Students in Penn’s Pre-Health Programs travel to China for hospital observation and cultural immersion
It is August in Hangzhou, and members of the PennCHIME student group are touring a hospital in the scenic coastal city. Coordinated by Penn Pre-Health Post-Baccalaureate Programs Director Jackie McLaughlin and biology lecturer and advisor Lisa Witmer, the trip to China was organized to give PennCHIME members first-hand experience with medical practices and policies on the other side of the globe. While the students eagerly anticipated the opportunity to observe hospital rounds abroad, they had not expected their tour to include an entire hospital and emergency room dedicated to traditional Chinese medicine. But there they were, observing as patients received acupuncture treatments, therapeutic massages and poultices for flu prevention.
Perhaps these future health professionals also did not expect to become patients themselves, but an opportunity presented itself when the group encountered a curiously pungent herbal odor in a wing of the hospital dedicated to treating throat problems and digestive issues. Here, specialists were burning sticks of strong-smelling wormwood for a therapy known as moxibustion, which they were applying in conjunction with acupressure to treat sore throats. “There weren’t a lot of questions we could ask because of language limitations,” recalls McLaughlin. “But they were very receptive to us coming in and having a treatment.” So the future doctors, surgeons and dentists found themselves in the position to not only observe but receive therapies such as moxibustion and medicinal teas.
Hospitals that treat patients with traditional medicine are not uncommon in China; there is a facility dedicated to the ancient practice in nearly every city, and many hospitals that practice Western medicine also prescribe some traditional remedies. (The reverse is also true.) But this hospital observation was special for the student travelers, whose experiences shadowing medical professionals in the United States are typically less hands-on. Throughout PennCHIME’s inaugural hospital observation and cultural immersion trip to China, the group enjoyed a warm reception and an invitation to engage with healthcare providers who were eager to share their knowledge. And though the Pre-Health students signed up to expand their medical and cultural horizons, the journey was even more transformative than they imagined.
“PennCHIME is a group that grew out of the students’ interest in Chinese culture and health disparities and health-related issues in Chinese Americans,” explains McLaughlin. Initially, the student group came together under the guidance of Dr. Witmer, who arranged for the Pre-Health students to tutor local high school students who were born in China. Their mentorship quickly became more of a cultural exchange. Working closely with teenagers who had grown up in China’s healthcare and insurance system, even the Pre-Health students who already had connections to Chinese American communities became curious about how these practices differed from healthcare in the United States. Furthermore, as emerging medical practitioners, the students hoped acquiring some familiarity with Chinese languages and culture could facilitate doctor-patient communications in their future careers.
In time, says McLaughlin, the PennCHIME meetings grew to encompass bimonthly lectures on Chinese healthcare and opportunities to practice basic medical Mandarin; then, “the trip grew out of an interest in exploring health-related issues and how medicine is practiced in China.” Building an itinerary with the help of Penn Global and various contacts in the medical field, Witmer and McLaughlin accompanied six Pre-Health students to spend 11 days in China.
The group began their observations in Zhengzhou, the populous capital of Henan Province in central China. With a population surpassing nine million, Zhengzhou is quickly approaching megacity status—and with close to four thousand beds, the capacity of Henan Provincial People’s Hospital is correspondingly vast. Although video chatting and telemedicine help accommodate a greater volume of patient consultations, Zhengzhou’s doctors might see close to 100 patients in one day. For the student travelers, this provided a unique opportunity to observe more patients with a greater variety of medical concerns, but the group marveled at the ease with which the doctors managed their patient volume.
Henan Provincial People’s Hospital is also home to an International Medical Center where the students had the opportunity to observe doctors communicating with patients that did not share the same language. In some cases, doctor-patient dialogue was facilitated by a translator; in other cases, nonverbal cues such as body language and facial expressions were vital to building rapport. “I observed an English-speaking Finnish neurosurgeon working through a translator,” recalls David Ting (Pre-Health Programs ’18). “Seeing both sides of the conversation, it was surprising to me how much was lost in translation. Simplifications and complexity were equal threats to the patient’s ability to act on the diagnosis.” Observing intercultural communication in action inspired reflections on how to build patient trust across cultural or even language differences. “Especially in medical settings, it’s important to get your point across clearly without overwhelming patients with medical jargon,” says PennCHIME foudning president Nicolas Nelson (Pre-Health Programs ’18), who also remarked that communication skills were vital for caring with patients even without the language barrier.
During visits to a small private clinic that practiced traditional medicine as well the larger facility where they encountered moxibustion therapy, the integration of technology and traditional medicine prompted the student travelers to reexamine their preconceptions of the latter. “The experience inspired me to form a fuller picture of the science and culture behind traditional Chinese medicine,” says Nicolas. “Seeing its undeniable prominence of in Chinese health culture helps us respect our patients’ values and views about healthcare.” Victoria Chang (Pre-Health Programs ’18) was already familiar with traditional therapies such as coining and cupping, which are practiced in Chinese American communities, but observed techniques in the clinic that were unfamiliar to her. “After seeing the immense number of patients and size of the traditional clinics, I have developed more of a grasp on how Chinese people perceive Western medicine,” she says. “Every individual has a different perspective on medicine and approach to health.”
At Henan Provincial People’s Hospital as well as other local clinics, a few Pre-Health students were able to observe practices within their intended medical fields: a member of the Harrison Surgical Scholar program spent a day with a thoracic surgery team, a pre-dental student observed a private dental practice, and a few students were able to explore surgery simulations. The doctors they met were eager to accommodate their questions and comments, helping the students feel immersed in the experience. “They were so enthusiastic to share cultures, practices and perspectives,” says Nicolas, “whether in the halls, in classrooms or at hot pot.” That is to say, after talking shop in health insurance panels and consultation rooms and simulation centers, their new medical colleagues often wanted to meet for dinner or tea and continue the conversation. “Experiencing culture through food is something we did on a daily basis,” laughs McLaughlin.
Despite an arduous travel schedule, the group was still able to make time to enjoy the beauty and history of the regions they visited: they stood on the Great Wall, saw Beijing’s Forbidden City and attended a martial arts exhibition at the Shaolin Temple Kung Fu School in the Henan Province. Toward the end of their trip, the group spent half a day at the New Day Foster Home, a facility which provides care for orphans with medical needs. After a morning touring the facility and playing with the children, many of the students were moved by the organization’s dedication of time, resources and medical knowledge to serve their vulnerable patients. “This trip confirmed my aspiration of returning to China as a dentist and helping to provide care and prevention education,” says Victoria. “Meeting the foster home staff inspired me to channel a greater amount of energy into serving others.”
“These students didn’t come to Penn expecting in their wildest dreams that they were ever going to get to do medical observations in China,” says McLaughlin. “We were incredibly lucky to have the support of the University and its leadership helping us to do it.” Now returned home, the students and faculty would like to see the China trip established as an annual experience or linked to a Pre-Health course; Pre-Health Program leadership is also exploring options for developing international medical observation experiences in other countries. Until then, PennCHIME will continue its lectures and programs to help Pre-Health students understand Western medicine in a broader global context and prepare for successful intercultural communications.