HHS 350 in China — Day 6: Tradition and Health

We have officially passed by April Fool’s Day in China, but we were not able to evade the day, not even in the far reaching lands of Beijing. We had some determined jokesters on April 1, and they came up with a pretty good idea to keep us on our toes. They let me in on the plan to partake, but kept me guessing for the final outcome.

As for today, I think we were all pleasantly surprised and somewhat uncomfortable by the degree of access we had a the Hospital of Acupuncture and Moxibustion CACMS. We were able to visit patients with treatments in progress, talk to various doctors and clients, visit the pharmacy and, in the case of one student, get a personal demonstration of Traditional Chinese Medicine (TCM) cupping procedure.

I think the first thing you notice upon entering a TCM Hospital is the smell of herbs. The intensity of the odor was a bit overwhelming at first and seemed to permeate through the building and intensify as we rose to higher levels. Sage was prominent on the floor we reached, but eventually the smell saturated my senses and became more neutral rather than imposing. I also noticed that although the hospital lobby followed the seemingly Chinese way of keeping heating to a minimum, the rooms in which the patients were treated were well heated, if a bit crowded. Personal space is just not looked at the same way as it is in American culture, whether you are walking in a crowd, on a subway, living in a shared space, or in a hospital for treatment.

Dr. Wang and Dr. Zhang were our guides today as we split the group in two to better navigate the hospital without disrupting daily life with our big, somewhat conspicuous group. Every time I talk to people in Chinese at all of the sites the number one questions I get asked after explaining that everyone is a university student in America is, “Are they all American?” We are such a mix of different ages, skin tones, heights, sizes, male & female, etc. that I think our differences stand out in Beijing, a place that more than once, in my experience, has expressed a bit of pride in being (or at least feeling) more homogeneous in nature.

We found we were not the only ones to stand out here as we encountered TCM students from Los Angeles coming to China to learn on-site as part of their program, plus we met a student from Brazil also here learning in person. Seeing as so much of the TCM practice stems from tradition, it would be hard to learn TCM without experiencing at least some of the culture. We ran into foreigners who were patients too, both at the rehab center earlier this week and the TCM hospital.

I took a lot of notes today and I still feel like it would be difficult to summarize everything we learned, especially since I feel like I am still processing it; the details of the day are still running through my mind trying to find a place to settle. TCM has a lot of concentrated information and many forms of treatment, but the philosophy of this branch of medicine stems more from heritage, history, and experience, and less from anatomy & physiological study. The treatment and results take longer and it is not as specialized as Western medicine; it is more holistic in nature. That said, there are still 360 (or so) meridian points on the body that correspond to various ailments and can be addressed in various combinations.

Typically, straight out of high school, students would enter a TCM college, study for 5 years, do one year of residency, and then be a TCM doctor. This period would include western medical training for the first few years, as part of the integrative TCM of today, followed by specialized TCM training. They also mentioned “Barefoot Doctors” as another level of care, especially in rural areas far from medical assistance. These village “doctors” are individuals provided enough training (usually 3 mos.) to care for people in the villages and also refer them on to the next level of care at a township hospitals, which then may refer on to county/district, then city, then province care.

One issue that came up in our discussions and via the presentation we saw later in the morning was the lack of training and specialization in mental health issues, primarily due to the stigma associated with focusing on that field as a profession. This came up after hearing about three patients’ stories and one of our guides (Dr. Yuhong Jiang) noting that though the TCM treatment would likely help, it seemed to her that the patient might be dealing with depression as well. Without adequate training in the mental health issues, that might not be noted or addressed.

Health care and service disparities are also an issue, especially when you look the two main groups being served: urban and rural people. The fact that payments are part of the doctor’s responsibility and that there is a lot of pressure for hospitals to be almost fully self-supporting since the government contributes only a little, leaves hospitals in a situation in which they require upfront payments and doctors are often involved in the collection, which makes things awkward. Pharmaceutical mark up by hospitals is also a way in which relations are damaged when medicine or tests are suggested for monetary gain, verses the patient’s best interest.  TCM used to be very affordable and assessable for many, the preferred health option, in fact, but that has changed and is no longer the case. The current level of tension prevalent between the patient and the doctors, in all medical facilities, has left some headlines in the news and made becoming a doctor a less coveted profession for many. There is health insurance, but that was a whole other animal to try to understand and definitely not considered universal in nature.

The statistics we learned about served to magnify the primary and secondary issues in a very in-your-face manner, especially when dealing with issues impacting a population of over 1.3 billion. The health reform starting point seems a daunting challenge when also factoring in all of the more recent health issues diagnosed with more regularity: stroke, obesity, cancer, etc. Whether impacted through cultural or societal norms, or via the ecological impacts on the human body over time, the past and present always seem to intersect and reach gridlock.

One interesting statistic was the future population outlook to about 25% senior citizen status. For a culture and society with family care as a typical model for seeing to senior welfare, that might look bleak with the impact of the one-child policy, but there are some changes taking place that seem to come from a place of planning and concern for a rising population of elderly with no family in place.

After leaving the hospital and hearing the presentation at the Peking Union Medical College campus, we headed out to see the Forbidden City. If you have not seen the film The Last Emperor, that would be a great way to experience some piece of the magnificence of the location, layout, and history. I felt in awe standing in structures built about 1420. Danny explained more about the rules of The Forbidden City and the emperor, touching again on yellow as the emperor’s color, and adding the note that even blond visitors were forbidden to enter certain areas because of their yellow (golden) hair color. One of the British men visiting to work on a project there was made to wear a wig throughout his entire process.

I quickly ran out of space to store photos on my phone, but luckily with 5 GoPro cameras, multiple point-and-shoot options, a few professional cameras, and other folks with phone cameras, I think we have the photos and video covered for this trip and I look forward to seeing them.

The area of the Forbidden City was huge and, though fascinating, I could see the group’s energy fading fast as we reached the end. We had our short reprieve in the old town hutong areas, for the rickshaw rides, and were able to get a sense of how families typically live in China: mini 3-generation family units connected by a common courtyard. I could see people were skeptical that this would be worth the time when it was getting late and Peking Duck was tempting us all, but everyone loved it! Our rickshaw drivers were actively engaging us, making jokes (in Chinese and smatterings of random words in English), and just adding a level of entertainment that you will never get in the U.S.A. because this was Chinese-style fun.

We left the old town area famished and ready to experience the famous Peking duck. We were not disappointed and were quite impressed by the overall quality and variety of all the dishes. I’ve got to say, I think this trip may have added a bit to my waistline.

Once again, it’s getting late and I will need to recharge for our final day together tomorrow before our various Sunday departure times. I just want to say that I feel like I’ve been really lucky to have such a great group of SDSU students for the HHS 350 China group. They’ve all been amazing! They’ve stepped out of their comfort zones to explore the area, try new foods, have new experiences, overcome fears, and make new friends. They’ve also been very open to my role in all this. I hope I was viewed as not too overbearing, but definitely consistent as a group leader in my style and expectations. I think, as a group, they’ve all just been great travel companions in general. Our last day together tomorrow will be fun and bittersweet.

This post is part of a series of guest blogs from Ine Williams, Study Abroad Advisor at the International Student Center and group leader of the spring 2015 HHS 350 course to China.

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