Tuesday, June 10, 2008

Addressing Needs in Western China

June 4, 2008

Xi'an is a city of 8 million, located in Western China. It's rich in history (terracotta soldiers) and current-day industry (agriculture, chemical and pharmaceutical). It was the capital of China (Chang'an) during the Qin and Tang Dynasties.

Its health-related challenges have changed in recent times. Ten years ago, the major causes of death were communicable diseases (pneumonia, tuberculosis and HIV/AIDS). Today, the greatest worry for its citizens is cancer (gastric cancer and breast cancer). For those over 50 years of age, 60% have one or more chronic diseases.

There is speculation about possible explanations for these changes. They range from pollution (air and food) for cancer to living longer (life span now averaging 72 years) for chronic diseases.

Obesity, while not immediately life-threatening, is a concern. It is seen in children, as well as adults. It is thought to be related to the over-use of oils in cooking.

Diabetes is being addressed by HOPE's training programs in Xi'an and the surrounding Shaanxi Province. Three Xi'an Jiao Tong University leaders (1st Hospital and Medical School) participated in the Launching Ceremony for the Lilly/HOPE community-based training program, in Beijing, earlier this week.

Monday, June 9, 2008

Project HOPE in Beijing

June 3, 2008

The Beijing Children's Hospital is world reknown for its services, from specialties to size. Over 7000 children are seen in its outpatient clinics each day. Its inpatient census of children treated for cancer now numbers 150.

Visiting Gaucher Patients
The little girl, age 7, was a charmer. She had come to the Hospital with her mother for Cerezyme treatment. She has Gaucher's Disease and is now in her fourth year of replacement therapy. She had the biggest brown eyes, not missing a thing, as she described her days at school.

Gaucher's Disease is a metabolic disorder which, if undiscovered and untreated, leads to death. Its patients lack an enzyme, required for normal handling of proteins. Its absence causes massive enlargement of the liver and spleen. Its replacement (intravenous infusion every two weeks) with Cerezyme, a Genzyme product, leads to a normal childhood.

The 13 year old boy came with his dad. He had been under treatment for five years and was doing well. He, and the little girl, are among the 130 children now participating in this Project HOPE/Genzyme program, overseen by a group of worldwide experts in this disease. Through the generosity of Genzyme, the medicine is provided to the patients at no cost. HOPE, in turn, has responsibility for training the physicians who administer it. Children, from throughout China, are alive today, because of this nearly ten-year old partnership between HOPE and Genzyme.

HOPE Service Honored in Beijing
The last of the three (Wuhan, Shanghai and Beijing) recognitions of HOPE's 25 years in China and our 50 years around the world took place at a final banquet. It brought together 90-100 government officials, collaborating foundations, donors and friends. It was characterized as a "working dinner," rather than a celebration, because of its proximity to the May 12th tragedy in Sichuan Province.

It was a gathering of friends. Dr. Wang Longde, the recent Executive Vice Minister of Health, is now a member of the Peoples Congress, Chairman of the Chinese Preventive Medicine Association, Dean of the Beijing University School of Public Health and a longtime supporter of HOPE; he came from earthquake-related meetings to be with us. Dr. Shen Jie, who previously headed HIV/AIDS programs for the Chinese CDC and is now Party Secretary for the CDC, has been to Carter Hall many times. Eve Wen-Jing Lee is a senior leader with the Ford Foundation. They, and their counterparts from the Beijing area, signalled their support of Project HOPE in ways that bode well for our future in China.

Sunday, June 8, 2008

Project HOPE & Eli Lilly Launce New Diabetes Program in China

June 2, 2008

The health leadership of 12 provinces, as well as the Ministry of Health, the Chinese Center for Communicable Diseases, the Beijing Bureau of Health, the Chinese Medical Doctors Association and the U.S. Embassy joined in the official launching of the "Expanding and Improving Diabetes Care and Education in the Community" initiative, a joint effort of Eli Lilly and Project HOPE. It was attended by local and national media.

In 1998, President Jiang Zemin asked HOPE to develop a country-wide program to train physicians, nurses and health workers in the recognition and treatment of diabetes. At the time, only 20% of those with diabetes in China knew of their illness, before they developed an eye or kidney complication. HOPE carried out its "trainer the trainer" methodology in all 31 provinces. A decade later, over 200,000 have received this training, with the support of Eli Lilly, BD and Roche Diagnostics.

The program announced today, sponsored by Eli Lilly, will expand this training to the community level. A five year initiative, it will establish 7 training centers, principally located in the west. Dr. Carlos Paya, Vice President for Research (Diabetes and Endocrine), and Jorg Ostertag, President of Lilly China spoke to its impact on improving the lives of those with diabetes throughout China. This event was subsequently highlighted in the next-day edition of the China Daily.

Beijing is in the countdown for the August 8th opening of the 2008 Olympic Games. This is seen in the dramatic architecture of newly-constructed buildings: the new terminal at the Airport, the so-called "bird's nest" which will hold the Opening ceremony, the colorful swimming center and the media headquarters designed in the shape of the Olympic torch. It's also seen at the Beijing University Third Hospital.

The Third Hospital, and its Institute of Sports Medicine, is the designated center for the treatment of injuries of the competing athletes. Yu Changlong is the Chief Medical Officer for sports rehabilitation for the 2008 Games. He predicted that most of those that he'll be asked to treat will be athletes with exacerbations of chronic conditions that they'll bring to the Games. Knee, shoulder and ankle diagnoses, in this order, will likely be the most commonly seen. The top inpatient floor of the Institute has been cleared, and is waiting, for the first of the injured athletes.

The President of the Beijing University Health Science Center, Dr. Han Qide, is a remarkable physician leader. He began his career as a family doctor in Western China, earning $6 a month. His practice included delivering babies, setting fractures and performing surgery. He went on to become a revered academic family practitioner--and a prominent political leader, as well.
In addition to his current University responsibilities, Dr. Han is the Chairman of the People's Congress, the 175 person governing body in China, as the leader of his 110,000 member "minority party" which is populated with "intellectuals." He spoke, at length, about his priority for "equity" in access to health care across the country.

Dr. Ke Yang, an internationally-recognized investigator in oncology, is the Executive Vice President of the Health Science Center. She invited HOPE, given our roles with Wuhan University and Shanghai Jaio Tong University, to assist in the recruitment of an outstanding new leader for the Beijing University Nursing School. As in Wuhan and Shanghai, she is eager to engage the School in curriculum reform.

This is in keeping with a similar effort in the Medical School. She observed that, while the School has received acclaim for its reputation in research (molecular level) and clinical practice (specialties), it can benefit from strengthening in two areas: creation of clinical investigators and primary care physicians. For example, in the aftermath of the SARS epidemic, the related published studies were more basic than clinical in nature due to a relative lack of clinical investigators. Her observations were in keeping with those of Dr. Chen Zhu, during last year's visit.

Saturday, June 7, 2008

International Children's Day

June 1, 2008

June 1st is International Children's Day, a day celebrated every year in China with great gusto. Today was no exception at the Shanghai Children's Medical Center.

The foyer, or Great Hall, of the SCMC, is a high-ceilinged room about the size of an Olympic swimming pool. It was a point of contention, when the hospital was in design. Our Chinese colleagues viewed it as too Western. Dr. Walsh saw it as an important gathering place. It was certainly the latter on this occasion.

Months ago, members of our Western Regional Advisory Board gathered in San Francisco to plan this day. The WRAB is a group of influential Chinese Americans, who were very important to the early support of the SCMC. They collaborated with their friends and relatives in Hong Kong (Project HOPE Hong Kong) to provide encouragement and funding.

The current Board members raised nearly $20,000 to underwrite a children's art competition, involving children in Taiwan and China (Beijing, Wuhan and Shanghai). This led to 3600 entries (paintings). Those of the 250 finalists were displayed in the Great Hall on this June 1st. And, what talent was represented in each of them--and the twenty children who received awards for contributing the very best pieces!

The paintings, all 3600 of them, now will be displayed in China and the U.S. They will be available for purchase. The proceeds will be used to support additional training programs, for physicians and nurses, at the SCMC.

It's important to point out the significant role of the Board of Project HOPE Hong Kong, a national organization of HOPE at the time, in the development of the hospital. Edmund Tse and his colleagues provided funds for the hospital's initial planning and, later, its patients and physicians.

The day ended with recognition of ongoing support from FedEx, Covidien and the Schneider Foundation for the programs of the hospital. From neonatal equipment to fellowship exchanges, they are making an everyday difference in meeting the needs of children who depend on the SCMC.

This ceremony served as a reminder that the agenda of the Shanghai Municipality and HOPE partnership remains an unfinished one. For example, in a city of 18 million, there are only 20 thousand nurses. Lily Hsu, Shanghai Program Director for HOPE and Dean of the Shanghai Jiao Tong University School of Nursing, is leading efforts to respond to this particular need--at the SCMC and beyond.

Friday, June 6, 2008

Shanghai Celebrations Honor Earthquake Victims

May 31, 2008

It was a day of recognition, amidst the felt focus on the Shanghai response to the earthquake in Sichuan Province. The long-planned evening banquet, celebrating our three anniversaries (10th for the Shanghai Children's Medical Center (SCMC); 25th for Project HOPE in China; and 50th for HOPE around the world) had been cancelled, in honor of those who lost their lives in Sichuan Province.

However, the day's events at the hospital continued on schedule.

It was a day of beautiful weather, with the hospital's three flag poles, side by side, flying the flags of HOPE, the SCMC and China. Over two hundred people gathered on the lawn in the front of the Heart Tower to witness a "first" in the history of China. Never before had a bust of an American been unveiled on hospital grounds. Today, the leadership of Shanghai honored the memory of Dr. Bill Walsh, the founder of HOPE, in a formal ceremony unveiling his handsome bust, the largest of its kind in the city. Beneath it are the words: "Doctor, Teacher, Friend," which well reflect the esteem in which he continues to be held in China.

His son, John, speaking on behalf of the Walsh family, recounted his father's abiding commitment to the hospital in its creation. While he saw it as a place of healing, he also envisioned it as a means of connecting people who care deeply about health. The previous day's CEO forum, bringing together hospital leaders from throughout China, along with their counterparts from four continents, would have greatly pleased him.

Lynn Schneider, the daughter of the benefactor who inspired and supported the creation of the Schneider's Children's Hospital in Israel, spoke of her father's similar view of a hospital for children. He described it as a "bridge to peace." This has been HOPE's experience in Krakow, Shanghai and soon in Basrah. It has been our experience, as well, with clinics in Santo Domingo and Monte Plata.

The formal 10th Anniversary Celebration followed in the hospital's International Conference Hall. It began with singing, in Mandarin, by the SCMC staff choir. Their first song was a tribute to the victims of the earthquake. Its words, "We will hold your hand" and "Be safe and be lucky" were most compelling. The words of their second song, "Big hand holds little hand" recognized the work of the hospital.

Dr. Liu Jinfen, the internationally-reknown heart surgeon and President of the the SCMC, spoke of the hospital's beginning: "Shanghai Children's Medical Center was jointly established by Shanghai Municipal People's Government and U.S. Project HOPE."

He went on to speak of this moment's significance: "As the symbolized project of Shanghai's social development during the period of the "Ninth Five Year Plan," Shanghai's key construction project, one of the 10 great deeds implemented by Shanghai Municipality and U.S. Project HOPE's largest collaborative program in the world, SCMC has become the establishment of the century with huge investment."

He concluded with a recognition of the "leaders at all levels" who shared "care and support." He closed with the words, "Special thanks should also be given to Project HOPE for their selfless support. By drawing advantages from others, we will strive to be the best in Asia and seek to attain the advanced world levels with our diligence."

After the ceremony, Yang Qiao Du, the former Vice Mayor came by the hospital to share his regards. He was a physician leader in Tibet, before assuming his Shanghai responsibilities. His schedule kept him from the unveiling but, because of his friendship with HOPE, he wanted to let us know of his appreciation of our continuing contributions to the SCMC.

We finished the day with rounds of the patient wards, which allowed an opportunity for us to meet with patients and their families. I won't soon forget little Lisha, a six-year old girl, who survived the earthquake and had recently been transferred to the SCMC for the care of her orthopedic injuries. She was lying in bed, with her right arm and right leg in casts--and a stuffed dog, with floppy ears, in her left arm. She had the warmest of smiles, as she described, through her mother, what she experienced at her school on the 12th of May.


Tuesday, June 3, 2008

Project HOPE Trained Health Professionals Provide Care Where Needed in China

May 12, 2008 will never be forgotten by the Chinese people. It will be remembered, and vividly so, much in the same way that those in U.S. remember the day of President Kennedy's death and the attack on the World Trade Towers. The earthquake, in Sichuan Province, dwarfed another health disaster, occurring at the same time to the east, in Anhui Province.

Anhui Province was dealing with an outbreak of hand-foot-mouth disease (HFMD), a viral epidemic, principally effecting children. Its presentations were severe, from pulmonary edema to respiratory failure. Over 10,000 patients were stricken, and 26 died from the complications of this illness.

Project HOPE Trained Medical Professionals Offer Help

Two experts, a physician and a nurse trained by Project HOPE, were deployed from the Shanghai Children's Medical Center to the Anhui Province. Both were HOPE Fellows in the past. Dr. Li Bi Yu received training at the Schneider Children’s Hospital in Israel, and Nurse Wang Hue Yong was trained at the Queen Mary Hospital in Hong Kong. Dr. Li is a well recognized physician educator and, because of this, is respectfully called "Pearl of HOPE."

Health Education Key to Successful 25 Year Relationship Between Project HOPE and China

This served as a reminder of the significance of 1983--to HOPE and to China. Our now 25 year relationship began with an invitation, in 1983, from a network of universities, to establish medical and nursing education programs in China. From 1983, when we accepted the invitation of the Shanghai Second Medical University and Xin Hua Hospital to help in creating a pediatric cardiovascular center at Xin Hua Hospital, and 1984, when we helped develop a pediatric and neonatal intensive care unit in Hangzhou, in collaboration with Zhejiang Medical University, to 2008, when we will soon announce, in Beijing, a community-based diabetes training program, involving partners in 31 provinces, HOPE has trained over 200,000 doctors, nurses and other health workers in China.

A most recent example of our education programs was seen, just this week, in the International Children's Hospital CEO Forum at the Shanghai Children's Hospital. Speakers included Professor Joseph Press, the President of Schneider Children's Hospital in Israel, Steve Rusckowski, the CEO of Philips Healthcare and a HOPE Board member, and Dr. Shen Xiaoming, the Vice Mayor of Shanghai. Nearly 60 CEOs of children's hospitals, from throughout China, attended this daylong conference.

The presentations included "Past and Future of Hospital and Health Care Administration in China." "Current Medical Equipment Demands in Children's Hospitals," "Strategy Planning for Hospital Specialty Development," and "A Primary Immunodeficiency (PID) Genetic Diagnostic Network for Asia," among other topics of current interest in China.

One of the Conference banquet attendees, the head of higher education in Shanghai, underscored the importance of international education to the current Chinese leaders. He, himself, received his doctorate in physics in the U.K. (Manchester) on a scholarship. In his present position, influenced by his own experience, he has created 45 scholarships for outstanding foreign students to come to Shanghai for their graduate degrees.

This day was yet another example of the "bridge to peace" that comes with the sharing of health and education across time zones--and oceans.

Monday, June 2, 2008

Project HOPE's Dr. Howe Visits Shanghai Children's Medical Center

The Shanghai Children's Medical Center is remarkable for its youth (ten years) and its accomplishment (now #1 in the world in the number of open heart surgeries on infants and children). It was conceived and created through a partnership between Project HOPE and the Shanghai Municipal Government, one which continues to this day.

Our visit to its Heart Center, a seven story building devoted to cardiology and cardiovascular surgery opened just a year ago, was inspirational. Its beds are filled to capacity with patients, only 20% of whom come from the Shanghai area. The remainder are from throughout China--and beyond (South Korea, Japan, Thailand, Australia and Austria, for example). Its cardiac surgeons, now 24 in number, will perform 2600 open heart surgeries this year.

We went on to City Hall to meet with the Vice Mayor, Shen Xiaoming. An internationally-recognized, academic pediatrician, he served as President of the Shanghai Children's Medical Center from 1998 to 2004. Since then, he has had positions of increasing responsibility in university and city settings. He is responsible today for the City's health and education programs, from hospitals to universities to public schools.

He spoke of his priorities, now and in the years ahead. He has a keen concern for the children who were injured in the earthquake in Sichuan Province. He encouraged HOPE and the Shanghai Children's Medical Center to join in the creation of a rehabilitation facility for children in Chengdu, one which would address both physical and emotional needs. This could be a model for the nation, as China's expertise in this specialty is yet undeveloped.

For the future, he sees two health-related concerns for China: first, emerging infectious diseases, which require the best of surveillance, diagnosis and treatment; and second, a focus on the "whole person," rather than disease. He feels strongly that physicians need to shift their emphasis from focusing on the treatment of disease to the maintaining the health of their patients.

For example, he described a new City-wide policy of limiting the amount of salt in the daily diet of children. An actual amount has been set as the limit, and an education program is currently underway to assure compliance with it.

All this is in keeping with his energy--and his unrelenting curiosity. It was he who did the original research in lead poisoning in children that led to the Central Government's decision to require unleaded gasoline in China. He continues to mentor Ph.D. students and maintains an active lab, looking at sleep patterns in children--and their effect on learning.

The American Chamber of Commerce, in Shanghai, is now in its fourth year with a Committee on Corporate Social Responsibility. We were invited to present the HOPE story before the Committee; other presenters included the Grameen Foundation, the Ruan Yi Shan Heritage Foundation, UNICEF and the World Wildlife Foundation.

HOPE is the only one of twelve foundations, outside China, officially approved by the Central Government for work in China, and we were the third behind the Gates Foundation and the Clinton Foundation (November 2007).