“If you only do what you know you can do- you never do very much.”
It is your typical stuffy airport. We arrive early Friday morning. The team assembles. It is a long fight (1hr to Detroit, 14 hrs to Tokyo, 3 hrs to Shanghai, and a 2 hr car ride to Suzhou). All of the members of the team except one know each other. We are excited and anxious. Many questions flutter through our minds. What cases will we do? What equipment will be available? Did we bring enough to do our cases? What are the facilities like? Etc.
We arrive in China at night. There is a large greeting party with a sign that says WELCOME HTC, and has all the members names. We are all dragging, but there is still a 2 hour car ride to go. We receive a welcome packet and the agenda for the week. Hmmm ... the agenda is pretty packed.
Sunday is a recovery day. A little site seeing. We are introduced to old China, through a tour of a several century old garden. I feel a bit jet jagged. We are taken for a traditional Chinese dinner with the president of the hospital, head of the CDC, and the head of the pediatric orthopaedic department. Dinner was very interesting, especially the jellyfish.
Monday was a clinic day. All of the perspective patients were viewed. The pace was different than I am use to, not the usual 35-40 patients in the morning. Patients were brought in and examined, decisions were made, and surgeries planned. We took breaks for tea. I spoke with one of the Chinese pediatric orthopaedic masters. He is greater than 80 years old and still his mind is vibrant.
After all of the patient were seen. We then toured the hospital and looked at the OR's , evaluated our instruments, and planned for the coming day. We get the lay of the land.
“One generation plants the trees, and another gets the shade”
The inpatient facility was not attached to the operating rooms. Therefore, the patients would have to be transported across the small street post operatively. The inpatient unit was filled with beds. There were beds everywhere. They lined the hallways and filled the rooms. We walk past children in skin traction for elbow fractures. We learned that the patients care on the floor is rendered by the family. The family changes the beds, provides the food, and does the primary observation of the child. We learned that in the Chinese system there is no rush for people to be discharged. The hospital stay is relatively inexpensive for the families (about $5/day). These were slight differences from the US system.
During our first day, we were also introduced to a number of residents. I learned that their system is similar to the British system, yet different. There are 2 tiers, an academic path and what I would call, a "worker" path. In the Chinese system, medical school is 5 years. After medical school, you can do a residency and start to practice. To receive you license and become officially a "doctor" then you must obtain a masters to sit for the licensing examination. In this path, the "worker" path, you will not be considered for the higher level positions within the hospital. This is good for some, but if you desire to have a higher level position, you must do more formal classroom training. Those in the academic path continue schooling and receive a Ph.d. in medicine. Now, my understanding of the registrar and resident roles is fuzzy. I am not sure if they are like junior attendings or high level residents. But, the registrars and residents are guided by a senior attending and appropriate cases chosen for them. Needless to say, in every case, we had 4-7 residents, registrars, and attendings in the room. This hierarchy took a little getting use to.
We operated from Tuesday through Thursday. Our cases varied from Scoliosis (idiopathic and congenital) to clubfeet. During the first day, we operated primarily with our team. For the subsequent days, we operated in tandem with the physicians from China. It was a wonderful experience. The hardest part was communication. Many of the physicians understood some English, but not enough to fully describe surgical procedures. So, there were a lot of hand signals. We learned a little mandarin. Just enough to get by. (You know, yes, no, ok, and like a good American, we learned a couple swear words.)
All of the surgeries went well. There were no immediate surgical complications. Overall, the surgical experience was good. We didn't take on any cases that we couldn't handle. We kept it simple. Of course, our ultimate goal was to DO NO HARM. We hoped for a good learning experience. Our education did not come in the form of surgical procedures or clinical cases; it came from learning a different culture. We learned a different approach to medicine. We saw some older techniques and treatments that we typically do not use. The patients were very appreciative. They even came in their best clothes to the appointment. This was a great experience.
On the final day of our mission, we were able to do a little more site seeing. Then back on the the plane for a full flight and a long night. Was the trip worth it? I would say without a doubt. It reminds you of the basics of medicine, the practice of medicine. The worries of documentation, malpractice, billing, hospital administration, and university policy, were gone. All we thought about was treating patients. It was nice.
“Happiness is the meaning and the purpose of life, the whole aim and end of human existence”