Last Word: Remembering Sister Mary Aquinas, who dedicated her life to fighting tuberculosis

Like many places around the world, Hong Kong was deeply affected by tuberculosis (TB). The first case of TB in the city was recorded in 1849, according to figures from the Hong Kong Department of Health, and the highly infectious disease of the lungs became increasingly common throughout the late 1800s and early 1900s.

After World War II ended in 1945, TB was considered the leading cause of death in Hong Kong due to social instability, poor nutrition and overcrowding. At its most dangerous point, the epidemic claimed a record 4,190 lives in 1951.

At the time, many people were working to contain the devastating disease. Among them was Sister Mary Aquinas, a determined and selfless Irish nun and doctor who dedicated her life to fighting TB.

Ending the epidemic

Born on 30 August 1919 as Kathleen Gertrude Monaghan, Sister Aquinas was from the town of Ballinasloe, in central Ireland. When she was 20 years old, Sister Aquinas joined the Missionary Sisters of St Columban (an Irish organisation dedicated to serving those in need in underdeveloped nations) in 1939 and became a nun that same year.

After joining the St Columban order, Sister Aquinas studied medicine at University College Dublin where she graduated in 1947. In what was a big step for gender equality at the time, Sister Aquinas was one of the first four nuns in Ireland to qualify as a physician, following the removal in 1936 of a Papal prohibition on nuns becoming medical doctors and midwives.

Sister Aquinas completed two medical residencies in Dublin before being reassigned to Hong Kong in 1949 with four other Columban sisters, according to Father Joseph Houston, an Irish Columban father who lives in Hong Kong.

Then 30 years old, Sister Aquinas was appointed as the medical superintendent of Ruttonjee Sanatorium (now known as Ruttonjee Hospital) in Wan Chai, which opened that same year as one of the city’s only dedicated institutions for treating TB. It owes its name to a Parsi businessman, Jehangir Hormusjee Ruttonjee, who supported the construction of the hospital in memory of his daughter Tehmi, who died of the disease in 1943.

At Ruttonjee, Sister Aquinas headed a group of young Columban Sisters with a mission to combat TB. “Under [Sister Aquinas’s] leadership as medical superintendent [of Ruttonjee Sanatorium], this dedicated group of sisters and lay staff became deeply involved in Hong Kong’s greatest public health problem at that time, tuberculosis, achieving great success in their battle to eradicate this dread disease,” wrote the Catholic Diocese of Hong Kong in its obituary of Sister Aquinas, which appeared in its weekly newspaper the Sunday Examiner in December 1985. “With her natural charm, her pleasant, understanding nature, and her ease of approach, she won the confidence and the full support of the group.”

The early days for the sisters were difficult. The hospital had limited funds and equipment, and many of the patients were so ill that they could barely walk. But even in the most challenging times, Sister Aquinas was known to buoy the room with her positivity. “Her administrative and clinical skills, boundless energy and a sense of humour are legend,” wrote her former colleague Dr Michael Humphries in his 2014 book Ruttonjee Sanatorium: Life and Times.

Just two years after Sister Aquinas started working in Hong Kong, new options to treat TB became available. In 1951, researchers in the United States discovered streptomycin, an antibiotic used to treat bacterial infections. It was often combined with other drugs, such as isoniazid, rifampicin and para-aminosalicylic acid to effectively combat the disease.

However, the treatment regime was physically strenuous and time-consuming, requiring patients to have a daily injection as well as oral drugs for 18–24 months. If patients did not complete the regime, they would often not be cured, remain contagious and develop resistance to drugs.

When Sister Aquinas joined the effort, only a quarter of patients actually finished the full treatment course. “The patients, many of whom were poor and recently arrived from China in the 1950s and 1960s, were Sister Mary’s main concern,” recalls Sister Nora O’Driscoll, who worked alongside Sister Aquinas. “She once said, ‘Don’t give me flowers – give me money so I can help the poor,’” recalls Sister O’Driscoll. “She usually slept in a bed in her office at night so she could be available to staff and patients, especially when there would be emergencies.”

To improve the situation, Ruttonjee Sanatorium established a Directly Observed Therapy (DOT) programme at her behest, long before it became the global norm, according to her obituary. The medical strategy, which is endorsed by the World Health Organization, strives to improve adherence by requiring health workers, community volunteers or family members to observe and record patients taking each dose.

As part of the programme, Sister Aquinas and her team were responsible not only for diagnosing the disease but also for ensuring that her patients followed the complete treatment for the best chance of recovery and containment. The plan worked: In 1961, the number of TB-related deaths in the city fell to 1,907 – dipping below 2,000 for the first time in 13 years. By 1974, that number fell to 974 and continued to plummet through the late 1900s.

Life of service

In charge of Ruttonjee Sanatorium for a total of 36 years, Sister Aquinas devoted much of her life to fighting the illness, both in Hong Kong and abroad. According to the Catholic Diocese, she contributed to dozens of scientific papers, studies and trials which advanced management of the disease worldwide, specialising in the areas of the drug resistance of tubercle bacilli, the treatment of patients with recurrent tuberculosis, and the side effects of antitubercular drug. As such, Sister Aquinas built up a global reputation as an authority on tuberculosis and related medical problems.

She garnered many awards for her work in Hong Kong, including the Sir Robert Philip Gold Medal from the British Chest and Heart Association in 1964. In the association’s publication, Health, they wrote of the occasion: “If there is anyone who still thinks of missionary sisters as remote from the world and its problems, a brief acquaintance with Dr Aquinas would soon dispel the illusion.”

In the decades that followed, she was invited to many countries to give lectures, mainly in the developing countries of Asia and Africa. In the early 1980s, for instance, Sister Aquinas devoted a good deal of her time to lecturing in Africa and joined the effort to alleviate communicable diseases while working in Ethiopia.

After TB became more manageable in Hong Kong, Sister Aquinas turned her attention to combating drug use in the city, joining the government’s Action Committee Against Narcotics as well as the Society for the Aid and Rehabilitation of Drug Abusers, of which she was chairman from 1981 to 1985, according to the Catholic Diocese. In recognition of her service, the University of Hong Kong awarded her an Honorary Degree of Doctor of Social Science in 1978.

Just two years later, she received another meaningful award: the Most Excellent Order of the British Empire (OBE) – one of the highest honours for art, science and social work in British culture. Sister Aquinas travelled to London, where Queen Elizabeth II presented the honour at a garden party in Buckingham Palace.

At the age of 66, Sister Aquinas passed away from cancer on 28 November 1985 at the Ruttonjee Sanatorium. A Sister Aquinas Memorial Fund for the ongoing study of tuberculosis was established after her death to honour her life’s work. There is also an academic prize in her honour, dubbed the Sister Mary Aquinas and Purviz & Rusy Shroff Scholarship, which sees the Hong Kong Tuberculosis, Chest and Heart Diseases Association award HK$10,000 and HK$5,000 anually to the top two medical students in HKU’s TB Module.

Even three decades after her death, Sister Aquinas’ work continues to touch the lives of families in Hong Kong. Last year, Father Houston visited St Michael’s Catholic Cemetery to pray for Sister Aquinas and other Columban Missionaries who are buried there.

“I noticed two women placing flowers at Sister Mary’s grave and, out of curiosity, I approached them and asked if they knew her,” he recalls, noting that the two women appeared to be a mother and daughter.

“The younger of the two replied: ‘Yes, she cured me of tuberculosis.’”

Additional reporting by Rafelle Allego and Doris Lam.