What would it take to change the system?

nicolejoy

nicolejoy

Registered User
I've been doing a lot of thinking about the hospital system in Hong Kong - I have had two babies at QMH and my 2nd born has been in NICU for two months tomorrow - so I'm no stranger to the hospital system over here. I know a lot of the policies over here are in place post-SARS in order to be cautious not to spread infection - the nurses were telling me that pre-SARS, kids were allowed to visit in the public hospitals, the visiting hours were much longer and they weren't restricted to only two visitors at a time. During SARS, everything got a lot stricter and it never went back to what it was before. That's what one of the nurses told me, not sure if it's true or not...

Anyway - the visiting hours is neither here nor there to me, but there are two things that "bother" me about NICU...

1) there is no "kangaroo care". I was "lucky" that our daughter was born at term and we were able to hold her for the first time when she was "only" two weeks old. But I see other parents in there with their preemie babies and they've been in there for nearly as long as us, maybe six weeks, but they've never held their babies. But studies have shown that it's good for the babies to be held skin to skin. I don't understand why, with that evidence, Hong Kong doesn't encourage that practice when most other world-class hospitals do.

2) there is no milk bank. Again, studies have shown that particularly for preemie babies, breastmilk is much better than formula - so why not encourage some kind of milk bank to help those little ones get bigger and stronger faster??

The visiting hours are inconvenient, I know, but ultimately it's not that much of a health issues. But the two above issues are something that will likely only improve the "statistics" of the hospital - and I don't get why HK is so far behind the rest of the world in these areas.

I've been thinking of taking those two issues up with the doctors or the nurses or the hospital, but I don't really know who to talk with. I'd love to be able to get some help or support from other people too - because I know that probably one person won't be enough to change the system...

Those two issues don't affect me directly - but I've just been watching other parents with their preemies - and I would love to be a part of something that will help other mums in that situation in the future. And you never know whether that might be you in the future - it could happen to any of us...

So any thoughts? ideas? suggestions?? Anyone ever had a preemie baby in HK? What were your thoughts? Or am I just looking at it from "Western" eyes and maybe local parents don't value the same things as I do?
 
Hi Nicole,

I would definitely support you in asking for things in "the system" to be changed. I had twins at 32 weeks and was not able to hold them even though they were able to be bathed. I have since studied a lot about the benefits of touch especially in premmies and can't believe that QMH does not explain how parents can best help their babies.
I was also in the hospital for ten weeks on bed rest so was very frustrated with the visiting hours and I don't believe that the restrictions should be placed on husbands. It can be a very lonely stressful place if you are alone for 21 hrs a day, especially if you think you will lose a child or as was the case with some women I met there, have lost a child.
It's very hard not to get angry with the staff sometimes, but at the end of the day it is "the system" and it seems daunting to try to change it as one person, but maybe if enough of us got together we could try to open them up to some new ides.

Hope your baby is well and you can see the light at the end of the tunnel.
 
i think you would have to approach the hospital authority rather than the hospital itself. these rules are handed down from "on high" and so the hospital has very little say in the matter, the doctors even less.

good luck!
 
Just curious, but what's the reason that they don't allow preemies to be held by their parents for so long? Before you contact anyone - it may be useful to understand why they have such policies and then argue against the reason for those policy rather than just argue against the policy. Does that make sense?

As for milk bank - I myself am very pro-breasfeeding and wouldn't imagine feeding my child anything else for the first at least 6 months and hopefully up to a year of their lives (did so for 11 months with my first child and hope to do so for a year with my second) - but the reason why there is no milk bank probably has to do with the fact that I don't think the majority of Hong Kongers (i.e. the locals) would use it. I don't think that locals would go for the idea of feeding their child someone else's breastmilk. It's just not part of the local culture. That doesn't mean that people don't think breasfeeding is good - I think they would just have a hard time giving someone else's breastmilk to their child.
 
FutureHKmom - my husband said the same about locals probably not wanting to feed a baby someone elses breastmilk, but I thought surely if their baby was born at 28 weeks and they were told that the chances that the bub would make it were only about 50% (I think that's the right statistic), surely they'd want to do ANYTHING to make that statistic better?? I don't know - again I know I'm looking at it from my Western point of view... I can understand people not wanting to feed their perfectly healthy three month old someone else's breastmilk, but a sick preemie who needs every chance he can get??
 
I went to antenatal classes at UCH, and there, they do encourage skin to skin contact and breastfeeding. As I delivered in at Union Hospital instead, I don't really know how supporting they really are... But in Union Hospital, they don't do that. I had my baby through C-section, and after the birth, I didn't get to see him again till the next day, when I was able to get down from bed and go to the nursery room to breastfeed him. Of course, as I was in a private room, I could room in with him and do the skin contact by my own.

About milk bank, I do agree with FutureHKmom. I think HK people would probably prefer to give their babies formula rather than someone else's milk. Also, even when the government is promoting breastfeeding, I don't think the percentage of people that really breastfeed is that high. The other day I was in a elevator when I overheard the conversation of some women saying how the babies nowadays are much smarter than years ago because of the formula. Probably they just saw too many advertisements about formula on TV, magazine, and everywhere. And also due to my recent blocked ducts problem, I went to see the lactation consultants from the public Maternal and Child Health Center, and there weren't really that many people learning to breastfeed, or having problem with breastfeeding. I am also surprised that there are so few private lactation consultant available in Hong Kong.
 
Nicole....hmmm....that's an interesting question you pose....knowing locals, I think they would need a doctor to actively tell them that giving BM to a preemie would greatly increase their chances of surviving. I'm just not sure that the culture for that exists in HK....
 
Hi Nicole

I hope Maddie will be home with you soon. I can't imagine what you are going through emotionally on a daily basis, and then to have the desire to invest emotional energy in 'changing the system'.

I do think that any letters need to be directed to the Health Authority - try to send it directly to the top dog there - maybe google will help.
I would also suggest you send a letter to Dr Margaret Chan - she's a Hong Konger who is now Director-General of WHO. Again, google should be able to help with an address. As WHO recommends breastfeeding for the first 2 years of life, it might be interesting to ask her why HK hospitals don't promote this.

Good luck with your endeavour!
 
i remember after my 2nd's birth, i exclusively breastfed for 6 months. at about 4 months, the doctors were shocked that i was STILL breastfeeding. she said that she thought it was great, it was just REALLY uncommon in hk for mums to feed that long....i also think that locals would be very hesitant to use another woman's breast milk. heck, most of them aren't organ donors either....
 
carang said:
i remember after my 2nd's birth, i exclusively breastfed for 6 months. at about 4 months, the doctors were shocked that i was STILL breastfeeding. she said that she thought it was great, it was just REALLY uncommon in hk for mums to feed that long....i also think that locals would be very hesitant to use another woman's breast milk. heck, most of them aren't organ donors either....
Click to expand...

I also get praised when I tell the doctors that I am breastfeeding exclusively... But people are not always so bad about doing donation... at least they do give blood... but probably most people are still conservative and think that they should die and be buried or burned as a whole.
 
It is really mystifying why the NICU doesn't promote kangaroo care, because the research evidence is now so overwhelming that it saves babies' lives. My guess is that it is a logistical issue. For mothers to spend many more hours with their babies, there needs to be more provision of seating and/or bedding in proximity to babies. Staff will need training. This might require infrastructure changes within the hospital, as well as cost money to train the nurses, and nurses' routines would need to change a lot. But with enough public pressure, maybe they will realise that this is an important issue and that any money spent will be recouped in the future, because of the infants' reduced need for healthcare expenditure in the future. Does anyone know where would be a good place to start with initiating such a campaign?
 
Honkyblues said:
Hi Nicole

I hope Maddie will be home with you soon. I can't imagine what you are going through emotionally on a daily basis, and then to have the desire to invest emotional energy in 'changing the system'.
Click to expand...

I don't really want to invest that much emotional energy in changing the system, but I've spent a lot of time observing the way things happen up there in NICU... and the little one in the bed next to Maddy is about the same age as her, maybe only a week or two younger. The parents are ALWAYS at the hospital, a lot more than I am - they're there when I get there and they're still there when I leave... then they're still there when my husband goes after work too. (must be a first child! If I didn't have an older child, I'd be there that much, probably!!) - but they still have not yet held their baby. Their baby is kept in a box, and they can touch their baby through holes in the side. It's completely crazy, in my opinion...

The baby across from Maddy is probably only about a month old (mustn't have been AS premature as the one next to Maddy) and the parents just held him for the first time this past week...

I don't talk to the other parents, but I observe them... and I "feel their pain" because I'm in a similar situation. But I'm lucky because I can hold Maddy and now I can even bath her... they watch me bath her and I'm sure that it makes it harder for them because they can't even hold their little ones... and I don't think there's any medical reason why they shouldn't be able to.
 
JennyB said:
It is really mystifying why the NICU doesn't promote kangaroo care, because the research evidence is now so overwhelming that it saves babies' lives. My guess is that it is a logistical issue. For mothers to spend many more hours with their babies, there needs to be more provision of seating and/or bedding in proximity to babies. Staff will need training. This might require infrastructure changes within the hospital, as well as cost money to train the nurses, and nurses' routines would need to change a lot. But with enough public pressure, maybe they will realise that this is an important issue and that any money spent will be recouped in the future, because of the infants' reduced need for healthcare expenditure in the future. Does anyone know where would be a good place to start with initiating such a campaign?
Click to expand...

That's a good point - because there aren't that many chairs there (and they are all the hard stackable plastic kind), and not much privacy if you want to do the proper "skin to skin" kind of kangaroo care which involves opening up your shirt and placing the baby on your bare chest.

I think maybe another thing is, the hospital seems so afraid of infection that parents must wear hospital gowns when holding their children. That's kind of the opposite of kangaroo care!
 
hi nicole

our triplets were born at 26 weeks. we did not get to hold them for at least a month and they never encouraged skin to skin kangaroo care. yes, we were at QMH as well.

i hope your dd comes home soon. i am near to qmh if you ever want to meet up and chat, or if the parents of any of the preemies ever want to talk about the NICU tango (one step forward, two steps back.)
 
This is not only a problem in Hong Kong but also in New Zealand. In New Zealand a group of mothers have got together to lobby the government there and formed a group called NUMB, Neonatal Unity for Mothers and Babies, http://www.numb.net.nz/index.html

I think it would need a campaign like this in Hong Kong to change anything. I realise that this seems like a huge thing to do but remember the quote from Margaret Mead
?A small group of thoughtful people could change the world. Indeed, it's the only thing that ever has. ?

Best wishes,
SARAH
 
Hi Nicole,
When my son was in the NICU (born at 30 weeks he was in the hospital for 50days) I found the nurses were very supportive of kangaroo care but only after he was more stable (I held him for the first time at 17days, before that he would just stop breathing so I think it was too dangerous). I had to be the one to initiate it. We did our research and told the nurses that we wanted to kangaroo care our son. For those 17days we just kept telling the nurses, everyday we would go in and ask "is he stable enough to kangaroo care today?" Given the NICU can get very hectic and there is not a lot of space, we improvised by me wearing a button up front shirt that I could undo easily without having to take off my shirt, placing the baby on my chest, and then wearing the purple gown with the ties in the front. for privacy, i would sit facing the wall. Please share this with the parents in the NICU!! Kangaroo care is completely do-able in HK!! You just have to insist on it and be ok with the lack of privacy. They also may not have milk bank but they are very supportive and encourage moms to bring breast milk in for the preemies, they have a room where you can pump/breastfeed right across the hall, I would often spend the nurses shift-change periods in there pumping so I wouldn't waste the visiting time I had while at the hospital. Same goes for getting there early to pump, you can just buzz in and say you want to pump milk, even if it's not visiting hours.

For new parents, i think it's hard to challenge the hospital but I think regardless of where you are in the world, patients need to speak up about what they want for their health care. A lot of it comes down to liability. They just want to limit the chances for accidents to happen. Going through the HK system, we found that we had to be very vocal and strong about what we thought was best for our son (hard for new parents in NICU, you're just so worried about your baby and don't want to do anything wrong), if one person says 'no', you just have to keep asking and insisting - sometimes sounding like a broken record. we also found talking to the head nurse and getting the Drs to talk to the nurses for us, helped. Once a Dr. has agreed and they write it down in the charts, you will find the nurses will be more helpful - seems like they just don't want to do anything to get in trouble, especially the younger/newer nurses.

The other thing we found was if we were hands on, the nurses welcomed the help. I would always ask if I could do it, be it holding the feeding tube, changing diapers, etc. I would just watch how they nurses did things and then would copy and ask if I was doing it right, in this way we became part of their team instead of a hindrance (for lack of a better word) to their system. They are just so busy in there, especially when its a full house, all those little babies fighting to survive... Things like occupational therapy, when the therapist was there doing the exercises, I would ask the therapist to teach me so I could learn the technique and do it by myself, this way I could make sure he was getting therapy a few times a day versus the once a day that was scheduled. It's tough having a sick child, you really need to become a specialist/advocate for your child.

Glad to hear you're doing ok, hugs xx
 
sorry forgot to mention that we too were at QMH. They have a premature baby support group that the parents can join for emotional support either by phone or in person, this was very helpful for us to hear others' experiences and to find out that the kids were grown and ok now. (Dimsum Mum, thank you to you also for contacting me during those difficult times!!) I am also available to meet up with any of the NICU parents if you or anyone wants to talk.
 
I had a big long talk with the head doctor up there today about some of my personal frustrations and he was SO helpful. Apparently, the visiting hours used to be from 8am til 8pm but they've just been reduced to 3pm to 8pm recently. I can never stay later than 5:30 because I have another daughter who eats around 6:30pm and is in bed by 8. The visiting hours and the "strictness" of everything is the hardest thing for me. But you are right, the doctors do really listen if you're assertive enough... (hopefully they'll be able to work a way for me to be able to go outside of visiting hours because I would love a bit more flexibility in when I can go up...)

My daughter's already been in NICU for over 2 months and we're looking at minimum of another 2 months it seems - so I think given that, they're a bit more "willing" to bend the rules for us...

They have already bent the rules a couple of times - the "best" time was when they allowed my 23 month old in to meet her sister for the first time. But if I hadn't have pushed for that, I wouldn't have gotten it...

I just wish for the sake of new parents that there would be things that were a given rather than something that they have to push for. When I was talking to the doctor today, I mentioned that the system there makes the parents feel more like visitors than parents - and being a generally non-confrontational person (unless really pushed), I wish that I wouldn't HAVE to fight for some of that stuff... and I know that there are other people up there who probably feel the same.
 
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