I am prefacing this post to inform those who read this to understand that it is not my intent to upset, diminish, or minimize a diagnosis of cancer. I have spent my entire career dedicated to generating a positive impact to those patients and families diagnosed by cancer, and too have lost my own father recently. This post draws on a parallel of my personal experience in China and a movie I loved as a child.
Imagine walking into your family practice physician and being told that you may have cancer. Time stops. Your heart falls to your stomach. The thoughts in your mind begin to race. You may experience sadness, anger, fear, or a multitude of various emotions all at once. You hear nothing else.
Now if you are in the United States, you can most likely see a specialist to complete the workup on a diagnosis of cancer within the next 24-72 hours, if that is what you wish.
However, this picture is much different in China. I had the fortune of visiting one of the leading cancer hospitals in Tian Jin, a city of over 12M people, and the fourth largest city in China.
This is a view from just outside the gates as you approach the Cancer Hospital. (It is the large sky rise, just behind the rainbow building) This particular hospital has just over 3000 beds.
The first thing I noticed upon approaching this cancer hospital, is that there is a gate, that is closed, with a security guard. Just to the left of the security gate is a small wooden booth, with a glass window, with a person in it. There was a large line that circled the front of the entrance waiting at this window.
I asked, what are the people waiting in line for here? I discovered that those people were waiting in line to obtain a ticket to get an appointment for a consult with a cancer doctor in this hospital. I learned that the earlier one arrived to get in line, the better chance one had to get a ticket that would allow them to see one of the top specialists in cancer care. The later one arrived and stood in line, the less of a specialist or an “expert” one would have access to see in their consult. (I would equate this to the difference between a physician at an academic medical center versus a physician in a community hospital. Both are good, but have different experiences and bring different skills to their patients)
At the same time, I noticed another group of men and women approaching me asking me if I needed a ticket. I was told to ignore them and just continue to walk. I came to realize later on, that the people approaching me with tickets were a cancer version of “ticket scalpers.” Apparently anyone can stand in line to obtain a ticket to see a physician in the cancer hospital. If you arrive late and there are no more tickets, you are out of luck for the day, unless you are willing to purchase a ticket from one of the “scalpers” on the street.
That’s when it really hit me. The experience for cancer patients in China is a lot like Willy Wonka and The Chocolate Factory.
In order to get into the gates, one must have a “golden ticket.”
Once you have a ticket and are allowed into the cancer hospital, you are then allowed to make an appointment. Again, you go to a booth and schedule an appointment. That appointment could be today, it could be tomorrow, or it could be in another month. It all depends on your ticket number, who you are trying to see, the kind of cancer it is they think you may have, and your ability to pay.
A lot of things you have no control over, yet at the same time, I am sure patients are filled with this growing anxiety knowing that if they do have cancer, it is growing inside of them as they sit and wait. Not being able to do anything about it.
Once you do get an appointment, you may be scheduled for additional imaging. I observed one patient receive an appointment for the following week, but was told to go stand in line for an imaging test. That patient walked across the hall and took their place at the end of the line. The line was wrapped all the way done the hallway. Patients were leaning against the wall, some sat on the floor, some on crutches. No one dared to get out of line for fear of losing their place. Some patients were outpatients and some were inpatients. All waiting in line for an imaging test.
I learned that part of the reason for this is because if you are called and not in line, you get skipped and may not be able to get your imaging performed. I also learned that part of their workflow is to do the same type of scan, over and over and over again, repeatedly, all day and all night long.
In comparison, in the United States we have a significant amount of downtime in which our imaging scanners are not used consistently. Either at night, in the afternoon, or on the weekends. We can usually power down the systems and conserve energy and life of the system. In China, they run their systems day and night, 24 hours a day, 7 days a week. They have patients line up and just as soon as one patient makes it off the scanner, the next patient is on and is being imaged.
Another item I learned is that the government regulates the equipment that hospitals can have and use to help care for their patients. For example, PET-CT scanners. In China, the government will only allow just over 300 PET-CT scanners to be installed throughout all of China. In comparison, as of 2009, the United States had 2000 PET-CT scanners. Europe had 350 PET-CT scanners installed.
To give you an idea on the ratios:
China: 330 PET-CT for just under 1.4B people
United States: 2000 PET-CT for 307M people
Europe: 350 PET-CT for 830M people
Again, this made me think of the potential bottle necks in accessing cancer care in China. Which brings me back to my movie analogy…..cancer patients are probably feeling like Augustus…
In the cancer centers I have designed, built, or influenced that development of the layout and amenities, there has always been a melding of patient aesthetic with clinical workflow and sensibility.
I have taken great pride to ensure that there are open spaces, natural light, plenty of flowers, plants, and trees. There have been places for people to visit and commune, places for privacy, places to promote silence, laughter, education, emotional support. There has always been a melding of bringing things that help people to heal emotionally and spiritually with the form, functionality, and practicality of caring for patients and families that have cancer.
In China, from the outside, the story appears to be very similar to one that we see in the United States. Large monolithic buildings with granite, windows, and lots of people. However, once you step behind the curtain one realizes that there is no consideration for the experience of the patient. It is all about the function of a hospital. To move as many people as you can through a system that lacks the process to move patients seamlessly from follow up, to diagnosis, to treatment, to post cancer care.
This story doesn’t have a happy or a bad ending. It continues on. I hope to take all of the opportunities I discovered and be able to continue to go back, share, educate, and help to make some changes to impact the lives of cancer patients in China.
I hope to help provide some good stories to a few cancer patients in China.
Perhaps one day I will help to rid China cancer care of the Golden Tickets, Wonka Bars, and Scrumpdiliumptious. I would like to develop and create a Chinese oncology network that allows everyone to have an Everlasting Gobstopper.
As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek
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