Abstract
The Global Surgery Program at the University of Toronto aims to increase surgical expertise in underserved communities around the world, with a focus in low- and middle-income countries. On the suggestion of our colleagues and in the footsteps of the world-renowned Canadian surgeon Dr. Norman Bethune, we realized that China, with an increasing cardiovascular disease burden and a population exceeding 1.2 billion, offered an opportunity like no other. In this chapter, we reflect on our 23 years of experience in the region, recounting how we began in 1998 as a small initiative to increase access to cardiac surgery in areas that had little of it, but have now evolved into a multidisciplinary effort across 160 medical institutions and 29 subspecialties. In doing so, we have established cardiac surgery training programs at 11 centers, mimicking the “Competency by Design” curriculum implemented here in Canada by the Royal College. We also successfully advocated for health coverage for over 95% of Chinese citizens, while additionally welcoming 142 trainees for observerships to Canada. Not only have these experiences taught us many invaluable lessons, we have also been very fortunate to witness one of the most remarkable socioeconomic developments in recent Chinese history.
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References
Deslauriers J, Goulet D. The medical life of Henry Norman Bethune. Can Respir J. 2015;22:e32–42.
China statistical yearbook;2020. http://www.stats.gov.cn/tjsj/ndsj/2020/indexeh.htm.
China country assessment report on ageing and health. World Health Organization;2015.
Life expectancy at birth, total (years)—China|Data. https://data.worldbank.org/indicator/SP.DYN.LE00.IN?end=2018&locations=CN&start=1960&view=chart.
Scharping T. Birth control in China 1949–2000: population policy and demographic development. Routledge;2003.
Han Y, et al. Aging in China: perspectives on public health. Glob Health J. 2020;4:11–7.
Ni D. Why China’s young doctors want out of the system. Sixth Tone;2019.
GDP growth (annual %)—China|Data. https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG?locations=CN.
Yao GCK. China’s economy picks up speed in fourth quarter, ends 2020 in solid shape after COVID-19 shock. Reuters;2021.
Zha B. The gap of economic development expanding between eastern China and middle, western China. China Popul Res Newsl. 1996; 2–3.
Staff R. China to invest $450 billion modernizing agriculture by 2020. Reuters;2016.
Su A. China fulfills a dream to end poverty. Not all poor people are feeling better off. Los Angeles Times;2020.
Is China succeeding at eradicating poverty? Center for strategic and international studies: China power project;2020. http://chinapower.csis.org/poverty/.
China|Commonwealth fund. https://www.commonwealthfund.org/international-health-policy-center/countries/china.
Cheng ZLLF-H, Zhang K, Zhang S. Healthcare enforcement and litigation in China|Lexology. https://www.lexology.com/library/detail.aspx?g=52af1dd1-33fa-43cd-88fd-fb3e6d4c960e.
Berchick ER, Barnett JC, Upton RD. Health insurance coverage in the United States: 2018. U. S. Census Bur. 2019; 44.
Collins SR, Gunja MZ, Aboulafia GNUS. Health insurance coverage in 2020: a looming crisis in affordability;2020. https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/looming-crisis-health-coverage-2020-biennial.
Pezzella AT. Global aspects of cardiothoracic surgery with focus on developing countries. Asian Cardiovasc Thorac Ann. 2010;18:299–310.
Yankah C, et al. Cardiac surgery capacity in Sub-Saharan Africa: quo vadis? Thorac Cardiovasc Surg. 2014;62:393–401.
Vervoort D, Meuris B, Meyns B, Verbrugghe P. Global cardiac surgery: access to cardiac surgical care around the world. J Thorac Cardiovasc Surg. 2020;159:987-996.e6.
Chen WW, et al. China cardiovascular diseases report 2015: a summary. J Geriatr Cardiol JGC. 2017; 14:1–10.
Zilla P, et al. Global unmet needs in cardiac surgery. Glob Heart. 2018;13:293–303.
Turina MI. European association for cardio-thoracic surgery: carrying the torch. Eur J Cardiothorac Surg. 2002;22:857–63.
Cardiovascular diseases (CVDs). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
Ma L-Y, et al. China cardiovascular diseases report 2018: an updated summary. J Geriatr Cardiol JGC. 2020;17:1–8.
Bei Y, Yang T, Xiao J. Cardiovascular medicine in China: what can we do to achieve the healthy China 2030 plan? BMC Med. 2018;16:132.
Watkins DA, et al. Global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med. 2017;377:713–22.
Competence by design: the royal college of physicians and surgeons of Canada. https://www.royalcollege.ca/rcsite/cbd/competence-by-design-cbd-e.
Harris KA, et al. Competence by design: reshaping Canadian medical education;2014.
Huang Y. The SARS epidemic and its aftermath in China: a political perspective. Learning from SARS: preparing for the next disease outbreak: workshop summary. National Academies Press (US);2004.
Xiaotangshan hospital—Noah’s ark. http://www.china.org.cn/english/2003/Sep/75309.htm.
Williams S. Coronavirus: how can China build a hospital so quickly? BBC News;2020.
Low DE. SARS: lessons from Toronto. Learning from SARS: preparing for the next disease outbreak: workshop summary. National Academies Press (US);2004.
G. J. Ontario declares SARS an ‘emergency’. The Globe and Mail;2003.
WHO|Update 55—change in status of Toronto, situation in China and Singapore. WHO. https://www.who.int/csr/sars/archive/2003_05_14/en/.
Norman Bethune: China’s hero|CBC radio;2014. https://www.cbc.ca/radio/rewind/norman-bethune-china-s-hero-1.2801190.
Tan SY, Pettigrew K. Henry Norman Bethune (1890–1939): surgeon, communist, humanitarian. Singapore Med J. 2016;57:526–7.
Rao C, et al. The China patient-centred evaluative assessment of cardiac events (China PEACE)-prospective study of 3-vessel disease: rationale and design. BMJ Open. 2016; 6:e009743.
Tu JV, et al. Determinants of variations in coronary revascularization practices. CMAJ. 2012;184:179–86.
Nissen AP, et al. Global perspectives on cardiothoracic, cardiovascular, and cardiac surgical training. J Thorac Cardiovasc Surg. 2021;161:168-174.e5.
Wu L, et al. Development of a medical academic degree system in China. Med Educ Online. 2014; 19.
Kuang L, et al. Family practice and the quality of primary care: a study of Chinese patients in Guangdong province. Fam Pract. 2015;32:557–63.
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Errett, L., Khalid, M.U. (2022). Global Cardiac Surgery in China: 23 Years of Mission Work. In: Kpodonu, J. (eds) Global Cardiac Surgery Capacity Development in Low and Middle Income Countries. Sustainable Development Goals Series. Springer, Cham. https://doi.org/10.1007/978-3-030-83864-5_39
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DOI: https://doi.org/10.1007/978-3-030-83864-5_39
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