Rehabilitation services suffer from lack of investment, low pay

by Alice Yan
In China, rehabilitation services face increasing demand, but the sector is suffering from a lack of investment and a failure to attract staff.
Seated beside a bed much larger than those usually found in hospital wards, Zhang Xiue looked hopefully at her 72-year-old husband as his legs were bent and stretched time and again by a young female rehabilitation technician.
The old man's journey to the Shanghai No 1 Rehabilitation Hospital started six months ago at their home in Taixing, Jiangsu province, when he had a sudden fall and lapsed into unconsciousness. Even with an operation after his stroke, he still could not move his limbs, speak, or even eat.
Discontented with her husband's recovery, Zhang decided four months ago to move him to this hospital, one of just a handful of dedicated rehabilitation institutions in the city.
"I am glad he can now swallow food - his stomach tube was removed a month after we came here. He can also speak simple words," Zhang said. "He still lies on the bed, and can't sit or walk. But I'm confident my husband's situation will improve."
Zhang said she never had heard of medical rehabilitation before her husband's stroke, and his treatment had rekindled the family's hopes.
In a room next door, Hang Chao , 36, stood with his legs bound to a vertical bed and his arms supported by a table, as part of rehabilitation exercises for a rare nerve condition.
Four weeks previously, after his hands and feet went numb and he could only lie in bed, Hang was treated by a leading general hospital in Shanghai, which recommended a follow-up programme at the rehabilitation institution.
Like Zhang and Hang before illness struck, most mainlanders have little if any idea of rehabilitation and what it can do. This is partly due to the snail's pace at which this relatively new medical field is developing on the mainland, even as officials face the problems associated with an ageing society.
According to Professor Li Jianan , the newly elected president of the International Society of Physical and Rehabilitation Medicine, at the end of 2009 there were only about 300 rehabilitation hospitals on the mainland, of which four out of five were not qualified to conduct treatment because of a lack of licensed doctors and technicians. Among the country's 10,000 or more public hospitals, a third have set up rehabilitation departments, many of which stand empty for most of the time.
The Ministry of Health, clearly unaware of the slow growth of rehabilitative medicine, has called time and again for fast and sweeping development of the sector.
In particular, health authorities have called for private capital to be injected into rehabilitation centres and have encouraged most of the country's public Class-B hospitals, those with 101to 500 beds and which serve several communities in a city, to turn themselves into rehabilitation centres in the coming years.
Rehabilitation hospitals, however, have little appeal to investors and hospital management. Luo Zengyong , vice-president of the public Sichuan Rehabilitation Hospital, which was built after the 2008 Sichuan earthquake claimed tens of thousands of lives and left hundreds of thousands injured, said a number of rehabilitation institutions on the mainland were struggling to make ends meet, mainly because the authorities would not allow them to charge fees that came even close to recouping their costs.
"Our prices are so low. For example, we charge just 38 yuan (HK$47) for a 45-minute-long rehabilitation training session for a child with cerebral palsy," Luo said. "Our service is even cheaper than a foot massage."
At his hospital, Luo said a lot of advanced equipment, such as spa rehab tubs, was seldom used. "The more such equipment is used, the more losses we suffer," he said.
"Therefore, although many experts and authorities play up the bright future for rehabilitative medicine in China, very few private businesses are interested in the sector, since they know they will make little if any profit."
Tang Dan , president of the Guangdong Provincial Work Injury Rehabilitation Centre, said the demand for rehab services on the mainland stemmed from the country's ageing society, with its growing ranks of patients with chronic illnesses, and from the injuries caused by accidents and natural disasters.
With the economy thriving, Tang said people had higher expectations for their quality of life, and more turned to rehab treatment and exercises. Patients who might have died before but were now saved by modern medical technology were also big users of rehabilitation services.
He said the fact that only a small number of rehab services were now included in medical insurance schemes had deterred potential operators, given that poor patients could not afford them and that rehab hospitals did not receive many patients.
Li said that years ago he proposed to mainland health and social security authorities who oversee medical insurance arrangements to include 70 rehab services, but they agreed to include just nine items in the insurance scheme. "The authorities seem to think that rehabilitation is a waste of social resources," he said "It clearly is not."
Tang said: "The medical insurance scheme is unreasonable. "Why don't they include a wider range of rehab items? I think policymakers don't see the real benefits rehabilitation provides."
Without more professional rehab training, many patients were doomed to be a burden to their families and society, Tang said. But rehabilitation offered many the hope of partial, if not full, recovery and of becoming contributing members of society.
Li said a common misunderstanding about rehab, not just among ordinary people but doctors and government officials, was that it was a form of relaxation. They fail to see that rehabilitation training involves investment in technology, which costs money, he said.
Since the Shanghai municipal government announced its hope in 2011 that the city's 80 or so Class-B hospitals would switch to rehab services, only one, the former Shanghai Yangpu Geriatric Hospital, had made the transition, with the remainder adopting a "wait-and-see" position.
Wu Xiaotong , president of what is now the Shanghai No1 Rehabilitation Hospital, was optimistic about its prospects.
"Surgery performed by mainland doctors in on par with Western counterparts," he said. "But our patients don't recover as well, and the reason for that is the absence of rehabilitation medicine in China."
"To me, rehabilitation is a new medical frontier on the mainland and full of opportunity."
Wu admitted his hospital was still at a preparatory stage and a severe lack of qualified staff was the biggest obstacle. There are 11 licensed rehabilitation doctors, short of the 60 the health ministry requires for a standard rehabilitation hospital, and just 26 licensed rehab technicians, 94 short of the number the ministry deems necessary.
Li said the shortage of professionals was a bottleneck restricting the development of rehab services on the mainland, where officials expect to see 3,000 rehab hospitals by 2020. He suggested grooming clinical doctors as rehab specialists to help meet the shortfall.
Wu said that to motivate clinical doctors to sit for tests to obtain a licence to practise rehabilitative medicine, he himself had applied to take the test, even though he was a senior orthopaedic specialist, and would attend classes every week with other doctors on his staff.
Zhou Yang , another orthopaedic doctor at the Shanghai Rehabilitation Hospital, said that since changing his practice to rehabilitation his income had fallen by a third, but he felt happy about his future. "The job gives me a sense of achievement and I am highly valued," Zhou said, giving the example of a 12-year-boy who was in a vegetative state four months ago but could now walk, eat and speak following rehab treatment in his ward.
Source: SCMP

Rehab to re-take: Shanghai doctor makes films on medical themes

Dr Sun works in rehabilitation medicine but makes movies about health, society and personal relations

by Wang Yizhou
Sun Xudong is a busy and committed film director and scriptwriter. But he is a long way from Hollywood. By day Sun is a doctor in the rehabilitation department of the Shanghai Shunchang Hospital, a public hospital that specializes in aged care in the city's Huangpu district.

At night, in his spare time and over weekends he is a director. He doesn't make films with car chases, guns being fired, impossible heroes and sexy women. His latest film is called Baby, Sorry and is about how a young man saves a child's life by donating stem cells to help her fight cancer. But he only does this after persuading his parents that this will not harm him personally and will help the little girl. The film is one of the new breeds of microfilm and will be screened online probably in January when it is completed and will then be accessible on a range of Internet portals. 
It is also based on true stories that director Sun became involved with. Zhang Yujia was a bright and happy 5-year-old girl who suddenly and inexplicably collapsed one day at her kindergarten. Tests revealed she was suffering from leukemia. 
She was given chemotherapy but her condition worsened until a stem cell donor was found in another city. This young man was willing to provide the stem cells needed to save the girl's life but first he and the doctors had to persuade his traditionally-minded and over-protective parents that this was a good and safe thing to do.
In reality, the girl received the treatment and recovered. Sun's film, however, has a bleaker ending inspired by another case where parents had forbidden a son to transplant stem cells and a child died for lack of treatment.
"For the film I was inspired by the son of one of my teachers. The boy died of the disease because the man whose stem cells matched and who could have saved him could not convince his parents to allow the transplant," Sun said.
The making of Baby, Sorry started in November and Sun and his team - office workers by day and filmmakers by night - have been deeply involved in all aspects of the shoot since then. They are united in the belief that it is important to make the film to try to raise public awareness of the facts about stem cell donations.
The Shanghai born 29-year-old Sun has been helping other people for many years now and uses his position as secretary of the Youth League Committee at the hospital to promote good public health care. 
As a middle school student he used to occasionally visit nursing homes to play chess with some of the elderly residents. His visits became regular and he began helping tidy the rooms or bring the elderly fruit. "I felt happy because they had so much to tell me and so much wisdom to share," he said.
Since then he has been active in many different ways but usually winding up helping others. He was fond of reading and theater and at university set up a literature club and a drama club. The drama club became a success and he persuaded members to give performances in nursing homes and cancer patient rehabilitation centers. 
Last year Sun established a photography club with friends and colleagues and then proposed something different. "Making homemade music videos is growing in popularity on the Internet, so why don't we help those who cannot make them?" he asked. 
He and other members advertised on bulletin boards in universities and eventually helped dozens of people make their own music videos. "Everyone has his or her own little dream and I am glad to be the one that help them realize this," Sun said.
Based on the success of the music video, he decided to try making longer more involved films, a proposal that won support from his friends. With little experience in the field, he did his own research and formed a team of 15 who became actors, directors, cameramen, producers and technical staff and they made their first film in March, a microfilm about environmental concerns that appeared on the Internet. In May there was another film about a young man's journey seeking a mysterious girl who had helped him years beforehand and in August the team made a film about a doctor who gave up the chance of a prestigious award and left his pregnant wife at home in Shanghai while he rushed to Sichuan to help victims of the earthquake there.


Read more: Global Times