There were signs that it was no ordinary event taking place on the Cambridge, Mass., campus of the Massachusetts Institute of Technology one muggy week this June. Local county sheriff deputies and MIT security guards prowled Kresge Auditorium's perimeters like rottweilers. Practitioners of the Falun Gong religion lingered nearby, protesting China's oppression of their sect. But in the plenary sessions and during breaks, attendees of a landmark conference, “Health Care, East and West: Moving into the 21st Century,” were too focused on discussing issues like substance abuse and alternative medicine — and forging new relationships with their peers across the Pacific — to notice. They were opening the door for collaboration between U.S. and Chinese health care professionals, and that's all that mattered.
Bringing an unprecedented 600 Chinese physicians and health care leaders — the largest Chinese delegation to the U.S. other than the Olympics — to join their U.S. counterparts to examine the health care systems of the two countries was a massive undertaking, but one well worth the effort.
Presenters from the U.S. and China emphasized the similarities, including an increasingly aging population, decreasing outbreaks of infectious diseases balanced by growing chronic noncommunicable diseases like heart disease and diabetes, and the challenge of providing care to underserved populations.
Miles Shore, HMS Bullard Professor of Psychiatry, who served as the conference's vice chairman and senior education consultant, said that the U.S. can learn from China's policy of emphasizing prevention of health problems caused by smoking, poor diet, and sedentary lifestyles. “The payment system here pays for treatment — it doesn't pay for prevention,” he said.
Huang Jiefu, vice president of the CMA, summed up what the Chinese hoped to accomplish during the conference: The Chinese want to see the lessons learned by Americans because, for good and for ill, “the today of America will be the tomorrow of China.”
Harvard Medical International, a not-for-profit entity established by Harvard University and Harvard Medical School to improve the quality of health care through medical education, coordinated the conference, which was jointly sponsored by the Chinese Medical Association, Harvard Medical School, and MIT.
The conference began as the brainchild of Nelson Kiang, MD, Harvard Medical School professor emeritus of physiology, who was born in China and raised in the U.S.
Back in 1998, Kiang set out to work on the meeting with Beijing-based China Medical Association, which has more than 430,000 members and encompasses 75 separate medical specialty societies. Harvard Medical International, which has been involved in projects such as the Beijing-Shanghai-Boston Orthopedic Education and Research Initiative, was brought in early to help put together the organizing and planning committees, among other tasks.
According to Bridget Testa, senior administrator at HMI, organizers scoured the Boston health care community and Harvardto find the right people to work out the difficult aspects of the project.
On the Chinese side, committee members were “drafted from across China,” says Roman Xu, department director assistant in the Chinese Medical Association's Department of Foreign Relations, which provides full-service meeting planning for the CMA's 7 to 10 international conferences annually.
Another department within the CMA handles its approximately 200 domestic meetings every year, although the two departments often pull together for major conferences.
The meeting was originally to have been held in 2000, but time started to run out on the organizers, says Xu. In addition, the CMA was undergoing a leadership change. Kiang jumped in again and intuited that the new Minister of Health of the People's Republic of China — who also would be the next president of CMA — would be Zhang Wenkang. Kiang got Ziang's support ahead of time, so everything was ready to roll when Zhang became CMA's president.
Last fall, CMA and HMI brought in the third major meeting planning player, Atlanta-based international health care communications group MediTech Media, to help with the logistics, organization, and meeting communication and promotion.
In March, Testa found herself drowning in details and turned to a local temp agency to get some relief. “It was only by chance that the person they provided, Deb Shapiro, CMP, was a professional meeting planner who had just relocated to the Boston area,” says Testa.
Everyone then buckled down to make this historic meeting happen on its new dates, June 24 to June 29, 2001.
The Chinese Medical Association and Harvard Medical International each set out to find financial support for the ground-breaking meeting. HMI's strategy, says Testa, was to raise funds through a meeting registration fee, and from donations from pharmaceutical and non-pharmaceutical companies, foundations, and associations. A private foundation in Boston, which prefers to remain anonymous, was the first to jump on the bandwagon.
CMA turned to Johnson & Johnson. The key supporter early on was Beijing-based Jerry Norskog, who was responsible for Johnson & Johnson's operations in China (the company currently has nine affiliates in that country). HMI and CMA had already begun to develop the agenda when Kiang and CMA officials went to see Norskog and other J&J executives.
Xu says they had a tough sell. “[Kiang] had to tell them, ‘You will not have any distribution at this meeting, no exhibition, no mention of your products. But you need to support this meeting.’” Which they did, recognizing the value of helping to bring together some of the top physicians and health care researchers from each country to begin a dialogue for change.
Though the conference was multinational, J&J had to adhere to U.S. rules governing commercial support. “Neither J&J nor the other donors had any influence or input into the content, agenda, or speakers for this meeting,” says Testa. “Before accepting the donation, we made it very clear that there could not be any involvement in content, speakers, etc., nor could they have exhibit space or product endorsement.” The conference organizers also asked speakers to submit disclosure statements, as required by the Accreditation Council for CME's Standards for Commercial Support.
They decided not to have any exhibits because “we wanted the focus to remain on the exchanging and sharing of ideas between leaders in health care from two important countries,” says Testa. “We wanted our delegates to feel that they could act and speak freely, absent of any commercial influence.”
Organizers faced a huge hurdle long before the Chinese delegates set foot on U.S. soil: Just thinking about the travel arrangements elicits groans from MTM and CMA staffers.
First, they had to get a list of the Chinese delegates — not an easy task, says Xu with a grin. He advertised the meeting in CME journals, held a press conference for medical journalists and popular newspapers, and made information available on CMA's meeting Web site, www.chinamed.org.
“We wanted to encourage the participation of young Chinese doctors particularly, because they will be the future leaders,” Xu says. “Then the senior doctors became even more enthusiastic about coming to the conference. The only problem is that the senior doctors are very busy. It is very difficult to get a response from them.”
E-mail was all-important, especially since the organizers were working across multiple time zones. “If we didn't have e-mail, this meeting would never have happened,” says MTM's senior account manager Christa Nance. Two of Xu's department's staffers e-mailed daily updates to MTM, which was in charge of sending out the invitations the Chinese delegates and speakers needed to get their visas. If a delegate's name was not on the list, his or her visa would have been cancelled, says Xu.
After receiving the letter, each doctor had to get approval from his or her hospital, says Xu. Hospitals in China have limited resources for meetings and they have to limit the number of international meetings a doctor can attend. Once the doctors got approval internally, they could apply to the U.S. embassy for a visa.
“Just a week before the conference we had a call from the Chinese government asking us to check to make sure one delegate's name was on the list,” says Shapiro. Fortunately, it was.
Realizing that a week-long meeting would be a tough sell for U.S. attendees outside a short plane hop or drive-in distance, they marketed the program mainly to affiliated hospitals in the New England area, says Testa. HMI, working with MTM, also e-mailed information to Harvard faculty, and did a mass mailing to specialty societies and other targeted groups.
MTM launched a meeting Web site, www.chinausahealthcare.org, about nine months prior to the meeting. People from as far away as California found the meeting through the Web site. One potential lure was that U.S. attendees could earn up to 41 CME credits for attending the full week of sessions. (Chinese participants received a certificate of completion from Harvard.)
It seems that all thoseefforts worked perhaps a bit too well. A week before the meeting, MTM was expecting about 800 Chinese and U.S. attendees. Instead, they ended up with more than 1,600. Nance says, “That was a massive challenge for MTM; we had an additional 240 registrations from local university faculty who wanted to attend.”
“The Chinese want to see the lessons learned by Americans because, for good and for ill, the today of America will be the tomorrow of China.”
— Huang Jiefu
MTM also handled housing for the influx of domestic attendees. “Harvard Medical International was very weary of signingwith the hotels, committing them to a financial obligation for the rooms,” says MediTech's Susan Moore. Because the area hotels, including several Holiday Inns, the Radisson Hotel Cambridge, and the Best Western at Longwood, have an ongoing relationship with Harvard, she arranged to have a group of rooms reserved at a special Harvard rate. They had an early release date of one month out from the conference, but were not required to have a . “We listed the hotel information on the Web site,” says Moore, “and the U.S. delegates contracted the hotels directly.”
The initial idea was to hold an intimate gathering of 300 delegates from each country, says Testa. “The ideal situation would have been to connect a U.S. cardiac physician with a Chinese cardiac physician by literally having U.S. doctors take their Chinese colleagues home. But we soon realized that would be an overwhelming task, logistically.” So they turned to dorms.
Because Harvard lacked the space to house the Chinese delegates, HMI looked to MIT, where the plenary sessions were to be held, to see if they had dorm rooms available.
Then the ranks of Chinese delegates began to swell — and MIT began to accelerate construction on its campus, rendering some dorms unavailable. The organizers went to Boston University and Simmons College to secure more dorm space. Once those were filled, the planners turned to Boston Marriott Cambridge to house the overflow.
Independent planner Shapiro worked with a local shuttle company, Yankee Lines, to get everyone to and from the airport, the plenary sessions, and the evening breakout sessions on the MIT campus. “We had a meeting every day to figure out the details,” she says, noting that construction projects in Boston and around the MIT campus made shuttling a tricky proposition. “I'm just thankful the shuttle company was so flexible.”
Even though the conference was much bigger than originally expected, organizers made sure to provide lots of opportunities for interaction and relationship-building. Breakouts were held on three nights during the conference. “There were 23 specialty areas covered, with no planned sessions or objectives,” says Testa. “We just got the specialties together to focus on different topics each night: patient care, education, and research.” The breakouts were held in MIT classrooms near Kresge auditorium.
Shapiro says of the breakouts, “I think the interaction far exceeded anyone's expectations. I got a call from one of the Tuesday night breakout leaders who wanted to get in touch with one of the Wednesday speakers who he thought could answer a question one of his attendees had asked. Someone else asked if they could develop their own Web site to keep things going after the conference.”
Chinese delegates also got to unwind and discuss their experiences from the week-long program at a reception hosted by Johnson & Johnson after the closing ceremonies, and during shopping, whale-watching, and hospital tour expeditions on Saturday following the conference. The post-con activities ended with a New England clam bake on the front lawn of Harvard Medical School.
Although there were no planned field trips or excursions during the week that might have interfered with the program, Chinese delegates were spotted at numerous hospitals around the Boston area. “American speakers and physicians met up with colleagues and invited them over to their department or their lab,” says Testa.
“We didn't really think about follow-up when we began to plan this event,” she adds. “What we did know is that one of our objectives was to create a forum for interaction and exchange. One of the byproducts we hoped would come out of it was that relationships would be built among the physicians in both countries. Now that we've seen this week unfold, well, you can't hold an event like this and expect everyone to just go their own separate ways come Friday evening.”
As the old proverb says, “We see things not the way they are, we see things the way we are.” Now that they've had the opportunity to see their health care systems from a new perspective, HMI and CMA hope attendees walked away with new knowledge and new partnerships with overseas colleagues that may well begin to make change for the better possible for both countries.
But for the meeting organizers, the satisfaction of a job well done is countered by a slight sense of loss at no longer being in daily communication with each other. “I find it very hard to believe it's all over,” says Xu. “Every day I think, ‘Where's Deb? Where's Bridget?’ I enjoyed this whole experience very much.”
The Chinese Medical Association went all out to make sure the Chinese presenters — and CMA's staff — were ready for the conference. CMA's Roman Xu says that they put the speakers through rigorous training, including three pre-con rehearsals where members of the program committee picked out the weakest parts of presentations so speakers could further refine their talks. CMA also brought in language tutors to help speakers with their pronunciation of English words, presentation experts to show them how to gesture and speak and even to suggest what kind of clothing to wear to fit in with Western culture.
CMA also brought in an international etiquette expert twice a week to give lectures to staff at CMA headquarters, concentrating on the cultural differences between the U.S. and China.
The coaching continued during the conference in a-ready room. MediTech Media's Christa Nance says, “Toward the end of the conference, some U.S. speakers came into the room feeling nervous that their presentations won't live up to the Chinese presenters earlier in the week.”
Having never attended a meeting of this magnitude before, I didn't know what to expect from this gathering of some of the greatest medical minds in the U.S. and China. Frankly, I didn't really expect to understand the sessions — much less get anything out of them. Boy, was I wrong!
Just a few of the things that struck me at the last day's sessions:
China's one-child family policy may be reducing overpopulation, but it's having other impacts as well. For example, Li Liming, MD, professor and dean, School of Public Health, Peking University said that with only one child per family, the child's opinion becomes very important. So one of the most successful anti-smoking campaigns used in China was to have kids, as part of a school program, go home and plead with their family members to stop smoking. Unfortunately, these kids' favored status means that while smoking may be on the wane, juvenile obesity is becoming more common as their families spoil them with special treats.
John M. Last, MD, emeritus professor of epidemiology and community medicine with the University of Ottawa, Ontario, said the largest single health problem for women in China, upper respiratory diseases, comes at least in part from bending over cooking stoves that emit toxic fumes.
Psychiatry in China is still in its infancy — It's only been developed over the past 50 years, and there's a huge shortage of trained psychiatrists to this day. Most psychiatrists focus on severe disorders like schizophrenia, which are treated almost exclusively with psychotropic drugs.
The most reliable predicting factors for a Chinese woman becoming HIV-infected are her husband's income level and the amount of time he spends on the road. High-income, frequently traveling husbands increase her odds enormously.
In China, health care is centralized, with oversight by the Ministry of Health. Despite the difference in health care delivery structures, the countries face many of the same challenges in providing health care to their people. In China, the doors are opening to private medical practice and privatized health insurance — but the country also needs to provide health care to its more than 1.2 billion people with limited resources.
No one would argue that the U.S. health care insurance industry isn't having similar problems resolving disparities in coverage, which amazed Chinese physicians at the conference. How can the U.S. have millions of uninsured when health care in this country accounts for more than a trillion dollars, which is close to the total gross national product of China? “It is difficult for other developed nations to understand,” said Dr. Cao Zeyi, vice president of the CMA, during one session.
— Sue Pelletier