zaterdag 7 februari 2015

Lost in Shanghai

He was lost in Shanghai.
Was it hubris just to walk in this Chinese metropolis alone without a map and a vague destination : the Bund.
Why didn't he just stay in his room, eating e-mails and go to bed early before moving back to France the next day.
Was it the fact that you can't leave Shanghai without having a walk at the Bund and having a look at the Huangpu river and the skyscrapers of Pudong or was it an attempt in vain to organize and control the overwhelming impression of this Shanghai experience.
He had been alert enough to take along a business card of his hotel with Chinese characters just as a last resort guarantee in case of total disorientation.
A Chinese man must have seen him staring in an indefinite direction and asked him in fluent English whether he was lost.

The Bund", he answered : “I'm looking for the Bund.
The men proposed to accompany him for a while and told that he was an electric engineer educated in Shanghai and now for several years working in Canada in a city near Vancouver.
"You earn four times as much as in China or in Europe" he explained "and life is not more expensive over there".
He was visiting his Chinese girlfriend and he hoped once to return to his home city to create his own business.

After another tourist intervention, Tuur got on track.
A Chinese hooker tried to seduce him to leave the main road but in vain.
After a walk of about three quarters of an hour he arrived at the
He had expected traffic jams and crowded noisy streets with bars and restaurants with a marvelous view on the Pudong skyscrapers.
But none of this.

He should have known that China seldom reveals what is expected.
He remembered that he was told at the first night that the big towers were not continuously enlightened anymore because of the huge consumption of electricity, so he could only gaze at the dark silhouettes of the “key opener tower” as she had called the Shanghia World Financial Center the day before.

The Chinese guide had invited him for coffee at the 97th floor of the giant to enjoy the view over Pudong and the Shanghai Center.

"Call me Lisa", she proposed Tuur, "we all have a European name to make foreigners feel comfortable".
The young Chinese worked as an English teacher for medical students.
That morning, she was proposed to him by John to guide for a tour throughout the city.
She didn't start with long and encyclopedical history talks and funny details about the city, she wasn't continuously pointing at different buildings with names and dates and there was no program for the visit.
So Tuur understood that she was not an ordinary guide, as she admitted, and except for a visit to the Old City, the French Concession and the Pudong area, they rather visited universities and hospitals on his request.

During long traffic jams and lunch and dinner they mainly talked about medicine, teaching and management especially focused on differences between Chinese and European culture.
Tuur emphasized that Shanghai and probably big parts of China had made a gigantic progression in the last decades with as result that economic activity, living standards, technology and educational level were comparable to the US and Western Europe.
Because of the failure of the communist system in Russia and many other countries in the eighties, Europeans were convinced that there was a strong link between capitalism, democracy and freedom of speech but China seemed to contradict this hypothesis by being an economic giant within a strong hierarchical and controlling one party system.

Lisa didn't seem to be limited by big brother while formulating her ideas and thoughts She mentioned growing physical violence to doctors by patients.
Because good healthcare is more and more being thought of by the Chinese people as a right and knowing that there was a very low tolerance for mistakes in the Chinese community, this hat created a thorough frustration within a broad proportion of the population, especially for low educated people who had unrealistic expectations to medicine.
Tuur replied : "Maybe China has adopted the irrational belief of Western world that healthcare and medicine are able to conquer definitely illness and pain.
And death is not anymore an event that hits you at the moment in a way you can't predict but in euthanasia, it’s reduced to a decision under complete control of the patient and the medical administration.”

During another traffic jam, she mentioned that young people were very connected to the international world but that nevertheless the educational system was still very much focused on knowledge transfer.

In her work, she encouraged students to elicit their own meanings and to discuss freely about all kinds of subjects
Tuur referred to the copy culture as many Europeans think about Chinese industry and wondered whether China could or wanted to move from economic development based on smartly doing business and hard-working to an economy with emphasis on innovation, ecology and sustainability.
"That's exactly what at this moment in China is happening", Lisa answered, "or at least it seems to be the intention.”

Tuur wondered whether the evolution to a full-blown democracy was just a matter of time or on the contrary an illusion regarding the history and cultural identity of Chinese people.
Was it the doctrine of Confucius that shaped the Chinese society into an hierarchical, hard-working, disciplined construction or was it the political, economical and cultural autocratic dominance that had been occurred during ages of emperor dynasties.
But from the other hand, shouldn't we forget that Europe also had its kings and emperors and in recent history great dictators as Hitler, Mussolini, Franco, Stalin and Milosevic.

Some believed that the extremely efficient execution of projects by Chinese was due to a kind of military discipline although it had also to be concluded that this had not been a good medicine against corruption.
During the last year, the government was heavily involved in chasing corruption and several high-ranking responsibles in society were accused and moved away from their position.

But Tuur’s Chinese project hadn’t even yet started.
A few weeks before, the trip to Shanghai of the French team had been cancelled.
Bert, Tuur and Walter had prepared the visit for several weeks as they were asked to setup a hospital management program in order to meet the growing needs for management expertise within the Shanghai hospitals.
It was John, a Chinese consultant who had lived for many years in France, who had mentioned the request to Bert, who works for Novellas, a French company with several branches in China.
Bert had invited Tuur, who had 25 years of experience in hospital management, to consider the offer.
He brought in Walter, assistant professor of the Paris Management School and responsible for the healthcare management unit.
The Shanghai hospitals had wanted to set up a hospital management program with a famous European business school and the Paris Management School had a good reputation and had already established a general management education program in Bejing in cooperation with a local university.
Setting up such a program and embracing the significant cultural and financial differences between health care delivery in Belgium and China needed a thorough preparation and in that perspective, Tuur, Bert and Walter had agreed to come to Shanghai for discussing and preparing the program.

When the meeting was canceled because of organizational reasons, Walter and Tuur couldn't hide their regret and frustration from the point of view that a canceled invitation, when guests are prepared to come, doesn't seems polite and respectful.
They were taught by Bert that reality in China was less predictable and controllable in the preparation phase because often new circumstances modify plans and that sometimes Chinese people take their time to find out whether they can understand and trust their potential business partners.
It reminded Tuur to the “tribute system” within China in the 17th and 18th century when European leaders and businessman had to bring gifts to the advantage of the emperor often without the opportunity to be received at the.Court.

Tuur’s curiosity overruled his frustration and he decided nevertheless to move to the Far East with Bert as a guide to taste the flavor of Shanghai in order to better understand the project and its opportunities.
Tuur experienced an anxiety attack as he received his visa the day before departure.
After a 12 hours flight, Tuur  landed at Pudong Airport where he was welcomed by Bert and  John and it was a relief for Tuur that he could shake hands with one of the email ghosts he had been communicating with during the last weeks.

John explained the difficult circumstances and the inability of hospital staff to discuss the program at that moment but reassured that the program would move ahead.
The budgets was already allocated and that there was a strong willingness to establish the program.

On the second day at the fancy MINT-restaurant, Bert and Tuur discussed about the magic of the city and the opportunities for business in continuously changing environment..
“But if I want to do some shopping for dinner, it takes me about 1h½”, Bert complained : :”Anyway, when I mentioned to my wife to move to Shanghai three years ago, it took her five minutes to decide, now we’re supposed to come back to France, it took her quite a longer time…”

The next day at the occasion of the city tour, Tuur visited a leading hospital where he could  freely walk around and take some pictures because the hospital was linked to the University where Lisa was teaching.
Generally buildings, medical equipment and process design of the clinic were comparable to modern European hospitals except the fact that at different points in the hospital, patients seemed to be a bit pushy in an overcrowding environment.

John later explained that there were one, second and third tire hospitals in China and because of the free choice of the patients, the first tire top hospitals were overcrowded.
In contrast, the third tire clinics were confronted with a lack of occupation and attendance.

The day after, Tuur and Bert visited the Shanghai Children's Medical Center.

This 500 bed hospital was exclusively dedicated to children from 0 to 18 years old and had been developed to a reference center for the whole country especially for cardiac surgery and oncology.
They had all modern medical equipment at their disposal except proton therapy that was established in two independent centers in Shanghai as a referring site for all the hospitals in the region.

During the visit, Tuur noticed that local artists worked to transform grey corridors to fairy tale landscapes.

Great was his surprise when he found out that within the electronic medical records Chinese marks were emerged on the screen by tapping small sets of European letters on a traditional keyboard.

Tuur realized that for every Chinese mark, there was a correspondence with a set of letters which referred to the pronunciation although every letter combination could corresponded with different characters which were popped up to present the possibilities of choice.

He was explained that healthcare was basically financed by government and the health care expenditure in China didn't exceed 5% of gross national product.
Nevertheless mean life expectancy and birth death were similar to those in Western countries with an healthcare expenditure from 10 to 18%, a doctor emphasized not deprived of a proud feeling.
Only a small part of costs for salary of staff and equipment and also big infrastructure projects were financed directly by the government whereas 80% of the budget had to come from the middle and upper class segments of the society as an out of pocket or insurance contribution.
One could imagine that hospitals had to focus on wealthy people in order to meet the budget especially when they have strong ambitions in terms of professional level and quality.
It had to be noticed that the hospital had obtained already twice a JCI accreditation!
So they became magnet hospitals not only for the rich but for every Chinese regarding the freedom of choice and especially for children who were very precious as a consequence of the one child policy during the last decades.

After two hours of visit and discussion, Tuur was mesmerized by the transparency and willingness to share.
The doctor ended up the meeting and left.
Tuur was told that he was very influential in setting up the hospital management program in Shanghai…

Staring from the Bund to the Huangpu river, Tuur realized that in Chinese world, it's very hard to get what you’re looking for.
But if you persist, you might find something else than expected, at the beginning poorly understood.

At the moment you’re forgotten your initial target, change has occurred and new expectations were born and hopefully fulfilled. 

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