Shanghai Children’s Medical Center

Ni hao! Last week I spent in Shanghai learning from the very experienced Project HOPE team in China. The China office celebrated the 25^th Anniversary of Project HOPE’s presence in Shanghai in 2008 – a HUGE accomplishment. As one of the first non-profits to enter China, Project HOPE is still one of the only foreign foundations formally registered with the Chinese government and it took almost 20 years to gain this status (there are only 13 total, 5 in the healthcare space including the Gates Foundation, Clinton Foundation, Merck HIV/AIDs initiative, and a French TB-focused NGO).

Project HOPE was brought in for its technical expertise to help build the Shanghai Children’s Medical Center (SCMC)in 1998 – and still remains an active partner for the facility as it continues to grow over the years. Performing more pediatric cardiology procedures than any facility perhaps in all of Asia, their Heart Center has become a regional destination center for high quality care. SCMC was the only hospital in China to receive a USAID grant and has invested it with a number of well-known, global donors to transform a radish field (literally this entire area was a radish field) into a hospital nicer than many I’ve seen in the US at an affordable price. In addition to helping with the physical and technical infrastructure design, Project HOPE also provided resources to train a large contingency of the hospital staff during its first opening.

I was able to get a special perspective of SCMC this week as a resident in the hospital guesthouse! It was extremely convenient to be on-site but also privileges as the rooms are very comfortable.

My first tour of the center I did with one of Project HOPE’s nutritionists, focusing in the weight management and obesity center, in addition to a few of the patient wards. We focused on some of the educational materials available to patients and their families in the center. Was it “practical” enough for patients to understand (i.e. not overly technical)? Families in general don’t have the same communication challenges as you might see in India where the language and level of literacy changes from one town to another. We asked one of the children’s father in the ward if the posters were easy to understand – he said that one with example meal schedules was very helpful, but another detailing out amounts of different nutrients was confusing, “what does potassium such and such mean,” he said.

On Wednesday, Pete, David, and Hui from Deloitte US came to greet me in Shanghai and attend a number of my meetings, interviews and tours.

We took a comprehensive tour of the SCMC facility (including the range of patient wards) and learned all about how patients receive and pay for treatment in a facility like SCMC. One of the most interesting things we learned (news to me!) was that many patients with sick children want treatment immediately, and the preferred method for pharmaceutical administration is by IV.

Patients are admitted for part of the day to one of the IV rooms seen below to quickly treat patients without the need to wait for a pharmacy to receive prescription medication. They mentioned the “one child per family” as actually having some impact here on how care and medication are delivered in the pediatric center (so interesting!).

It’s hard to describe how beautiful the facility really is in person. They’ve done a lot to make this an exemplary hospital for other cities and regions in China. I hope that Project HOPE can be a part of helping patients in the extended community in the future as well!

During lunch we interviewed Jia Yun, a diabetes educator from Shanghai Ton University. There she provides individual consultations and group workshops for about 10 patients at a time. In addition, they do free classes for up to 30 patients at a time to diabetes patients, 97% of which are Type 2, older patients.

In 2008 the hospital decided it needed a formal diabetes educator role and sent Jia Yun to Denmark, Japan, and Sweden to understand the operational model used in countries with developed programs. Since then, her passion for treating patients with diabetes is inspiring to say the least. In addition to visiting with countless patients during the day (and performing some administrative roles, as “patient educator” doesn't fit in with the current Chinese hiring model), Jia spends many of her evenings preparing general and tailored educational materials for her patients.

She has also created what she calls a “volunteering model” to perform peer-educational roles. This was extremely interesting to me after witnessing the success of Project HOPE’s peer-education programs in Mexico. The model has 24 volunteers with diabetes that have been hand selected to do education for patients – each one offering a different role based on their capabilities (one is better at explaining pharmaceuticals and the other at carb counting for example). She says the largest challenge she has is that many patients don’t believe they can manage their condition – “this is the only way we could fix that.” In addition to knowledge and skills to perform self-management, she also stressed that affordability is an issue. She sees hope in specialized diabetes centers (as seen in other countries, like Brazil’s Hypertension and Diabetes Centers) that provide integrated education and treatment.

Lily and Pete discussing the transparency of costs in SCMC (the board behind them lists out the services and associated prices).

Like anything in China, an effort of this scale (or any scale) would require substantial support from the government for both execution and political reasons. And although each healthcare facility is technically public, the government requires that each be financially independent (break even). Interestingly, this creates similar profit-focused issues as seen in many private healthcare systems like the US. Is care altered to drive profitability? Well, not exactly. But it does make it harder to increase non-revenue generating activities such as education vs. investments in surgical capabilities which both patients are willing to pay and the majority of services are reimbursed by the government. In general, patients don’t necessarily want or feel like they need education – let alone the motivation to pay for it! I doubt many people in the US or other developed countries would pay money for an education-only visit (you might ask, “Wait no prescription? Why did I pay to come to the doctor?”). Our Deloitte and Project HOPE teams probed a lot on these issues to uncover any barriers that would need full acknowledgement in developing a new chronic disease program in China.