The
Duchess of Kent Children's
Hospital at Sandy
Bay was founded by
the Society for the
Relief of Disabled
Children in the mid
50's. It was the brainchild
of Professor Hodgson
and a group of charitable
businessmen from Hong
Kong. Initially called
the Sandy Bay Convalescent
Home, it is situated
in Pokfulam, by the
sea, about one kilometer
from Queen Mary Hospital.
Do not be deceived
by its name, as even
in the early days,
the bay that it stands
on is full of rocks
and relatively little
sand.
The
Home initially had
fifty beds and was
usually occupied by
patients with tuberculosis
of the spine. The
standard treatment
for tuberculosis of
the spine then was
anti-tuberculous therapy
with bed rest for
months, often up to
a year. Even with
the advent of the
Hong Kong Operation
of Anterior Spinal
Debridement and Fusion
with Bone Graft, developed
by Professor Hodgson,
the patients had to
be kept in bed until
the grafts incorporated.
In those days, the
disease was usually
extensive, requiring
long bone grafts,
and the Home provided
an ideal place for
long term convalescence.
Around
the time when the
Home opened, the poliomyelitis
virus attacked Hong
Kong, inflicting a
significant number
of children and many
of these were left
with residual problems
in the skeleton. The
Society for the Relief
of Disabled Children
responded to this
by expanding the Home,
which included a physiotherapy
department with an
indoor heated hydrotherapy
pool. This was one
of the first in Hong
Kong and was in anticipation
of the demand of physical
treatment that would
be required of these
children. The extension
opened in 1962 and
fifty beds were added.
This addition proved
invaluable as it not
only provided the
appropriate treatment
for those in real
need, but also provided
a significant relief
on the strain on hospital
beds for children
in the general hospitals.
The
surgical operations
on these children
were performed mainly
at the Queen Mary
Hospital. But as operating
time was limited,
some of these operations
were also done at
the Ruttonjee Sanatorium,
an anti-tuberculosis
hospital ran by another
charity. Initially,
this only involved
children with tuberculosis
but later on, with
increasing demand
on operation time,
a lot of the surgery
involving polio patients
was performed there.
With this in mind,
the Society for the
Relief of Disabled
Children took another
challenge. They expanded
the Convalescent Home
further to a hospital
with an Operation
Theatre Suite and
all the other facilities
and services required
to support the new
addition.
With
a powerful fund-raising
team and assistance
from government, the
Sandy Bay Children's
Orthopaedic Hospital
and Convalescent Home
opened in 1968. (The
name of the hospital
was subsequently changed
to its present form
after a visit by the
Duchess of Kent in
1974.) The first operation
was done on 25th July
1968. I witnessed
the event, as I was
an intern in the Orthopaedic
Department in Queen
Mary Hospital at that
time and Sandy Bay
was one of the peripheral
hospitals covered
by the Department.
The
Columban Sisters,
a Catholic religious
order with good hospital
management experience,
ran Sandy Bay in the
early years. They
were managing the
Ruttonjee Sanatorium.
Sandy Bay's matron
cum chief executive
officer was always
a Columban sister
and Professor Hodgson,
and later on Professor
Arthur Yau, was honorary
medical superintendent.
The Sisters ran the
Home, and later on
the Hospital, most
efficiently. They
were caring on the
one hand and meticulous
on the other, and
would never fail to
carry out any of the
policies or orders
set by the doctors
on the patients. One
of the policies that
Professor Hodgson
insisted on was that
all patients' records
be clearly written
or typed and all notes
and X-rays must be
kept indefinitely.
Sandy Bay has maintained
this policy until
today. This, indeed,
was the secret behind
Sandy Bay's wealth
in clinical research
material. Credit should
not just go to Hodgson
alone, but also to
the Columban Sisters,
who made this possible.
Very sadly, they had
to leave Sandy Bay
in the late 70's.
I joined
Sandy Bay as a medical
officer in 1969 immediately
after I finished my
internship and was
a paid member of staff
for two years. The
Hong Kong University
Orthopaedic Department
then took me over
as lecturer, and seconded
me back in 1976. I
became Medical Director
(honorary) of the
Hospital in 1978 and
remained till I left
in 1989. Despite leaving
the hospital, I remained
in the Executive Committee
of the Society for
the Relief of Disabled
Children and later
on became its chairman.
With handing over
of the hospital to
the Hospital Authority
of Hong Kong, I automatically
became the chairman
of the Hospital Governing
Committee of the Duchess
of Kent Hospital at
Sandy Bay. I, therefore,
had first hand knowledge
of what took place
at the Hospital at
Sandy Bay.
One
of the outstanding
features of Sandy
Bay was its fellowship
programme for young
orthopaedic surgeons
outside of Hong Kong.
Every six months,
two young surgeons
who have just finished
their orthopaedic
programmes in their
own country are selected
to take up posts in
Sandy Bay. The programme
was installed almost
immediately after
the Hospital was established
and has continued
until today. Surgeons
from all over the
world have taken up
these fellowships,
most commonly from
the United Kingdom,
United States, Australia,
Japan and other Asian
countries; but also
from Argentina, Nigeria
and South Africa,
and lately mainland
China. The programme
was extremely popular.
For every surgeon
that made the trip
to Sandy Bay, at least
another two were rejected.
Many of those who
came here are now
orthopaedic celebrities
in their own country
and the world.
Hong
Kong, through Hodgson
and Yau, pioneered
anterior spinal surgery
with their work on
tuberculosis of the
spine. And in the
late 60's and early
70's the world was
becoming aware of
the importance of
the anterior technique.
They realized that
the anterior approach
allowed greater flexibility
in the management
of spinal problems,
such as spinal deformities
and injuries. This
approach to the vertebral
bodies offered greater
bone mass for fusion
and instrumentation,
and in turn would
provide greater stability,
earlier union and
rehabilitation. There
was a growing thirst
for knowledge of the
anterior technique.
Hong Kong was the
ideal place to learn
it from, and Sandy
Bay was the ideal
venue. Up to date,
over 120 orthopaedic
surgeons have gone
through this programme.
The
other great clinical
attraction at Sandy
Bay was the development
of the Halo-pelvic
apparatus. At the
time when Sandy Bay
became a hospital,
there was little in
the way of spinal
instrumentation or
internal or external
corrective devices
for spinal deformities.
The only spinal instrumentation
available was the
Harrington rods and
the only external
corrective devices
were body casts and
halo-femoral traction.
John P. O'Brien who
was with the Department
then, developed the
use of pelvic pins
through both ilium,
connected a ring to
the pelvic pins and
then extension bars
from the pelvic to
the halo ring. With
distraction of the
extension bars, extremely
powerful forces could
be generated and very
rigid deformities
could be corrected.
The gadget became
very popular and attracted
a lot of international
attention. The Hospital
manufactured the apparatus
and was receiving
orders from all over
the world. It was
ideal for the correction
of the tuberculous
kyphosis, which was
a common deformity
at that time. And
a lot of these patients
benefited. With the
development of better
and stronger spinal
instrumentation, the
halo-pelvic apparatus
has gradually been
replaced by other
means of spinal fixation
or correction.
In the
70's, Sandy Bay was
without doubt, an
international attraction.
The anterior spinal
work, the halo-pelvic,
the large numbers
of severe scoliosis
and kyphosis cases
which previously Hong
Kong could not handle,
the crippling polio
deformities in the
limbs, the large number
of congenital deformities
and children's orthopaedic
problems and injuries
that have filtered
into Sandy Bay, mostly
from Hong Kong itself,
but also from abroad,
made Sandy Bay very
attractive for a clinical
visit. The attraction
to visit included
international orthopaedic
celebrities such John
Moe from Minneapolis
USA, Robert Salter
and John Hall from
Toronto, JIP James
from Edinburgh, Lloyd-Roberts
from London, Kashiwagi
from Japan, and many
others from all parts
of the globe. Personally,
I was most impressed
by John Hall, an excellent
spinal surgeon from
Toronto. The posterior
spinal surgical technique
that he demonstrated
in Sandy Bay was so
impressive and useful
that I have used them
until now.
Motivated
by clinical success
at the Hospital, the
Society for the Relief
of Disabled Children
and the Hong Kong
University Department
of Orthopaedics went
further and invested
research facilities
and manpower in the
Hospital. A gait laboratory
and a center for spinal
research studies was
established with purpose
built facilities in
the mid 80's and had
provided visiting
fellows and trainees
the right environment
for study and research.
The Society, where
appropriate, also
provides research
funds for this purpose.
With
tuberculosis and poliomyelitis
under control, the
number of orthopaedic
cases has dropped
slowly over the years
and the Hospital has
had to redirect its
service into other
areas of paediatric
care. The Children
Habilitation Institute
is the latest addition
to the Hospital. Run
by a developmental
paediatrician, this
is a referral center
for children with
any type of developmental
or neurological problems
ranging from cerebral
palsy, muscular dystrophy,
autism to simple deafness
and mental retardation.
It houses the ventilation
center, which provides
training facilities
to children with spinal
muscular atrophies
to ventilate themselves.
This center is the
first of its kind
in Southeast Asia.
In the
last 50 years, the
life style in Hong
Kong has changed from
squatter huts and
poorman's night club
to posh high rise
units and restaurants
in Soho. The pattern
of orthopaedic diseases
has changed in a similar
fashion from tuberculosis
and poliomyelitis
to congenital and
genetic anomalies.
Sandy Bay went through
this change with Hong
Kong and I was very
lucky to have shared
a part of it.
