Nonprofits and nongovernmental organizations are often faced with a moral dilemma namely how to decide who is most deserving of their limited resources and who will they regrettably have to turn away. Shangdi Hospital fortunately has never had to face that dilemma concerning access to their medical resources. They do in practice have a ‘no one turned away policy’ and never refuse medical treatment to patients regardless of their ability to pay. What moved me most about Shangdi Hospital was the resident doctors who themselves hold a ‘no one turned away’ policy in their personal lives, for this is what is needed to make the sacrifices they have in order to serve the patients at Shangdi.
My first contact with Shangdi was meeting Dr. Sun, a retired anesthesiologist from Aviation Hospital, who at the time was on the Shangdi staff. Dr. Sun has been conscientious about giving back since his youth. A graduate from Peking University Medical College, Dr. Sun requested to be sent to Qinghai Province in 1974 shortly after he was married. He was in fact the only person who voluntarily transferred to this remote, high altitude area at that time. He primary concern was to be closer to his sister, who was ill and the area was surely in need of doctors with his background. Dedicated not only to his sibling but also to Qinghai, he subsequently spent fourteen years at Qinghai Medical College. Later after working in Shangxi, he was invited as visiting scholar to the University of Mississippi Medical Center.
Given his vast experience in anesthesiology and combined knowledge of Western medicine, he was specially hired by the military at age forty-four, where he began his career at Aviation Hospital. This is where he met Dr. Wang, a former Dean of Haidian Women and Children’s Hospital and the founding Dean of Shangdi, who eventually recruited him. Dr. Wang, who was assigned to assemble the hospital team, asked Dr. Sun to contribute two days a week, setting up the anesthesiology department. Dr. Sun, reluctant at first to travel the distance to Shangdi, was unable to turn down the offer when he saw the contribution he would be making. He instead became the full-time Chairman of the Anesthesiology Department. Dr. Sun committed three years to Shangdi’s mission and patients.
As I spoke to the Shangdi staff, I became convinced that they were truly committed to helping everyone they could. But could this ideal to serve the poor actually be realized? They serve the poor effectively with fees half that of other government hospitals and pharmaceuticals sold at cost price. Many people come from other cities despite added transportation and accommodation costs because Shangdi’s costs are so low. While most patients come from surrounding areas, the majority are minorities living and working in Beijing.
The first of its kind, a hospital built to “serve the poor,” Shangdi was established in 2005 by three hospitals, Haidian Maternity Hospital, Haidain Chinese Traditional and Western Medicine Hospital, and Haidian District Hospital, all who contributed funding and resources. These hospitals realized the need for medical services for people who were migrating to Beijing for work. Since the Hospital’s recent acquisition by the Haidian District Government, Shangdi is now solely funded by the government. There are no private donors but the Hospital does receive equipment from private donations to Haidian Government. This 200 plus bed facility can serve up to 1000 patients per day. It is a general hospital with a large Obstetrics Department that delivers 600-700 babies daily.
Cost is not the only reason people choose Shangdi. One patient interviewed chose Shangdi for her heart condition. The cost is indeed low but this is of little importance because her insurance covers her medical bills. She chose Shangdi because she finds it cleaner and less crowded than other hospitals and because she feels the nurses take better care of her. This was seen in the tender relationship she had with her nurse, who was chatting with her when we came in for the interview. Again I was reassured that Shangdi is committed to the poor.
Dr. Zhang, the Vice Dean, recalled an incident where a woman in labor arrived at the hospital with not even one RMB on her. “Was she turned away?” I asked. No quite the opposite. The baby was delivered safely. Unfortunately, without money in her pocket, the mother was unable to buy disposable goods used but not included in the birthing procedure, so Dr. Zhang paid for them herself as well as baby formula, dinner for the mother, and even credit for the patient’s cell phone so she could notify her husband. The baby clothes, for when the mother and baby were discharged, came from Dr. Zhang’s own home. “So no one is turned away,” I confirmed. If a patient is unable to pay their bill they will be charged and asked to pay at a later date. Even in the case that they are unable to pay at a later date, they are never denied service. Despite this unspoken rule at the hospital, Shangdi Hospital is not only a successful social experiment but has also managed to cover all their costs.
Part of the reason why the hospital is able to cover its costs, is due to the low salaries paid to the staff. Doctors, despite their educational and professional experience, gross one third of what they can expect to make in other hospitals. Additionally they do not receive bonuses from their employer nor can they accept hongbao’s (envelopes of gift money) from medical companies or their patients, as many doctors in traditional facilities come to expect. These factors alone could prove a substantial deterrent for many physicians, not to mention the remote location of the hospital and the lack of public transportation and restaurants in close proximity. But seeing the needs of the patients, the doctors and Shangdi staff are unable to turn down the job offer regardless of the salary and lack of benefits.
That’s not to say that the staff roster is anything but impressive. It includes physicians like the Dean Gu who was formerly in charge of the Emergency Department of Haidian District Hospital; Dr. Zheng, the former Chairman of the Thoracic Department of Beijing Haidian Hospital where he is still staff; and Nurse Chen, the former Head Nurse of Three Star, 306 Military Hospital. As well as the doctors mentioned earlier, Wang and Zhang.
So why did Dr. Sun finally leave Shangdi to take a joint position as the Dean of Jianxiang Hospital and Vice Chairman of Medical Office of Evercare Company, a plastic surgery hospital. “I was finally convinced by Smile Angel Foundation,” he said, a charity established by actor Li Ya Peng that provides free cleft pallet surgeries to sixty infants a month from low income families. After a three year commitment, where he successfully established the Anesthesiology Department at Shangdi, Dr. Sun felt his knowledge was vital during the surgery of two to three month old infants. General anesthesia and a respirator are required for the procedure. Due to the size of the patients, the respirator tube, which must remain free of blood and saliva, is difficult to use effectively during surgery. Additionally, anesthesia for such small patients is a challenge. On top of the challenges of the surgery, there are additional pressures from the parents who often bring extended family to be present for the operation of their only child. Concurrently, Dr. Sun is establishing an Anesthesiology Patient Safety Organization to monitor procedures and raise standards of Anesthesiologists throughout the twelve branches of Evercare Company. His goal is to create a model for a national foundation.
Apparently Dr. Sun was also unable to turn away these low income children in need of early cleft pallet surgery. When I mentioned that this article would detail his story he responded “it was not such a big sacrifice, I was close to retirement age when I started at Shangdi,” referring to the forced retirement age for professionals at government institutions. When I asked if he thought riding his bike an hour and a half or taking three buses to get to Shangdi was considered a sacrifice he simply laughed. So I remain convinced. A common ingredient among the doctors and staff who gracefully serve patients at Shangdi Hospital is the idea that they can deny no one access to their valuable resources.
By Allison M. Johnson
As seen in the Charitarian Issue 1 – January 2010
