Osteopathic Profession Helping to Overhaul China’s Health Care System
“BRIDGING CULTURES TO ENRICH GLOBAL HEALTH”
For the last two years, there has been an historic medical effort building between osteopathic physicians and health officials in China as they tackle the transformation of a country’s medical system. Development of the ultimate goal – a medical system based on family medicine rather than the current specialty care system – moved closer to fruition with the October 2007 signing of a Memorandum of Understanding: “Towards the Development of Family Medicine in Sichuan Province, China.” Royce K. Keilers, D.O., FACOFP dist. (KCUMB-COM ’65), once again led the delegation of osteopathic family physicians on the most recent trip to Chengdu, China.
This effort is supported by the American Osteopathic Foundation (AOF), of which Dr. Keilers is a board member, and Heart To Heart International, one of the ten major humanitarian organizations that provides international emergency relief and also supports medical educational programs.
Dr. Keilers recently took the time to answer questions regarding this humanitarian project which, if all goes as expected, will assure affordable and quality health care for millions of Chinese citizens – no small feat by any means.
TOMA*: What is Heart to Heart International?
Dr. Keilers: Heart to Heart International is an humanitarian organization providing medical care, disaster relief, and other programs to more than 40 countries throughout the world. They are often first responders in disasters, bringing in emergency medical supplies with medical and support personnel. They work in countries like Russia, where for over ten years they have had an ongoing medical education effort with the AAFP (American Academy of Family Physicians). They have also been a presence in China for ten years, providing education in neonatal resuscitation and supporting ophthalmology projects with cataract surgery. They have actually established a residency exchange program with the Chinese physicians in Sichuan Province.
TOMA: How did the osteopathic profession become involved in China’s medical system?
Dr. Keilers: Heart To Heart asked the AOA/AOF to join them in their humanitarian relief efforts, inasmuch as a number of D.O.’s already are working with them. This partnering would provide opportunities for our physicians and students to participate in medical mission services throughout the world. I was sent to China in May of 2006 to see how Heart To Heart functions and to determine whether their program was something the AOF wanted to support in order to help make osteopathic medicine known throughout the world. My presence in China in 2006 was well-received, and I recommended that the AOF proceed with plans to cooperate with Heart To Heart.
In February 2007, Heart To Heart brought a Chinese delegation to the U.S. The delegation’s responsibility at that time was to pursue their national goal of establishing primary care family practice as the basis of their medical practice. China currently has a centrally focused system based on specialists who practice only out of hospitals. People must visit a specialist at a specialty hospital of their own choosing. This provides very limited care to only a few and is very costly. The Chinese government wants to change to a family practice model where family practitioners will become first-line providers in their communities. The Chinese delegation came to the United States to talk with the AOA and AOF and the American Academy of Family Physicians to request assistance. The Chinese delegation visited our school in Kansas City, where they spent hours touring our facilities. They learned that osteopathic physicians provide manual medicine, and they felt that this fits into their medical philosophy. Thereafter, they developed a special understanding and interest in the osteopathic medical approach.
This trip culminated in an invitation to send a DO Family Practice team to China in May 2007 to present a program detailing what family medicine is; how we choose, train, and rate students; how family physicians practice—virtually everything about family medicine. The team included four family physician educators who gave lectures about family medicine, as well as an OB/GYN specialist who helped to teach neonatal resuscitation. After this visit, we were asked to return in October so that we could actually begin teaching family medicine.
TOMA: What happened during your most recent visit in October 2007?
Dr. Keilers: The Chinese in Chengdu have their first family practice residency group of 17 doctors. They are the first family practice residents in Sichuan Province. Another 8,400 MD specialists have been chosen to be retrained as family physicians by the year 2010. We began teaching the first 81 of those chosen for retraining, along with the 17 residents. Methods included lectures, teaching at bedside, and small group demonstrations, as we train in the U.S. These trained physicians will, in turn, become the frontline teachers in China—they will teach others how to practice family medicine.
After hearing the lectures and seeing how we make hospital rounds, they were very impressed with the caliber of the teaching and learned what family physicians could do. One Chinese doctor said, “Before we met you and heard about you, we used to think that family physicians didn’t know very much and weren’t very good doctors. Now we know that they are like decathletes—rather than doctors that don’t know very much, they know quite a lot about many different areas.”
In addition, one of the heads of postgraduate medicine for the largest medical school in China told me, “We now understand about treating the patient as a whole and not just the disease.”
TOMA: What’s next?
Dr. Keilers: The Chinese in Sichuan knew nothing about D.O.s or osteopathic medicine when I first contacted them in May 2006. Now, they’ve been educated and are very accepting. The AOF and Heart To Heart are bringing 20 Chinese future leaders to the U.S. in April 2008 for a three-week family practice training session. We plan to take them through a faculty training initiative in Chicago, and then hands-on training at various residency programs (Texas, Miami, Philadelphia, Ohio, and Orlando), where they will be shadowing our family medicine instructors to learn how to teach family medicine.
Our major goal is a five-year program to take osteopathic family educators to China on a regular basis for the next five years. We need volunteers who are credentialed to teach family medicine.
TOMA: What will be the overall benefits of a successful transformation?
Dr. Keilers: It is estimated that there are 600 million people in China – out of a population of 1.3 billion – with no medical care. With a quarter of the world’s population in China and its increasing role in world economic development, the success of China’s health reform will have a major global influence. It is felt that the success of their medical reform will result in changes in other countries around the world. One of the goals of the Sichuan Health Bureau is to have one community health center for every 50,000 people within a 15-20 minute walking distance. These will be staffed by family physicians that will have the responsibility for prevention of disease and education in their respective communities. This model can be adopted worldwide.
Dr. Gary Morsch, president and founder of Heart to Heart International, said this is the biggest change in medicine that he’s seen anywhere in his 17 years of working with Heart To Heart in 40 different countries. He reiterated that this is the biggest opportunity he’s ever seen for changing an entire medical system, and the osteopathic profession is poised to play a major role in that endeavor.
TOMA: Is there anything you’d like to add?
Dr. Keilers: The goal of Heart To Heart is basically to help people in need throughout the world, regardless of their creed, regardless of their politics. The goal is to establish personal relationships with people through one-on-one relationships. When you do that, you create goodwill and once you create goodwill, hopefully, we’ll have peace. I found the people of China to be extremely hospitable, kind, and considerate. They are major players on the world stage and we want them to be our friends.
Dr. Keilers is a retired family practice physician in La Grange, Texas. He is a past president of TOMA, TxACOFP, and the ACOFP. He serves on the Board of the American Osteopathic Foundation.
*TOMA is the Texas Osteopathic Medical Association.