COVID-19 writing from Zhejiang Province in China - experiencing health information and life

17 February, 2020

Dear Neil and our HIFA community, [*see note below]

Greetings from Haining, where the Zhejiang University International Campus is based and currently, we are the second province with highest number of COVID-19 cases. Luckily our city with the size of Boston has only 4 individual in one family and the response with preventive measures since the beginning of February is significant including the limited quarantine that allows us to go out but prevents the entrance to places where we do not reside.

It has been very long time since I first joined our HIFA community of health leaders that are striving to create an impact by giving support and sharing knowledge to be disseminated freely to reach the furthest patients globally and to empower health professionals to deliver services to improve health and wellbeing of everyone. Since that time I've left the work assisting refugees relief and development in my birth place of the Balkans, worked extensively in the Middle East specifically on occupational health and than in the USA and Canada with universities such as Northeastern and McGill mentoring and guiding health leaders to strive to deliver the seemingly undeliverable. Never I thought I will be in the center of a pandemic where my medical knowledge will not be used at all even, I would be a great value added to the professional or the volunteer community.

We live and work in China since last fall, when myself, Global Health Adjunct Professor at Northeastern University in Boston Massachusetts, joined my husband who started his new job here. We never imagined that the journey will take us in 2020 through this pandemic that will be rolled into our lives while I was away on an international trip, while in same time we received results of his year medical with recommendation for cardiology follow up.

I will continue with, we truly enjoy living and working in China and learning to navigate what is a totally different culture, but it is absolutely not easy to be an international in cities that are not Shanghai or Beijing, but luckily WeChat has a translation function that makes the life easier. The people are amazing and very helpful in Haining, but the system is not yet created for engaged inclusive newcomer friendly experience and the university office could have prepared for this better if there were guides and services that we had experienced while living in the Middle East.

To say the least the university did not reach out to us during the time of the holiday even the emergency preparedness of the government was rolled out, flights were canceled, cities were closed and there was flowing information mainly on WeChat that is similar to WhatsApp with shared as Facebook common area for users stories. I flew back in Shanghai on the 26th of January on Delta flight from LA. The airport was well organized and without panic or long lines. Having a driver to wait for me made it simple to get back home which is almost two-hour drive from Pudong International Airport. The checkpoints to get in Haining in few places measuring temperature and checking documents gave me reassurance that things are starting to be addressed for the control and prevention. Since there were no cases reported in Haining the city was very strict on its policies implemented in the next days.

We offered our work to the citywide volunteers group and were told that all is organized and no need of others to participate at the moment. Probably we maybe not the best to serve as neither of us speaks Mandarin, but we could have maybe worked on helping pack boxes or anything....writing health information messages for foreigners in the province. Luckily many international and Chinese students have returned home for the Lunar New Year, so the campus had no necessity to deal with a massive group on campus. However, the services could have addressed the sharing guidelines and information right during the holidays, assuming they were given the right signaling to initiate responses.

Going into February, I learned more through accessing various sources of the communities I belong to, where information was shared and could learn more from the alerts circulated by the USA embassy and my university back in Boston that has diligently kept us informed and alerted. I have shared with the top leadership the concerns and remarks on what I have recognized that was lacking as information and support and was reassured that all will be taken into consideration for improvement of services for faculty, staff and students. It was shared that it is recognized that the initial handling could have been better from the start of the pandemic in December if it was made publicly available that it is transmittable from human to human.

The days are passing since my husband's flight on the 31st of January was canceled and today, I went for the first time at the campus clinic to pick up his cardiac medicine refills. We are well assisted by the staff while everyone works from home as the ministry has issued request to delay the start of the semester until further notice. For the first time online lectures are becoming in the center of interest and someone will definitely capitalize on this demand. I do hope that the doctor's community will come out with stronger and more respected position in the society in China after this time. I say this with sadness from past witnessing and hopes in my thoughts as I do believe that the public health system in China is well organized. The universal coverage offers access to health for all, yet when you come to the doctor's office patients do not wait to enter and give privacy to the other patient and the doctor for the exam. This was in non-emergency time when I had an eye exam in the fall of 2019. All is smooth and automated until you reach the door of the doctor's office that is widely open, patients swamp into it and try to ask for attention the overwhelmed doctor. I had to let dozens of people in front of me until I realized they keep coming and I had to ask them to stay out until I get the exam. Being there with a translator to be more difficult. I wish I have mastered Mandarin in my previous life!

We are now deep into the third week of February. There is a case in Boston and some in other cities globally. One of my mentees started today her first job with CDC in Boston, applying the knowledge from her master's, being public health advisor, which makes me proud that somewhat, part of my knowledge or assistance and guidance is going to contribute to stopping this pandemic while I continue building my global health diplomacy syllabus, develop further the mentorship practice for young professionals, however nothing being used by the local community and school here. Maybe I get an opportunity to start teaching from September here or I continue with PhD research.

We have a great data now well presented through daily briefs and receive reassurance about the readiness and confidence in fighting the pandemic, while we continue to hope to have enough information in each important time, we need to make decisions as individuals and professionals too. We hope to see the learning outcomes of this tragic circumstances teach the communities in different sectors on how fragile we are and how we all deserve to have resources to navigate what may be the best solution for many of us guided with the principles of the Hippocratic Oath (refresh your knowledge with its text at the end of this message).

Uncertainty is hard to navigate, but I always love to say that we are at least not refugees and have home to live in and means to support us. The access to various websites is much harder since last Friday and it takes longer for them to open. We know that the measures in place will work where we are but not sure how long it can take for recuperating and restoring the normal life in Hubei and Wuhan where more lives are lost each day. It is a tragedy that will teach us what we can improve in this well connected yet so siloed world we live in. It is more than ever widely recognized that access to health information is essential and we cannot move to reach the SDG3 and all the other 16 if this is not taken into account. Please forgive me on the length of this short novel that I postponed drafting it since the weekend, but what better day to write it if not on the President's Day celebrated in the USA where the healthcare calls for rebalancing through cultural communityship guided by the health professionals, not administration/pharma/insurance industry, to sustainability and universal health coverage for all.

With my best regards,

Dr. Tatjana Martinoska Kobb

The Hippocratic Oath: The Original and Revised Version:

Life is short, the art long; Hippocrates once said of the art and science of medicine. The Father of Medicine, Hippocrates, upheld high standards for treating patients and laid down these rules for all to-be physicians to follow. His testament came to be taken as an oath on finishing medical school, as a rite of passage.

In this article

1 The Classic Hippocratic Oath

2 The Revised Hippocratic Oath

3 Download & print posters of the Hippocratic Oath

4 Share this:

The Hippocratic Oath is the oldest and most widely known treatise on medical ethics. It requires new physicians to swear by numerous healing gods and dictates the duties and responsibilities of the physician while treating patients. There are two versions of the Hippocratic Oath: the original one and the modern one. The need for a revision was felt as drastic procedures like abortions & surgeries became commonplace and medically valid, questioning a physician's morals anew.

Let's consider the classical one:

The Classic Hippocratic Oath

"I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.

I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master's children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else.

With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.

Nor shall any man's entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will give no sort of medicine to any pregnant woman, with a view to destroy the child.

Further, I will comport myself and use my knowledge in a godly manner.

I will not cut for the stone, but will commit that affair entirely to the surgeons.

Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.

Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.

If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate!"

This Hippocratic Oath has been modified and revised several times. In 1960, the words “utmost respect for life from its beginning” were added, making it a more secular concept, not to be taken in the presence of gods but in front of other people.

The Oath was rewritten in 1964 by Dr. Louis Lasagna, Academic Dean at Tufts University School of Medicine and this revised form is widely accepted in today's medical schools. The modern or revised version of Hippocratic Oath is:

The Revised Hippocratic Oath

"I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.

Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.

Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter.

May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."

Thus, the classical Oath of Hippocratic involves the triad of the physician the patient and God, while the revised version involves only the physician and the patient, reliving [relieving] the Gods of a few responsibilities.

HIFA profile: Tatjana Kobb Tatjana Kobb is a Medical Doctor and founder of Boston Sustainability Advising. She has worked on developing strategic programs for international organizations, national services providers and universities from UNICEF and WHO to Qatar Petroleum and King Abdullah University of Science and Technology. In the past decades she has mastered stakeholder engagement and relationship management toward building strategic partnerships to ensure each organization’s mission can be realized to ensure the best interest of the served community. She is passionate about leading and enabling delivery of best services and products in line with the UN 2030 Sustainable Development Agenda and implementation of the 10 Principles of the UN Global Compact. Working on reaching the 17 Sustainable Development Goals (SDGs) by stakeholder engagement and performance improvement of governments and organizations she has a role in mentoring and supporting executives, as well as youth leaders in their career transition and development is in addition to her PhD work at the IEDC Bled School of Management and the GRI G4 reporting she conducts. She is a HIFA Country Representative and member of the HIFA working group on Information for Citizens, Parents and Children and the HIFA working group on Mobile Healthcare Information for All.

[*Note from HIFA moderator (Neil PW): Tatjana, on behalf of us all, thank you so much for sharing your first hand experience of living in Zhejiang Province, the second most affected province in China. The WHO Director-General gave a moving speech on Friday at the Munich Security Conference: 'We are encouraged that the steps China has taken to contain the outbreak at its source appear to have bought the world time... We’re encouraged that the global research community has come together to identify and accelerate the most urgent research needs for diagnostics, treatments and vaccines... But we also have concerns. We’re concerned by the continued increase in the number of cases in China... We’re concerned by the lack of urgency in funding the response from the international community... We’re concerned about the levels of rumours and misinformation that are hampering the response.' He ends with the words: 'This is a time for facts, not fear. This is a time for rationality, not rumours. This is a time for solidarity, not stigma.' Facts, rationality, solidarity. Thank you Tatjana for generously sharing your personal experience in this way - so valuable for all of us working in global health. We hope you, your husband and others in Zhejiang Province and beyond will remain safe and well, and that life will return as soon as possible to normal. Neil PW]