15 Aug, 11 | by BMJ Group
A few weeks ago I took the family on a trip to Wuhan. We went with another family and a family friend, so it was a jolly party that crossed the border and took a domestic flight from Shenzhen to Wuhan on the Friday evening.
Wuhan is a fascinating city, positioned half way between Beijing in the north and Guangzhou in the south, and half way between Shanghai in the east and Chongqing in the west. The Lonely Planet guide says that Wuhan is a place that many visit but only to pass through. This is a shame as it has many historical and cultural sites to visit. It stands on the mighty Yangtze River and the Yellow Crane Tower figures in many classical poetic works. Wuhan features a rather politically sensitive anniversary this year. It was 100 years ago in October of 1911 that the Wuchang Uprising overthrew the Qing Dynasty to bring democracy to China. Dr Sun Yat-sen, the Che Guevara of the Orient, played a prominent role in the process. But I digress somewhat.
On the Saturday morning I went to the First Affiliated Hospital in Wuhan to deliver a lecture on the surgical management of skin pathology to an assembled audience of dermatologists. They were attentive, appreciative, and there was a lively discussion. After the talk I was shown round the department by the senior doctor in charge of the outpatient department. I was told that between two and three thousand patients were seen each day by the 70 doctors in the clinic. I noticed the electronic information board was calling for ticket holder 750 and it was only eleven am.
Treatments were about 50/50 traditional Chinese and Western medicine. The treatment rooms contained a plethora of equipment for steaming, soaking, injections, and infusions as well as bandaging and other topical treatments. In the afternoon we went to the 3rd affiliated hospital to meet up with old friends in the burns centre. Both adult and children wards were full and overflowing. Adult patients in the ICU had a minimum of monitoring equipment and the patients lay in either air fluidised or spinal beds that allowed easy rotation.
I asked the paediatric burn surgeon about the costs of care and the operative strategy. She told me about the mounds of paper work that had to be filled in before operating on a child. “That’s good,” I thought until it was explained that the paper work was not to protect the patients but to protect the doctors. Emotions can run very high if a family sells all its belongings to pay for the treatment of a family member who then does not survive.
Much work needs to be done in mainland China to bring affordable healthcare to the whole population. In the meantime doctors share their concerns about their moral and ethical dilemmas with regard to patient care but also concerns about their personal safety.
The following day we went to a futuristic science park to visit a cutting edge R&D centre for antibody targeted drug therapy for cancer. After lunch it was time to return to Hong Kong. The question was how? I have always liked trains and so I had suggested we try the high speed train from Wuhan to Guangzhou. This met with general agreement and we headed for the Wuhan station. This was an incredible building with a high curving roof that looked far more like an airport terminal than a railway station. Indeed the interior was so vast that individual voices melded into a background hum much as in the giant cathedrals of Europe.
With our tickets purchased, we passed security and went to the designated waiting area with comfortable seating surrounded by shops and restaurants. When the time came for boarding we descended a long escalator to the platform level to enter the lavishly appointed bullet trains. Needless to say the journey was spectacular. We could constantly monitor the speed from the electronic display at the end of each carriage and the maximum speed I noted was 345 kph. The ride was quiet, smooth, immensely comfortable, and we were all highly impressed. Quite a contrast to the local train from Guangzhou to Shenzhen.
It was two weeks later that the Beijing to Shanghai high speed link started amidst a lot of politics and adverse comments from both local and international experts. Then the fatal crash on the Wenzhou line occurred; six carriages derailed and 40 killed. Some say it was inevitable; some say it is just the “tip of the iceberg.” In four years China has built the most extensive high speed train network in the world, a massive and very expensive undertaking. Even if there was no corruption it would be virtually impossible to expand at such a rate without having some significant problems. But then I try to put things in perspective. When returning to the UK, I still prefer to take my chances on a train rather than the motorways, despite the history of fatal train crashes in the UK. And in China, road, rail, or plane? I am pragmatic and in the past my position has a been planes for the longer journeys but trains, high speed trains if applicable, for the rest. Another major train crash in the high speed rail network would be politically unacceptable at this time. As such I expect a massive review of safety policies and procedures is underway right now. Next time I am visiting the mainland if there is a choice, plane or train? My choice would still be the train. And if there was a crash? I have travel insurance and if I had survived, would seek care from one of the many excellent private hospitals in the mainland and, not having the power of the people behind me, I hope the doctors would feel relaxed enough to give me their best care.
Andrew Burd is professor of plastic, reconstructive, and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.