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After spending most of his dental career working at The London Hospital Dental School (now The Royal London) Professor Fred Smales was looking for a new challenge when he was offered the position of Dean at the Faculty of Dentistry of the University of Hong Kong. The Faculty's history goes back to the period following the Second World War when discussions were held as to whether or not Hong Kong should train its own dentists, but it was not until the mid-1970s that it was decided to establish a dental faculty in the University of Hong Kong with a dental teaching hospital, subsequently called the Prince Philip Dental Hospital.

Back in China

But, as we all know, history can change things and I was intrigued to know how (and if) the return to China had altered life, both in Hong Kong itself and for the dental school. 'I had been here in the mid-1990s as an overseas examiner for the Dental Council of Hong Kong so I knew I would find a well resourced Dental Faculty. I think what was a surprise however was the extent to which the cosmopolitan nature of the Faculty, the University and Hong Kong itself was being maintained, just after reunification with Mainland China. Everyone had seen the pictures on television of Chinese troops coming across the border but apparently they immediately went to their barracks where they have remained. Long before I came in January it was quite clear that China was behaving in an exemplary and restrained way and the people of Hong Kong were governing themselves in almost every respect.

I hadn't been here for very long before I was invited to go to the gathering of representatives of the Faculties of all the Chinese Dental Schools at their annual scientific meeting in Beijing. The nature of the relationship between Mainland China and the newly-returned Hong Kong was not clear to me at that time and I had never been to Mainland China so I think it was fair to say I was nervous, particularly because I had to give the first clinical lecture. Any apprehensions on my part were rapidly dispelled however when I arrived because it was clear my fellow deans were very excited and pleased by the recent return of Hong Kong to the motherland. As the representative of Hong Kong therefore I was given a place of honour at the meeting'.

Captured the magic

Although it was still early days for the new dean, right from the start of the interview I felt he had already captured some of the magic of eastern Asia, but perhaps more importantly the magic of the new future that faced Hong Kong. 'You can't help noting the pride in China but I was also the recipient of constantly expressed wishes to maintain the high levels of cooperation that already exist between this Faculty and many of the Dental Faculties on the mainland. People have been coming down from Mainland China for postgraduate dental training here for several years now. It's a greatly sought after opportunity for the bright young dentists, and it is encouraged by the senior faculty staff both there and here'.

That magic was obviously part of the influences when he was drawing up his vision for the future of the School. 'My core ambition is that the Faculty will be a splendid example of the best of both Western and Chinese achievement in terms of dental education and dental care so that members of each community can come here on a basis of equality. In some respects that already happens and reveals the great debt which is owed to the senior staff who have been here during the years and particularly Professors Geoffrey Howe, Ted Renson and the others who founded the Faculty. What perhaps is missing is an understanding in the UK and other western dental faculties of the opportunities for scholarship and interchange of ideas in Hong Kong'.

The specifics

His broad vision made sense to me, and sitting in his office overlooking the city I felt he would make it happen. But words on strategic thinking are easy (albeit important). What I wanted to know was the specifics. As ever, Fred did not disappoint me as he outlined his 4-point plan.

'We are a single-department dental school where the departmental boundaries have been dissolved and I am the only Head of Department. To replace the hierarchical arrangement associated with departments we have a matrix management structure. That means that Faculty staff can decide which programmes to affiliate themselves for teaching, and research and clinical activities.

We are also bringing in the educational system of Open Discovery Problem-Based Learning for our undergraduates this year. Students are learning the curriculum by spending each week attempting to solve a carefully designed problem. The staff act as coordinators as part of a number of resources which are available to help students with the current problem. The decision to do this has been applied to the whole University and has been taken at high level by the Governments of a number of Asian countries. However, while it is a very good learning technique if it is properly done and resourced it is also quite hard work so an objective evaluation of whether it works here is of great importance. We will not know the answer to that for some time.

The third thing is that we are setting up four interdisciplinary research groups, which are topic-based rather than subject-based. As well as advancing scholarship in the usual way they will be required to pursue some very carefully designed goals largely with a view to how we can help Mainland China and make an impact there. The groups will also be paying attention to the needs of Hong Kong itself, and together with the rest of the University we want our efforts to contribute to the prosperity of the Region.

The final thing we will really have to develop arises from the fact that Hong Kong is a big communications centre with excellent links throughout the world, and of course into China where the medium is the Chinese language. That indicates we must be involved in video conferencing, tele-dentistry, electronic translation and that sort of thing probably on a bi-lingual or tri-lingual basis. None of that is well developed in the Faculty at the present time and it will need to be built up. It offers many exciting possibilities, one of which is the creation of a new grade of Faculty members who are based abroad but are affiliated to us and make their contribution via communications links'.

The current situation

Hong Kong has been fluoridated since 1961, and periodontal disease tends to be a bigger problem than dental caries. Furthermore, although until recently Hong Kong was a very young society, that is now changing and there are significant numbers of the elderly which will result in changing patterns of dental disease.

Fred told me that the dentistry provided in general practice in Hong Kong is market driven, with neither funding provision nor any control of the financial side of dentistry by the Government. The emphasis is very much on intervention and preventive dentistry has not really been accepted yet, although people are talking cautiously about developing reputations for having preventive practices. As in so many countries significant sections of the community have not yet woken up to the benefits of dental care, and the profession is not marketing these benefits. Because of that, and the absence of government money to get people into a dental surgery for basic care, large numbers of the population do not perceive dentistry as relevant. 'I think the situation regarding uptake of services is probably like the UK 20 years ago when people would never dream of setting up a private practice because demand seemed fixed and for basic items of care only. Though it is all private here in Hong Kong, the perception is that demand is fixed for ever as it is at present. So I think it is probably in the cycle of development of uptake of that service there are still some years to go. Eventually, there will be an explosion of uptake of services some time in the future but it is unpredictable. That will be quite exciting when it comes about'.

I asked Fred to expand on his comment on marketing in Hong Kong, or rather lack of it. 'This is a superficial impression at present, and I am sure I will be corrected if I am wrong, but I do get a sense in talking to colleagues here that there is still a naïve feeling that patients ought to be seeking out the dentist, and an even more naïve one that if patient flow reduces the simple remedy is to stop training dentists so the reduced patients go to fewer practices. The experience in the UK shows that that attitude leads to all kinds of other problems for dentists, and we know that the real solution to a sluggish demand is for all dentists to work together to create a positive rather than negative image of dental care and to ensure that message gets to all sections of the population'.

The Dental School

I decided to move closer to home and to talk about the purpose of the Dental School itself, the education and preparation of dental students. I asked him if he had noticed any cultural differences between students in Hong Kong and those he had taught in London. 'I have noticed one interesting difference between the students I taught at Whitechapel and those here in Hong Kong, In the UK students will often travel to a University two or three hundred miles away and live a radically different life to that which they had at home.

In Hong Kong, the University will be only a few miles from the family home and a few miles from the School where the students have been educated. Although they can go off for an overseas holiday, for most of their time during the summer months before university they are in this very small area. The result is quite unexpected in that the University lay on a whole series of orientation events for freshers during the summer. In fact it is the older students who do the organising which can run to days and weeks of activities by the time all the societies and special interest groups have had their go. The result of this seems to me to be a team spirit, a camaraderie and a sense of taking responsibility that I did not detect in UK students. I have to confess that I am not sure if it persists up to and beyond graduation, but if it does it must make the dentists we graduate very caring members of the profession'.

Globalisation

As the interview progressed I found myself impressed by what I had seen and sharing in Fred's excitement for all the possibilities open to him as he steers the Dental School into the twenty-first century. But it is very easy to be drawn into the world of south eastern Asia when you are there, experiencing it. The majority of BDJ readers, especially in the UK, might well be asking themselves why they should be interested in what happens on the other side of the world. After all, what Hong Kong Dental School does now is hardly seen as relevant to what happens in the dental practice in Europe, is it? I put that very point to Fred.

'I am absolutely certain that what you say is true. I think the huge danger for the dental practitioner is to get stuck in a rut. I would suggest that travelling to conferences and meeting up with dentists from other countries does wonders for many dentists, and I believe that general dental practice in the UK has transformed itself for the better by actions like that. But striving for that kind of progress is not always easy — travel is only possible to a limited extent. I am an advocate of the globally connected dentist who uses modern possibilities of communication. It is a wonderfully powerful force with location and cost no longer the barriers to access of those techniques as they were at one time. I think UK dentists wherever they are, wherever their practices are situated will become very active participants in this sort of global dental community and immense beneficiaries from the activity'.

Perceptions of China

Of course, Fred's concepts do not just apply to Hong Kong, or to any specific part of the world, but to the entire world. His background in computing has always given him an insight into electronic communication that has always been far ahead of most of the rest of us. I asked him how he saw the Dental Faculty playing a part in modifying the perceptions (especially in Europe) that the world still holds toward China. His reply was characteristic of the new dean. 'Well the question really is the general one although you have related it to this Dental Faculty. It is the globalisation of China, which we are talking about here. I am very conscious that numerous universities abroad have many direct links with Dental Faculties in Mainland China that obviously do not involve this Faculty at the University of Hong Kong. So it is quite possible that the dental education aspect of the globalisation of China will happen on a one-to-one basis between Chinese institutions and those outside, regardless of what is done here. However two factors suggest that the Faculty will have a role to play.

The first is that we have specialised approaches to China which are in existence and which are both well-developed and structural in nature. Therefore they do not have to be created here and paid for, as they would be in any non-Chinese University. Our western origins mean that one logical approach to China for an overseas dental institution is via ourselves using advanced communication techniques.

The second factor which suggests this Faculty will play an important part in links with China is the sheer size of that country which for rough guidance is equivalent to Europe as far as Moscow. Many individuals return from China thinking they have cracked the problem of understanding China because they have made contact with an institution, some dentists or some official. In fact they have only scratched the surface. Hong Kong has the continuity and tradition to make sure that links are substantial, widely spread and lasting, and I am sure that will be increasingly recognised in the future'.

Finally ... the future

And finally ... what of the future under Chinese rule. Memories of revolution and suppression linger. Fred's view is both analytical and pragmatic. 'I think all dentists are sophisticated about risk analysis now because of things like dental x-rays, possible amalgam toxicity, and so on. We know that risk is relative. With that in mind I would say that the future of Hong Kong is highly assured and similar in stability terms to an average western European country. Clearly some forces that might deflect progress do exist and they could be exacerbated by the financial crisis. My own view is that the major concern is that the people of Hong Kong might lose their well justified sense of self-confidence and start to become inward looking. All the signs are however that exactly the opposite will occur once the current financial crisis draws to an end'.

It was an optimistic note to end on, and one that only time will prove. But, with Dean Smales (as he is known by his staff) at the helm it is possible to see all his predictions happen.