in.

Air crewman Savio Chan said that the service handled 3,900 cases in 2023, of which 1,850 involved casualty evacuation from outlying islands.

When a call comes in, his team first assesses if patients are in imminent danger - whether they are having a heart attack or stroke, for instance.

“If there's no immediate life-threatening condition, we will land on a helipad and do ground transfer. But if patients need immediate care, we will land on the rooftop of one of the urban hospitals in Hong Kong,” he said.

To improve the process of patient transfers, GFS conducts joint trainings with local clinics, where they teach staff how to handle the incubator on board. Where needed, GFS will send an auxiliary member to stabilise the patient on site before the transfer.

With the demand for geriatric services on the rise, GFS also focuses on geriatric care during its in-house training.

“They have different pathophysiology from younger adults. So, we focus on how to handle older people in our lessons. Our aircraft are equipped with the necessary equipment. So we can handle different emergency situations,” Mr Chan added.

Aside from the air crewmen, who are medically trained, the GFS also has 67 healthcare volunteers on its roster. These volunteers, also known as auxiliary members, are only available on weekends.

Among them is Dr Jerome So, who’s been with GFS for six years.

"More than two-thirds of our workload is (made up of) medical transfer for our patients who are over 60 years old,” he said, adding that common cases involve heart issues and falls.

He added that air medical officers like him can provide intervention like intubating a patient, and inserting chest drains and intravenous lines - services typically provided in a hospital setting.

For critical cases, the crew has a time limit of 20 minutes. For less serious cases, they can take up to two hours to complete their mission.

Sometimes the crew may need to make a snap decision whether to pack controlled drugs that may be temperature sensitive.

Dr So highlighted one recent case of an 89-year-old woman with a history of heart disease and kidney failure who had chest discomfort and low blood pressure and needed to be transferred by GFS. 

However, she quickly deteriorated after being loaded onto the aircraft.

"She was in distress and got very sweaty. We gave her oxygen throughout the flight, and medication after her blood pressure crashed. Thankfully, we got her to hospital in time, and she was placed on ventilator support immediately," he said. 

Cases like hers reflect the significance of timely intervention.

TAKING CARE OF THE ELDERLY

Over at Peng Chau, another outlying island about 40 minutes away from the city by ferry, residents similarly struggle with a lack of medical services.

Of its roughly 6,000 residents, about 1,000 are elderly.

Instead of a hospital, residents have four medical clinics, including one outpatient clinic which offers 24-hour first aid services.

Mr Jordan Yeng, who co-founded daycare centre Silvermorph Charity, said he did so because there was a service gap.

“The helicopter can help in very acute emergency situations. But in my view, there should be more resources related to providing those long-term care, such as daycare centres, such as elderly homes, or broadening those home base services, because those are kind of the day-to-day needs,” he said.

The same healthcare labour shortage that plagues the city also affects his centre.

Despite providing a wide range of services including bathing and meal assistance, nursing care and rehabilitation, the centre only has three full-time staff. To make up for the lack of staff, Mr Yeng gets islanders or their relatives to help on a freelance basis.

Aside from Silvermorph Charity, residents can also tap on Happy Ageing in Peng Chau, a programme that recruits volunteers to help seniors with daily tasks. 

“We organise different kinds of activities, including chair dancing, stretching, calligraphy and tea appreciation,” said project manager Derek Tam. 

“These activities are great for their physical and mental health - not just exercising, but also building a social circle for them.” 

Though most of the activities take place at a community centre, volunteers conduct home visits, where they sometimes help with light repair work. Like Silvermorph Charity, the programme also does home modifications for the elderly. 

“We help to repair or improve the hardware at the elderly’s home, like fixing faulty light bulbs, to water leakage from the windows. Our volunteers also help install handrails in bathrooms for those in need," Mr Tam said.

"These may seem like minor repairs or adjustments, but they make a significant improvement in the lives of the elderly."

SHIFT TO PRIMARY HEALTHCARE

Such community-based support forms an integral part of Hong Kong’s shift to primary healthcare.

Hong Kong introduced a blueprint in 2022, to standardise primary healthcare services throughout the territory, and to ease the burden on hospitals.

Primary health care focuses on prevention and early detection and diagnosis, especially for chronic diseases like hypertension and diabetes, said Hong Kong Secretary for Health Professor Lo Chung-mau.

“If you can detect and diagnose these two conditions early, you will be able to avoid complications, rather than waiting until complications happen, and you will have to go to all the specialists and even tertiary care,” he said.

“In that sense, that will help us in the long run, not just to improve our people’s health, save lives, but also to save money in our overall public healthcare expenditure.”

Improving primary care includes the setting up a District Health Centre in every district, where residents can access a range of services, like traditional Chinese medicine, chronic disease health screenings and physiotherapy.

Hong Kong believes that the reform could save about 28 per cent on healthcare expenses and prevent 47,000 deaths. Over 80 per cent of Hong Kong’s public healthcare expenditure went to specialist treatments in 2022 while less than 20 per cent was used for primary healthcare.

Industry players told CNA that it is common for clinics to refer stable or minor cases to specialists. n fact, the Hospital Authority found that up to 65 per cent of total cases at emergency departments in the past decade, were stable and non-life threatening.

“People in Hong Kong still have the mentality that when we get sick, we go to see the doctor in the emergency room," said Dr Eric Lai, a research assistant professor at the Institute of Health Equity in the Chinese University of Hong Kong.

"That creates a problem because they don't see the doctors in the primary care setting, and that leads to an immense burden for hospitals."

Even as Hong Kong shifts towards primary healthcare, hiring enough healthcare workers has emerged as a problem.

There were over 16,400 doctors in Hong Kong as of March, translating to only two doctors serving every 1,000 patients – a ratio far lower than other advanced economies.

To overcome the shortage, Hong Kong is racing to catch up, especially as the city’s ageing population steadily climbs.