Day 5: Fri 28 Sep - Chongqing

On the second day of the Seminar there were four presentations – all in Chinese, therefore the four invited guests were excused from attending. We visited the displays instead.

At a brief MEPS meeting held on Wed 26 Sep 12, just before the MEPS-Biochem Signing Ceremony, it was agreed that a small MEPS working group, consisting of Jane, Wendy and Sylvain, should convene on Fri morning whilst the Seminar continued in Chinese. Once again, Zheng-yu used his exceptional organizational skills to secure a small conference room for us to meet to discuss Disaster Response Management Planning. It is clear that there is a need for information on preparing individual pharmacists in all areas of practice to manage in their situation when an emergency strikes. Guidelines are required to help national authorities and member organisations develop comprehensive national plans. They need to consider the response from a more global point of view (community, hospital, industry etc.) related to an internal emergency, rather than from the perspective of a HADR response. Aspects that should be covered in any guidelines include: 1. Consideration of the plan from the national, regional and individual level of preparedness and response; 2. Breakdown into the four phases of the emergency management cycle: a. Reduction (Risk Mitigation): identifying and analysing long-term risks from natural or non-natural hazards; taking steps to eliminate these risks if practicable, and, if not, reducing the magnitude of their impact and the likelihood of their recurring; b. Readiness (Preparedness): developing operational systems and capabilities before an emergency happens; c. Response: actions taken immediately before, during, or directly after an emergency to save lives and property and to help communities recover; and d. Recovery: the co-ordinated efforts and processes used to bring about the immediate, medium term and long term regeneration of a community following an emergency. 3. Patient information. Based on the experience of MEPS members and from the various workshops, this area is one of the major ones that impact patient care and where pharmacy can make a significant contribution. Patients require guidance on how to manage their medicines and medicine supply in an emergency at home and during travel. However, during major disasters, access to patient information is often non-existent (e.g., destruction of records, power outage, etc.), whether the patients are from the local population or if they were visiting the area when the disaster happened. Contingencies should be considered as part of the reduction phase.

MEPS submitted a discussion document to the BPP recommending the BPP establish a working group to produce a ‘terms of reference’ to assist in the development of FIP Pharmacy Emergency Management Guidelines.

After the Seminar had concluded, it was off to lunch then back onto the bus for the trip to Southwest Hospital, also known as the First Affiliated Hospital of the TMMU. When we got off the bus, the sight was amazing; a large sweeping set of stairs leading up to an impressive entrance to the Outpatient Department of the Hospital. Inside, there was a large electronic sign welcoming the Seminar participants and we were met and welcomed by a neatly presented guide.

Southwest Hospital

Southwest hospital is, especially by European standards, a very large (the OPD alone is 760,000 sqm!), comprehensive hospital integrating medical, teaching and scientific research. It has over 2,500 inpatient beds and treats over 60,000 inpatients per year. The OPD receives in excess of 1.2 million emergency cases with approximately 30,000 of these requiring surgery. The hospital is equipped with 600milliion RMB (AS$1m or NZD1.22m) worth of health equipment and treats military and civilians; 34% of these being outsiders or foreigners. There is an Administration and Cashier desk on every floor. We visited the OPD, the Surgery Mansion and the Teaching/Learning Department.

Entrance to OPD of Southwest Hospital

The tour group

Nice!

The five above ground floors of the OPD

The Outpatient Department

The SW Hospital OPD occupies seven floors; two below ground and five above. It has six MRI machines, three of which are in the operating theatres. OPD treats everything from your little toe right up to the hair on your head and everything in between. There are far too many departments to list them all, but here are some: burns, urology, neurology, gastroenterology, cardiothoracics, joints, cancers, respiratory, endocrinology, ophthalmics, TCM, dermatology.

The most important part of the OPD, from our perspective is the Pharmacy which is situated on the first floor, with another bulk pharmacy one level below ground. When you visit the hospital, you are given a number. If the doctor has written a prescription for you, it is sent electronically to the pharmacy. Your number will appear on a sign above one of the lanes and you then join that queue. As military personnel are important, there is one lane dedicated to military only. TCM still makes up a large proportion of the scripts, although many formulations have since been commercially manufactured and pre-packed enabling easier dispensing. More than 70 pharmacists work in the OPD pharmacy dispensing more than 10,000 scripts per day. PharmD pharmacists undertake the patient counseling, whilst the pharmacists with a BPharm do the dispensing.

In the OPD

The pharmacy waiting area

Col Chen adjacent the pharmacy counselling area

After the tour of the OPD Pharmacy, we took a stroll through the remainder of the department and then through the Surgery Mansion to get to the Teaching/Learning Department. Here we visited the Clinical Skills Simulation Training Centre, located on the 11^th and 12^th floors (we stayed on the 11^th floor). The first room we were taken into had at least 26 simulation manikins – all females. One had been programmed to have appendicitis and when you touched her abdomen, she groaned in pain! The quantity of manikins was something to be seen; most of us had never seen that many in the one place before. We were also treated to extensive array of ‘scope’ practice machines – gastroscope, colonoscope, bronchoscope, etc. It was all very real with small puffs of smoke to be seen on the screen when an excision was cauterized. The other unit we spent some time in was the Rehabilitation room – soldier manikins with all sorts of wounds, including missing limbs were laid out for healthcare professionals to practice their trade. Other units viewed more quickly were the general wards, operating theatre and ICU, and pediatric ward. All came complete with alarms very much mimicking the real world.

The manikin room

The 'scope' simulation room

The rehab simulation room

Southwest Hospital Surgery Mansion

The Surgery Mansion is the tall building you can see here. It has 23 floors, two of them below ground. As the name suggests, this is where all the surgery (elective) takes place. There are four floors just for hepatobiliary surgery, accounting for six surgical units. There are three eye hospital units, three orthopedic surgery units, whilst most other departments have two units (general surgery, neurology, cardiothoracic, obstetrics and gynaecology). ICU is on level 2F, with the blood bank, CSSD, administration, in-patient pharmacy on level 1F. Underground there is parking, ultrasound, Xray, ECG and frozen pathology examination departments. The 22^nd floor is reserved for VIPs.

After the hospital tour it was a quick visit back to the hotel to change into more casual clothing for our river cruise on the famous Yangtze River; another generous gesture from our hosts. There was a small hike across many pontoons to get to the ferry, and as it had just started raining, some of the footing was a bit treacherous; we all made it though, and the ferry was quite flash. There were four decks, with the meal being served on the first. Again, the meal consisted of about six or seven different dishes and was all very yummy. After dinner it was time to sit back and relax and enjoy the sights – those that we could see through the drizzle. There were many tall buildings all with different arrays of colored lights. And not only did we cruise the Yangtze, we also made a short journey on the Jialing River. We all slept very well that night in preparation for the early start the next morning.