Medicine and Memories: John Mackay’s Hong Kong Chronicles
John Mackay is a Scottish doctor who moved to Hong Kong in 1963. He practiced medicine there for several decades, becoming a respected physician in the city. Mackay’s memoir, “A Doctor’s Life in Hong Kong,” published by Earnshaw Books, recounts his experiences over six decades in the territory. He witnessed major events like the 1967 riots and the 1997 handover to China. The book details changes in Hong Kong’s healthcare system and society, as well as Mackay’s personal and professional life in the city.
What inspired you to document your life and experiences in “A Doctor’s Life in Hong Kong”?
What inspired me to write A Doctor’s Life in Hong Kong was the thought that after I was gone, my children and family would not have a good record of my life. My parents did not leave any record of their adventurous lives—to my lasting regret. Once I started writing, I realized there was enough of interest for a wider audience.
Can you share a particularly memorable or challenging medical case you encountered during your time in Hong Kong?
In the 1960s and 1970s, infectious diseases were rampant, particularly tuberculosis. There were many memorable medical cases, but one stands out. One of the first HIV sufferers in Hong Kong was an unfortunate man from Sydney, Australia, who came to Hong Kong with his wife to celebrate his retirement. Tragically, he was infected by HIV when he was given a tainted blood transfusion while having a minor operation in Sydney. When I saw him in the hospital, he had an unusual chest infection that did not respond to antibiotics. A blood test confirmed the diagnosis, AIDS. There was, at that time, no treatment; I had to advise him to return home for terminal care. Thankfully, medical advances in HIV management no longer mean that AIDS is the hopeless death sentence of the 1970s.
What were the most significant changes in the healthcare landscape of Hong Kong that you witnessed during your career?
The most significant changes in the healthcare system in Hong Kong were the growing sophistication of disease investigation and management, and the establishment of the Hospital Authority in 1990. The result has been that average life expectancy has increased from around 65 years when I arrived to a present-day 85, one of the longest in the world. I do not claim credit for all this improvement! On a personal level, I found that some local citizens would come to see me, a doctor practicing Western medicine, only because practitioners of Chinese medicine had failed to cure them and they believed they needed the magic of a Western medicine injection. It was sometimes difficult to persuade them that an injection was not necessary. Today, the disease pattern in Hong Kong mimics that of many affluent countries, in that long-term chronic diseases like high blood pressure, cancer, diabetes, and heart disease have replaced infectious diseases, infant mortality, and diseases of poverty. The health system, as elsewhere, is struggling with this change.
Can you describe your initial impressions of Hong Kong when you first arrived in 1963?
Initial impressions of Hong Kong in 1963 were many. The stunning topography, mountains soaring out of the sea, and multiple islands reminded me of the West Coast of Scotland; the contrast between the opulent residences on The Peak and the squatter huts of bamboo and corrugated iron in some lowlands, and the vibrant neon-decorated streets downtown. At the boundary with China, I saw PLA soldiers on patrol on the far bank of the Shum Chun River; behind them, rice fields, and an occasional rice farmer. Now, the rice fields have been replaced by the dramatic skyscrapers of the Shenzhen metropolis, today a city of 13 million people. The population of Hong Kong in 1963 was just over 3 million. It has doubled since then.
What motivated you to stay in Hong Kong for over six decades?
In my first thirty years in Hong Kong, I had an interesting and rewarding career as a doctor and made many friends, who remain friends to this day. My wife, Judith, also a medical doctor, had developed an important career as a Public Health advocate in Asia. For the last thirty years, I have continued to enjoy my life and friends in Hong Kong, and Judith has become a world-famous advocate on tobacco control, working with all the governments in Asia.
What challenges did you face in balancing family life with a demanding medical career?
The greatest challenge to family life was when our two sons were young. I cut back on my weekend sports to be with the family. Judith stopped full-time work for several years. Happily, we could afford help in looking after the home and children. When we took the boys to Scotland for secondary schooling, the parting was heart-rending, but the day-to-day pressure eased. Judith and I developed our careers and sports interests, the boys have flourished, and we are all still the best of friends.
How did the political and social changes in Hong Kong over the years affect your practice and daily life?
When I arrived in 1963, Hong Kong was very much a colony, ruled by a London-appointed Governor with the help of senior citizens, mostly appointed by himself. British Army, Navy, and Air Force units were present, and the police officers were British. Scottish pipe bands of the military were heard at official functions! It was a time of privilege for a British expatriate like me, although there were some privations for all citizens during my first year, such as only 4 hours of water supply every 4 days due to drought. The 1967 riots were a time of disruption, an offshoot of the Red Guard Revolution in China. The Bank of China was festooned with red flags and blasted Chinese patriotic slogans, many directed towards the British with words such as “Expatriates go home.” Cardboard boxes on the streets often contained bombs, manufactured in the Chinese schools and banks. It was touch and go as to whether Hong Kong could stand firm and survive as a British colony. By the time the fighting was stopped by Chinese Prime Minister Zhou En Lai (who had decided that the time was “not ripe” to take back Hong Kong), 51 people had been killed. A difficult time, during which I returned from long leave in the UK and brought back my wife—who courageously arrived in the midst of the riots.
The 1997 return of Hong Kong to China was a time of anxiety for many people of the population who had come to Hong Kong as refugees from China; many left. Many others, like myself, believed the return to China would be smooth, as it turned out to be. The world’s press descended on Hong Kong in 1997 for the day of the handover. It was joked that St John’s Cathedral was full of journalists praying for “blood on the streets” so they could file a dramatic story. They left disappointed. It was probably the smoothest transition of a British colony ever.
The Union Jack flag has gone, replaced by the Chinese flag. The British forces left, to be replaced by the People’s Liberation Army, whose presence was, and still is, hardly visible, confined to their establishments. I always believed that the reversion of sovereignty to China would be smooth, stayed on, and have been happy that I did so. The practice of medicine has not changed. Hong Kong prospered. Many British systems have been maintained, such as the legal system and the courts. My medical practice increased, caring for patients at home or in the hospital, visiting ships to administer vaccinations and check medical supplies, and providing medical cover for the Hong Kong Jockey Club race meetings. The 2014 Occupy Central sit-in was largely peaceful, students living and studying in tent encampments on the main roads behind barricades. After weeks, the occupation was cleared. I had retired from the Drs Anderson and Partners Medical Practice, but it continued and enlarged as Quality Health Care.
The riots in 2019 were more serious, disruptive, and combative. They subsided after the National Security Law was passed in 2020. Hong Kong then immediately suffered in 2020 from the Covid epidemic. Many families left, especially because of interference with their children’s schooling. This affected me much more in that travel and social pursuits closed down. I caught Covid but only when I was in Scotland in 2022.
What was the most challenging aspect of writing “A Doctor’s Life in Hong Kong”?
The most challenging part of writing was knowing when to stop. There was so much to say. I chose anecdotes that amused me and, I hoped, would amuse readers, and described events that would illustrate the kind of life I was leading in Hong Kong. I left out some stories, for example, of my patients, that might offend or distress the subjects involved.
How did you choose which anecdotes and stories to include in the book, given your long career and varied experiences?
The book is a factual memoir of the places where I have been and of the people I met. I am an activist in that I support organizations working to preserve the welfare of humans, animals, and plants. In my work, I came across people enduring hardship, physical, mental, and social. Refugees from warfare and climate change, living on charity, not permitted to work in Hong Kong while waiting to be accepted as refugees worthy of settlement in Hong Kong or elsewhere, a process that might take many years. With wars raging in Europe, the Middle East, and civil war in Myanmar, I am grateful that I continue to live in Hong Kong, now a calm and peaceful territory.
Photo courtesy of John MacKay
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