"Your Schneider Children's Medical Center of Israel is a state-of-the-art facility, similar in size to our new Shanghai Children's Medical Center, built by the Shanghai government with the support of Operation HOPE (a global non-profit organization). Thus, the Schneider Childrens Medical Center is an ideal place for us to learn how to run our own hospital. Just as Schneider is setting new standards for excellence in pediatric health care, so too are we. Actually, our new hospital is the most advanced one in all of China." The speaker is Dr. Bochang Chen, one of four doctors, all from Chinas SCMC, who were in Israel from October, 1998, through January, 1999, on training fellowships at the Schneider Childrens Medical Center of Israel (SCMCI).
All of the physicians - Dr. Chen, an attending surgeon in Shanghai Childrens Medical Centers pediatric orthopedic unit and Director of its Development Department; Dr. Zhuoming Xu, a specialist in pediatric and cardiac intensive care; Dr. Jun Ye, a specialist in pediatric endocrinology and metabolism, and Dr. Yeming Wu, a pediatric general surgeon - are highly qualified in their respective pediatric sub-specialties. Upon returning to China they expect to pass on their new knowledge and skills to colleagues from Shanghai and other provinces, thus demonstrating one of the ways Chinas SCMC is being groomed to be a national training center.
These training fellowships were the last component of a four-pronged pediatric exchange program between China and Israel, sponsored by MASHAV Israels Center for International Cooperation of the Ministry of Foreign Affairs and facilitated by Project HOPE. Preceding the doctors visit to Israel, MASHAV had sent three teams of medical experts from Israels SCMCI to China on short but intensive ten-day missions.
The first delegation, an ambulatory pediatric team, sent in March, 1998, concentrated on advising Chinas SCMC how to transfer its out-patient department from its old hospital (Xin Hua Hospital) to the new site. Since Schneider underwent a similar transition several years ago, the Israeli planning experience was particularly pertinent and timely. During this visit, emphasis was placed among other things on the child-centered and family centered approach to pediatric practice, including more lenient visiting hours for parents. This concept places paramount importance on the psychological well being of the sick child. It is an important turning point in pediatric practice where, traditionally, health professionals treat the disease rather than the patient.
The second delegation, sent in July, 1998, included advice by the Israeli experts of SCMCI on how Chinas SCMC could consolidate its departments of pediatric general and orthopedic surgery and its operating rooms. This concept of combined out-patient clinics, involving orthopedic and other pediatric sub-specialties, again reiterated the importance of team work and a multi-disciplinary approach which is not common practice in China.
The third delegation, sent in September, 1998, consisted of two experts from Israels SCMCIs Department of Physiotherapy. Since the contribution of the work of physiotherapists is often underestimated by Chinese medical practitioners, the intensive courses in chest physiotherapy and rehabilitation demonstrated the difference which physiotherapy can make and convinced Chinas SCMC of the need to develop this specialty. Today, physiotherapy in China does not exist as a separate discipline and has not played the role on the health scene that it can.
As noted, the fellowships to Israel were the last component of this 1998 pediatric exchange program. Speaking to the doctors, it was clear that they had all greatly benefited from their training at Schneider Childrens Medical Center of Israel.
Dr. Ye spent her three months at Schneider in the out-patient clinic that treats diabetic children and those with endocrinological disorders (problems relating to disorders of glands). "Here, at Schneider, where some extremely advanced work in this field is being done," she reported, "I observed how the doctors diagnose the hormone deficiency, stressing the point that successful treatment is based on proper diagnosis, i.e., knowing the cause for the short stature indicates what treatment to give, such as growth hormone to make up for the deficiency. I learned, however, that where growth hormone is indicated, this treatment is more successful with the addition of the sex hormone as a primer to increase the child's growth. In China we don't combine the two therapies. Theoretically we know we should, and here, I received practical reinforcement of the efficacy of this combined treatment."
Dr. Ye also observed problems of precocious puberty and learned how to diagnose this condition, "one we don't see too much of in China. And this," she stressed, "was a very meaningful experience for me. And most important," she added, "was seeing how diabetic patients in Israel are treated - and this was a new experience for me. I saw that every diabetic should have a self-monitor blood-glucose meter to measure the blood-glucose level three or four times a day. In China we tend to depend on urine tests to get this information. I also observed how diabetics are given injections three to four times a day, while in China we only give injections twice a day. Better control can be achieved with more frequent injections."
The other woman on the team, Dr. Xu, spent her three months working in Schneider's Pediatric Intensive Care Unit (PICU). "Although our hospital also has a PICU," she said, "observing in depth the set-up here gave me much additional knowledge on how to treat patients with very severe respiratory conditions, and especially those who also have congenital heart disease - which is one of our main problems. We use the ventilator model, as is done here, but only for volume control. Here we saw the way two models are used to control not only volume but also pressure.
"Equally exciting was seeing some very new advanced equipment, such as the BIPAD machine that is similar to a ventilator we have but it uses a special mask through which the child can breathe more deeply. This gives the doctor a very high-pressure reading. We also saw how this equipment is used to treat patients suffering from atalectasis (a condition characterized by incomplete expansion of the lungs), as well as those who have had open-heart surgery. When so used, it minimizes post-operative complications by allowing the patient to recover more quickly - and this is especially important for neo-natal infants."
Two of the doctors, Dr. Chen and Dr. Wu, are surgeons. Both learned, as Dr. Chen noted, "many small but very significant diagnostic and treatment skills. Take, for example, the way you at Schneider approach the problem of congenital hip dislocation, using advanced technology such as the ultra-sound to diagnose the condition very early, almost immediately following birth. This makes it possible to begin treatment, such as the use of a harness, very early and thus improves the chances for recovery. In China we normally only make the diagnosis at age six months which we have learned here is a less satisfactory way of dealing with this condition."
Dr. Chen was also impressed by the extensive use in Israel of the Iliazarov extra-fixation scheme, designed to treat those whose limbs are either too short or too long. "In China," he said, "we do have some elongation systems and we do, of course, treat children whose limbs need to be shortened or lengthened, but nowhere as frequently as here and not with the very successful Iliazarov scheme."
Dr. Wu, who as Dr. Chen observed more than a hundred operations at the Schneider Center during their three-month stay, was privileged to assist at thirty-five of them "where I learned," he stated, "some very interesting surgical procedures, especially the use of the laparascope (a slender tubular endoscope that is inserted through an incision into the abdominal wall and used to examinand perform surgery within the abdominal and pelvic cavities). With this method," he explained, "surgeons do not need to open the abdomen. When they operate, they check each step on the video projection on the wall and, thus, can operate with more precision and exactitude for they can see what they are doing clearly in real time. The advantages for the patients are also impressive. They can be released from hospital much sooner following surgery, often within a day or two. There is less bleeding, fewer post-operative complications, little scarring and, in general, a faster and more successful recovery. In China, although we have begun to use this technique when operating on adults, we have never used it for children - as we saw done here."
Dr. Wu also visited the organ transplant center and observed how it works. "In China," he said, "although we have begun to do research on transplants, we don't, as yet, do them, perhaps because the Chinese, who are basically very conservative people, have yet to understand or accept this procedure." Dr. Wu observed two kidney transplant operations and one liver transplant and found all extremely interesting, "especially since," he repeated, "in China we are still only at the research stage regarding organ transplants although we have begun to develop a bone marrow bank."
Comparisons between conditions in China and those in Israel were inevitable, with the doctors referring both to cultural differences as well as demographic factors as having an impact on how medical services are delivered.
"In addition to the new techniques and methods we observed," said Dr. Chen, "we also learned a great deal from the Israel experience in the area of organization and management. Since our center is only a year old and yours is almost seven or eight years old, we found your experience very helpful. We gained much from this opportunity to observe how a large children's medical center functions. At the same time, we have problems that you here do not have, including the fact that your center is adjacent to the Beilinson Hospital from which you can draw personnel, while our center is far from the older general hospital in whose pediatric departments we all worked and from where we draw staff. In many cases this means that doctors and other medical personnel coming to work at our center must relocate and it is not always easy to persuade them to make this move.
Assessing their three-month training period in Israel, Dr. Chen, who was the senior member of the team, described how he and the other doctors had meticulously followed every detail of every procedure done by the heads of the departments to which they were attached. There was uniform appreciation of the opportunity to broaden their horizons in so many different ways.