Our day began especially early, as we had a conference call with a highly experienced electrophysiologist at Johns Hopkins Hospital, Dr. Ron Berger. We were able to get more answers about the pacemaker care pathway at Johns Hopkins and the United States in general, in order to better our own knowledge as well as be better prepared to answer the Chinese cardiologists questions. Dr. Berger explained the pre-op discussion with his patients, patient concerns and pacemaker acceptance, as well as post-op monitoring and follow-up procedures in the US. The call was very insightful, and we look forward to further collaboration with Dr. Berger, one of our clinical mentors, throughout the duration of our project.
After some quick naps and actually getting dressed post-conference call, we headed out to our morning hospital visit at the Second Affiliated Hospital of Kunming Medical University, just down the street from our hotel in Kunming.
As requested by us, our interview session was much more relaxed and informal, as to encourage more honest discussion. The cardiology department is split into three separate wards at this hospital, and we met with the head of the second ward, Dr. Ruan, as well as a few of the cardiologists on her team. Their team is the only one that can do pacemaker implants, and do about 100 implants every year, 30-40% of which are single chamber. After a brief discussion of their cardiology ward and our program’s end goals, we began a detailed Q&A. Although we obtained many insightful information from the doctors present during our small interview, our valued translators (Katie and Victor) had some trouble with this interview because of how small the room was and due to the long blocks of speaking by the doctors.
Discussion first focused around their involvement with the 100 county awareness campaign to support lower level county hospitals diagnose, and treat pacemaker patients. They also explained many other ongoing campaigns to increase physician, patient, and general public education regarding pacemakers, e.g. their hospital educational seminars, TV programs, and pamphlets. This led to a discussion of how this increase in education and ultimately pacemakers would affect their hospital. Their response led to an explanation of a bi-directional referral system, where patients could go down to a lower level county hospital to get the implant, leaving the city hospitals to do the more complex cases and implants.
Next, our discussion focused on pacemaker patient follow-up, including: post-op care before discharge, remote monitoring (infrequently used because of cost), patient feelings and compliance. Although most patients before surgery ask “is there any way that I don’t need a pacemaker?” many are very surprised and satisfied with how well they feel after the procedure. Patients are typically convinced via the doctors showing them their ECG and explaining the physiological reason behind their symptoms. The post-op stay was only 2-3 days, shorter than we have been hearing from some other hospitals, as they mention that the sutures can be removed at a local hospital, closer to the patient’s home. The cardiologists also explained that there are two limiting factors on the post-op care length: (1) the hospital is given a maximum of 9-days post-op care and (2) reimbursement can only cover a certain amount of care. There are also two main reasons the patients stay longer: (1) the lack of distrust among the patients and their doctors and (2) complications that occur when an inpatient are covered by the hospital, whereas outside complications must be paid out of pocket. Lastly, we discussed their opinions about the future of pacemakers. They anticipate the number of implants per year will increase, as well as the number of local pacemaker brands used.
Then we headed out for lunch, hot pot round 2. We enjoyed what seemed like endless meat, the JT noodle guy performance, and lots of sketchy-spicy hot dogs. Jon proved himself to be a member of the team by only eating from the spicy section of the hot pot. Also, we got Dr. Yazdi to take his first selfie-stick selfie; he got a great angle.
After a little bit long of a lunch, we headed out to the Green Lake of Kunming for some sightseeing. Arvind and Katie bought some massive flower cotton candy, mostly for the looks because the taste wasn’t great. Katie proceeded to make Dr. Yazdi hold hers for a photo op as well.
Then we joined in on some street dancing and singing (not really, but we contemplated).
After taking advantage of some great photo ops and taking lots of candid pictures of Dr. Yazdi, we went to a nearby coffee shop to catch up on mindmaps – which we called the Cafè|Design (Studio)|Bistro. Joke credit: Dr. Yazdi.
Very thrown off that the waitress spoke English, we eventually remembered that we could in fact order for ourselves, instead of relying on Katie and Victor per usual. After hours of hard work (actually though), we went to explore the nearby shopping – made some tea purchases from sketchy shops and lost Dr. Yazdi on multiple occasions.
After a while, we went back to the Green Lake to watch the sunset and see the other areas we had missed on the first time around it. We finally made it to the nine Dragon Lake, which really just consisted of nine hungry swans.
On our way out of the park, Dr. Yazdi noticed a fake shooting range and challenged Arvind to a shoot-out. Smack talk was prevalent and ultimately the face-off of the vegetarians to shoot animals resulted in crowning Dr. Yazdi the winner. His response: “I just wanted to show you who was boss”.
Then we rushed to a nearby McDonald’s for a late night dinner before our weekly meeting with Medtronic, now a tradition to eat it during our call. Connecting was a struggle with the hotels mediocre wifi, but eventually we had good connection and were able to have a nice discussion with the Medtronic engineers.
We spoke about some key differences between the two provinces (Yunnan & Sichuan) thus far, including:
- WeChat is more widely used in Yunnan for diagnosis, communication, and awareness
- The Class 3A Hospitals have seemed much less developed and overall smaller than the ones in Sichuan
- Access to pacemaker care due to the mountains is more difficult in Yunnan
- There is a more defined/strict referral pathway that patients must follow in Yunnan
CBID • Team China • 2016 