Clinical Genetic Service, Department of Health, Hong Kong

In Hong Kong, the development of medical genetics can be classified into three phrases, namely, the era of search, application, and research.

Firstly, the formative years of medical genetics in Hong Kong spanned the sixties to seventies. During these two decades, much clinical and epidemiological data were collected on common genetic conditions in our locality, for example, on thalassaemia and glucose-6-phosphate-dehydrogenase deficiency, and on clinical cytogenetics and confirmation of a number of paediatric syndromes, such as Down Syndrome. In addition, the clinical presentation and epidemiological spectrum of many congenital malformations were studied both at the neonatal period and prenatally.

Towards the end of the seventies, it was realized that there was growing need for genetic diagnostic and counselling services in Hong Kong. In 1981, two clinical genetic centres were established to cater for such need. While Clinical Genetic Service (now in Department of Health) was established to answer to the demand for, mainly paediatric genetic services; the Prenatal Diagnosis Service (now in Hospital Authority) catered for the need for reproductive genetics. These services were founded by the government and had the major function as service centres rather than research centres. In the course of discharging their duties, these centres collected and collated much clinical and epidemiological data which proved to be most useful for patient care and health care planning. This is also the period when a new breed of clinical geneticists were committed and trained in this medical specialty. During this period, a large number of non-government organizations, for example, parents' groups and patients groups for specific diseases, and social welfare organizations for specific disabilities were established as alternative forms of care for these patients and their families. It was during this time that the Hong Kong Society of Medical Genetics was set up (1987) to facilitate intersectoral collaboration among different medical genetic professions with the aim of promoting genetic knowledge and services in Hong Kong.

Finally, in the middle of the nineties it has become apparent that our development is at a turning point. Three major areas await our urgent attention. There is a tremendous need for research, either basic or for application, in the following areas-clinical and epidemiological data collection, elucidation of genetic mechanisms and pathogenesis of diseases, and the legal, social and ethical implications of clinical and non clinical application of genetic knowledge. To answer these needs, it is envisaged that different approaches are required. Firstly, data collection will depend on intersectoral collaboration among hospitals and clinics, both in the public and private sectors, and research institutes in the universities. Secondly, for basic research into pathogenetic mechanisms, research institutes will need to be more heavily funded for their activities. Finally, to address the issues of lego-social-ethical implications of genetics, more community participation will be required.