October 5, 2009

Global Health Leader Amelia Wood arrived a couple weeks back at Kijabe with her husband Jim and baby Josiah. She is serving as a neontologist there, bolstering health care delivery and training.

by Amelia Wood, M.D.

We have now been in Kijabe a full week. We arrived to homemade zucchini bread and an invitation to watch "So you think you can dance" from the wonderful Davis family (our neighbors just below in the Sitaplex guest house). Not having a TV at home, we were way less in the know than some of the long term missionaries here. Kijabe is like summer camp for doctors. And although there may be some sacrifices in being in Africa (like broccoli free of aphids) our overwhelming sentiment is, "man, don't we feel at home!" 

We have made many good friends in the short time since we arrived, including a missionary couple who are living our dream. Mark and Sue Newton have been in Kijabe for 12 years and they are so authentic and enjoyable that they make missionary life seem easy. Mark is a pediatric anesthesiologist who spends 10 weeks working at Vanderbilt every year and the rest of their time is at Kijabe. They have a welcoming home, wonderful children, and a black lab named Moshi. Their lives are busy, but they have graciously had us over twice in the first week - of course, one of those times we arrived un-invited! But they didn't seem to mind. It has been great to listen to them and realize that some of our hopes could in fact become realities.

PRAISE THE LORD, Jim and I found an angelic nanny named Helen who I will cry to leave. She makes it possible to work in peace knowing that our sweet Josiah is cheerfully smacking around our home under her watch. I am only working until lunch time (plus taking call) which is good because everything takes longer in Africa. It is a slow walk with Josiah on my hip to the dukkas (pronounced doo-kus = produce vendors); then bleaching the vegetables is another considerable speed bump once we get home! I actually really love hanging my own laundry out on the line (although it does mean you can't leave the job unfinished until tomorrow).

So as for our "test run" here at Kijabe....I'd say we love it. Where else could a country-boy practice pediatric surgery and his wife practice academic neonatology while their children run through the country-side?

The people here are smiley and energetic. The children are beautiful, just like everywhere. I work in the "nursery" which is an absurd understatement for the degree of illnesses managed in the small, overly heated room crammed with sick infants. We pile in as one big mass of white coats to begin rounds while the nurses sing praise songs in the next room for morning devotionals. Their singing sounds like a dream or the soundtrack to a Francis Ford Coppola film. In the nursery, the mothers all gather round to listen to our discussions as we move from baby to baby. There is no HIPPA so they support each other when things aren't going well and consol one another's babies when they are crying. Mostly, it is a type of sweet interdependence and community lost in the ultra-private and sterile US. Sometimes however, it is a cacophony of cultures-a yelling match in varied languages with beeping incubator alarms and empty infusion pumps filling in any moments of silence. The Somali women are particularly prone to finger wagging and loud refusals to suggested medical plans. I sometimes struggle to teach amidst all the hot commotion.

I usually round with my friend Stephany Hawk, who was my co-resident at Vanderbilt and is now doing a two-year stint as the pediatrician at Kijabe. Together we are training African residents in pediatrics during our daily discussions of patients in the nursery. I have also been asked to lecture at Grand Rounds for the missionary physicians -- pediatricians and family docs. Because I have had the privilege to train under Susan Niermeyer, an international expert in the care of newborns at high-altitude (Kijabe is 2000 feet higher than Denver), I plan to teach about the special challenges of caring for infants transitioning from fetal to post-natal circulation at high altitude. I will also be giving lectures in basic neonatology to the nurses who do much of the bedside care and are pivotal to keeping these babies alive. I am already attached to them, and I often need their hugs on the way out the door each day-neonatology in rural Kenya is sometimes very difficult.

Our biggest limitation to sick newborn care is the lack of total parenteral nutrition. We have many pre-term babies as well as several infants with inadequate intestinal length due to operations, who would all receive TPN in the States. At Kijabe we manage them by feeding at the earliest opportunity and praying for a miracle. It is the best thing available. We can sometimes get lipids (a component of TPN) to add to their IV fluids, and there are rumors of amino-acids, but I have yet to see any-I don't really believe they exist in Kenya. So we do the best we can with what we have.

We see a lot of death and pray that we are communicating Christ's love to these moms by caring for their children who would otherwise be forgotten. This morning, I barely left the bedside of a dying child, whose mother insisted that he was already dead-as evidenced by the ventilator breathing for the baby. The baby is not dead, but he probably will be soon. With all of the challenges and obstacles, it can be difficult to persevere at times.

Still, we do see some miracles. We have two former 29-week preterm infants who are thriving and have graduated into what American neonatologists call "feeder-growers". My favorite is baby James. He is almost ready to ‘hatch' from his incubator. Another baby I love is baby Joseph-a term newborn we admitted for sepsis. I told his father (‘Babba Joseph' as the Kenyans refer to a child's father) that he should expect Joseph not just to survive but to be a normal child. I told him that Joseph will play football (soccer) with his brothers one day. Babba Jospeh smiled broadly and declared "This is a good prophecy." Indeed, I agree.

Life is simple, hard, and lovely.


 Baby James

September 30, 2009

by Jenny Eaton Dyer, Ph.D.

Last night we had a really fantastic Global Health Gathering at the Frist home. Welcoming all Nonprofits who were dedicated to Global Health issues (or Millennium Development Goals) in Tennessee, we had an array of groups who attended who had traveled from as far away as Johnson City or Memphis.

These great groups, all who have joined the Tennessee Global Health Coalition, provide aid and service around the world. They provide beds, shoes, education and clean water for the world's poorest. Some offer leadership training, mental health services and a haven for child soldiers. We have groups who fight trafficking in all forms, and we have groups who train community health workers to provide better health care in forgotten corners of the world.

To be in a room with these heroes and learn from and about their great work was so encouraging for everyone.

Big Kenny (www.bigkenny.tv) and his beautiful wife, Christiev, came (www.loveeverybody.com) and shared their latest experience in the Sudan. He played his new song, "Forgiveness" with a collage of photos from the trip. His gift is storytelling, and he's out to change the world.

Lewis Lavine, president of Center for Nonprofit Management (www.cnm.org), joined us to offer his organization as a resource for the nonprofit groups.

And, Senator Frist shared his story of getting involved in global health policy, the commitment to saving lives in medicine and politics, and the trajectory of Hope Through Healing Hands' Global Health Coalition for Tennessee.

Everyone enjoyed Moe's burritos and guacamole, and I think all left realizing that Tennessee indeed has a robust global health community of works that can and will be showcased. After a "speed-dating" for nonprofits ice-breaker (Kenny said it was louder in the Frist's hall last night than in a good bar!), we prompted small group discussion for these groups to think on ways to work together.

We are excited to see what the future holds for these amazing groups and partnerships.

 Courtesy of Jena Nardella: From left -- Senator Frist, Jenny Dyer, Sten Vermund, Big Kenny Alphin


 Frist Basement Hallway: "Nonprofit Speed-Dating"











Frist Basement: Small Group Discussion--Africa Group

September 24, 2009

Senator Frist was the Commitments Presenter in an Infrastructure Breakout Sessions Seminar: Infrastructure of Recover: Good Jobs and Smart Growth.

Global recession has slowed private sector investment and caused rampant job loss. In response, governments around the world are investing in economic recovery though forward-looking public works projects. This new generation of infrastructure investments -- from broadband networks to transit systems to clean energy technology -- is laying the ground word for global deployment of advanced technology and private sector innovation. The response to to the economic crisis has set the stage for a new generation of smarter infrastructure empowered by better use of information and more efficient use of resources. Outdated development patterns are being "leap-frogged." This session provides an opportunity to reflect on progress one year into the economic crisis and to examine the relationship between the public and private sectors.

Frist announcing Commitments.

September 23, 2009

P&G Dinner: The Procter & Gamble Company (NYSE:PG) honored partnerships that have helped the company achieve three life-saving commitments at their "Live, Learn and Thrive" Awards event. Held at a VIP reception in conjunction with the 2009 Clinton Global Initiative (CGI) in New York City, the Awards recognize partners CARE, PSI, UNICEF and World Vision for their help in improving the lives of more than 40 million children, by providing vaccines and safe drinking water to help those in need.

Senator Bill Frist was one of four who presented awards to the partners. While there, we took several photos featured below.

Sheraton NY Hotel and Towers, Avenue Restaurant

 Frist giving interview prior to award beginning on importance of clean water at global level.

Frist chatting with Hans Bender, P&G VP External Relations Global Household Care--Note PUR Packet and PUR Product produced by P&G













Frist chatting with Rich Stearns, President of World Vision (awardee) and his wife Renee Stearns.











Frist visiting with Fellow Awarder Actor Dania Ramirez
















President William J. Clinton and P&G Vice-Chair of Global Household Care, Dimitri Panayotopoulos wrapping up the evening, celebrating the launch of new commitments.



September 23, 2009

This morning I participated in an Action Network Workshop that focused on Health Systems. This past month, I wrote an Op-Ed for the Boston Globe, "Global Healthcare Needs More Than a Pill." In that, I argued that we need to consider a "systems-approach," looking at health systems as a whole - beyond just preventing and treating infectious disease. This would include considering the renovations of health clinics, providing good roads for transportation to those clinics, access to clean water, treating chronic disease, addressing child survival, and partnerships across governments, NGO's, and the private sector to make this work. Given this framework, a discussion followed about how to move forward horizontally and vertically with infectious disease, chronic disease, and maternal and child health.

Dr. Tedros Adhanom Ghebreyesus also delivered a framework for discussing Health Systems. He is currently the Minister of Health of the Federal Democratic Republic of Ethiopia. Focusing on Ethiopia, he addressed their top priorities (Infectious Disease and Maternal/Child Health) and the strategies to address these priorities to strengthen the health care delivery in Ethiopia. In sum, these strategies included the following: 1) Focus on Primary Care, 2) Building information system, 3) Strengthening the supply system for pharmaceutical delivery, 4) Providing health care financing, 5) Bolstering Human Resources, and 6) Addressing Governance. Their motto is "bigger, faster, and better" for speed, volume, and quality for better health promotion and prevention.

A robust discussion among top level NGO's and others commenced. We are eager to hear their results! Those results will then be presented back to CGI for suggestions for future commitments.


 Frist opening discussion--CGI, Sheraton NY Hotel and Tower--Wednesday, September 23, 2009

 Minister Tedros Adhanom Ghebreyesus


September 22, 2009

This afternoon, the 5th annual Clinton Global Initiative commenced with the Opening Plenary led by President Obama. It is such an exciting event for global issues with the world's elites--governmental, nonprofit leaders, private sector leaders, and celebrities to name a few--who are committed to health, infrastructure, women and girls, development, and the environment.

We are proud to announce that Hope Through Healing Hands has pledged a Commitment at CGI this year. We hope to grow our Global Health Leaders Program over the next few years to place health professionals in underserved clinics and to train community health workers around the world.

For the first evening we attended a few receptions. Along the way we ran into friends, new friends, and colleagues. See a few photos and names below.

We hope you'll follow our time here in NYC. It will be exciting.

Professor Mohammad Yunus, Grammen Bank, Nobel Peace Prize Winner and Bill Frist --Grameen America Reception, Le Parker Meridien Hotel


 Dr. Sanja Gupta and Bill Frist -- CGI Global Health Dinner, The Plaza Hotel



 Doug Ulman, President and CEO of Livestrong and Bill Frist -- CGI Global HEalth Dinner, The Plaza Hotel

Krista Ford, Princeton University

September 9, 2009

The Beginning of Ramadan

The end of August has brought with it an amplified reminder of the cultural divide between America and Tanzania. The sighting of the first crescent of the new moon signified the beginning of Ramadan and because Tanzania has a sizable Muslim population the effects are quite noticeable. Ramadan is a Muslim holy month meant to cleanse the soul and express repentance for all the sins committed during the rest of the year. Muslims must, amongst other things, fast from dawn to dusk everyday for the duration of the holy month. The goal is to be pure in thought and deed, which means Muslims give up behaviors that are thought to be sinful, negative, or distracting from spiritual introspection and closeness to God. Less orthodox Muslims who usually don't are now wearing traditional Muslim clothing and in many parts of the city where there are concentrated Muslim populations you will find restaurants closed during the day and open late into the night. In Zanzibar, where something like 98% of the population is Muslim you can be fined if caught eating publicly during daylight. The most orthodox Muslims are so strict about fasting that they spit on the ground all day to avoid consuming their own saliva.

In my office this translates into about 1/3 of my co-workers skipping lunch while the rest gather together in the staff kitchen eating traditional foods and inquiring after one another's families. Personally, I'm amazed by the determination of Mariam, the office lunch lady. Because she is Muslim, she is also fasting but she still shows up everyday like clockwork to cook lunch for the office. Even though I eat breakfast every morning, my stomach always rumbles around 2 o'clock when the smell of fried fish, ugali (a stiff porridge) and pilau (a spice rice dish featuring potatoes, meat, and a tomato salad on the side) wafts its way up to my office. I ask myself daily how someone who hasn't eaten since before dawn can stir a pot of delicious smelling food at 2 p.m. and not partake.

I usually grab lunch outside the office at one of the local restaurants, but nowadays I feel guilty knowing that my chips (fried potato pieces similar to french fries) and mishikaki (meat skewers of either beef or goat meat) are stirring stomachs and tempting my co-workers from their spirituals paths.  Out of respect for what my co-workers are trying to achieve I've taken to quietly sidling out the door for an eat-in lunch or consuming something non-fragrant at my desk. This is, admittedly, lonely since my usual lunch partner is unavailable because he is fasting.

Ramadan will end on the first day of the next lunar month with Eid-ul-Fitr or The Festival of Breaking Fast. I'm not exactly sure how Tanzania will celebrate Eid. I've heard there'll be everything from gift giving, to visiting neighbors and friends, to money and toys for the kiddies and the widespread buying of new clothes. I'm not sure how much of this will pan out but one thing's for sure-Christians, Muslims, and school kids alike will have the time off because in Tanzania Eid qualifies as a public holiday. Since the Muslim calendar is a lunar one the occurrence of Eid is dictated by the phases of the moon. No one knows yet exactly when Eid will be but its predicted to fall on September 20th and 21st. Everyone is hoping that it'll be on the 21st and 22nd, creating the ever-so-rare four-day weekend.

I'm keeping my fingers crossed for a wonderful Eid celebration bur for now I'm enjoying the heightened visibility of Muslim ladies wrapped in beautiful scarves and men sporting tennis shoes under traditional Muslim dress, as well as the respectful and supportive solidarity showed by their Christian counterparts.

August 28, 2009

Xi'an, China

Terracotta Warriors

It's not all that easy to get to Xi'an, in the heart of China, when you are in Beijing or Shanghai, but since we have a day, we are off to see one of the great wonders of the world - one that man built 2,300 years ago but just discovered during my adult lifetime.

Situated geographically in north central China, Xi'an is ranked among the great historic centers of the world. From its early role in Chinese civilization as the center for the first empire from which "Qin" (I pronounce "chin") gave the West the concept of "China," this gateway to the fabled Silk Road also was the largest and most cosmopolitan city on earth during the golden ages of the Han and the Tang.

My geography of China is pretty basic but the way I think of it on the map is that the borders of China are the silhouette of a rooster - the head to the right and the tail to the left with two feet extending below. The two feet are the islands of Taiwan and Hainan. Beijing is located in the throat of the rooster and Xi'an is the heart. China has had a total of 19 dynasties (I think). Xi'an served as the capital of China for 1,100 years; it has been a city for 3,100 years. The four main dynasties while it was the capital, and probably the most significant four of all since they were so fundamental to establishing Chinese culture was the Zhou (I pronounce "Joe"), the Qin (the ‘chin"), the Han (the "hand") and the Tang (the "tongue") dynasties - sorry but this is the only way I can remember the names and come close to pronouncing them.

We spent the day in Xi'an, the whole purpose of which was to visit the famed terracotta warriors, one of the true wonders of the world. What amazes me is that this stunning archeological find occurred the same year I graduated from college. (What will be found next?). The buried army of Qin Shi Huangdi is one of the largest and most stunning archaeological finds of the 20th century. Discovered in 1974 by a farmer (farmer Young - we actually met one of the other 4 "founding" or "discovering farmers" at the museum), the warriors and horses have earned the distinction of being one of the Wonders of the World, deservedly so. The full-size terracotta army (so far over 1,000 have been excavated - of an estimated 8,000 that are believed to exist at the site) testify to the imagination and ingenuity of man and his commitment to be protected in afterlife. What you see when you visit is three buildings (one the size o fan aircraft hangar) that have been constructed over the sites that are being excavated - you see a stunning display of life-size sculptured warriors and horses. Pretty unbelievable and hard to describe.

The emperor had constructed an army of warriors to protect him in the afterlife. We were told 720,000 people spent 38 years constructing the 8,000 terracotta soldiers and horses. At the end of the project, all of the workers were sacrificed (killed) o that no one would know of the project - mass graves were found later. The terracotta soldiers were left as standing armies in large pits, with a ceiling constructed above them, and then 20 meters of earth placed on the ceiling (all beneath ground level) to hide the entire operation under the farmland That is why it took 2,300 years to find them. These warriors with their horses stand in these pits in battle-ready position, fully armed, battalion after battalion over several acres. At the time of the discovery back in 1974 Newsweek magazine described the eerie and monumental find as "the clay clones of an 8,000 man army."

That's as well as I can do describing the site. Karyn and Bryan and the rest all loved it. Add it to your bucket list.

Now we are off to Hong Kong.


From Big Kenny Interview: The First Trip -- Impressions of Akon, SUDAN 2007

Love Everybody has helped with the facilitation of the Konyok School for Girls in Akon, Sudan. The school currently has 550+ students enrolled. Love Everybody's goal is to instill hope, strength, and excellence to all students who attend so they can prosper in life. Their motto: "Highlight the good, inspire greatness, and encourage mutual responsibility for the betterment of humankind. -- Love Everybody." Member of the Tennessee Global Health Coalition.

August 26, 2009

So, two years ago; October of 2007, my wife and I and several friends from the organization My Sister's Keeper from Boston and Dr. David Marks and Walt Ratterman from Sun Energy Power decided we were going to get together and go into the country of Sudan.  We went there and visited this village, which is basically a refugee camp right in southern Sudan, about 50 kilometers from the line of demarcation between there and Darfur.  So this is an area that people had fled into that had been pushed off of their land.  Like farmers.  My dad's a farmer, and I guess that's why it hits with me. 

They'd just been pushed off their land that they had fought for over a half a century.  This thing's been going on in Sudan since 1956, a full on by God civil war.  And then in 2005, the south of Sudan and the north entered into what was called the CPA, or the Comprehensive Peace Agreement, which was mentored and led by the U.S.  It's a good thing.  And they've been trying to keep that peace, and that's when the north started trying to push against the west of Sudan and push all the Darfurians out also.

And it's crazy to think that a person that lives over there and a person that lives over here, that there's any difference between them and that they shouldn't respect each other.  And so we decided after seeing this and going and visiting this village that Dr. Gloria Hammond from Boston had originally told me about.  I met her here in Nashville at an event where she was speaking, and she told me about the people in Akon and how we were both in this conundrum: there's a war going on where these people are being tormented and hurt so bad.  But you know, I'm a musician.  I can't go into a war zone.  She's a minister and a "nun", a sister and a doctor and an educator.  You don't put women in a war zone.  But get as close as you can to it and shine as bright of a light as you can possibly shine, and all that other stuff just has to go away, or at least stand on the sidelines and chill out for a while and see what happens when three, four, five, six, seven, eight, 900, 1000 girls are meeting underneath of a tree to get educated, to get an education, because they know that they can rise up and lead their people and lead their country and there can be peace.  And they can be friends with everybody, everywhere, and make music.

At the same time, you know, we got do what I call "due diligence."  I went in to make sure that the people that I had met and had organized with on the ground were really doing what they told me they were doing cause I didn't want to go; you know, I've worked real hard to get what I had, and I didn't want to blow it, you know, and end up being in some corrupt system somewhere where people are just pulling off the top. To me, it's easy enough to grow food and provide for your family.  You know, when you're going to step outside of that to try to take care of some other things, that's when it can get real tough.  But you know, if you use your noggin a little bit, go check it out, do your due diligence. 

Well, that's what we did.  We went in there, checked it out, and did our due diligence. So then, I mean, just so many amazing things happened.  The first plane we flew on, the cowling came off the left engine, and it was pulling that plane hard left.  Fortunately, we'd only been up in the air about 15 minutes, so we were able to circle back around, and there was another runway just outside of Nairobi at Wilson Airport.  We landed there, and ended up the only plane that we could get was a bigger plane, and they had to give it to us for the same price.  So we were able to carry in all the crates and all the people that we were carrying then, plus we picked up 300 refugee survival kits.  These are people who have been burned out of their homes, and this is enough to keep them alive for a little while until they can get somewhere or get to a village and get their feet back under them.

We flew to Akon. Dr. Marks saw about 300 patients in two days.  About a third of the people had malaria at that point, so he was just delving out all these pharmaceuticals that we had brought over with us in 21 cases that we carried through airports. 

So we move forward a couple years.  We go back there this year, right where I saw people take those refugee kits and start to establish themselves. Here's a doctor's clinic over here.  Here's a runway right here.  Something's got to keep happening here.  And kind of right in between them there's now a little village that exists, when there was nothing when we went there the first time.

At least I've got you up to now now.

More to come...

Wednesday, August 26, 2009

11 am


             Met this morning with the Minister of Health. The last time I was at the ministry we met just down the hall from the minister's office.  That was in 2003, and SARS had struck just the month before.  Allegedly the Chinese government has hidden the problem from its people and the world, but as the outbreak grew, the news exploded, and no longer could the government contain the news.  I was openly critical that day in our public meeting, representing the U.S. and world opinion.  Though my remarks had nothing directly to do with what was about to occur, the minister just hours later was summarily fired, a sign of recognition that China would officially change its secretive policy of minimizing the ongoing impact of SARS.  And the epidemic rapidly spread throughout China, Asia, and Canada, paralyzing travel and tourism, killing hundreds, and greatly diminishing economic growth for the next year of Asia and Canada.

             That was just 6 years ago.  Wow, things have changed.  Today, the Minister met with me, my son Bryan, brother Tom and Chuck Elcan and Henry Zhou.  Though one of the main purposes of the meeting was to discuss how we as a government and we in the U.S. private sector could work with the Chinese government and their private sector to address the health challenges the Chinese people are experiencing today, I in particular wanted to get a full understanding of what China was doing in their major domestic reform efforts announced in April.

             Before outlining what I learned, I should point out that being a doctor in China is not very remunerative.   In a web-poll conducted by sohu.com, 75 percent of the 2,183 doctors surveyed earned an annual salary of less than 40,000 Yuan ($5,883).  These data and much of the content of the discussion below were gleaned from my conversation with Elizabeth F. Yuan, R.Ph. who is the Health and Human Services attaché to the Embassy.  Her discussion at the U.S. embassy yesterday combined with the discussion today with the Minister of Health are the background for the following summary of health reform in China as it stands today.

             China's blueprint for healthcare reform was released on April 6 and has been heavily promoted by the official Chinese media.  My interviews and interactions over the past two days with health experts in Beijing, visiting infectious disease hospitals and doctors, talking last night to local Chinese businessmen, interviewing our ambassador and health experts a the embassy agave me a tremendous opportunity to leave behind for a few days all of the reform discussions in the U.S. and to see how another emerging country is approaching health care reform on a massive scale.  I wrote this today, but over then next several days of discussions I may well modify these observations.

              The overall scheme aims for universal healthcare coverage by 2020.  In the initial 2009-2011 phase, China intends to invest $124 billion in five broad reform areas: 1) basic healthcare insurance, 2) a national essential medicines program, 3) improvement of the rural health care service network, 4) elimination of the gap between urban and rural healthcare, 5) and continuation of public hospital pilot projects.

             The 5 areas parallel much of what we have and are attempting to do in the U.S.  We are shooting in the U.S. for universal coverage overnight (and won't get true universal coverage for another 5-10 years, I predict).  We in the U.S. did the national drug program (2) when I was Majority Leader. And in our major health bills like the bill we passed in 2003 and the Obama bill which will pass in November, there will be a number of significant pilot or experimental projects which importantly will allow some determination of what works and what does not before a proposal is adopted nationally (too risky - I am a big believer in these pilot projects!).

             One of the things we are seeing in the U.S. is reform from Washington being dictated at the federal level, but in the end (as feared by many governors) much of the cost of universal care and reform will fall to the states.  Governors ask, where is the money going to come from (for example the potential doubling of Medicaid under the Obama plan is funded more than 50% by the states - but where are they going to get it? - obviously taxes will have to go up on everyone).  Similarly in China about 60% of the proposed reform spending will be paid for by the provinces, though their reform is mandated by the central government and communist party.  How are the poor provinces going to come up with the money?   Thus, will the ambitious reform really ever take place?  The parallels with what is happening in the US with a paternalistic government mandating huge spending at a time of recession and an obvious inability to pay for it are striking.

            The following is only for the policy wonks and much too much detail for the average reader.  But I love this stuff (and it leads to greater understanding of overall health reform globally and domestically):

            The key features of the announced plan include the following:

`           1.   Government support for the construction of 2,000 county-level hospitals and thousands of urban community clinics;

            2.   Training sessions for village and township medical clinics and urban community medical centers. Specifically, China hopes to train 360,000 health care professionals for township health centers (this seems like an impossible goal to me but at least they are shooting for the sky.  And what I am finding on the ground is not an absence of facilities or even pretty good equipment but an absence of trained human healthcare capital (i.e., people).

            3.   160,000 for urban community health institutions in three years;

            4.   Coverage of 90 percent of rural and urban residents with basic medical insurance by 2011.  By 2010, subsidies to the Urban Residents' basic medical insurance (URBMI) and the New Rural Cooperative Medical Scheme (NCRMS) will be increased to RMB 120 (US$17.60) per person per year.  The maximum amount payable by the Urban Employees' Basic Medical Insurance (UEBMI) and URBMI will be increased to six times the annual average salary of local employees and disposable income of urban residents.  The maximum amount of the NRCMS will be increased to over six times per-capita net income of local farmers. (The importance of the expansion of the social insurance program is much more important that what I initially thought.  Why?  Because the Chinese people, today without much in the way of social insurance, keep saving knowing that someday they will need it for health;  this excessive savings means that they don't spend today, which is clearly needed not just in times like today but in all cases of growing economies).

            5.  A list of national essential medicines was released in August 2009.    It consists of 205 chemical and biological drugs and 102 traditional Chinese medicines.  This is a big deal because supposedly the Chinese people will have success to these in the public hospitals (98% of hospitals are public).

            6.  Increasing government regulation of medical services and prescribing practices to avoid over-prescription to fund hospital operations.  ((This was also surprising to me.  About 50% of hospital budgets come from the charges associated with excessive prescribing of medicines.  Hospitals literally operate on the profits they receive from the medicines they prescribe and dispense.  That is all over the country.  My obvious question was, "If you close this source of hospital revenue, what will replace it?  How will these hospitals stay open?)) The Implementation Plan includes wording to increase public disclosure of hospital budget, expenditure, and revenue management information.

            7.  The Government's plan calls for continued pilot projects to reform public hospitals.  In the key area of hospital funding, which underlies the problem of relying on drug sales and expensive diagnostic techniques, the plan calls for gradual changes to service charges, drug sales, and fiscal subsidies.  The goal is to make service charges and fiscal subsidies the primary channels for funding public hospitals.

            I can't wait until the business and medicine course I teach at Vanderbilt begins this year because I want them to look at the following argument and see what they think on the relationship among this plan, rural consumption, and rebalancing: In the official media, Chinese academics argue that increased healthcare expenditures under the plan will help reduce precautionary savings, thus increasing domestic consumption, helping to rebalance the economy to rely less on exports and investment.  Official media reports that the plan will help reverse the trend in who bears the burden of medical costs, in which the share of personal spending on medical services has doubled from 21.2 percent in 1980 to 45.2 percent in 2007, while Chinese Government funding has dropped from 36.2 percent in 1980 to 20.3 percent.  (Note: This data is based on official records.  Because many doctors and hospital fees are paid covertly in 'red envelopes' (gratuities) directly by the patient, the proportion of private medical expenditures are likely even greater.  In my discussions with a broad range of people I estimate that private out-of-pocket medical spending is probably 60% of all spending.

             Again, I want to thank Elizabeth F. Yuan at the American Embassy for explaining so much of this to me yesterday after I met with Ambassador Jon Huntsman  Our embassies do a remarkable job.  I also wish to thank the Minster of health in china who so generously gave of his morning today.  I have much more to learn.


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