Thursday, January 5, 2012

Chinese Medicine

A few years ago I wrote the following essay after returning from mainland China.  I was one of the medical ambassadors on a People to People trip.  The 2 week time period I spent there was a real eye opener as far as my being able to see the stark differences between Chinese herbal medical care and Western medicine.  I don't think we realize how fortunate we are to have all of the medical advances, technology and diagnostic testing available to us when we become ill, until that is, it is not available. 

So as we look towards this New year, let us be grateful for our medical care, and the medical care of our family members.  Let us all make this year better for ourselves, our family members and our friends by addressing our health issues in a responsible, accountable way.  Then the end result can be that we are all healthier and better for it.

As always, thanks for reading my blog and writing comments.  I appreciate it.  --sharon 

                                    An Outsider’s View on Chinese Medicine

            On October 31st, 5 PA delegates and 2 guests took off from Los Angeles for mainland China.  We had been asked by the People to People Ambassador program to take part in an exchange of ideas/medical training with our Chinese counterparts. 

            We landed in Hong Kong and within a few hours we were deplaning in Beijing to begin the first part of our trip.  The five PA delegates came from across the U.S. (Lois Brown, Pittsburgh, PA; Rosemary Chidester, Malvern, PA; Ellen Namer, NY, NY; delegation leader, Pamela Scott, Williamsburg, WV, and myself, from Denver, CO). 

            We spent 10 days touring China, seeing many of the historic sites such as the Great Wall, Tiananmen Square, Forbidden City (Beijing area); Reed Flute Cave, Li River cruise (Guilin); Yu Yuan Gardens, Jade Buddha Temple, Shanghai Museum, and Old Shanghai, (Shanghai).  Additionally, we partook in many cultural events such as attending the Peking Opera, Shanghai Acrobatics, and watching a performance by the Guilin Ethnic Dancers. 

            But, of course, our main purpose in traveling to China was to see Chinese medicine in action.  We meet with many different Chinese physicians and administrators in the three cities we traveled to: Beijing, Guilin and Shanghai.

            In the process, we learned from our Chinese counterparts, as well as they learned from us.  In many of our meetings we advised them on the training of PAs, and on various ways we are employed.   They in turn, discussed with us how they are trained, medical school, and residency training.  As of 2004, they do not have specialists (as we know them).  This is an area they are investigating and forming their fellowship training programs to met the need.   

            Some of the health care issues in China that surprised me was, first the lack of health insurance.  Only 30% of Chinese nationals have insurance.  The remaining 70%, if they were to get ill, would only have their own available personal monies to pay for it. 

            Another eye-opener for me was the health care facilities themselves.  They ranged from looking like a 1940s Appalachia Mountain region clinic facility up to an early 1990s U.S. urban hospital facility.  For example, the clinic in Guilin was housed in a building which was so dilapidated that the floor of the x-ray machine had large holes in it, and no lead in the walls to prevent radiation seepage.  Laboratory equipment ranged from nearly nothing to an up-to-date laboratory facility with all the latest lab tests available. 

            On our visit to Beijing’s Traditional Chinese Medicine (TCM) Hospital we were shown around an out-patient facility which saw 3,000 patients per day.  All sorts of eastern-type medical practices were performed here from acupuncture;  tuina (a form of chiropratic manipulations);  moxi-poxi (lighting with a match an ½ to 1 oz herbal concoction which is positioned on the end of an acupuncture needle, and then allowed to smoke).  The majority of patients who are given prescriptions go home with a form of herbal medication.  Each day they are to boil water, pour their bag of herbs into it, let it simmer, then drink the ‘hot tea’  during the day, starting the whole process over the following morning. 

            During our tour of the TCM hospital we were informed that herbal medicine can only treat disease symptoms, it doesn’t treat the disease process.  If a patient were to be hospitalized, then they use western medicine.  For the majority of Chinese patients, they don’t have the monies to pay for western medicine, and hence they use the less expensive herbal formulation. 

            As an example of their lack of monies to treat disease, the Chinese population has a prevalence rate for chronic hepatitis B of 9.7% (per a report from the Beijing government).  This means that 130 million Chinese are infected with this virus.  The medication used to treat and clear this virus from a patient costs approximately $600 per month, and you need to be treated for 11 months.  This kind of medication cost is beyond the reach of all but the richest of Chinese.  For instance, the annual salary of Chinese physicians is $3,000 USD/yr.

            Another thing that surprised me was that Chinese physicians do not do any sort of physical examination on their patients.  I didn’t see an examination table in any of the clinics we visited.  Nor do the physicians wear stethoscopes around their necks.  Basically the process for a patient is that they go in and speak to the physician about what their symptoms are, the physician decides what they need, gives them a prescription and out the door they go. 

            While I was in Shanghai, and meeting with a few of the attendings of the Shanghai Medical School, I asked the Chinese physician responsible for taking care of viral hepatitis patients, whether she would be interested in doing some clinical research in conjunction with the medical school I work for.  She seemed quite interested in pursuing this option.  I went on to tell her of the long-term remission rates we have acquired with chronic hepatitis B and C.  I advised her that I had access to medications for the Chinese patients, and hence they wouldn’t have to be concerned about this cost.

            During my conversation regarding viral hepatitis, I was surprised that my Chinese counterpart didn’t know the prevalence rates in China of two of the diseases she treats (chronic hepatitis B and C).  I had to inform her of the rates as quoted from one of the Beijing government sources.  I would have thought that this sort of information would be one of the first pieces you would learn about a disease you are treating.  But, not so, in China. 

            The other item that took me by surprise was there was a TCM physician sitting next to the physician who treats viral hepatitis, and during our conversation he sat up in his chair, looking proud, declared that he had a 40% remission rate using TCM on his patients who have acute hepatitis A, B or C.  I had to keep my jaw from dropping to the floor, for I knew that if you combined all three acute hepatitis cases together and just gave them symptomatic care for their disease, 70% don’t need anything else, they will totally recover and do just fine.   That made me wonder what kind of herbs he was giving to them, to make them recover at only 57% of the rate that placebo would give you.

            Another parameter of where Chinese medicine is, in comparison to the Western world,  is that they still, to this day, put all infected patients in one hospital, and all other patients in another.  This means that chronic hepatitis and HIV patients, if hospitalized, are put in a hospital separate from other general hospital patients.  This is their idea of infection control.

              Now that I’m back home, I’m grateful that I live in the U.S. and if I were to become ill, have medical facilities and technological advances available to me that 99% of the Chinese do not.  I have at my fingertips, physicians who understand epidemiology of disease, how to appropriately diagnose them, know which medication to prescribe to rid my system of most diseases, for other diseases, control it.  This is in stark contrast to what I saw in China.  It’s no wonder that most Westerners who if they become ill in China, are told to get to Hong Kong.  For the Hong Kong physicians have been trained in the British medical system, and hence treat with Western medicine. 

            China has come a long way (their economy is growing at a rate of 9.8%/year, they are now vaccinating their children under the age of 3 for prevalent childhood diseases including hepatitis B, as well as their overall level of poverty has decreased).  But they still have a long way to come.  They need to develop wastewater treatment plants, increase their electrical capability, as well as have potable drinking water.  Seeing the current situation of medicine in China was an eye-opener for me.  Just give the ‘sleeping giant’ another 10-20 years and don’t be surprised if it truly becomes a world power to be reckoned with. 

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