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NATMA 2G 旅 Taiwan!! 2023

Updated: Jul 14, 2023

July 4, 2023

Cheryl Wu, MD, with additional reporting by Gary Chuang, MD

We started our third day with the same delicious breakfast buffet, and headed over to the Taipei Veterans General Hospital 臺北榮民總醫院. We heard from the hospital's vice superintendent, Dr. 李偉強 Wui-Chiang Lee, who described the hospital's leading Heavy Ion and Carbon Therapy Center with linear accelerator, which is not available in the US. Unlike the VA hospitals in the US, the 榮總 VA hospital systems in Taiwan are open to all citizens. The Taipei VA is the largest hospital and a leader in medical management of cardiac arrhythmia, Fabry disease (especially in the pediatric population) and renal anemia. We visited the Heavy Ion Center, which is replete with the newly installed machine ($150M USD - funded by 50% donation, 50% hospital funds), and learned about its history. The technology was improved in Japan, and has been in use since 1996 there, and has helped over 5 million patients with cancer. This machine is the first of its kind built in Taiwan. However, this service is not covered by Taiwan's single-payer system. Each treatment costs roughly $40,000 USD, and is only 1/3 of the treatment length of traditional photon therapy.

The team in Taiwan assured us that they do accept international patient referrals. I can imagine our patients with cancer in the United States, particularly those with refractory cancers, to want to come to Taiwan to seek treatments. We exchanged contact information, and NATMA is also planning a US-Taiwan Referral & Exchange Pipeline with these hospitals. We will keep you posted!

This machine? Oh it's just pocket change, $150M USD.

Our very own "GQ" Sheng-Han Kuo, MD, a neurologist from NYC

After a nice lunch at 蘇州杭, we visited 振興 Chen-Hsin Hospital, the home hospital of our lovely Taiwan 2G committee member, Dr Valis Tanapima 田知學. Chen-Hsin Hospital was initially founded by Madam 宋美齡 Soong Mei-ling to treat children suffering from Poliomyelitis. There were still tiny metal railings in the hallways of the hospital to support pediatric patients who learned how to walk again. The hospital is now well-known for heart transplant surgery (in fact, the Chairman of the hospital arrived late because he was mid-CT surgery). We were received by the Vice Chair of the hospital, and it was time for our own members to shine.

We proceeded to hear from six of our members about their respective work in the US. First we heard from Jeffrey Chen, MD, a pain specialist at UCSD. As an interventional pain specialist, Jeff presented various procedures he performs at his academic center, including nerve ablation with radiofrequency, and neuromodulation.

Next we heard from Peter Hou, MD, an EM and CCM physician at Brigham & Women's Hospital, who described his startup, iDoc TeleHealth Solutions, which delivers real-time, tele-critical care utilizing a robot with attachments that can examine patients at bedside. We all ooh'd and aaah'd when he demonstrated a (probably) 100x magnification view to exam the retina of a dummy patient.

Peter Hou, MD, EM/CCM from Boston gives us a glimpse of the future!

Then we heard from the youngest member of our troupe, Arthur Chyan, DO, a high-risk OB Anesthesiologist at UCSF. Impressively, Arthur delivered his entire speech in Mandarin! (He was born and raised in the US - who says Chinese school is useless?! 3Gs, listen up) He explained the difference between US and Taiwan OR management. Many questions were raised by the hospital physicians about the use of CRNAs and medico-legal concerns.

Arthur Chyan, DO, a high risk OB anesthesiologist, describes the miraculous properties of the uterus - in Chinese!

Next up is Sheng-Han Kuo, MD, a neurologist with a special interest in cerebellar diseases, from Columbia. He explained that the cerebellum actually has about 80-90% of all our neuronal connections, and holds the secret to the mystery of our brain. The chair of the hospital has arrived after surgery by then, and was quite intrigued by this factoid.

Sheng-Han Kuo, MD regales us with tales from down under (the cerebellum)

We heard from yet another 2G colleague, the inimitable Gerry Sheu, MD, who is the Director of the Robotic Surgery Center at Kaiser Permanante, Riverside, and a urologist. She described how she on-boarded a robotic surgery center at KP-Riverside, and her clever use of metrics (such as OR underutilization rates, surgeons' operating times) to inspire all members of the robotic OR team to be good at their jobs. I was struck by her ability to relate to every team in her OR, from the surgeons to the housekeeping staff. Her accomplishment stems from an exact combination of skills and knowledge, such as high interpersonal EQ, systems thinking, intense numbers/data utilization, and of course, her in-depth experience with robotic surgery. Take that, A.I.!

Speaking of A.I., we also heard from Linda Hou, MD, who is an endoscopic GI specialist (also at Kaiser Permanente). And she showed us an impressive array of A.I.-assisted polyp idenitification videos utilizing CADx and CADe, since ~25% of polyps are missed on traditional colonoscopy. However, the data is still out on whether these AI-assisted programs will lead to widespread utilization.

Linda Hou, MD talks about implementing A.I. in colonoscopies

From left, Christina Lin, DDS, Jeng Wei, MD, the Chair of Chen-Hsin Hospital, and Valis Tanapima, MD

After another round of photos (we are all getting used to massive photographing at this point), we proceeded to 草山夜未眠 Grass Mountain Sleepless Nights Restaurant (the name sounds waaay more romantic in Chinese, I promise) and took in the beautiful views of Taipei and the food. Afterwards, we all went back to the hotel to rest up, as we are checking out early tomorrow!

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