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A Harvard Orthopaedic Presence in China | Scientific Articles | Alumni

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A Harvard Orthopaedics
Presence in China

Hu-Ping Hsu, MD • Mitchell W. Spellman, MD, PhD • Arnold Longboy, MS • Myron Spector, PhD

          In February of 1996, the chairmen of four of the top orthopaedic departments in China met at Harvard Medical School to embark on a collaborative endeavor with Harvard Orthopaedics and Harvard Medical International. The meeting was the outgrowth of interactions that Hu-Ping Hsu, a researcher in the Orthopaedic Research Laboratory at Brigham and Women's Hospital, had had with the orthopaedic community in China over the prior 10 years. The organization resulting from that initial conference in Boston was named the Beijing-Shanghai-Boston (BSB) Orthopaedic Education and Research Initiative. The alliance has already organized two symposia in China that have brought together over two hundred Chinese orthopaedic surgeons with 13 Harvard Orthopaedics' faculty.

          Hu-Ping Hsu received his M.D. degree from the Capital Medical University in Beijing in 1970.

Figure 1: One of the attending orthopaedic surgeons at the Peking Union Medical College Hospital (right) points out radiographic features of a case to Conrad Wang, M.D., one of the new Harvard Orthopaedic residents.

From 1976-1979 he was Senior Resident and from 1979-1980 Chief Resident in Orthopaedic Surgery at The Peking Union Medical College Hospital (PUMCH). The Peking Union Medical College, established by the Rockefeller Foundation in 1921, is the premier medical school in China, and where Hu-Ping's father was a Professor of Neurology. After 3 years as an attending orthopaedic surgeon at PUMCH, Hu-Ping emigrated to the United States and in 1985 joined the Department of Orthopedic Surgery at the Brigham and Women's Hospital as a Research Associate. In addition to participating in the administration of the China project, Dr. Hsu supervises the orthopaedic surgical (animal) research program at the Brigham and Women's Hospital and is involved in a number of biomechanics and biomaterials projects. Dr. Hsu has maintained contact with his prior teachers and classmates, some of whom have now risen to become presidents of the medical centers as well as department chairpersons. These relationships have provided the opportunity for Harvard Orthopaedics to establish a presence in China.
The Founding Members of the BSB:

Gui-Xing Qiu, M.D.

Chairman, Department of Orthopedic Surgery
Peking Union Medical College Hospital
Peking Union Medical College; Beijing, China

Guo-Wei Rong, M.D.

President & Chairman,
Department of Orthopedic Surgery
Ji Shui Tan Hospital
Beijing Medical University; Beijing, China

Shi-bi Lu, M.D.

Chairman of Orthopedics and Traumatology
General Hospital of PLA; Beijing, China

Ke-Rong Dai, M.D.

President & Chairman,
Department of Orthopedic Surgery
9th People's Hospital
Shanghai Second Medical University; Shanghai, China

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         Hu-Ping Hsu and Myron Spector serve as representatives of Harvard Orthopaedics in the BSB and Harvard Medical International is represented by Mitchell W. Spellman, M.D., Ph.D., Professor of Surgery, Emeritus, Harvard Medical School, a Director of HMI, and Arnold Longboy, M.S., Director of Educational Programs, HMI.

          Recognizing that international medical programs at Harvard would be of growing importance, in 1994, Dean Daniel Tosteson established Harvard Medical International to review opportunities for international programs and facilitate their development. The goal of HMI is that patients should not have to leave their region to receive the highest level of medical care

The Mission of the BSB:
To advance education and training programs in orthopedic surgery in China.
To facilitate the exchange of students, fellows, and faculty among the participating institutions.
To facilitate the exchange of ideas and advice regarding laboratory and clinical research and assist in the development of research facilities at the Chinese hospitals.

          In September of 1997 the BSB organized its first symposium in Beijing at the Peking Union Medical College Hospital with Drs. G-X. Qiu and C.B. Sledge serving as co-chairs. The topic was total joint replacement, and approximately 100 surgeons from throughout China were in attendance. Six faculty from Harvard Orthopaedics (C.B. Sledge, T.S. Thornhill. F.C. Ewald, D.T. Reilly, H-P. Hsu, and M. Spector), J. McCarthy from the New England Baptist Hospital, and a few Chinese surgeons addressed several aspects of total joint arthroplasty and other topics. At the close of the meeting participants were presented with a certificate from Harvard Medical International.

          The second BSB Symposium was convened in Shanghai in March of 1999 and was hosted by the Ninth People's Hospital of the Second Medical University of Shanghai, with Drs. K. Dai and J.H. Herndon the co-chairs. The topics included trauma and spine surgery and selected issues in sports medicine. Related presentations dealt with tissue engineering and gene therapy. The attendees included over 150 orthopaedic surgeons. The faculty comprised nine members from Harvard Orthopaedics (J.H. Herndon, J.B. Emans, S.D. Martin, R.M. Ozuna, F. Pedlow, J.E. Ready, J. R. Wright, H-P. Hsu, and M. Spector) and 11 Chinese orthopaedic surgeons. The American contingent was joined by Walt LeClair, M.D. from the University of Massachusetts Medical Center and Mitchell Dube, M.D. from the Lahey Clinic.

          The third BSB Symposium is being planned for the fall of 2000 in Beijing with the Ji Shui Tan Hospital of Beijing Medial University the host. Topics will include sports medicine, tumors, upper extremities, osteotomy, and revision arthroplasty. All of the symposia offer simultaneous translation. It is interesting to note, however, that most of the younger surgeons and many of the senior surgeons understand and speak English well enough to participate in the meeting without translation.

          The educational and training programs for orthopaedic surgeons in China have many similarities with those in the US. Understandably, there are, however, only limited opportunities for residents and attending surgeons to participate in meetings outside of China where they would have an opportunity to learn of new techniques and results of long term follow-up of procedures and implants. Moreover, there is not widespread availability of current issues of international orthopaedic journals. These limitations notwithstanding, Chinese surgeons are remarkably up-to-date with respect to their awareness of the current state of orthopaedic surgery in the West. This is a reflection of their desire to meet the standards of care set by the international orthopaedic community. In part, the BSB symposia were conceived to address the lack of opportunity of Chinese surgeons to interact with American orthopaedists, by bringing the experts to China to teach the teachers.

          The collaborative tie between Harvard Orthopaedics and orthopaedic programs in China has also facilitated the placement of our students in externships there. One of the new Harvard Orthopaedics residents, Conrad Wang, spent a month at the Peking Union Medical College Hospital in the spring of 1998. During that time Dr. Wang had the opportunity to witness the approaches taken to the care of a wide range of orthopaedic patients and contrast patient management with that in the West. As an MIT graduate, Dr. Wang was eligible for funding from The MIT International Science and Technology Initiative. With an increase in the number of such exchanges of students, and faculty, should come the kind of understanding and friendship that will assure the longevity and productivity of the Harvard-China connection.

          The quality of orthopaedic care in China is high. This despite the limited availability of advanced imaging equipment and surgical devices that might not be of current design or highest quality with respect to materials composition, machining tolerances, and finishing. The orthopaedists demonstrate great surgical skill and their resourcefulness often makes up for any lack of modern equipment, instruments, and implants. Interestingly, one of the greatest differences between orthopaedic care in China and the United States is the length of hospital stay. A joint replacement patient may be admitted to the hospital one month prior to surgery and still be found as an inpatient up to three months postoperatively. This is not due to the orders of the surgeon but rather one of the privileges of the current health care system that is sure to undergo change.

           The level of interest of Chinese orthopaedic surgeons in laboratory research is notably high. This is, in part, related to the fact that many orthopaedic residency programs confer a Ph.D. degree. While the course requirements and depth of thesis research may not be directly comparable with doctoral programs in the US, the dedication of the academic orthopaedic community to laboratory as well as clinical investigation is clear. The integration of laboratory research into the orthopaedic residency program is reflected in the attitudes of many residents who have approached us for comments on their investigative work including tissue engineering and gene therapy projects as advanced as any being pursued in the US.

          Of course, one of the most gratifying aspects of an international collaboration is the opportunity it provides to get to know colleagues in other countries and to obtain insights into their culture. For example, tea is an important ingredient of the Chinese culture, and during one trip we (H-P H and MS) visited the premier green tea growing region of China - Dragon Wells - in the lush hills bordering the city of Hangzhou, a 3-hour train ride west of Shanghai. Our host was Dr. Xiang-Jiang Lin, Vice Chairman of the Department of Orthopaedic Surgery at the First Affiliated Hospital in Hangzhou. In a small hillside village, we were taken into a room in the home of one of the growers to sample the tea prior to purchase. We were unprepared for the large number of samples set before us - more than ten types of green tea from which to choose. As we sat there rather bewildered, Dr. Lin proceeded in systematic fashion to examine, smell, and lightly touch the mounds of tea set before us. He requested that a few leaves of one sample be brewed in a glass with water heated to just under boiling. He then assessed the aroma and tasted the tea which displayed only the faintest hint of a green color. As Dr. Lin explained the process of evaluating the quality of a tea, one could not help but be struck by his connoisseurship and the parallels with the evaluation of a good wine, single malt scotch, or coffee. But as we complimented Dr. Lin on his expertise, we learned that his knowledge was not obtained entirely voluntarily. During the cultural revolution he, along with most academic physicians and others in learned professions, was sent to the countryside to work for at least four years. Dr. Lin spent much of his time toiling in the tea fields. He was one of the lucky ones, to survive the times and get the opportunity to start a new life. Perhaps this helps to explain the general desire of most of the people who we have met, to look ahead. Absent the luxury of fond memories of the past, the emphasis is on the promise of the future.

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Figure 2: The operating room scene at the Peking Union Medical College Hospital is much like that of any to be found in hospitals in the US.

          China has a population of over 1.2 billion people and a political system that now accommodates the free commercial enterprise of those people. The resourcefulness of the Chinese is in evidence in their orthopaedic programs just as it is in their agricultural and industrial sectors. This resourcefulness, along with the ingenuity, craft, and refinement amply seen in the arts of China, demonstrate their potential for quickly raising the level of medical specialties such as Orthopaedics to world-class status. A Harvard Orthopaedics presence in China meets one of our own university goals of providing global leadership, and at the same time offers us the unique opportunity of learning from our Chinese colleagues.

Hu-Ping Hsu, MD is a Researcher in the Orthopaedic Research Laboratory at the Brigham and Women's Hospital and Instructor of Orthopaedic Surgery at Harvard Medical School

Mitchell W. Spellman MD, PhD is a Director of Harvard Medical International and Professor of Surgery, Emeritus at Harvard Medical School

Arnold Longboy, MS is Director of Educational Programs at Harvard Medical International

Myron Spector, PhD is Director of Orthopaedic Research at Brigham and Women's Hospital and Professor of Orthopaedic Surgery (Biomaterials) at Harvard Medical School

Address correspondence to:
Dr. Myron Spector; Department of Orthopaedic Surgery; Brigham and Women's Hospital;
75 Francis St.; Boston, MA 02115
E-mail: mspector@rics.bwh.harvard.edu

Chiefs Reports | Osgood Day | Cartilage Regeneration and Repair, Where Are We?
A Harvard Orthopaedic Presence in China | Scientific Articles | Alumni