July 18-22, 2024.
Chongqing is a futuristic, modern supercity located at the confluence of the Yangtze and Jialing rivers. Known as one of the tre "Furnaces" of the Yangtse it is hot in the summertime and by some measures is the world's most populous city.
Chongqing Central Emergency Hospital
The central control room at the Central emergency hospitals resembles NASA Mission Control with all ambulances affiliated to the hospital in continuous electronic contact and their positions at any given moment projected on a Hughe screen. A patient with suspected stroke is attended by paramedics who re then in direct contact with this control room and arrive at the hospital directly into a CT scanner. Stroke thrombectomy is delivered by the neurosurgical department and if appropriate the patient is transferred to the biplane angiography suite directly adjacent to the reception CT room for clot retrieval within minutes.
We toured the wards and neurosurgical theatres before leaving to attend a regional neurosurgical conference being hosted by the unit and coinciding with my visit. I had the opportunity to present our experience with the management of spinal cord vascular malformations, a very rare condition where few centres worldwide have accrued significant surgical experience. China contributed significantly to the medical literature on this topic and I very much enjoyed my discussion with the team in Chongqing.
Data was presented at the regional conference from an ongoing trial of minimally invasive evacuation of primary brain haemorrhages (SICH). Practice in Europe is changing with the latest guidelines issued shortly after my return reccomending amore aggressive surgical approach using these techniques since the presentation of results from the ENRICH trial in the US. Other trial results are imminent not least the NESICH study ongoing in China.
We have hosted several fellows in neurosurgery, neurology and nursing at King's College Hospital and there has been a fruitful exchange of ideas that could potentially lead to research and clinical collaboration in the future. The world has become a smaller place since the internet and although the Great Fire Wall poses some practical challenges in recent year requests for educational collaboration have increased exponentially all over the world including in China. It is a constant reminder of how alike we all are at a human level.
Culture.
The enormous Chongqing municipality is historically part of the Sichuan Province.Downstream from the city the Yangtse reaches passes through the Three Gorges region and the enormous and controversial Three Gorges dam. The municipal museum in Chonqing is full of fascinating artefacts excavated or retrieved before large areas in the Three Gorges Region were submerged with he completion of the dam in 2006. The Yangtse has a rich history as a river highway fthrough central China from Tibet to the East China Sea near Shanghai. Some of the earliest records of inhabitation in the area relate tot eh ba people and the artefacts of that civiilisation are fascinating. The museum also vividly recreates the lifestyle of those who lived on the river.
Food is incredibly important anywhere you travel in China and it is consistently marvellous wherever I have travelled. Chonqing is particularly known for hotpot. The Chinese take their mealtimes very seriously and I confess to be a little embarrassed at what they thin when we buy a sandwich at Mark's and Spencers for lunch. A few of our visiting fellows have confided that it is western eating habits that they find most difficult to accommodate.
We will have to try a bit harder for our visiting fellows. Almost every meal was a wonder.
The modern history of Chiongqing has been heavily impacted by World War II. Close to the central business district is a great museum dedicated to - of all things- an American General, namely "Vinegar Joe" Stilwell..
Chongqing served as the national capitol for the government of Chiang Kai-shek and served as liaison and in due course his Chief of Staff. Stilwell famously declined an airlift out of Burma when it fell to the Japanese preferring to walk with his staff to Assam. Enormously popular with his men he was by background an engineer and an accomplished linguist, proficient in written and spoken Mandarin.
I had a memorable exchange (assisted by an interpreter) with another Chinese visitor to this museum. He worked in mobile communications and was interested in his accomplishments as an engineer particular on the railroads. Despite the gulf of language and background we had a shared interest in history and I think were both pleased to have unexpectedly met the other on our common ground quite by chance. There is a plaque at the exit of the Stilwell museum which I attach below and is a reminder of how it is always possible to find common cause.
