by Ginger Kanzer-Lewis RN, BC, EdM, CDE, FAADE

In May 2011, I was invited to speak in Beijing, China at the 15th Anniversary Convention at the Beijing Exhibition Center. It was conducted and sponsored by what is now called the Tang-An Health Center and Beijing Tang-An Nutrition and Healthcare Products Company. It is an adventure I will never forget.

This adventure is about a journey and the promise of education to a group of people who are hungry for knowledge. It is about a person who had a dream to change the lives of the people in her country. It's also about a voyage that took both of us to a day that could only have been imagined 15 years ago.

That person is Nancy Cheng, MD, PhD, Founder/Director of Tang-An Health Center in Beijing. I met Dr. Chang 11 years ago at the AADE annual meeting in Louisville, KY when I was AADE president. She came to AADE because she wanted to learn about diabetes education in the United States. She wanted to see if what we were doing here could be transferred to China and if it would work in her diabetes program.

Dr Cheng had started teaching people in Beijing about diabetes 4 years before because she had identified a need to help her people and discovered that nothing was being done. She had done this on her own, with private funds.

How the journey began

In 1999, with the support of the Chinese government, Dr Cheng held a big convention in the People's Great Hall of China in Beijing. In this incredible hall, they invited 8,000 people to attend a half day session. Executives from Eli Lilly, Johnson & Johnson, Pfizer and BD were invited to the VIP stage. Larry Ellingson from Eli Lilly was there and stayed through the entire program.

"In 1999, with the support of the Chinese government, Dr Nancy Cheng held a big convention in the People's Great Hall of China in Beijing…this was a day that changed diabetes care in China forever."

Larry later told me that this was a day that changed diabetes care in China forever. Two years later a new program, Project Hope, was funded and administered by Cindy Wang. It has being going for seven years. Project Hope has educated 1,577 trainers from 812 hospitals and has just been given a new 5 year grant. Over 165,000 patients have benefited.

It was an incredible day because this was the beginning of diabetes education in China. I've seen the video of this program and if you could stop looking at this incredible hall long enough to look at the faces of the participants, you would see crying people who are joyful and hopeful. In addition, from that day, the Tang-An Health Education Center blossomed. To date, they have educated over 3 million people with diabetes throughout China.

Our spirited meeting

Back to my personal journey in May, I arrived in Beijing at 10:30 pm on a Saturday night after a 13 hour flight from Seattle. I was schedule to speak at 8am the next morning. When I arrived at this beautiful center, I was escorted to the reception room, all red and gold with chairs that looked like thrones. There I was introduced to Jiming Cai, Minister of Health for China and Deputy President of the Association of Preventive Medicine. Also present was Dr. Cheng and Richard Anderson, MD, a chemist from the US Department of Agriculture. Dr. Anderson is the lead scientist at the Beltsville Human Nutrition Research Institute on Bethesda, MD.

I was there to bring the "American" human side of diabetes to China. They knew the technical side of education, but the program was the same for each person. They were ignoring the family and lifestyle issues critical to success.

I mentioned to Mr. Cai that I conducted a program in Barcelona Spain in 2001 to bring 25 countries together in diabetes education. I explained that 25 heads of diabetes education organizations worldwide had joined together to share what they were doing globally. At first he looked annoyed and asked, "Was the Peoples Republic of China represented and who spoke for us?"

He was taken aback and pleased when I explained that I had invited Dr. Cheng and that she had excellently represented his country to the world of diabetes educators. I proposed that he think about the role of diabetes educators during my presentation.

The audience of 3,000 attendees included patients who had participated in Tang-An programs and diabetes educators (almost all physicians) who worked all over China. Many of the people had come in groups, busloads from all over the country. Many of the groups identified themselves with colorful matching shirts or hats. Each group requested pictures with the speakers after the program and we spent what seemed like hours having our picture taken. I even got some hats to wear.

During the program I watched their faces. Many sat there smiling and applauding. Many were fascinated by the new information, some laughed, mostly at me. It seems I am even funny with a translator. But some wept what I believe to be tears of joy and gratitude. They were enthusiastic, excited, and proud to be there. So was I.

A symbolic gift

Here is an anecdote I'd like to share with you. I had looked everywhere in NY to find a gift to bring to Dr Cheng for her gracious invitation and could find nothing that was appropriate. Can you imagine? Then I remembered something that I had kept for 40 years that made sense to me. President Richard Nixon had visited the healthcare facility where I worked in New Hampshire in 1971. He presented me with a presidential pin and a White House pen signed Richard Nixon. It just seemed right.

" Dr. Cheng and the Tang-An Health Education are pioneers in China's diabetes education campaign and have an enormous commitment and passion for their patient population."

I told the audience about the pen and invited Dr. Cheng to the stage. I told them that a year later, in 1972, President Nixon came to China to bring our countries together. So it was fitting that I give the pen to Dr. Cheng, since we were intending to bring our countries together in diabetes care. The place went wild.

After the meeting, Dr. Cai came up to look at the pen. I told him I only had one, so I did not have a pen for him. He smiled. Everyone had to have a picture of Dr. Cheng with me and the pen.

Dr. Anderson was the keynote speaker and gave an inspiring program on the value of cinnamon water extract and his research on glucose management utilizing the product to manage diabetes. Many people in China are very interested in nutritional therapy and the message is now going stateside. More and more people are investigating Dr. Anderson's research.

That afternoon I had the opportunity to teach 150 Chinese diabetes educators. I found it fascinating that most of the diabetes educators in China are physicians. While speaking to Dr Cai, I expressed my concern about China having enough doctors to teach the estimated 50 million Chinese people with diabetes. I explained how the United States and many other countries around the world utilized the expertise of nurses, dietitian, pharmacists, and other healthcare providers to work as a team to teach people with diabetes.

Lost in translation?

This experience was such a pleasure but very difficult. I had heard that most Chinese professionals speak English. Don't believe it. They all learn it in school the way we learn a language in high school in the US. Then they forget it just like we do.

If you've never taught through a translator, it can blow your mind. I've done it before in Argentina and Montreal, but it is not quite the same in China. The cultural issues are so different that it would have been very arrogant of me to tell them how to teach patients in their clinics. I decided to tell them what we do and what almost 40 years of teaching professionals and patients have taught me.

The translator worked so hard but I had no way of knowing if her translation communicated the message and nuances of my presentation. Nevertheless, I think it went well. They all applauded and were so sweet and respectful. After the seminar, Dr. Cheng told me that people loved my speech and my personality because I made them so excited and interested to learn about diabetes. It was very sweet and she insisted that I put it in the article. That evening, at the banquet, they all wanted their pictures taken with me again. I never took so many pictures in my life.

Do I know if the programs changed anything? Not yet. Do I know if there will be non-physician diabetes educators in China? Yes, but not nearly enough. I have learned that Johnson & Johnson and The Hope Foundation have started to train nurses to educate patients with diabetes in hospitals in China. Yet it is too early for outcome measurements or evaluation methodology.

Hope based on past history

All over the world diabetes educators are growing as a force for global change. It is exciting for educators, but more importantly, it will continue to make a major change in the lives of people with diabetes.

In 2000 at the International Diabetes Federation meeting in Mexico City, I lectured 100 Japanese physicians about training nurses as certified diabetes educators and now they exist. I also spoke to Israeli diabetes educators and they got the Knesset to approve diabetes educator certification in their country. I wouldn't take credit for that, but the conversation was started.

"All over the world diabetes educators are growing as a force for global change…We are kidding ourselves if we believe only the US is doing incredible diabetes education."

Sponsored by Aventis in 2001, the AADE and the Federation of European Nurses in Diabetes (FEND) partnered to bring 25 heads of diabetes education organizations around the world together in Barcelona. Our 3 goals were to identify what we did the same, what we did differently, and what we could do together in the future. The program, called Global Diabetes Educators Leadership Forum (DELF), was produced by a firm called Innovara. They developed a website where we could all communicate in the future. FEND's Anne Marie Felton and I chaired the meeting.

Dr Cheng and I have fond memories of this meeting and getting to know educators from Europe, Mexico, Argentina and Brazil, Canada, UK, Taiwan, and the US. It was overwhelming to see what was being done all over the world. We are kidding ourselves if we believe only the US is doing incredible diabetes education.

Conclusion

I really want to thank Dr. Nancy Cheng and the Tang-An Health Education Center for their invitation and incredible hospitality and kindness. They are pioneers in China's diabetes education campaign and have an enormous commitment and passion for their patient population. They are true professionals.

This trip was a professional milestone and a personal adventure. I know I enjoyed seeing this beautiful country. China is excited about diabetes education in their country and so am I.

I hope that one day each of you has the opportunity to see how diabetes education is being done outside the US. Amazing things are happening in all parts of the world.