1997 - 2017

 

July 1, 2017 marks the 20th anniversary of the return of Hong Kong to our Motherland and the establishment of the Hong Kong Special Administrative Region (HKSAR).  Since our return to the Motherland, the principles of "one country, two systems", "Hong Kong people administering Hong Kong" and a high degree of autonomy have been successfully implemented in Hong Kong.  With the staunch support of our country, the concerted efforts of all sectors of the Hong Kong community and the co-operation of the Mainland provinces and municipalities, Hong Kong has made good progress in its social and economic development.

The above is the first and second paragraphs of the foreword message from our Chief Executive C Y LEUNG in the Hong Kong SAR’s 20^th Anniversary website.  In 1997, I was in my early thirties and had been a general practitioner in private practice for a few years.  Memories of that year were unreliable, as the background was blurred, but some unimportant items were in distinct focus.  I had not begun my long journey of postgraduate learning.  I was playing computer games day and night.  Emails were seldom used.  There was no messaging or any other function except making phone calls with expensive and robust mobile phones.  Leon Lai was the best male singer from Commercial Radio.  Faye Wong was the best female singer.  The Best Film Award of the Hong Kong Film Awards went to Comrades: Almost a Love Story (甜蜜蜜).  The soap drama of TVB was Old Time Buddy (難兄難弟).  I had never come across the Medical Registration Ordinance.  I could barely distinguish between HKMA and HKMC.  Doctors seldom wore masks at consultations.  At that time, a newbie general practitioner could afford a small flat.

On July 1, 1997, I sat at home watching TV, as there was nowhere to go with the extremely heavy rain.  I even considered following urges from TV to sing together when the screen showed the song “Tomorrow will be better” in karaoke mode.  Then, 20 years went by.  Were tomorrow and the days after tomorrow really better?

Recently I heard officials putting up the increase in population in Hong Kong as evidence that Hong Kong had flourished.  I found this argument familiar and convincing.  I remembered listing this as the reason for one of the Ming emperors being considered a good guy in an examination in Chinese History and gained one mark for it.  There was no natural disaster.  People could make a living there and thus they did not flee and started to reproduce.  The population in Hong Kong in 1997 was 6.489 million.  It rises to 7.403 million in 2017.  The difference is 0.914 million.  However, immigration is another cause for a rise in population.  If we take into consideration the 150 people per day allowance, we have 150 x 15 x 365 + 150 x 366 x 5 = 1095750, which is roughly 1.096 million.  Whether the officials gained one mark for their illustration is up to readers to decide.

The Hang Seng Index reached its highest at 16673 on August 29, 1997.  It then dropped to its trough at 6660 on August 31, 1998.  The historical peak was at 31638 in October 2007.  The Hang Seng Index closed at 26030 on June 9, 2017.

The Centa-City Index (CCI) is an index created to reflect trends in the property market of Hong Kong.  It is a monthly index based on all transaction records as registered with the Land Registry to reflect property price movements in previous months.  It comprises a number of constituent estates.  July 1997 is used as the base period of the index. The index in the base period equals 100.  So, July 1997 was set as the reference point.  In July 1996, the CCI was 65.74.  In October 1998, the CCI dropped more than half from that of July 1997 to 47.94.  Then in July 2007, the CCI was 55.90.  In June 2017, the CCI reached historical high at 147.24.

The Gini coefficient is a measure of statistical dispersion intended to represent the income or wealth distribution of a nation's residents.  It is commonly used to measure inequality.  A Gini coefficient of zero expresses perfect equality, where all values are the same.  A Gini coefficient of 1 expresses maximal inequality among values.  The closer the Gini coefficient is to 1, the more inequality there is.  In Hong Kong, the Gini coefficient is announced every 5 years.  In 1996, the Gini coefficient was 0.518.  In 2016, the Gini coefficient was 0.539.

I am also not sure whether TV will put up the song “Tomorrow will be better” in karaoke version this year. But anyway, tomorrow is another day.

 

(Source: HKMA News June 2017)

Community Health Center

I read a proposal by the Primary Care Office on a pilot project of setting up a community health center.  Actually community health center is nothing new.  By definition, it is a health center in the community, though people nowadays would say that a health center needs to be multidisciplinary.  To me, I would consider the Sai Ying Pun Jockey Club Clinic, referred to by local people as the “Government Civic Hospital” and has been there for decades, is a community health center.  There are general out-patient clinic and different specialty clinics including maternal and child health center, dermatology and social hygiene clinic and chest clinic in a multi-storied building.  There are also X-ray and laboratory services.  If you think that there must be other healthcare disciplines other than medical doctors, then there is the David Trench Rehabilitation Center nearby.  There are physiotherapy, occupational therapy, psychogeriatric day care, psychiatric community nursing, general psychiatric day care and medical social services.

The Hospital Authority thought differently.  In 2012 it announced the opening of its first community health center in Tin Shiu Wai.  It was described as “the first health centre with design based on the Government's primary care development strategy and service model”.  And, “it is a one-stop centre where people receive comprehensive primary care services by multi-disciplinary primary care professionals in the community.  The general out-patient clinic on the first floor provides around 200 consultations per day.  Patients visiting the Tin Yip Road health centre are referred to the multi-disciplinary primary care professionals (including nurses, physiotherapists, occupational therapists, prosthetist-orthotists, dieticians and optometrists) located on the second floor to receive appropriate intervention and follow-up services.  The centre also collaborates with non-governmental organisations to provide health-care education and psychological counselling services”.

Let’s first skip the aims and objectives of setting up community health centers.  Although such objectives serve for navigation during the night, they are like stars that are difficult, if not impossible, to reach.  Afterall, it is how you communicate with Einstein and how you build the rockets that matter in your project to Mars.  We look at the operational aspects.  What are the differences between the Tin Shui Wai Community Health Center and the Government Civic Hospital?  Or how about adding a general out-patient clinic to the David Trench Rehabilitation Center? 

One obvious difference is that doctors from the general out-patient clinic can directly refer patients to services of other healthcare workers at the clinic.  However, putting all services spatially in the same building does not benefit patients.  Patients are unlikely to go directly from general out-patient to other clinics in the same day.  They have to wait for another appointment.  Unless patients are able to see the same doctor each time and more time is allowed for each consultation, the concept of family doctor and continuous primary care do not apply.  If just for direct referral from general out-patient clinic, this can easily be achieved by opening up the existing services to accept direct referrals.  Instantly, we have many community health centers. 

The pilot project of the Primary Care Office was different, as it said.  I summarized the differences from what I read as follows:

1. There is no medical doctor in the center.
2. It accepts referrals from doctors in private practice.
3. It targets more on prevention than cure.  Thus the scope of services includes risk assessment and chronic disease management; patient empowerment programmes; and health promotion services.
4. A case-coordinator, likely a senior nurse, will lead the primary healthcare team there.
5. The center will be led by a non-government organization.

Again, I am more interested in how it works, or how it is going to work.  All disciplines of healthcare workers exist in the private market already.  The opening of a community health center is unlikely to create more physiotherapists or podiatrists.  Instead, it employs its own healthcare workers and theoretically it will decrease the supply of workers in the private market.  This shortage also applies to senior nurses.  The concept of having a senior nurse as case-coordinator is adorable.  However, to fulfill the objective of continuous primary care, the same case-coordinator should follow-up his own patients.  The center will need to have many case-coordinators.  They are then overlapping the job of family doctors who are supposed to know their patients well and to lead a primary healthcare team. 

Preventive care does not come cheap.  High rents are eating away the major share of profits in the private market.  Charges for each visit for any healthcare worker are already higher than visiting family doctors.  In the community health center, there is the addition of a case-coordinator.  That will incur extra costs.  The case-manager is going to identify needs of patients and extra services are expected.  Why would building a community health center change the health seeking behavior of Hong Kong citizens?  How is the center to compete with other healthcare workers in the private market? 

The answer could not be found in the document I read.  So I asked.  The right question usually gives you the gist of the matter.  The community-health-center-to-be will be funded by the government (and thus you and me) and will be highly subsidized.  The intended charge for each visit is around $60, or in-line with other out-patient clinic charges.  It is always an ideal to provide comprehensive and continuous preventive care to all citizens.  However, ideals never work in real world.  Money is usually the limiting factor.  There is no need to go again into the healthcare system, budgeting and rationing.  The Primary Care Office might argue that the community health center targets high risk patients.  Nonetheless, that would include all patients with chronic illnesses, all smokers, all overweight people and all the elderly.  I guess that covers more than half of the population.  Another possible outcome is that the center turns out to be no different from other clinics run by the Hospital Authority where patients get routine healthcare services at an out-of-proportionally low cost.  In that case, the same effect can be achieved by just opening up the existing clinics to accept referrals from private medical practitioners.

I wish that this community health center will bring us to Mars, or will bring us one step nearer to Mars, or at least will point our way to Mars.  I hope it will not turn out to be trucks loading patients to watch movies on stories about Mars.

(Source: HKMA News May 2017)

As Simple as That

 

 

Eleven years ago, when I was a newbie in the Medical Council, I attended an inquiry.  The case was about a doctor found guilty of not keeping proper records of dangerous drugs in the magistrate court.  At that time, I was clear that I had to decide the case according to section 21(1)(a) of the Medical Registration Ordinance.  It was not about professional misconduct, which was covered by section 21(1)(b).  What puzzled me was the seemingly generally agreed comment among members that keeping an accurate dangerous drugs record was very easy.  It was simple mathematics and the doctor just needed to do the checking twice a day.  Thus, any mismatch should be condemned.

Of course those who maliciously sold dangerous drugs and those grossly neglected record-keeping should be sanctioned.  I also agreed that keeping a proper dangerous drugs record was important.  However, the point was that it was far from easy or simple to do so.  Ask an accountant, he would share with you that keeping an account balanced is not as simple.

Let us start with a single dangerous drug.  The best case is that everyone involved makes no mistake and the record is perfect.  You can secure it with auditing the record twice a day as suggested.  That needs counting the stock of that dangerous drug to match the balance in the record.  If it does not match, you need to go back to all the prescriptions of that session.  You might not find out where things went wrong because there might have been unnoticed mistakes in dispensing.  Even if you can find out where the mismatch comes from, you need to scratch your head before you can rectify it.  If you are using 20 dangerous drugs, you need to go through the above procedures 20 times.  Do not forget that human errors can occur in auditing also.  That might further complicate your daily exercise.

Time is another factor.  Dangerous drugs record keeping is important.  But there are many other issues that are as important, or even more important.  Checking expire dates of stocks is important.  Making sure investigation results are read and followed up is important.  Tracking drug compliance and follow-up appointments of patients with chronic illnesses is important.  Writing summaries for ten-year-old, five-inch-thick patient records is important.  Do not forget, maintaining the health of the doctor by enough rest and regular exercise is also important.

In real world, things are not as simple as your first impression.  I am not listing excuses for doctors to evade from proper record keeping.  Instead, you have to understand the nature of a task and to contemplate root causes for errors.  Further, knowing theories and methods is not the same as being able to carrying them out.  Otherwise, drug compliance or vaccine uptake rates would not bother us.  Smoking cessation would be as easy as snapping your fingers.

Another example of over-simplifying a problem and ignoring the role of other expertise is the use and abuse of antibiotics.  Recently there had been repeated open attacks on the abuse of antibiotics especially in treating upper respiratory tract infections by primary care doctors in the private sector.  This was said to contribute much to the development of antibiotic resistant bacteria.

Primary care is a branch in medicine no different from microbiology, or surgery, or oncology in the sense that it deals with a special aspect of patient care using specialized skills.  Primary care is not just treating upper respiratory tract infections with or without antibiotics.  Understanding health-seeking behaviors of patients, encouraging healthy living style, and modifying behaviors are but some of the challenges of primary care.  Overuse of antibiotics has been an all along existing problem.  As a family doctor who is practicing primary care and communicating with patients and colleagues every day, I can state with confidence that the situation is improving over the years rather than getting worse to the extent of out of control.  I do not have statistics to support me.  But neither did those who accused have any concrete evidence.  It is unfair to focus the spotlight at primary care doctors when antibiotics are used as food to feed live stocks and fishes, when you can buy antibiotics without prescriptions, and when most patients need to have intravenous antibiotics for most illnesses or non-illnesses in nearby areas.    

Despite facing a weak case, various strong measures were suggested and planned to spy on primary care doctors, to educate them, to regulate them, and to punish those who still choose to misbehave and endanger our Earth.  The usefulness of some of these measures was debatable.  For example, it was suggested that confirmation tests needed to be done before prescribing antibiotics.  How about sensitivity tests?  Do we need to monitor drug concentrations in blood?  Do we need to repeat the tests after treatment?  How about prophylactic antibiotics?  Longer term use of antibiotics poses more risk on the development of resistant strains.  Do dermatologists need to culture for bacteria and do sensitivity tests before treating acne?  Do gastroenterologists need to do sensitivity tests before treating H. pylori infection?  And, do they need to constantly monitor blood concentration?  Another example: the healthcare system in UK is different from our system.  They have registry for every prescription.  Thus statistics for antibiotic use is readily available.  It is unfair to compare two different healthcare systems and try to introduce large scale registry for antibiotics in Hong Kong.

But all the above are minor points in the argument.  An important element for primary care doctors to function is the trust between them and their patients.  Ruining this trust, the long term effects are disastrous.  Health education would be less effective, vaccination rates would drop, and investigation rates would shoot up.  Patients would turn to other healthcare workers who have all along promoting their without-side-effect-treatments and immeasurable holistic care.

Behavioral modification takes time and needs skill.  It is not as simple as that. 

(Source: HKMA News April 2017)

Mediation, Disciplinary Procedures and Legal Procedures

 

I heard repeatedly people talking about mediation as the solution to the long waiting time for the Medical Council to handle a complaint.  I would like to point out that without drastic changes made to the disciplinary procedures, mediation would not work.  In particular, the definition of professional misconduct needs to be readdressed.

Mediation is a useful means of dispute resolution.  The special nature of being non-adversarial and non-fault-finding allows mediation to be flexible and to address the needs of both parties.  There can be a win-win outcome as decision of fault is not necessary.  Either party does not need to fight claws-and-nails to defend themselves.  It is therefore most useful in settling contractual disputes and matrimonial disputes.

However, it is also the nature of mediation that makes it not suitable for disciplinary purposes.  The aim of disciplinary procedures is to uphold professional standards, and thus ultimately to protect the public.  Clear rules are set to tell members of the profession what conducts are not acceptable.  Members falling below such standards result in disciplinary actions.  Such actions are not just for punishment.  They serve to deter undesirable behavior.  The criminal arm of legal procedures shares the same objectives with disciplinary procedures.  There is no room for mediation and settlement between parties in such respect.

In actual practice, disciplinary procedures are between the Secretary of the Medical Council and the defendant doctors.  They are not between complainants and defendant doctors.  Once the Medical Council proceeds with a complaint, even the complainant cannot withdraw it and stop the action.  They cannot settle among themselves.  This is because the Medical Council is not just answerable to the complainant.  The Medical Council has to investigate the case and decide on it so as to uphold the standard of the profession.  It is answerable to the public.

Therefore mediation cannot be incorporated into the current disciplinary procedures simply as an alternative to inquiries.  It needs to run parallel to the current procedures and with a different objective.  Mediation cannot uphold standards.  Rather, it provides redress to dissatisfied patients.  They serve different purposes and cannot replace each other.

There are 2 major difficulties in adding mediation to our disciplinary procedures.  First, talking about redress, apart from apologies, compensation in terms of money is involved.  The Medical Council needs to consider whether it wants to open another channel for compensation in addition to claiming personal injury in the area of tort.  Second, if the aim is to expedite disciplinary procedures, complaints need to be channeled to either inquiry or mediation, but not both.  To do so, a clear distinction between professional misconduct and non-professional misconduct cases is needed.  

However, the scope of misconduct now is exceedingly wide.  Anything fallen short of expected standards would be regarded misconduct, no matter how slight or trivial it is.  This resulted from a judgment from the Court of Appeal which ruled that the fallen short of standards needed not be serious.  It would be very difficult, if not impossible, to find cases not within such wide scope of misconduct.  Thus, mediation would not be helpful to lessen the case load of inquiry or shorten the waiting time.  Rather, mediation deals with some other new categories of complaints.

To further illustrate the interplay among legal procedures, disciplinary procedures and mediation, I use the case of the 7 police officers as an example.  7 police officers were charged with causing grievous bodily harm with intent, contrary to section 17(a) of the Offences against the Person Ordinance.  They were found guilty of a substitute offence of assault occasioning actual bodily harm, which was of lesser degree than the original charge.  All of them were sentenced to imprisonment for 2 years.  The verdict caused dissatisfaction among the police and some citizens.  There were criticisms against the judge and there were assemblies to support the defendants.

In this case, it was the Hong Kong Government that prosecuted the 7 police officers.  It was not a case between the victim who was beaten up and the 7 police officers.  In criminal procedures, it is the role of the government to uphold law and order.  During the trial, lawyers representing the defendants argued on every fine detail of the case.  They challenged the authenticity of each and every video and photograph, the admissibility of each and every video and photograph, the identification of all the defendants, the credibility of every witness, and when and how the wounds on the victim were caused.  Much time was spent on issues such as the carrying of batons and the use of protective knee caps by the police officers.  However, not one of the lawyers argued that it was lawful to beat up someone after tying him up.  No one challenged the Offences against the Person Ordinance.

It was alarming to see members of the police who were law-enforcing personnel to opine otherwise.  The court had to act according to provisions and case laws.  There was no room to address requests for preferential treatment.  A clear message had to be sent against behavior that was sanctioned by the society.  The same applied for disciplinary procedures.  Once found guilty, the services of the 7 police officers had to be terminated without pensions.  Otherwise, a wrong message of endorsement of illegal acts might be conveyed.

Mediation does not focus on right and wrong.  It is not relied upon to send important messages to the public.  It aims at resolving dispute and addressing the needs of both parties.  Allowing all shades of gray, the conduct of the 7 police officers was not real evil.  At least some of their colleagues took it as if it was their norm.  The crime was out of rage and I did not think they meant to cause serious harm to the victim.

Mediation is also about being down to earth.  It distinguishes between wants and needs.  The defendants might unrealistically want to maintain that they were innocent.  Some people might want the charges quashed.  However, did they really have no remorse at all?  Given another chance, would they do it again?  What they really need was rehabilitation.  Donations would be helpful.  But was it necessary to bundle donations with all sorts of wants from other parties?  During the trial, because of the adversarial nature, there was no chance for the parties to communicate, or to offer apologies to each other.  It would be of much benefit to the defendants, to the image of the police, and to the public if the 7 police officers and their colleagues could see their needs and moved on.

It is time to understand more on mediation, legal procedures and disciplinary procedures.  It is time to use them accordingly and appropriately.  

(Source: HKMA News March 2017)

There is a Reason

“One man one disease!” was one of the diagnostic principles taught by medical professors while I was a medical student.  It was not until I graduated and went into practice for a few years before I realized the beauty of this principle.  Of course in real life, one man could suffer from more than one disease.  But if we tried to explain different symptoms with several diseases causing each, such as influenza for fever, trauma for splinter haemorrhage, mitral valve prolapse for heart murmur and urinary tract infection for haematuria, then we might miss the important diagnosis of infective endocarditis.  This principle reminded us that in a diagnostic process, we should try to connect everything, to think hard for THE reason behind.  It was after such careful consideration that we could then talk about a patient with two diseases, or better an acute disease in a patient with a chronic condition.

I loved this diagnostic principle so much that I tried to generalize it for everyday life activities, particularly in speculating human behavior.  There was a reason behind why people acted in a one way rather than the other.  Again, there ought to be many underlying causes for an action.  It could be out of animal instinct, it could be just by chance, or it could aim at something, or actually it could be a result of all the reasons, known and unknown.  But first considering whether there was A reason served its purpose.  In Singapore, while you mocked at your local friend who carried an umbrella in a sunny afternoon, the next moment you got drenched.  In 1997, some people realized too late why others stayed away from the stock market.

It was difficult to preach with theory alone.  So I translated the theory into practical terms: “When you think others are stupid, first consider whether you are the stupid one.”  It was far too easy to think that others were stupid.  As you gained in experience and intelligence, it became more and more true that some people were real stupid.  You might see no reason why people acted in such strange manner, or more frequently, there were smarter ways to tackle.  However, follow my principle if you cannot afford to be the stupid one.  In Chapter 28 of Jin Yong’s (金庸) famous novel The Heaven Sward and Dragon Saber (倚天屠龍記), Zao Min was able to decipher the plot to escape of a council member of the Beggars’ Association by noticing his strange stance and posture.  Both of them were not stupid.

In real life, a candidate of the Chief Executive Election deliberately exposed her ignorance.  She did not know how to ride an MTR.  She described in detail her failure in tackling an obstacle of lacking toilet paper.  People from all walks of life regarded her stupid, or at least unskillful both in problem solving and in PR.  Guided by my principle, I searched for a reason behind.  It would be negligence for a candidate and her PR team to show clumsiness and ignorance in an arena of election activities.  It was not difficult to rehearse an MTR tour nor to proof-read a blog diary.  For election activities, apart from the consideration of sending what sort of messages, another concern was the target group.  It would be logical to deduce that the candidate tried to identify herself with the second-generation-tycoons who, in the mindset of her and her team, were deficient in the knowledge of MTR and toilet paper purchase.  By careful calculation, the side-effect of annoying the public was tolerated.

Working out the reason behind an action led to the question of whether we could make use of our finding.  If a candidate was willing to scarify her public image in exchange of potential votes, would it be possible for members of the Medical Subsector or Pan-democratic members of the Election Committee to negotiate for favorable terms and policies?

If we went back 5 years ago, CY was desperate for votes.  He got many crucial votes from our medical colleagues because he “was willing to listen to us and to consider our needs and concerns”.  What happened then was history.  Our concerns were addressed with policies trying to realize our nightmares.

Knowing the reason behind did not mean that you could make the quantum leap and get something useful out of it.  In the “Heaven Sward”, Zao Min could not stop that hypocritical beggar from gaining power even though she spotted out his hidden agenda.  Willing to identify oneself with the rich did not necessarily mean that one would negotiate with doctors.  Skillfully designed promises with calculated ambiguities built-in were just fantasies.  We could not sue the CE for breach of contract even if a real promise was made.  In a system where an orchestrated majority could be secured, there was hardly any say for third parties.

It is just mind-game.

(Source: HKMA News February 2017)

福

(Source: HKMA News January 2017)

They Shook the Earth!

It happened that I encountered some people who were obsessed with questions about jumping together.  The favorite scenario was about gathering all the people on earth and then asked them to jump together.  They wanted to know whether the earth would be moved by such momentum.  Some went further and thought that the rotation of the earth, or even the orbit of its revolution around the sun would be affected.

We tended to brush such question off by some common sense arguments.  It was impossible to gather so many people together.  They needed to be in a relatively small area so as to focus the momentum and not to have the forces cancelled out each other.  Not only that those people needed to synchronize in jumping up, it would be more important for them to land at the same time.  The list could go on forever without attacking the question head on.

However, some scientists, maybe influenced by the famous thought experiments of Einstein, took the question seriously.  Randall Munroe in his blog (what-if.xkcd.com) and then his book (What If?: Serious Scientific Answers to Absurd Hypothetical Questions) defined the question: What would happen if everyone on earth stood as close to each other as they could and jumped, everyone landing on the ground at the same instant?  In a site which claimed to fight ignorance since 1973 (straighdope.com), a similar question was post as early as 1986, and it involved Chinese: If every man, woman, and child in China each stood on a chair, and everyone jumped off their chair at exactly the same time, would the earth be thrown off its axis?  In scienceblog.com, a blogger did some calculation taking into account the mass of the earth, the mass of all the people on earth, the gravitational field, the height that people jumped, velocity of the earth, action and reaction forces.  As I did not understand the calculation, I could only tell you the simplified result was that there would not be any detectable effect.  The main reason was that the mass of the earth outweighed the mass of the total population by a factor of over ten trillion.

Randall Munroe chose to go into more details of the jumping experiment.  He assumed that all people really gathered in Rhode Island, as he figured that it needed an area the size of Rhode Island to accommodate all the people on earth.  He came to the same conclusion that the earth would not be moved, though he added that there would be a loud sound resulted from the synchronized landing of so many people.  Then came his further analysis.  There would be no signals for mobile phones.  The people found it very difficult to leave either by plane, by train or by car.  People did not speak a common language.  There were insufficient food and water supply.

In October 2016, 19 doctors planned to shake the earth.  They formed an alliance and got started to take part in the Medical Subsector Election of the Election Committee.  They formulated a seemingly unrealistic goal of getting all 19 members into the Election Committee.  They vowed to change the Chief Executive and to change the system of election of the Chief Executive and Members of the Legislative Council.  Their causes were shared by pro-democratics of other subsectors.  There was actually a bigger alliance which aimed at getting more than 300 votes in the Chief Executive election.  At the same time, there was a shared common platform among the majority of all candidates for the election: the Chief Executive had to be changed.

Then, at 3:30pm December 9, 2016, the earth stopped spinning for a fraction of a split second.  While Hong Kong people were gloomy about their fate, the Chief Executive, CY, announced that he would not go for another 5 years.  Before those guys started to jump, their mere gathering had shown power.  Statistics clearly showed that the coming Election Committee would not favor the present Chief Executive to continue his heroic acts.  CY got his red light.

I felt the earth shaking on December 12, 2016 when the results of the Election Committee were announced.  All the 19 doctors were elected.  And they were not alone.  Whole cabinets were elected in many other subsectors for the bigger alliance.  Having the whole cabinet elected was quite historical in elections of the medical profession.  The 19 doctors were different in weight.  Their abilities to jump differed.  They even did not synchronize to start jumping.  However, most importantly, they were able to land together perfectly and delivered their unified force.  They had clear and admirable causes.  They had strategies, energy and discipline to execute.  Voters were moved by their enthusiasm.  All the members got similar number of over 3000 votes.  This clearly reflected that voters supported the team as a whole.

At the same time, when they landed, they delivered a unified and resonating voice.  It was clearly heard.

They really shook the earth!

(Source: HKMA News December 2016)