For our hospital visits today, we broke into two groups. One group went to the nearby Guangzhou Chinese Medicine University Hospital in Guangzhou and then went a few hours away to visit the Zhuahi People’s Hospital, a class 3A hospital, and the other group left at 6 am for Meizhou to visit Yuedong Hospital.
The Chinese Medicine hospital was a great experience. The combine western medicine with Traditional Chinese Medicine for their diagnoses and treatments, and explained to us that it was important to have the old as well as the new. This was definitely the most beautiful hospital we have seen in China. Each floor represents one of 24 Chinese seasons, and there is a courtyard with statues depicting Chinese medicine. Patients were already walking around the grounds before the hospital opened for check in. Speaking with the doctors, we found out that patients who come in with indications for a pacemaker, but do not need it immediately, will be treated with medicine instead. These Chinese herbs cause the patient’s heart rate to go up to normal, so the patient and doctor both believe they do not need a pacemaker. Patients coming here also do not want to have a machine inside them. They are very loyal to traditional medicine, and skeptical of Western Medicine in general. They believe Traditional Chinese Medicine cannot harm them because it is natural, and Western Medicine could be harmful because it is artificial and made with chemicals.
This visit was especially useful because we got to speak with patients and their families in a speed-dating fashion, as they kept being ushered in before we finished up with the previous one. The first we spoke with got a pacemaker and was very pleased with it, but was also devoted to Chinese medicine and this particular hospital, and continued to receive medicinal treatment along with his pacemaker. The next two patients we spoke with rejected pacemakers because on traditional medicine they had no symptoms.
The second hospital was very impressive. The EP we spoke with was very open about what was good about their hospital as well as ways it could be improved. It was an interesting case, because in this area most of the price of a pacemaker is reimbursed, so cost was not the main factor. She told us some techniques she used to communicate with patients needing pacemakers to educate them, and emphasized the need to tailor what kinds of things you say to specific patients. We went to the CCU and the cath lab, and she pointed out the long distance between the two. Patients had to be pushed on transport beds outside down the road to go back and forth, even in the rain. We think this hospital would be a great one to collaborate with!
Meanwhile, the other team visited the YueDong Hospital, affiliated to the Third Affiliated Hospital of Sun Yat Sen University, at Meizhou, which was about 400 KM from Guangzhou. The team left at 6 AM and reached the hospital around 10:30 AM. After meeting with the Director of General Administration of the Hospital, who gave us a good introduction tour around the Hospital. This is a county hospital that was affiliated with the Sun Yat Sen University in 2014. This move was initiated by the city government with a 1.3 Billion RMB funding. This was used to build infrastructure and procure devices like C-arms. They have a capacity of 700 beds and are planning to expand to a 1500. However, they are critically understaffed and can currently handle up to 500 to 600 beds. The main reason pointed out by the Director was that people who now required the qualification demanded by the esteemed Sun Yat Sen University would prefer to work at a much higher level hospital. The team then visited the Cath Lab, which was built after renovation which had a Philips C-arm, which was also procured after the affiliation. A senior cardiologist, Dr. Zeng had just finished Coronary angiography for a patient with acute myocardial infarction.
The team then interviewed Dr. Zeng and the Director. This hospital performs around 10 pacemaker implants (including ICDs and CRTs) every year, majority of which are dual chamber pacemakers, with the help of a senior Doctor from the University. Whenever they diagnose a patient with symptoms, they communicate with the corresponding surgeon and try to organize the surgery at the earliest possible instant. In case of emergency, they have been granted the permission to contact the surgeon by phone. The surgeon then travels at the scheduled date. It was interesting to note that the travel expense for the surgeon was reimbursed by the University and the surgeon could also earn a consultation and surgery fee. It was estimated that the surgery could be arranged between 2-5 days after diagnosis. They proactively work on trying to have all the relevant cases for a surgeon pushed to the day he travels to this place. There is a heavy emphasis on education and training in the surgeries that are performed by the surgeons from the University. Since Dr. Zeng was an expert in PCI, he pointed out the differences between stent and pacemaker procedures – the challenges with handling leads, sterilization, and the slow learning curve due to the comparatively low number of patients and expected this hospital to independently perform simple pacemaker procedures in a couple of years. A lot of the other common challenges pertaining to patient mentality and awareness of both patients and physicians were pointed out. Currently they are building a team around each main surgeon and have a holistic approach to start performing surgeries independently. They opined that they could do a lot more surgeries even with the current system and were of the opinion that patient awareness and affordability were the main reasons and that starting to perform the surgeries independently would not drastically improve the numbers.
After the insightful conversation, Dr. Zeng had to leave and the Director invited us for lunch at the hospital canteen, during which he explained in further detail about the relationship between the hospital and the University and pointed out that this was a trail for more such similar collaborations between large established hospitals and county hospitals. He was happy with the progress of this Hospital and reiterated his confidence in this approach.
The team then interviewed a nurse who had an early lunch. She recollected the last two patient cases who had pacemaker implants and both were uncommon cases. The first was undergoing treatment at a larger hospital for acute heart failure and was diagnosed with bradycardia there. She was sent to this hospital immediately after her surgery there, since this hospital was capable of performing implants. The second patient was undergoing treatment for MI here was and recommended for pacing therapy post-surgery. She then explained about the 15 day post-op care that patients were given at this hospital and recollected some common concerns for patients who needed pacing.
After exhausting all our questions to the nurse, the team thanked here and looked around to try and interview more healthcare providers. To our surprise, the hospital seemed deserted, partly due to the fact that it was lunch time. The team was able to observe a lot of counters and nurse stations not being used and realized the criticality of the understaffing at this hospital. The team then left for our hotel at Guangzhou.
After reaching our hotel, the team was joined by Dan, who felt much better by then, and they visited an Indian restaurant. The group reached the place by metro. Everyone ordered the Indian dishes they could recognize. The starters that Arvind ordered were particularly spicy and Thai especially had a tough time handling it. He was sweating throughout the dinner. After having dinner, the group rushed to the hotel to join Dr. Yazdi and the other group to have an overall discussion about the project.