| Global Times | 2012-8-5 17:25:03
By Global Times
China's accelerated economic development has led to an imbalance in the development of medicine and healthcare across China. The impact of this has been felt across rural areas where medical expertise and services are lagging far behind the healthcare available in big cities like Beijing and Shanghai. The scenario is even worse for pediatric medicine, already challenged by a vast shortage of pediatricians in China.
Many parents in rural areas take their children to see doctors in China's major cities because they are concerned about the quality of pediatric care closer to home and believe their children will get better care in Beijing, Shanghai or Guangzhou. The cost of traveling from rural communities to seek medical care in China's larger cosmopolitan cities places a substantial economic burden on rural families. Children's hospitals in China's big cities are constantly packed with patients, most of whom are from under-developed counties or villages.
According to the 2000 statistics, the mortality rate of children under 5 years old in rural areas of China was 45.7 percent, compared to 13.8 percent in major cities across China. This disparity underscored the urgent need for better medical care in rural China. The global NGO, Project HOPE, recognized the problem and sought ways to bridge the gap between the medical care available in big cities and the care available in rural communities.
Sending experienced healthcare professionals from developed areas to rural areas may treat a few children and teach a small number of local health professionals but the impact is very limited. Although donating modern medical equipment seems to improve a local hospital's efficiency, local doctors may not know how to best use advanced technologies. HOPE experts understood that the best solution would be to develop programs that are practical, economical, effective and sustainable.
Thus in 2002 Project HOPE and the Shanghai Children's Medical Center (SCMC) agreed to launch a program to train healthcare professionals from rural areas in SCMC. The professionals who complete the courses return to their hometowns and then train other healthcare workers. The "Train The Trainer" method is like the old Chinese saying: It is always better to teach a person, who is hungry, to fish than to give him fish.
A rural program
In 2002 using the "Train The Trainer" concept Project HOPE initiated a rural training program with SCMC. The program aimed to accelerate healthcare development with a focus on critical care medicine in China's rural areas, and to reduce the mortality rate of children under 5 by improving the skills and capabilities of rural doctors and nurses through training.
Every June, Project HOPE and the Shanghai Children's Medical Center recruit 25 doctors and nurses from rural areas, especially from the western and northeastern parts of China. Considering the needs of these local hospitals, the programs mostly recruit professionals specialized in Pediatric Intensive Care Unit (PICU), Newborn Intensive Care Unit (NICU), Internal Medicine and Hematology.
The rural medical workers are typically interested in learning how to operate a ventilator, how to set a Peripherally Inserted Central Catheter (PICC), and critical care medicine. Their hospitals expect them to return with these skills and implement new clinical systems.
To date this program has trained 249 professionals from 18 provinces, including 20 from Inner Mongolia, 18 from Gansu, eight from Xinjiang and one from Tibet. Project HOPE provides room and board for these health workers for their one-year stay in Shanghai. Project HOPE also provides scholarships to address specific training needs for rural medical professionals.
The professionals who are selected for the program come to the Shanghai Children's Medical Center, a leading pediatric hospital and medical training center in China, for a one-year course. Each participant has a training plan tailored to his or her specialty and needs. Each rural professional is assigned an experienced mentor who shares his or her medical knowledge and teaches clinical skills. The trainees also rotate to different departments at SCMC to widen their experience and expand their knowledge.
During the one-year training period the participants must pass both clinical and theoretical exams after each rotation. For example many will obtain a Basic Life Support (BLS) certificate, a Pediatric Advanced Life Support (PALS) certificate and undertake a teaching skill presentation and a final exam to test their comprehensive understanding of the training for advanced pediatric practice.
The teaching skill presentation is a unique way of evaluating the participants. The participants have to deliver a lecture on a specific disease illustrating this with suitable clinical cases and direct clinical experience using PowerPoint (PPT). It constantly amazes the mentors when they discover these people have never used PPT before - some are not familiar with computers at all. Their SCMC colleagues help them to make the PPT presentations - teaching them how to make slides and their mentors coach them in public speaking.
This presentation means a lot because the participants will eventually bring home not only their new knowledge and clinical skills but also modern methods of teaching which will enable them to pass on precisely their knowledge and skills. Project HOPE and the SCMC continue working together to identify and provide more professional workshops or clinical practice opportunities for these medical professionals. Most of the lecturers at the workshops are prominent experts from China or abroad and the participants cherish these special learning opportunities.
Project HOPE has also recognized that more has to be done to address some of the many other health challenges in China - for example, talking with those involved to address issues like the shortage of pediatricians and the importance of setting standards for pediatric residency training.
Life in Shanghai
Every year the participants are surveyed for satisfaction rates and every year they report high levels of satisfaction with the program. This is not just because of the training they receive, but also because they are living for that year in Shanghai. Their mentors and management teams are concerned about they way they live and, because many are from ethnic minorities, they want to ensure that their diets and customary lifestyles are as familiar as possible. The participants all have to overcome the difficulties of leaving their families and going to live in an unfamiliar city.
Food can be the first problem they encounter as a lot of Shanghai food tastes sweet and not spicy. But at the SCMC canteen, there are always two bottles of chili sauce beside the serving hatch. This little tradition began to show support for the participants from far away and has continued since the first group of rural doctors and nurses arrived in Shanghai.
The trainees have to get used to the fast pace of life in Shanghai. Here professionals take very short lunch breaks and go back to work promptly after lunch. In the rural hospitals where the trainees have been working, they can take a two-hour break after lunch. Every day the trainees in Shanghai work with their mentors learning how to maintain the pace of life and seeing increasing numbers of patients. One of the hardest things for a visiting pediatrician has nothing to do with their professional skill, but has to do with handling angry parents speaking the Shanghai dialect.
One participant talked about his experience in the emergency room. He said he had had a hard time understanding Shanghainese and had tried hard to understand the parents' requests. It took time and effort for him to respond to their questions but there were misunderstandings. When he felt the parents were disappointed in him, his mentor and colleagues stepped in to advise him on how to better communicate with parents, how to comfort them and their children. He took the advice and discovered that it really worked. The participants learn that communication skills are as important as professional and clinical skills.
Project HOPE and SCMC organize regular sightseeing trips around Shanghai and neighboring provinces for the program participants.
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