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