Hong Kong (HKU) Medical Elective

• Hong Kong used to be British, then was handed back over to China in 1997, so it’s quite ‘Westernised’.   
• The Chinese language is compromised of the following dialects, in the order of most spoken: Mandarin, Cantonese, and Hakka.  ‘Mainland China’ = Mandarin.  HK’s main dialect is Cantonese, however most people are educated to speak a bit of Mandarin and English.
• Geographically, HK has 3 territories. From the most North: “The New Territories”, “Kowloon”, and “Hong Kong Islands”. 
• There are only 2 medical schools in HK: Chinese University of Hong Kong CUHK (Kowloon) and Hong Kong University HKU (Islands).  Taught in English.  5 year course.  Similar to UK.
• Colleagues speak together in a mix of English and Cantonese.  Chinese is mostly spoken with the patients.  Sometimes, there’ll be English-speaking patients or expats. 

Application process:
I approached CUHK as an ‘SSC student’, but CUHK doesn’t accept 'SSC students', only 'elective' applications.  So I advise future students to just approach CUHK as an 'elective' application.  HKU accepted the fact that I described it as an SSC.  They have something equivalent in their MBBS course called SSM (Module instead of Component). 

I had to apply 6 months in advance (now it’s changed to 12 months apparently).  The earlier you apply the better.  It is competitive as I heard of rejections, but I think some time periods might be less competitive than others.  After giving me an offer, HKU gave me a document about the blackout periods in departments in HKU due to exams.  My first choice was actually Paediatrics but there was a blackout period then.  A few other specialties had blackout periods in March-April.

HKU Medical School

Standard medical school application procedures.  No placement or admin fee.  They do have hospital accommodation but had no vacancies for my period, but I stayed at my grandparents in Kowloon and did a daily 50 minutes commute by public transport.  HKU got back to me in about 2 months time (December) – offered Cardiology, Queen Mary Hospital (biggest hospital in HK).  Bought flight tickets (~£480).  HKU required me to send in 3 insurance policies within 2 weeks before I could be officially accepted: Indemnity (MPS/MDU); Life, Death, Disability, Critical Illness (Insure-Me-Online); and Medical (a HK insurance company $192=£18 for a year).  This was during revision/exams, and knowing little about the different/cheapest insurances, it took me a while to try and find cheap ones that was sufficient cover, so do a quick search in advance!

Placement Life There

I kept a diary and video diary of what I did and patient cases, which I’m glad of – as literally reading/watching back over the stuff, I wouldn’t have been able to recall it!

You wear a white lab coat on the wards.  They wear the same white coats to the canteen.  The white coats differentiates you as a doctor/medical student.  Bare-below-the-elbows do NOT apply.  You wear a mask in any clinical area, ward round and taking a history/examination.  (You often see in the streets of HK people wearing masks anyway!  Very common.  Ever since SARS.) 

From the bus stop

You arrive on your first day …and the hospital is overwhelmingly MASSIVE and TALL.  Once you gulp that down, you report at 9am at the Professorial Building (admin) and the lady you’ve been emailing gives you the 4^th year (in UK terms, however they are considered 'Final Year' as it's of '1.5' years duration) medical students’ timetable who are doing their Specialty Clerkship, so you can go join any clinical teaching or lectures with them.  You watch an Infection Control teaching video, do some paperwork, then go meet your supervisor.  At 11am that day there happened to be a small group-based medical student Case Discussion which I went to and met 7 other medical students, who I afterwards had lunch with at the overwhelming hospital café, which was a Café de Coral (大家樂 Daai Ga Lok) - a fast food restaurant…Chinese style!  

Then in the afternoon I went to an AIM clinic with the medical students, which is like a primary care (GP)-like clinic within the hospital.  Literally, in a medium-sized consultation room (like a mini-classroom), us 7/8 medical students would sit there in chairs with those mini-tables, we’re briefed on the patients case, the patient comes in, we watch the consultation (sometimes one of us took the history), and then let the doctor examine the patient (or again, one of us examined and presented the findings), then after the patient leaves, the doctor does another briefing.  Total of 3-4 patients in one session… all in front of 7/8 medical students… as opposed to 1-2 medical students in UK!  I attended several teaching OPD clinics of the same teaching format, so I came across a lot of different specialties, and it was really good teaching I have to say!  I also attended some lectures (Haem, Neuro, even Evidence Based Medicine, Pharmacology, Resp) to complement the teaching clinics, refresh my memory, and to prevent me from getting ‘bored’ of just doing Cardiology.  You can pretty much join any medical students from whatever year!  I met some 3^rd years and attended lectures/clinical teachings with them too.  Even went to a 2^nd year’s microbiology labs session.  I was just curious how it all compared to UK’s medical school syllabus…and the answer was just pretty much the alike!!  And the medical students that I met were simply genuinely very nice and hardworking people.

A few Cantonese vocab I picked up along the way:

"Chung ying": Double vision
"Deem mm deem ar~?": Is it sharp? (testing sensation)
"Mei sac": Close tightly (your eyes).
"Dou lic": Resist (power of peripheral limbs)
"Siu bo" : small steps (describing Parkinson’s gait)
"Gei yuk": muscles

I pretty much started speaking/self-teaching Cantonese when I was 17 and can converse basic day-to-day stuff. So I always had a Cantonese phrasebook with me, as well as my Oxford Handbook.  And I found a really useful leaflet off Google with English pronunciations of how to take a history and instruct on clinical examinations in Mandarin and Cantonese (click for the pdf). But cutting to the chase, as long as you know English it’s fine!   Consultants and doctors and medical students spoke to me in English, despite trying to speak Cantonese as much as possible anyway.

The hospital library lets you access Facebook.

Cardiology

The Cardiology department is highly reputable in HK.  Even 'important people' would be treated in this public hospital.  I saw reporters and cameras outside the ward doors and downstairs at the building entrance like 3-4 times that I had to use the back entrance.  The team was very hard-working.  The consultants/professors (and my supervisor) were all very nice, and valued good-quality care and would quietly pull aside juniors for ‘a word’ if necessary.

So, 26-bed ward.  I pretty much came across everything expected of Cardiology.  On the wards: WPW, Brugada Syndrome (age 17), femoral dissecting flaps, heart blocks, PE, cardiomyopathy, pulmonary hypertension, congenital defects, MIs (obviously), Sinus Sick Syndrome, etc.  In the Catheterisation Labs: Percutaneous Coronary Interventions, pacemaker replacements, ablation of accessory pathways, etc.  Saw lots of ECGs.  Went to arrhythmia and pacemaker clinics.  As my ‘assessment’, I did a case report and literature review on the safety of dual antiplatelet therapy and management of patients with thrombocytopenia and acute coronary syndrome requiring percutaneous coronary intervention… 4000 words and 70 references (probably won't sound exciting to you).  My supervisor also asked me to do a presentation on top.  I asked him to clarify whether he wanted it ‘formal’ or ‘informal’.  He said the latter, so I thought it would be just a handful of people… but it turned out to be like 25-30 people, so thank goodness I prepared a formal Powerpoint and all that jazz!

Since I hadn’t had my Cardiology rotation yet, nevermind much teaching, I initially felt a bit in the deep end, having to read up so much and get my head around ECGs.  But it was interesting, especially Interventional Cardiology.  It is certainly a challenging, difficult, responsible, yet rewarding specialty.  In addition, I had to pay extra hard attention to listen to what the doctors/patients were saying, translate it in my head, keep up and remember the new medical Canto vocab.  So every day I was drained and had tension headaches, but the scenery FROM the hospital and journey back was stunning.  I sat outside with a ice lolly one day after placement in front of the sunset.  And I always stopped off at CAKE shops after placement, visit one set of grandparents with cake, then returning to my other set of grandparents for dinner.  So I was tired, yet happy.

Cultural differences
I don’t think my supervisor has had an elective student with him before and the whole team didn’t quite know what to do with me…as an international student too.  I’m one of those who quite like to build a rapport with the HOs/Registrars and not have a hierarchical relationship.  I like to be able to banter in other words.  But you’ll find that that is not so easy in HK.  Cultural reasons I guess, or maybe 6 weeks was a ‘short-lived’ period, as it was only by the end of the placement did I finally feel ‘settled in/accepted’.  I’ve always been told the medical students and doctors in HK “don’t have a Life”, and is always working and very stressed… which I’ve found to be very true.  The doctors were always ‘serious’ and ‘intense’ on the wards, yes understandably busy, but the hierarchy was very defined.

Patient-doctor relationship is also different.  There’s the rise of the patient’s authority and decrease in ‘respect’ for doctors in UK, whereas in HK, doctors are always authoritative and well-respected.  Patients often waited for more than 1 hour for their clinics…maybe 3!  In UK, patients would either make a formal complaint or leave by that point!  Not to forget HK has a highly dense population, so hospitals are always buzzing.

Student life is completely different.  They have a ‘Student’s Union’ but it is no social hub…more like an admin building.  Alcoholic social events… are pretty much almost non-existent.  I do believe there is a minority of medical students somewhere out there who do enjoy nightouts/drinking but that would be done at their own discretion and in places like Mong Kok, Wan Chai or Central, and would more likely be the Westernised-Chinese/Internationals/Expats.  Alcoholic clubbing activities are not ‘popular’ with (medical) students.  Most don’t drink, some might do a casual beer once in a while, and a very minute minority will ‘get smashed’.  If you told them you casually go clubbing a few times a week, it might just shock them.  The 'locals' prefer Karaoke bars or eating out as a form of socialising.  Most of the students live at home too.  HK isn’t that big and the majority of the medical students are HK locals.  They can live in Halls of Residences next to the hospital, but do so only for short periods if they have to do lates/nights or live on the outskirts of HK.  So basically the HK students don’t get the same experiences we get from living with each other and socialising.  Sports don’t seem to be a big thing either.  Occasional badminton, table-tennis and football (amongst boys), maybe yes.  But other sports/societies… no. 

So basically, if you’re ‘westernised’, be understanding of the culture differences.  It's where East-Meets-West.  Being respectful, well-mannered and PUNCTUAL are very important.  Also modest… and modestly dressed.

Why did I choose HK? (A bit mushy so welcome to skip. I’ve tried to make it short.)

My university allows students to do 2 electives and I always had Canada and Australia idealised.  My best friend was going to Los Angeles and offered me to come with – she had an amazing time.  HK hadn’t crossed my mind but I kind of did a spontaneous turn at this point of time: what was more important – family/grandparents or excitement?  Since having little ‘family’ exposure in my upbringing, family pretty much has become of greatest importance in my life.  Life clock ticks on, right?  When else would I be able to stay this long in HK and get to know my roots and family...and finally grasp onto Cantonese? And I love my grandparents. I asked them to tell me their Life stories (often repeated, yet still enjoyed them) and found out how alike I am to them in terms of personality, skills and principles.  They’re so super cool that I would do my best all-roundedly to do them proud.  I had and still have no intention to study/work in HK.  It was simply ‘family’/personal reasons.

Reflection

On reflection of the whole placement, I definitely learned and gained a lot clinically.  I gained an insight and understanding of the culture and lifestyle of medical professionals and the healthcare system in HK.  I got to know my family and my roots.  So objectives achieved on all levels: academic/clinical, cultural, social, and personal.  Win.

Now just general touristy tips/info about HK

VISA

• If you’ve a British Passport you can enter HK and Macau for free. 
• However you need to pay for a Visa if you go to Mainland China (anywhere else).

General

• It’s very polluted in HK…especially the busier bits (Mong Kok & Central).  You may want to take a packet of tissues to just cover your nose/mouth now and then!
• Market places, Mong Kok and Central can be bustling with people.  Common-sense: hold onto your purse/wallets in packed places.  
• People walk quickly in general in HK. 
• People carry and use umbrellas when it's NOT raining to protect themselves from tanning the in sun.  They like to have pale skin.  But it does help keep you cool.  Very useful if you go to places like Disneyland, Ocean Park, the Peaks in the HOT summer.
• Take/buy bottled water.  They don't drink tap water.  People living there FILTER, then BOIL, then let COOL their water before drinking it.

Weather

• March/April was like UK’s spring/summer – just perfect, a few light showers now and then, but mostly soft sun and light breezes.  I had to wear a cardigan sometimes … and few times wore a coat for the super early morns/late night commute. 
• Hot and humid in summer, no doubt about that – shorts, T-shirts… you want to stay in air-conditioned places. 
• December is like UK’s spring… definitely need a cardigan.

Public transport

Straight-forward and cheap.  Get an Octopus Card (you can use them in convenience shops as well).  The train (MTR) straight-forward and quick.  Trains stop at 11.30/11.45pm…ie. before midnight.

For bus routes, if traveling on Kowloon side : http://www.kmb.hk/en/  . 

If on Island, http://www.nwstbus.com.hk/home/default.aspx. 

There are night buses (12am-) that don’t run that frequently but are a cheap method of crossing the harbour instead of taking a taxi. 

If crossing the harbour bus 970 and 970X (stops at QMH) are quicker than other buses, and actually quicker and cheaper than MTR. 

Tram is HK$2 (15-20p), but not air-conditioned.  Sit on the upper deck so you won’t inhale much pollution!  Fairly slow, but cheapest option for short journeys.  Kind of have to try it once though for the experience!

Taxis: $18 for the first 2km.  Then $1.5 for every km afterwards.  Fast. Convenient. Door-to-door.  Wave your hands on the street if you want to hail a taxi.  Lots of them on the road.  They generally don’t scam you…but you never know if you strike unlucky if they take you a longer route.  Generally it’s safe for a lone female to get the taxi at night.  Just call someone when you get in the taxi that you’re coming home, and note down the registration plate if you want. Taxi drivers know basic English in general.  They certainly understand 'home' and 'see you soon'.

Minibus: quite fast, quite cheap.  You need to shout/call out if you want to get off at the next stop.  So unless you’re familiar of where you’re getting off, these minibuses can be convenient to travel.  If not, avoid.  Minibus stops in general 11.30pm.

Shops

I like cheap stuff.  I’d recommend: Mong Kok (for girls, Argyle Centre, D2 MTR exit); Tsim Tsa Tsui and Causeway Bay.  Central is the posh bit and brand names.   Mong Kok is simply cheap and has the markets.  Tip: have a look around an area before you buy anything.  They often sell the same thing but at different prices.  Patience is a virtue.

There are $2 (20p) shops, and also JUSCO $10 shops…like UK’s Poundland.  

Entertainment 

Arcades are cheap and common.  Time Crisis 2/3/4 always a classic.  Have to be 16 years old to enter.

Ice skating - at 'Sha Tin', 'Tai Koo', 'Kowloon Tong' (Next to MTR stations).

Cinemas - slightly more pricier than UK.

Recommended Sights:

• Disneyland.
• Ocean Park most definitely.  Animals, rollercoasters, etc.
• Victoria Peak most definitely.  Take the Peak Tram up. Madame Tussaud’s is also up there.
• Tsim Tsa Tsui (TST) Harbour.  At 8pm there’s a flashing light display.  Walking along TST harbour at night is considered a ‘romantic’ stroll.  This is also where you get to see stone hand-prints of celebrities on the ground like Jackie Chan and Jet Li.
• Big Buddha (Ngong Ping).  Take the cable car up.
•  Lamma Island and Cheung Chau Island for seafood and beaches.  
• Just wander around Central and TST.  Check out the architectural sky scrapers and brand-name shops.  
• Macau. Take the ferry across. Famous for its Casinos and Portuguese egg tarts.
   

Nightouts

Lan Kwai Fong in Central (http://www.hiphongkong.com/drink/bars/nightclubs/dance) : probably the closest thing to the ‘clubs’ in UK.  It’s where expats and International High Schoolers and ‘Westernised-Chinese’ go usually.  There’s no ‘massive 4-floored clubs’ in HK, they’re all small-medium sized. Wednesdays and Thursdays tend to be Ladies’ Nights, so free or discounted entry/drinks.  Guys on the other hand... pay full price for drinks, and some places are ‘Open Bars’ costing $200 (£18-20) for the whole night.  Clubs and Bars change quite often.  There was a bar back in 2010 called Sliver – Wednesday Ladies’ Night: FREE Cocktails, and I had my favourite oh-so-yum (but oh-so-strong…beware!) Lychee Martinis.  Don’t know if it’s still there, but look out on the internet for Ladies’ Night or drink offers.  There's a bar called Balalaika which you have to go to - a Russian Ice Bar, where you can stop melting in the hot weather and put on a fur coat.

Wan Chai and Mong Kok also have bars popular for drinking.

Most Chinese people prefer Karaoke and Drinking Games (dice games, 'game of 5s') over ‘clubbing’.

Food

• Amazing food…EVERYWHERE!  Local Chinese places that look a bit shabby (stools, circular tables) can offer sometimes the most amazing bowls or plates of noodles/rice and are super cheap.
• Cakes: in SOHO (eg Causeway Bay) they sell expensive-ish but beautiful cakes.  For mid-range nice cakes: Maxim’s,  Arome, St Honor’s and A1.  I’d recommend local family-business bakeries for fresh egg tarts and Chinese buns, best in the morning/lunch.
• Dessert places and Bubble teas are very popular.  You can get Mango, Coconut, Aloe Vera, Watermelon, etc drinks with tapioca (small glutinous balls) or aloe vera/grass jelly.  There are lots of fruit/jelly desserts, and  traditional Chinese sweet dessert soups “Tong sui”.  They’re everywhere…and cheap and YUM!  Be adventurous.
• Try the Pizza Hut, KFC and McDonald's there.  It's slightly different to UK and yum!
• There are also Starbucks and Krispy Kremes.
• Go to food shops and check out all the Japanese and Korean candy/chocolate/delicacies there.
• There are vegetarian restaurants, where they use tofu and beancurd imitating meat! It was amazing!
• Hotels do really good value buffets of EVERYTHING!  Give it a google. 
• There's a restaurant in Wong Bo (Whampoa) has the most amazing Dam Dam Meen (Sichuan Spicy Noodles).  My absolute favourite!
• I have a ridiculous amount of food pictures from HK...

1st row: Bakery shops: Maxims, Arome, St Honor's
(Toffee, Blueberry, Mango, Chocolate, Japanese Cheesecake, Green tea and Lychee, Oreo, Chestnut, etc.)
2nd: Hotel buffets.
3rd: Chinese-y style and dessert places.
4th: Bought from food/convenience shops
(Japanese fresh cream mochi, sesame ice cream, red bean ice lolly, ice cream mochis)

Beaches

There’s lots.  Yellow sand.  Some waters are murky, but Stanley beach is probably the most popular.  You can rent umbrellas and floats.



 




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