Mr. Kwan has been serving in the non-profit sector in Hong Kong for over thirty years. Formerly he worked for an international conservation organisation helping to conserve our precious, natural environment and endangered wildlife species for the benefit of human beings. In 2004, he joined the social welfare sector contributing to the promotion of holistic hospice and palliative care for people living with terminal illness and their families, as well as advocating a positive attitude towards life and death to the general public of Hong Kong. In 2010, he kick-started the project of constructing a non-profit hospice home, the Jockey Club Home for Hospice located in Shatin. With the new hospice home has been up and running, Mr. Kwan moved on and joined Maggie’s Cancer Caring Centre in 2016 to care for people affected by cancer, bringing hope for all those people to live with, through and beyond a cancer journey. Mr. Kwan also serves other non-profit organisations on a volunteer basis. Currently, he is a Council Member of the Asia Pacific Hospice Network, and ReSource The Counselling Centre and Will in Action in Hong Kong.
Tell us about your background. How did you get into palliative care and why did you stay?
Actually, I studied business so I am not a clinical professional by academic background. I started at a Non-Governmental Organisation (NGO) as my first job; so I worked in environmental protection or conservation for many years—over 15 years. And then, because I studied business, I also worked for a number of commercial companies, mostly in marketing or communications.
Just by chance, I was recruited by the Society for Promotion of Hospice Care in Hong Kong, years ago. I started to step into this field of promoting end-of-life care, palliative care, whatever you call it, from that time. I have been working in the healthcare field for almost 20 years.
Once I joined the Hospice Society [Society for Promotion of Hospice Care] in 2004 (if I remember correctly), I attended the Asia Pacific Hospice Society Conference in Seoul. From there I connected with the Asia Pacific Hospice Palliative Care Network (APHN), and very soon I was honored to be elected to the council. From then until now, I have been in this field. In between, I have also worked to promote cancer care.
That is the simplest way to describe it.
You are someone who is deeply involved in the mental health and palliative care scene in Hong Kong. Tell us more about some of the memorable moments you’ve had through the years.
There are quite a number, mostly related to terminal patients and their families because palliative care is about taking care of both the patient and family in a holistic manner. One important thing about palliative care is to fulfill patients’ last wishes and to care for their quality of life during their very last journey.
One thing that hit me was what patients can or cannot eat.
Traditionally, when someone goes to see the doctor, at the end of the appointment they will ask “Is there anything I shouldn’t eat/take?” I think it is especially prominent in Chinese culture. We gai hau
(戒口)—we try not to eat certain foods.
Then, I heard from the palliative doctors and nurses that, during that very last journey, there is nothing that a patient cannot eat. The most important thing is to give them that quality of life instead of trying to maintain their health. At that moment in time, health is the last, last little thing you would be concerned about because you know the patient is walking towards the last part of his or her life. It is more important to keep them happy, and give them that quality of life, rather than telling them, ‘you shouldn’t do this,’ ‘you shouldn’t eat that.’
That’s why one of the services in a hospice environment is to try to fulfill the wishes of the patient. One thing that looks very simple, very minor—that is, eating—and giving them what they want to eat, whether it’s more sugar, more salt, or even ice cream! Never mind, it doesn’t matter; the point is to let them taste the feeling of life, rather than the taste of sweet or sour.
That’s one thing that, at that time, really changed my attitude about caring for terminal patients.
How do you think the COVID-19 pandemic has impacted palliative care in Hong Kong and around the region?
Oh! Of course, it’s the separation.
All the measures for preventing the spread of the pandemic are about maintaining social distancing. At the beginning of the pandemic, people thought that it would, hopefully, only last a short period of time. Everyone was taking many precautions to maintain this social distance. Typically, in a hospital or care home setting, there were very tight restrictions for families to visit their relatives.
Unexpectedly, the pandemic lasted for a long, long time. All these social distancing measures imposed a very, very tough hurdle for families to get together. From this, it led to all the mental issues, all the other issues [aside from physical issues]. But I think it’s more about the social aspect—I think this is the most significant thing. And, of course, the care workers are getting busier, not only to take care of patients with terminal illness, but also to prevent the spread of COVID.
But I think it is getting better—it’s just that people are getting more used to it. It keeps changing, and all the workers in a palliative care setting are trying to adapt to the changes. Now, we have more ways to let families and patients get together. It has improved a bit but is still far from the normal [standard].
What was the most important skill or mindset you have developed throughout your career, and how does it aid you in your work?
I will talk about mindset first.
It’s the way I see life from a different angle. Before I stepped into this field, it was very simple: medical professionals, doctors, and nurses—they are there to cure. But after I got into contact with this palliative care environment, it really changed my attitude towards illness, terminal illness, and end of life.
From there, I understood that curing is not everything about treating a terminal patient. I now know about advanced care planning, advanced directives, and all these types of terms. But before that, I was like many other people—you go to the doctor because you want to cure an illness. When the doctor tells you it’s something you should prepare [yourself for], that it’s not something you can [cure], people will feel very disappointed and frustrated.
But now I see things in a different way. You have to accept it and handle it, and then let go, right? And leave a more beautiful memory instead of fighting for someone that may not [be best.] I think [this mindset] is very important. What I’ve been doing over the past 15 to 20 years is to promote to the general public about palliative care, end-of-life care, and attitudes towards life and death. People have to understand the limitations of life and then how to deal with them. This mindset change [influenced me to] work to promote life and death education.
In terms of skills, it’s about [learning from others]. I learned a lot, and am still learning throughout the years, throughout my career. I meet with different professions and try to understand their languages, understand their thoughts, and try to put them together you know.
Palliative care—it is a holistic care model. It puts together different dimensions of care, and also [brings] different professions together to try to do what’s best for a patient and their family. I’ve been learning to work with different healthcare professionals—doctors, nurses, psychologists, social workers, academics, and even spiritual people. I am still learning.
I have worked with so many people to launch different projects, such as the biennial Asia Pacific Hospice Palliative Care Conference, and all these training programs. From [these initiatives], I have also learned a lot.
[I have also learnt to] be a [good] audience. Initially, I am part of the organising team, but I am also one of the audience. I sit there and listen and learn.
What advice would you give to people wanting to get involved in palliative care?
It’s like most types of charity work: it’s the passion. You have got to have the passion to do things.
Palliative care is a tough job. It’s not easy, facing death—not even your own, it’s anothers’, but you are in between. You see life and death. The most important thing is to have passion, be open-minded, and look at things from different angles.
Death is not necessarily something very sad. Yes, naturally, we feel sad when separated from others. But our role [is to] turn things around. Even if the ending is the same, the process—that’s something we can change. I really like the motto of the Society for Promotion of Hospice Care in Hong Kong. It says: ‘When days cannot be added to life, we add life to the days.’
People who want to enter this field have to know that they are doing something very meaningful, and they have got to contribute their hearts to do this. The reward is, if you can add life to the days of someone, that is something very big.
The [medical] skills and physical things—that’s easy. Just get a medical degree and you can do it! But it’s the heart, it’s the passion—that’s something you’ve really got to prepare.
How do you maintain a work-life balance? Do you have any hobbies or interests outside of work?
I have too many hobbies indeed! I keep up with physical exercise, [doing] a lot, and regularly.
I hike—a lot, almost every weekend. Hiking in Hong Kong is very convenient. Hong Kong is a small place, and we have a lot of hills (I won’t call them mountains, because they’re not very tall..). It’s easy to go out and see nature and enjoy a day out. It keeps me physically and mentally healthy.
Other times, I do lots of other sports. I play badminton. I practice Chinese Kung Fu every week. Sometimes I go to the driving range to play golf. I also meet friends.
These are only a means, not necessary activities. Physical exercise can help you clear your mind. You put down your work, your mind—it is a very good way to destress.
When you hike, you’re sweating, you’re concentrating on the steps to make sure you don’t fall. And social interaction—seeing people, chatting with them about things other than work. [These activities] really allow for you to clear all the [mental and] physical direct inside your body. It’s a very good detox.
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Original article source: APHN