Reflections

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  Xian, China
Wednesday, November 22, 2006

Hello from a hazy, lazy afternoon in Xi'an.

I thought it was about time to give you all an update on my placement. As you may remember I have been spending my mornings at the Fourth Military Medical University. Over the past 3 weeks we have participated in much more than a simple dialogue on the differences of the medical systems of our respective countries. We have discussed history, culture, sports, even cooking, and have debated topics as varied as western materialism, the evolution of the United Nations, and influential inventions of the 20th century. My students are intelligent and caring and just as eager to teach me about their country and customs as to learn about mine. I am also starting to get to know some of them more personally and have been invited in small ways into their lives. I've been told childhood stories, shown stories of pets, and heard complaining about exams and studying....

I think that more than anything else my placement is about cultural exchange. It is in it's capacity for fostering relationships between people that it contributes to making the world a better place (for lack of a better cliche). Different from the front line volunteering more readily available, if you will, in countryside villages and war zones, this placement uses communication to breed familiarity to breed understanding thereby building a bridge which we can all cross. I like to think that if nothing else I will have given a face to the name of a country. Perhaps when one of these medical students is involved in the making of a decision affecting Canada he or she will not just see a name of a country but the face of a person (and vice versa with me of course)

Some observations from my placement this morning, just to give you a flavour for what I am experiencing:

1) Sometimes when a student has difficulty expressing themselves in English they apologize to no end and seem to feel quite guilty that they cannot find the right words. My response to this is always the same - do not feel guilty, I don't speak a word (well I have learned a few words, even some sentences...) of your language. You are the one who speaks both English and Chinese. This kind of interaction brings me back to a conversation I've had several times with some of the other volunteers about how we sometimes feel guilty ourselves that our first language IS English. Of course in terms of actions we did nothing wrong, but sometimes it's off putting to realize just how lucky we are and how we do take so much for granted.

2) We spoke today of China's westernization and how about how many Chinese are so eager to attain Western standards, and to own Western products that not enough time is spent on understanding the concepts and infrastructure behind such products. For example, everyone wants to own a car and be able to drive yet the system of traffic laws is not yet developed enough to support so many cars efficiently.

3) I was talking about how his week has been a bit difficult because new friends are leaving, and new volunteers are coming and so there will be another period of readjustment. One student made this insight: Western people are much more adapted to programs like CCS where people come and go because to a Western person leaving some friends also means making new friends. Links between people in China, family as well as friendly, are much tighter she continued, perhaps a reflection of the deep seated cultural difference between individualism vs. collectivism, the chinese connection to the land and hometown etc....which culminate to make leaving friends a much bigger and dooming affair than considered by westerners...

4) When speaking of the medical system there is a general consensus that western medicine is better for acute treatment and that traditional chinese medicine is better for chronic pain and general well being. Most of my students are very realistic about the state of their health care system while a select few maintain that healthcare in China is on par with the west and that they do most things the same way and use the same equipment. I don't try to argue too much with such people because they tend to go on the defensive quickly making a meaningful discussion next to impossible. Some things I have learned/observed about the healthcare system in China (however all these are not always entirely true, vary from hospital to hospital etc...):

- Morphine is closely monitored and it not delivered to patients unless absolutely necessary (I haven't figured out yet if this is because it is too expensive or because the Chinese tend to parralel it too closely with their opium history....).
- The concept of palliative care is utterly foreign to the Chinese. The phrase "just make them as comfortable as possible" seems to make no sense them whatsoever.
- It is fairly common practice for a doctor NOT to tell his or her patient that he or she has a life threatening disease like cancer reasoning that such knowledge will kill hope and lessen the patient's chance for survival. In these cases, a family member is told who then brings the patient in for treatment of "some general problem".
- Family members are expected to do most of what is required to care for patients while in hospital. They feed the patient, bathe them, dress them, change bandages etc...(what nurses would do in the west)
- Many doctors think that homecare services will boom in China like in no other country as only children grow up and have to care for their own young child and two sets of grandparents all by themselves.
- Gloves are only worn during very risky procedures (whereas in the west gloves are worn for every procedure that has the smallest risk of disease contraction, infection, etc...to protect both the patient AND the healthcare worker)
- Dentist offices are located right beside the road with the chairs and equipment behind glass windows so that anyone on the street can see in during any checkup.
- As in many countries (including good ole Canada) the biggest problem with the healthcare system as it stands is providing access to the rural population. Doctors, who are for the most part trained in the cities, do not want to go back to their villages and the countryside after their schooling.

Some additional un-medical and much less intellectual tidbits:

1) Our apartment looks over a school playground and every single morning we are woken by the school's loudspeakers at 7:20 am spewing out such classics as 'I will always love you' by Whitney Houston, 'I'll never break you heart' by the Backstreet Boys, and their favourite, 'London bridge is falling down'. Add to that minute after minute of prerecorded speeches-?? (I don't speak Chinese so I'm not really sure) and you get the acoustic chaos of every single morning in Xi'an!!. This love for loudspeakers can be seen, or heard I should say, not only in schools but on any street you walk down....some store, somewhere is playing music AT you.

2)Yesterday was Ghost's Day according to the lunar calendar. All over the city we saw people burning circles of clothes and fake money within a chalk-drawn circle on the ground. The money and clothes are then carried by the smoke to the tombs of the ancestors who need such things just as badly as we do for the land of the ancestors in just another world much like ours.

3) Walk around Xi'an in the early morning or in the early evening and you will see groups of people all over the place practicing tai chi, dancing, or singing....it's quite a lovely sight. I'm not quite sure why I feel this way nor if my understanding is accurate but when I see such people it seems as though they are acting out an admirable contentment with life and supreme acceptance of the lot they have been given....very Taoist, and very foreign...

4) I learned today that in China pedestrians and bicyclists always, no matter what, always have the right of way. That is to say then even if a pedestrian jumps over a road barrier into an upcoming car and is injured or killed the driver of the vehicle is still at fault and can be held liable. Now let me tell you...that explains A LOT about pedestrian traffic in Xi'an...it's an Olympic sport if I ever saw one.

Bye bye for now.

-Taylor

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