Strengths and weaknesses of traditional Chinese medicine and Western medicine in the eyes of some Hong Kong Chinese

OBJECTIVE: To explore the attitudes of Hong Kong Chinese towards the strengths and weaknesses of traditional Chinese medicine (TCM) and Western medicine. DESIGN: Qualitative study of subjects' opinions using semi-structured focus group interviews. SETTING: Southern district of Hong Kong Island where many of the residents have a fisherman background. PARTICIPANTS: Twenty nine participants took part in eight focus group interviews. MEASUREMENTS AND MAIN RESULTS: Participants' attitudes towards TCM and Western medicine were explored in the interviews. Both TCM and Western medicine are used concurrently by many people in Hong Kong. Patients make decisions on which type of doctors they want to see for the specific illnesses that they are suffering from. They consider both types of medicines to have strengths and weaknesses: TCM being better in curing the root of the problem but quite slow in action while Western medicine is more powerful but sometimes too powerful with significant side effects. CONCLUSIONS: It is important for medical practitioners to be aware of the health attitudes of their patients from different ethnic backgrounds. It will lead to a better patient-doctor relationship and better compliance of treatment.     

The ecology of health care in Hong Kong

To better understand the distribution of resources and health care consumption patterns in different geo-ethnic and socio-economic settings, we sought to describe the patterns of illness, care-seeking behavior and health services utilization in Hong Kong compared to the US and UK. Data were derived from the 2002 Hong Kong Thematic Household Survey covering 31,762 non-institutional and institutional residents, representing 6,504,255 persons after applying population weights. Of 1000 individuals during a 1-month period, 567 reported symptoms, 512 of whom considered seeking health care. Four hundred and forty persons visited western allopathic medical practitioners, with 372 (84.5%) in primary care and 68 (15.5%) in specialty care. There were 54 visits to traditional Chinese medical practitioners and 16 emergency room episodes. Seven individuals were hospitalized in community hospitals and on average one in 1000 were admitted to a tertiary medical center. Ninety out of the 567 who experienced symptoms undertook self-management strategies, which included over-the-counter western allopathic medications (n=54) or traditional Chinese remedies (n=14) or both (n=2), dietary modification (n=1) and rest (n=15). We have mapped the ecology of health care in Hong Kong. Monthly prevalence estimates were remarkably similar to US figures for hospital-based events, whereas there was evidence of apparent, substantial "over-consumption" of ambulatory, community-based care. Our results also indicate that the local community's care-seeking orientation still very much favors western allopathic medicine over traditional Chinese therapy, at least for acute illness episodes.     

Studies on common illnesses and medical care utilization patterns of adolescents in Hong Kong

Purpose: To estimate the prevalences of common illnesses in Hong Kong adolescents, the sociodemographic and selected risk factors associated with these illnesses, and their health care utilization behavior and attitudes.

Methods: A cross-sectional questionnaire survey of 3355 participating secondary school students (response RATE = 98%).

Results: Self-reported 3-month prevalences were obtained for cough/cold/influenza (55.2%), digestive disorders (34.6%), accidental injuries (29.5%), headache/dizziness (23.6%), chronic anxiety/insomnia (20.1%), skin problems (9.5%), asthma (3.8%), liver disease (1.3%), and menstrual pain (13.8% of female students). Self-perceived poor health, smoking, and alcohol consumption were associated with many of these illnesses. Treatment choice depended on the illness suffered (e.g., most students with respiratory problems consulted medical practitioners, whereas most with chronic anxiety/insomnia did not). Many students lacked trust in their doctors, doctor-shopped, relied heavily on self-medication, did not comply with prescribed treatments, would not seek help about medical problems, felt they had insufficient access to health information, and wanted confidential health care.

Conclusions: This study examined for the first time the common illnesses and health care utilization patterns of Hong Kong adolescents. Students with chronic anxiety/insomnia were much less likely to seek care, indicating a need for better education on mental health. Efforts to prevent smoking and alcohol consumption among adolescents need to be strengthened. The students’ attitudes, poor compliance and help-seeking behaviors suggest suboptimal use of the health care system. Our findings are useful for international comparisons by medical practitioners, health care managers, and researchers.     

Existing Roles of Traditional Healers (<Emphasis Type="Italic">mor baan</Emphasis>) in Southern Thailand

Traditional healers ( mor baan ) played an important role in Thai health long before the introduction of Western medicine. Although modern health professional play a key role of health care provider of Thai health care system, traditional healers and their practice still exist in most rural areas of Thailand. In this article, we address the roles and practices of traditional healers in southern Thailand. An ethnographic method was employed. This approach is the hallmark method used to describe the role and the practice of traditional healers and to grasp in-depth understanding of their everyday life. Participation observation and unstructured interview with 18 traditional healers were conducted. Thematic analysis method was used to analyse the data. Most of the traditional healers chose their role because they were influenced by their ancestors, although a few others chose it because of individual interests and a desire to help ill people. All are trained in multiple skills, using supernatural spirits, ceremonies and natural plant products as resources for counteracting various health problems. They refer patients to modern hospitals or other healers if they cannot adequately manage illness themselves. Their service provision is flexible and based on a holistic approach that suits people’s lifestyles and needs. The role of traditional healer tends not to attract the interest of younger generations, although traditional healers have contributed greatly to people’s health. Their presence improves people’s access to healthcare and offers an alternative to modern medicine, which often has a limited role. We conclude that the services of traditional healers should be incorporated into contemporary healthcare provision of Thai health care system.     

Health care in Hong Kong and mainland China: one country, two systems?

Hong Kong and Mainland China are undertaking health reform following recent economic fluctuations and Hong Kong's transformation to a Special Administrative Region of China in 1997. Despite spending only 4.7% of its Gross Domestic Product on health care, one third as much as in the United States, Hong Kong has developed health statistics comparable to those in leading western nations. In contrast, Mainland China's 3.6% of GDP expenditure on health is associated with health statistics and expenditures similar to those found in most developing countries. Hong Kong has adopted health care financing and organizational health systems that are commonly seen in centrally planned economies, while its economy functions as a highly capitalistic enterprise. In contrast, mainland China has integrated many features of health care systems associated with market economies, while its overall economy is largely centrally planned. In this paper we examine the policy factors associated with these disparate health systems and investigate whether they can be maintained according to the 'one country, two systems' approach that has been adopted by Chinese policy makers.     

Age, chronic non-communicable disease and choice of traditional Chinese and western medicine outpatient services in a Chinese population

Background  

In 1997 Hong Kong reunified with China and the development of traditional Chinese medicine (TCM) started with this change in national identity. However, the two latest discussion papers on Hong Kong's healthcare reform have failed to mention the role of TCM in primary healthcare, despite TCM's public popularity and its potential in tackling the chronic non-communicable disease (NCD) challenge in the ageing population. This study aims to describe the interrelationship between age, non-communicable disease (NCD) status, and the choice of TCM and western medicine (WM) services in the Hong Kong population.     

Exchange between Andean and western medicine

Western medicine has not been functionally incorporated into Andean economic, cultural, and social systems. Evaluation studies show that even though accessibility to Western medicine has increased considerably for rural Andeans, they still rely on traditional medicine. Western medicine has not been able to articulate with Andean ethnomedicine because of different structural relations within each system. Western medicine assumes a mechanistic idealogy, chemical-based cures and technology which function efficiently within an urban-industrial framework; whereas Andean medicine assumes a synchronistic idealogy, natural-based cures and personal skills which function efficiently within a mountainous rural area with structural components of verticality, specialization and reciprocity.Verticality implies that Andeans specialize in extracting resources from a limited number of zones and then exchange their resources for those produced by people on other zones. Andean ethnomedicine follows principles of verticality in that certain communities specialize in various aspects of Andean medicines, according to the resources available to that community. These medical practitioners travel to other communities providing their services in exchange for services or goods. The author illustrates this from his research among the Qollahuaya Andeans. The community of Kaata specializes in curing by divination and ritual. These diviners are important for community health of Andeans. The communities of Curva and Chajaya specialize in herbal curing: these herbalists are important for treating physical causes. However, the diviners and herbalists complement each other in providing for the total health of Andeans.The final section deals with concrete suggestions of how certain features of Western medicine can functionally fit Andean economic and social structure.     

Dietary beliefs in health and illness among a Hong Kong community

Dietary adjustment for health promotion and maintenance and for helping the body to expedite its recovery from illness conditions has been part and parcel of the Chinese medical culture. The paper reports on the extent traditional dietary beliefs in health and illness persist in a fast changing Hong Kong community. It explores the community interpretation of the role of diet therapy; and the relationship of social demographic variables with peoples' tendency to give traditional dietary suggestions. Traditional beliefs were found to be quite prevalent. Differentiation in responses was seen for different types of belief concepts. Over 80% of respondents had strong belief in the role of diet expediting recovery during illnesses. Measles and anaemia were used as indicators to look at the types of foods suggested for consumption or avoidance and the rationale behind the suggestions. Explanations of diet therapy for measles were in general traditionally based and that for anaemia were based on a mix of traditional and modern concepts. While there is a tendency for the more Chinese culturally affiliated in this study population to have stronger traditional food beliefs, the relationship of social demographic factors with the tendency to give dietary suggestions for specific diseases are not clear. Diet therapy is a form of self-care and is an inseparable part of the total health care system in the community. The efficacy of traditional food remedies and the role of diet therapy in self-care should be further explored.     

The relevance of traditional medical cultures to modern primary health care

This paper attempts to identify forms of traditional medicine which have the greatest potential for advancing primary health care goals. It begins by differentiating traditional medical systems into types, according to the kinds of medical knowledge which they depend on for preventing, diagnosing, and treating sickness. Emphasis is given to the facts that some traditional systems concentrate on producing varieties of pathophysiological knowledge, while others focus on forms of etiological knowledge; and that some traditional systems accumulate the medical knowledge which they produce, while others diffuse and fragment it. These differences give clues to a medical tradition's abstract potential for achieving three distinct, and only sometimes linked, ends: curing disease, healing illness, and enhancing the productivity of official primary health care programs. To make these clues concrete, it is also necessary to know something about the different ways in which traditional medical beliefs and practices are embedded, together with modern (cosmopolitan) medicine, in actual patterns of resort. The remainder of the paper assesses the relevance, for advancing primary health care goals, of particular classes of traditional healers--e.g. herbalists, midwives, bonesetters--and technologies within different types of medical systems. Four possibilities are described; integration, complementarity, rivalry and intercalation.     

Self-perceived quality of life of Chinese elderly people in Hong Kong

Central to the philosophy of occupational therapy is a commitment to the improvement of clients' quality of life (QOL). There has been a growing interest in the QOL of elderly people in Hong Kong. Social and cultural differences may preclude the application of QOL findings for elderly people in Western countries to their Hong Kong counterparts. This study, which is the preliminary phase of a larger study, explored the QOL of Chinese elderly people in Hong Kong from their own perspective. Focus group interviews were conducted with six Chinese community-residing elderly people who identified the following domains and component elements as being important to their QOL: physical and functional well-being (good health, leisure), psychological well-being (life satisfaction, happiness), social well-being (social interaction, social network/support) and economic well-being (money, housing). Further investigation of factors including self-concept, self-pride, personal autonomy, role fulfilment, and coping ability is required to determine if these are QOL elements for this population. Participants' culturally related philosophical beliefs were found to influence their QOL. Copyright © 1998 Whurr Publishers Ltd.     

A review of 'traditional' aboriginal health beliefs

ABSTRACT: Western health professionals often experience difficulties in service delivery to Aboriginal people because of the disparity between Aboriginal and Western health belief systems. This article reviews the literature which considers 'traditional' Aboriginal health beliefs and medical systems. The traditional Aboriginal model of illness causation emphasises social and spiritual dysfunction as a cause of illness. Supernatural intervention is regarded as the main cause of serious illness. There are gender divisions in Aboriginal society that impact on the delivery of Western healthcare. Management strategies such as preventative care, bush medicine, and the role of traditional healers are discussed. These belief systems are considered with particular reference to their interactions and implications with regard to the Western medical system. This information provides a framework to allow improved understanding by health professionals of the health-related decisions made by Aboriginal people.     

Hip fracture in Hong Kong and Britain

Hip fractures in elderly people are an important public health problem in many Western populations. Little is known of their epidemiology in Oriental populations. A comparative study of hip fracture incidence in Hong Kong and Southampton showed similar incidence rates by age and sex. In the last two decades hip fracture incidence in Hong Kong has increased, particularly among men. This can be partly explained by reduction in the levels of activity among the elderly Chinese population.     

Determinants of job satisfaction in foreign domestic helpers caring for people with dementia in Hong Kong

The job satisfaction of live‐in foreign domestic helpers (FDHs) may influence their caring motivation and the quality of care they provide, which may in turn affect the health status of care recipients. This study identifies the factors affecting job satisfaction of FDHs caring for people with dementia in Hong Kong, focusing especially on the role of FDHs' adaptation status, job self‐efficacy and care recipients' situation. A total of 152 FDHs taking care of people with dementia were recruited from 6 day care centres for elderly people in Hong Kong when they attended with their care recipients. Data were collected from February to August 2011 and the response rate was 95%. Participants completed questionnaires which included measures of care recipients' dementia severity and disruptive behaviours, FDHs' demographic factors, personal adaptation status, caregiving self‐efficacy and job satisfaction. Hierarchical regression analysis was conducted to analyse the data. The results showed that longer stay in Hong Kong, better fluency in Cantonese (local dialect), greater satisfaction in living conditions, higher caregiving self‐efficacy and less disruptive behaviour of care recipients were independently associated with stronger job satisfaction in FDHs looking after people with dementia. On the basis of these findings, we would suggest that employers should consider helpers who have been in Hong Kong for a longer period of time and speak fluent Cantonese, and have previous experience of taking care of people with dementia. In addition, FDHs caring for people with dementia may benefit from carer training which improves their self‐efficacy in dementia care.     

Contract medicine arrangements in Hong Kong: an example of risk-bearing provider networks in an unregulated environment

It is increasingly common in Hong Kong and elsewhere for employers to contract directly with physician networks to provide medical services to employees. These contracts are known in Hong Kong as contract medicine arrangements. In other countries and areas, managed care organizations are generally required by regulation or legislation to ensure that services of adequate quality are provided to patients who are locked in to network providers. There are no such requirements in Hong Kong and concerns have been raised about potential quality and cost trade-offs in contract medicine arrangements. Satisfaction surveys were sent to contract medicine enrollees in one large company in Hong Kong. The response rate was 30% and analysis of non-respondent data shows that respondents were representative of their group. Comparison of satisfaction using logistic regression showed that risk-bearing networks paid by capitation had consistently lower satisfaction ratings across all major dimensions including access, interpersonal care, communication with the doctor, choice of doctor, and outcomes. These findings suggest that quality, at least as perceived by the patient, may be lower in these networks. The issue is of concern in Asia where infrastructures and data systems are not well developed to adequately monitor quality of care or protect patient interests. This study highlights the need to structure pre-paid provider networks and managed care organizations so that quality of care is not compromised. At a time when managed care concepts are being applied throughout Asia, we believe attention needs to be drawn to this problem.     

Survey on death and dying in Hong Kong: attitudes, beliefs, and preferred end-of-life care

Social Workers in end-of-life and palliative care have a particular opportunity to ease the dying process by providing culturally appropriate services to the dying and their families. In today's multicultural social environment, with an ever-increasing immigrant population, social workers are challenged to be knowledgeable about diverse cultures. Recently, a forum of health care professionals and social workers in Hong Kong conducted a survey of the general population to assess death and dying attitudes, beliefs, and preferences for end-of-life care. Four-hundred-thirty Hong Kong Chinese participated in a telephone interview. Responses were compared by gender. The survey results not only contribute to an understanding of Hong Kong Chinese, but can inform social workers who practice with Chinese immigrants to the United States.     

A Brief Introduction to the Chinese Health Care System

The Chinese health care system is changing in response to the rapid changes in Chinese society as a whole, but several constants are helpful in understanding it. Preventive health care receives considerable attention. It is believed to be cost effective as well as health promoting. Medical health care involves Western medicine, traditional Chinese medicine, and combinations of the two. Fee-free patients and fee-paying patients have differing options in the system. Care options also vary between the cities and the countryside. Recuperative health care plays a much more important role in China than it does in the West. Chinese media offer many magazines and broadcast programs attempting to meet the public's interest in better health.     

Economic development and the health care system in Hong Kong

This article describes parallel developments of the Hong Kong economy and its health care system. The purpose is to illustrate how the Hong Kong health system evolved in response to external and internal pressures generated by economic prosperity. The Hong Kong system illustrates the importance of clear policy making in the face of these pressures. In particular, issues of investment, financing and distribution of health services are examined in relation to hospital cost control and service accessibility. In the past, health care costs in Hong Kong have been controlled at the expense of limited accessibility of health services. At present, Hong Kong policy-makers are faced with the challenge of maintaining a sharp focus on cost control as they face pressure to expand and improve health care coverage for the citizens. So far they have responded by emphasizing management efficiency through reorganization. It remains to be seen whether this strategy can be successful without passing increased health care costs to the consumers.     

The correlates of depressed mood in adolescents in Hong Kong.

PURPOSE: Most studies of depressed mood and its correlates in adolescents have been conducted in Western countries. This study examined the relationship between a broad range of stressors and depressed mood in a community sample of Hong Kong adolescents. METHODS: Secondary school students (n = 996) completed the Chinese Beck Depression Inventory (C-BDI), provided demographic information, and indicated their perceptions of family and peer relationships, school function and pressures, and subjective health, and some measures salient to the Hong Kong environment: triad gang pressure, religiosity, and intent to emigrate. The correlation between C-BDI and these variables was assessed in bivariate and multivariate analyses. RESULTS: Hong Kong adolescents reported higher levels of depressive symptoms than a comparison group of Western teenagers. Girls showed more symptoms than boys. All stressors correlated in bivariate analyses with C-BDI, indicating similar influences on depressed mood in Western and Hong Kong teenagers. In multivariate analyses, the stressors contributed cumulatively to the C-BDI score. Perceptions of a lack of parental understanding and peer acceptance appeared as the strongest variables in predicting depressed mood. CONCLUSIONS: Depressed mood is highly prevalent among Hong Kong teenagers. Stressors play a cumulative role in their relationship to mood. Our findings point to the importance of broad screening of this vulnerable population.     

Graduates' evaluation of a postgraduate diploma course in family medicine

BACKGROUND: Postgraduate programmes offer an opportunity to learn family medicine for physicians in practice who were unable to obtain formal training in the immediate postgraduate phase of their career. Since 1985, the Chinese University of Hong Kong has provided a part-time 1-year diploma course at hours convenient for private practitioners. The curriculum has evolved, reducing public health components and increasing family medicine concepts. Between six and 16 students took the course each year until 1999, when formal recognition led to increased popularity. OBJECTIVE: The aim of this study was to evaluate the components and outcomes of the course as a prelude to further development. METHODS: Evaluation comprised a structured telephone interview conducted with two enrollees from each year of the course (total 28), selected randomly from class lists. RESULTS: Participants were mostly young doctors, with an average of 5 years in general practice. Many graduates are now prominent in training and development of family medicine in Hong Kong. Graduates rated most components favourably, but found the original research components too demanding, and not useful subsequently for most. Counselling, family dynamics, consultation and practice organization skills were valued. Conventional continuing education components, such as lectures by specialists, were evaluated poorly. CONCLUSIONS: This course has proved useful in the Hong Kong context, being practical for physicians, and allowing them to study ideas they would not otherwise encounter. Critical appraisal and evidence-based medicine exercises now replace the former research components.