I am coming back from China after a whirlwind tour of several cities. My first stop was in Shanghai where I spent three days in a workshop discussing Transcranial Magnetic Stimulation as a possible therapeutic effort for autism. Later on I moved by car on a three-hour ride to Hanzhou. Peculiarly, academicians at the Technical Institute of that city selected me as a representative from the US in trying to arrange a research agreement between our countries. Finally, as something that I try to do in every city that I visit, I had the opportunity to tour a model school for special education where a large percentage of attending students had been diagnosed with autism. I am hoping to post some of the pictures and possibly videos in the near future.
My visit to Shanghai was hosted by the Shanghai Mental Health Center. This is one of four regional health centers distributed throughout China. Its sheer size dwarfs any health institute within the United States. Given China’s socialized medicine, patients can select receiving services from this Center regardless of their home geographical location. The Shanghai Mental Health Center receives some 650,000 outpatient visits every year and has over 2000 inpatient beds. (Note: The statistics are for the main campus, they have another site primarily for drug abuse and geropsychiatry). I was surprised to learn that the average inpatient stay is about 2-3 months. Also, emergency patients may stay housed in the hospital for 1-2 weeks (!) pending resolution of their medical complaints.
For those individuals who would rather pursue some traditional medicine for their complaints, there is a neighboring hospital that will take care of their needs. At first glance, the major difference that I saw between the Eastern and Western hospitals were in the size of the medication bags that patients were taking when leaving the hospital. Patients at the traditional hospital had huge bags filled with herbal medicines for every conceivable ailment.
Culture as well as the socialized nature of medicine provides stark contrasts in the approach both of our countries take in regards to autism. In China, patients are institutionalized for as long as deemed necessary in order for the patient to improve. There is no financial constraint on the hospital or physician dictated by health insurance companies. (Note: I was told that patients paid not more than 10% of the initial charges, call it a deductible. Capitalism has made inroads in China and for patients wanting closer attention there is a VIP section where you can enjoy a luxurious suite and other amenities). Autistic patients receive multidisciplinary therapy where parents are instructed in behavioral approaches. I was struck by the apparent success they enjoyed in teaching communication skills to the children. It seemed to me that the graphical, and almost artistic nature, of their alphabet promotes visual learning that may be easier to learn by autistic individuals.
Family involvement is an ever-present feature of the Chinese people. Parents seeking help for their autistic child usually did so in company of their extended family, sometimes 8-10 people at a time. This involvement is primarily beneficial but may interfere with some interventions that they deem as modern or don’t have proper understanding, as a result, Transcraneal Magnetic Stimulation (TMS) has made little inroads in China.
In Hangzhou I had the opportunity to meet the Dean of the University (Psychology) and the Minister of Health. I was able to formalize an agreement for a clinical trial as well as an exchange program between our countries. The city considered small by Chinese standards (“only” 5-6 million inhabitants) boasts 72 schools with formal special education classes. Two of their institutions had close to 600 autistic individuals. I was assured by government officials that any clinical trial in China would have several hundred participants. I am looking forwards to this opportunity and also promoting a new brain bank initiative primarily aimed at fostering autism-related research.
I had the opportunity to visit the model school for special education at Hangzhou (Hangzhou Yanglingzi School). The same blew away many of my preconceived notions about autism. In the United States we use muted colors, incandescent lights and avoid jarring noises, like school bell ringing, in our schools. In China, it is more of a Disneyland setting with colors, balloons, fluorescent lights, and blasting noises on their loudspeaker system. Despite this, autistic individuals do not seem to care and thrive in this environment.
Hangzhou Yanglingzi School’s motto is: “Hope, happiness and health”. In keeping with their motto students enjoy an hour a day of exercises in the form of parades and gymnastics. Parents are urged to attend all sessions and they are the primary cheerleaders for their children. The school emphasizes life skills training. In China gainful employment after training approaches 50% (compared to about 5% in the US). The school has more than ten rooms for special purposes, including a rehabilitation training center, a multisensory training room, a hydropathic room, a mini-supermarket, a simulated home, and rooms for vocational training. Autistic individuals enjoy making crafts (sold to the public) and participate in gardening activities as well as auto detailing.
I had a very positive impression about China and will be going back in the foreseeable future. In the meantime I have arranged for an exchange program for educators to visit our country. I think we all stand to learn from each other.