More resources needed to improve ‘grossly inadequate’ health services for skin disorders in Hong Kong, dermatologist warns

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To veteran dermatologist Tommy Luk Nai-ming, a 23-year-old Hong Kong woman’s suicide note last month saying her eczema left her feeling she would be better “dead than alive” underscored how distressing skin disorders could be.

“Skin diseases can lead to many psychological problems,” said Luk, who retired in 2015 after spending more than 20 years treating skin conditions in Hong Kong’s government hospitals and clinics.

It was not known if the woman – whose parents were also found dead with stab wounds in their home – received treatment from the public sector.

But to Luk, it was a stark reminder of the need for more resources to develop public dermatology services, which he described as “grossly inadequate”.

To give the poor and elderly a “helping hand”, the 64-year-old provides free consultations and runs the non-profit Hong Kong Dermatology Foundation to raise awareness of skin conditions.

Luk, a former senior medical officer with the Department of Health, proposed restructuring the department’s Social Hygiene Service, under which dermatology services and treatment of sexually transmitted diseases are lumped together.

This is common in some countries but other developed economies, such as Britain, have made dermatology a separate medical service.

Doing the same in Hong Kong would mean the specialty received targeted resources and this would improve treatment options for disorders, Luk said.

“The department has placed a higher priority on sexually transmitted diseases … as they are infectious diseases,” he said, agreeing that curbing the spread of such diseases was critical.

But he stressed that proper treatment of skin diseases, which might be misunderstood by some people as being for cosmetic purposes only, was equally important for patients’ well-being.

Twice a week the foundation’s clinic in Yau Ma Tei, Luk offers free skin consultations to underprivileged patients referred from partnering non-governmental organisations, including those serving the elderly or people with intellectual disabilities.

More than 440 patients have benefited since the free service started in 2016.

Luk said there had not been much progress in treating skin diseases in the public sector; for instance, the options were roughly the same now as about 20 years ago. Yet there are more than 2,000 skin diseases and, globally, there have been advances in how they are understood and treated, he added.

Last year, more than 236,000 patient attendances were recorded at clinics under the Social Hygiene Service unit for skin problems while the number was over 86,000 for sexually transmitted diseases.

Only about 30 doctors work in the unit but they do not treat HIV/Aids patients who are handled by the department’s Special Preventive Programme.

A patient could wait more than three years to see a doctor.

Meanwhile, only two public hospitals – Prince of Wales and Queen Mary – have their own dermatologists working there.

Dr Leung Sze-kee, president of the Hong Kong College of Dermatologists, said ideally the two services should be separated in the long run, but the unit needed more doctors first.

“There would be even less manpower for dermatology if the current two services were separated in the public sector,” Leung said.

Private dermatologist Dr Kingsley Chan Hau-ngai said a public-private partnership scheme could be introduced to provide public patients with better access to skin services.

The department said it planned to increase the number of doctors in the Social Hygiene Service unit this year to improve treatment for those with severe psoriasis and other serious skin diseases. However, it had no plans to split the dermatology and sexually transmitted disease services.

The Food and Health Bureau said it would continue to monitor the service’s manpower and enhance its provision as appropriate. The Hospital Authority said it would work closely with the department to explore the strengthening of specialist training in dermatology and service provision in public hospitals.


Markets have ‘never seen anything remotely similar’ to a no-deal Brexit, strategist warns

It’s unclear what EU can do to deflect danger of UK’s Brexit turmoil, says analyst

It’s unclear what EU can do to deflect danger of UK’s Brexit turmoil, analyst says   3:42 AM ET Mon, 19 Nov 2018 | 02:42

Market participants are finding it extremely difficult to fully appreciate the risk of the world’s fifth-largest economy being thrust into the unknown post-Brexit, one strategist told CNBC on Monday.

His comments come at a time when British Prime Minister Theresa May is fighting for her political survival, after a draft divorce deal with the EU prompted a flurry of government ministers to resign.

Moritz Kraemer, former chief sovereign analyst at S&P ratings agency, told CNBC’s “Squawk Box Europe” on Monday that, at current levels, it is clear markets remain underprepared for the prospect a no-deal Brexit.

When asked whether sterling and Britain’s FTSE 100 index accurately reflected the risk of a no-deal scenario, Kraemer replied: “No, I don’t think so.”

“This is not fully incorporated, partly because markets understandably have a very hard time (trying) to assess what this would actually mean … We have never been through anything remotely similar,” Kraemer said.

A no-deal scenario is generally considered to be where the U.K. crashes out of the EU without any formal relationship and has to rely on WTO trading rules.

The U.K. currency has largely been viewed as a barometer of fear during Brexit negotiations, with sterling suffering steep losses against the dollar last week amid heightened political turmoil.

On Monday afternoon, sterling was down around 0.1 percent against the dollar, trading at around $1.2831. The British currency was as high as $1.3176 earlier this month, before a draft deal struck with the EU prompted a wave of government resignations.

Intense scrutiny

The British government unveiled its long-awaited draft withdrawal agreement on Wednesday, which details the terms of the U.K.’s departure from the EU on March 29, 2019.

May is facing opposition from across the political spectrum to the proposed draft deal, which must be approved by Parliament, with critics saying it could leave Britain indefinitely tied to the EU post-Brexit.

In addition to protests from opposition lawmakers, May’s draft Brexit proposal has come under intense scrutiny from many within her own Conservative Party and, crucially, from members of the Northern Irish party which props up her minority government.

Theresa May, U.K. prime minister, gestures as she delivers a speech to the Confederation of British Industry (CBI) annual conference in London, U.K., on Monday, Nov. 19, 2018.

Jason Alden | Bloomberg via Getty Images
Theresa May, U.K. prime minister, gestures as she delivers a speech to the Confederation of British Industry (CBI) annual conference in London, U.K., on Monday, Nov. 19, 2018.

In response to May’s proposal, Britain’s Brexit Secretary Dominic Raab resigned from his post on Thursday, prompting sterling to suffer its worst one-day fall against the euro since 2016.

A junior minister for Northern Ireland, Shailesh Vara, the Work and Pensions Secretary Esther McVey and Suella Braverman, a junior minister in Britain’s Brexit Department, also submitted their resignations on Thursday morning.

Despite mutiny from some members of May’s own party, leading Brexiteers in the cabinet have rallied behind the prime minister.

Relief rally

“We think the risk-reward for U.K. stocks is looking positive here, given the negativity expressed in the market,” Emmanuel Cau, head of European equity strategy at Barclays, told CNBC’s Julianna Tatelbaum on Monday.

“So, if we were to see a soft or no-deal Brexit — which is still our base case as a house — we do think that domestic stocks and FTSE 250 in particular will see a significant relief rally,” he added.

When asked whether sharp declines in domestic homebuilders and some U.K.-focused banks last week should be viewed as an opportunity for market participants, Cau replied: “Yes, absolutely.”

“Our advice for investors is not to overreact … It is going to be a very busy week for the U.K. and Europe in negotiating Brexit.”