Hang-en cave

Hang-en cave
(credit: National Geographic)

Thursday, May 22, 2014

So it begins

Hi all,

The first full day is done! A team of us (me, my coworker, and two of the Chinese students who are helping us this week) went back to the airport to meet the students and help them take the maglev(!!! why don't these exist everywhere?) and subway back to the hotel. Man, those things are hard to navigate with luggage, though.

It's hard to remember just how many people there are here. We've already had to force our way onto the subway to make sure that everyone went together. I think I've adjusted to it already this year, and it seems like things (especially traffic) is less chaotic than last year. Maybe it's because I'm actually pretty relaxed so far this trip--I'm not constantly counting heads or worrying that someone's too far behind---and certainly a part of it is because there's a huge conference happening this week in Shanghai. Putin's in town!! What that means for us is extra security everywhere: there are police directing traffic, military on the street corners, and the SWAT team was in the hospital today (just watching, don't worry!)

We had our first day of shadowing today at Huashan Hospital today, which really meant we had a tour of the hospital from 9:30-10:30, then had a break until 2:00pm. Like last year, we're split into three groups and rotating through inpatient, outpatient, and pharmacy. For the inpatient and outpatient areas, we see the foreigners' clinic, which is renowned for its traveler's care...and also exactly like a Western clinic. Because it's more expensive (Chinese nationals can also go if they can pay), patients have the luxury of scheduling appointments for within the week and physicians are able to spend more time talking with the patients and they have better equipment, as well has their own CT scanner and lab. Physicians there see about 15 patients in a half-day. By comparison, physicians in the "common" areas see 100 each by noon.

My group visited the inpatient ward first, where we met with a dermatologist to hear a case presentation of a patient with acute epidermal necrolysis as a result of a SEVERE drug eruption. Basically, this poor man had been in the hospital for over a month because 75% of his skin fell off. The dermatologist had spent some time in Vancouver and was able to talk about the differences in treatment between China and the rest of the world. A drug eruption is a severe immune-mediated reaction to a medication. China differs from most of the rest of the world in treatment of TEN, choosing to treat with steroids which is at the very least frowned-upon in the United States. Steroids block the immune reaction, which can keep TEN from progressing. However, your skin is the first line of defense against infection, and without it you're extremely susceptible to everything, so you need your immune system to combat bacteria. The team of doctors treating him had to implement an intense regimen of steroids, antibiotics, and sterilization to keep him healthy as he healed. We got to see him doing some physical therapy today, so all is well--they don't think he'll have any lasting damage.

As we talked with the dermatologist after the presentation, she brought up one of the themes we'll see a lot of during these two weeks: China is not a good environment for a physician. She was really frustrated by the limitations of the equipment they have and the amount of time they can spend with patients, because they don't actually get to see any of the fruits of their labor.

We went to the outpatient ward next, which was basically like the doctor's office in America. After about an hour, we were released to see the normal clinics on other floors, which are incredibly different. One of the students described it as a DMV--you take a number, wait in an enormous waiting room, go to the admitting desk or physician room or pharmacy window or operating room when your number gets called, then do it all over again until you can finally leave.

It's an interesting conflict of cultures over here. It seems like some of the solutions to problems are so easy, but there are huge social barriers. For example, Huashan built two sister hospitals in different areas of the city to try and alleviate the patient load on the main campus...and they're empty. Huashan has some of the best specialists in the country, and that's a huge draw. People are worried that they'll miss out on the caliber of care if they go to one of the sister hospitals, so they sit empty while the main campus is overwhelmed day after day.

Tomorrow, we have a morning of shadowing in the pharmacy (I've never seen it before!) and then another reaalllly long lunch break. In the afternoon we'll meet with an adjunct health policy advisor to Harvard to talk about healthcare in China--I'll have more to report after that, I've got a lot of questions prepared.

I still have 14 students! I took a lot more pictures today, and found a new favorite food: yams covered with sesame seeds and caramelized sugar. SO. GOOD. But for now it's off to bed! The jet lag's hitting me pretty badly tonight, and there's a lot to do tomorrow.

Good night!!

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