Change in China.

Change in the world has been occurring at an ever-accelerating rate, bat nowhere is this more evident than in the People's Republic of China. Marlene and I had the opportunity to cruise down the Yangtze River through the area of the three gorges in September and, of course, to visit medical facilities in China.

The physical, social, and economic transformation since our first visit to China in 1980 is phenomenal. Everywhere there are enormous housing construction projects, new skyscrapers, abundant consumer goods, airports, Western-style multilane highways, and hordes of new automobiles. In Wuhan we were even transported in a Lincoln Town Car. Buicks are manufactured in China, as well as Volkswagens, Citroens, and brands unique to China.

The three gorges of the Yangtze, although beautiful and still worth seeing, are now largely obliterated by the rising water behind the dam near Yichang. China's largest city, Chongqing, has more than 30 million people.

Shanghai has undergone the most dramatic changes, with a skyline not unlike that of Chicago or New York City. Construction has begun there on what is intended to be the world's tallest building. I visited the Shanghai Second Medical University, which has a new high-rise ENT and dental hospital that had just opened two weeks earlier. The hospital specializes in head and neck cancer.

The Eye, Ear, Nose and Throat Hospital of Fudan University offers cochlear implants, acoustic neuroma surgery, and other neurotologic procedures. Prof. Liang Zhou, the hospital's vice-director, was trained in Bordeaux. Their facilities include brainstem audiometry, otoacoustic emission testing, electronystagmography, and a new computerized rotatory chair.

Patients in China must now pay for their own medical care and hospitalization, but they can now select their own physician and facility.

I had the pleasure of seeing a patient of mine, a 3 1/2-year-old boy from a town west of Beijing, for whom I had done a cochlear implant two years before. He was talking clearly in Chinese, and his parents reported that he was at the head of his class and in school with hearing children.

The phenomenal speed and enormity of the transformation taking place in China will likely have a major impact on the lives of everyone else in the world. In the span of 25 years the country has made a leap from the 19th to the 21st century because of change in leadership, the Internet, and the entrepreneurial spirit of the people.