Despite the beautiful and positive things I seem to be portraying of China, they do have many problems and this can only be solved by the actions of the government – the government needs to invest more in their people, most importantly, healthcare, rather than flashy gadgets. The most basic of healthcare is not provided for everyone, and the quality of healthcare here lags far behind that of the West. There seems to be a lot of corruption where money is concern – especially with Big Pharma.

The government has also spent billions of dollars in building massive monuments, attractions, etc., which all of course impresses and amazes visitors – but if a visitor stays long enough, the amazement will diminish to sadness and disgust as the extreme poverty, the unequal distribution and the social economic gap becomes very apparent; on the streets, you will see cripples begging for money when you know they should be in nursing homes or somewhere to be taken care of; Despite the immense wealth and riches that one sees in Beijing and Shanghai, the rest of China still have a long way to go. Even major cities have a long way to go before they meet the standards of the West that we here simply take for granted – like safe tap water; For many of them, our privileges are a struggle to gain. I admire China’s ability to develop so fast as a developing country, but I think she is leaving behind her most important assets, her good people.

 

(For those going to Shanghai or the Uni area and would like to get more information, send me a message and I can help you with the preparation as I have some of it written down in my separate journal.)

Brief Vignettes of my 2 weeks vacation:

Shanghai and Suzhou:  I haven’t left out much in my written form of expression previously so I will leave you with pictures below.

Hangzhou: You cannot but be filled with happy thoughts as you gaze out into Hangzhou’s beautiful lake. All earthly concerns become minor, insignificant, and meaningless compared to this beautiful, splendor of nature. Here, you can see the vast mountainous landscape where distinct, horizontal lines form only to be blurred by heavy fogs in the distance. The obscurity lends a mystical appeal to the landscape that a clear view could not – and there is a Chinese philosophy to this; unlike Western society who wishes to see things all in Black and White, the Chinese finds the mists to be a part of life, as  life is not always clearcut and we can never see everything clearly; therefore the fog serves as a figurative portrayal of this.

In Beijing, the nights are filled with luminous lights, soaring kites, shrill laughter and excited movements of children throwing neon lights into the air.  While the children play, the elderly walked the streets in groups of 2 or 3 to bask in the simple pleasure of being outside rather than in their cramped quarters.  In the Summer Palace, as we walked by pavilions, stone bridge and sculptures of grotesque monsters, we found ourselves walking through symphonies of music put together by a gathering of old folks with their traditional instruments. As we pass by them we heard another group singing their own chorus, and another playing the trumpet and flute. Another group down the dirt road was choreographing Tai Chi, and upon observing them, you cannot but feel very peaceful and relaxed.

Beijing quickly disappeared from me, just as fast as it had taken me to get there on the high-speed train. In the past two weeks, I have traveled from Shanghai to Suzhou for 2 days returning only to travel to Hangzhou with friends (2 Fudan students, a French guy, and an American); my friend and I separated from the group to travel directly to Beijing from Hangzhou. We returned to Shanghai one week later to depart on a flight connecting me to Tokyo before I would land in the states. Four cities and 2 countries in 2 weeks traveling by train and airplane. You can imagine my exhaustion and jet lag after returning. But this is overshadowed by the wonderful experience that is forever imprinted in my memories. In China, I received a very enriching and flavorful experience of the great cities; I visited many temples, understood Buddhism even better than before, learned a lot about Traditional Chinese Medicine, and met and conversed with the typical Chinese families; I tread the awe-inspiring grounds of the Suzhou gardens, saw the world-renown Westlake in Hangzhou from atop a Buddhist pagoda, climbed the Great Wall in Beijing, and felt the calling of the past in the Forbidden City. These are just a few places that I visited – to list them all now would not do them great justice without pictures beside them. My friend will send me the pictures in a CD later (his camera is so much better than mine, hence I let him be the photographer for most of the journey), but for now, here are some of the pictures I took with my own camera.

Life at home is busy so I will delay my other thoughts for later.

Friday was my last day of rotation for Module A. It took some time to sit and compose my thoughts and final reflections on my international experience. Overall, this journey has been a very quick one, and although I believe some changes should be made for future students on rotation, my experience in its entirety has been very enriching and eye-opening. I was able to be exposed to so many different facets of pharmacy: visited pharmaceutical companies as well as attended a conference, worked alongside students/pharmacists doing intense research, experienced just how different hospital pharmacy in China is from America, and even more interesting, dabbled in Traditional Chinese Medicine (from tai chi to acupuncture). Not only was I able to learn a lot from this rotation, but I was also able to show them a pharmacy perspective from the U.S through the Case presentation and other presentations I gave throughout the course of the rotation (Julie, who is a pre-pharmacy student from the U.S, was the driving vehicle to the communication process – without her, I would be lost). I shared with them some useful resources like globalrph.com. These pharmacists are very interested about the clinical side of pharmacy in the U.S and I hope that one day they will finally reach that point where they will be able to provide the same services and quality of care that we in the U.S are able to provide to patients in the U.S.

On the other hand, this rotation not only widened my pharmacy perspective (globally), but it also helped me grow as a person. As Americans traveling anywhere, we are representatives of our country and our institutions, therefore we need to be respectful of the differences (despite the fact that the differences are ginormous) we encounter. People here lead very simple life, and those who live in a big city such as Shanghai lead a very hard, fast-paced life – you will see very wide gaps in the social economic ladder, and you will cringe at things you normally will not see on the streets of America. You will have a hard time adjusting to the public bathroom department, dealing with the mosquitoes, the hygiene here, the density of crowd, pollution, etc. But overall, these are minor compared to the experiences you will have once you look past the minor details and talk to and meet local people (although I would advise caution with complete strangers.)

The Chinese are very hospital people – the team at Huashan hospital has been helpful and accommodating to me since Day 1. Even being lost on the streets, people will be very nice to point you to the right direction. You will be welcomed to Shanghai, and it is up to you whether you will embrace it.

Now 2 weeks of exploration with a friend from the U.S!

Cathy, me and the student who was like my personal translator, Julie :-)

6/28

I went to Longhua hospital which is one of the biggest TCM hospitals in Shanghai that also practices Western medicine.

I was told that about 7000 patients register each day (there is no such thing as appointments in China, in both Western/TCM hospitals – patients are sent to various departments according to their illnesses). TCM is popular for many different ailments, but they are big on Cancer treatment (liver, lung, etc)– this is typical even in the U.S, as an option of last resort. There are a variety of treatments, and they don’t work to treat just one single condition, but on the whole body – that’s why it’s called holistic medicine. Even if two patients have liver cancer, the herbs used to treat one patient is not the same as for the other patient because they tailor the treatment specifically to the individual; in addition, different stages of the disease require different concoctions, so the patients seldom have the same herbal treatment for the entire course of the disease. I saw that the usual days supply ranged from 6-14 days, with 14 days being the most common. Again, just like the western medicine here, if they need refills, they always go to see the doctor so that the doctor would determine their next regimen, which mostly likely will be different.

There’s also a unique form of diabetic infection treatment (foot/hands/etc) that they also implemented 4-5 years ago, after trying it on mice; due to its success, they use that treatment on people who do not want to have their appendages amputated – this requires a fabric or something saturated with an herbal concoction which is inserted into a hole in the skin as a result of the infection; this hole is sometimes surgically created so that the fabric can enter and the purpose is to basically unplug and reach all areas of the infection that neither rinsing nor oral and topical antibiotics can reach; rinsing is actually done in conjunction with this therapy. For those of you who are squeamish, you might not sit well with the grotesque pictures and the seemingly painful procedure, but from the before and after pictures that they showed me – it looks like the therapy really works. I was unable to get the Chinese name for this treatment down, but will get it and record it here later.

I will also go into the basic concepts behind TCM sometimes later, as this post is simply based on my observations of my one day “fieldtrip.”

I also tried acupuncture; let me tell you something: if the acupuncturist asks if you feel something, say yes, because they will fidget until they make sure you definitely feel something (I almost yelped because it seemed as if the needle was hitting muscle). Afterwards, you will feel sore for a short while; no wonder they all say that I was brave for trying. But it was definitely an interesting experience – if I think this is painful, the people who get acupuncture done on their face have it worse; it’s even more painful on the face.

 

 

Alternatively, there is tuina (therapeutic massage – different from normal massage therapy) which have the same methodology as acupuncture – with the meridians points and all, but their approach is different because they have a larger area to cover than acupuncture; most people turn to tuina for spinal problems; also for conditions such as pain, they would go to tuina to avoid the needles. Acupuncture is popular for stroke patients, immunological conditions, and arthritis as well. There were quite a lot of people here, and I even saw one foreigner waiting in line.

I was shown their herbal department, and if you were not familiar with the strong scent, it would have made you cough. They also use an interesting scale to weigh the herbs, which is the traditional way to do it.

 

 

These herbs are basically combined, boiled and then the patients drink the “soup” afterwards; as you can see in the photos in the gallery, these are the corn hairs, shell of silkworms, etc, and they’re all used for various conditions; they weigh them here, and package them in a plastic bag, which is then placed in bins according to physician orders; each patient gets this huge bag to bring home and boil.

 

I think just being here and seeing how things are done in TCM is priceless. You can’t get any closer to TCM in America than this, and your perception of holistic medicine completely changes once you are immersed in the smell, the actions, and the experience (me under the needle).

Most people are either completely against TCM or for it, but I think that there is a middle point where some of the practices have validity. Do you think one day, Eastern Medicine would meet Western Medicine and shake hands?

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Last Thursday I went to PIVAs and learned the workflow and the responsibilities of the workers there. Basically, physicians send the orders down electronically, then the pharmacists check to see whether they’re correct and then they select the medications, place them in a basket where they enter through the slot in the Clean room, where the nurses would then make the IVs. Nurses usually work from 6:30 to 4:30 with a one-hour break. They do massive volumes of prescriptions, approximately 700 per day. Get this, that is considered small relative to other hospitals; in other hospitals, the IV Clean rooms are actually 3 times the size and the volume of IV products compound and dispensed are in the thousands/day.The IV products here are required to be dispensed in generics if there are ones; IVs are more highly regulated, which is in stark contrast to oral drugs, hence is a higher volume of brand names being dispensed.

Yesterday, I gave a presentation to a full room of Infectious Disease Doctors/Residents and pharmacists. Mind you, it was intimidiating when JL told me to turn around – I expected less than 15, not a full house.  But the subject wasn’t too bad – I had the help of a clincal pharmacist from the U.S and my experience to put together a powerpoint to show the Clinical side of Pharmacy in the U.S.

Today I also had a case presentation that I gave to all the pharmacists on CAP in a patient with Bronchiectasis; I delivered both very well and fielded through quite a few questions compared to yesterday’s. Overall, they were not as nervewracking, as say, the P/F Seminar I had to give during the school year.

I also went to a TCM hospital which I will elaborate later on with lots of pictures!

 

The conference was for the most part – incomprehensible because most of it was in Mandarin. There were only 2 lectures that were given in English; one from a Pharm company in the UK and the other from France. I was introduced to both and actually sat in the same lunch table with them as well as two US citizens, a professor from Michigan and the other, a U.S official, and other organizers of the event.

What I learned is that the pharmaceutical market now is looking towards emerging markets like China and India where there is a greater growth potential compared to western market. This isn’t hard to believe considering how expensive and regulated the pharmaceutical market is in Western society, especially the U.S.  (**see below for more of my thoughts) 

Adding to the growth potential, China is the 2nd to largest world economy – it will be first in 2025 – again, there are billions of people in China – imagine in every service sector in the U.S, there are 4x the amount of people to service, driving the need to supply the demand for those services.

The UK and China are partnering up in this Research and Development business where both sides will benefit. Of course, there are financial benefits and patent rights that both will gain, but China will benefit in receiving the drugs discovered here first before it will be distributed to the rest of the world. Drug discovery, meanwhile, will be less expensive and become more prolific.

The world is constantly changing and there are many opportunities out there to be involved in the change – be it minor or grand, and good or bad. This rotation is definitely increasing my global perspective of the pharmaceutical market.

More pictures later on Yuyuan Garden and Xintiandi

 

**There aren’t policies in place, like it is in the U.S to prevent drug representatives from influencing the decisions of doctors (remember the incentives e.g., vacation packages, free accessories, and other perks). What was once an ethical issue in the U.S has become a huge problem in China – and with no hospital drug protocols (as I was told), and no bar over Big-pharma influence, there is a lot of money to be made in the pharmaceutical industry

My rotation site is at Huashan Hospital (an hour and a half) away from Zhang Jiang campus. This location is like a 15 min walk away from Jing’an Temple.

My first week at Huashan hospital ended and I am learning a lot about what pharmacists here do and what it takes to become one. In general, the name “pharmacist” can be applied to anyone who works in a pharmacy – so it’s not as specialized as what we in the states may think of it. To be a “pharmacist,” you can either get a B.S, Masters, Ph.D, or go to a specialized high school to train in pharmacy. After working for a year, you may take a licensing exam to become a junior pharmacist – but you are still called a pharmacist. Some “pharmacists” work in the dispensary, dispensing thousands of prescription a day; others conduct research after research, because in order to get promoted (this applies to even the professors at Fudan), you need to publish a paper.

In contrast to the prevalence of Retail chains in the U.S, most patients here in China get their prescriptions from Hospitals, as they are a more trusted source, and patients can speak to the doctors when any issues arise. Licensed pharmacies are a recent development here, and although it is required to have one “pharmacist” in a pharmacy, it’s not completely known whether these pharmacists are licensed – “junior pharmacists” – I know, it’s confusing even to me – but the main point here is, the role of “pharmacists” in China is not very clearly defined and it is not at a certain tier that the U.S is in. In addition, for the most part, “clinical” pharmacists are trained clinically when they graduate and work in the hospital. They do not have any clinical background in school, and are expected to learn it when they are practicing. I am by no means, demeaning their work; the perception of what we hold of “pharmacists” in America is different from that in China – the major role here with pharmacists is centered on research and some of the clinical pharmacists/pharmacists here are doing groundbreaking research that neither you and I can even wrap our heads around. It is one of the best hospitals in the region, many patients come here for their dermatology, neurology, and nephrology departments. The people here are very nice and friendly!

Huashan is affiliated with Fudan, so the Fudan pharmacy students come here to do research, salvaging patients’ blood samples that would eventually go to waste. This comes across a lot of ethical issue, but it is not my place to complain. In addition, there is no such thing as HIPAA here. Since being at the hospital, I am experiencing major culture shock just from how different the health system is like from America, and that include things that should be minor like sanitization.

Boiling water is a requirement to drink tap water here (which I agree, it amazes me what sort of biohazards people dump into the sink); people also actually peel the skins of their fruits before eating them – that should give you a little insight into the condition here. I think this is an area of improvement that China should spend a little time in investing. Again, like the infrastructure I discussed much earlier, the quality of healthcare is also not equally distributed; you can see the obvious distinction when you enter the healthcare clinic (in the hospital) for foreigners and local “VIPs”. It’s like entering a completely different world – like a hotel, metaphorically speaking – there’s soap, tissue, filtered water, supreme cleanliness (which surprisingly, is hard to come by in public places). On a pharmacy-related note, patients are given only a 7 day supply; there is no such thing as refills – patients need to see their doctors to get a prescription for another 7 day supply and so forth.

I gave a presentation to both pharmacists and “clinical” pharmacists (Wednesday) about the pharmacy healthcare system in America, which went pretty well. Here, you have a similar hierarchy of workers like in the U.S, but slight variances. You have the residents doing the rounds, and one physician in a department overseeing them. There is a “genius” doctor that comes twice a week and goes thru every case and then select the most urgent case to work on. It looks like many things are done by hand – as they don’t have a Pyxis system. Clinical pharmacists assist, but most of the drug decisions are dictated by doctors.

I’m working on an infectious disease case which I will be presenting during the final week, peer-editing a research paper, and reviewing information for a possible “lecture.” I’m being kept busy so sorry for the delay in blogging. Tomorrow is the “postponed” conference with the pharmaceutical companies. You’ll hear about it soon.

Other fun things I’ve experienced in the past week:
-A heavenly foot massage – which is a nice treat from all the walking I’ve done – I don’t know why he’s shocked about the calluses on the foot of an American.
-I visited Handan (SP?) campus, the main one with one of the students. It was beautiful day, beautiful visit, and had a strawberry milkshake and an interesting tiramisu in a glass.

-Played chess for the first time in ages near the Bund with a Brit – I won, hehe – hopefully I’m smarter than I was 10 years ago, and can beat my brother now.
-Went to the Shanghai Museum then to a French-Chino concert
-Went to Jing’An temple

I’ll devote the next post to pictures of the hospital and my events – when I get faster internet connection

What should have been an half-hour presentation this morning turned into an hour-long discussion-based presentation.

My presentation this morning was informing the students what pharmacy is like in America by giving a description of the school, the curriculum and the pharmacy healthcare system. I incorporated some discussion-based questions into the presentation and was met with many questions and answers (hence “hour-long” presentation). What I learned from the students- not just one, but with the many perspectives in the room, is that most of the students who finish their B.S, go on to work in the hospital/retail and then take a test to become “pharmacists.” Other students would go on to pursue their masters for an additional 3 years (this involves mainly research). Some of these students who finish their masters again can decide again to go into hospitals, or become drug representatives (a more desirable and lucrative field), or work for domestic/foreign drug companies, or go for even further schooling to get their Ph.D so that can work as a researcher. Apparently, to work as a researcher, you need a Ph.D

The pharmacy curriculum, in their undergraduate years, have a more chemistry-based leaning. They have analytical chemistry, chemistry this and chemistry that– (erhm, chemistry is not my most favorite or best subject, so I’m thankful that biochemistry was the end of the “-chemistryism” for us).

The students were unfamiliar with pharmacotherapy courses, but it’s understandable because their curriculum is more research-oriented.

Now, if you take a step back, the definition/profession of pharmacy varies according to different countries, so going into China believing that pharmacy is the same – or even close to the same as pharmacy in America is an outright fallacy (I admit to thinking that it was at least similar). The pharmacy profession in China, is still in its developmental stages so it’s not as greatly developed as our system, but I do believe that there will be exciting changes ahead when new programs open to offer more opportunities for the students. I think Fudan is trying to be the first to initiate those changes.

In regards to retail, retail pharmacy isn’t a large component of pharmacy as it is in the United States.  Again, being lost in translation with the students, I think patients obtain most of the drugs from the hospital pharmacy, but hopefully I’ll know better next week when I go to Huashan Hospital.

Traditional Chinese Medicine, unlike what we in the U.S might think, is not just one herb, or one pill, but a concoction of multiple herbs. I was told that each of the herbs in the concoction works synergistically to help treat the ailment and reduce the side-effects. One of the students at Fudan actually transferred in as a graduate student from a TCM school and so she’s going to explain to me more about it later. Otherwise, the students here in pharmacy school have minimal exposure, if any to TCM practices. The TCM college next door, is where I would probably need to go to if I would like to be more informed about TCM.

So there you have it. There seems to be a decent proportion of the population that believes in TCM and uses TCM and but a greater proportion that only trusts Western medicine. The hospital I will be going to next week will have a TCM department in addition to their pharmacies and this is interesting because the health system here really seems to fuse both Western and Traditional Medicine together to accommodate the different health needs/preferences of the people. I’m really eager to try acupuncture on myself, and if they let me, taste an herbal concoction.

However, don’t get me wrong though, their healthcare system is far from perfect as there is a great discontent between healthcare workers and patients here primarily due to lack of trust – but this is an issue I will detail at the end. (Although it’s terrible to compare, just by being and seeing things on both sides of the pond makes you a little bit more appreciative for what you have back at home.)

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