自從2019年三月開展住院服務以來，我們的服務不斷擴展，各方面都取得成果。很高興最近本院團隊和同事獲得嘉獎，肯定了大家的服務水平。
這兩年間，本院接收330多宗癌病新症，以白血病、腦／脊椎腫瘤，及淋巴瘤居首。除化療、標靶治療、免疫治療及放射性核素治療外，我們還進行了70多宗造血幹細胞移植。另外，2020/21 年度的手術宗數比前一年度上升近八成，當中的開胸心臟手術、腦腫瘤切除、唇顎裂修補和腎臟移植等，都屬於超大型手術。
這些數字顯示，我們很多病童本身都罹患危重複雜疾病，治療程序既高難度，亦高風險。在現今醫學限制下，即使醫護人員盡全力亦難以完全避免併發症，或保證治癒。同事不要因此氣餒和動搖了價值觀，應繼續持守專業和幫助病人的心。
同時，我們要體會家長疼愛子女的心情，多作溝通，盡量釋除疑慮。若然病情無可挽救，也透過紓緩治療等支援，陪伴他們安然渡過。醫患互信和合作，確是治療的重要基石。
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醫院行政總監李子良醫生
2021年伊始，香港兒童醫院進行了開院以來首宗腎臟移植手術。患有局灶節段性腎小球硬化症的少年建璋，接受俗稱「洗肚」的腹膜透析約一年半，竟在生日前夕接到醫院電話。「當時覺得有點突然，因為聽過不少病友分享說要等數年才有機會換腎。」建璋隨即入院，通過連串檢查後，翌日黃昏被送入手術室。
香港兒童醫院腎科的顧問醫生馬立德表示，當日接到器官捐贈聯絡主任通知有死者捐贈腎臟後，便與負責做手術的瑪嘉烈醫院泌尿外科團隊溝通，並迅速進行評估，包括捐贈者的腎臟狀況、是否有傳染病、配對輪候名單上病童的年紀、接受透析多久、血型及遺傳密碼等資料。腎科亦同步與院內不同部門商討，為手術全期各流程做好準備，如深切治療部安排病床、放射科進行超聲波檢查、病理科化驗腎臟組織等。
當天前赴本院進行手術的瑪嘉烈醫院泌尿外科顧問醫生馬偉傑說，當處理捐贈者腎臟時，發現連接腎盞的大動脈血管切口並不完整，團隊於是決定花額外時間修補，才接駁至病人體內，減低日後血管收窄的風險。
另外，由於該腎臟比較特別，有兩條血管，增加了手術難度。除要小心分離組織保持血管完整，亦要更準確計劃腎的擺放位置和血管形態，確保移植後能正常運作。他說：「加上患者是青少年，我們希望做得更仔細。」
當日亦有另一段小插曲。當駁通血管後放開手術鉗一刻，新的腎臟即時充滿血色，是一個好跡象，但一分鐘後病人卻血壓突降。麻醉科醫生立刻注輸強心藥及吊液，血壓瞬間回復正常。馬偉傑醫生亦感謝手術室護士的配合，一些臨場狀況亦能迅速應對，令手術順利完成。
換腎之後，建璋只需按時服食抗排斥藥，不用像以前每晚七時開始洗肚，困於房中。馬立德醫生指：「雖然透析治療可緩解末期腎衰竭病童的症狀，但病症本身會影響其他器官和生活質素，因此最理想的還是腎臟移植。」腎科會為每位等候移植的病童訂立治療計劃，令手術達致最佳效果。
香港兒童醫院是醫管局轄下唯一為慢性腎病病童提供腎臟替代治療（包括腹膜透析、血液透析和腎臟移植）的中心。其實醫院早於去年初已萬事俱備，可以進行腎臟移植手術，可惜全年都未等到合適屍腎。馬立德醫生說，現時有20名病童正等候換腎，呼籲市民支持器官捐贈；腎科亦會致力增加移植機會，包括預計於今年開展活體移植，及研究利用三維打印器官模型作術前規劃，希望降低體重門檻，令病童可盡早重獲新生。
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「醫務社工不只是一份工作，更是我人生重要部份，能夠服務小朋友是一份福氣。」本屆醫管局優秀青年獎得主、助理社會工作主任吳子聰（Roy）道。他以一枝行山杖形容自己的角色：「我們陪伴病童家庭走過高山低谷，有需要時撐扶，幫手整理資訊和分享經驗。」
Roy主要負責血液及腫瘤科，難免遇上臨終個案。他表示：「我會盡我所能協助病童及家人完成心願，令他們有多一份滿足，少一份遺憾。」Roy憶起一名父親渴望帶危在旦夕的女兒外出慶祝生日，他便立即與醫護團隊商量如何穩定女孩的情況，再小心翼翼送上輪椅和復康巴士，一起到附近室內遊樂場玩。病童滿足的笑容，就是Roy工作最大的動力。
一個周末，Roy被召回醫院協助家長與一個突然離世的孩子道別，期間家長提出因宗教原因，遺體必須於日落前下葬。當日並非醫院死亡證件辦事處的辦公日子，未能如常辦理遺體認領手續，但Roy鍥而不捨：「當時距離日落只剩約三小時，我們四處詢問並翻箱倒籠找文件，終確認警方可在緊急情況下簽發許可證。」他於是陪家長趕赴警署，同步聯絡墳場職員到醫院準備，最終順利於日落前完成。
香港兒童醫院的醫務社工除了處理經濟援助申請等日常工作，更要深入了解不同兒科病症，掌握病童的治療情況，與跨專業團隊緊密合作，提供最適切支援，同時要處理病童家庭林林種種的問題。醫務社會服務部社會工作主任鍾家寶稱：「我們經常要應付不同危機，如家長突然在病房情緒失控、病童無覆診要登門尋人……工作用一個字來形容的話，就是『急』！」
本院醫務社工是由院方聘用，而非社署調派，因此可長駐崗位，從病童確診一直跟進至治療完成，加強服務延續性，更有助與病童整個家庭建立長期關係。鍾家寶舉例說：「我們會投放資源培訓同事輔導小朋友的技巧，好像利用沙遊治療、畫畫等方法，引導他們講出感受，例如病童的兄弟姊妹會否覺得被忽略？對疾病感到害怕嗎？」
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本院感染控制主任及顧問醫生（病理學部）黃卓凝憑著任職伊利沙伯醫院期間的傑出表現，同樣獲得優秀青年獎，特此恭賀。
造影檢查是不少病童的必經之路。本院放射科與麻醉及全期手術醫學科合力為病童提供安全和輕鬆的環境，拍攝清晰影像以助診斷治療，剛獲醫管局頒發優異團隊獎。
放射科部門主管簡以靈醫生表示：「我們把檢查室佈置得像不同主題的遊樂場，紓緩病童緊張情緒。」曾有一名骨癌病童因痛楚難當，一直不願離開病床。有次他被送到電腦掃描室，被周圍的卡通吸引，想伸手觸摸，團隊乘勢逗他玩和鼓勵他，成功令他轉床檢查，父母感動得當場落淚。
本院放射科服務另一大特色是麻醉科團隊的充份參與。麻醉科醫生除了為病童提供事前評估，更會在場施行鎮靜麻醉，大大提升檢查成功率，病童亦無需在院內不同部門間折騰。麻醉及全期手術醫學科部門主管袁文英醫生稱：「我們會全程監察病童狀況，調校麻醉藥劑量，確保安全及可盡快復原。」部門運作經理莫依丹說：「病童檢查後會由手術室護士照顧，他們可直接於復甦房出院回家，免卻住院的不安，亦可更善用病床資源。」
然而，團隊仍會盡力避免不必要的麻醉。例如，合適的半歲或以下嬰兒可參與「食飽就瞓計劃」，由家長預先調校寶寶的睡眠和吃奶時間，到檢查時剛好吃飽有倦意，便會自然睡着，安定地接受掃描。
簡醫生憶述，曾有一名患黏多醣症的幼童需接受磁力共振檢查，其頸部需要擺放在正確角度才能拍攝，但由於他的頸椎異常，擺動不當恐怕會壓住神經線。為降低風險，團隊希望保持他清醒，若有不適可即時表達。然而，不麻醉又如何令他半小時內不動？團隊於是與物理治療師及遊戲治療師合作，利用模擬器跟他反覆綵排，逐步建立信心，最後真的不用麻醉，令人鼓舞。
輻射對兒童身體影響較大，尤其是一些要不時覆檢的病童。放射科部門經理黎永德稱，團隊成功透過研究，更精確地按病童的體重調低電腦掃描儀的電壓，產生足夠X光射線確保影像質素，同時能將輻射及顯影劑用量減至最低，提升安全。
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啟德海濱公園（香港兒童醫院段）現已開放予公眾。前來覆診、檢查和接受日間治療的病童及陪伴的家人可考慮到公園曬曬太陽，舒展一下身心。同事公餘亦可做做運動，強健體魄。
據建築署介紹，附近一帶原為啟德機場的南停機坪，故此公園設計以航空為主題。仿紙飛機形態的休憩亭、客機造型的兒童遊樂設施，以及入口展示的真飛機螺旋槳，種種元素都喚起大家對舊機場的回憶。
為照顧所有使用者的需要，建築署利用了海濱高低不平的地勢，建造觀景台階及斜度較低且寬闊的無障礙散步徑。兒童遊樂場的「氹氹轉」則鑲嵌在平地上，坐輪椅的小朋友也能參與，共融同樂。
海濱公園屬於公共設施，由康樂及文化事務署管理。至於本院A與B座之間的中央復康花園則屬於醫院範圍，僅供病童使用，並不對外開放。公眾人士途經花園旁通道前往海濱時，請避免進入醫院其他地方，包括花園及室內，以免影響醫院運作及病童治療。遊人可使用祥業街入口的公眾洗手間和育嬰室等設施。
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公園內的欄杆、長櫈和步道全都可化身為健身器材，讓大家一邊欣賞風景，一邊活動筋骨，為身體充充電。
物理治療部提供
長櫈十分適合做腹部鍛鍊，例如這個捲腹動作。緊記集中收緊核心肌群，保持呼吸。
利用欄杆作支撐，伸展四肢，放鬆一下繃緊的肌肉，舒緩日常壓力。
可因應自身能力，沿着海濱散步、急步行或跑步，提升心肺功能。
本院在5月12日國際護士節舉辦慶祝活動。醫院行政總監李子良醫生和護理總經理溫月媚感謝各位護士為醫院及病童作出無私的付出，同時亦勉勵大家，只要上下一心，必定能夠跨越種種挑戰，繼續擴展護理服務。
護士們在繁忙工作中仍不忘求變創新，提升護理質素。護理部當日特別邀請了三位護士分享他們努力的成果和心得，內容包括如何支援心臟衰竭病童過渡至成人醫療、紓緩病童在手術室的緊張情緒，及使用電子系統監察手術失血量。
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本院互聯網站最近獲頒「無障礙網頁嘉許計劃」金獎，表揚其設計能夠照顧不同公眾的需要，傷健人士亦可透過閱讀軟件，便捷地獲取資訊。
本院網頁設有高反差版，圖片和按鈕附設提示文字、字款與背景顏色有足夠對比度，並設有清晰標題等，符合了金獎的24項評審準則。
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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、行政事務總經理郭慧敏、專職醫療行政經理陳娜智、護理部高級護士長馮靜雅、高級人力資源經理吳海寧
杜蘊慧、董潔欣、吳文諾、溫嘉敏、邱雅錡、姚恩
如對本通訊有任何意見，歡迎電郵至 enquiry_hkch@ha.org.hk
網上版請瀏覽 www.ha.org.hk/hkch
© 2021 醫院管理局版權所有
Since the launch of our inpatient service in March 2019, we have been expanding our services continuously and achieving results on different fronts. It is encouraging to see our teams and staff being awarded recently, which is a recognition of our service standard.
In these two years, HKCH took in over 330 new cancer cases. Leukaemia, brain / spinal neoplasms, and lymphomas were among the top three. More than 70 haematopoietic stem cell transplants were performed, other than chemotherapy, targeted therapy, immunotherapy and radionuclide therapy. We also saw an 80% increase of operations in 2020/21 from the previous year. Examples of ultra-major operations conducted are open heart surgery, brain tumor excision, cleft lip and palate repair, and kidney transplant.
These show that the conditions of many of our patients are complex or critical, involving difficult and high risk treatments. On one hand, we must recognize the limitation of medicine. Complications cannot be completely avoided, and sometimes there is simply no cure no matter how hard we try. We should not feel frustrated or second guess ourselves, but stick to our value and continue to serve patients professionally.
On the other hand, we have to be more empathetic. Communicate well with patients and their families. Prepare them for the possible outcome. Address their worries. For those approaching the end of life, offer support such as palliative care so they can find comfort. These are all important to gain their trust.
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Dr Lee Tsz-leung
Hospital Chief Executive
The HKCH performed its first kidney transplant at the start of 2021. The recipient, Kin-cheung, is a teenager with focal segmental glomerulosclerosis and had been on peritoneal dialysis for a year and a half. Right before his birthday, he got a call from the hospital that changed his life, “I was quite surprised as I heard other patients had to wait several years.” He was admitted right away for tests and sent into the operating theatre the following evening.
Dr Alison Ma, Consultant of HKCH’s Nephrology recounted that upon learning a donated kidney was available, they immediately communicated with the urologists of the Princess Margaret Hospital (PMH) who were going to perform the transplant. They assessed the kidney’s quality, conducted matching of the patients on the waiting list, including their age, duration of dialysis, and blood and tissue compatibility. At the same time, other teams in HKCH prepped to play their parts. For example, the Paediatric Intensive Care Unit would arrange a bed for post-op care, Radiology Department readied for ultrasound scan, and Pathology Department prepared for biopsy tests.
PMH Consultant Urologist Dr Ma Wai-kit recalled that while preparing the donor’s kidney in the theatre, they found the aortic patch incomplete. At that moment, they decided to perform a vascular reconstruction before transplanting the graft kidney to the patient to prevent future stenosis.
The operation was further complicated as the donor’s kidney had double arteries. The surgeons exercised extra caution when trimming off the surrounding tissues and keeping the vessels intact.
The kidney also had to be placed in the body very accurately to ensure it would work properly. Said Dr Ma, “The patient is young with much time ahead of him, so we tried to perform everything as detailed as possible.”
When vessels were unclamped, the transplanted kidney instantly turned red, indicating normal blood flow. Right when everyone was about to breathe a sigh of relief, the patient suddenly developed hypotension. Anaesthesiologists injected cardiotonic drugs right away, and his blood pressure quickly normalised. Dr Ma also thanked the nurses for their swift response which helped make the operation successful.
After the transplant, Kin-cheung has to take immunosuppressants regularly, but is no longer tied to a dialysis machine at home every night. Dr Alison Ma explained, “Kidney transplant is the best curative treatment for end-stage renal diseases. Even with dialysis, patients may suffer from other related conditions and a compromised quality of life.” The Nephrology team has individualized management plans for patients enlisted for transplant to ensure the best surgical outcome.
The HKCH is the only HA hospital offering chronic renal replacement therapies for children (including peritoneal dialysis, haemodialysis and kidney transplant). The hospital’s transplant service was ready to commence early last year, but unfortunately, there had not been any matching cadaveric kidney until this case. At present, there are 20 paediatric patients waiting for transplant. Dr Alison Ma appealed to the public to support organ donation. At the same time, her team is exploring innovative methods to help more patients and reduce their transplant waiting time by using 3D-printed organ models to assist surgical planning for smaller children. The first living related transplant is also expected to take place this year.
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“Being a medical social worker is more than just a job, but an important part of my life. It’s a blessing to be able to serve children,” said Assistant Social Work Officer Roy Ng who just won the HA Young Achiever Award. He thinks of himself as a hiking pole, “We walk through the ups and downs with patients’ families. We help sort out information and share experiences to lift them up when they need it.”
Roy mainly takes care of haematology and oncology cases, and inevitably comes across some terminally ill patients. He said,“I try my best to help patients and families fulfill their last wishes without regrets.” Roy recalled a girl whose life was at stake, and her father was longing to bring her out for birthday. Roy quickly gathered the healthcare team and worked out a plan together to stabilize her condition and transfer her onto a wheelchair and rehab bus to a nearby indoor playground. Seeing the smile on patients’ faces is Roy’s biggest motivation.
On one weekend, Roy was urgently called back to the hospital to help the parents of a child who suddenly passed away. They raised that the burial must be done before sunset due to religious reasons. However, the death documentation office was closed, so the body could not be claimed with usual procedures. Yet, Roy did not give up, “There were just about three hours left. We asked around and searched everywhere, and finally confirmed that the police could issue a permit under urgent circumstances.” He then rushed to the police station with the parents while contacting the cemetery staff to stand by. It was completed by sunset at the end.
Apart from routines like handling financial assistance applications, the medical social workers at HKCH need to have a thorough understanding of different paediatric diseases and treatments, and work closely with interdisciplinary teams in order to provide the best support. Urgency is another feature of their work. Karre Chung, Social Work Officer of the Medical Social Service Unit said, “We deal with crises all the time, from calming parents who have a sudden breakdown, to searching for patients who don’t show up at follow-up appointment.”
All medical social workers in the unit are specifically employed for HKCH and do not need to rotate. This allows them to see through the whole treatment journey, which enhances service continuity and rapport building with patients’ families. Ms Chung explained, “For example, we could allocate more resources to equip colleagues with child counselling skills, such as sandplay therapy and drawing that help children express themselves, like feeling neglected when all the attention goes to their sick siblings.”
Congrats to our Infection Control Officer and Consultant (Pathology) Dr Sally Wong. Her performance in her previous post at the Queen Elizabeth Hospital has earned her the HA Young Achiever Award as well.
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Undergoing imaging examinations is a common experience for many patients at HKCH. Acquiring clear images is crucial for their diagnosis and disease monitoring. The Department of Radiology and the Department of Anaesthesiology & Perioperative Medicine work together to provide a safe and fun imaging service, and they have recently been recognized with the HA Merit Team Award.
“To ease patients’ anxiety, we have decorated our examination rooms like amusement parks,” said Dr Elaine Kan, Chief of Service of the Department of Radiology. Once there was a child with bone cancer who had been refusing to leave the bed because of pain. When he arrived at the CT scan suite, he was mesmerized by the cartoon characters around. The team then entertained and encouraged him, and finally got to transfer him to the examination table. His parents were moved and burst into tears.
Another distinctive feature of the HKCH radiology service is the heavy involvement of anaesthesia team. Prior assessment and onsite sedation are provided by anaesthesiologists, which increases success rate and saves patients’ hassles from moving around different hospital departments. Dr Vivian Yuen, Chief of Service of the Department of Anaesthesiology and Perioperative Medicine said, “We will closely monitor patients’ condition during the process, and adjust the sedatives to ensure safety and quick recovery.” Department Operation Manager Mok Yi-tan supplemented,“After the scan, patients are put under perioperative nurse-led care, and can be discharged home directly from the recovery room without hospitalization, which helps reduce bed occupancy.”
Yet, different measures are in place to avoid unnecessary sedation. For example, suitable babies up to six months are put on a “feed-and-sleep” programme. Parents are instructed to adjust the feeding and bed time before an exam, so that the babies would feel content and fall asleep naturally.
Dr Kan quoted the case of a young patient with Mucopolysaccharidosis who needed an MRI. Due to abnormality of his cervical spine, there was a high risk of nerves compression if his neck was positioned incorrectly. Therefore, it was preferred to keep him awake during the 30-minute scan so he could express any discomfort. Physiotherapists and play therapists were brought on board to help. After repeated rehearsals using a simulator, the boy felt confident and stayed calm without any sedation.
Radiation exposure may have a bigger impact on children, especially for those requiring repeated scans. Mike Lai, Department Manager of the Radiology Department said the team has conducted studies to minimize radiation and contrast medium doses through optimising scanning parameters based on patients’ body weight, without compromising image quality.
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The Kai Tak Promenade (Hong Kong Children’s Hospital Section) is now open to the public. Patients and their families coming for follow-up consultation, examinations and day treatments may consider visiting for relaxation. Staff could also exercise here after work to keep fit.
According to the Architectural Services Department, an aviation theme was adopted as the area used to be the south apron of the former Kai Tai Airport. One may recall memories of the old airport when stumbling upon the pavilion that resembles an origami plane, the flight shaped children’s play equipment, and a real aircraft propeller at the entrance.
Leveraging the uneven terrain, a viewing platform and a gently-sloped, wide walking path are built to cater to all users. The children’s play area is also designed inclusively. For example, the roundabout is embedded in the ground, so children in wheelchair can also join the fun.
The promenade is a public facility which is managed by the Leisure and Cultural Services Department. The hospital’s central rehab garden, however, is exclusive for patients and not open to the public. While visitors can access the promenade through the path adjacent to the garden, they should refrain from entering the garden and indoor areas of the hospital, so as to avoid affecting hospital operation and patients under treatment. There are public toilets and baby care room at the Cheung Yip Street entrance for visitors to use.
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The promenade can serve as an outdoor gym with soothing waterfront view. Railings, benches and walking trail are all ready-to-use fitness equipment for a nice workout!
By Physiotherapy Division
Long benches are perfect for training your core muscles, like this curl-up exercise. Remember to maintain proper breathing while keeping your core tight.
Experiencing muscle tightness after a long stressful day? Take a break and stretch your body by using railing as support.
Strolling, brisk walking, or jogging along the promenade are great ways to enhance cardiovascular fitness.
An event was held on 12 May to celebrate International Nurses Day, during which the Hospital Chief Executive and General Manager (Nursing) expressed gratitude to all nurses for their selfless dedication, and encouraged them to overcome future challenges in a united effort.
Despite busy clinical duties, our nurses strive to enhance patient care through innovative ideas. Three nurses were invited to share their team effort in cardiology transitional care, easing patient anxiety, and electronic intraoperative blood loss monitoring.
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The HKCH website received the Gold Award in the Web Accessibility Recognition Scheme recently. This recognizes the hospital’s effort in developing a website accessible to all users, and enabling people with disabilities to obtain information easily, such as by using a screen reading software.
The website has met 24 judging criteria including adding text descriptions to images and buttons, ensuring enough colour contrast between text and the background, and setting clear titles.
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Chairperson: Dr Lee Tsz-leung, Hospital Chief Executive
Members: Dr Vansie Kwok, Associate Consultant (Anaesthesiology and Perioperative Medicine) | Miscelle Kwok, General Manager (Administrative Services) | Nerita Chan, Manager (Allied Health) | May Fung, Senior Nursing Officer (Nursing Services Division) | Elaine Ng, Senior Human Resources Manager
Editorial team (External Relations & Donation Management): Vivian To, Haze Tung, Mandy Ng, Kyra Wan, Karis Yau, Yannis Yiu
Please send comments and suggestions to enquiry_hkch@ha.org.hk
Read online copy at www.ha.org.hk/hkch
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