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“Hope and the original sincere heart” MONOGRAPH A HISTORY OF PROJECT HOPE IN CHINA 1983 to Present A Project of the Project HOPE Alumni Association May 2018 MONOGRAPH: A HISTORY OF PROJECT HOPE IN CHINA TABLE OF CONTENTS FORWARD: Project HOPE Programs and the Evolution of US-China Relations 01 I. Introduction to HOPE in China History 03 II. China-HOPE Partnership Phases and Milestones 07 III. Individual Initiatives 22 IV. Lessons Learned 123 V. Counterpart Stories 127 VI. Epilogue: Where Do We Go From Here? 134 APPENDICE 135 S Acknowledgements 136 About the Authors and Contributors 138 Financial Supporters 141 Project HOPE Consultants, Volunteers and Staff 145 HOPE Impact Maps 158 Additional Photos 160 FORWARD PROJECT HOPE PROGRAMS AND THE EVOLUTION OF US-CHINA RELATIONS FORWARD PROJECT HOPE PROGRAMS AND THE EVOLUTION OF US-CHINA RELATIONS The health care system in China has made remarkable advances over the past few decades, and Project HOPE has been an important partner in these achievements. I had a wonderful opportunity to work with Project HOPE when I was the President of Shanghai Second Medical University in late 80’s to start the Shanghai Children’s Medical Center (SCMC) project with Shanghai Municipal Government. The project was the first mega international collaboration at that time in health care, and many challenges were solved through partnership, leadership support, and wisdom exchanges. Our mission was clear: to provide the best and first-rated pediatric tertiary hospital for China. It was a dream that both Dr. William Walsh and I shared dearly, so we were able to conquer obstacles together. Three key elements ensured the success of SCMC: true partnership and sincere collaboration, developing local talents in pediatric medicine, and carrying out the mission of Project HOPE – “Health Opportunity for People Everywhere.” The Shanghai Children’s Medical Center is certainly among the most notable results of this long and enduring partnership – but as this Monograph makes clear, Project HOPE’s work has had impact across the heath spectrum, and it has touched children and adults in every region of the country. I know that, when Project HOPE embarked on its first programs in China some 35 years ago, it was in the spirit of friendship between peoples and countries, and collaboration among professionals who shared a commitment to the cause of advancing China’s health care system. This respectful relationship became the foundation for all of the programs which Project HOPE and its Chinese counterparts have undertaken over the years. Over the years, I was able to witness the impact of the collaboration with Project HOPE in China: long-term results and a gradual transition to full responsibility by its Chinese counterparts. It has achieved this by its dedication to the principle of “training the trainer,” and by following an approach that involves and engages its partners – from the Ministries of Health and Education to professional health and medical associations to university faculty to hospital administrators and clinicians – in all phases of a program, from planning to implementation. SCMC, which in its 20 years has become a state-of-the-art treatment center and a model for successful children’s hospitals around the world, is a shining example of how a commitment to respect and partnership can have a profound and lasting impact. The effort to create SCMC has truly tested the essence of collaboration and cooperation among various parties engaged in the design, construction, operation, and management of SCMC. All relationships are tested over time, and the relationship between Project HOPE and the government 1 FORWARD PROJECT HOPE PROGRAMS AND THE EVOLUTION OF US-CHINA RELATIONS and institutions of China is no exception. We all approach problems from our own cultural vantage point, and as a result – even when we agree on goals and objectives – we often perceive different paths to reach the ultimate destination. But a good relationship can actually be strengthened by these differences, and we believe in this case that both sides have grown and learned and adapted by listening and by being open to new ideas. As society progress, the Chinese health system is not the same system it was in 1983 – and Project HOPE is certainly not the same organization it was when Dr. Walsh signed those first, hopeful agreements with Zhejiang Medical University, Beijing Medical University, Shanghai Second Medical University and Xian Medical University. We all learn, we change with the times, we move forward. This Monograph documents many of the programs in which Project HOPE has been involved in China over the past 35 years. It is not a scholarly assessment of the achievements, challenges, and lessons-learned. Its authors are largely storytellers, and the stories they have narrated here weave a tapestry of friendship, collaboration, mutual respect, and a commitment to change and progress. I am proud and honored to have been part of this story, and I look forward to many more years of dedicated work and accomplishment. Wang Yi Fei, MD Senior Advisor, Shanghai Jiao Tong University School of Medicine Former President of Shanghai Second Medical University 2 Introduction to HOPE in China History I. Introduction to HOPE in China History The China Project HOPE partnerships in health now span 35 years. Through education and capacity building initiatives to improve China’s health system, new models of health care delivery and health sciences education have been developed. The knowledge and skills of many thousands of Chinese health personnel have been upgraded, and health care for people throughout the country improved. And the lives and careers of countless “Hopies1” have been improved as a result of working with counterparts in this extraordinary country. These partnership programs occurred during decades of major change in China and its health care system. That evolution is still underway. Under the banner of economic modernization, health care delivery and health policy were transformed to a more western style system, albeit with Chinese characteristics. HOPE education programs enabled its Chinese medical university partners to be among the first to apply the modernization principles, and to adjust direction as experience was gained and new health policies developed. The HOPE approach in all countries begins with an in-depth assessment by HOPE experts of the setting that the host country partner desires to improve. Objectives and desired outcomes are defined, and a timeline and plan developed for their completion. Training and equipment assistance programs are organized to achieve the objectives. The head of the host country institution and department head agree to the approach, realizing that it can be adjusted as challenges arise. A range of education methodologies are utilized. These include external fellowships, short-term and long-term training programs offered by “visiting “HOPE teachers in China and Internet-based instruction. The entire health team is trained – not just the physician. Associated administrative changes required for program success such as adding more staff, remodeling, and the development of new policies and protocols are also adopted as part of the agreed upon approach. Whereas HOPE staff and preceptors providing training are experts, their nationality is universal. The China HOPE program began utilizing experts primarily from outstanding institutions in the U.S. As the programs evolved, and China’s health system advanced, more and more of the experts came from other Asian countries and China. This Monograph tells the story of many of China HOPE programs that have employed this partnership approach over the last 35 years. It is written more as a memoir than an academic paper, capturing the importance of personal relationships among the China and HOPE teams for presentation to the reader. As the Table of Contents indicates, the Monograph begins with a general narrative on how the China HOPE partnerships began, and initial challenges faced. Its evolution, in the form of milestones and achievements follow. Chapters providing a detailed story of several programs follow. The final section is a brief overview of lessons learned that may benefit others involved in transnational ventures in China. The Appendix contains an illustrative list of HOPE team members, China counterparts and sponsors, and information on the contributing authors. 1 This term was first coined in the 1960’s by volunteers and staff of the SS HOPE who referred to themselves as Hopies, and who developed the expression, “Once a HOPIE, always a HOPIE.” 3 Introduction to HOPE in China History The Beginning In 1981, Project HOPE identified China as a potential international program location in its strategic planning process. China’s adoption of an “open door” policies to the West and its focus on the modernization of its economy matched HOPE’s track record of building health systems in developing and emerging country health care settings. As fate would have it, two health care professors from China – Dr. Zheng Shu, an oncologist from Zhejiang Medical University (ZMU), and Dr. Li Shujun, a general surgeon from Beijing Medical University (BMU) – came to the United States on an exchange visit later that year. The HOPE campus headquarters in Millwood, Virginia was one of their stops. Dr. Li and Dr. Zheng Shu described the structure of their health system and its effectiveness in primary care and “A journey of a thousand miles communicable disease control. They were optimistic that begins with a single step” new modernization policies would come to the health (Confucius) sector in the form of new approaches to tertiary health care. HOPE staff in turn described its history and approach to partnerships with developing countries. Particular emphasis was placed on recent experiences in Poland and countries in the Middle East, where tertiary care settings were improved by the addition of modern equipment and multidisciplinary training programs Dr.