From the heart of Beijing to the edges of the global stage, you're at Roundtable.
I'm Niu Honglin.
Around the world, access to specialized health care often depends on geography.
In China, a new experiment is testing whether aviation can close that gap, not by evacuating patients, but by flying the hospital itself.
For today's show, I'm joined by Fei Fei and Steve Hatherly.
Now pull up a chair and join the conversation.
There was no ribbon-cutting ceremony, no futuristic lunch video, but with a single regulatory approval, China has just quietly turned a passenger aircraft into a licensed medical institution, one capable of diagnosing, treating and even performing surgery after it lands.
Now the country's first flying operating room, can perform complex surgeries not just in major cities, but on the well tarmacs of remote regions as well.
So this sounds very exciting and high-tech, and I want to know all about this new airplane hospital.
Yes.
So, first of all, the approval comes from Shanghai that recently the Municipal Health Commission officially issued a pilot license to I and ENT, which is Ear, Nose and Throat Hospital of Fudan University, to operate an airplane hospital.
That is basically a facility focused on facial health that was converted from a C909, a short to medium range aircraft domestically developed in China.
And this aircraft has been operating for several months, actually.
It debuted in September last year.
And they actually flew to Xinjiang as their first stop and then trialed how they can help local residents in terms of their eye, ear and nose throat issues.
Yeah, so at that stage and this plane, by the way, was jointly developed by the hospital that Fei-Fei mentioned, the INENT Hospital of Fudan University
Good hospital.
Yeah, also together with the Commercial Aircraft Corporation of China.
So they worked together to design this aircraft not the aircraft itself, but what happens inside the aircraft.
Very much needed.
Yeah, but at the beginning stages it was all about consultations and examinations, also training local doctors and also remote diagnosis through 5G networks.
And it was about proving one thing first that was crucial.
And that thing was that high-level medical expertise could move with the plane and reach places where it struggled to cover before, into remote areas in the countryside first.
Since that time, the project has been, as you said, quietly evolving.
The aircraft itself.
It was upgraded step by step, by step by step, and it was transformed from a basic flying clinic into something far more complex and capable.
So we know that now the plane is already on the move.
It's able to do things and it has done things.
And one thing very interesting about this is that we know this is already a class one clean surgical cabin on an aircraft.
The idea itself is not that novel, to be exact, because the Something that can move around and cure people has been existing here in China for quite a long time.
Ever since 1997, we've got to the very first train hospital.
They call it the Health Express.
It is a mobile train hospital.
At that time, the only charitable eye hospital in China that was built on a train.
And that train hospital, ever since 1997, has traveled to 28 provinces and regions and cities across China.
It stopped at 202 stations.
Of course to remote areas and it can help patients with their eye problem already.
So the idea of moving the health or medical crew to remote places.
That idea itself is not new.
But for this one, well, first, it's on an airplane.
It's something that has never happened before.
And this Class 1 clean operating room is also groundbreaking.
Yeah, so there are four levels of clean operating rooms.
This was new information for me.
I didn't know this before.
But they have Level 1, that's the highest, to Level 4, which is the lowest and a level 1
It is the most sterile.
It is designed for high-risk surgeries, for example, like an open-heart surgery or something like that.
That would be level one.
Very clean.
Yeah, exactly.
Well, it has to be, right?
Organ transplants, things like that would qualify as well.
So that means, yes, cleanliness, but it also means safety as well.
And that's why integrating a class one, clean surgical environment into the C-909, into the airplane environment, is such a technical achievement.
The interior of the plane it's more than just first aid, of course.
It's designed for these really delicate eye and ear, nose and throat surgery procedures that restore sight and hearing, and that's why the standard is so high in terms of sterility, and this is really having a transformative impact on quality of life for the people who are able to take advantage of this.
And it proves that it can be done.
Yep, they did it on a train before, but now they've proven that it can be done on a plane and it's a new benchmark for mobile medicine.
Yep, the concept itself existed before, But this kind of achievement on an airplane has not been achieved.
So for those of you who are not that familiar with the system here in China, actually here in the country, the idea of allowing top-notch doctors to go to remote areas is has been a longstanding tradition.
My mom is a doctor and herself, as well as her colleagues, teams in the hospital.
They have very long-lasting programs asking sometimes young doctors, sometimes very mature doctors specialists, to go to remote areas.
And this is not the case for only one hospital, it's for almost all of the good hospitals around the country, and they even have designated areas or designated grassroots hospitals that they send help to every single year for a period of time and for those doctors they go to the villages, they go to remote areas And they would do things like not only treating patients but also, for example, teaching doctors there and even setting up a certain system so that, when they leave, the doctors there would be able to have a better system, a better routine, a better protocol to treat patients.
So when they're there, yes, these doctors are experts.
Or maybe some young doctors.
So they're not only specializing on their own, let's say, specialty.
They would treat doctor from a general surgeon's or general physician's perspective and then give them special treatment.
I mean, specialized treatment.
So that's the system here in the country.
And besides that, we also have a system that is allowing people, not only from the medical area but all around all walks of life, to help remote areas.
Say you're a construction worker or you're a urban planner and you work in big cities.
You have the knowledge and expertise and everything.
And you would have the choice of going to remote areas like cities.
Little villages in Xinjiang or in Xizang, those places would need the talent.
And that program also has been going on for quite a long time.
So I think this one, if we are looking at cases like this, this one, taking Xinjiang for example, they can also do a lot in under these framework.
Exactly.
As Honglim said, that not only for local residents.
They have easier access, I think, to their top-notch doctors and medical resources, because we are talking about doing surgeries basically on these planes, meaning these doctors On the ground, by the way.
We should clarify that.
After it lands.
Yeah, because when I was looking at this story in the beginning I thought are they flying up in the air and doing ear, nose and throat procedures?
No, the plane comes and lands, and I think you mentioned it in the beginning quickly, the tarmac, the plane parks...
And then they do the procedures on the ground.
But in the beginning, I thought they're flying around.
And I thought, why don't they just land the plane first?
They just sort of basically flew all the equipment they need, as well as the staff they need and the whole crew, to the places so that residents they don't have to travel.
For example, in the case that we mentioned, it's from Xinjiang to Shanghai, which is basically nearly 4000 kilometers journey, and that can be thousands of yuan's of air ticket or 40 hours of a train ride.
It's either expensive or it's time consuming.
I mean even the flights about what?
Four to six hours.
Also, if you're traveling for surgery and you're thinking, oh okay well, what about other hospitals?
There must be some closer.
Well, we're talking about, you know, this hospital, um frank, from shanghai.
This is one of the top, consistently one of the country's top hospitals in terms of rankings for ophthalmology and ENT.
So for these types of procedures that need to be done.
You know we're putting this in a context that these people from other parts of the country if they wanted to visit there.
Yep, it's far away in terms of flights and And getting there by rail it's expensive.
And oftentimes, too, the people who need these procedures, they're not going to travel alone.
Yeah, exactly.
They'd have to travel with other members of their family or caretakers.
So that's going to multiply and multiply again the costs. perhaps.
And also they need to navigate mega city transport system and also you know different registration procedures at different hospitals and you know coming to, coming from a you know basically to a new place and you need to sort of navigate through this kind of complex and very new areas for you can also be very stressful at the same time.
And also you need to figure out where to stay accommodation, every meals, and if you're traveling with a patient, you also need to find a place to take care of that patient.
And in the case of, you know, ENT and eye problems, sometimes the patients have hearing or sight, you know, impairment.
That is another hurdle on the way, you know, it's just make more sense to transport, to fly the doctors on the site.
As complicated as it is, it is still a simpler option.
But when it comes to modern day medical services, I think about the top-notch doctors, but also think about the equipment.
The larger machines that you would see in hospitals, the very expensive ones For this airplane hospital.
Can they really operate on?
What kind of operations are we talking about?
They can.
If you think of a luxury car and all the amenities that it has inside, this is basically like a high-end car.
This is a high-end hospital airplane.
And what they can do is they can deliver complete medical workflow from the interior of it.
Screening diagnosis treatment rehabilitation, specialist consultation and training for the doctors as well.
All of these things can happen on board.
You asked specifically about the equipment, though.
Here's what they have.
It has over 10 types of advanced devices, which all, by the way, were developed by the hospital or in partnership.
One, they have an OCT scanner or scanners.
Those are high-resolution cameras that take cross-section images of the eye to detect retinal problems.
They have ENT endoscopes.
Those are those little tiny cameras that check inside your nose or your ears or your throat.
High definition though nobody likes those, do they anyway?
They have that um ar vision training platforms, 3d displays that's used for visual therapy and eye exercises.
Then i think i mentioned before the 5g enabled um technology is there as well, and that allows that's.
That's important because that allows for specialists which are thousands of kilometers away to examine patients in real time, making remote consultations possible too.
This actually reminds me of my trip to Tibet earlier last year, in the very beginning last year.
And when I was there uh, we interviewed a medical truck.
So instead of having an entire crew on the truck, what they have is a mobile ct scanner and they would be able to drive that ct scanner or that truck to remote areas and they went to sit down to give people ct scan.
It was right after a earthquake struck so majorly.
They were there to help those who are disaster struck.
Yet A lot of people with chronic disease would go line up in front of the truck and go up there and get the CT scan so they would have a better diagnosis over their disease.
And at that time I remember that car had its own cable and also its high altitude area and you have to wear the protective gear.
I mean the medical staff, would have to do that so that they are not hurt by the X-ray, radioactive X-ray.
And it's really noble and also, I think, arduous work.
And at that time, I remember those patients, many of them do not even speak Mandarin.
They speak their local Xizang language and it takes a local younger person.
Usually, the younger generation in Xizang would be able to speak both languages and they would act as the translator, telling them what the doctors are saying or suggesting.
Maybe you really do need to go to a local hospital and show them the CT scan so that it can help them diagnose and give you better treatment.
And sometimes it's not in that dire needs.
And the thing is, the patients at that time as I remember, I remember vividly the smiles on their faces.
Yeah.
I mean, the patients in this case, too, are are really enjoying this.
One patient who came for a follow-up after surgery said that he had never expected to have the procedure done on an airplane hospital.
He said that the doctor and his team that he worked with made him feel completely at ease.
And it highlighted the trust, I suppose, or the anxiety that some patients might have, which is kind of, maybe a little understandable.
First time on a plane.
First time procedure on a plane.
First time to the airport for some people, I'm sure.
But talking about procedures, what are they getting done?
Well, there was an older lady.
She had severe myopia and she had her procedure done completely on board.
There was another younger patient who was seeking laser vision correction.
That was able to be done.
Oh, really?
Allergy sufferers with nasal congestion could be examined using those fun little endoscopes that I mentioned before.
And then one post-eye surgery patient was monitored remotely by a surgeon in Shanghai.
And that was the first real time follow up between the two regions, two areas Xinjiang and Shanghai.
Really cool.
Yeah, and also that reminds me that by having these kind of medical visits from top-notch doctors in Shanghai to a remote area such as Xinjiang or Xizang, as Hongli mentioned, is also helped with awareness as well.
For example, from where I live when, like an elderly lady when she had suffered myopia, she may not fully aware the problem that she's having at the moment.
Most of the time she will just endure that discomfort or sort of inconvenience in her life and just pass by.
But when they have the opportunity on their doorstep with somebody with credentials and with experiences and resources, telling them you know, this is something that can be cured and we are here to help.
It actually also helps with awareness when it comes to health, because a lot of people in remote areas in China they are not fully aware some of the problems they have and there are actually treatments to make their life more comfortable and better at the same time.
That's a good point too.
Yeah.
And also when it comes to allergies as well, you're suffering.
For some people, maybe they're suffering from nasal congestions.
You know, put on some swallow, some pills.
If it's get better, well, it's lucky.
If not, we'll try some other medicine, but they may never, you know, get into the root of the cause.
And another perk of moving a top-notch medical team to remote areas is to spread the necessary knowledge to the doctors themselves, to trained doctors.
And that is something that the trained hospital we mentioned earlier is also doing, has been doing for quite a long time.
Yeah, this is kind of the added bonus, if you will, from having these types of services available when the airplane lands.
So, yeah, of course, taking care of the patients is a top priority.
But this time local doctors.
In fact, there were 16 from grassroots hospitals in the Xinjiang region.
They learned advanced INDNT techniques, and they didn't have to leave home to do that.
And they even practiced hands-on using the hospital's equipment, and the expert guides were there to help them learn.
And it built this self-sufficient medical team that was capable of continuing care locally.
And that's what I guess you were talking about before, Niu Honglin, when you said Yeah, sending doctors to an area to take care of patients is one thing, but also to train the doctors that are there to be able to take care of these procedures so that hopefully in the future there's no need to come back.
It sounds all rosy and pretty and high-end, a lot of cool equipment.
Must be expensive.
Definitely.
For example, I think we, for reference, we currently have some hospitals here in China that offer air medical transfer using, for example, in a city called Nanchang in Jiangsu province.
They have a program involving using helicopters in their medical services.
And their medical charges include a model of take-off fee plus hourly flight fee.
So for trips under 240 kilometers, there is a take-off fee for about 15000 yuan, which is 2200 US dollars, plus roughly 9800 yuan, which is 1400, per flight hours.
You can imagine the cost.
And it's only within 240 kilometers.
But this is for very dire situations, right?
If we're talking about the hospitals as well as the medical team, in this not remote just, you know, relatively developed areas.
Yeah.
But when it comes to, for example, the cases that we are talking about today, the C-909 airplane hospital, first of all it needs a hospital to working together with that airplane company to convert a airplane into basically a hospital surgical, you know, operating theater.
And that not only needs technology, that also means costs, and when it comes to traveling to 4 000 kilometers away, the cost of transportation, The cost of those equipment that we just mentioned, are all very expensive.
But all of their services currently are run on a charity basis.
So pro bono surgeries.
Patients do not have to pay.
Yeah, patients do not have to pay.
Not now.
But when it comes to if we are talking about scaling such services up.
Yeah, multiple regions, multiple airplanes, multiple flights all of a sudden everything gets far more expensive.
We need funds from different, well, coming from different, sustainable.
Sustained funds, yes, from different sources.
Yeah, then you've got to take care of these airplanes too.
The maintenance for airplanes is probably not cheap.
I don't own one myself, but I'm assuming it's more expensive than a car.
You've got fuel, you've got your staff salaries, you've got your equipment upkeep and replacement.
There's a lot of Overhead and there's a lot of continuing costs.
And taken into consideration that this one is developed by one hospital and an airplane company, we are not currently assuming that doctors are from all around the country, from different hospitals, right?
They're from this one hospital.
Mm-hmm.
Which means it's possible that if we're talking about really a high-end crew, there's not a huge pull to come up with to to form that crew of medical team on board.
Yeah, and also this plane, the C-909 pardon me is specifically designed for the procedures that they are able to do in there, from what I understand,
And you're right, it's from one hospital.
So, you know, I don't know how many hospitals are in Shanghai and Beijing and the other big cities or wherever the best hospitals are, but they'd all have to have their own planes And they'd all have to have the interior of those planes designed in a way that was suitable for whatever procedures they were offering.
But actually I checked online before the show that a number of hospitals actually are also working with the same airplane company, the Commercial Aircraft Corporation of China.
They're also converting C909 to C, for example, a Shanghai hospital called Reijin.
They're also collaborating with that company and to see if they can also have their own airplane hospital.
And another hospital based in Guangzhou.
They've actually done performed a eye surgery aboard that's the 909 aircraft.
So a number of hospitals in China are looking at that direction and sort of figuring out their own path.
But mostly I think the current services offered are mostly on I's and Y's.
And also we were chatting before the show.
Niu Honglin and you brought up a really good point which I think is important for this discussion is that there are indeed remote areas in China, but with connectivity in terms of rail and roads and things like this continuing to grow almost daily, then the number of remote regions, we have to assume will shrink in the future.
Precisely.
Remember the Chuang Hospital?
It has been there for almost 30 years.
And many things are happening to the Chuang Hospital because 30 years ago it was one of the most state-of-the-art train hospital with the best team, especially that is also for eye surgery as well and the medical staff on the train, especially the long-term one.
After, for example, nearly a decade of observation, One doctor said she observed or she realized different things.
For example.
The first is that because in different places, even in remote areas, because of the improvement of the medical insurance service and insurance programs for farmers and villagers,
They find that they are looking at, they are treating fewer and fewer patients because the patients would be receiving similar level of surgery, of treatment in the local hospitals already.
And also they find that the top-notch technique they used to have are no longer that top-notch.
It's seen at many different hospitals.
So they no longer have the quote-unquote edge when it comes to technology.
And the third thing is with them constantly going the train and the medical team going to different places in the country.
They have left behind a legacy in the sense that they trained the doctor there, they told them, they tell them what the protocols should be and they improved the local medical service, which is now their challenge.
They're trying to upgrade the training hospital.
So I'm also curious, about the future of the airplane hospital.
Now it's the best out of the best.
But we can only assume very quickly, like Steve mentioned, there won't be that many remote areas and maybe not that many lagged behind kind of medical service or institutions.
Maybe it's not as complicated as I assumed it to be.
One of the big questions that I had was about the airplane itself right, the C-909, because I thought how big is this plane?
And the reason I had that question is because runway length needs to be a certain length for an airplane of a certain size to land.
But the C-909.
It requires a runway between 1600 and 1900 meters, which is relatively short for an aircraft carrying medical staff and medical equipment.
And that means that it can operate at smaller regional airports.
And then I was curious oh okay well, because if the runways are there, well that means there's an airport there.
But wait a minute, if we don't have enough airports, that means we don't have enough runways.
So where's the plane going to land?
But Xinjiang, I found out that it has 25 airports.
Inner Mongolia has 19 airports.
Sichuan has 16.
Yunnan has 14.
So that doesn't seem to be an issue as well.
Yeah, exactly.
Because these places, they are mostly less populous compared to eastern regions in Shanghai.
And airplane would be a more efficient way of travel.
And then coming back to how, in the future of such airplane hospital would be.
I would imagine it's not only just about helping people in China.
And I think, as Hongli mentioned, the train hospital, not only are helping people in China, I think they're also going overseas, for example.
The reverse of medical tourism.
Yeah, yeah.
Well, kind of.
Yeah.
In the other direction, right?
Yeah, and also even have an ark.
It's called the Peace Ark.
It is a Type 920 hospital ship of the People's Liberation Army Navy of China.
And...
Well, it is also pretty cool.
It has the capacity of 300 beds, 20 ICU beds, 8 operating theaters, and can perform 40 major surgeries a day.
And it's mainly to carry out overseas missions.
So perhaps, like Fei-Fei said, in the future we can see this plane flying off to overseas places and helping people.
So no need to worry about the future of it.
Just fly.
Very excited to observe the development of that airplane.
Maybe our driverless taxis of the future will be robotic doctors inside, where you can get your eye procedure done on the way to the shopping mall or something.
I mean, that is the future of futures of futures.
I'm glad.
