Tuesday, March 27, 2012

New immigrants from China

Talked with a few other fellow doctors in the recent week and we kind of summarized what we saw in terms of the epidemiology of diseases in these new immigrants. These represent of course, anecdotal evidence and are not backed up by statistical tests[1].

Demographics of these new immigrants

There are basically four groups of immigrants. The first of them would be the ladies aged around 30-40 by now, which corresponds to the time when the vast interest in searching for wife in mainland began. The second, would be the kids that were first raised in mainland and brought to Hong Kong in the past 10 years. The third, would be working people holding the one-way permit, and the last group is the rather old people that were brought to Hong Kong to be cared after. I will focus on the first two groups.

First group of new immigrants: Ladies around 30-40

The major illness that comes in this group is anxiety-depression and female genital tract diseases. It is of no surprises that the prevalence of VDRL positivity and HPV positivity is much higher in this group of people and we are seeing a lot of really young patients with cervical cancer.

For the psychiatric part though, are really the fault of the Hong Kong people - their husband by the time now is already some 60, 70, or 80, and more often than not their husband are of the lower social class, and their health is poorly managed. You see them crippled by illness such as cerebrovascular accident, chronic obstructive airway diseases et cetera and it is really an ever-lasting difficulty for these ladies to care for their husband.

As to the female genital tract aspect however, it is more of a selection bias which I do not attempt to discuss here.

Second group of new immigrants: Kids raised in China

The problem with these kids is mostly psychiatric, and sometimes learning. It is not a surprising thing that students in Hong Kong in the past (during the British rule) has been shown to be superior in terms of their mental capability compared with peers in the western countries.

And our education system, unsurprisingly, is extremely high stress -- our top students (whom, are selected from a population of a mere 7 million) are able to get into the top universities, more often than our mainland counterparts (whom are selected from a country of 1.2 billion). After all, when we say that our medical examination is having so high a standard that it fails half the candidate, do we remember that our HKCEE fails (as in making the student not acceptable to matriculation courses) up to 80% of candidates in the past[2]?

The problem with these kids (or young gentlemen/ladies) is that they find it very difficult to position themselves in Hong Kong, where even local professionals have difficulty in living a reasonably cozy life.They often end up in two routes - one is early psychosis, and another substance abuse. They often do not have enough money and as a result, they will buy what they can afford - ketamine. The street price of ketamine, according to the police who presented in the HA toxicology conference this year, is around HKD$120 per bag, and each bag, could be used by first-time abuser for 5-6 times, thus it is just around HKD$20 per trip. Comparing the experience of two ketamine trips to a so-so lunch in [insert fast food chain here] which would cost you about the same amount of HKD, and without the knowledge of the consequences, I am sure we can understand why these kids would choose ketamine over the lunch.

I guess we can talk about the other two groups in the next few days...


[1] We do, however, have a firm belief that if statistical tests are being done then it has a real high change of being significant although an analysis like this has almost zero chance of passing through the ethics committee...
[2] Of course we understand that the medical doctors are a selected group compared with the relatively unselected group of HKCEE sitters...but anyways, there are three kinds of lies - lies, damn lies, and statistics.

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