This is a continued feature multi-part blog post written by our Executive Director, Alanna Hendren. Alanna will be blogging about her recent experience flying off to China as the leader of the People-to-People Psychiatric Services and Developmental Disabilities Delegation. Every Tuesday and Friday, we will be posting about her journey in China, the developmental services offered there, and the people there. To read part 8, click here.
I must say that the discussion about funding amongst the psychiatrists in Guilin was a highlight of the journey for me. No matter where you go – Canada, China, Russia, the U.S. – there are vastly different approaches to funding health, rehabilitation and long-term services, but the problem is the same with the professionals and patients squeezed in the middle – everyone needs and wants the best healthcare with the best outcomes, but nobody wants to pay for it. And when you get into the very high-priced necessities like heart surgery, spinal cord treatment, autism supports or long-term care, very few of us could afford the cost. Health risks are universal and often unpredictable.
Although government funding debates at home are just as lively as the one in Guilin, particularly in these days of decreasing government revenues, the fact that Canadians have universal healthcare coverage is a blessing we often do not appreciate as much as we should. New parents who have a baby with Down Syndrome who needs heart surgery can have it done immediately with no downpayment necessary and full coverage. Parents with children who have autism can at least receive physical and psychiatric healthcare, if not appropriate social services. Adults with developmental disabilities receive the full range of acute care services instead of a reduced fee schedule unacceptable to most physicians as in the US. Canadian long term health services are regularly denied to people with developmental disabilities, however, and this is an area where we must all stay vigilant in terms of discrimination.
No country anywhere has good healthcare coordination, but the Chinese idea of having follow-up as a critical component of psychiatric treatment in order to prevent future hospital admissions and maximize the person’s participation in community makes a great deal of sense. In B.C., follow-up is usually the first component of any treatment to go. Community care is not a luxury but an effective low-cost alternative to hospitalization. We can work harder, smarter and accept greater responsibility for our own health, but we also need to demand that our governments continue to demonstrate that the health of our people is our number one Canadian cultural value.
When asked about Alzheimer’s treatment, the Guilin hospital staff admitted that this was a challenge and all they could really do was delay degeneration for some time in spite of medical and behavioral treatments. They also found that prolonging mental health for people with Down’s Syndrome was much harder. With an aging society, longer lifespan and physically healthier seniors, Alzheimer’s and other dementias are increasing in prevalence quite rapidly. In North America the same is true – 50% of Americans over the age of 85 have Alzheimer’s.
In China, couples have a pre-marital health check-up and a chromosomal screen prior to marriage and also have prenatal counseling. Pregnant women receive medical attention before, during and after birth.
Fetal Alcohol Syndrome is not a problem in China because women traditionally don’t drink. The families of both partners also supervise pregnancies, so there would be a great deal of family pressure on a pregnant woman who began drinking. There are also public education initiatives that teach people about healthy pregnancies. Dr. Liu’s clinical observation was that other than genetic syndromes, developmental disabilities occurred primarily during pregnancy through dehydration, fetal infection, fever and environmental effects.
It was difficult for the psychiatrists in our delegation to determine what medications were being used in treatment because the Chinese have different names for all of them. In China, the name is generally descriptive of the result or the action of the medication rather than a brand or chemical name. Chinese people also tolerate medications at lower doses than Caucasians, so their prescribed dosages of Western medications is generally lower. For example, the average dose for Caucasians of aspirin is 300 mg., whereas for Asians, its 100 mg.
Regardless of the issues in China’s healthcare system today, it is improving. In previous years, two women would regularly give birth in the same hospital bed. Now they can each have their own bed and access good care, but there is a price.
After a fond farewell to Dr. Liu and his team, we joined our guests at the Park Hotel for a lovely lunch overlooking a beautiful Guilin lake. As we discussed funding and the universal difficulty of obtaining services for families of people with developmental disabilities, we talked about the lobbying success of autism family groups and the current trend of funding-by-diagnosis in North America. Families are often doing all they can to get a diagnosis of autism because that’s the only way they can get funding for anything and if they can’t – “They sue us!” exclaimed Shona, the OB-GYN who was our guest from Ontario. It was true. If families have exceptional expenses associated with their child’s disability and government funding is unavailable or woefully inadequate, their only option is to sue the obstetrician, even though most of these law suits are not successful. All the more reason for adequate, universal health care – including social services and rehabilitation funding.