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June 3rd 2015
Published: June 10th 2015
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June 3, 2015 (Chengdu) Factoid of the day: there are now an estimated 20 million registered permanent residents and 130,000 expats in Chengdu! What an amazing city.

Yesterday was an exercise in patience. We met with folks on the Chinese side (hospital) from facilities planning and management. They speak no English. We translate via physicians who are on our team (who are to some of the the business terminology) and try to communicate concepts like blueprints through the “telephone game”. If it were a Seinfeld sitcom it could be very funny!

So it goes something like this....

I ask a question like “How many operating rooms do we need?” expecting to hear an answer like “one” or “two”…7-8 minutes later after animated jumbled Chinese conversations I’m answered with “you can’t build standards compliant operating rooms on the floor you were assigned because the ceilings aren’t high enough.” I respond “That wasn’t my question.” After a few rounds of this, we end up with an actual number of operating rooms needed “Three”. So we now have a need for more operating rooms but they provided us with 1/3 the actual space we anticipated needing for a two operating room plan. After about five hours of this type of back and forth dialog, we ended up with a framework of requirements for the Chinese architects, and they told us that they’d like us to work with architects and then send them the plans for approvals. Not a bad outcome...it just takes time. The victories for the day were that 1) we did manage to get some requirements agreed upon for the space we have been given, and 2) we are now advancing an actual collaboration pilot project! Now we have to agree on equipment which is a whole other world here…the formula is US retail price X 3. So we are talking major investments for operating rooms here.

The afternoon was spent in clinical teaching, systematically working through a diagnostic approach (history, physical exam, differential diagnosis, workup, assessment and plan). The Chinese medical mindset seems quite different to us. It isn’t as structured - selective information that supports their conclusion is presented and key information is omitted. The diagnostic work up seems to be driven by what is available rather than what will distill out a diagnosis from the differential list. Again, lost in translation, we try to direct their thought processes to a more Western style approach. It seems they see it as inefficient, even though we make the case that the discipline of our thought process dramatically improves clinical and economic efficiency. Slow change inside the current system. An interesting case presented to me was an orbit/periorbital mass. It appeared to be a vascular malformation - on the surface a hemangioma of some kind. It had been treated with radiation, surface laser and radio frequency ablation - all failed and now six months of rapid growth. We examined the patient and found a massive A-V fistula from his external carotid artery that probably developed after radiation causing the problems. He was a guy in his mid 20s, bright, motivated and other than the disfigurement of the angioma good looking. We referred him to UCSF for vascular surgery - hopefully he’ll be able to get it done.

The evening, Dr. Farris and I were invited to a tea house across town. For ten years, a bright young woman who has been finishing her education in the US has joined our team here. She just finished her PhD at Harvard School of Public Health. She and her mother are Chinese by birth but spend a lot of time in the US. Her mother is a business woman here in Chengdu and her father is a cataract surgeon at SPPH (the hospital we work with here). We drove across the city to a part of town we rarely get to see because we’re so entrenched in activities with the hospital. This area (called Tian Fu) was a new and more upscale than our hangouts - felt a bit more like we were in Hong Kong...an amazing part of town. We went into this elegant tea house and met with her mom. About 30 minutes into our tea/coffee time, a charming couple joins us - he an animated entertaining man, she was a charming beautiful Chinese lady who spoke pretty good English. He was dressed very casually, she was dressed casually buy elegant. He had just been discharged from hospital, bandages from abdominal surgery in place! The conversation started of lightly, but by the end of the evening we found out he was a real estate developer. Most of his experience was in commercial and residential real estate, but he was now building an orthopedic hospital in SW China. He
Dr. FarrisDr. FarrisDr. Farris

Riding in comfort
had gone to the hospital we work with for his surgery, and knew a lot about the economics, the opportunity, the politics and the strategy of the SPPH hospital. We discussed our model and approach and he strongly endorsed it, and also gave us valuable insight into the market segment we need to address here. We Uber’ed back to the hotel shaking our heads in amazement at the connections and people that seem to be falling into our path…who knows where it might lead us. Though rambling, I'm hoping to convey the complex, frustrating, yet fascinating environment we are working in here. Its so difficult to relate to it once we get back home - even the simple concept of 20 million underserved populations is hard to communicate, never mind the cultural, economic and social contrasts we work through every day!


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The Hospital Van

The Hospital generously allowed the Hospital van to transport us wherever we need to go.


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