Johnathan Craik and Edmund Chedgy VSA report

Medicine at the sharp end

Twenty-two smoky hours after boarding the train we finally arrived at our destination; Chengdu, the capital of Sichuan province and gateway to Tibet. We stepped out of the station onto the bustling streets and attempted to interpret any one of the hundreds of street signs. One of them pointed the way to the building that would be our home for the next month, but finding which one was no easy task. We spoke little of the language and relied on the charity of strangers to point us on our way. None of the people we turned to spoke English and, only by repeating the few phrases we had committed to memory, did we make progress towards the university.

Jon Craik and Ed Chedgy on return to Worth to speak to year 12 and 13

So what were we doing thousands of miles from home, away from the comfort of our medical schools in Bristol and London? We were on our elective-an opportunity for medical students to experience medicine within very different cultural, political and financial environments to that of the UK. As well as widening personal life experiences, electives have direct relevance to the ethnically diverse population within which medicine is practiced in the UK and as such are now a common component of the medical training curriculum.

The staff at Sichuan University claimed to work in the biggest hospital in China, if not the entire world. Although it was politeness that encouraged us to respond with credulity, their friendliness and warmth were as genuine as our exhaustion. We were led to our rooms to wash and recover. 

After a brief interlude to freshen up, it was time to venture onto the hospital wards. We were excited but also anxious as we prepared to step into a world that on first appearances was very different from anything we had ever experienced before. We had planned to spend half of our month in Chengdu working in the Traditional Chinese Medicine (TCM) department and our anxieties were sharpened by the fact that our knowledge of TCM, and indeed Mandarin, was virtually non-existent.

TCM forms an incredibly important part of Chinese society and culture, and is seen as a mainstay of treatment rather than as an alternative. We were surprised to find out exactly how important a role TCM plays in Chinese healthcare and what it means to the people who benefit from it.

On our first day we were introduced to our supervisor, a junior doctor in the TCM department who was fortunately fluent in English. As she led us to our first encounter, we were enveloped by a pervasive miasma of smoke and stench that hung in the corridors of the department. Despite chain smoking being the apparent ‘norm' in Chengdu, and a striking inability to escape the cigarette advertisements plastered throughout the hospital, the culprit responsible for this smoggy atmosphere was moxibustion. The heat and fumes generated by burning this blend of therapeutic herbs is thought to have healing properties.

Moxibustion combined with acupuncture formed the majority of the TCM treatments we learned to perform. Needles were driven deep into the muscles at specific acupoints to improve the flow of Qi, the body's energy, through the meridian system. Occasionally electrodes were connected to the needles to further stimulate these acupoints.  The doctors spent several hours trying to explain the basic theory behind TCM but we found it very difficult to follow and understand as it appeared to revolve almost entirely around invisible channels and metaphorical concepts-far different to the rationalised confinements of Western medicine!

In addition to acupuncture, we became involved in other TCM therapies including cupping and Tui Na, a form of therapeutic Chinese massage. We were also taught how to use an instrument known as Mei Hua or Plum Blossom Needle. This instrument resembles a small hammer with seven sharp points across its head. It is used to treat persistent facial pain by striking the patients skin repeatedly and, despite causing considerable pain itself and a substantial amount of bleeding, it did appear to benefit many patients.

There were five beds in our clinic, situated side by side with no partitioning to offer even the slightest form of privacy. Patients were treated next to each other and, to our surprise, the atmosphere generated by this arrangement was one of a friendly, gossiping community rather than embarrassment as we might have expected. There was no mention of confidentiality! The clinic was run by two doctors both specialising in TCM. Our interest in the treatments being performed seemed to be equally reflected in the patients' reaction to our presence. We were some of the first Western students to visit this hospital, which may help to explain why we seemed to cause raucous amusement to both patients and staff alike.

So what to make of TCM from the perspective of two prospective British doctors? We had expected a certain degree of disagreement and friction between TCM and western ideologies. However, they appeared to complement each other very well and the relationship between staff working within the different departments was highly respectful. An example of the complementing roles of TCM and western medicine that we regularly experienced related to the control of post-operative nausea suffered by many patients. In the west, medication is routinely prescribed to control nausea. But in China, patients appear to benefit from the use of acupuncture and smouldering moxibustion over specific acupoints on the shins.

Despite our enthusiastic involvement in many of the TCM therapies, our efforts to maintain an open attitude towards these treatments were frequently challenged by certain claims of efficacy, which in western medical terms would be considered no more beneficial than the placebo effect. This conflict with our scientific background, together with the extreme pain and discomfort experienced by many children, and indeed adults, receiving acupuncture and Tui Na, was emotionally demanding. It would seem that TCM definitely provides alternative options for treatment-but whilst providing avenues of possibility when Western medicine turns to drugs, TCM should still be exposed to the standards of effectiveness that apply to all medical procedures.

The second two weeks of our month in Chengdu was spent with the general surgical team. Each morning we would meet in the staff room where announcements would be made to the entire team-doctors, nurses and students alike. Once there was even a DVD message from the chief medical officer of the hospital telling of recent problems relating to funding. We have never seen so many white coats in one place at a time! The ward rounds that followed were invariably very crowded with students and were of limited educational value since they were always in Chinese. Some consultants were kind enough to translate for us following the round. However, despite their efforts, we found ourselves in an all too familiar situation: we had no idea what was going on for most of the time!

We were surprised, given the political position of the Chinese government, that their health care system resembled more that of the US than the NHS. We were unexpectedly impressed to find the use of highly up-to-date surgical equipment, a huge number of operating theatres and incredible procedure capacity. Patients are required to fund their treatment, either personally or through healthcare insurance. Interestingly, all government workers automatically receive healthcare cover. However we often encountered patients who were unable to afford insurance and who could not cover the costs of their treatment. Occasionally the hospital or charities would subsidise these costs but often patients were unable to receive the optimal treatment available and some were even forced to sell their houses to raise funds!

One interesting ethical dilemma in this regard involved a 17-year-old boy who was admitted to the general surgical ward with a stab wound to his abdomen. He was being investigated for suspected perforation of his bowel and potential infection. The doctors informed us that if he could afford it, he would receive intravenous nutrition. However instead he was forced to continue to attempt oral feeds and, due to vomiting and poor appetite, he was becoming malnourished which was further complicating his condition. As with any healthcare system there are obvious problems with medical care in China. However, despite this, we were impressed with the standard of care offered to patients and the expertise of the medical staff giving treatment.

As well as being a unique travelling experience, our elective has taught us a great deal about the differences that exist in healthcare between the UK and China: the frequency of medical conditions and their treatment; the relationship between culture and attitudes towards healthcare; and differences with regard to health care financing and political influence. However, perhaps most importantly, our experience has enabled us to fully appreciate the value and quality of healthcare that we receive in the UK and we both feel incredibly lucky to be able to live and work in a country where healthcare is free and available to all.

We would both like to thank WOBS for supporting us during our elective and making our trip possible.

Johnathan Craik (Chapman ‘00) and Edmund Chedgy (Gervase ‘00)