Visiting Chinese medics making a difference
On January 13, a 37-year-old woman spent 20 hours under the knife at the San Fernando General Hospital to remove a brain tumour almost the size of a table tennis ball.
The high-risk surgery was performed by specialist neurosurgeons who came from the other side of the world—a team of Chinese medics who have been operating out of the hospital since last year.
The patient, a mother of two, survived the surgery and is recovering well. She owes her life to the people she may never meet again.
Last August, ten Chinese medical professionals left China’s capital city of Beijing, where they live and work, to come to Trinidad and Tobago’s southern city. It was the first time some of them would travel to the Caribbean.
The staff at the South West Regional Health Authority (SWRHA) were happy to have the Chinese medics based at their RHA since patients suffering with brain and spine injuries had to be transferred to the Eric Williams Medical Sciences Complex at Mt Hope to be treated, including emergency cases—an issue that has plagued the San Fernando General Hospital for almost five years.
Before the Chinese medics came, the hospital had only one neurosurgeon—Pedro Cesar Nunez, a Cuban doctor.
The Chinese not only brought their service, they also brought their knowledge which they shared with others.
They created history, being the first medical team from China to work in this country.
The China Medical Team (CMT) conducted numerous high-risk surgeries at the San Fernando General Hospital and Mt Hope where the country’s only catherisation (“cath”) lab, used for special imaging, is located.
For the first time, patients did not have to wait on a foreign neurosurgeon to conduct endovascular coiling, a procedure performed to treat abnormal brain conditions between arteries and veins. The procedure would have usually been conducted by a neurosurgeon from Venezuela or England, paid for by the Ministry of Health and undertaken at West Shore Medical Private Hospital, Cocorite. The endovascular coilings were conducted by head of the medical team, Dr Hongqi Zhang at the cath lab. At least 30 of these procedures have been completed.
Also for the first time, an abnormal connection between blood vessels in the brain was treated using embolisation (the blocking of the abnormal connection between arteries and veins under imaging guidance) at Mt Hope.
Two weeks ago, Zhang and his team spoke with the Sunday Express at the San Fernando Teaching Hospital. Also joining them was neurologist Dr Suresh Boodram.
Zhang explained the complicated 20-hour procedure to remove an acoustic neuroma was the second longest surgery ever conducted at the hospital. Zhang, neurosurgeon Dr Yukei Wei, anaesthesiologist Dr Ting Ma and nurse Leili Niu headed the team.
An acoustic neuroma is a rare tumour that develops on the main nerve leading from the inner ear to the brain.
Zhang said: “It was a long surgery from one morning to the next morning. We tried to do our best to preserve every neuro function of the patient, so we spent a lot of time to do this surgery.
“This surgery is a very extremely risky case in the ward because the tumour was so big. It was found two years ago, a small tumour, but it grew.
“I think the patient didn’t want to take any risk at that time, or the surgeries were short of human resource, so the patient was in the long waiting list.”
He said: “She cannot walk properly without a cane. She cannot speak and there is also some problem with swallowing and there is also facial palsy. This (tumour) was a latter stage.
“The mortality rate and the morbidity rate is very high with this surgery. We discussed it with her family and we discussed it with the patient very carefully. We cannot guarantee the safety totally before the surgery. We also consider what are the complications during and after surgery. And we also need preparation for the surgery.
“We took a long time to dissect the tumour piece by piece and tried to preserve the nerve and the structure of the brain stem and every artery in this region.”
Zhang: Saving lives and medical costs
Zhang had high praise for this Government, specifically the Ministry of Health and its line minister, Dr Fuad Khan. Contrary to what some citizens may think, he said the Government was trying its best to develop the health sector.
There was also high praise for the staff at the SWRHA and Mt Hope, whom he said were always ready to assist.
However, there are challenges to improving health care in our hospitals, with emphasis on the San Fernando General Hospital. Some challenges are not isolated to Trinidad and Tobago alone, like the global rising costs for medical care. Zhang said: “Trinidad and Tobago developed very fast in the recent ten years. But the improvement of the health care cannot be so fast.”
He gave some reasons.
Training
Zhang said: “The public health care system in Trinidad is totally free and there is also the private section in Trinidad which is a higher quality of service. If the Government wants to increase the quality of their public health sector, it will cost a lot. And the cost of medical care is rising.
“The free public services is good, but if it is absolutely free you have a big burden to the Government and sometimes it is very difficult to guarantee quality and quantity.”
Team member general surgeon Dr Jia Li said: “I think Trinidad and Tobago do their best. They try to encourage the doctors to improve their skill. They (doctors) have a very strong will to study and improve their skills and the hospital encourages them to do it.”
Zhang said the team has met with Khan to discuss further arrangements between China and Trinidad and Tobago.
Khan told the Sunday Express soon five local doctors will be going to China to study, under funding from the Chinese government. He also said it was cheaper for this Government to pay for doctors to China instead of the US or the UK.
During the six months the CMT has been here, educational sessions were conducted on weekdays, but Zhang said that was not enough.
“Official training exchange should be necessary in some specialities,” he said, and young doctors should be encouraged to specialise in certain medical areas.
In terms of cost, Zhang suggested the private sector step in to assist.
He used an example of a 35-year-old patient who suffered a spine fracture after a one-tonne gate fell on her. The patient, grateful she could walk again, will be refurbishing the new neurosurgery ward.
Human resources
“There is not enough human resource to provide the service to more patients,” Zhang said.
Pneumologist Dr Han Xiao said: “The main problem is people. There is not enough people to help in the health sector. There are many doctors, but not many of them are trained in specialities. We definitely need more people.”
The Sunday Express was told more nurses were needed, especially ones who are trained in specific fields such as neurosurgery.
Equipment
Zhang said: “Trinidad is a small island, so there is not enough suppliers or distributors like in China or in the US or the UK. The supplier can supply one day before the surgery, but in Trinidad you have to meet a long process.
“Here, because we are short of some instruments before and even now, we have to take twice the duration for the operation, twice the hours in China, but we try to make the results good. We try to find some equipment and instruments and the facility to serve more patients in San Fernando.”
He said: “We did so many complicated neurosurgeries here. These kind of neurosurgeries the local neurosurgeons has not faced before. When we do the neurosurgery, we face the shortage of equipment, and I think the Government will try its best to bring more equipment.”
Some equipment was also outdated, Zhang said.
Space and facilities
Since the Chinese neurosurgeons have been conducting more procedures, there have been more patients at the neurosurgery ward at the hospital.
Zhang said: “We need a bigger ward. The neurosurgery team is becoming bigger and patients are becoming more, and the surgery is using advanced equipment.”
The neurosurgery ward can only hold up to six patients at a time. Soon, there will be a new neurosurgery ward that will be able to accommodate 20 patients. When that will be completed, no-one knows for sure.
Another cath lab is also needed so that patients and doctors would not have to travel to the Mt Hope hospital for surgery or treatment.
Speaking about his endovascular coiling procedures at Mt Hope, Zhang said: “The cases finished uneventfully and successfully. We just had a problem with the shortage of instruments. We had to transport the patients from south. Traffic was also a problem.”
10 neurosurgeons in
Trinidad and Tobago
There are only ten neurosurgeons in Trinidad and Tobago’s public and private health sector and only consultants can be considered neurosurgeons. At Xuanwu Hospital, from where the team hails, there are 60 neurosurgeons, but in the neurosurgery department there are various divisions.
Zhang said: “We have several groups and several specialities. The basic training is the same. We have up to ten years’ training and then we go to the specialities. After training, then you will be a consultant in some specialities.”
Most cases conducted in Trinidad and Tobago were similar to those encountered in China. But more modern equipment is used in China, Zhang said.
Last Monday, the hospital recorded the longest surgery ever to take place there. The 23-hour-long procedure involved a 59-year-old man with a brain tumour that was wrapped around the nerve.
This team leaves at the end of this month. Another comes to take its place. And for the next year and a half, the Chinese medics will be working mainly out of the San Fernando General Hospital. During that period, they would have conducted hundreds of surgeries and seen thousands of patients. A record, perhaps.
By then, the CMT would have fulfilled its mandate.
And by then, this Government would have saved at least US$1.5 million since it is not paying the team’s salaries.
As Dr Zhang said: “We came to help the Trinidad and Tobago Government save money, so they can use that money to help save more lives.”