When Zhang Xinyu's father begged cardiologist Koko Gu to save the life of the seven-year-old girl with congenital heart disease, Dr Gu had no idea how to help. An operation would cost about 70,000 yuan and Xinyu's father - a manual labourer in a small town in Shanxi province - could only borrow 30,000 yuan from friends and relatives. The family had already spent 40,000 yuan on tests in many other hospitals, but they refused to conduct the operation because of its complexity. The chance of the operation succeeding was not high, but the frail little girl was unlikely to live for more than a few years without the procedure. Dr Gu returned to China after spending 10 years in Japan and five in the US working as a doctor and medical researcher. She said medical practitioners were under huge pressure on the mainland. She pointed out that doctors' bonuses depended on the revenue of their hospitals, and if many patients could not pay their bills their income would be affected. China's current medical system was unfair to doctors, said the veteran cardiologist. 'Doctors' salaries are pitifully low and there is no policy to support them. However, they are required to deliver high-quality services even when they are not guaranteed a certain standard of living. 'For paediatricians, the pressure is even higher because of the one-child policy. Parents are under a lot of pressure and so are the hospitals.' The basic monthly salary of a departmental director in a Beijing hospital ranges between 2,000 to 3,000 yuan, medical practitioners say. A top medical expert in China may earn about 3,000 yuan a month, although some may have other sources of income such as conducting research projects or treating patients from private hospitals. In the end, Dr Gu said Xinyu was exceptionally lucky. The doctor came across a Filipino colleague working for a charity on the mainland during an international conference and revealed the little girl's plight. Although the charity could not help because it only deals with orphans, the Filipino doctor managed to raise funds among her friends and Xinyu had an operation in August. However, doctors expected complications after the operation and Xinyu was readmitted to the intensive-care unit after she showed symptoms of infection. The girl is now recovering and may be able to be discharged in two weeks, but her treatment for the infection cost another 20,000 yuan and the family is still looking for the money. It is estimated there are between 150,000 and 200,000 children with congenital heart disease on the mainland. Only about 30,000 undergo surgery each year.