Chapter 91

I had been to HK once in the past with my mom and grandma. It was a very very long time ago and to be honest, my recollection of the time I was there is very hazy. I do recall one particular aspect that was ingrained into me though. I recall that it was crowded. Like really crowded. So it came as a surprise to me that when I was back here again as an international student that it was pretty scarce. Walking around HK honestly felt like just walking around downtown Toronto. If you paid attention to any type of social media in 2019 you’d probably know but just hold that thought for now. 

The first week of being a student at PolyTechU was pretty standard. Our small group of Canadians were shown the main clinic, all the tools, exam rooms we would be doing exams in for the next 2 months and all our supervisors and fellow interns.

Though our group struggled to find our way around on day 1, after a day of going with the flow once, the route to and from school has very quickly become ingrained into our mental maps. It was around a 20 minute walk from our student residence via an elevated overpass walkway to the campus and honestly, it was pretty easy to just follow the crowd to students moving once you get a feel for things. 

Speaking of which, this was a common structural phenomenon around HK’s universities and streets in general. By this I’m referring to the overpassing sidewalks or “skywalks”. There were streets for cars only and no sidewalks. In this regard, the people had to be walking on bridges above it. This is not something Canadians were used to and Google maps was also notoriously really bad at naming streets on the car level and streets on the elevated walkway level. To figure out where you were, you had to look below you and try to find a street sign and then work everything out 3 dimensionally. Often, this meant you had to go into and out of many buildings along the way to your destination.

Fortunately, when you made it on campus, it felt like any other university. All the same as UW except instead of a population of around 50% asian, it was more like 98% asian. They had an audibly large volume of international students. It was quite common to overhear English being spoken back and forth around the common areas. 

I think this was one of the reasons we didn’t feel out of place there. English was still widespread enough to be conversational. I guess the biggest difference from UW was that we needed our issued student cards to enter most buildings whereas in UW, security was pretty lax. I liked this idea. I mean, it was an extra layer of protection for our equipment, which we had to bring from Canada and would be residing in our clinic lockers. Oh and did I mention they were worth thousands of dollars? 

Back to our tour of the clinic…It was nice! To be honest, it was nicer than our clinic back in Waterloo. They had electronic photopters with split prisms and a lot of electronic refraction machines. These were relatively new and much better maintained than our school’s 20+ year old machines. 

Apart from that, the clinic was pretty normal and there were no other surprises. Oh, except for the fact that our supervisor was an American caucasian optometrist. This was surprising. I had fully expected to be supervised by a local but instead, we got an Optometrist from America who only spoke English. How did this even come to be? It’ll be a mystery because I didn’t ask and just to foreshadow a bit, I wouldn’t get a chance to ask either. I figured in the first week that I would save that question for later on in the term since we’d have all the time in the world to figure things out. For the first week of our 2 month internship, our Canadian group was just in the business of getting used to all the things that were going on so as to not look bad on an international level.

By the end of the second day or so, we were put on duty and even got to do a few eye exams (with translators of course). When the time came to do eye exams, I was relieved that this didn’t seem anything out of the ordinary. The clinic was known to host students as part of their program and having international students was commonplace too. In fact, just before we arrived there in the clinic, the clinic was occupied by a few Australian optometry students who also needed translators. 

As we settled in more and more, we eventually got enough comfort to stop focusing on the clinic and get started with talking with the domestic students. Here, we would find out some interesting facts about Optometry around the world. My Canadian friends I was with were ones who had gone to Moldova with me in the past and we were no strangers to OD’s from around the world. However, in Hong Kong, since we would be staying longer, I think we would finally dive into the differences in detail. 

Aside from the obvious superiority in languages the domestic students had over us, the glaring obvious difference from us right from the get-go was that all the students there were years younger than us. Why? Here’s a mini history lesson for Canadian and American Optometry. 

Once upon a time, the Optometry program in Canada and America were programs you studied straight out of highschool. You would apply with your high school grades and if you got in, you would then spend the next 4 or 5 years doing optometry and then graduate. At that point, you would undergo a licensing exam and be a full fledged optometrist. Somewhere down the line, optometry began to evolve in the Americas. There was an increase in the scope of practice and we were suddenly given access to prescribe drugs for diagnostic purposes and also drugs for therapeutic purposes. These were termed diagnostic pharmaceutical agents (DPAs) and therapeutic pharmaceutical agents (TPAs). 

The DPAs were the first ones to be implemented and involved usually dilating agents to open the pupil to assess health better. This wasn’t the whole story though. As optometry moved away from glasses prescriptions and into health assessments, optometrists eventually got privileges to prescribe medication to treat in addition to diagnose problems. When we finally got access to TPAs to treat the conditions we saw, we moved away from what the rest of the world saw as “optometry”. 

Since we could now use TPAs and needed more regulation, why not go a little further and push for a “doctor” in front of our name too? Afterall, both of those two facts required more regulations and guidelines in order to implement. So that came to be. Hence, now in the US and Canada, Optometrists were considered Doctors while across the rest of the world, they usually weren’t. But this still wasn’t enough. Afterall, how good is our profession if everyone can do it? The profession needed to be more specialized and this meant there had to be some gatekeeping as to who could and couldn’t do it. 

First step to that? Easy. Money. The universities, who now branded the optometry program as a “Doctor of Optometry” program, doubled our tuition. Furthermore, they made schooling twice as long. There was now a mandatory 3-4 year science undergraduate requirement for applying into the Optometry schools. You can’t just enter straight from high school anymore. 

Was this bad? Not necessarily. In recent times, it has become apparent that this move to push our field on a much more healthcare related basis was the right one. This is because the ability to prescribe medications does indeed need regulation and furthermore, to get the best candidates, high school GPA just doesn’t cut it. The high school accreditation system is too easily abused. I mean, just look back at the chapter about year 1 undergrad. Remember LP and I had friends who graduated high school with 95% GPAs only to fail out the first year? The high schools were a fallible testing ground for capability. Pitting university students together really does better weeding out those who aren’t at the top of their game. 

Since extra requirements never came to be in HK and the rest of the world, it meant that the graduates for Canadian optometry schools were now much older. Was this good for the reason I just mentioned? Yes. But also…If you ask any optometrist today, myself included, we’d tell you that the years in undergrad cramming for science courses are completely lost on us. I can attest myself that all the material I learned from undergrad science has left my brain almost completely. They were just a means to an end. An audition of sorts I’d say. Just to prove our abilities in cramming. 

When the Moldova Optometry group did our VOSH trip to Moldova, we met a lot of other optometrists from countries, such as France, Romania and Spain. In those places, it would appear that it was similar to HK. But we just kind of brushed it off. It only now occurred to me that those optometrists we worked with almost exclusively just did just glasses and almost no ocular health at all. 

I was kind of worried because at first. It would seem at a brief glance that in HK, all we’d be doing was glasses and nothing more. I mean, we knew the caucasian supervisor was good since she was American and graduated from America but my biggest concern was that she wasn’t our only supervisor. We had others and I was afraid we were overqualified to learn under them. Sure, I was all in for a unique cultural experience but at the end of the day, I wanted a learning experience to make me a better doctor too. 

To my relief, most of the other supervisors all spoke English too and got their “doctor” suffix by completing the optometry program and then doing their Masters’ and PhDs to earn the title. They were all much older and because of the two extra degrees, they were given privileges that expanded their scope of practice to the point where they essentially matched the North Americans. Or so I would assume. To be honest, we wouldn’t get to spend too much time with everyone here (foreshadowing). 

Our domestic young colleagues knew their stuff too. Though their schooling was much shorter and did not involve a whole 8 years of studying (just 5 years), I think if I had to guess at the curriculum of the students in HK, I’d say it was quite similar to what we had. They did not seem to be behind in anything, even the health stuff we were discussing in our program back home. With that said, they all knew that the health things they were tested on weren’t things they could implement in the future for themselves without going through even further schooling. I guess in a way, they were tested on redundant information in school to give them more background information on things that were achievable in other parts of the world. 

Well…There was one other reason for knowing more about Optometry as it was practiced in Canada. And that reason is…if they ever wanted to move to our country at some point. 

As I mentioned just a few paragraphs ago, the Optometry program in Canada and America now requires a very strict minimum of 3 years in science undergrad. Since the HK students nor the rest of the world had that in their optometry program (optometry programs around the world aren’t considered “science undergraduate degrees”), this meant that they could not bridge over to the Americas with their international Optometry degrees. If I had to guess, I would say this was probably the largest reason as to why we had the undergrad requirement. It was to protect domestic interests from foreign invasion. In other words, it was to be a gatekeeper to international eye doctors.

Now, while I don’t think the extra 3 – 4 years in undergrad did anything, I do think there is some merit on this. This is gonna be a hot take. If you let anyone from any country just come into Canada and become an Optometrist, it wouldn’t work out very well. They would probably get sued and our profession would look really bad. You can’t just let anyone from anywhere around the world with vastly different understandings of what Optometry is come into a country and prescribe medications that could potentially lead to blindness if used incorrectly. Sure, HK did teach some things optometrists needed to practice, but when the students learned of it, they didn’t all learn it with the express intention of using it in the future. And furthermore, in that regard, what if some countries just didn’t have ocular health on their curriculum at all? I mean, it was by no means required by most countries outside of North America! Having protection in domestic standards is important. 

So what would you do if you were an international Optometrist trying to come into Canada to practice? Well. There was only one thing you could do. You could enroll in the international bridging program. This program was to re-educate international optometrists to the Canadian and American standard. You can take it in any of the US schools but we did have one in UW as well. Is this a big program? Nope. And it was in this manner by design as well. There’s a reason why you don’t see a lot of foreign optometrists running around in Canada. It’s because even if you did have the money, which was essentially just my domestic schooling tuition of two years, you would still need to enroll and beat out every other optometrist trying to get into Canada for around a total of … SIX seats… Yeah. I know. JUST SIX??? But that’s where it stands right now on the UW Website under “ASOPP”, the new international bridging program. It’s hard. This is why for most international optometrists who did actually make it into Canada, most of them went through a bridging program from the US. A place where my domestic schooling tuition of two years seems like pennies. 

Ok. Rant over. Let’s talk about something less political and happier in nature. 

DRUGS!

As I mentioned before, North American optometry was mostly different from the rest of the world in that we could prescribe drugs. So how does that play out in HK? Well…I would like to tell you I know the answer to this question but in truth, I never really got to find out. All I can tell you is what I’ve been told by our American supervisor. Keep in mind, this is second hand information at best. 

Our blonde haired supervisor told us that in HK, there were around 4 tiers of Optometrists. The lowest tier were full of opticians who really only just did sales. The next level up were opticians who could refract. Next level up you got DPA qualified and then at the very top you got the optometrists who could do DPAs and TPAs. Each level up had all the power beneath them to work with. With that said, it was sketchy in how this worked…In fact, TPAs in general were kind of sketchy.

It seems that even if you couldn’t give out TPAs, or just prescription medication, you can tell your patients what you “would” prescribe if you had the power to. You can even write them a note on what you think is a good idea. Then, with this information, your patient can go to the “lawless wasteland that is the HK pharmaceutical industry” (the words of my domestic colleagues) where pretty much everything was Over The Counter and find the medication. I’m still not quite sure how I feel about this but I do know that I hope it’s not as bad as it would seem. 

So…

Was this like Canada? Absolutely not. To what extent? Hard to say. There were definitely similarities but there were crucial differences as well. So where does that leave us? Well…I’d have to get more experience working as a clinician in HK to tell you.

However, 

I wouldn’t really get that chance. 

As I stated various times before, this was HK. 2019 HK. 

The situation was… volatile … to say the least. 

And I was about to see this first hand. 

I was about to find out why it wasn’t crowded in the city.