Monday, December 16, 2013 C7
HEALTH
WORDS OF
WISDOM
Lily Chan’s life was wrecked by mental illness but she used the experience to help others as a peer specialist, writes Elaine Yau
L
ily Chan Lei-hung has had more than enough ups and downs for a lifetime. She’s has gone from working as a business development manager for a publicly listed American company, to being an unemployed divorcee battling bipolar disorder. Chan certainly knows how mental illness can destroy your life. But she never thought that her mental illness, which at one point drove her to the edge of suicide, would also paradoxically give her a lifeline. Chan, 46, is the first person with a mental disorder employed by the Hospital Authority to work as a full-time counsellor. The peer specialist scheme was launched two years ago at Castle Peak Hospital as a way to boost the recovery and rehabilitation of mental patients. The peer specialist programme follows in the footsteps of Western hospitals, according to Dr William Chui Wing-ho, associate consultant with Castle Peak Hospital. “I went to Holland before the launch of the scheme. I saw that the scheme could reduce hospital use and boost illness management there,” he says. More than 30 US states have launched peer specialist programmes, according to a recent report in Stateline, a publication of US-based nonprofit The Pew Charitable Trusts. People with mental illness who are helped by peers tend to have more longer-lasting recoveries. According to the Hospital Authority Mental Health Service Plan for Adults 2010-2015, the number of people with a mental disorder in Hong Kong is estimated at between one million and 1.8 million. Chui says the life experience that a peer specialist gains in overcoming mental illness is something professionals can’t get from training.
“[Chan] is better than us in this respect,” says Chui. “Her empathy and first-hand understanding of the difficulties in battling the disease make her the ideal person to help patients set recovery goals. It’s much better than us just telling the patient that they will recover if they stick to the medicine regimen. That she beat the disease, and could eventually stand on her feet and hold a fulltime job, also provides a persuasive case to patients that they can do the same.” Armed with some nonclinical training in fields like pharmacology, Chan helps patients stick with their medication, find jobs and build social support networks. Her
She provides perspectives that [doctors] have never thought about DR WILLIAM CHUI WING-HO
work duties involve attending case meetings with doctors, counselling patients and their families, and organising focus groups with patients. “As a former patient, she provides perspectives that we have never thought about. The doctors actually get inspiration from her; she makes us more patient-oriented in our treatment,” Chui says. Chan has counselled over 100 patients so far. The majority suffered from bipolar disorder, and the rest had depression. Chan has battled mental illness for 16 years. “I spent over 10 years getting it under control, and I am still on medication,” she admits. Born on the mainland, her family moved to
Correction In the article entitled Complements to the Chef on food synergy published in this newspaper on Tuesday, December 10, the writer stated that soaking corn kernels in a lime solution was a process called nixtamalisation that increased the nutritional value of the grain. It was therefore suggested to pair corn with lime (the fruit) when eating. This is incorrect. Nixtamalisation involves steeping cooked whole kernel corn in limewater, an alkaline mineral that is unrelated to the acidic fruit.
Hong Kong in the 1970s. She graduated from secondary school, and studied engineering at Purdue University in the US. Her first job was with the Dow Chemical Company, headquartered in Michigan. She quickly rose through the ranks to become a business development manager at the age of 30. But at the peak of her career, she was diagnosed with bipolar affective disorder. “It might have been caused by stress. I was in high spirits at night, and couldn’t sleep, even though I was tired. The jet lag from work trips made it worse,” Chan says. She sought medical help in the US and Hong Kong. She first received treatment in 1998 at Queen Mary Hospital’s psychiatric ward. In 2002, her condition worsened and she told her company, which let her go with a “nice severance package”. She returned to her husband’s hometown in Indiana and opened a flower shop with him “as a way to turn over a new leaf in life”. But the business folded after a blizzard in 2008 cut customer numbers. The failure caused a relapse of her illness. In 2009, she returned to Hong Kong alone to seek treatment and find a new job. “I lost a lot of confidence from the business failure. I tried to find a job in my previous field, chemical engineering, but failed. To survive, I worked as a cashier, real estate agent and tutor. But after I told my employer about my mental condition, I was fired from my tutoring job. So I was unemployed for a time.” She had another relapse, ending up in hospital. “I didn’t return calls from my husband during this period, and we divorced in 2010.” When she was at rock bottom, she saw the job advertisement for the peer specialist placed by the Hospital Authority. Colleagues have discovered new perspectives in treatment from working with Chan, says Jolene Mui Hang-chun, a nurse consultant in community psychiatry.” We recently asked more than 90 staff for their views on Chan’s work. They said Chan helps them know what they should pay attention to when communicating with the patients,” says Mui.
From left: nurse consultant Jolene Mui, Dr William Chui and Lily Chan, the peer specialist at Castle Peak Hospital. Photo: Paul Yeung
100 • Number of patients Lily Chan has counselled
“Recovery is much more than medication. After the condition stabilises with the help of medicine, there’s a long road to recovery and Chan helps us understand what needs to be done. “Many of our patients get discharged and refuse to take
their medication, and get sent back to the hospital again. Chan comes in at this stage to explain to patients why taking medicine is important for their recovery.” Chan’s own refusal to take her medication led to a bumpy recovery, with several relapses. “Mental patients are afraid of medicine because of the side effects, like getting fat and feeling thirsty all the time,” she says. “But what makes them most reluctant is the sense of stigma that comes with it. It’s like you are admitting that you have mental illness if you take the medicine, and mental illness is something that still brings discrimination from society.
“When counselling patients, their experience strikes a chord with me, because I go through the same thing myself. I help them set simple goals. One patient’s goal is to be able to go home to cook a meal for her family every day. Many cases are young people who suffer from bipolar disorder, but are still holding a job. I advise them on how to work, and battle the disease at the same time.” Mui says Chan’s words often have more effect on patients’ families than those of medical professionals. “Many patients have overprotective family members who want to do everything for them. But that makes the patient feel worthless,” says Mui. “Using her own experience, Chan explains
to them that doing so is counterproductive. Family members usually mend their ways after listening to her.” Chui says there’s plenty of scope for the peer specialist scheme to expand in Hong Kong’s mental hospitals. The hospital cluster in New Territories West serves 1.1 million people, but has only one peer specialist. In Holland, there is one for every 12 to 15 frontline staff, says Chui. Mui says the peer specialist model needs further development before it expands, stating examples such as recruiting peer specialists with different types of mental illness to provide more specific counselling and help. elaine.yau@scmp.com
Authorship corruption taints mainland scientific publishing ................................................ Jeanette Wang jeanette.wang@scmp.com China has a flourishing academic black market involving scientists, agencies and journal editors, according to a report published in a leading international science journal. The report in Science magazine, based on a fivemonth investigation by a team of reporters, reveals myriad questionable practices, including paying for author slots on papers written by other scientists and buying papers from online brokers. Looking into 27 agencies that trade in SCI papers – papers in journals indexed by Thomson Reuters’ Science Citation Index (SCI) – the investigation found authorship fees ranging from US$1,600 to US$26,300. SCI papers – especially those published in journals with a high impact factor – are so critical to getting promotions in China that researchers are willing to shell out for them, says the report’s lead author Mara Hvistendahl, a contributing editor with Science who has been based in Shanghai for seven years.
In the end, some scientists don’t even know what their papers say CAO ZEXIAN, PHYSICIST
“In the US, there is pressure to publish research papers for a scientist, but not anything on the scale of what scientists in China experience,” Hvistendahl said in a telephone interview from Shanghai. China has become a powerhouse in scientific publishing. The number of papers originating in China on SCI Expanded – an information database of more than 8,500 of the world’s leading scientific and technical journals – skyrocketed from 41,417 in 2002 to 193,733 in 2012, ranking it second in the world, after the US, the Science report says. But corrupt practices taint that achievement. “[Some scientists] are publishing better and better papers and getting
into top-notch journals, but in the end they don’t even know what their papers say,” says Cao Zexian, a physicist at the Chinese Academy of Sciences’ Institute of Physics in Beijing, in the report. “They spend a lot of money hiring researchers to write them.” The investigation began with a tip-off that a sales agent for a Chinese company called Wanfang Huizhi was selling authorships for a forthcoming scientific paper to be published in Elsevier’s International
Journal of Biochemistry and Cell Biology. According to the report, the company was selling the title of co-first author for the paper, which described a potential strategy for curbing drug resistance in cancer cells, for 90,000 yuan (US$14,800). Adding two names – co-first author and co-corresponding author – would cost US$26,300, with a deposit due on acceptance, and the rest payable on publication. This led to an investigation whereby
Science reporters posed as graduate students and scientists. They contacted selected agencies by phone or via the Chinese messaging system QQ, inquiring about buying authorship on a paper or paying the company to write a paper. “We investigated a lot of these agencies undercover because there was no other way to confirm that these companies were doing what they were doing,” says Hvistendahl. “But after we were done with our reporting, we went back to the people and showed them what we found and asked them for their reaction. “We were careful not to make any allegations that weren’t unfounded.” Only five of the 27 companies contacted refused to write papers or broker authorship. “It was pretty easy to confirm that there were companies offering papers for sale. The more difficult thing was actually confirming that they did make these sales and the papers did actually get published, so they weren’t tricking the scientists,” says Hvistendahl. As it turns out, the cancer
paper which Wanfang Huizhi was selling authorship for did get published – with late changes to the names of the author list. A second first author was added, among other names. Interviews with the paper’s authors and with the journal’s editors found that all denied having knowledge of anyone paying for authorship. When contacted by the Post, the corresponding author of the cancer paper, Wang Xuedong, of the Fifth People’s Hospital of Wuxi and the Affiliated Hospital of Nanjing Medical University in Wuxi, responded in an e-mail in Putonghua that he had engaged Wanfang Huizhi’s research paper editing services previously, but denied being involved in selling authorships or receiving the purported 90,000 yuan. “The arrangement and addition of authors to the paper is based on each individual’s contribution to the paper. It is up to the research team to decide on the names; we don’t have to consult the opinions of unrelated people,” Wang said. The Wanfang Huizhi website, which was accessible before the
investigation report was published, has ceased operating. The website had listed the company’s other services, such as arranging conferences and producing tailor-made coins and commemorative stamps. Asked if this black market existed elsewhere in the world, Hvistendhal says it probably does in “any place you’d receive incentives for a promotion, or there’s a reward structure in place where scientists are under enormous pressure to publish”. She says she spoke to a journal editor in India who had heard of a similar black market there. But he did not have the details to confirm that companies are actually getting papers into international journals. Mainland companies are much more brazen. “In China, it’s very much all in the open,” says Hvistendahl. “If you want to search Baidu for paper selling agencies, you don’t search for ‘paper selling’, just search ‘how do I publish a paper’, and you come up with all these companies.”