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HK RN's hold the line against illness

Lopsided equation * Doctors, who spend their time analyzing X-rays and meeting in situation rooms, account for 15 percent. * Thirty percent are nursing assistants and other hospital staff. * Nurses earn US$38,000 yearly. * Doctors make more than double nurses' pay at US$80,000 a year.

Joanna Pong, a 24-year-old registered nurse, has put up with a lot in nearly eight weeks of caring for severe actue respiratory syndrome (SARS) patients here.

She has had to move out of her parents' home and into the nursing quarters next to the Prince of Wales Hospital, for fear that she might otherwise infect her parents or someone along her bus ride to work.

She must wear a mask when going on weekly dates with her boyfriend, and she seldom sees her friends any more.

She has to wear a full-length, waterproof body suit, a disposable surgical gown, goggles, gloves and a tight-fitting mask for up to eight hours a day, an outfit that quickly becomes hot and sticky inside when she is moving around and then cold and clammy when she pauses.

But the worst by far has been the fear, a constant dread that the slightest mistake, like touching her eyes with a virus-contaminated finger, could leave her as feverish and breathless as the patients she treats, and perhaps even kill her.

"The most difficult part of the job is the psychological, not the physical," she said.

While SARS is not quite as terrifying as it was nearly two months ago, when scientists knew almost nothing about it, the disease remains extremely dangerous for nurses. Despite many precautions, hundreds of nurses here and in other cities in Asia and Canada have been infected. Two or three more health care workers, usually nurses, are still being infected in Hong Kong every day.

Indeed, there are signs here that SARS is becoming a disease that strikes nurses harder than anyone else. Doctors accounted for many of the initial patients here, as they became infected while checking the throats of patients and performing other clinical diagnostic tasks. But as blood tests and other means for identifying patients have emerged, doctors have spent less time close to infected patients.

Nurses, however, have been falling sick in large numbers. According to the Hong Kong Hospital Authority, nurses now make up 55 percent of the 368 health care workers who have had confirmed cases of SARS here over the last two months.

Doctors now account for just 15 percent of cases, a percentage that is steadily dropping as more nurses fall ill, while the remaining 30 percent of cases are among ward attendants, nursing assistants, cleaners and other staff at hospitals and clinics.

SARS is a major risk for nurses here even when they are performing their most routine tasks. For Pong, the most alarming moment since the SARS outbreak began came a month ago, when an old woman suffering from dementia as well as SARS lowered her facemask and coughed hard right at Pong.

"It was a scary feeling," Pong said.

Nurses "are exposed to a much higher risk of infection than doctors because usually the doctors do their rounds in the morning and in the afternoon, so they are in the ward for less than two hours," said Dr. Justin Wu, a gastroenterologist here.

"The nurses need to spend the whole day in the ward, looking after the patients," he said.

Like Pong, Wu has been treating SARS patients at Prince of Wales Hospital, one of the city's best. The doctors spend their hours outside the pneumonia ward studying X-rays, holding meetings and performing other tasks.

Some SARS patients have become disorderly or even violent, either because of depression over their illnesses or because of pre-existing mental conditions. This has further increased the danger to nurses.

"The patients pull down their face masks and even vomit their food on the nurses," Wu said, adding that at least two nurses at Prince of Wales Hospital had been infected when patients vomited on them.

There are also more nurses than doctors in the pneumonia wards here, with 4,500 nurses caring for SARS patients, compared to 1,300 doctors.

The first health care worker to die here of SARS was a nurse, Lau Wing Kai. His funeral was held Wednesday.

Hong Kong Chief Executive Tung Chee-hwa (董建華) ordered that Lau be buried at Gallant Garden, the cemetery for civil servants who die in the line of duty, even though Lau was technically not a civil servant because he worked for the Hospital Authority, a government-owned entity separate from the rest of the bureaucracy.

In addition to facing more risks than doctors, Hong Kong's nurses earn considerably less. The heavily unionized nurses at public hospitals here typically earn about US$38,000 a year, while staff doctors at the same hospitals earn close to US$80,000, said Joseph Lee, the chairman of the Association of Hong Kong Nursing Staff, the union that represents two-thirds of the territory's 30,000 nurses.

Pong said that she had no regrets about becoming a nurse despite the difficulties of the last two months. She decided that she wanted to be a nurse at the age of seven because she wanted to help people, and says she never wavered about what she wanted to do with her life.

SARS patients frequently become deeply depressed at their steep physical decline, and relieving that depression is as important in some ways as curing their bodies, Pong said.

"I'm a cheerful person and outgoing," she said, "and I feel that I can make them feel better."
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