常有人問我,究竟醫院發展進度如何。事實上,我們截至七月已開設了194張病床,臨床服務亦相當齊全。以門診為例,現時有多個專科進駐,而一些複雜病種(如腦腫瘤、骨骼發育不全、炎症性腸病和今期介紹的唇顎裂),更設固定跨專科會診時段。以往病人覆診要「走幾科」,重複訴說病情。聯合會診免卻病人舟車勞頓,整個團隊亦可同步檢查問症,面對面溝通,就治療方案達成共識。看似「大陣象」和花時間,卻具成本效益,對病人也最好。
同時,我們正密鑼緊鼓籌備開展心臟科及心胸外科服務。醫護團隊和病人會分階段由瑪麗醫院調遷,屆時服務將更完善。
疫情期間,病人資源中心在極短時間內統籌七個非政府機構(兒童癌病基金、菲奧多拉基金會、香港紅十字會醫院學校、生命小戰士會、願望成真基金、智樂兒童遊樂協會及麥當勞叔叔之家慈善基金)製作電視節目在病房播放,發揮創意、靈活性和合作精神,為病童提供不可或缺的心理社交支援。
衣食住行是同事關注的環節,我和大家一樣著緊。期待以久的職員餐廳即將開業,希望帶來更多方便。
醫院行政總監李子良醫生
因應2019 冠狀病毒病疫情,本院暫停了一般親友和義工探訪。面對突如其來的轉變,病童難免不適應,因此院方提供治療之餘,亦盡力關顧他們的心靈需要。
病人資源中心與七個非政府機構在三月底合作推出「童趣繽紛台」電視頻道,為病童度身製作一系列精彩節目,逢星期一至五播放,內容包括消閒娛樂、停課不停學、防疫常識及情緒支援,病童只需安坐病床就能收看。
十一歲的貝貝分享:「最近義工們不能來病房陪我玩和聊天,真的很悶。不過現在可以在電視見到他們,又教我做手工和摺紙,很開心呢!」
本院近月不時收到社會各界捐贈口罩及搓手液等物資,以支持我們抗疫。在裝備供應緊張的挑戰下,這些捐贈能給予及時支援,有助確保不同崗位的員工得到所需防護,更專注服務病童。善長心意,我們衷心感激。
5月12日為國際護士節,由於疫情關係,院內慶祝活動從簡。醫院行政總監及護理總經理和護士們合照,藉此肯定及感謝各位護士在疫症期間時刻緊守崗位。作為抗疫的重要防線,護士們付出無私努力,並要兼顧日常護理工作和協助推展服務,貢獻良多。
香港兒童醫院啟用至今年七月共開設194張病床,而以下臨床服務已相繼投入運作,為病童提供診斷、治療及復康服務。
兒童及青少年科
外科服務
麻醉及全期手術醫學科
病理學部
放射科
專職醫療
藥劑部
唇顎裂屬先天顏臉缺陷,會導致外觀、進食、說話、聽力和牙齒問題。香港兒童醫院去年5 月起為唇顎裂病童提供一站式會診,包括第一期跨部門綜合治療及早期第二期治療。院方現時正跟進約700 名病童,並將逐步擴展服務至提供全面的第二期唇顎裂治療。
負責統籌服務的小兒外科顧問醫生趙式言指,跨專業團隊能為病童提供全面治療︰「病童顏臉結構隨成長轉變,衍生不同的複雜問題,需由多個專科合作,在最適當的時機進行相應治療,循序漸進。」
趙式言醫生指,綜合會診方便各專科共同商討病情,作出一致決定。見證病童由嬰兒慢慢長大,變得接受自己,與同學融洽相處,能燃點團隊繼續服務病童的熱誠。
皓堯一出世便到香港兒童醫院接受會診,展開漫長的治療旅程。他媽媽道:「雖然兒子註定要經歷多次手術及留下疤痕,但我們會用愛去彌補缺陷。很感激醫療團隊全方位支援,令我們更有信心陪伴他成長。」
唇裂病童出生約三個月便會接受首次重建手術,改善外觀之餘,亦能修補父母的心。皓堯爸爸憶述,之前因陌生人眼光而不敢帶兒子外出。他明白手術必有疤痕,並不強求效果,但在術後揭開紗布一刻,不禁讚嘆「完美無暇」。
這項手術其實難度非常高,要從肌肉、內膜及皮膚三層修補唇部皮瓣,同時替下陷的鼻子矯型,確保對稱。團隊更引入手術後的預防性激光治療,令疤痕不顯眼。
至於顎裂縫合手術則於一歲左右進行。如有需要,耳鼻喉科醫生會同時切開鼓膜及植入引流導管,防止中耳炎。
嬰兒接受首次手術前,需要長時間配戴塑型器。牙科及口腔頜面外科顧問醫生黃永傑解釋, 它能協助糾正唇鼻歪向一邊的情況,提升手術效果。
患者約六歲後便要接受多次矯齒治療,主要是為配合不同階段的手術。「例如病童兩邊顎骨太近,我們會慢慢將上顎擴闊,以便日後進行顎骨修補手術;術後則會透過箍牙將牙齒移至植骨位置,防止植骨萎縮。」黃醫生補充。
顎裂患者常因軟顎及咽喉肌肉欠協調,出現咬字不正、鼻音過重和鼻漏氣等問題,需由兩歲開始接受言語治療。在醫院籌備階段,言語治療師姚靄欣和其他治療師合力開發了全港首套粵語顎裂語音評估工具。她說:「本地的顎裂病童有獨特的語音問題,這套工具能幫助我們提供更準確的評估及訓練方向。」
急性白血病是兒童最常見的癌症。香港兒童醫院負責診治全醫管局的兒童急性白血病個案,並提供全港唯一的兒童造血幹細胞移植服務。在病理學部,一群血液學組的「偵探」每天穿梭化驗室,爭分奪秒化驗血液及骨髓樣本,揪出致病元兇,為病童帶來希望。
本身負責帶領血液學組的病理學部部門主管蘇志釗醫生表示:「當子女受疾病纏擾而不知原因,父母往往感到焦急和自責。我們提供快而準的化驗報告,除了協助主治醫生診治,亦讓父母的心可以安定下來。」
急性白血病病童的血液和骨髓能為其診斷、治療、病情展望和監察提供重要線索。化驗團隊會利用各種科技, 包括在顯微鏡下觀察細胞形態、進行染色體分析, 及透過先進儀器在治療後追查癌細胞蹤影。蘇醫生表示:「病童需要經常抽血, 加上血量較成人少, 因此我們特別選購了只需一毫升血便足夠進行多重檢測的儀器。」
由於不同類型的白血病治療方法有異,醫務化驗師會運用先進的流式細胞儀分析病人的骨髓樣本,透過辨別癌細胞的獨特抗原, 確認急性白血病的種類, 醫生就可制訂最適切的治療方案。它亦可計算出癌細胞殘餘量, 從而評估治療成效及如何跟進。蘇醫生解釋:「這部儀器非常高速和精密, 只需數分鐘便可掃描成千上萬個細胞。即使一萬個細胞中只有一個癌細胞,亦能偵測出來。」
他認為醫院的臨床及化驗室團隊合力為病童診治,猶如電影製作:「一部電影要成功, 除了男女主角, 亦需要出色的劇本、服裝、攝影和剪接。病理科好比電影幕後人員,我們運用專業知識和經驗提供高質素的化驗報告,與主治醫生緊密聯絡,一起拆解棘手病症,很有滿足感。」
雖然經常埋首化驗室,但蘇醫生一直心繫病童:「每次發現病童確診白血病,想到他們整個家庭都要與疾病戰鬥,我都會很傷感,並提醒自己做好本份,否則是對不起病人。」
人體骨髓中的造血幹細胞負責產生全身的血液細胞。急性白血病患者卻因癌細胞或高強度治療破壞了幹細胞的造血功能。雖然大部分患者可透過化療或標靶治療痊癒, 但是有些病童仍要接受造血幹細胞移植,才可正常造血。香港兒童醫院提供全港唯一兒童造血幹細胞移植服務, 並配備一間幹細胞移植化驗室作支援。
工作人員會在無菌空間小心翼翼地處理採集得來的造血幹細胞, 包括清除會引致移植後排斥及嚴重併發症的成份。樣本亦會進行細菌測試,確保安全。
若幹細胞並非即時使用,會暫存在零下190 ℃ 的儲存缸裡,直至病童需要移植時才解凍使用。
儲存缸中的液態氮為造血幹細胞提供超低溫保質環境,以備在適當時候注輸予病童。
疫情為大家的日常生活以至全球政治經濟環境帶來轉變和不確定性,感到焦慮不安實屬人之常情。這裡跟大家分享一些面對疫情時保持心理健康的貼士:
願大家身心平安!
撰文: 臨床心理學家潘秀群博士 插圖: 病人服務助理蔣承浚
即使工作繁忙,身邊仍有很多美好的事物為生活注入正能量。誠邀香港兒童醫院同事們用鏡頭記錄「感恩一刻」與大家分享,一經選中便有機會在《香港兒童醫院通訊》刊登,詳情如下:
醫院行政總監李子良醫生
麻醉及全期手術醫學科副顧問醫生郭蕙漩醫生
行政事務總經理郭慧敏女士
專職醫療行政經理陳娜智女士
護理部高級護士長馮靜雅女士
高級人力資源經理吳海寧女士
高級行政主任(對外關係及籌募)杜蘊慧女士
一級行政主任(對外關係及籌募)董潔欣女士
二級行政主任(對外關係及籌募)林瑞敏女士
二級行政主任(對外關係及籌募)吳文諾女士
二級行政主任(對外關係及籌募)邱雅錡女士
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I am often asked about our development progress. In fact, we will have up to 194 beds up to July and our services are quite comprehensive. Taking the outpatient clinic as an example, many specialties are now providing service, and there are multidisciplinary consultation sessions for some complex diseases, such as brain tumors, skeletal dysplasia, inflammatory bowel diseases and cleft lip / palate. This arrangement saves patients’ hassles and effectively enables team members to discuss diagnosis and treatment plans together. It may seem an extravagant use of manpower and time, but is indeed cost effective in the long run.
Meanwhile, our new cardiology and cardiothoracic surgery services are already in the pipeline. Manpower and patients will be translocated from the Queen Mary Hospital gradually.
Under the COVID-19 pandemic, the Patient Resource Centre has quickly pulled our NGOs partners together to launch an in-house TV channel for patients to stay connected. This is a good example of using innovation, flexibility and concerted effort to provide psychosocial support, which is an essential part of our service.
I am also pleased to announce that the long awaited staff canteen will soon be in service. I hope colleagues would find it more convenient.
Dr Lee Tsz-leung, Hospital Chief Executive
In response to the COVID-19 outbreak, visiting of visitors and volunteers has been suspended in public hospitals. At HKCH, alternative ways are taken to support patients to go through this difficult time.
The Patient Resource Centre has lined up seven NGOs to launch the “Children’s TV Channel” in late March. Inpatients can tune-in on weekdays in their bed to enjoy a series of tailor-made programmes which cover entertainment, learning, infection control knowledge and emotional support.
11-year old Pui-pui shared, “I get bored as the volunteers cannot come these days. We used to play and chat. But now I can see their faces on TV. I am happy that we can do artwork and origami together again!”
We have been receiving donated items such as masks and hand sanitizers for fighting against the pandemic. Under the global shortage, these timely gifts really help us ensure appropriate protection for our staff. A big thank you to all donors!
This year’s International Nurses Day was celebrated in a simple but meaningful manner. On 12 May, the Hospital Chief Executive and General Manager (Nursing) took a photo with a group of nurses as a recognition of all nurses’ contribution as gatekeepers against institutional outbreak of diseases, as well as their dedication in providing quality healthcare and supporting service expansions.
Since our opening, the following clinical services have gradually commenced to provide children with diagnosis, treatment and rehabilitation; and 194 beds will be in use as of this July.
Paediatrics & Adolescent Medicine
Surgical Services
Anaesthesiology & Perioperative Medicine
Pathology
Radiology
Allied Health
Pharmacy
Cleft lip and palate is a congenital deformity which can cause problems to appearance, eating, speaking, hearing and dentition. The HKCH cleft team has begun one-stop outpatient services since May 2019, providing multidisciplinary primary cleft care and early secondary treatments. About 700 children are currently managed under HKCH, and secondary cleft services will expand in due course.
Consultant in Paediatric Surgery Dr Nicholas Chao who coordinates the service explained the merits of the multidisciplinary care approach,“As children grow, their facial structure changes and different problems emerge. It’s important for us to work together to give the right treatments at the best timing during the long journey.
Dr Nicholas Chao said that joint consultation facilitates communication in the team. They feel motivated seeing children thriving in society and accepting themselves after treatments.
Little Ho-yiu came to the HKCH cleft clinic days after birth. His mom shared, “Though our son would undergo many surgeries and have scars, our love shall overcome. I’m grateful for the cleft team’s support which has prepared us to face the challenges ahead.”
Children with cleft lip normally have their first reconstructive surgery at around three months. Ho-yiu’s father recalled keeping him home before the surgery to avoid strangers’ look. “Honestly, I didn’t have high hopes in the surgery. But to my surprise, when the gauze was removed, the closure looked really flawless!”
This surgery is in fact highly technical. It involves repairing the lip defect and the nose in layers with meticulously designed tissue flaps to achieve a symmetrical alignment. The team has also introduced prophylactic laser treatment to reduce scars after surgery in collaboration with Paediatric Dermatology.
For palate repair surgery, it is usually done at one year old. If necessary, ENT surgeons will simultaneously perform grommet insertions to prevent associated recurrent ear infection.
Before undergoing their first surgery, infants have to wear a moulding device daily. Consultant in Dentistry & Maxillofacial Surgery Dr Ricky Wong explained that it is to reduce the severity of the deformity in order to improve surgical outcome.
Multiple orthodontic treatments would be arranged for patients after they reach six. “They are mainly to complement surgery at different stages. For example, we may need to widen the maxillary arch to prepare for the alveolar bone grafting surgery, after which we may apply braces to move the dental roots into the bone-grafted area to prevent bone resorption.” Dr Wong added.
For cleft palate patients, the dysfunction of soft palate and pharyngeal wall may cause articulation errors and nasal sounding speech with nasal emission which warrant speech therapy from the age of two. Speech Therapist Yoyo Yiu, together with other therapists, developed Hong Kong’s first Cantonese cleft speech assessment tool during HKCH’s commissioning phase. “Local children have their unique speech problems. This dedicated tool helps us provide more accurate assessment and training direction.”
Acute leukemia is the top childhood cancer. In the Hospital Authority, HKCH is the only centre for treating paediatric acute leukaemia and performing paediatric haemopoietic stem cell transplantation. Besides frontline doctors, the“detectives” in the Division of Haematology under the Department of Pathology work relentlessly on blood and bone marrow samples to identify the culprit behind the diseases.
“When children get very sick without a reason, parents often feel anxious and guilty. Our timely and accurate laboratory reports help attending doctors to confirm diagnosis and formulate treatment plans. Telling parents what is going wrong also puts their mind at rest,” says Dr Jason So, Chief of Service (Pathology) who also heads the Division of Haematology.
The blood and bone marrow of a child suffering from acute leukaemia provide important clues for diagnosis, treatment, prognosis and monitoring after treatment. In the laboratory, team members employ different technologies, from morphology examination under the microscope, chromosome analysis, to the use of advanced equipment to detect traces of cancer after treatment. “As our sick kids require frequent blood-taking and their blood volume is small, we have selected testing platform which requires as little as 1 ml of blood for multiple testing,” Dr So says.
With the help of an advanced flow cytometer, medical technologists are able to classify the exact type of acute leukaemia that is harming the patient, so that doctors can prescribe the right therapy. It is also used for counting the quantity of residual leukaemic cells to evaluate treatment effectiveness and guide further management. “This machine can scan hundreds and thousands of cells in minutes. Even if there is only one cancer cell among 10,000 cells, it can still spot it,” Dr So says.
Dr So described the collective effort of the clinical and laboratory teams in treating patients as movie-making, “A successful movie needs great actors as well as great script, costume design, cinematography and editing. We at Pathology are like those working behind the scene. I find it rewarding to be able to use our professional knowledge and experience to produce quality laboratory reports and crack difficult problems in our patients with the clinical team.”
Although Dr So spends most of his time in the laboratory, he always keeps patients in his mind. “Whenever a child is diagnosed with leukaemia, I feel sorry knowing that another family has to suffer, and that always reminds me to do my best for them.”
The haemopoietic stem cells inside our bone marrow produce all types of blood cells. In acute leukaemias, these cells are either suppressed by cancer cells or damaged by the intensive treatment. While most leukaemias are curable with chemotherapy or targeted therapy, some patients may eventually require haematopoietic stem cell transplantation (HSCT). HKCH is equipped with a stem cell laboratory to support the territory’s only paediatric HSCT service.
In the laboratory, staff carefully process the harvested haemopoietic stem cells, such as removing components that may cause rejection and other serious complications after transplantation. Microbiological culture is also performed to ensure safety.
Stem cells that are not used immediately are stored in a cryogenic container at -190℃ . They will be thawed for use when a patient requires transplantation later.
Haemopoietic stem cells are stored in cryogenic containers filled with liquid nitrogen to keep them in good condition.
The COVID-19 pandemic is causing changes and uncertainties to people’s daily lives and the global political and economic landscape. It is understandable to feel unsettled. Here we would like to share some tips for maintaining psychological health during this difficult time:
May you be well!
Text: Dr Connie Poon, Clinical Psychologist Illustration: Thomas Chiang, Patient Care Assistant
There are many wonderful things in life that make us happy and motivated. Why not capture a moment of “gratitude” with your camera and share with us? All HKCH colleagues are welcome to participate. Your photo may get published in this Newsletter!
Dr Lee Tsz-leung, Hospital Chief Executive
Dr Vansie Kwok, Associate Consultant(Anaesthesiology and Perioperative Medicine)
Ms Miscelle Kwok,General Manager (Administrative Services)
Ms Nerita Chan, Manager (Allied Health)
Ms May Fung,Senior Nursing Officer (Nursing Services Division)
Ms Elaine Ng, Senior Human Resources Manager
Ms Vivian To, SEO (External Relations & Donation Management), HKCH
Ms Haze Tung, EOI (External Relations & Donation Management), HKCH
Ms Sarah Lam, EOII (External Relations & Donation Management), HKCH
Ms Mandy Ng, EOII (External Relations & Donation Management), HKCH
Ms Karis Yau, EOII (External Relations & Donation Management), HKCH
Copyright © 2020 Hospital Authority
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