PROJECT CHINA Achievement Through Collaboration 1988-2013

Royal Australasian College of Surgeons

CONTENTS

3.

Project China–1988-2013. A Review

6.

The Oral English Program

6.

The Sino-Australia/New Zealand Conferences in Surgical Oncology

Gordon Low (

) and Rosie Low (

)

Bronwen Ronan

CHEN Gong (

7.

)

Plastic and Reconstructive Surgery at the Sir Run Run Shaw Hospital, Hangzhou SHAO Yan ( )

8.

Education Exchange Program: Pain Management and Anaesthesia



9.

Alex Konstantatos



China-Australia Medical and Cultural Educational Exchange John Reeves

10.

News From Xiang-Ya Hospital, Changsha

11.

A Tale of Two Surgeons

ZHANG Pihong (



12.

)

CHEN Jie ( ) LONG Jianhong ( Gordon Low



)

The Bridge JIANG Zexi (

)

13. Epilogue Michael Henderson 14.



Acknowledgements

14.



Map of China

15.



Project China Delegates: 1993-2013

3

Project China: 1988-2013 A review

Dr Gordon Low (

) & Mrs Rosie Low (

)

September 2013

T

he sharing of ideas is the essence of progress. The sharing of resources and technologies between parties promotes mutual respect and reliance between the parties. The aim of Project China is to facilitate the conduits for the sharing of the resources of a large population in China with the scientific excellence in medical research in Australia/New Zealand. 25 years ago, we were not aware of any major systematic exchange visits for colleagues in the medical sciences between these countries. In Guangzhou, previously called Canton, we were aware of a program of neurological science founded by Dr WEN Hsiang–Lai ( 1 ) , a neurosurgeon from Hong Kong. He was an inspiration, and we approached him for ideas. He introduced us to Professor LU Guang-qi ( )2, President of the Sun Yat-sen University of Medical Sciences. After a period of gestation, and with the encouragement and guidance from Presidents Tom Reeve and John Hanrahan, we boldly sent 2 spine surgeons, Ian Torode and Peter Turner in 1993 to the Second Affiliated (Memorial) Hospital of the Sun Yat-sen University. They worked together for 1 month, financed totally by ourselves. Later that year, 2 urologic surgeons, one from Western Australia and the other from Queensland, spent 2 weeks in Guangzhou, followed by the visit of a Chinese urologist to Australia. That was the start of Project Guangzhou, later Project China. Our pioneer surgeons had done a very good job and news of Project China spread quickly by word of mouth. We visited a number of hospitals in various cities all over China, including Beijing, we explored the needs of the various hospitals. A number of them wanted to send their surgeons to Australia for further experience, this set the pattern of the work before us, that was: to respond to the needs of the hospitals in China and act ac-

cordingly. More Fellows of the College went to China and more visitors from China came to our hospitals. All of these activities required financial support. Although the College was able to provide a fair amount of administrative support, no additional money was available to sponsor Chinese surgeons to come to Australia / New Zealand, or to provide fares for our own Fellows to travel to China. We had to find money to finance our objectives, and were fortunate in having many generous friends and relatives from Australia, Britain, Canada and Hong Kong, who willingly donated large amounts to support our activities. Two of these philanthropists created the Hui Yin-Fong Travel Grant to facilitate the sponsorship of visits of colleagues between China and Australia/New Zealand. The late Mr Colin Martin3, through the Rotary Club also supported a number of doctors to come to Australia to further their experience. The progress of Project China has paralleled the great economic resurgence of the People’s Republic of China. This is an achievement of enormous dimensions involving political, cultural, economic and scientific developments, with implications affecting the financial balance of the whole world. Any visitor to China three or four years ago will find the situation quite different today. The gradual availability of funds in China for hospital building, research and for the medical workforce to go abroad has encouraged more overseas contacts. These essentials coupled with a thirst for knowledge and new technologies resulted in a massive progress on all fronts of the medical and health horizons. Technological advances in some fields in China have overtaken those in Australia. The major teaching hospitals can afford to purchase the best available equipment in ultrasound, x-ray, magnetic resonance

“

Sharing of resources and technologies betweeen parties promotes mutual respect and reliance

”

Royal Australasian College of Surgeons, Melbourne

4

Mrs Rosie Low & Mr Gordon Low

and positron emission tomography machines for diagnosis. By 2003, requests for financial assistance for Chinese doctors and nurses to travel to Australia dwindled, but were available when required. Most of the visits by Fellows of the College to China were of one week duration. There would be lectures, workshops and operations. Accommodation and meals would be paid for by the host hospitals. Up to 1998, every Australian colleague going to China received funding. This was considered unnecessary by our Fellows, and since then, every visitor to China under Project China would receive an honorarium on return. The International English Language Testing System (IELTS) is a test of English proficiency. Its application is widespread in many English speaking countries. This test was introduced to Australia and New Zealand about 10 years ago and has been used by academic institutions as an entry prerequisite to courses of studies. There are 4 sections to the test, and a score of 7/9 in each section is usually considered adequate to pursue tertiary education in Australia. This is not an easy task for Chinese academic aspirants. All Chinese visitors who previously came to our shores under the auspices of Project China were allowed to assist at operations. The IELTS barrier removed this privilege. Furthermore, IELTS generated much fear and concern for just about everybody wanting to go to English speaking countries for any type of continuing education. It has therefore dampened the enthusiasm of the Chinese doctors to go overseas, including our Countries. From time to time, particularly in the early period of our venture, we would send to China

equipment and instruments that would assist the Chinese hospitals. We have sent to China diathermy machines, bench-top autoclaves, a Bair hugger and even hospital beds. The moderate standard of spoken English has been a handicap for many doctors and nurses who intend to go abroad. For this reason we introduced the Oral English Program for Chinese doctors and nurses in 2006. Mrs Bronwen Ronan, a retired English teacher, is the coordinator of the Program. She would recruit other retired teachers to go to Chinese hospitals for this mission. They would stay in the designated hospitals for 3 months, and write their own curricula. This program has been welcomed by a few Chinese hospitals and we are struggling to find teachers to fill the roles. All expenses including air fares are paid by the host hospitals. This enterprise has in some way allayed the threat of the IELTS. In honour of the work of Mr Colin Martin and his wife Dorothy in Project China, the Rotary Club of Balwyn has set up a Bursary under their names in 2010. The sum was $4000 per year for 3 years. This grant is ear-marked for the Oral English program. On completion of each assignment, every teacher is paid an honorarium of $400. It is inevitable that Project China would be approached by other specialties of medicine in China. For this reason, there have been exchange visits by anaesthetists, intensivists, physicians, paediatricians, physiotherapists, oncologists, research scientists and nurses, particularly operating theatre and pain management nurses. The surgical input included dentistry, maxillofacial and cranio-facial surgery, ophthalmology, orthopaedic, chest, heart, head and neck/ENT, urology, vascular, paediatric, plastic and neuro-

“

It is inevitable that Project China would be approached by other specialties of medicine in China

”

Below: Doctors from Changsha (L-R) LONG Jianhong, TAO Lijian, Gordon Low, Rosie Low, CHEN Jie, ZHANG Pihong

5

Left: Doctors from Wuhan Children’s Hospital. Back (L-R) ZHONG Liang, XU Yang, SUN Zhipeng, XIA Zhongfang; Front (L-R) Rosie Low, Gordon Low, JIANG Zexi

surgery. There have been visits for a single topic/ technique such as cochlear implant, and also by delegations to observe the Australian/New Zealand health systems. The work of Project China has not been confined to just trips for the participants. An example is the biennial conference on Surgical Oncology between the College and the Cancer Hospital in Guangzhou since 2000. There is a program to enlarge the scope of plastic surgery at the Sir Run Run Shaw Hospital in Hangzhou. Dr Alex Konstantatos, an anaesthetist from the Alfred Hospital, Melbourne, has conducted courses on Pain Management and Peri-Operative Medicine. Dr John Reeves, an intensivist from the Cabrini Hospital, Melbourne, has ongoing programs of monitoring the performance of Intensive Care Units in China. The retrospectoscope tells us there have been 120 visits by surgeons and related specialists to China under the auspices of Project China. 80 of these were Fellows of the College. The others were made up of dentists, maxillo-facial surgeons, anaesthetists, nurses and physiotherapists (these figures do not include English teachers). Some colleagues have made multiple visits to China; others have established programs of their own. Past Chairman, Associate Professor Vincent Cousins made multiple trips to China over 4 years to share his knowledge in Skull Base Surgery with his Chinese counterparts. Similarly, 90 Chinese visitors have come to our shores. Of these, 60 of them were surgeons, and other specialities made up the numbers. Some Chinese colleagues who had made transient or one-day visits are not in the list. It has been enormous fun running Project

China over the past 25 years. We hope we have in a small way stimulated mutual understanding and appreciation between colleagues in China and in Australia and New Zealand. We have made many new friends both here and abroad and we hope that we have left a legacy of trust and respect for both the Orientals and the Occidentals. It is hard work to break down the language barrier in order to achieve communication, but we must keep on trying. Not only will China become the dominant economic power in the 21st Century but the centre of scientific and technological advances, including medicine. Let us not forego this opportunity.

Dr WEN Hsiang-Lai is a neurosurgeon from Hong Kong. He had extensive contacts in China. With his understanding and foresight, he had guided the College and the formation of Project Guangzhou through many difficult negotiations with the authorities. Project China would have floundered very early on but for his energy and industry to bring the concept of the Project to fruition. He now lives in Boston, USA.

1

Professor LU Guang-qi was President of the Sun YatSen University of Medical Sciences, later the Sun YatSen University Medical School. It is the best known and most influential Medical School in southern China. Professor Lu was a physiologist and had received training in the United States. It is his foresight that launched the Project China program at the Memorial Hospital of his University.

2

Mr Colin Martin, a District 9800 past Governor, of the Rotary Club of Balwyn, Vic., had been a stalwart of Project China. He was a Committee Member and contributed much to the vision of the Project. He died in 2006.

3

“

It has been enormous fun running Project China over the past 25 years. We hope we have in a small way stimulated mutual understanding and appreciation between colleagues in China and in Australia and New Zealand

”

6

The Oral English Program Mrs Bronwen Ronan

Senior English Teacher and Coordinator - Oral English Program September 2013

P Bronwen Ronan

roject China has provided oral English courses to a number of Chinese hospitals in recent years, with the aim to assist Chinese doctors and nurses to achieve a high level of proficiency in spoken English. This ability is particularly important when they go to English speaking countries for study or training, and gives them confidence when applying for overseas medical and hospital appointments. Since 2006, Project China has sent 11 qualified English teachers to various cities across China. For each assignment, the teacher spent 3 months in the designated hospital. Formal evening classes were established usually as 2 classes of 20 students. Such an environment provided avenues for the participants to learn about each other, and break down apprehension. The curriculum is designed at the discretion of the teacher, and varies from time to time. Outside of the classroom, participation in organised social activities helps to improve

students’ English communication skills. Although many participants have a basic knowledge of English, most have not had direct contact with Westerners. They are often reluctant, through embarrassment or shyness to speak English. For some, their teacher has been very successful at addressing this problem. Without exception, the participants reported that they were no longer hesitant to speak English with a foreigner. Whilst improved competency varies, depending on individuals’ past experiences and natural language ability, most make remarkable progress and are able to converse in English towards the end of the course. Undoubtedly, the interactions between these teachers of Project China and those with whom they have met as a consequence have had far-reaching effects, and have led to a betterment of Sino-Australian good-will and understanding.

THE Sino-Australia/New Zealand (RACS) Conferences in Surgical Oncology Professor CHEN Gong （ September 2013

P

Professor CHEN Gong

), Department of Abdominal Surgery, Cancer Hospital, Guangzhou

rofessor WAN Desen of the Tumor Hospital and Cancer Center of Guangzhou is one of the leaders in establishing an exchange program in oncology between China and Australia/ New Zealand. Early in 2000, Professor Wan, together with Professor Glyn Jamieson of South Australia and Dr Gordon Low, co-ordinator of “Project China” from the Royal Australasian College of Surgeons held a Conference in Surgical Oncology in Guangzhou. About 10 surgeons from Australia attended the Conference. The topics included cancer of the large bowel and laparoscopic techniques in

7

large bowel surgery. A “bridge of exchange” has now been established. Since then, about 10 colleagues from Guangzhou have crossed that bridge, each spending between 1 to 18 months in each assignment. Another important sequel was the start of a series of biennial conferences in surgical oncology between our Countries. These conferences were usually one-day meetings and alternate between Guangzhou and one of the capital cities in Australia. Up to the present, 7 such conferences have been held.

City of Guangzhou

Plastic and reconstructive surgery at the Sir Run Run Shaw Hospital Dr SHAO Yan ( ), Senior Plastic & Reconstructive Surgeon Sir Run Run Shaw Hospital, Hangzhou September 2013

I

n 2010, the Sir Run Run Shaw Hospital (SRRSH) approached Dr Gordon and Mrs Rosie Low to see if they were able to assist our department in improving our repertoire in Reconstructive Surgery, particularly reconstructive surgery of the breast after mastectomy. Our scope in Aesthetic Plastic Surgery was also limited and we had hoped that the capacity of this aspect of plastic surgery could increase. Early in 2011, Dr Low arranged the visit of Dr Richard Bloom and Dr Howard Webster to our hospital. Both are experienced plastic surgeons from Melbourne, and have their own Plastic and Reconstructive Surgery partnership. During the week that they were here, they operated on 3 patients who required major breast reconstruction. 2 of these patients had DIEP (Deep Inferior Epigastric Perforator) flaps. The third patient required fat injection. They also gave lectures on reconstructive and aesthetic surgery. These lectures provided the bases of understanding the principles of this specialty of surgery.

Above: Department of Plastic & Reconstructive Surgery, Sir Run Run Shaw Hospital

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The next step was for me to observe how plastic surgery is done in Australia. My visit was facilitated by Dr and Mrs Low, and I spent 5 weeks in Melbourne in October 2012 with Drs Bloom and Webster, watching many operations performed by themselves and their colleagues, in breast augmentation and reduction procedures, and cosmetic surgery operations of the face and other parts of the body. The experience gave me much confidence to start this type of surgery in Hangzhou. It is always a daunting task to start a new field or endeavour, because there is often a gap between what you have seen and how you can put that experience into practice. We needed an additional boost to our confidence before we could embark on such ventures. To this end, Dr and Mrs Low sent Drs Dean Trotter, Derek Neoh and Eldon Mah to our hospital in August, 2012. They gave lectures and demonstrated the

finer points in plastic surgery and emphasized the importance of good micro-anastomosis techniques. In March, this year, we created history in our hospital by doing the first non-pedicle composite graft of a breast reconstruction, that is, the free TRAM (Transverse Rectus Abdominus Myocutaneous) flap. Since then, our department has performed a number of operations using the lessons we have learned in micro-vascular anastomosis. We have also refined our techniques in fat injections. We are deeply grateful to Dr and Mrs Low, coordinators of Project China, Royal Australasian College of Surgeons, and the surgical colleagues they have sent to our Hospital to help us to develop this branch of surgery. It is our aim to utilize this knowledge to the benefit of the patients of Zhejiang Province and beyond.

From left: Dr Webster, Dr Shao & Dr Trotter

Education Exchange Program: pain management and anaesthesia Dr Alex Konstantatos, Department of Anaesthesia & Peri-operative Medicine, Monash University, Melbourne Visiting Professor, Zhejiang University School of Medicine. September 2013

I

Alex Konstantatos

n 2006, Gordon and Rosie Low requested I visit the Sir Run Run Shaw Hospital (SRRSH) in Eastern China. I found the experience so rewarding, that I have continued visiting SRRSH yearly or twice yearly since that time, and am currently a visiting Professor with the Zhejiang University School of Medicine. Over this time, many innovations have taken place in pain medicine. I have now collaborated on numerous projects with this hospital, aiming to provide the citizens of Zhejiang Province with high quality care. One avenue to reach these targets has been to facilitate educational visits for the doctors and nurses of SRRSH to observe the practice of Acute and Chronic Pain Management in Australia, and from 2007 – 2009 we welcomed the visits of Dr Stevie WANG (2007), Associate Professor TONG Ying Ge (2008) and Associate Professor TIAN Suming (2009) to the Alfred and Cabrini Hospitals in

Melbourne. SRRSH has also contributed to this program by appointing a Head of Pain Services and 2 Pain Liaison nurses. A basic policy framework of pain protocols and methods of quality assurance has also been developed. In the field of anaesthesia, many new developments from Western practice have been shared with SRRSH including the use of ultrasound techniques to guide neural blockade and vascular access. Concepts of Intraoperative Trans-esophageal Echocardiography and Perioperative Trans-thoracic Echocardiography were introduced in 2012 and will be further developed over the coming years. Educational activities within the hospital, such as bedside teaching, have been supplemented by symposia and conferences, many of which take place during SRRSH’s annual “Academic Week”. A conference in Perioperative Medicine was included in the 2012 Academic

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“

I found the experience so rewarding, that I have continued visiting SRRSH yearly or twice yearly

”

Week, and was well attended by delegates from SRRSH and surrounding hospitals in Zhejiang Province. Pain research within the hospital has been fostered with several publications arising from special collaborations between myself and doctors and nurses from SRRSH. Two notable publications in peer reviewed international journals have resulted from the collaborations: 1. Tong YG, Konstantatos AH, Zhang CF, Hu JY, Ye AF, Boyd D. A cross sectional exploratory survey of knowledge, attitudes and daily selfreported pain assessment practice among nurses in Mainland China. Pain Medicine. March 2013. 2. Konstantatos AH, Imberger G, Ang-

liss M, Hong Ki Cheng C, Meng A, Chan MTV. A prospective cohort comparing early opioid requirement between Chinese from Hong Kong and Caucasian Australians after major abdominal surgery. British Journal of Anaesthesia. November, 2012. I will continue working closely with SRRSH and Monash University to enhance relationships with the respective departments of Anaesthesia and Pain Medicine, as well as facilitating relationships with other health disciplines. These enterprises will create better understanding between the medical colleagues of China and Australia/New Zealand and will serve to improve international goodwill.

China-Australia medical & cultural educational exchange Dr John Reeves, Director of Intensive Care, Cabrini Hospital, Melbourne Visiting Anaesthetist, Alfred Hosptial, Melbourne September 2013

I

n 2007, I was invited by Mr and Mrs Gordon Low through Dr Alex Konstantatos, an anaesthetist at the Alfred Hospital, Melbourne, to take part in an educational exchange with the Sir Run Run Shaw Hospital (SRRSH) in Hangzhou, China, under the aegis of Project China. I was to provide lectures to the Departments of Anaesthesia and Intensive Care, and conduct daily ward rounds in the Intensive Care Unit (ICU). During my first visit, I was able to look over these departments and assess the potential, and began to

“

I was able to look over these departments and assess the potential, and began to plan an education program for the future

Participants of the first BASIC course at Sir Run Run Shaw Hospital (June 2012)

”

plan an education program for the future. In 2008 and 2009 I returned to continue teaching and further build upon friendship and understanding. In 2010, I assisted Project China to host a high level delegation from the SRRSH to Melbourne. The officials included the President He Chao, and Ms Sherry Sun, Director of the Center for International Collaboration. They met a number of health bureaucrats, including senior government officials, private Health Insurers and operators of large private and public hospitals. During this visit, President He and Mr Michael Walsh, Chief Executive of Cabrini Health, agreed to form a lasting relationship between the two hospitals to foster educational and cultural exchange. Through this process, a number of clinicians have had exchange travels between Hangzhou and Melbourne, and have learned, taught and observed health care in the sister hospitals in different environments. In 2011, I returned to Hangzhou, to continue teaching and to plan new initiatives, one of which was an ICU database to measure the quality of care. After visiting Hangzhou, I travelled with Professor Michele Levinson, Professor of Medicine at Monash University, to the Zhujiang Hospital, Guangzhou, to look at the ICU arrangements there. Different programs are planned for this Hospital.

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Above Top: Dr Zhou Jian-Cang (SRRSH) and Dr John Reeves (2011) Bottom: Participants at the BASIC course

In 2012, I assisted in a major educational advance for the SRRSH ICU. The ICU hosted the Basic Assessment and Support in Intensive Care (BASIC) Course – a train-the-trainer course, first developed in Hong Kong by Dr Charles Gomersall of the Chinese University of Hong Kong, but now translated into more than 20 languages, including Chinese. The format is a mix of didactic lectures and hands-on small group tutorials. Pre- and post-course exams track knowledge acquisition. The first time that “BASIC” is run at a new centre, external trainers come from other BASIC centres and train the local lecturers. After a cohort of local lecturers is created, the course becomes selfsufficient. The Chinese University of Hong Kong generously provides all of the teaching materials. The first students for BASIC at SRRSH consisted of ICU residents, nurses, respiratory therapists and medical students. The lecturers

were ICU consultants and senior fellows. It was a great success. The course has been run successfully by the SRRSH ICU a number of times since and a total of more than 100 students have benefitted. During our visit to SRRSH in 2012, we convened a symposium on mentoring for the senior staff. Around 150 senior medical staff attended the symposium and it stimulated much discussion about how SRRSH should support their junior medical staff. Sir Run Run Shaw Hospital is a modern teaching Hospital. The care they provide equals international best practice in many areas. The challenge now is to continue to find areas in which visiting clinicians can contribute. I plan to remain involved with SRRSH at a personal level, hosting visitors from Hangzhou, encouraging teaching and research, and, at an organisational level, fostering the relationship between Cabrini and SRRSH.

News from Xiang-ya Hospital, Changsha Dr Zhang Pihong （

）. Consultant and Head of Unit. Plastic and Burns Unit

Xiang-Ya Hospital, Changsha, Hunan Province November 2013

Dear Mr and Mrs Low,

Zhang Pihong

I trust both of you are keeping well. It was a delight to receive your e-mail. My initial duty is to thank you for your care and assistance some 12 years ago when both of you had given me the opportunity to come to Melbourne to further my experience in surgery. In the short period of 3 months, Mr Michael Leung had shown me a wide range of surgery of the integument and plastic surgery procedures. In addition, he also introduced me to many operations in cosmetic surgery. After my return to China, I began to appreciate all that I had learnt in restorative surgery and the results I had achieved were very satisfactory. For all my progress, I deeply appreciate the help and guidance from yourselves and Mr Michael Leung. I reiterate my gratitude to you all for all my achievements at the Xiang Ya Hospital. Yours respectfully, ZHANG Pihong Consultant and Head of Unit Plastic Surgery and Burns Unit Xiang-Ya Hospital Changsha, Hunan Province

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A Tale of Two Surgeons LONG Jianhong, CHEN Jie and Gordon Low December 2013

T

his is an account of two Chinese surgeons who had worked in Melbourne about the turn of the century. CHEN Jie is a Head and Neck surgeon from the central Chinese city of Changsha. He works in the Hunan Province Tumor Hospital. He was sponsored by Project China to spend three months at the ENT/Head and Neck Department of the Alfred Hospital, Melbourne under Associate Professor Vince Cousins and Mr Peter Thomson in 2003. One of the procedures which impressed him was the management of cancers of the mouth and surrounding structures in the neck. These tumours were removed by the Head and Neck surgeon, and the defect was made good by the Plastic and Reconstructive surgeons. Prior to his visit, LONG Jianhong, a plastic surgeon from the prestigious Xiang Ya Hospital (Hunan/Yale-in-China Hospital) in Changsha, and also sponsored by Project China, had visited the Bernard O’Brien Institute of Micro-Surgery, Melbourne in 1998. LONG had spent three months under the tutelage of Professor Wayne A. Morrison. Along with observing many new sur-



LONG Jianhong

gical procedures, he learnt the techniques of micro-anastemosis and tissue transfer, and their applications in reconstructive and cosmetic surgery. Both CHEN and LONG had returned to Changsha. CHEN had a number of patients with tumours of the neck and mouth that needed radical surgery. He was aware of the experience of LONG’s, and discussed with LONG methods to treat such patients. Collaborative procedures by doctors from different hospitals for patient management were unusual at that time. In 2004, after overcoming bureaucratic obstacles, LONG was invited to CHEN’s hospital, and together managed such patients with good outcomes. These events became widely known and practiced in the Hunan Province. Such procedures lifted the profiles of both hospitals in the management of head and neck malignancies by surgery. A new name emerged as a consequence of this venture – Plastic Oncological Surgery! In the past 10 years, the scope of surgical procedures and the number of patients treated in the Department of Head and Neck Surgery of the Tumor Hospital have greatly increased. Much of this improvement is the combined efforts of Drs. CHEN and LONG.

LONG Jianhong, MD Professor and Chief of Service Department of Cosmetic & Plastic Surgery Xiang Ya Hospital South Central University Changsha, Hunan Province

“

In the past 10 years, the scope of surgical procedures and the number of patients treated in the Department of Head and Neck Surgery of the Tumor Hospital have greatly increased

”

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CHEN, Jie MD Chief of Service Head & Neck Department Hunan Province Tumor Hospital Changsha, Hunan Province

The Bridge JIANG Zexi（ ）Professor & Senior Surgeon, Wuhan Children’s Hospital Wuhan Medical & Health Center for Women and Children, China December 2013

T

JIANG Zexi

he year was 2004 when I first met Professor Gordon Low and Mrs Rosie Low. It was during an Annual Scientific Congress of the Royal Australasian College of Surgeons. I was impressed by their sincerity in wishing to widen the experience of Chinese medical personnel. Their aim was to establish a bridge so that there can be an exchange of medical colleagues between my Hospital and the specialists in Australia/New Zealand. Professor and Mrs Low visited Wuhan the following year. Since then, 19 specialists of various disciplines have been to my hospital. They included neonatology, paediatric general surgery, orthopaedics, neurology, cardiology, dermatology, upper G-I surgery, pathology, anaesthesia, obstetrics and urology. At the same time, 6 of our colleagues have been to Australia for varying periods. These were in the disciplines of anaesthesia, general surgery, orthopaedics and ENT surgery. Professor and Mrs Low also sent 5 English teachers to Wuhan to conduct Oral English classes to improve the ability of my staff to converse in English. The Children’s Hospital in Wuhan is the main institution in the central area of China dealing with children’s problems. Within the precincts of this Hospital, we provide obstetric services for mothers and for newborn babies. There is also a gynaecology service. I am the senior surgeon of this conglomerate. The contributions of Professor and Mrs Low to my Hospital have been immense. They have improved the standard of many departments and have also given encouragement to more than 240 members of the hospital to speak English with confidence. For all their kindness and generosity, my hospital administration and I are deeply grateful.

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Epilogue Professor Michael Henderson, Division of Cancer Surgery

Peter MacCallum Cancer Centre, St Andrew’s Place, East Melbourne December 2013

P

Michael Henderson

“

The whole idea of this Project seems so natural, so important and so worthwhile for an organisation such as the College that it is easy to take it for granted

”

roject China has been one of the premier outreach programs of the Royal Australasian College of Surgeons (RACS) for 25 years. Looking back over this time, the whole idea of this Project seems so natural, so important and so worthwhile for an organisation such as the College that it is easy to take it for granted. The reality however is that Project China, like all great endeavours, had humble beginnings, small triumphs and many setbacks, but was consistently led by people who were committed, passionate and dedicated to the idea of supporting surgeons and surgical practice in China. The College has never provided funding for Project China but has been most gracious in its support for the ideals of Project China, and a succession of presidents, CEOs and others have had a personal interest in the success of the Project. Project China was overseen by a committee of the College Council and included in its membership members of Council. In the early years, surgeons visited centres within China to provide teaching and support to local surgical teams. Together with colleagues from other disciplines including anaesthesia and pain medicine, the programs were tailored to the requirements of centres. The importance of English to clinicians was recognised early on, and an amazing team of English teachers was assembled, and English-language programs aimed at English speaking were undertaken in a number of centres. With the maturing of the relationship, Chinese surgical teams visited centres of excellence in Australia and New Zealand and a number of Chinese surgeons received surgical training in Australia. These exchanges have been uniformly successful and rewarding for both the surgeons and local surgical teams while promoting enormous goodwill and developing lasting relationships with Chinese colleagues.  There are many people who have played a role in the success story of Project China, but without doubt, the importance of Mr Gordon Low, a Fellow of the College and his wife Rosie, cannot in any way be underestimated. Gordon and Rosie understand what is required by the Chinese, have the contacts to facilitate exchanges and a gentle way of convincing anyone who need to be convinced! Dozens of surgeons have participated in Project China’s programs and it is extraordinary that many have done so repeatedly. Many relate the kindness and appreciation of their hosts and the unique opportunity they have received to be embedded in another culture and experience medicine in a different country. A common response of many visitors is an almost embarrassed admission they benefited more from the experience than their Chinese hosts! What of the future? The original aims of Project China have largely been met as China progresses towards the ranks of the first world. Relationships have developed and with the opening up of China, greater engagement between Australia and New Zealand and China can be expected. Project China has been a very public demonstration of the broader role of surgeons in society and is something of which the College and its Fellows can be enormously proud. It is only appropriate in finishing that I declare my conflict of interest in Project China. Having been persuaded by Gordon Low to visit Guangzhou several years ago, I was further persuaded to join the Project China Committee and have participated in and organised one of the Sino-Australian Surgical Oncology Meetings in Melbourne as well as hosted a number of surgical visitors and returned to China last year. Next year one of the surgical oncology fellows at my institution, the Peter MacCallum Cancer Centre in Melbourne will be a young surgeon I met in Guangzhou several years ago. I wish to acknowledge and thank Gordon and Rosie Low for their friendship and the opportunity to participate in what I have personally found to be a remarkably rewarding, educational (to me) and ultimately enjoyable exercise.

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Acknowledgements

We wish to thank all the participants of the Project without whom there would have been no Project. Many colleagues have freely given up time and talent for the sharing of information. We thank all the munificent donors who sustained the Project. We are grateful to all the managers and administrators of the hospitals who were involved in the exchange of personnel between the Countries. We are indebted to the many Presidents of the College and the Chairmen and Committee members of Project China. We give special thanks to Ms Daliah Moss and all members of the Department of External Affairs of the College for their advice, support and hard work over the years in order to achieve the targets of Project China, including the production of this brochure. We wish success to the newly formed China-ANZ Committee of the College in the years to come.

Chairmen: 1994 – 1997: Prof Bruce Barraclough 1997 – 2001: Prof Glyn Jamieson 2001 – 2005: Dr Robert Linacre 2005 – 2012: A/Prof Vincent C. Cousins

Members of Committee (2012): Dr Gordon Low – Coordinator

Mrs Rosie Low – Coordinator Mr Mark Caldwell – Rotary Club Dr John Chen A/Prof Michael Henderson Dr Alex Konstantatos A/Prof Bruce Mann Dr John Reeves

Ex officio: Dr Ian Civil - President Prof David Watters

Staff Members:

A/Prof David Hillis Dr John Quinn - Surgical Affairs Ms Daliah Moss - External Affairs

Map of China - Cities involved in Project China

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Project China Delegates: 1993 - 2013 BEIJING (Special Economic Zone)

GUANDONG PROVINCE

Plastic Surgery Hospital, Peking Union Medical College To China Brown, Kester (anaesthetist), VIC. Frawley, Geoff (anaesthetist), VIC Heggie, Andrew (maxillo-facial surgeon), VIC Holmes, Anthony (cranio-facial surgeon), VIC Klugg, Geoff (neuro-surgeon), VIC

GUANGZHOU

To Australia AN Gang (anaesthetist) DENG Xiaoming (anaesthetist) LI Guimin (O.R. Sister) SONG Yeguang (cranio-facial surgeon) SUN Xiaomei (orthodontist) TENG Li (plastic and cranio-facial surgeon) Tiantan Hospital, Capital University of Medical Sciences To Australia HAN Xiaodi (neuro-surgeon) KANG Shuai (neuro-surgeon) Capital Institute of Pediatrics To Australia WU Rongyan (paediatric nurse) CHONGQING (Special Econmic Zone) Southwest Hospital, Third Military University To China Conolly, Bruce (hand surgeon), NSW To Australia XIE Hanping (ophthalmologist) SHANGHAI (Special Economic Zone) Huashan Hospital, Fudan University To Australia JIN Chen (upper G-I surgeon) XU Wendong (upper limb surgeon) Yangpu District Central Hospital To Australia: DONG Jing (/head & neck/ENT surgeon) TIANJIN (Special Economic Zone) The Chest Hospital To China Bessell, Justin (upper G I surgeon), SA Watson, David (upper G I surgeon), SA

First Affiliated Hospital, Sun Yat-Sen University To China Corlett, Russell (plastic surgeon), VIC Dawson, Kevin (anaesthetist), VIC Heathcote, Peter (urologic surgeon), QLD Hill, R. Ian (urologic surgeon), WA Kolbe, Anne (paediatric surgeon), NZ PAN Weiren (plastic surgeon), VIC Taylor, G. Ian (plastic/reconstructive surgeon), VIC Stokes, Keith (paediatric surgeon), VIC Strong, Russell (liver transplantation surgeon), QLD IP Stephen (OR Technician), WA To Australia LIN Ying (breast surgeon) LU Guangqi (Physiologist) MEI Hua (urologic surgeon) WANG Shenming (breast surgeon) YANG Xiaomin (O.R. Nurse) YE Cai (breast surgeon) YU Guozhong (plastic surgeon) Second Affiliated (Memorial) Hospital, Sun Yat-Sen University To China Bates, Edward (paediatric surgeon), NSW Beasley, Spencer (paediatric urologic surgeon), NZ Buchanan, Cameron (paediatric anaesthetist), NZ CHUNG, Wui (orthopaedic surgeon), NSW Cole, Ian (head and neck/ENT surgeon), NSW Corlett, Russell (plastic/reconstructive surgeon), VIC Cousins, Vincent (head and neck/ENT surgeon), VIC Crosthwaite, Alan (urologic surgeon), VIC Dawson, Kevin (anaesthetist), VIC Heggie, Andrew (maxillo-facial surgeon), VIC Ludbrook, Guy (neuro-anaesthetist), SA PAN Weiren (plastic surgeon), VIC Randle, Ray (orthopaedic surgeon), NSW Taylor, G. Ian, (plastic/reconstructive surgeon), VIC Torode, Ian (paediatric orthopaedic surgeon), VIC Turner, Peter (orthopaedic surgeon), VIC To Australia HE Shuyi (OR Nurse) HUANG Jian (urologic surgeon) LIU Shangli (orthopaedic surgeon) OU Qingjia (vascular surgeon) PENG Shuling (anaesthetist)

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Third Affiliated Hospital, Sun Yat-Sen University To China de Steiger, Richard (orthopaedic surgeon), VIC Kiroff, George (chest and upper G I surgeon), VIC O’Donnell, John (orthopaedic surgeon), VIC Tumor Hospital and Cancer Center, Sun Yat-Sen University To China Campbell, Ian (chest surgeon), NZ Clarke, Peter (chest surgeon), VIC Hains, Daniel (head and neck/ENT surgeon), SA Henderson, Michael (breast surgeon), VIC Jamieson, Glyn G. (upper G.I. surgeon), SA Knight, Simon (chest surgeon), VIC McLeish, Andrew (colo-rectal surgeon), VIC Parry, Bryan (colo-rectal surgeon), NZ Sweeney, James (colo-rectal surgeon), SA Windsor, J (colo-rectal surgeon), NZ Wright, Gavin (chest surgeon), VIC To Australia CHEN Gong (colo-rectal surgeon) CHEN Minshan (hepato-biliary surgeon) FANG Yujin (colo-rectal surgeon) GUO Zhuming (head and neck surgeon) KONG Linghen (colo-rectal surgeon) LI Liren (colo-rectal surgeon) LU Zhenhai (colo-rectal surgeon) PAN Zhizhong (colo-rectal surgeon) WAN Desen (colo-rectal Surgeon) WANG Siyu (chest surgeon) WU Xiaojun (colo-surgeon) ZHANG Rongxin (colo-rectal surgeon) ZHOU Zhiwei (colo-rectal surgeon) Guanghua Stomatology Hospital, Sun Yat-Sen University To China Lawry, Denise (orthodontist), VIC Moloney, Luke (endodontist), VIC YUEN, Catherine (general dentist), VIC

HO, David (anaesthetist ), QLD Kimble, Roy (general surgeon), QLD Jean-Louis, Francoise (ENT), NZ Morreau, Philip (paediatric surgeon), NZ Simpson, Erroll (paediatric surgeon), ACT YU, Victor (neonatologist), VIC English Teachers Burns, Virginia VIC Ronan, Bronwen VIC Power, Maureen VIC Simkin, Heather VIC To Australia CUI Yingqiu (maxillo-facial surgeon) WANG Fenghua (pathologist) XIA Huimin (general surgeon) WU Qiang (general surgeon) XU Hongwen (orthopaedic surgeon) ZENG Ping (neonatologist) ZHANG Liyu (general surgeon) ZHONG Wei (general surgeon) ZHU Deli (general surgeon) Zhujiang Hospital, Southern Medical University To China Levinson, Michele (intensivist), VIC Reeves, John (intensivist), VIC English Teachers McLoughlan, Mark VIC Molloy, Angela VIC Power, Maureen VIC Robinson, Narelle NSW To Australia HUANG Maiojuan (oncology researcher) LIN Lijun (orthopaedic Surgeon) ZENG Qiyi (intensivist) ZHANG Jian (Oncologic Surgeon) ZHANG Jiren (Oncologic Surgeon)

Zhongzhan Ophthalmic Center, Sun Yat-Sen University To China Farinelli, Adrian C. (ophthalmologist), NSW McNab, Alan (oculo-plastic surgeon), VIC O’Day, Justin (ophthalmologist), VIC Sullivan, Timothy (oculo-plastic surgeon), QLD

GUANGXI PROVINCE

Guangzhou Children’s Hospital, Guangzhou Medical College To China Auldist, Alexander (paediatric surgeon), VIC Beasley, Spencer (paediatric surgeon), NZ CHOW Chung-wo (pathologist), VIC

English Teachers McKenzie, Jenifer VIC Witt, Pat VIC

LIUZHOU Traditional Chinese Medicine Hospital To China

To Australia PAN Yubiao (cardiac surgeon)

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HEBEI PROVINCE Shijiazhuang Fouth Hospital, Hebei Medical University To China Bessell, Justin (upper G I surgeon), SA Watson, David (upper G I. surgeon), SA To Australia LI Peng (upper G I surgeon) HENAN PROVINCE ZHENGZHOU Henan Provincial People’s Hospital. To China English Teacher Power, Maureen VIC HUBEI PROVINCE WUHAN Tongji Hospital, Huazhong University of Science and Technology To China Bergman, Neil (orthopaedic surgeon), VIC de la Harpe, David (orthopaedic surgeon), VIC Denton, Michael J. (vascular surgeon), VIC Dey, Marilyn (O.R. Nurse), VIC Love, James (anaesthetist), VIC Richardson, Martin (orthopaedic surgeon), VIC Turner, Peter (orthopaedic surgeon), VIC To Australia ZHAO Tiyu (O.R.Charge Nurse) Children’s Hospital To China CHAN, Yuenfu (pathologist), VIC Drew, John H. (neonatologist), VIC Drew, Sandra (paediatric echocardiographer), VIC Frawley, Geoff (anaesthetist), VIC Hamill, James (paediatric surgeon), NZ Howell, Katherine (Neonatologist), VIC Kimble, Roy (general surgeon), QLD Kornberg, Andrew (neonatologist), VIC Nattress, Garry (orthopaedic surgeon), VIC Neal, John R.L. (obstetrician/gynaecologist), VIC Putra, Lydia Johns (urologist), VIC Torode, Ian (orthopaedic surgeon), VIC Watkins, Andrew (neonatologist), VIC

English Teachers Molloy, Angela VIC Ronan, Bronwen VIC Simkin, Heather VIC Vogt, Joy VIC To Australia JIANG Zexi (cardiac surgeon) SUN Zhipeng (anaesthetist) XIA Zhongfang (ENT surgeon) XU Yang (orthopaedic sugeon) ZHONG Liang (anaesthetist) ZHOU Xin (general surgeon) First Traditional Chinese Medicine Hospital To China Brown, Gregor (gastroenterologist), VIC Cameron, Donald (gastroenterologist), VIC CHAN, Yuenfu (pathologist), VIC Gibson, Peter (Gastroenterologist), VIC Howard, Anne (dermatologist), VIC McFarlane, Anne (endoscopy nurse), VIC Yeatman, Josie (dermatologist), VIC English Teachers Bond, Judith VIC McLoughlan, Mark VIC HUNAN PROVINCE CHANGSHA Xiang-Ya Hospital, South Central University To China Brophy, Brian (neuro-surgeon), SA Cleland, Heather (plastic/reconstructive surg.), VIC Knuckey, Neville (neuro-surgeon), WA LEUNG, Michael (plastic/reconstructive surg.), VIC LEUNG, Stephen (anaesthetist), VIC To Australia HU Nianping (Immunologist) LIU Qiuqiu (O R Sister) LONG Jianhong (plastic and burns surgeon) TAO Lijian (nephrologist/administrator) WANG Donghua (orthopaedic surgeon) ZHANG Pihong (plastic Surgeon) Hunan Province Cancer Hospital To China Thomson, Peter (head and neck/ENT surgeon), VIC To Australia CHEN Jie (head and neck surgeon) WEI Wei (head and neck surgeon)

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JIANGSU PROVINCE Nanjing Chest Hospital To Australia LIU Xiaosu, (anaesthetist) Nanjing Health School To Australia ZHAO Ping (nurse tutor) Jiangyin People’s Hospital To China Rosenfeld, Jeffrey (neurosurgeon), VIC SHANXI PROVINCE TAIYUAN Taiyuan Municipal Central Hospital To Australia ZHAO Zhigang (urologic surgeon) SICHUAN PROVINCE CHENGDU West China Union Hospital To China Kelly, Justin (paediatric urologist), VIC To Australia HUANG Lugang (paediatric urologist) YUNNAN PROVINCE KUNMING First Affiliated Hospital, Kunming University of Medical Sciences To Australia DAI Wei (gastro-enterologist) The First People’s Hospital of Yunnan Province To Australia XIAO Minghui (urologic surgeon) DENG Zheng (Respiratory physician) ZHEJIANG PROVINCE HANGZHOU Sir Run Run Shaw Hospital To China Angliss, Margaret (nurse/research), VIC

Beevor, Harriet (anaesthetist), VIC Bell, Eliza (pain liaison nurse), VIC Bloom, Richard (plastic/reconstructive surgeon), VIC Boyd, Dana (pain liaison Nurse), VIC Bradley, Scott (physiotherapist), VIC Chan, Patrick (neurosurgeon), VIC CHIU, Daniel (ophthalmologist), VIC Cousins, Vincent (ENT/head & neck surgeon), VIC de Silva, Lucky (anaesthetic trainee) Duffy, Chris (anaesthetist), VIC Elliot, Jane (physiotherapist), VIC de Steiger, Richard (orthopaedic surgeon), VIC Fowler, Steven (anaesthetist), VIC Gerstman, Michelle (anaesthetist), VIC Goldstein, Jacob (cardiac surgeon), VIC Grummet, Jeremy (urologist), VIC Heriot, Alexander (colo-rectal surgeon), VIC Hill, Andrew (colo-rectal surgeon), NZ Konstantatos, Alex (anaesthesia/pain specialist), VIC Kourambas, John (urologist), VIC Lindholm, David (anaesthetist), VIC LOW, Gordon (colo-rectal surgeon), VIC MAH, Eldon (plastic surgeon), VIC NEOH, Derek (plastic surgeon), VIC QIAN Ximing (cardiac surgeon) VIC Paton, Anna (pain liaison nurse), VIC POON, Alexander (ophthalmologist), VIC Reeves, John (intensivist), VIC Richardson, Martin (orthopaedic surgeon), VIC Stark, Tony (anaesthetist), VIC Story, David (anaesthetist), VIC Trotter, Dean (plastic surgeon), VIC Vallipurum, S.K. (pain management), VIC Webster, Howard (plastic/reconstructive surgeon), VIC Williams, David (intensivist), VIC To Australia CAI Xiujun (general surgeon - laparoscopy) HE Chao (colo-rectal surgeon)) LAO Weifeng (colo-rectal surgeon) PAN Konghan (intensivist) SHAO Yan (plastic surgeon) SUN Xiaomin (Center for International Collaboration) TIAN Suming (anaesthetist/intensivist) TONG Yingge (Pain management nurse) WANG Hongwei (anaesthetist/intensivist) XIE Shuduo (breast surgeon) XU Heyan (cardiac surgeon) ZHANG Yueyi, (Director of Hospital Training Center) Second Affiliated Hospital, Zhejiang University To Australia ZHANG Mao (emergency surgeon)

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There are also Chinese administrators and doctors who visited Australia and New Zealand on fact finding tours. A few had attended clinical meetings and our Annual Scientific Congresses. Three delegations visited Australia and New Zealand in 2007. They came from the Kunming University of Medical Sciences (7 members), Guangzhou Municipal Health Bureau, Guangzhou Children’s Hospital and Guangzhou Women & Children’s Hospital (12 members) and the Wuhan Children’s Hospital, and Women’s and Children’s Health Centre (6 members). They visited the Alfred Hospital, the Royal Children’s Hospital, the Royal Melbourne Hospital, the Monash Medical Centre and the Mercy Hospital, Melbourne; the Westmead Children’s Hospital, Sydney and the Starship Children’s Hospital, Auckland, New Zealand. There were other visitors from the College who travelled to China on advisory and observation purposes. These included Presidents, Council Members, a Chief Executive Officer, and Fellows who attended conferences, gave lectures, conducted seminars and visited Hospitals. Many colleagues from Australia/New Zealand and from China have visited their opposite numbers on more than one occasion. However, regardless of how many visits they have made, their names will appear only once on this chart, unless they have made visits to different hospitals. With very few exceptions, all the English teachers have made multiple trips to China.

Australian and New Zealand Hospitals involved in Project China New Zealand Starship Children’s Hospital, Auckland New South Wales Children’s Hospital, Westmead Queensland Princess Alexandra Hospital Royal Brisbane and Women’s Hospital South Australia Flinders Medical Centre Queen Elizabeth Hospital Royal Adelaide Hospital Women’s and Children’s Hospital Victoria Alfred Hospital Austin and Repatriation Medical Centre Bellbird Private Hospital

Bernard O’Brien Institute of Microsurgery Box Hill Hospital Cabrini Hospital Epworth Hospital Epworth Cliveden Hospital Epworth Eastern Hospital Linley Private Hospital Monash Medical Centre Murdoch Children’s Research Institute Northern Hospital Peter McCallum Cancer Centre Royal Children’s Hospital Royal Dental Hospital Royal Melbourne Hospital Royal Victorian Eye and Ear Hospital St. Vincent’s Hospital Western Australia Princess Margaret Hospital for Children

Ms Daliah Moss, Director of External Affairs, writes: Mr Gordon Low, for his work in Project China, was awarded the Royal Australasian College of Surgeons (RACS) Medal in 1994; Mrs Rosie Low was presented a Certificate of Appreciation by Council for her contributions to Project China in 1999; Mr Gordon Low was appointed a Member of the Order of Australia in 2003; Mr Gordon Low was presented the Friendship Award of the People’s Government of the Municipality of Guangzhou, China, in 2007; Mr and Mrs Low were each named a Paul Harris Fellow by the Rotary Foundation of Rotary International in 2010. Mr and Mrs Low were together presented an Excellent Contribution Award by the Sun Yat-sen University Cancer Center, Guangzhou in 2012. Mr and Mrs Low were each awarded an International Medal of the College in 2013. Mr and Mrs Low were together presented a Distinguished Service Award by the Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University in 2014.

www.surgeons.org

For more information about Project China contact the College: www.surgeons.org

Royal Australasian College of Surgeons College of Surgeons Gardens 250-290 Spring Street , East Melbourne Victoria 3002 Australia ph: +61 3 9249 1200 fax: +61 3 9249 1219

Gordon Low (

) , AM MBBS (HK) FRCSEd FRACS ) Rosie Low (

Founders and Co-ordinators, Project China External Affairs Division, RACS 30 December 2013