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​​resident Bobby Yanagawa and cardiac surgeon Dr. Robert James Cusimano
Former PMCC surgical resident Bobby Yanagawa and PMCC cardiac surgeon Dr. Robert James Cusimano communicate with Xinxiang Medical University staff in China’s Henan Province (Photo: Bobby Yanagawa).

"It's another way to open people's minds and eyes up to what the world is really like."

These words inspire Peter Munk Cardiac Centre surgeon Dr. Robert James Cusimano to make annual teaching trips to China. Every year the Xinxiang Medical University in Henan Province south of Beijing welcomes him as a teacher from abroad.

"They – even the staff surgeons – are so thirsty for knowledge, it's amazing. Whenever you see that kind of enthusiasm, it's good," said Dr. Cusimano.

A Canadian history in China

According to Bobby Yanagawa, a Canadian doctor named William McClure founded and built Xinxiang Medical University in the late 1800s. Yanagawa is Dr. Cusimano's former surgical resident who has travelled to China with him.

In 2006, Dr. Cusimano accepted an invitation to join the celebration for the hospital's 110th anniversary. He travelled with an anaesthesiologist from Toronto General Hospital who had been raised in the town of Xinxiang.

"I really enjoyed teaching them," said Dr. Cusimano.

That first trip inspired a long-term project to help Xinxiang Medical University's knowledge-base grow. This area of China isn't as medically advanced as Beijing or Shanghai. One of Dr. Cusimano's goals has been to raise the standards of learning closer to Canadian levels.

"You do have to be careful about what you tell them," said Dr. Cusimano. He's been asked to perform a heart transplant in Xinxiang. "There's no way in the world they're going to be able to do that."

For now, a complex procedure like a transplant would be too dangerous because of the lack of tools and support.

Steadily, his Chinese students' expertise in handling complex surgeries is growing.

"I have noticed each time I go back that their levels of knowledge are better, "said Dr. Cusimano. "Just the fact that I go back every year is incentive enough for them to continue to raise their standards."

That's one of the biggest challenges – making sure that the learning continues in China while he's in Canada.

"I've been trying to set up a clinical skills lab for them, so when I'm gone they can work on their skills. They call it the 'Cusimano Clinical Skills Lab,'" he said with a laugh. With a new clinical skills lab, the students would be able to practice physical skills, like stitching blood vessels.

The teaching has been a two-way street and Dr. Cusimano's Chinese students have also taught him an important lesson.

"I've learned you can do a heck of a lot with much less than what we have here," said Dr. Cusimano.

Double the learning

Education -- both in Canada and abroad -- has always been a priority for Dr. Cusimano. Two years ago, he started inviting his students to join him on his teaching trips. So far, he has taken three students with him.

"I think it was natural for him, an extension of his spirit of mentorship at the Peter Munk Cardiac Centre," said Yanagawa, who accompanied Dr. Cusimano on two recent trips.

"The idea is to open people's minds up to different ways of life, to the different educational experiences of residents who are the same age as them and to the challenges people have in different parts of the world," said Dr. Cusimano.

Yanagawa's experiences in China have taught him about life abroad and just as importantly, his own skills and abilities.

"You see what people can do when they have such little resources. It humbles you," said Yanagawa. "You really do fall back on your basic training, all of which I learned at the University of Toronto."

Yanagawa's visits sparked a passion to study and treat Rheumatic Valve Disease. This disease accounts for most cardiovascular-related deaths among young people in developing countries but no specific treatment exists. It isn't prevalent enough in Canada to be studied, explained Yanagawa.

Dr. Cusimano helped Yanagawa secure a professorship at the Xinxiang Medical University, ensuring another Canadian will continue to visit and teach the medical community.

As a professor of the Division of Cardiac Surgery in Xinxiang, Yanagawa will be able to study treatment methods for Rheumatic Valve Disease and educate local medical staff at the same time.

"They have committed to our collaboration and this is a great sign moving forward," he explained. "I am excited by what we can do together to better understand this important but neglected disease."

Expanding knowledge enhances care

While he hopes to continue his trips "for a long, long time," Dr. Cusimano's ultimate aim is that the Xinxiang Medical University will no longer need him.

"My goal for that area of China is that we're going to set up a really viable teaching lab and they're going to have that as a nucleus for teaching in that part of China. It's going to start with cardiac surgery, but then it's going to spread to other parts of surgery," said Dr. Cusimano.

"Hopefully people from other universities will one day go and learn there. I want to give them a formal way of learning and then I won't be needed anymore."

Once the people of Xinxiang have enough knowledge to be independent in their healthcare teaching, Dr. Cusimano hopes to take his skills from the Peter Munk Cardiac Centre to another place in need. Yanagawa echoes these hopes.

"In Canada we are so fortunate to have so many resources," said Yanagawa. "Perhaps we should be getting out there more to see how the other 90 per cent live."

Where will Dr. Cusimano go next?

"Anywhere that will have me," he said.

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