Interview of Prof Joseph Sung – Hong Kong SARS Epidemic Ten Years On

As consulted with the Commercial Radio of Hong Kong (香港商業電臺, the Cantonese to English transcription of the interview does not breach copyright law.

Interviewers: May Chan, Loh Fai (transliterated)
Interviewee: Dr Joseph Sung (沈祖堯), vice-chancellor of Chinese University of Hong Kong
Date: March 9, 2013

Interviewer: Good morning. (Good morning) Mr Loh, things changed a lot in ten years. It has been ten years since the outbreak of SARS epidemic. And for Hongkongers, the ten-year mark means differently to them. I remember ten years back we were interviewing Dr Sung, then serving at CUHK Department of Medicine & Therapeutics. When SARS broke out at the 8th floor of Prince of Wales Hospital, and we interviewed Dr Sung. And about same time ten years later, we are again interviewing him. But he is of different status today.

Interviewer: Today Dr Sung is the vice-chancellor of CUHK. Good morning, vice-chancellor. (Good morning, vice-chancellor)
Interviewee: Good morning to both of you.

Interviewer: Prof, on what matters do you feel very deeply, when looking back at SARS epidemic ten years ago?
Interviewee: Recalling ten years back, it was as if I had had a dream. Within such a short period of time, a large number of individuals fell ill, many among them were our own friends and colleagues. And there were medical staff members who died in the course of performing their duty. I saw Hong Kong society suffered from a severe setback. Looking back right now, it is as if something happened just yesterday.

Interviewer: Do you still recall the incident in these ten years? Even if you are not yourself recalling the matter, other individuals and media members would have mentioned it to you.
Interviewee: Yup. The matter is still much talked about among the public. And I myself still keep in touch with the patients back then, and some of them have become my friends. Some of our students fell ill during the outbreak, and some of them are now working as doctors or even consultants. Some of them would say:“Oh ya, back then I was lying on the hospital bed.” People still recall of those memories.

Interviewer: I remember when we went to interview you ten years ago, SARS epidemic had just broken out. And some medical staff were infected at ward 8A and thus admitted for treatment. It was ten years ago… After mid or 20th of March. When we went to Prince of Wales Hospital, you said students, staff and patients were among those who were infected. And your team were still positive about the treatment, and steroids were thought to be effective. That time you still had some hope, but that point in time was still not the worst situation yet.
Interviewee: Yup. The situation was as if ‘touching the stones while threading the river’. When we moved one step forward, we thought it would be fine, but other problems popped up. Be it treatment or preventing infection, we had the same challenges. Initially, we thought putting on a mask or a protective clothing would keep us safe. But we found more and more individuals being infected. Which was why we had to put on more clothing. Not only you were changing clothes, you had to put on a cap, a pair of boots, or even goggles. I remember even when you put on a pair goggles, you still need to put on another protective piece meant for wielding workers. And you need a piece of rubber to block your face, because we found that some nurses were infected – just because patients coughed in front of them. Such was the very challenging situation back then. When you come face to face with a disease which you had no previous knowledge at all, we had to observe and decide our next step in treatment and disease prevention.

Interviewer: You mentioned about ‘touching the stones while threading the river’. Did you feel like the river is kind of too long in that the challenges were insurmountable?
Interviewee: Yes, indeed. I still remember vividly. On the 10th of March, we saw an outbreak in the hospital. Until end of March our colleagues were recovering, and we thought things would have pretty much improved. But later on we saw the Amoy Gardens outbreak, and we had to reallocate the wards to take in more patients. And things improved a bit. But when it comes to May, we took in ten patients from the same level of the same apartment in Sha Tin District. I remember myself was in quite a down mood that day. A reporter took a photo of mine, I was in an elevator with my head down. I thought to myself that time: if another major outbreak were to take place, Hong Kong hospitals – which were fully occupied – could not take in more patients. If another hundreds of patients were to be infected by SARS, we would not have been able to handle it. And we felt the fatigue after working for over two straight months, we toiled days and nights without going home, and putting on those clothing all day long was also tiring. That was the low back then. But fortunately, the new outbreak did not take place.

Interviewer: From March 10th until the death of Dr Tse Yuen-man of Tuen Mun Hospital; she died when performing her medical duty. That time we interviewed you too. We noticed you were quite positive around end of March, but when Dr Tse passed away, you felt so down during the interview. Throughout the several-month struggle with the disease, what is the most significant lesson for you? Did the experience influence your way of thinking as well?
Interviewee: Speaking of influences, it involves many aspects. The most significant one is that I realised human life is so vulnerable. Back then I was slightly over 40 years old; many of my colleagues were 20-odd or 30 years old, Dr Tse belonged to this younger group too. So was late Dr Cheng Ha-yan. They were very energetic and vigorous young doctors, and they were passionate about their work in the hospital. All of sudden they were infected and passed away. The 20-odd or 30 years old colleagues around me were in very dangerous situation, some of their wives brought children over to the main entrance of our hospital. They cried and wanted to know how things were going on – which I didn’t quite know how to answer. Back then I had 20-year medical experience, it was my first time to have experienced a sense of helplessness such as that. Despite the advancement in medical knowledge and medicine, we still couldn’t quite withstand sudden outbreak such as this. Which made me think we should appreciate our lifetime. When you thought you are still young and healthy, when you thought you still have many years to live on, and many plans waiting to be executed – all of these could disappear in the blink of an eye.

Interviewer: You rarely went home that time? (Not dare to go home perhaps) And your daughter wrote you a card. At the same time you were handling the pressure at the hospital to take care of the patients, and you missed your family too. How did you actually juggle well and strike a balance?
Interviewee: Yup. I did not dare to go home in that period of time. There was no Facebook back then; we communicated through emails and phone calls. When I had a chance I would call home, they didn’t call me because they knew I was very busy. I chatted with them; sometimes they sent an email or a photo over. In my book I had a very precious photo – they stood as if soldiers according to height in descending order and showed me a thumb up. It was important for me; and you would realise that the support from your family is what motivates you. If your family members didn’t even care for you, or you were quarreling with them or something else, I guess it would be quite difficult to move on in our work.

Interviewer: Other than encouragement from your family members, what else kept your spirits up?
Interviewee: Support from our colleagues. And very importantly, the support from Hong Kong society. My colleagues and I worked together closely, from breakfast until dinner we were eating together too. Even over the meals we were discussing how our patients were doing. Nobody mentioned about calling it a day; nobody mentioned about taking one-day off after working for six consecutive days. Nobody said that; every one of us knew we had to work everyday, and you couldn’t request for overtime pay or something else. Even some volunteers came on board. They did not belong to the department of internal medicine, some of them were not originally hailed from our hospital. They wanted to offer their help because they knew we did not have sufficient medical staff. Their help boosted our motivation as well. And I am particularly thankful that Hongkongers gave us massive support. On a daily basis I received countless emails, cards and flowers. I have never met or knew them personally. But their massive support was a great motivation for Hong Kong medical staff as a whole. Throughout Hong Kong history, never before did we receive such a great support from the public.

Interviewer: SARS epidemic also broke out in some other places, and some medical staff members were said to be escaping duties. But in Hong Kong, the medical staff were selfless, and their spirits moved many among us. In your teaching later on, how do you teach your students to treat their patients?
Interviewee: It didn’t need to be taught; they observed around and knew what was going on. Among the patients there were medical students who fell ill. They observed how best live up to their professionalism as a medical staff in such situation. Other than nurses, even our assistants in the hospital were helping around wholeheartedly. One of my medical course mate was among the patients. He was working as a private doctor, and when he was admitted into the hospital he was suffering from asthma, and his X-ray results were not looking good. He told me that he saw our assistants – we called them our sisters – walking around in the ward to look out for our patients. They asked the patients what they want to have for breakfast, whether they need to buy toiletries or something else. And the sisters fed the patients. My friend’s comment was that our hospital was full of angels. This is not something that can be taught – it comes from your heart. I wish our students understand how best to live up to our professionalism, even with a little bit of help – that means a lot for the patients. Not that feeding them breakfast, rubbing their body are something relevant to medical work – but still, it offers great comfort in heart for the patients.

Interviewer: But where does this spirit come from? It seems not ostensible in normal days. Sometimes we tend to have noticed something negative and overlooked something positive.
Interviewee: Yup I agree. In usual days you will see doctors and nurses tied up by their work – this and that patients are looking for them, some are urgently calling for them, and they might throw a tantrum or not in a good manner occasionally. But why they performed so well when SARS epidemic broke out? I can’t quite explain that. But I think it is a sense of togetherness to confront a major enemy. And Hong Kong was facing such a severe challenge back then. If we don’t help each other, then that’s it. And I think it was quite sentimental back then. You saw a doctor still doing his or her rounds in the wards yesterday, but today you saw him or her lying on the bed and was actually dying. Everybody was looking out and help one another, and it was quite a sentimental period I would say.

Interviewer: Ten years on, do you think that Hong Kong society as a whole has learned something from it?
Interviewee: I guess we have learned and forgotten something. Back then we were good at keeping our environment clean, and everybody still remembers that our streets became cleaner. And people were cleaning up their apartments and furniture. Even taxis had been cleaned up a lot. As of today, we will notice that our cleanliness was not as good as the past. Sometimes we forgot to wash our hands, some who suffer from fever are still walking around. Back then Hongkongers were united. Our artists wrote and sang a song to encourage our patients. Some individuals bought and sent new masks to hospitals. The unity that we saw ten years ago, it is not obvious today. I wish that we can still unite – even when we are not dealing with another SARS epidemic or major crisis.

Interviewer: Cleaning our desks with alcohol is something we still keep up with though.
Interviewee: Oh really?

Interviewer: Yup. Every morning when we are in the office we would clean up our desks.
Interviewee: Back then the ratio of bleach water was 1:99. You could smell the bleach when in the house.

Interviewer: And in the past when you go to a restaurant they would provide a pair of public chopsticks to give out the food. But now, you have to request for it.
Interviewee: It depends on whether you are visiting an expensive restaurant or an inexpensive one.

Interviewer: In the past both expensive and inexpensive restaurants offered you a pair of public chopsticks. But now, even if you ask for it, they would ask you in return:“Oh ya? You need it?”
Interviewee: People tend to forget things though. Which is why we need a reminder once and a while. As of today, media and the government did keep on reminding us a lot. For example, there are media reports when elder patients in old folks home suffered from a fever and admitted into hospital. It is as if taking a vaccine or a booster – to enhance our immunity and awareness. Lately, SARS cases in Middle East served as such an important reminder. It is an occurrence which took place exactly ten years after (Hong Kong SARS epidemic). And the death rate stood high – almost 60 per cent. Although the infection rate is not as serious, but I think everybody is still afraid – is it a ‘coming back’ after ten years? I guess it serves as a good reminder.

Interviewer: Speaking of the new disease, how much have you all understood of it?
Interviewee: Through World Health Organisation (WHO) we received information from Middle East and the United Kingdom. And at Prince of Wales Hospital, Dr Hui, the dean of Tuberculosis & Chest Service is also a committee member of WHO, so we are getting first-hand information. Such as the symptoms, is it infectious among humans, and more importantly we want to know the source of the disease. But as of today, what animal was actually the source of the disease? What environment triggered such disease? We don’t quite know about it. Speaking of symptoms, they are similar to SARS ten years ago. And there might be even more challenging situation. For example we saw patients experiencing weaker kidney function. And as we have mentioned, the death rate stood high. Since WHO can now give out samples to laboratories worldwide so that they can get ready earlier. Which is why we get our quick test ready. If a person returns from Middle East, and his or her lung disease symptoms are similar to SARS, we could spare with our guessing. We can quickly run a test to ascertain whether it is coronavirus or not.

Interviewer: Is the medicine treatment doing better right now?
Interviewee: This is not something we can say for sure. Even until today, we can’t say that a certain medicine is proven effective – including medicine that we used in 2003. Or some new ones such as Protease inhibitors. Up until now, we still don’t have concrete evidence to prove its effectiveness.

(After break)
Interviewer: Good morning.
Interviewee: Good morning.

Interviewer: Joining us today in the studio is vice-chancellor of CUHK, Dr Joseph Sung. He was named ‘Asian Hero’ by TIME magazine for his outstanding contributions during SARS epidemic ten year ago. As we mentioned just now, SARS epidemic broke out ten years ago, Hongkongers were united – a spirit which we are looking to carry on. As a vice-chancellor of a university, and you taught in medical school as well. Looking at the students today, are there any differences if compared to the medical staff who were fighting the disease ten years ago?
Interviewee: As time passes by, students and medical staff of today are different from their seniors in the old days. Looking at my experience as a student and a young doctor, in the past we enjoyed doing major surgeries and trying new medicine. We didn’t really mind if we need to report to work at the hospital at 1 or 2a.m. Or a surgery extended after 5p.m., we had to stand and work until 11p.m. before we could go home. But we were excited; we used to ask our senior or veteran doctors – when can I conduct a surgery? We were asking for more work from them. But now, from what I have been told, the students care more about whether they can go off at 5:30p.m., or whether they can take one day off because they had a longer shift yesterday. The difference is that they care more about quality of life – they think about where to go after work. But in the past, we tend not to think about that; instead, we always wanted to learn more as fast as possible so as to upgrade ourselves in our medical work.

Interviewer: This is not a phenomenon exclusive to medical schools. The society is talking about work-life balance; people think that life is not about working all day long. As a vice-chancellor, how would you tell your students?
Interviewee: It is not wrong if you want to have a balanced lifestyle. But if we are so obsessed with such matter… In fact, throughout our journey in life, we will surely come across a period of time whereby we need to roll our sleeves up and work hard, and we might still need to think about our work even when we are home at night. That is how we can build a career and acquire our capability. If you started thinking about quality of life at a younger age – how to enjoy life, how to lead a stable life – I think this is something which hinders our development. Not that I am saying that it is wrong if we are looking for steadiness in life – but if since your graduation you told yourself you merely want a steady job so that you can lead a stable lifestyle, and you will be very happy if you can buy an apartment. That way, we are lack of a sense of risk-taking and creativity. And I am afraid that the society as a whole would hardly improve itself.

Interviewer: Is that an attitude normally seen among Hong Kong students?
Interviewee: Of course I don’t have a data of that. But from what I observed when I was chatting with our students, I always heard something like ‘how nice would it be if I can find a job which requires not much hard work’. Or we tell our students we have an internship for them, but it requires them to go further such as Guangxi of China. And they replied:“It is so far away. Can I go to nearer places? Shenzhen should be good, or the furthest I can go is Dongguan. Can I not go faraway places?” They are lack of risk-taking spirit, nor do they want to work harder and endure a bit. In our younger days we were not afraid of taking tougher tasks. But now – maybe the parents don’t want their kids to go to a faraway place. And they find Hong Kong such a convenient and comfortable city to live in. They are lack of risk-taking spirit.

Interviewer: On your webpage you mentioned about your visit in Israel. And you interacted with the university chancellors and students. They are very different from Hong Kong students.
Interviewee: As we all know – Israel is such a long and narrow country. If you drive from the east to the west, it takes you less than two hours to reach the seashore. I think the Israelis have a great sense of emergency as they see bombs throwing over their roof everyday.

Interviewer: And they are surrounded by their enemies.
Interviewee: Yup. They have enemies around them and nobody else can quite help them. But that trains them to struggle and survive – otherwise they would have been eliminated by others in the world. Which is why Israelis are willing to go the extra mile. With a bit more of effort, they are looking to invent something new, or create a new career. When outsiders understand what is going on in Israel, they are willing to invest their money in small businesses in Israel. Investment fund of venture capital – if you talk about per capita, theirs is 2.5 times greater than Americans’. It has a tiny population of seven million people, about the same as Hong Kong. But they have money pouring in, and their venture capital is thirty times greater than Europe’s. Look at the European society which is so obsessed with comfort and relaxation – and compare with a tiny country which is always worrying about being invaded by others, you will see the difference which started from the sense of emergency. Of course the Jews have their own tradition, and others said they are smarter. But I don’t see that as the most important factor; they have the other thing (sense of emergency) instead. Back to Hong Kong, when we look back – say 1950s and 1960s – we had such a great sense of emergency. We didn’t have water or other natural resources. Our forte was setting up factories and manufacturing this and that product. But everybody was working really hard. As of today, we have much better quality of life compared to the 1960s – kids no longer need to study at the rooftop, and education and medical services are great. In the past people had to queue for hours outside Violet Peel Health Centre General Outpatient Clinic. And in a slower manner we have lost the sense of emergency. We have always lost the spirit that we have to struggle and work really hard to make a living.

Interviewer: But how are you going to teach your university students?
Interviewee: I want our students to look further and look outward. Hong Kong students tend to care for only what’s going on in Hong Kong. Not quite that level sometimes – they care for what is happening on Facebook website. What are those matters about? This or that friend went to the Ocean Park, or someone had meals and they took a photo and posted it. And they would be very happy. The furthest they look out for is the first few pages of local newspapers discussing Hong Kong news. Anything in a further place we might have no idea about it. Looking at Korea, maybe they are about to fight a war, but when you ask our students, they don’t quite know what is going on. Or you tell them Iran is about to produce nuclear bombs – they would find it such a ‘faraway matter’ and does not concern them. Further still, how AIDS is spread in Africa and how African women suffer from discrimination. They take it as if there is nothing to do with them. I think they should look further, understand what changes are taking place and what needs are emerging in the world, and they should ponder if they can do something in these issues. And it is very important for our students and graduates to have mobility. We wish that our graduates can do their part in many places in the world – not that you only want a 9-to-5 job so that you can enjoy life in Hong Kong.

Interviewer: As universities take in more non-Hong Kong students, does this kind of shaking up our local students?
Interviewee: Not that we can sum up the situation in one single conclusion. For some, if we take in more non-Hong Kong students – particularly those top students from mainland China, they are hardworking and smart – some local students would feel the pressure and take the challenge to try to do better. Another scenario is that local students think that non-Hong Kong students are here to take away my opportunities.

Interviewer: Another scenario of China-Hong Kong conflict.
Interviewee: Another scenario of China-Hong Kong conflict… That these foreign students are here to grab my resources and scholarship and dormitory placement. Even when I am looking for a job in the future, they might take it before I can reach it. Among them there are some conflicts. It should not be that way. When foreign students come in and bring over a sense of stimulation, students should work harder to perform even better. Hong Kong has always been a migrant city. People outside Hong Kong, groups and groups of mainland Chinese came here decades ago to build the Hong Kong that we see today. Which is why we should not have such attitude – that it is best if we don’t have competition from outside, that we should be complacent and be happy with what we have achieved today. That way, Hong Kong will never improve.

Interviewer: Speaking of China-Hong Kong conflicts, you can see that along the train line. From Shueng Shui it starts with milk-powder purchase. And everybody is competing for resources in demand. And this is also a scenario seen in our campuses. How would you advise your students to treat students from other places?
Interviewee: First of all, we should be friendly to them, and try to mingle them into our society and community. Try to learn something from them. As they mingle among us, our culture should also influence them in return so that they can also adapt well in Hong Kong society. Not that they found themselves incompatible with us. Looking back the history of the United States of America, why it became such a great nation? Many said it is a melting pot in terms of culture. Most of the Americans came from outside, many hailed from Latin America and Europe, and now they have more Asians. If you ask – who are the true Americans? You can’t single them out, because they are of such a great diversities. The more successful part of America is that it is a melting pot which mingles every person – no matter where they come from. And they have the opportunity to do what they want to do. If you have a dream and you are willing to work for it, you can then be successful. And I think this is the reason behind many successful nations. As Canada and Australia open up their migration policies, many countries are aware of such scenario – when foreigners come in, they brought over their wisdom and capability. Which is why we should not be hostile toward foreigners. Furthermore, the world is already a global village. I wish young Hongkongers see their peers from a foreign land in this perspective. Don’t treat them as someone who took away our benefit, or that they threaten our survival. We should find a way to mingle well in a society.

Interviewer: In biology they are talking about a species staying put in one place without incoming competition, that would mean doomsday when foreign species are coming over. Because they can no longer compete with others.
Interviewee: Historically, we saw some cities closing their doors to foreign competition, and in a slowly manner they deteriorated. And a well-known example is Venice, which hundreds of years ago served as the most prominent trading port in Europe. Of course today we still like to go to Venice, because it looks like a pretty decoration in a museum.

Interviewer: As China-Hong Kong conflicts escalate, some are even calling the mainlanders ‘locust’. How do you explain to your students when CUHK is about to open its branch in Shenzhen? Would they see it as giving out our resources to the Shenzhen branch?
Interviewee: On my blog piece I wrote about how I identify myself. Wherever I go in the world, I will never deny my identity as a Chinese. The publication of that blog piece prompted lots of criticism. Or some online comments highlighted that ‘we Hongkongers are not Chinese’. Which is kind of different from my point of view – I don’t think we should mix up politics, culture and ancestry. I hope that Hongkongers and mainlanders can tolerate each other, and to adapt each other’s lifestyle and to complement each other’s advantages and disadvantages. Not that we keep on criticising each other. Not that I am saying Hongkongers are entirely in the wrong, because others do have very harsh criticism of Hongkongers too. From the point of view of outsiders, they would find such argument weird. Looking at many countries, they do have their own arguments at home. But when they are dealing with outsiders they are united. The Japanese are such united people. And I hope that our mainland and local students can tolerate each other. In our campus, ten per cent of the students came from mainland China. When they first came to Hong Kong, there weren’t many of them, and they had no choice but to mingle with Hong Kong students. But when their number reaches the ten per cent mark, that makes them such a big group – there are now thousands of mainland students at CUHK. They mingle among themselves, they organise their own concerts and parties and activities. They speak Mandarin and sing songs which are different from Hong Kong’s. Which makes it harder for students to mingle together. I wish that mainland students can understand that if they are to develop their career in Hong Kong, they have to mingle in Hong Kong society.

Interviewer: What is the way to let local students and the ten per cent mainland students really mingle together? So that they won’t be alienating each other as if they are two groups?
Interviewee: We want some activities to really mingle them together. Firstly, when students attend orientation we hope they are playing together. But the local students thought it difficult, for the mainland students can’t understand Cantonese jokes in Mandarin. Which is why they won’t laugh and play along. But our point of view is that students should eat together, you share the dormitory, and later you will mingle. From orientation we already want them to mingle well, and we want them to share the same dormitory. And we want them to work together during service trips so that they can learn from each other. In the aftermath of Sichuan earthquake, I brought my students to render our assistance, among the CUHK students there was a Sichuan student. It was fortunate to have him, without whom we wouldn’t understand their local dialect. Even looking for a washroom would be quite hard, much less communicating well. He was a very open person; he led Hong Kong students to mingle into a farming community in Sichuan. That’s the best scenario. I hope that more of our mainland students can help us on such matters.

Interviewer: Not too tough perhaps? All you need is a change of your attitude.
Interviewee: Yup. Due to personality, some students refused to open up. Through activities and groups we are looking to mingle Hong Kong and mainland and foreign students. So that ours becomes a multicultural campus.

Interviewer: How about the I-Care programme?
Interviewee: It is a concept extended from the values of integrity and moral and aesthetic. In addition to academics, a university should also nurture personal and moral values in the students. So that they learn to take care of themselves and appreciate aesthetics of poetry, music, nature, and environmental protection. It is a development of an all-rounder. Not that you only know accounting and work as an accountant after graduation, not that you are from medical school then you know only medical knowledge. Moral, wisdom, execution, community, and aesthetics – the five ways of life – should be the way to nurture university students.

Interviewer: May mentioned about CUHK Shenzhen campus which is about to open. How is its influence be like?
Interviewee: The campus aims to nurture talents in southern part of China. As many of us know, tertiary education is problematic in mainland; they can’t produce independent and creative graduates, much less nurturing the correct values in them. It is our hope to bring in strong points of Hong Kong tertiary education into mainland. We don’t see it as a branch of our Sha Tin campus; not that you can’t get into the Sha Tin campus then you should go to Shenzhen campus. It shouldn’t be run that way. We should bring the best practices of international tertiary education into mainland to nurture the next generation.

Interviewer: Do you worry about ideologies? Mainland universities have party-appointed officials; would they be somehow hindering your freedom?
Interviewee: In our agreement we don’t have party-appointed officials as university officers. Instead, we have a university council and a vice-chancellor. I believe this is a breakthrough (in mainland), and we wish to replicate the education model of Hong Kong.

Interviewer: Thanks to Prof Joseph Sung, vice-chancellor of CUHK. (Thank you, vice-chancellor)
Interviewee: Thank you.