Life cycles of cities

Hong Kong has had its “glorious” moments. There was a time when China maintained a closed-door policy, and Hong Kong was the only gateway connecting China with the rest of the world. We prospered because of the unique role we played between China and the other countries. Since China opened up its doors under the government of Deng Xiao Ping, Hong Kong’s significance to China has slowly declined.

We used to be a great entrepôt. Not any more. Business routes between major cities in China and the outside world have become direct. Nothing needs to go through Hong Kong before entering China now. It used to be that there could be no direct contact between China and Taiwan. Therefore, people from both Taiwan and the Chinese mainland had to stop over in Hong Kong before moving on to either Taiwan or the mainland. This practice will soon come to a complete halt, as both the Taiwanese and the Chinese governments are eager to boost direct trade and cultural exchange between the two places.

Hong Kong construction worker scales scaffolding.

It is a well-known fact that Hong Kong depends on her mother country to prosper. As other cities in China become more developed and better connected to the global village, Hong Kong is losing its strategic importance. Our previous industrial and business orientations have changed from those of manufacturing to those of a service industry, manifested as banking, finance and tourism. Like other cities in the world, we are going through a cycle: struggle, development, prosperity, fading importance and struggle.

Members of a Hong Kong domestic workers union demonstrate.

Many a time, I hear visitors remarking that other Chinese cities are doing a lot better, implying that Hong Kong is lagging behind in many dimensions, losing its valour and glamour to neighboring areas and major cities in China.

Public housing estate in Hong Kong.

I am somewhat amazed that such remarks are being made. Just as families go through life cycles, so do cities. We have had our share of cheap labor in manufacturing. We were the production house for many developed countries for goods such as garments, toys and watches. Then, because of rising production costs, our factories moved inland to the southern part of China. Even in southern China, the situation is becoming more competitive now. Global manufacturers keep looking for cheaper places to produce their goods. Many production houses have been moved to Vietnam, Cambodia, and so on.

There are few cities on earth like New York, London, Paris or Tokyo, where the city never seems to grow old. Hong Kong may be progressing toward older age. But we are still bursting with life, with a population of more than seven million.

So Hong Kong will lose its attractiveness. But it is my hometown, where I have my roots and where many members of my family still reside. And there is no place like home.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Family values

When I visited Venice and Rome, I saw many older people walking in the streets, shopping or going somewhere leaning on the arm of another adult. I like to believe that those other adults were their family members or close relatives. I’ll call them the older persons’ family, because it makes me feel better. When these seniors paused to sit down at a sidewalk cafe, the younger adult would take great care to help them sit. They were patient and respectful. It was a heartwarming sight.

The situation is very different in Hong Kong. Here, the younger adults are busy working, and it is domestic helpers who take on the responsibilities of caregiving, day in and day out. Nonetheless, families do care about their elderly relatives in Hong Kong. In the housing estate where I live, there are many domestic workers who walk and exercise with seniors on a daily basis. You can see how well they relate to each other by observing how they interact.

Some domestic helpers talk amongst themselves—for example, a group of seniors and an equal number of maids gather separately each morning in the estate’s garden—while others stay close to carefully observe the seniors in their care. There are those who walk fast and drag the seniors with them along the way, and there are also those who allow the seniors to take their time. It is only during weekends and public holidays that you see more local adults taking care of their parents. You will find them in teahouses, parks, shopping malls and so on.

Filial piety has diverse manifestations in different countries.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

How should we relate to the misfortunes of this world?

I traveled with my sister after attending the board meeting of interRAI, an international health care research group, in Nuremberg, Germany. I am not a member of this group, but my teacher—my doctoral thesis supervisor—is. Thanks to her, I was invited as a guest. I thought this would be a good chance for me to learn.

After the meeting, I traveled with my sister to Vienna, Venice and Rome. I don’t know why, but the most disturbing thing for me on this trip was the panhandlers and beggars. There are beggars in all three cities. I am aware that I live a fairly comfortable life, sheltered and secure. I am also aware that there are many people who are very unfortunate. But I had no idea I would react this way. This was not the first time I had traveled overseas and definitely not the first time I had seen people who were very poor.

I believe that Hong Kong has no beggars who are from Hong Kong. We have homeless people, but no beggars. We used to have Hong Kong people who begged, but not anymore. I believe that the beggars we see on the streets of Hong Kong come from across the border (mainland China) to make a living. Because the social welfare system of the Government of Hong Kong has developed gradually over the years, no one needs to beg. For me, as a citizen of Hong Kong, this is an immensely comforting fact.

There I was in Europe, traveling as a tourist, enjoying myself, spending money as I chose. But there were people begging for money. I found myself not knowing how to relate, both to them and the situation. I looked at their faces, and sometimes our eyes met. I did not give to those I judged to be “professional” beggars. I gave a euro or two to those I thought might be in dire need. And then I moved on.

There were some old gypsy men and women in Rome who sat in front of churches begging for money. I knew in my heart that day in and day out, they sat there asking passersby for money. Begging has become a way of life for them. I didn’t give them any money, but I was so filled with remorse that I looked at them and apologized. I kept saying, “I am sorry,” “I am sorry.” Even professional beggars are beggars because they have the misfortune to be on a life path that, clearly, no one who had a choice would choose.

Phil Collins recorded a song called “Another day in paradise.” I am very much the person he described: Someone in the street “called out” for help but I pretended not to hear it. Streams of locals and tourists walked past these unfortunate people, just like me.

So what should I do? How do I relate to these people who are less fortunate than I am? Do I go back to my usual life and continue to live as I did, selfishly? Do I give up my limited resources and donate them all to charity? Do I take up charitable causes and live my life as a crusader?

I know I can’t do that. I can’t give all my money away. My sense of security is important to me. What then should I do? How should I live my life? I find my silly self asking the questions I asked when I was a young adult, passionately seeking a purpose in life. Should I not be past that stage by now?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

So what do we do after retirement?

I used to tell my sister to keep working and not retire too soon. If we live until 90 or 100 years of age, which doesn’t seem so unbelievable, then retiring at 60 or so means spending a third of our lives not engaged in full-time employment. And that is a long time. Work has many advantages, as we all know. It keeps us in touch with the world, helps maintain social contacts, brings in income and daily gives us a sense of purpose and usefulness. If the job is also interesting and meaningful to us, so much the better.

In Hong Kong, the retirement age is 55 for civil servants and 60 for employees of most companies and agencies. There has been talk of deferring the retirement age to 65 for certain jobs, such as that of academics.

I think that women (or men) who stay home to raise their kids are wonderful. Their children are so blessed. It is an extremely important job but often not recognized. I think that women who try to be working moms are superwomen. It is not easy dealing with competing roles.

If I say that females are the tougher sex, will I be called a sexist?

Inventory on display.

Open and ready for business.

Waiting for another passenger.

May I help you?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Form over substance

Appearance (or should I say packaging?) is overrated, but it is all we are focusing on these days—the presentation, the form, the look. As a teacher, I am sometimes frustrated by the demand or expectation that every lecture I give must be entertaining and that it should use the latest technology, or whatever is in vogue.

I wonder whether people in the audience (be they be the public or students) realize the amount of time that is needed to produce some interactive elements or to build some simulation exercises into a lecture. The use of multimedia in teaching is quickly becoming the norm, but it takes a tremendous amount of time to get the prep work done.

Some would argue that it is only the initial setup that is time consuming, that after that’s done it becomes easier. Not always. Imagine that you have produced a video clip and made a certain point (fact or argument, it doesn’t really matter). Later on, you want to revise your statement based on the latest research findings. What do you do then? Redo the entire video shooting or just make a corrective statement at the end of your clip?

I once watched a TV program about how a researcher in one of the local universities was trying to use virtual simulation, using computers to help children who were autistic. I cannot convince myself that this is a good idea at all. Imagine all the resources and effort required to produce a virtual simulation environment. But a child does not need a game. The child needs a person who loves, cares about and understands him or her and his or her condition, someone who is able to teach things and be patient when the child fails to cope with the demands of the situation and becomes withdrawn. Also, there is no guarantee that the skills one has learnt in a simulation environment can be transferred into real life.

Yes, I am aware that we must move on, that it is only with repeated use of technology that we become proficient. But the essence is not in the novelty of a communication technology. The essence is about the human connection. Nothing can replace it, not Facebook, not Twitter.

Nobody these days seems to be able to sit through lectures and concentrate on the knowledge—the substance—shared by the speaker. Yes, I am aware that, to learn, students need to be interested. Anything that is multimedia is, of course, interesting, more interesting than the words or syllables that make up the sound of words.

But, as a teacher, I do not believe it is my business to put on a show in every class I teach. Is that really necessary? What is the role of students in learning? Is it to learn only if the subject matter or the presenter is interesting? Unfortunately, what is interesting is different for different individuals.

I believe I need to motivate students to learn. I believe that, sometimes, my time is better spent on efforts to make the content of my talk cutting-edge knowledge. When time is short, my choice is always the substance, not the form.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Integration: The final developmental challenge of older adults

According to Erik Erikson, a person’s last developmental task in life is to overcome the psychosocial task of “integration and despair.” Either you integrate your life experiences and rise above them or become desperate for failing to meet the challenge.

I have read Erikson’s writings about the psychosocial task of old age. I have even discussed his perspectives in an assignment for a master’s course I took. But do I really know what integration means?

Does it mean making meaning out of one’s entire life experience? Does integration require us to determine what achievements we have made in our long life? Or to accept the fact that we really are small beings and have led ordinary lives? Does it involve finding out which relationships still bother us and settling all grudges with those we dislike? If that is not possible, does it mean we accept that we will never be able to make peace with those people we can no longer reach, to let it go and not let it bother us again? Or is it about forgiving ourselves for being silly, cruel, vain and stupid at various times in our lives?

What is integration, really? Is it possible? How do you forgive yourself for the tempers you have thrown and the cruel things you have said or done to people? How do you integrate odd and unsettling experiences that, over the years, you purposely have tried to forget? How can things be put into perspective when you cannot make sense out of these weird experiences?

Can integration occur if, after long introspection, you don’t like who you are or have far too many regrets? Can it happen only when you can see yourself in a positive light?

How, in old age, do we integrate all the things that have happened to us over a lifetime? As a gerontologist and a person, I am intrigued. I realize that I don’t really know.

Older people have a lot of work to do in meeting this developmental challenge. And only they can provide firsthand knowledge.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

“All older people are vulnerable.”

The above statement is from the lecture notes of an established global nurse leader at a conference on institutional care of older people, which I attended recently. The statement caught me by surprise. No offense intended, but I could not disagree more.

First, it’s patronizing. I don’t think all older people hold similar beliefs about themselves. I think health professionals should be caring and empathic, but certainly not patronizing. We do not always know what is best for others. We would like to think we do, but we don’t, at least not always.

Second, the message seems to imply that people can be categorized purely on the basis of age, according to whether they are fully capable of looking after their own affairs or not. In our society, we generally agree that children and disabled people are vulnerable and require protection, but if we follow the conference speaker’s logic, it would mean that only those in the well adult population are fully capable beings. So where does that leave us? Should we allow only well adults to lead the world?

Vulnerability should be perceived as a multi-dimensional concept when applied to humanity and should be not used as a descriptive label. A disabled person can be physically handicapped and, therefore, vulnerable to environmental barriers they come across in their daily life. A physically frail person can be vulnerable, in that he or she easily falls ill. A terminally ill person may be vulnerable to “assaults” on his or her humanity when the need for analgesics is ignored. A cognitively impaired older person may be vulnerablebecause his or her power of discretion is compromised.

But not all older people are vulnerable. They should not be. An elder with no loss of mental faculties, even though physically frail, can adequately manage his or her own affairs. Whenever we refer to the vulnerability of older adults, qualifying statements are required so that we are not disempowering our older clients.

The first baby boomers reached 65 in 2006. Let us not forget that future cohorts of older people are better educated and economically more secure than their predecessors. They certainly are in a much better position to manage their own affairs, and we should respect that.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.