In a packed auditorium not far from the Yangtze River, hundreds of delegates are on their feet clapping vigorously. They have just discovered that one of their national heroes has been sitting among them undetected all evening.

Xia Boya is China’s rehabilitation poster boy (or man, since he’s now 70). In his twenties during an attempt to scale Everest, his team hit bad weather just 250 metres from the summit. Xia gave his sleeping bag to a teammate who was struggling to survive. But his kindness came with a heavy cost – frostbite and the subsequent amputation of both his legs. Yet 43 years after that failed mission, he finally achieved his dream of climbing the world’s most unforgiving peak.

The televised feat from last year was replayed on big screens at the 2019 Asia-Oceania Congress for Neurorehabilitation in Nanjing – China’s ancient capital. The sight of Xia dragging himself up the final few metres made for an emotional opening to the conference. Applause broke out when an unassuming pensioner in a tracksuit stood up in the crowd and waved.

Xia Boya himself was here for this confluence of neuro-rehab. Not a single chair is empty in this grand hall. Scores of people standing up are lining the outskirts of the room. Most striking, however, is the fact that the vast majority of local delegates are in their late teens or twenties. This is perhaps indicative of China’s accelerated interest in rehabilitation. 

A surge of students and young professionals shooting for careers related to severe injury and neurological conditions is emerging. Partly this is driven by soaring demand. A landmark paper on rehabilitative medicine in 2009 reported that China had a personnel gap of 15,000 rehabilitative specialists and 28,000 therapists. While no update on this is available,  trends suggest that the need for more rehab specialists is intensifying.

By 2050 it is expected that the proportion of  China’s population which is 60+ will have risen from 15.2 per cent in 2015 to 36.5 per cent, putting pressure on many areas of healthcare. Around 2.5 million people in China suffer strokes every year, with 70 to 80 per cent losing the ability to perform routine activities and requiring care. A 2017 paper reports that only 11.5 per cent of patients undergo some form of rehabilitation within the first week of their stroke; 42.4 per cent do not receive any rehabilitation.

Meanwhile, the Chinese Journal of Traumatology reports an estimated 3m to 4m incidences of traumatic brain injury every year. The sheer number of neurological disease cases in a population of 1.3bn also creates massive demand for newly qualified rehabilitation workers. The number of Parkinson’s cases, for example, is expected to hit 5m in China by 2030, according to the World Federation of Neurorehabilitation.

Also driving heightened interest in neuro-rehab careers is the rapid reform of China’s healthcare system generally. Over the last decade, the Chinese government has been in the process of expanding social health insurance, reforming public hospitals and strengthening primary care. In 2016 it announced the ‘Healthy China 2030 blueprint’ – a plan to provide universal health security to every citizen by 2030.

China’s is an insurance based system whereby almost a third of citizen health costs are paid for by the individual. The aim is to reduce this to 25 per cent by 2030. Investment which helps to improve, and better connect, services, is being ramped up, while key goals such as earlier detection of diseases and increasing life expectancy have been put in place. All of which may aid the development of rehabilitation services.

The private sector – including technology developers – may have a lead role to play in this. The exhibition floor at the congress is themed around ‘high tech integrated with neurorehabilitation’. Exoskeletons, virtual reality systems and robotics are all represented. The dominant tech forces, by some distance, however, are functional electronic stimulation (FES) and transcranial magnetic stimulation (TMS) therapy machines.

Almost every firm’s products are made in China and marketed entirely to the Chinese market. None I meet are targeting the European market, with enough demand in their homeland to fuel steep growth curves. The private sector’s role is also evident in hospital development. During the week-long conference, eight of the world’s most eminent neuro-rehab practitioners are shown around a new children’s rehab hospital in Nanjing. 

They arrive to a heroes’ welcome from a small army of hospital staff, photographers and management flanking the lobby. Despite my repeated protestations that I’m merely a lowly hack there to make up the numbers, I too am lauded as a globally pioneering doctor in neuro-rehab. I autograph a huge sign in reception, then I’m presented with a doctor’s coat and ushered into numerous photo opportunities.

The chief clinician at one of India’s largest rehabilitation hospitals leans into me and whispers: “I spent 16 years at medical school, and you’ve become a doctor in 10 minutes”. My fraud continues as we move from ward to ward, with awaiting staff clapping us from one room to the next. I adopt the classic ‘doctor-walking-with-intentwith-arms-behind-the-back’ approach gleaned from Casualty and ER.

We are then taken into a large boardroom. Hospital staff file in and stand around the perimeter, while we experts take up seats at the table. After a presentation about the hospital, from its enigmatic founder who was inspired to set it up by his disabled brother, the spotlight turns to us. “How would you recommend that we make a success of this new hospital?”

I frantically scribble ideas on a notepad, while my fellow luminaries from the US, Switzerland and Indonesia thankfully step forward to speak up. The microphone edges agonisingly closer to me but my sage advice is ultimately left unsaid.

“Good luck for the future,” I write, while my peers feverishly pen relative essays in hospital management on a questionnaire we’ve all  been handed.

Back at the conference, I meet a German rehabilitation medicine physician currently involved in setting up a hospital in Shanghai. He explains an interesting distinction between European and Chinese rehab. “We’re building a rehab centre in the German tradition, mainly focusing on stroke,” he says.

“What’s amazing is that we’ll do the western approach to rehab each day, and then they’ll go off and do traditional Chinese medicine activities.”

He’s not convinced that all of it works towards recovery, but is open minded and admits that some herbal treatments do show promise. “Of course herbs work, its chemistry, but the rest depends on the frontal lobe. I call it the Hollywood machine. It can give you anything.”

I also meet Benny, leading a Mongolian delegation of rehab professionals. There, wrestling and horse-riding accidents are among the biggest causes of brain injury, he tells me.

A gaping shortfall in the number of rehabilitation doctors makes brain injury care a huge challenge – especially in the vast country’s rural areas with sparse hospital coverage. But interest in neuro-rehab is growing. It will soon host its third annual congress on the field and its development is gathering pace. The wider Asia-Oceania region, like most of the rest of the world, is typified by falling mortality rates but increasing morbidity and disability levels.

Dealing with this requires new approaches utilising improved technology, knowledge, research-based evidence and services. All of these topics are covered in-depth in the conference programme in well attended talks. The appetite among Chinese delegates to learn from rehab professionals in other parts of the world is evident in every session. Momentum certainly seems to be building in China and that can only be a good thing for neuro-rehab’s global progress.