Pioneering doctor offers high-level comfort

Wu Tianyi is not a household name in China, let alone around the world, but thousands of Chinese have benefited from his efforts as will the increasing number of people who will travel to Qinghai Province and the Tibet Autonomous Region.
Workers building the Qinghai-Tibet Railway have Wu, a 68-year-old former physician in Xining, the capital of Qinghai, to thank for helping them to overcome the hostile climate.
"I studied altitude medicine and biology for 40 years; and was waiting for a day when my research would really help," Wu said.
The second phase of the railway project, which stretches 1,142 kilometres between Golmud, the second-largest city in Qinghai, and Lhasa, Tibet's capital, traverses wilderness with altitudes averaging over 4,000 metres. It peaks at an elevation of 5,072 metres at the Tanggula Mountain Pass on the Qinghai-Tibet border.
So when construction began on June 29, 2001, to link Tibet with the rest of China, Ministry of Railways officials knew exactly whom they wanted to be the top health specialist for the new line.
The goal was simple: to ensure that not a single worker would die of altitude illness.
When even a slow walk or slight exertion leaves many out of breath, the idea of working in such a hypoxic environment proved to be a daunting challenge for tens of thousands of railway builders.
Wu, now the only member focused on high-altitude medicine at the Chinese Academy of Engineering, is not a native of the plateau.
He was born into the Tajik ethnic minority in the Xinjiang Uygur Autonomous Region. His parents moved to Nanjing, the capital of East China's Jiangsu Province, and Wu attended senior middle school there.
The couple left Nanjing for Guangzhou and then to Taiwan before the People's Republic of China was founded in 1949, leaving Wu, then 11, to continue his studies. They were not reunited until Wu was 57 in 1992, when they first met in his parents' adopted home in the United States.
Wu first came to the Qinghai-Tibet Plateau in the late 1950s as a graduate of the China Medical University in Shenyang, Liaoning Province. At that time, thousands of people from Henan, a populous central province, were relocated to Qinghai, a sparsely populated region that occupies roughly one-thirteenth of China's total area.
"It was appalling to see one or two elders or minors would die along the road now and then when they moved straight from their hometowns on plains to areas at least 3,500 metres above sea level," said Wu, who was a member of a rescue team.
Then in 1962, a brief border war between China and India in the Himalayas taught Wu another lesson on the effects of extreme altitude.
A host of Indian troops from regions at sea level fell victim to such diseases as "high-altitude pulmonary edema" in the battlefield, and a few Chinese soldiers from Qinghai also reportedly died in the harsh natural conditions.
"These two traumatic episodes had set me thinking what I should do as a doctor," Wu said. "It was then I decided to dedicate myself to the study of altitude sickness, taking advantage of the fact that I worked and lived on the plateau."
Wu began to accumulate case studies. He was the first doctor in China to report cases of high altitude heart disease among adults in 1965, identifying it as the human version of the "brisket disease," an ailment caused by a lack of oxygen that was first found in 1915 among cattle grazing on a high plateau in the mountains of Colorado in the United States.
In 1975, Wu worked out a series of measures for the treatment of acute altitude sickness, which proved useful for health care on the railway construction 26 years later.
"'Descend, descend and descend' (immediately from higher elevations) has been a golden rule for handling patients of high-altitude pulmonary edema," Wu said. "But in the case of the Qinghai-Tibet Plateau, it should be applied rationally."
With no rescue helicopters, patients on the plateau used to be transferred by car from high altitudes to hospitals at the foot of the mountain.
But usually, the car would have to climb over several mountains with even higher elevations before bumping along to the destination at a lower altitude.
The odds were high that the patients thus transferred and treated would die halfway, Wu said.
"Instead, we preferred to give first aid to the patients on the scene, put them into a hyperbaric oxygen therapy, and when their condition is stable, medical staff will use pressure bags to transfer them to a hospital," Wu said. "In this way, they would most probably recover before they get there."
High-level training
In 2001, before construction of the Golmud-Lhasa phase began, Wu did more than offer helpful measures to the doctors and nurses treating the workers.
He shared his traumatic memories with government decision-makers, warning that they would earn "lessons paid for with blood" if they did not observe the expertise he and his colleagues had spent decades gathering.
Wu and his peers hammered out a set of special rules for the railway project.
First, only the fittest may go to the plateau.
A stringent medical check-up was devised to screen out those with such diseases as high blood pressure, heart disease and respiratory illnesses.
Second, those who passed the exams must be exposed to altitudes step by step, meaning they must stay at each lower elevation for up to a week before going higher and higher.
Last but not the least, every worker must be taught about altitude sickness so that if they show any symptoms, cases would be reported without delay.
"This last one really helped," Wu said. "One day, when a worker was staggering like a drunkard and could not possibly get through the gate to a clinic by himself, his colleagues and nurses immediately yelled: 'He has high-altitude cerebral edema'."
Wu's research also helped railway authorities develop other solutions to countering altitude-related problems. For example, they built 17 large oxygen-generating stations and set up at least 25 hyperbaric oxygen chambers on the construction sites on the plateau.
They also piped oxygen directly into the tunnel they were boring through, to make sure they at least had the same level of oxygen as if they were working in Lhasa, about 3,600 metres above the sea level.
The outcome speaks for itself: According to Zhu Hao, director of the health-care department at the Qinghai-Tibet Railway Construction headquarters in Golmud, 1,970 medical workers treated 12,307 hospitalized patients between 2001 and 2005, and all were released, with no deaths.
Qinghai Standard
Wu's research has extended much farther than the railway stretches.
When the Sixth World Congress on Mountain Medicine and High Altitude Physiology was held in Xining in August 2004, Wu put forward criteria to diagnose chronic mountain sickness that were accepted internationally.
The criteria, which have become known as the Qinghai Standard, also marked the first time the provincial name linked with any international standards, Wu said.
The contribution to medical science did not come easily. Starting from 1979, Wu and his team travelled to almost every Tibetan village on the plateau to conduct an epidemiology survey.
"My plan was to sample and survey at least 95 per cent of all the Tibetans in one given region," Wu said.
But herding Tibetans live on vast grassland. Sometimes households were 30 kilometres apart.
"I am a good rider on horseback," Wu said. "But to find the herdsmen, I'd have to get up at 5 in the morning so that before they went out, I could talk to them and do medical checks on them."
He made so many friends among the Tibetans that they began calling him "doctor on horseback."
But conducting research on the plateau was also risky at times. The journeys left Wu with eight broken bones. He also had several narrow escapes. But the sacrifices have been worth it, he said.
Future applications
As China's western development strategy continues to unfold, Wu said he envisions altitude medicine research benefiting more people in the years ahead.
For Wu, the Qinghai-Tibet Plateau is the best natural laboratory for people to research solutions to hypoxic situations. The results will also help treatment of diseases common on low-elevation areas, he said.
"That partly explains why I would cling to this land rather than migrating to the US, where my family stays," Wu said. "The plateau is the root of my career and, indeed, of my life."
Source: China Daily