What started 10 years ago as a project to combat the spread of HIV and AIDS has blossomed into an ongoing relationship between the University of Chicago Medicine and Wuhan University in China. Over the past decade, the two universities have continued to work together on transforming medical education in China, and are now collaborating on research to stop the spread of hospital-acquired infections in China.
In April, Emily Landon, MD, Kathleen Mullane, DO, PharmD, and Renslow Sherer, MD, visited Wuhan, located in Hubei province in southeastern China, to continue work on a two-year project to teach Chinese physicians how to better diagnose and treat Clostridium difficile infections. C.diff is bacterium that causes severe diarrhea and gastrointestinal symptoms when the usual bacteria living in the gut have been wiped out by antibiotics.
Chinese researchers had thought that c.diff infections weren’t very common in the country. Yet data collected by researchers showed that between 20 and 30 percent of samples taken from patients in three different hospitals were positive for c.diff.
Landon, who is medical director of Antimicrobial Stewardship and Infection Control at the University of Chicago Medicine, said that Chinese medical staff face different challenges with infection control than their US counterparts because of the sheer number of patients.
“The same problem has to be handled in a totally different way in China than it does here,” she said. “You can’t just put everybody with an infection in an isolation room, because every hospital has 6000 beds.”
Landon and Mullane worked with Chinese officials on implementing more sophisticated testing methods to detect c.diff. They had been using an inexpensive toxin assay that provided quick results, but isn’t as accurate as PCR screening commonly used in the United States.
Given resource limitations in China, however, widespread PCR use for c.diff in hospitals isn’t feasible. Landon and Mullane instead recommended a two-step process that first screens for the bacteria and then uses the toxin assay as a confirmation. They also worked with Chinese doctors on managing patients with c.diff when stopping the use of antibiotics isn’t an option.
Close collaboration like this is possible because of the groundwork laid by Sherer, and his longstanding relationship with Chinese health officials and Wuhan University. In 2003 he began working in China with Project Hope, an NGO dedicated to stopping the spread of HIV and AIDS.The University of Chicago partnered with Project Hope to provide HIV training for physicians around the world. Eventually officials at Wuhan asked University of Chicago faculty to help them reform their medical education curriculum. Sherer said this work set the stage for further collaboration.
“Working with HIV and helping them with it engendered a tremendously strong and trusting relationship, because that’s very difficult work,” he said. “We established credibility that we weren’t going to be threatening or taking them to task for anything other than what they asked us to do. That really made a difference.”
In the past, the curriculum in Chinese medical schools was very different from that in the western world. Coursework focused more on technical mastery of large amounts of material and less on clinical decision making and collaborating in teams. The Chinese system also didn’t have a formal residency program, where recent medical school graduates could work in real world hospital settings under the guidance of experienced attending physicians in their chosen specialty.
Over the years, Sherer and dozens of students and faculty from the Pritzker School of Medicine have visited Wuhan to help implement many of the same education reforms now underway here in Chicago under the Pritzker Initiative, a program emphasizing collaboration among disciplines and integration of basic science research into clinical practice.
These reforms are beginning to take root at other medical schools in China, and Wuhan University has positioned itself as a leader. On this recent visit, Sherer and his colleagues signed a new memorandum of understanding between the two institutions, formalizing the partnership for another three years.
He said the relationship between the two universities continues to bear fruit for both sides. Doctors and researchers in Wuhan are gaining new insight into infection control and medical education from their counterparts in Chicago, who in turn learn valuable lessons from the Chinese on practicing health care on an enormous scale with limited resources.
“The impact of seeing this other culture and being part of that I think is really extraordinary,” he said. “It’s just been phenomenal.”