Doctors from Hopkins improve China's care

Medicine: Visiting physicians teach Western methods in a nascent effort to modernize China's medical system.

August 29, 2002|By Gady A. Epstein | Gady A. Epstein,SUN FOREIGN STAFF

BEIJING - The patient's heart was beating too fast.

On that single fact the physicians in the emergency room of Chaoyang Hospital could agree. But the emergency room otherwise seemed a poor place for the patient, a 26-year-old hardware store clerk, to receive expert help.

Doctors injected adenosine triphosphate, or ATP, but the medication failed to slow his heart. The physicians, who earn about $1.50 an hour, huddled around his electrocardiogram.

They decided the best step was to ask Dr. Michael R. DiNapoli of Johns Hopkins Hospital's department of emergency medicine for advice.

As they stood by the patient's bed, Tong Zichaun, the physician in charge, asked DiNapoli through a translator whether the ATP should have been administered via injection or by intravenous drip.

"Should you put the medicine in fast or slow?" he asked.

At Chaoyang Hospital, one of China's finest, his question was a sign of progress. With a guiding hand from DiNapoli and other visiting physicians from Johns Hopkins, the Beijing hospital is at the forefront of a nascent effort to modernize China's medical system.

It is a monumental task. Patients routinely encounter doctors who, by Western standards, lack sufficient training. Hospitals operate with little financial help from the government. Patients usually must pay before doctors will see them, yet they face the risk of inadequate treatment with unnecessary medicines.

Hopkins' program at Chaoyang, which started this year and will continue at least until 2005, is focusing for now on some of China's most critical health issues: the training of doctors and quality of care.

In rural China, many begin to practice medicine as teen-agers, with little formal education beyond middle school. In major cities, physicians typically start in their early 20s after four to five years of medical school but without garnering experience through formal residencies and interaction with patients.

Li Ning, vice president at Chaoyang Hospital, began his career as a surgeon 20 years ago straight out of medical college in Beijing. He was 25 years old and had little experience with patients.

"I was just placed here in this hospital," Li said. "So, I am a surgeon, specializing in liver transplants. But what kind of training program have I had?"

Li and other Chinese health officials know that reforms will come slowly, but the Hopkins program is an important step forward.

Hopkins is sending emergency room doctors - usually one at a time - to train Chinese physicians at Chaoyang, a 1,000-bed facility with 1,000 doctors and nurses.

Chaoyang, expected to be the flagship hospital for the 2008 Summer Olympics, has the busiest emergency room in Beijing, with 9,000 patients a year (Hopkins' emergency department treated 50,000 in 2001).

Each Hopkins doctor stays here at least a month to lecture, advise physicians informally and help establish formal training programs intended as models for other hospitals in China.

The program began this spring, when Hopkins and Chaoyang launched a one-year training program in emergency medicine. Officials say it is the first formal post-graduate medical training in the country. Next year, Chaoyang plans to begin China's first residency program in emergency medicine. Hopkins staff members also are expected to train their Chinese counterparts in hospital administration and nursing.

"We're going to have a consistent presence there in Beijing," said Chayan Dey, who runs the China program for the Johns Hopkins Center for International Emergency, Disaster and Refugee Studies. "You've got a health system that's untouched, pretty much, by influences from the Western world."

Chaoyang is paying Hopkins $300,000 for three years of help, Dey said. A similar program that Dey is running in Tanzania is funded through a $2.5 million grant from the U.S. government.

Chaoyang's ER lacks doctors trained to handle emergencies, because emergency medicine has not existed as a specialty in China's medical schools. Now, small groups of doctors from other hospitals visit Chaoyang's emergency room as observers, and the Hopkins doctor of the month is there to answer questions.

"I've been extremely impressed with the eagerness of these [doctors] to try to learn medicine from us and how we practice," said DiNapoli, 36, who has spent the past month at Chaoyang. In return, he said, Hopkins doctors may learn more about Chinese herbal medicines.

In Chaoyang's emergency room, cases range from bicycle commuters with bones broken in collisions with cars to older patients with emphysema or heart failure. Shootings and drug overdoses are rare.

Doctors treat their patients with dispatch and a professional, engaged demeanor, but the shortcomings of the medical system are hard to ignore.

In the case of the store clerk with a racing heart, Chaoyang's doctors and DiNapoli agreed that the patient might have a heart abnormality and should be admitted for further tests.

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