Medical Library Services of CUHK in times of SARS

Louisa LAM
Medical Librarian, CUHK

When I was writing this article, SARS claimed two more lives from the health care team of Hong Kong.  One of them worked in the Princes of Wales Hospital (PWH), the teaching hospital of the Faculty of Medicine of CUHK.  Deeply regretful, I believe nobody would forget the heavy toll SARS has taken and its enormous impact on our health care system.  It was also the first time in my career that a medical library service I worked in was affected by an infectious disease.

The outbreak of SARS in PWH took me by surprise.  The day before the outbreak caught the public attention, the library was busily engaged in the Accreditation Visit of the Hong Kong Medical Council.  The library was also a full house. The picture changed completely on 12 March 2003 when the Faculty Dean announced with sorrow the spread of SARS in the hospital, with a number of staff and medical students being infected.  To contain the spread of the infection, all undergraduate teaching at PWH was suspended and the hospital, including library and study rooms were placed "out of bounds."  The usage of the library in terms of visits fell sharply by 79% in a day.  Since all medical students were restricted from accessing the Clinical Science Building within which the medical library is located, numerous enquiries on returning books ensued.  Even worse was that many students had stored their books in their lockers.  Since the lockers were all located in the same building of the library, students could not access them and return them to any libraries.  We responded immediately by placing a book drop in the hospital hostel and waiving overdue fines.   Other medical library services remained normal at this stage.

Besides library services, the protection of the staff was enhanced.  All of them were given N95 masks and were advised to wear them especially when in contact with users.  The staff also wore gloves when handling the return of books.  Other branch libraries on campus were alerted about the development of SARS in PWH and advised to take precautionary measures, such as wearing gloves when handling the materials from the medical library.  The anxiety and fear of the library staff were keenly felt, but no one was thwarted.  Everyone was determined to continue the medical library service in the belief that in this time of crisis, it was crucial for the medical library to work hand in hand with the Faculty in providing any requested information in the battle against SARS.

The spread of SARS became so serious a week later that the Dean decided on the evening of 17 March 2003 to suspend all non-essential non-clinical activities of the Faculty at PWH in order to minimize the chance of cross infection.  All supporting units of the Faculty started to evacuate to the main University campus the following day.  The library did not follow suit but the opening hours of the library was shortened from 8:30 a.m. – 9:00 p.m. to 9:00 a.m. – 5:00 p.m.  A small skeleton of staff was willing to stay to maintain the normal services.  The library became the only serving body of the Faculty in the hospital.  The use of the library continued to drop so that by 18 March 2003, only 89 visits were recorded.

The decision to close the library at the Clinical Science Building and set up another one in a temporary location in the hospital was not made until 19 March 2003 when the preparation of the site was ready.  The temporary office was wired with PCs to maintain a book returns service.  The book drop service also continued.  Students in urgent need of using the print collection could call the library in advance to make special arrangements.  The library staff went back to the library once a day to retrieve the needed items for them.  Special arrangements were also made to mail the books to students’ hostels on campus in order to minimize their visits to the hospital.  With the help of the Circulation Department, the pick up of recall items was centralized at the University Library on the main campus.  The Interlibrary Loans Service was only partially available.  Borrowing requests could be handled as usual via the online system, ILLiad, but only urgent lending requests could be processed.  The document delivery service of the MEDLARS Center had to be suspended for a while.  The opening hours remained shortened and no seating could be provided to the users on the temporary site.  The 24-hour study room in the medical library was not affected, though its use was very low.  Other library services such as reference were delivered on the phone.  A lot more enquiries were received via e-mails.  The Internet now became an essential tool of communication.   A website was developed to provide online information about SARS.  One of our online journal vendors also agreed to open up all their full-text journals to assist in clinical research.

The infection control measures in the library had never been loosened.  Much effort was made to ensure every staff member of the library was provided with free N95 masks and they wore them all the time in the library and in the temporary office.  Surgical gloves were also provided to them.  The returned books were cleaned with disinfectant as far as possible.  I am glad to say that all library staff stayed healthy.  They were as devoted to work as ever even in the midst of profound worries.

The state of partial library services in the hospital continued until 22 March 2003 when the Dean observed that more cases were surfacing in the community and advised us to leave the hospital, even though the temporary site was at low risk.  Thus, on 24 March 2003, the library was relocated again to the late reading room in United College Wu Chung Multimedia Library (UC) on the main CUHK campus.  Many measures were taken to offer as much library service as possible.  With the help of the UC Branch Librarian,  users were able to return and borrow requested books of the medical library at UC's Circulation Counter.    Since the location at UC kept us from travelling to the medical library at PWH too frequently, the book drop services in the hospital hostel has to be suspended and only very urgent Interlibrary Loans requests could be entertained.  The overdue fines continued to be waived.  Though all students in the Faculty were informed about this, the flood of e-mails and phone enquiries on late returns was still overwhelming.  We understood their worries and concern.  Librarians have to be more lenient and understanding given any critical situation the users are facing.  In our particular case, I know that some medical students and staff were still lying sick in the hospital.  To address the issue, all outstanding loans were renewed automatically by the library in the Innopac system.

We tried our best to entertain users' urgent requests.  I recalled that a Faculty member requested to photocopy 50 articles in the medical library for research.  I opened the library to him in the afternoon.  Many students also requested us to photocopy journal articles and retrieve books from the medical library for their term assignments.  I did this too and took up all protective measures to minimize the risk of infection.  But nothing could be sadder to know that one Faculty staff was still in the hospital and could not return his books to the library.

The subsequent spread of SARS to the community caused the University to suspend all classes for 2 weeks.  The original plan of the Faculty to resume undergraduate teaching on 31 March was thus delayed till 7 April.  However, as soon as the Dean announced the resumption of teaching in the Faculty Executive Meeting on 26 March, the medical library prepared to move back.  We moved back on 31 March, but the library did remain closed to students, but not to Faculty.  The opening hours remained shortened.  Other library services such as Interlibrary Loans were resumed.  Before the move, the whole medical library was disinfected.  Regular hygiene was also enhanced by cleaning the reading tables, the computer keyboards and all entrances and exits of the library daily and thorough cleaning on a weekly basis.

All medical library services went back to normal on 7 April when the teaching of Year 5 students resumed.  The policy of all users wearing masks in the library was also implemented at the same time on advice from the University.   However, the usage of the library was still low.  The number of visits of March and April 2003 decreased by about 60% compared to that of the same period in 2002.  This could be attributed to the fact that most lectures and tutorials were held in the School of Public Health, which was several blocks away from the medical library, to keep students from the main epicenter of the hospital.  Many students were also afraid to visit the hospital.  They were still requesting us to mount special delivery services of books to the campus.

SARS forced the medical library to close for two weeks, but did not stop us from providing medical library services at other sites.  We were the last unit to evacuate to the main campus and one of the first to move back.  No matter what undesirable impact SARS had exerted on library services, we succeeded in providing information to all our patrons as and when needed.  Our staff were dedicated and devoted to work.  The Chinese University Library System provided all the most needed support at all times.  The supply of surgical masks never stopped until the lifting of the travel warning by the WHO.   As the Dean said, "In times of a major medical crisis, it is even more important that the education of the next generation of doctors goes on full steam."  The medical library worked towards this goal to the very best of its ability.

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Burd A.  SARS and medical education in Hong Kong.  BMJ 2003 Apr 17.  Available online at http://bmj.com/cgi/eletters/326/7393/784/c#31274.