In the run-up to the first Guangzhou Marathon on Sunday the city leadership made no secret of their desire to use the event to showcase Guangzhou's arrival as a world-class metropolis. "Combining professional competition and public sports, a marathon is a perfect show of a city's development," read an op-ed published by the Yangcheng Evening News ahead of the event. "The Guangzhou Marathon is a starting point for Guangzhou to run into a truly internationalised city." Such aspirations are common for mainland cities, especially in the Pearl River Delta, which is understandably anxious to flex its muscles after three decades of breakneck economic growth. But problems reported by participants of the marathon - from slow medical response times to a lack of bottled water - suggest the city may be leaving several important details behind in its race to catch up with London, New York and Shanghai. The inaugural marathon has already recorded its first death: a 21-year-old college student who collapsed just after reaching the finish line of the 10K race. Guangdong native Chen Jia received medical treatment at the scene and was declared dead at a nearby hospital. More troubling, however, was the case of Ding Xiqiao , 25, who remains in a coma after collapsing 300 metres from finishing the 5K competition. A colleague of Ding's, Chen Yangjie , said the runner lay on the ground untreated for 20 minutes, waiting for emergency personnel to respond. "Ding fell down on the ground at about 8.06am, but the first ambulance only arrived at 8.27am," Chen Yangjie told the Nanfang Daily . When an ambulance finally did arrived, it was not equipped with a respirator, he said. Medical staff performed CPR, while they waited for a second ambulance equipped with defibrillators and respirators to arrive, Chen said. The runner was not admitted to hospital until 9.10am - an hour after his collapse. Running a race can put immense strain on a person's body and fatalities do sometimes occur, especially among untested runners. But some participants of the Guangzhou Marathon questioned whether the organisers, the Guangzhou Sports Administration and Guangzhou Athletic Association, were fully prepared for dealing with such health risks, or even more basic needs. Runner Bobo Wei, 33, who finished her first 10K race on Sunday, said she noted other signs of disorder at the Guangzhou Marathon, such as dirty toilets, a lack of drinking water or even a poorly secured carpet at the finish line. "I had to drink from the bottles left behind by other runners," Wei said. "And when I was finally approaching the finishing line, I stumbled and fell on the ground when I tried to sprint because the red blanket was not even laid out smoothly!" The organisers official response to Chen Jia's death left much to be desired. "We're deeply saddened over the sudden death of the competitor," said Guo Zengwei, a spokesperson for the marathon. "It is possible for some runners suddenly to faint or even die if they did not have enough rest before hand. In order to control such risks, we arranged medical staff in preparation." Not only does that statement fail to answer the complaints about the medical response and lack of water, it also failed to promise that there would be review of the marathon's practices before next year's event. Hong Kong's Amateur Athletic Association, in contrast, responded to this year's death of a male participant by bolstering efforts to educate runners about the health risks. Doctors are advising runners to provide self-assessments and, if they believe they may be at high risk, to see a doctor before signing up for the race. Guangzhou should consider doing the same. Becoming a world-class city is a marathon, not a sprint. Obviously, Guangzhou still has a long way to go.