The Girl Scout Motto and Law states to “be prepared” and to use resources wisely to make the world a better place.  These are words to live by as I write this blog with Girl Scout Troop 591’s banner on my desk next to my 3 bottles of donated propofol, surgical headlamp, and an old general surgical textbook.  With $77 of hard earned money, a group of 10 girl scouts voted to donate their money to our mission to Haiti.  I received it yesterday in a small plain envelope with a message, “Making the World a Better Place”.  Somehow, these 12-year-old girls may understand more about the disaster in Haiti than many of us adults.

Well wishes from Girl Scout troop 591

Over the last two weeks, our team has scrambled to assemble the resources to provide a self sufficient medical unit for a small orphanage 1 hour north of Haiti.  Despite early reports of the futility of providing medical care so close to a natural disaster in a country, our team thought it was worth trying.

Our goals were clear:

1. Help build things.  With an ability to use a private jet and our large network of resources, we could build, improve, and restock an existing operating room to better handle disaster victims.
2. Help people.  A team with surgeons and nurses even with limited supplies could help care for people with life and limb threatening injuries 4 weeks after an earthquake.
3. Learn something.  After spending a week in the foreign environment of a disaster, we hope to learn more about the human condition and about ourselves.
4. Tell a story.  The more other people learn about why we want to respond to Haiti and how they are suffering, the more people may want to help.

Through the use of social networking and real life networking we have succeeded in amassing 600 lbs of medical material.  We found a jet generously donated by the Ariel Corporation in Mt. Vernon, Ohio.  We had people donate an anesthesia machine and an X-ray machine. Individuals from Cardinal Health, Kimberly Clark, Stryker, Wright Medical, DJO, Medline, Clinical Trays, OhioHealth, and OSU East Hospital went out of their way to help find critical equipment. A documentary film team from Malaysia has reached out and offered to help while in Haiti. I have met people daily who volunteered to go. I never realized there were so many people who I knew who had a background in the military or missionary work who were willing to help. ..immediately.

What I’ve learned through this early phase of preparation is that we live in a larger community than we think.  We are far more connected than we give ourselves credit for.  And if you ask for help, the natural tendency of man is to give.  I can see why Goethe’s guidance continues to ring true, “be bold and great forces will come to your aid”.

Our great force is well symbolized by Girl Scout Troop 591.  Thank you for your aid.

Planning for Haiti: week 1

Exactly 1 week ago, I agreed to go to Haiti on a humanitarian mission.  Given a little experience in Vietnam and Afghanistan, I thought I had the skills to help. The difference was that in those missions, a preexisting infrastructure of care and healthcare delivery had already been established.  So the challenge was to build the medical team that could make a difference in Haiti, just 3 weeks after the earthquake.

The response was immediate and complete.  Of course Minh Nguyen, MD, was on board. He started the whole effort in the first place.  His interest started when he rode his bicycle across the country to raise money for charity.  He ran into Project Help Haiti and knew it was a good cause with good infrastructure. As a chief resident at the Ohio State University, he is at the pinnacle of his knowledge of Orthopedics.  Working on a daily basis in a level 1-trauma center, there is little he hasn’t seen or hasn’t done.

David Kasserman MD.  General Surgeon volunteered after only 6 hours of contemplation.  After training in New York City, he has amassed a ton of experience with both rural and urban general surgical emergencies.  Well regarded in at least 4 different hospitals., he’ll bring expertise to abdominal trauma and injuries.

Amy Bush RN serves currently as the VP of Operations at Dublin Methodist Hospital.  A former critical care nurse with experience in mission work in the Caribbean and well as travel experience through China, travel into inhospitable environments are not foreign to her.   In addition, she has an MBA!

Regina Chen, RN is probably one of our best PeriOperative nurses.  She knows the ins and outs of getting patients ready for surgery and getting them through surgery. With little equipment in Haiti, she’ll be able to put her resourcefulness to the test.

And finally, Ed Chen, MD.  Chief of Anesthesia at Dublin Methodist Hospital.  I’ve known Ed since he was a resident at Ohio State University.  Even then he was an agile clinician who found physiology more interesting than the mundane world of surgery.  He got even better as he got specialized training at the Cleveland Clinic.  With a recent trip from Africa under his belt, he’ll be our best asset on the trip.

Logistical planning into a disaster zone is difficult.  There are no commercial flights to Haiti currently.  Landing slots are tightly controlled.  We were able to get clearance for our mission dates of February 13 to 20 through Project CARE.  With a lot of pleading through Facebook and Twitter we were able to acquire a jet.  But with every victory, there is a little loss, and we found out the pilots who have been shuttling teams nonstop have reached their monthly quota of flight time.  We may have a jet, but we don’t have a pilot.  Our search continues.

In addition, the xray machine, which was marginally operational, finally broke.  Again with more pleading and begging on Facebook and Twitter, we found a mini-C arm. With a weight of almost 900 lbs, we face the challenge of shipping it down to Haiti.

Interest from the orthopedic community remains high despite negative reports from some of the earlier missions.  Ruth Thomas MD from Little Rock, head of the Humanitarian Committee of the American Orthopedic Foot and Ankle Society is beginning to plan her own mission 3 weeks following ours.  Rob Veith, MD, my teammate from a Vietnam mission is flying to the Dominican Republican and plans to get to Haiti overland!  Mark Slovenkai, MD, another surgeon with Vietnam background is considering a mission shortly. Joao De Carvalho Neto, MD

But the greatest interest comes from our friends, families, and neighbors.  I get daily volunteers willing to join.  Regardless of skills, there is a great sense of desire to come into a dangerous region and just help.  Pretty inspiring.

We’ll be evaluating all of our donated medical supplies this week.  Hopefully finalize flight plans.  With continued contact with teams 1,2, and now 3 (leaving today), we’ll try to define our medical goals in the coming days. We’ll keep you up to date through Twitter, Facebook, and this blog. I anticipate the chaos to only get worse with time.

Immunizations now up to date.

My thoughts after a week revolves around the many offers to help.  Volunteerism seems to be a root element of our culture.  It is yet another aspect of our community that we can be proud of.

Haiti street scene before earthquake

At 4:53:09 pm on January 12, 2010, 15 miles southwest of the capital city of Port-au-Prince, Haiti, an earthquake measuring 7.0 on the Richter scale struck. In the ensuing days, its estimated that 200,000 people lost their lives.  As phone camcorders documented the Asian tsunami disaster, Twitter and blog feeds recorded the devastation in real time.  For many of us on Twitter at the time, we’ll recall the flurry of activity on our Tweetdecks.

As an active orthopedic practice with some experience in humanitarian missions, the question of how to help came up rapidly.

Several influential teams responded rapidly. Here is an email from Dr. Dean Lorich who participated in a rapid response team within the first week:

I believe we went in with a reasonably comprehensive service we wanted to provide acute trauma care in an orthopedic disaster.  Our plan was to be at a hospital where we could utilize our abilities as trauma surgeons treat the acute injuries involved in an orthopaedic disaster.  We expected many amputations however came with a philosophy that would reasonably start limb salvage in what we thought was a salvageable limb.

David Helfet put a team together which  included:
2 orthopaedic trauma surgeons
3 orthopaedic trauma fellows
2 highly skilled anesthiologists
1 general surgery trauma surgeon
2 synthes reps who were also scrub techs
1 trauma nurse practioner to do triage
2 OR nurses

Our equipment including a huge amount of anesth medications and equipment, ability to construct 150 ex fix both small and large, OR equipment including scalpels etc, OR soft goods, splint material, OR prep material.

We also had a plan of physician and equipment replacemnt that was dynamic where w/i 24hrs we could bring in what was necessary on the Synthes private jet.

We thought the plan was a good one.

We were incredibly naïve.

Disaster management on the ground was nonexistent.  The difficulties in getting in despite the intelligence we had from people on the ground and david helfet’s high political connections with Partner’s in Health as well as the Clintons only portended the difficulties we would have once we arrived.

We started out friday morning, got a slot to get in friday that was eventually cancelled when we were on the runway to be rescheduled the next day.  We diverted to the DR and planned on arriving in P OP saturday.

Once on the ground the hospital we had intelligence that was up and running with 2 OR’s General Hospital was included severely in the earthquake and not capable of running functioning OR’s as there was no running water and only a limited electrical supply on generator.

We quickly took our second option
Community Hospital of Haiti.  We found approx 750 pt in the hospital upon our initial eval, the hospital had running water, electricity and 2 functional OR’s
Our naivette did not expect that the 2 anesth machines would not work, there would be 1 cautery for the hospital, autoclave that fit instruments the size of a cigar box, no sterile saline, no functioning fluoro and no local staff only a ragtag group of voluntary health providers who like us had made it there on there own.

To summarize we had no clue the medical infrastructure of the country was so poor.

As we got up and running in the OR and organized the patients for surgery we communicated our new needs back to Synthes and more supplies were loaded for a second trip – these included battery operated pulse lavage, a huge supply of saline, soft goods in the OR.  This plane landed as planned sunday pm, equipment was loaded on a truck and subsequent hijacked between the airport and the hospital.

At the hospital we had zero security despite promises form NYPD and NYFD to provide that to us.

Our philosophy was to work like this was a marathon run the OR’s around the clock with the idea that we would have a defined extraction time of 11pm tues.  The plane that extracted us would come in with a new medical staff compliment to replace us. Equipment included urgent things to maximize issues that were nonexistent in the hospital that would enable us to provide better and more efficient care:
2 portable anesth machines
2electrocautery
2 portable monitors for the pacu
2autoclaves
Replacement exfix
Things that didn’t arive with the previous flight

That planes slot was cancelled by the military at 6am tues.
We also previously had seen daylight in the remaining patients monday night haviving completed approx 100 surgeries.  However on tues morning we found a huge # of new patients.  The hospital was forced to undergo lockdown closing its gates to the outside and outside crowd becoming angry.

We also noted tues morning that many of the patients we were operating on were becoming septic.
We finished operating at noon tues, the last surgery our group assisting an obstetrician on a caesarian and resuscitating a baby that was not breathing.

We decided as a group the situation for us at the hospital was untenable supplies were running out, team was exhauted, safety a huge concern, and no extraction plan with resupply.  We decided to make our way to airport thru the help of a hospital benefactor.  Jamaican soldiers with M-16 were necessary to escort us out with our luggage as the crowd outside saw us abandoning the hospital.

We made it to airport on back of a pickup track, got onto the tarmac, hailed a commercial plane that carried cargo to montreal and had private jet pick us up there.

The issues we were unprepared for and witnessed were
1.  The amount of human devastation
2.  The complete lack of a medical infrastructure in the country
3.  The lack of support of the haitian medical community
4.  The complete lack of any organization on the ground.  Noone was in charge, we had the first functional up and running hospital in the P OP area yet noone and I me NOONE came to the hospital to assess what we were doing, what we were capable of doing and what we would need, to be more efficient. The fact that the military could not or would not protect the resupply equipment on sunday or let the tues flight come in says it all.
5.  Lack of any security at all at the hospital

I would take away that disasters like this need organization on a much higher level than we had with the clear involvement and approval of the military from the beginning.

Currently there is Noone obviously running the show and care is in chaotic at best.  MD’s are coming in country with no plan of what the are going to do. Surgeons that expect to just show up and operate are delusional as to what there role would be as without a complement of support staff and supplies they would be of limited or no value.

I hope this helps.  We all felt as though we abandoned these patients and that country and feel terrible.  Our role now being back in NY is to expose the inadequacies of the system to the media in the hopes of effecting a change in this system immediatly.  We feel that the only way to really help now is an urgent programtic change and organization in the support of the medical staff on the ground and what is critically needed to expeditiosly bring in.

Cherrios on the tarmac are not getting it done on these patients which clearly would be savable if good care could urgently be provided.

Please share this email with everyone and anyone you find might help.

Good luck
Dean

With these obstacles in mind, Minh Nguyen MD, a chief resident at the Ohio State University recalled an established organization he interacted with while riding his bicycle across America fund raising for Partners in Health.  This group, Project Help Haiti, ran an established orphanage in Pierre Payen.  This orphanage and hospital sits about 60 miles north of Port-au-Prince.

http://www.project-help-haiti.blogspot.com/

Because they had an intact infrastructure, they have been able to maintain a functional hospital through this disaster.  With a goal of serving the disaster but more important to keep a functional mission in the months/years to come, they have been sending medical missions rapidly.

With donated private jets and clearance from the 82nd Airborne, 7 teams have been organized.  Team 1 is just returning while team 2 has landed.  Here in Columbus, we are assembling team 5 for a departure of February 13.  Planning a team of 2 orthopedic surgeons, 1 general surgeon, 1 anesthesia, and 2 nurses, our goals will be to get on the ground and help in anyway possible.

This team will land almost exactly 1 month after the earthquake strike.  The challenges will be different from the acute devastation of the first few weeks.

Unlike the usual challenges of orthopedic surgery to return function, our goals here will focus on stabilizing bodily function and averting infection.  And in the end, hopeful save a life.

Follow us here on this blog as well as on Twitter for continual updates

Cleaning up mounds of snow can cause more pain than just a headache. While this seasonal activity may seem mundane, it can also be dangerous.
According to the U.S. Consumer Products Safety Commission:

In 2007, more than 118,000 people were treated in hospital evergency rooms, doctors’ offices, clinics and other medical settings for injuries that happened while shoveling or removing ice and snow manually.
More than 16,000 were injured using snowblowers.
Types of injuries can include sprains and strains, particularly in the back and shoulders, as well as lacerations and finger amputations.
The Orthopedic Foot and Ankle Center offers the following tips for safe snow clearing:

Check with your doctor. Because this activity places high stress on the heart, you should always speak with your doctor before shoveling or snow blowing. If you have a medical condition or do not exercise regularly, consider hiring someone to remove the snow.
Dress appropriately. Light, layered, water-repellent clothing provides both ventilation and insulation. It is also important to wear the appropriate head coverings, as well as mittens or gloves and thick, warm socks. Avoid falls by wearing shoes or boots that have slip-resistant soles.
Try to clear snow early and often. Begin shoveling/blowing when a light covering of snow is on the ground to avoid dealing with packed, heavy snow.
Be sure you can see what you are shoveling/blowing. Do not let a hat or scarf block your vision. Watch for ice patches and uneven surfaces.
Shoveling tips:

Warm-up your muscles. Shoveling can be a vigorous activity. Before you begin this physical workout, warm-up your muscles for 10 minutes with light exercise.
Pace yourself. Snow shoveling and blowing are aerobic activities. Take frequent breaks and prevent dehydration by drinking plenty of fluids. If you experience chest pain, shortness of breath or other signs of a heart attack, stop shoveling/blowing and seek emergency care.
Use a shovel that is comfortable for your height and strength. Do not use a shovel that is too heavy or too long for you. Space your hands on the tool grip to increase your leverage.
Try to push the snow instead of lifting it. If you must lift, do it properly. Squat with your legs apart, knees bent, and back straight. Lift with your legs. Do not bend at the waist. Scoop small amounts of snow into the shovel and walk to where you want to dump it. Holding a shovelful of snow with your arms outstretched puts too much weight on your spine. Never remove deep snow all at once. Do it in pieces.
Do not throw the snow over your shoulder or to the side. This requires a twisting motion that stresses your back.
Snowblowing tips:

Never stick your hands in the snow blower! If snow jams the snowblower, stop the engine and wait more than 5 seconds. Use a solid object to clear wet snow or debris from the chute. Beware of the recoil of the motor and blades after the machine has been turned off.
Do not leave the snow blower unattended when it is running. Shut off the engine if you must walk away from the machine.
Add fuel before starting the snow blower. Never add fuel when the engine is running or hot. Do not operate the machine in an enclosed area.
Stay away from the engine. It can become very hot and burn unprotected flesh.
Watch the snow blower cord. If you are operating an electric snow blower, be aware of where the power cord is at all times.
Do not remove safety devices, shields or guards on switches, and keep hands and feet away from moving parts.
Beware of the brief recoil of motor and blades that occurs after the machine has been turned off.
Never let children operate snowblowers. Keep children 15 years of age and younger away when snowblowers are in use.
Read the instruction manual prior to using a snow blower. You need to be familiar with the specific safety hazards and unfamiliar features. Do not attempt to repair or maintain the snow blower without reading the instruction manual.

Late last night, the House of Representatives passed HR 3962 by a vote of 220 to 215.  Very close. One Republican jumped ship and a huge debate over federally funded abortion was resolved to carry the vote.

From an orthopedic surgeons point of view, there are a few good things about this bill.  There are provisions which promote a state grant for medical liability alternatives.  There are provisions eliminating the antitrust exemption for health insurance and liability insurance companies.  There are no provisions for a punitive Physician Quality Reporting Initiative.  Finally, there are no provisions for Independent Medicare Advisory Council where Congress would abdicate its reposonsibility for Medicare policy.

These are the good things.  But there are many things of great concern for those of us who remain thoughtful about health care reform.

HR 3962 calls for the formation of a new advisory body, similar to the CMS Innovation Center proposed by the Senate.  This body lacks input from physicians.  There will be no regulatory agency accountability either.

There will be a redistirbution of residency slots with the sole focus on primary care.

There will be restrictions on physician owned hospitals.

There will be the establishment of a public national medical device registry which lacks privacy protection for physician level data.

Finally, there needs to be a permanent repeal and replacement of the Medicare Sustainable Growth Rate formula.

HR 3961, the “companion bill”, takes these major factors into account.  The provisions within this bill will allow health care reform to succeed by creating a stable Medicare program on which our elderly patients can rely.  If we allow these current flaws to continue, health care reform will be in trouble.  We all know our current system is in trouble. But like surgery, we can’t stop after the diseased organ is removed, we still have to finish the operation until the patient is closed up and successfully awake in the recovery room.

Apologies for a very serious blog but major changes are coming and we are all in a position to influence how health care will be delivered to us in the coming generations.

Excercise vs. Diet

This may be controversial but after a certain age, excercise and activity will not make you thin.  This is important for me as a surgeon because after injury, so many patients make a renewed commitment to lead healthier and more active lifestyles.  This often begins with weight loss.  So a frustrating cycle begins with more activity to try to burn more calories and it leads to more injuries.

If a person runs a full 26 mile marathon, they will only burn 2600 calories.  That will easily be made up by the celebration Big Mac and French fries.  In fact, the Powerbar that’s consumed to prepare for a workout will have more calories than the workout will consume.

Running burns only 100 calories per mile

There has been much written about this.  The purpose of excercise it seems is to maintain a habit of activity which in the end will lead to a more active lifestyle which in the end will lead to great health.  None of this will however make you thin.

Only maintaining healthy eating habits will make you thin.

I have a few suggestions:

Don’t eat food that is white.  No pasta, no rice, no bread, no flour, no sugar.

Never skip breakfast.

Eat at least 5 small meals a day.  Always.

Eat at least 100 grams of protein a day! Always. (one chicken breast is 30 grams of protein)

Drink 2 gallons of water every day.  Check to make sure your urine is always clear.

All of these suggestions will minimize highly refined sugars which inappropriately stimulate insulin.  These sugars give you a false metabolic high and promote fat production.  Only protein provides the correct stimulus to build muscle, decrease fat, and tells the brain to stop desiring food. Protein may be the single most important substance in promoting weight loss. Breakfast and small regular meals prevent sensations of hunger and will help avoid binge eating.  It is hard to control eating if you are always hungry.  Finally, water will flush away all the by-products of fat breakdown and is an effective appetite suppressor.

These suggestions are not a diet but a reasonable approach to permanently changing our eating habits which will lead to a healthy lifestyle and weight control.

Never expect to lose more than 1 pound of weight per week.  To lose more than that will be at the cost of bone strength, muscle atrophy, and a large increase in the risk of injury and disease.

In two months, our annual Orthopedic Foot and Ankle Weight loss competition will begin.  Stay tuned for details and join our progress through this blog and our Facebook fan site at www.facebook.com/ofaccolumbus.

Candy, candy, and candy.  Halloween is one of my childrens favorite holiday. And in just a couple of weeks, your kids will be tugging on your arm to take them trick or treating the moment they get home from school.

My children are crazy for Halloween

So, before you slip on your witches hat, please keep these 10 tips in mind for a safe and fun Halloween night.

1.) Select a safe and bright costume. Make sure your child’s costume (including beards, masks and wigs) is clearly marked as flame resistant or look for flame resistant fabrics such as nylon or polyester. If the costume does not have any reflective fabric, add your own reflective tape on the back and front. Avoid billowing or long trailing features, especially those made of lightweight fabrics or materials. Your child should wear well-fitting shoes to prevent trips and falls. Costume accessories, including swords and knives, should be soft and flexible.

2.) Masks can obstruct children’s vision and restrict breathing. Consider make-up instead, checking all labels to ensure that it is non-toxic. If children do wear a mask, make sure they can see and breathe easily.

3.) Do not let children under age 12 go trick-or-treating or cross the street without the supervision of an adult on Halloween night. For guidance and safety’s sake, accompany younger children to the door of every house they visit.

4). Make sure your child has his or her own flashlight or glow stick to illuminate pathways and curbs.

5). Trick or treat with your smaller children during daylight hours.

6.) Teens should always go trick-or-treating in a group. Advise them to only stop at familiar homes with an illuminated outdoor light. Remind teens that they should never enter a stranger’s home, car or walk in unpopulated areas. At least one child in their group should have a fully charged cell phone.

7). Make sure you know where and when your teen will be trick or treating and with whom. It’s also a good idea to have the phone number of their friends’ parents in the event of an emergency.

8). Illuminate jack-o-lanterns with flashlights or glow sticks. Avoid candles as they can pose a danger for trick-or-treaters who may come in contact with the open flames and ignite their costumes.

9). Advise your child not to eat any of the candy until you have inspected it first. This is especially important if your child has any food allergies.

10). Monitor their candy intake too. You’d be surprised at how much sugar, fat and calories a single, snack size candy bar has.

And here are the dates for Beggars Night in Central Ohio 2009

Ashville

October 25

4-5:30 p.m.

Ashley

October 31

6-8 p.m.

Baltimore October 31
5-6:30 p.m.

Bexley October 29
5:30-7:30 p.m.

Blendon Township October 31
6-8 p.m.

Canal Winchester October 29
5:30-7:30 p.m.

Carroll October 29
6-7:30 p.m.

Clintonville October 29
6-8 p.m.

Columbus October 29
6-8 p.m.

Commercial Point October 29
6-7:30 p.m.

Concord Township October 29
6-8 p.m.

Delaware October 31
6-8 p.m.

Dublin October 29
6-8 p.m.

Gahanna October 29
6-8 p.m.

Galena October 31
6-7:15 p.m.
Costume party at Ruffner Park will follow at 7:30 p.m.

Genoa Township October 31
6-8 p.m.

Grandview Heights October 31
6-8 p.m.

Granville October 31
5:30-7 p.m.

Grove City October 29
6-8 p.m.

Groveport October 29
5:30-7 p.m.

Hamilton Township October 31
6-8 p.m.

Heath October 29
5:30-7 p.m.
Mall-O-Ween, Indian Mound Mall October 30, 6-8 p.m.

Hebron October 29
5:30-7 p.m.

Hilliard October 29
6-8 p.m.

Jefferson Township October 29
6-8 p.m.

Johnstown October 29
6:30-8 p.m.

Lancaster October 29
6-7:30 p.m.

Lewis Center October 31
6-8 p.m.

Lithopolis October 29
6-8 p.m.

Lockbourne October 29
6-7:30 p.m.

Madison Township October 29
5-7:30 p.m.

Marble Cliff October 31
6-8 p.m.

Mifflin Township October 29
6-8 p.m.

Milford Center October 31
6-8 p.m.

Minerva Park October 29
6-8 p.m.

New Albany October 29
6-8 p.m.

New Concord October 31
6-7 p.m.

Newark October 29
5:30-7 p.m.

Norwich Township October 29
6-8 p.m.

Obetz October 31
6-8 p.m.

Orange Township October 31
6-8 p.m.

Pataskala October 29
6-8 p.m.

Pickerington October 29
6-8 p.m.

Plain City October 31
6-8 p.m.

Powell October 31
6-8 p.m.

Prairie Township October 29
6-8 p.m.

Reynoldsburg October 29
6-8 p.m.

Shawnee Hills October 29
6-8 p.m.

Sunbury October 31
6-8 p.m.

Upper Arlington October 29
6-8 p.m.

Utica October 29
6-7:30 p.m.

Westerville October 31
6-8 p.m.

West Jefferson October 29
6-7:30 p.m.

Whitehall October 29
6-8 p.m.

Worthington October 29
6-8 p.m.

I have never encountered such a stark difference between two cities in any one country as I have seen between Beijing and Shanghai.  Whereas Beijing instills the weight of history with Tiananmen Square, the Forbidden City, and the Great Wall of China, Shanghai is modern, organized, and expansive.  People here will say that if you want to see China the way it was in the past, go to Beijing but if you want to see where China will go in the future, go to Shanghai.

Even the public bathrooms at the hospital demonstrate this difference.

A typical traditional bathroom in Beijing

The typical Shanghai hotel bathroom with heated seats and power bidet

The hospital I visited had 1100 beds with almost 2 million patient visits every year.  They perform 27,000 surgeries a year.  The orthopedic service has formal rounds with a full team of attendings, residents, all nurses, and all therapists twice a day.  Yet, to keep costs controlled, they employ traditional interventions.

A bamboo splint for a low cost option

Their medical experience is different from ours.  Neither is better but without question, China’s experience is vast.  Both their medical teams and their patients demonstrate stoicism, perseverance, and discipline.

This applied discipline appears to begin early and continues in nearly everyone I have met.

2nd grade recess in the school yard

For complicated reasons, I found myself at a street side noodle shop at 2:30 in the morning with an equally hungry 30 year old man.  I am in my business suit and he is in his hip torn jeans with an equally hip polo shirt.  He tells me he makes socks.  I wonder if he works in one of the many narrow alleys I’ve seen around the city.  Rather, he makes socks for the US.  He makes all the socks for the US, including those for Walmart, JC Penny, Target, and Nike.  He owns a large factory outside of town and employs 300 people to make socks.  Armed with 2 cell phones and a laptop, he constantly monitors the price of cotton in Turkey and Yemen to remain competitive and worries over the timeliness of his container ships crossing the Pacific.

I leave wondering if he is typical of every 30 year old man in Shanghai.

Training 120 Chinese Orthopedic Surgeons who do not speak English posed more than a few challenges.  Many of my lectures rely on humor and subtitles.  Explaining complex ankle deformities become almost impossible.  However, amazingly, through body language and intonations and I think their desire to understand, the day ended with a successful grasp of techniques of ankle replacement and arthritis, tendon reconstruction, and bunion surgery.

120 Orthopedic Surgeons from every province in China

Beijing itself has over 20 million people.  Over 150 cities in China are larger than Columbus Ohio.  Although the surgeons and hospitals are equivalent to ours, there are very few Orthopedic Surgeons who specialize in Foot and Ankle. The surgeons here recognize this need and I’m sure this is why the meeting this weekend was so well attended and so enthusiastic.

Training new techniques on artificial foot bones

Meeting and conversing with a wide variety of Chinese surgeons was rewarding.  The Chinese are not allowed more than one child per family.  Therefore, everyone is an only child.  No one has brothers and sisters.  Unless someone is ill or handicapped, almost all Chinese people work.  So all these only children were raised not by their mothers but by grandparents or relatives. Families are strong.  People do not eat alone.  Meals, even in business meetings, are always eaten family style.  Food is placed in the center of the table and people will reach and double dip one serving at a time. People rarely move from the province of their families and if they do, it’s only for educational opportunities.

There are not enough university positions for the 1 billion people who would like to enter.  Therefore, education is highly competitive.  Those who do not score well on their entrance exam will never receive further education.  Conversely, those who succeed into medicine are truly the best and brightest that China has to offer.

With a few hours of free time and a quick visit to the Great Wall of China, it was easy to see how this cultural discipline could create a mind boggling 2000 mile wall through precipitous mountain ridges.

The meandering Great Wall of China cutting through the mountainside

China Day #1

As many of you may have know from my frequent twitter and facebook posts, I had an upcoming trip to China.  I thought this would be a good way to launch our social media efforts.

With a new Blackberry phone, equipped with all the latest Twitter and Facebook add-ons, I was prepared to Tweet and Facebook my way through China and Taiwan.

The surprise of course was to discover that neither Facebook nor Twitter is available in China.  It is available almost everywhere in the world but not here.  For many reasons, most of which are outlined in every weekly copy of Newsweek and Time magazine.  As progressive and modern as China is, there are certain freedoms and liberties that do not exist here that we enjoy daily in the US.

My last twitter post summarized the difference between a coach seat and a business class seat.  Hope everyone caught that.

It was a long flight.  For anyone who may not have braved a transpacific flight, unless you have a great backlog of fiction books, a full iPod of songs, and 2 powerpoint presentations to produce, do not attempt this alone.

The flight map of a long trip

Once you land in a foreign country, it’s disorienting.  In addition to being sleep deprived, a queasy sense of nausea, and a constant mild headache, none of the signs make any sense.  Exiting the airport, you want to find baggage claim and a taxi but they’re no where to be found.

Even the signs out don't make sense

Wisked away to a business dinner surrounded by well meaning Chinese orthopedic surgeons, we dig into dinner. Smells great, looks great but no one can tell you what it is.  The most common comment was ”it not chicken”.

Really good food if you knew what it was

Given that I’ve been here for only 5 hours, I have a few thoughts.

Traveling is an adventure.  It is tiring and should be enjoyed when young and not old.  The subtle differences are thrilling but thank god that there are a few things that are constant……or is this a good thing?

The KFC by Tianemen Square

A typical dessert stop for the average Chinese

Just steps for Chairman Mao's tomb. I think he would be proud.