Valentian Pasquali – Washington Prism
Shanghai - Dr. Wang explains that the painter “has an acute inflammation of his prostate.” However, for the time being he will wait to operate. “We will try with medicine and injections and if the infection gets better you will not have to undergo surgery,” the doctor communicates to the family. Dr. Wang is completing his rounds of daily visits to his patients at Huashan Hospital, a complex of a few newly built buildings in the French Concession, in the heart of Shanghai. Huashan Hospital is a public institution affiliated with Fudan University, the second best medical school in China. The hospital was originally created by the International Red Cross in 1907, a past memorialized only by a lower-rise, red-brick building now transformed into a museum. Huashan‘s specialty is neurology, with 8,000 patients undergoing neuro-surgery every year. As an example of how the reforms have transformed China, the hospital provides its services via a system based on income that divides patients into four categories. The top floor is reserved for China’s senior leaders. The three floors below comprise a relative small number of large rooms, one patient in each, with a personal television set and bathroom. Waiting times for those who are housed here are brief, but one must be able to afford such preferential treatment, since staying on these floors is considerably more expensive than what is within the reach of a regular Chinese. The end result is that this section is usually filled with foreign patients or with a few very rich Chinese entrepreneurs. The painter is lodged in the mid-range category, on the mid-level floors. There are three to four patients per room and no foreigners in sight, but the accommodations are comfortable and the price high enough to allow only those who can afford such luxuries. Finally, the lower floors offer less comfortable facilities in overly crowded dormitories. The number of people per room grows to seven or eight in an area that is much smaller than the ones above. A similar system of casts is applied to the outpatient building, which houses the emergency room. A modern ER structure is built on the eighth floor, but the prices of consultation there are only affordable to upper class Chinese and foreigners, so the average citizen must settle for the ground floor venue. The country’s modern healthcare apparatus was created with the birth of the People’s Republic of China in the 1940s and was inspired by the ideal of offering free, quality service to every Chinese. Since the launch of the reform in 1979, the provision of medical services has undergone profound restructuring to incorporate the market mechanisms that were required when China opened up to capitalism. These transformations have contributed to improving healthcare services in the wealthiest areas. At the same time they are at the roots of growing disparities among the haves and have-nots. According to a study by the World Health Organization (WHO) published in 2006 in collaboration with China’s State Council, in 1979 the country showed much better health indicators than one would have expected if looking only at its GDP. The relative success at that time can be attributed to the universal access to preventive care that had been built in the precrrding thirty years. However the report notes how in 25 years of economic reform, “China's health indicators have improved at a slower rate than predicted by its growth in income per capita.” This insurance, Dr. Wang explains, should cover 80 percent of the costs for day-hospital services and 90 percent of the expenses of those who must undergo longer treatments or surgeries In reality such coverage has so far failed to reach the poorest share of the population. According to the WHO, by 2003 around 80 percent of Chinese living in rural areas and 50 percent of urban dwellers did not have any health insurance plan. The absence of coverage forces families to spend out-of-pocket and often resort to their savings in order to face the burden of medical care. In 2004 such out-of pocket expenses were as much as 90 percent of the total spending of rural households. The growing frustration of the population in the countryside is aggravated by episodes where medical personnel refuse service to patients who cannot afford to pay hospital fees. On December 12, 2006 around 2,000 people attacked and ransacked Guang'an City People's Hospital in Sichuan Province, in Southwestern China, after reports spread that a 3-year-old boy was denied life-saving treatments because his legal guardian could not afford to pay. Since 2000 the Chinese government has been trying to address these failures and has designed two plans targeted at rural areas and the urban poor: the New Rural Medical Scheme and the Medical Financial Assistance. The WHO assessment in 2006 found that neither policy had yet succeeded in expanding healthcare coverage. “The problem is,” Dr. Wang says, “that there remains a significant difference between the health care system in the wealthiest cities and in the countryside.” Wang Xiang is a 39 years old urologist who comes from Hefei, the capital of Anhui province, an inland province in Southeast China and home to the country’s President Hu Jintao. Wang completed his entire medical education in China, finishing first in his class at Fudan University. During his time at Huashan, Dr. Wang spent two years in Montreal at McGill University, and one year as a visiting scholar at the University of Kentucky. Dr. Wang’s personal story speaks of the rapid changes that are occurring throughout China. Dr. Wang himself is a successful example of the modernization and internalization of the country, at least as far as the new Chinese elite is concerned. At the same time, his family history tells the story of China in the past fifty years remarkably well. His grandfather was a landlord at the time of the founding of the People’s Republic of China. After 1949 all of his possessions were expropriated, and he tragically died of starvation in the midst of the Great Leap Forward when China, Dr. Wang says, “was trying to develop faster than fast.” Dr. Wang’s father was able to embark upon a safer path. He became a pilot for the Air force and was deployed during the Korean War. Because of his privileged position in the armed forces, he and his family lived a relatively protected life, even during the tumults of the Cultural Revolution. Nonetheless, Dr. Wang still recalls what a less advanced China was like before Deng Xiaoping launched the reforms: “There was poverty; no televisions, no radio and no cars. Everything was very simple. And everyone wore the same colors, green or blue. If you wore something very colorful you were considered a capitalist,” he recalls. Today, back at the hospital, dusk is falling and the rays coming through the window become feebler. Dr. Wang walks out of the room of the painter. “Sometime a doctor simply has to be a psychologist,” he says. The conversation he just had with his patient was an act. The painter’s wife had asked to see the doctor previously and they had already met. She is aware that her husband does not simply suffer from an acute prostate infection, but instead has a cancer that is already at its latest stage. The painter is 46 and is the youngest patient affected by such a fatal disease in the hospital. “He probably has three to six months left and operating would not make any difference,” Dr, Wang says, “but I think he knows. At least he has an idea. He pretends like he does not know but I’m sure he understands. He is a smart man.” Dr. Wang shakes his head at the thought and continues walking to the next patient’s room.
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