Taking knowledge to where it’s needed

Stroke is among the deadliest killers in China. As a cause of morbidity and mortality, the disease is second only to cancer. Recent epidemiological studies have placed stroke as the most frequent cause of death in the country of some 1.3 billion people.

Inasmuch as the causes of the problem could be pinned on development and internationalisation, so too could its potentially far-reaching solutions.

Amid a push from the Chinese government to tap into a global knowledge base to advance local medical education, six experts from the University of Melbourne and the Royal Melbourne Hospital led the field by conducting a five-day neuroscience master-class in Shanghai in July 2010.

In collaboration with the Shanghai Jiatong University and First People’s Hospital, the neuroscience team shared its pioneering work in treating brain artery blockages, brain haemorrhages and aneurysms, among others, with 42 neurologists gathered from across China.

The academic team was led by Professor Terence O’Brien, Head of Medicine at the Royal Melbourne Hospital, and comprised program director Associate Professor Bernard Yan, Professor Stephen Davis, Professor Trevor Kilpatrick, Professor Brian Tress, and Associate Professor Owen White.

The master-class introduced several cutting edge diagnostic and treatment technologies, particularly in the treatments of stroke, epilepsy and multiple sclerosis.

Participants engaged in a series of scenario-based lectures and workshops to learn new neurological treatments. Real patient cases were featured and neuro-imaging and video cases of advanced techniques on opening up arteries.

A technological component of the master-class focused on telemedicine software developed and pioneered at the University of Melbourne and Royal Melbourne Hospital that allows for remote assessment and treatment of patients.

Using telemedicine, patients may remain in the emergency departments of remote hospitals. Mobile consultants can log on to the system via laptops to interview and examine patients, look at their scans and make decisions regarding treatment without being constrained by location or distance.

Associate Professor Bernard Yan, neurologist and neurointerventionist from the Royal Melbourne Hospital’s Comprehensive Stroke Centre, told Voice the impetus for the project was to transfer knowledge to where it was most needed.

“If we take China as an entity, neurological diseases are now declared the number two killer, and there is significant government resource allocation to treat these diseases,” Associate Professor Yan says.

“Furthermore, there are greater distances to overcome than in Australia, particularly between the eastern seaboard and inner China. There is a burgeoning ageing population to cope with. And in the north, northwest and southwest, they have far fewer doctors and specialists to address mounting needs and pressures.

Pointing to changes in the environment, lifestyles and diet in the past 20 years of economic boom, Associate Professor Yan noted China was also witnessing a spike in the incidence of stroke.

“The disease is assuming a profile more common to the developed world,” he says.

“The management of stroke is time window-based. If an artery is blocked, the brain will start losing 1.9 million neurones a minute, 120 million in an hour, and 1.2 billion after 4.5 hours. You have to ask yourself, how many neurones can the patient afford to lose?” asks Associate Professor Yan.

“Given the time window, we’ve got to get in there quickly and open up the artery to restore blood supply. This requires getting the cutting-edge technology that is available in Melbourne, but not in China, and skills to use them. These are key techniques we want to teach the Chinese,” he says.

Associate Professor Yan added that the potential cost savings to the Chinese were phenomenal.

“In Australia, the government spends $750 million every year to look after the 50,000 new strokes presenting to Australian hospitals. Increase that amount by about a hundred-fold, and you come close to the magnitude of the issue in China. The potential savings for China are massive.”

Associate Professor Yan is quick to point out that benefits flowed to the University of Melbourne from these exchanges too.

He says, “Initiatives like these raise the profile of the University and its affiliates in China by showcasing our research achievements. It encourages higher degree students in China to consider the University of Melbourne as a destination for their endeavours”.

With many benefits to be reaped, the interest in the master-class, both from participants and the host organisations, was very encouraging.

“The inaugural master-class was over-subscribed significantly, and we had to be selective about the participants,” says Associate Professor Yan.

“There was a lot of ceremony and excitement when we arrived. We had the director of the Shanghai Health Authority attending the opening ceremony and the Dean of Medicine at the Shanghai Jiatong University giving the project very public and visible endorsement.

“It augurs well for our plans to conduct these master-classes annually,” he says.

The second part of the master-class will be delivered at the University of Melbourne in November 2010 for the visiting Chinese neurologists.