Advocacy & Health Policy: Lessons Learned from My Travels to China

By Bill Fong, MD, Assistant Professor, John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health

The significance of our role in the lives of our patients is deeply felt when working with underserved populations. The experiences I have had while traveling with Global Health Outreach in cooperation with the Chinese Red Cross are a testament to this. For the last nine years, I have had the privilege of working in remote and rural areas of China conducting medical and dental clinics.

Most times, these trips involved grueling travel across the country to access rural areas. We once took a 30-hour ride from Beijing all the way north to Inner Mongolia. Everyone was very warm and welcomed us graciously. Much of what we saw in those rustic villages was so far removed from what we would experience in our day-to-day lives at home. We had the opportunity to try local delicacies, like deep-fried silkworm larvae or mutton fat. Outside, pigs roamed the front entrance, while all of us-staff, in-patients, and visitors-walked out back to use the communal outhouse.

China itself is vast, and much of health and medical services are concentrated in the cities. Unfortunately, this means that health care services in rural areas are not as easily accessible. The doctor-patient ratio of China’s population of 1.3 billion is about half of what we have here in the Unites States.

During our trips, there were many aspects of Chinese medicine that are of note:

  • Well-woman exams, pap smears, and mammograms are not routine
  • Traditional Chinese Medicine is often practiced alongside western medicine, and they often overlap or conflict
  • It was nearly impossible to find any estrogen products such as oral contraceptive pills or hormone replacement therapy. Even in hospitals and clinics, these were nowhere to be found
  • Antibiotics, medroxyprogesterone, anti-hypertensives, and even tamoxifen could be bought easily and inexpensively over the counter
  • A visit to the doctor cost the equivalent of three US dollars
  • A paper smear cost the equivalent of 30 US dollars
  • Although the one-child policy has become more relaxed, it is also easily enforceable through the use of string-less IUDs after delivery
  • Similar to the United States, obesity is a medical problem in China due to the availability of American fast food, like Mcdonald’s and KFC, as well as the overreliance on cars and mopeds, and children who increasingly prefer to spend time indoors on computers instead of outside

Overall, these visits were consistently enjoyable, and we learned so much during each trip. It warmed our hearts to see the locals, as they were very excited to meet us and very talkative. They greeted us dressed in their best clothes, with hands that were toughened and leathery from hard farm work. We shared a few jokes and took pictures together. We also spent time treating any minor conditions that could be safely treated in a single encounter. For any serious conditions that required diagnosis or immediate treatment, we encouraged them to visit a medical center in a larger city.  We noticed that old-wives-tales sometimes played a part in the perceived seriousness of their conditions and maladies. We did our best to dissipate some of these stories and help them to realize that some of their maladies were really not so grave after all.

I do not speak Mandarin, but communication is easy when using compassion, which is universal. Opportunities for medical diplomacy such as these benefit the populations they serve and renew that passion that we as physicians initially felt when we were first called to medicine as a life-long career. 

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