Medicine in China

**This is very much my opinion interlaced with as many "facts" as I was able to obtain by talking to friends, Chinese patients, and other doctors. I have done my best to explain everything as it was explained to me (but the language barrier persists...)

I have really avoided writing a lot about the medical system, ophthalmology clinics, etc in my blog because I find it overwhelming.  It is so nice to be here and learn from the Chinese (my boss Dr. Wu is an incredible cataract surgeon), but also to teach them about our way of doing things.

First off, the medical system is very different in America. As I have mentioned before, there is a LOT of violence against doctors in China. And Chinese doctors aren't considered "rich". Therefore, it is a demanding job, with the possibility of ungrateful patients, for moderate pay. And, the schooling is very lengthy, just as in the U.S. There is "no room for error" in Chinese medicine. I don't proclaim to be a perfect doctor. I care deeply about my patients and work hard to arrive at the correct diagnosis. I seriously try to treat all patients as if they were my own family member. But I have to remember, I am not infallible. And at some point in my career, I risk the possibility of a missed or delayed diagnosis or a surgical complication. These are things that doctors fear...it is a big responsibility to take care of other people's eyes (and in some cases, lives). We do not take this lightly. It even keeps us awake some nights and causes us to "take work home" when we are to be spending time with our families. But it is a wonderful profession too with many inner rewards.

Recently, there was a large positing on one of the doors to the hospital. It was only present for a few days, then taken down. I was walking home with a friend one day, when she stopped to read the sign. I inquired as to what it said. She reported that it was a notice that a pediatric surgeon had jumped to his death from a building several days earlier (age 34). The root cause was apparently because the parents of a child under his care were not happy with the care the child received. Not only does violence against doctors occur, but some choose to end their own lives as a result of complications. Again, doctors are not  perfect. And complications will occur, even in the hands of the "best" surgeons. And sometimes, despite our best efforts and a "technically perfect" operation or a timely diagnosis, the patient will still not fare well.

At any rate, the statistics I recently read in the Chinese newspaper (English version online) indicated the following:
      The average number of assaults on doctors in China surged to 27.3 per hospital in 2012, up from 20.6 in 2008, according to a survey by the Chinese Hospital Association. And more than 17,000 violent incidents against hospital and medical staff were recorded by China's Ministry of Health in 2010, comparing to 10,000 in 2005. (South China Morning Post: scmp.com)

When discussing all this with Mr. Z (one of my "burning questions" was to learn more about the medical system in China), he indicated that the doctors' salaries are in part, determined as a percentage of the treatment prescribed. Thus, the more expensive them medication or treatment, the higher the doctor's wages. This has made patients become VERY distrustful of the "Western" medical system. Often times, patients will seek treatment via Traditional Chinese Medicine as first line treatment.

In the United States, I really try to be judicious about my healthcare spending, both in my personal life and in my professional life. I think about how much things cost. I give samples to patients when available (although 'samples' are rare these days in the University setting because it is considered a large conflict of interest). I try not to order imaging (CT/MRI) without a really convincing reason. I try to avoid the "costly treatments" and will start with conservative therapy whenever possible. But I have had 13 years of education beyond high school to be the best doctor I can be. And sometimes, that means  prescribing costly treatments (medications, glasses, surgery, etc) and ordering expensive tests.

Yet, the patients here have become very skeptical that a certain treatment is in their best interest, but rather feel it may be in the "best interest" of the doctor's pocketbook or paycheck. (I am sure this sentiment occurs in the U.S. as well.) Additionally, medical care is very expensive (sound familiar?), and many people cannot afford the exorbitant costs. Many feel the government needs to intervene and start providing more funding for medical care (sound familiar?).

So, as Mr. Z described it, "Every problem in China has a reason behind it."

       The traffic problem? Too many cars because people have migrated from the countryside in recent years. (Remember, 40 some years ago, Chengdu's population was 1/14th what it is now...)

      The population problem? People are having too many children in an already overpopulated country. (Solution = one family, one child policy).

      And the problem behind medicine in China is the culture of doctors prescribing expensive treatments when very in expensive treatments may suffice, in a country where many patients do not have the means to afford the care. Thus, leading to patients' mistrust of the doctors and the system. (Solution?? Possible more government assistance for health care, but this debate/solution is ongoing...)

Of course, this does not describe the entire problem. It is much more complex and intricate than that. An additional problem is...there are so many people to treat! How do you provide medical care to 1.3 billion people?!  Another issue is lack of education. Mr. Z is very educated. He sates that often the educated people understand the system. But some people (laborers in the rural areas) with little to no education may not understand.

I will say, I have met some incredible doctors here. The absolute majority of whom do not use money as motivation, but rather treat the patient in the most honest manner. But you know the relationship between patients and doctors is not good when one of your attending physicians chooses not to wear a white coat because they don't want to divulge that they are a doctor...

I think China is a phenomenal country! I have been treated like a queen here. I am NOT trying to be critical of the system (goodness knows we have a lot of "issues" in the U.S.A.), but rather describe and open people's eyes to some of the healthcare problems in China. (I'll save the "Healthcare System Problems in the U.S." for another day!)

Tea with Mr. Z

Mr. Z and me.

I admit, I have been terrible about blogging lately.  I take photos daily at both the hospital and in my "everyday" life, but I somehow  cannot seem to translate that to the "computer screen".

There is a very nice man here (Mr. Z) who knows my friends/bosses in Oklahoma. We were introduced via email before I arrived in China. He is the retired as a the head of the department of International Exchange of Health Services. As I understand it, he was basically a liaison between foreign countries and China for promoting healthcare exchange. Subsequently, he has traveled all over the world. 

He reached out to me via email and invited me to join he and his wife for lunch and tea this afternoon. Unfortunately his wife couldn't make it at the last moment (her sister fell ill), but we had a really nice time. His English is absolutely great, and he is a wealth of knowledge when it comes to Chinese history, culture, and custom. He was very open, and I felt like I could ask him anything, so I received answers to a lot of my "burning questions" today. He talked all about Chengdu when he was a child (it was only a city of 1 million, not the14+ million that it is today), about Chengdu during the time of the rule of Chairman Mao (Mao Tse-tung), and Chengdu today. It was really interesting!

We had a wonderful lunch, walked around the park, and then we enjoyed talking/Chinese  tea. He and his wife even brought me a little "care package" with fresh fruit and traditional  Chinese snacks. It is so fun, wonderful, and refreshing to meet such an open, kind, and generous person.

I hope to see him again and meet his wife before I leave!

A perfect day for a walk in the park!

A child and his mother feeding the fish in the Park. The fish are fed via food in a baby bottle attached to a stick. The fish will suckle on the bottle to get the food out. The kid has to be sure to hold tightly onto the stick...those hungry fish were feisty!

So I will add this to my list of  "interesting cultural practices" in China. While Mr. Z and I were having tea, these people came around multiple times and asked us if we would like to have our ears cleaned (I, of course, couldn't understand). Both of us politely declined. But, this man, took her up on it. It is not unusual to be walking through the park and see someone getting his/her ears cleaned out. She even has a heavy duty headlamp on :)

Not your typical Q-tip :-)

Homemade dumplings and dinner on the boss!

Leo and Cookie live very close to my hotel, so it is easy to spend time with them. They had also graciously offered to let me do laundry in their apartment. Last Sunday, Cookie's mom was in town and was planning to make homemade dumplings for dinner, so Cookie told me to bring over my laundry for washing and then stay for dinner! The dumplings were absolutely delicious. It was so kind of Cookie and Leo to help me do laundry. The simple things! (I love the smell of clean laundry!) I carried it back to my hotel and then proceeded to get very creative and hang the wet laundry all around my room (they do not use clothes dryers here).

The dumplings ready to be steamed

Homemade dumplings...a work of art!

Dinner is served!

Today (Friday), after clinic, Dr. Lucy gave Jim (who was in clinic with us) some money to buy a very nice dinner. She treats me to dinner EVERY week (she never joins because she lives far away and wants to spend time with her husband), but always wants to treat me. (They are incredibly generous here in China and it is RARE that someone will let me pay...even when I try to "fight" them on the bill...). It was just me and Jim and she had given us WAY too much money for just the two of us, so I quickly called Cookie and Leo to see if they wanted to join. They hadn't eaten dinner yet, and they happily joined us at a nearby restaurant (Chenmapo Beancurd), which I had read online was delicious. We had so much fun, all thanks to the very generous Dr. Lucy!

"Thanks, Dr. Lucy!"

Afterwards, we took a nice long (several miles!) walk around the "wetlands" park. Apparently Chengdu is known as the "City in the Countryside" because there are so many parks, etc. It was a beautiful evening and there were many cultural activities going on in the park. Another fun evening in Chengdu!

 

Saturday in the center of the city

Jim, me, and Cookie in Tianfu Square in front of the statue of Chairman Mao.

I am not sure if I have mentioned this before or not, but on Wednesday afternoons I give ophthalmology lessons in English to the Residents. We always have a lot of fun, and I try to get them to participate (most do!)

Well, weekends can be kind of isolating here, so this week I told my English class that I was going to go to Tianfu Square (THE center of the city) on Saturday. I invited all of them to come along. I told them if no one wanted to go, I would go by my lonesome!

Luckily Cookie, her husband Leo, and Jim wanted to spend Saturday out and about. We met up in Tianfu Square at 11a.m. and, per my request, we headed to Starbucks. I treated them all to coffee. (Other than the pizza last night and Starbucks today, I have avoided all things American).

Starbucks!
Me, Jim, Leo, and Cookie

We walked around Tianfu Square and took photos with the giant statue of Mao Tse-tung ("Chairman Mao").

Chairman Mao. The Chinese have differing opinions about him.

Next, we walked through People's Park, had a delicious lunch of dumplings (so delicious!!!), and then we walked down two "famous" streets translated as Wide Alley and Narrow Alley. I got to see lots of interesting things...

Spiced duck necks...

Chicken feet in the foreground and duck heads in the background (yes, look closely, you can see the duck bills...)

Chicken or duck hearts on a stick...

Live frogs for purchase. Frog is a common food in Chengdu.

Eeels for sale. I have not tried eel here (but ate it often in Japan when we would have sushi or sashimi).

I call this photo "The Innards".  Stomach, intestine, etc.

Roast duck. My favorite part is the worker taking a rest while waiting for customers.

We ducked into McDonald's because I wanted to compare the menu with the American McDonald's (honestly not too different). I was surprised to see the Tibetan Monks (left side) eating at the local Mickey D's!

Walking along Narrow Alley

I had forewarned my friends that I was slated to read in church at 4pm. I had to be there by 3:30. They wanted to walk me to church, and on the way they asked if they could sit in and listen. I said sure! So they came to English Mass and then we had dinner at a spicy noodle restaurant.

By this time it was about 6:30 pm, and I was pretty tired. But Cookie and Leo wanted to have me and Jim over for tea (they drink tea CONSTANTLY here). We headed over to their apartment and lo and behold, we discovered that one of their two new puppies was ill. So, Jim and I helped them get the puppies to the veterinarian, and then we waited, and waited, and waited... Cookie was appreciative that we stuck around while the vet treated the puppies. I finally got home at 10:30pm! We walked almost ten miles today! Never a dull moment in China...

Consulting with the vet late on a Saturday evening.

A fun Friday night!

Hannah, Cassie, and me at the gate to Huaxi University.

I had expressed interest in seeing a local university campus, so my friends (Tom and his wife Hannah and Cassie and her boyfriend Steven) took me to Huaxi University here in Chengdu. The campus is in the "old Chinese style", which was neat!

We then went and had Pizza Hut. It was quite comical because we walked to the first Pizza Hut, and it was in complete disrepair and closed. So we walked to a second Pizza Hut, and this one had a sign outside that said "Coming soon!". I suggested  we just eat Chinese food, but they were persistent. So we walked to a third Pizza Hut and it was open... hooray! We had a great dinner and then walked around the center of the city "Chunxi Road", which is the shopping/restaurant district of Chengdu.

A very afternoon/evening with fun friends!

A building on the Huaxi University campus.

My comrades

The university library.

A bird sitting in the lotus pond. All of the green plants are lotus. The lotus root is a common food here (and I love it!)

I had them take my photo at the West China School of Medicine.

A tree outside the largest hospital in Chengdu. These "prayer ribbons" have been tied to the tree by Tibetans in prayer that that a friend/family member recover from illness.

Pizza Hut!

Chunxi Road at night.

Just a tad overwhelming...

I thought this was a perfect example of just how illiterate I am here in China. Do YOU understand this bus schedule?!

Recycle or "unrecycle"?

You choose: do you love or hate the environment?

Rosie and Tony's wedding!

Friends with Rosie on her wedding day!

Rosie and Tony got married this past Saturday, May 2. It was a beautiful, wonderful day, and we all had a great time.

I met Lily, another resident friend, at the main entrance to the hospital. She and I walked to the nearest Metro stop and then caught up with two other friends. We took the Metro as far out as we were able, to the outskirts of Chengdu. Then we took a taxi to the hotel where the wedding was being held. I use a lot of mass transit here in the city!

On the Metro with Lily and Jenny (and a friend of Jenny's).

Jenny and Lily with cards from friends. It is customary to purchase a red envelope and put cash inside for the couple (as a gift). Of course, you have to give an even number of bills--giving an odd number of bills is taboo.

Rosie and Tony were there to greet us. Rosie looked phenomenal! And they both appeared incredibly happy. They were happy to see us :)  I noticed that the Best Man was standing off to the side with a beautiful platter of...cigarettes. Yet another difference from the U.S. (where smoking indoors is banned in most locations. I was very spoiled in Iowa!). It seems that everyone here in China smokes... I digress.

Rosie and Tony with their Best Man, who was in charge of providing guests with cigarettes.

We then headed up to the fourth floor to mingle with other guests and drink hot tea. We found a dinner table near the stage on which they were to be married. The wedding ceremony was to take place during dinner, almost like a dinner theater (at least that is my analogy). The ceremony started at noon, and it was pretty short and sweet. I, of course, couldn't understand it, but during the exchange of rings, both Rosie and Tony both had tears in their eyes.

Rosie with her father. Tony had to get down on one knee and present her with her bouquet.

Exchanging vows. The lady in the fancy blue dress serves as a "hostess" (hired by them) and she talks them through the ceremony. She also sang a few songs at the end!

At the end of the ceremony, the couple had their parents come up on the stage and take a seat. The couple then presented each parent with a cup of tea, which they drank.

Maid of honor holding the platter of tea cups, while Tony presents a tea cup to his new father-in-law (drinking the tea on the left).

The lunch feast!
 

Immediately after the ceremony, the bride throws her bouquet (as in the U.S.). The groom throws these small red envelopes...

And inside is money! (This is 1 yuan, or about $ 0.15). Some envelopes were filled with much greater amounts :)

Afterwards, Rosie switched into a cute red dress and we all had fun and enjoyed our lunch. I was planning to leave after lunch with my other friends, but Rosie came over and told me she wanted me to stay "very late". I wasn't sure what this meant...



Liz and Rosie

We all sat down and had tea and talked. We watched others play poker and Mahjong, which is a very common post-wedding practice. The other guests just sat around and talked and drank tea. This all went on for several hours. The friends that I accompanied the wedding decided to leave, but Rosie wanted met to stay...



Guests playing Mahjong after the wedding.

Tony (far left) playing poker with his buddies.

Finally at about 6pm, they served us a delicious dinner. I have never seen so much food!  After dinner, Rosie asked me to go to the karaoke bar with the other wedding guests and her high school and college friends.

The dinner spread. It was delicious!



Hitching a ride to the karaoke bar.
 

Post-wedding karaoke fun!

The Chinese sure love their karaoke!

I ended up staying out until about 10:30, until some of her other friends were going to catch the Metro back into the center of Chengdu. I went with them (but the karaoke was still going on in full force). I was back to the hotel by 11:30 pm and was so tired! It was quite a day.