Twenty million people and no primary care (but it works)

Ni hao (hello)

We arrived after a very easy journey from London Heathrow direct to Shanghai  to be met by Zhang Zhong Jiu a very knowledgeable and extremely friendly guide. Zhong is going to be with the tour for the next 14 days and sharing with us all the facts and figures about this interesting and exciting country.

After a 45 min bus journey we arrived at an very comfortable hotel in the centre of Shanghai. It is directly opposite a beautiful Roman Catholic Church and the streets are very busy but seem safe to walk out alone at night.

What are we here for and who are we?

This tour has been superbly arranged by Jon Baines Tours and FIH. The aim of the tour is to allow us to experience how another culture uses diet, exercise, the local community, environment and traditional Chinese Medicine  alongside  main stream medicine.

In the group we have general practitioners, anaesthetists, obstetrician and gynaecologist, nurses, surgeons,  psychotherapists and pharmacists: 12  of us in total. We are all beginning to learn a lot from each other as well as from the deep culture that exists here.

A city soon to be the size of Britain

Shanghai is a rapidly changing city with huge development taking place. Expo is coming to Shanghai in 2010 and they obviously want to make this an enormous success.  There are three main geographical areas of interest. The old city typically Chinese; then there are the former concession areas once under the direct rule of the French, British and Americans; the third area is the shopping and  business area with some of the tallest buildings in the world. Expansion of the city is occurring at a rapid speed.

There seems to have been a huge social change over the last 20 years and the days of jobs for life are a thing of the past. The population of Shanghai over the next 20 years is going to increase from 20 million to 80 million people - what will the city and its infrastructure look like then?

In the park

This morning we had the pleasure of visiting a local small park in the middle of the rush of the city. There groups of young, middle aged and old were dancing, performing Tai Chi or playing cards  and doing body stretches.  All to stimulate the mind and body- inspirational. What community spirit and use of the natural environment.

Exercise is encouraged and actively promoted by employers.  I do hope this wonderful tradition will not be lost by development.

At present obesity does not appear to be so publicly obvious - will this change with development as well? It seems so - with one fifth of school children in big cities now overweight and the incidence of type 2 diabetes increasing.

In the hospital

After a light lunch we went on to visit The Cao Yang Red Cross Hospital. Here diabetics can get their insulin as well as a herbal foot soak followed by reflexology as their treatment.

Surgical orthopaedics sits next to Chinese branch orthopaedics. Patients hold their own records and payment is means tested. However they are made fully aware of the costs and the prices of drugs are displayed on a huge screen in the pharmacy.

The education of the public on medical issues is seen to be very important. We saw posters highlighting the risks of smoking and the dangers of a high salt intake. There is a 24hour TV channel on health and healthy living. 

Patients seem to have a key role in decision making and if they don't like the doctor they are free to move onto another. There is a nurse at the front of the hospital who seems to act as a gate keeper and advisor on whom to see. This in some way is essential as there are no general practitioners or other primary care service.

In the large 60 seated room where patients were given outpatient intravenous therapy there is a huge poster saying:  ' To look after the peoples health we offer the best service.' 

Family planning

As we moved on around the hospital we passed the obstetric and gynaecology department. A large cabinet at the entrance provided examples of the family planning that is offered so people can stick to the ' one child one family policy'. I was also fascinated to see they had a clinic dedicated to the menopause and its problems.

We then visited the acupuncture unit. Here  a man was having acupuncture with moxibustion as well as lamp heat therapy for rheumatism. In the same room a woman was having electoacupunture. A practical demonstration of cupping then took place - . I was the ' guinea pig and I now have 6 enormous round raised areas on my back due to the cups being applied  with negative pressure to allow a local inflammatory reaction to take place.

Care for older people

We then moved on to visit a local Centre for Care of the Elderly. Here 90 old people live in a clean building converted from a kindergarten.

Interesting how times have changed with an increasing ageing population They all seemed very comfortable happy and well fed. Men were playing a kind of draughts and all did T'ai Chi in the morning. On the way out they all applauded us and waved !

What a great start - we have all learnt and experienced so much - and it is only day one. It is a privilege to be here and to be allowed to investigate the true nature of their healthcare society. More tomorrow.

Xiexie ( thank you)

and

Zai jian  ( good bye)