Today was not quite as eventful as the past two days, since I pretty much just watched a surgery similar to the ones I had seen previously, except that it was a revision, meaning that they had to redo a lumbar disc resection (due to re-herniation). It was twice as long as the other operations because there was a great deal of scar tissue to clean through and discard, and even the suturing took perhaps 45 minutes because there were four layers of sutures necessary (from a posterior approach, you must pass through skin, subcutaneous fat, muscle & fascia, vertebral spinous process, vertebral lamina, and then cauda equina before you can reach the intervertebral disc). That’s probably more detail than I really need to delve into, but you get the gist of it. Unfortunately, there are no pictures allowed in the OR, and so there will probably be less pictures in the next week and a half I have left over here (sorry!).
However, I can perhaps discuss some public health issues that I think China faces (and maybe relate them to the U.S. a bit). Some of the biggest health problems I have noticed are: ungodly amounts of pollution, large prevalence of smoking (even both surgeons I have been shadowing smoke about 1/2 pack a day), growing obesity rates, aging population, huge staffing deficits, inadequate distribution of medical care (very sparse in rural areas), ’empty’ diets, lack of workers (an increase in education is driving young people into more white collar jobs), among many others.
The pollution and smoking are causing some really significant rates of lung cancer and affect every possible organ system indirectly somehow. These are only exacerbated by growing obesity rates as KFC and other fast food chains are growing very popular, and the aging population will make chronic conditions related to all of these trends more prevalent. Those in the countryside have a lack of access to the same medical care as those in cities, though they are in theory covered under the same insurance plan; one patient’s mother traveled 200 km just to get a consult from the doctor I shadowed yesterday. Even in the normal Chinese diets, most of the food tends to be meat and few vegetables with some carbs (typically noodles or rice) in a sauce that is high in sodium. Though this is not usually an excess of calories, some doctors were telling me that it has a reputation for being relatively devoid of significant nutrients. With the lack of workers, the Chinese economy will have to confront a shift in their base, which is now more focused on industrial production, but will have to increase its availability of service-related jobs.
This is a lot to take in, but I think the way China is changing is that the people are becoming less healthy, but are finding medical interventions that help them live longer, and are moving into career paths that are also less active. This means that more of them will also have access to technologies that can perpetuate their unhealthy habits, decreasing the ability to motivate patients to take responsibility for their own health. I’m not entirely sure how physicians and healthcare administrators will approach this, but I think there are some things I have seen that are a good start. Based on the high volume of traffic, many people are commuting via bike or public transport, forcing them to walk at least somewhat daily. There are many public, outdoor events on a daily basis that anyone can avail themselves of, to include public parks that have workout facilities (see the picture below), some very fun line dancing (anyone who has traveled to China can attest to this), tai chi, etc. If China can use its more centralized government (quite an understatement, trust me) to motivate these behaviors and decrease usage of cigarettes, perhaps they long lives they will live will be more enjoyable!
Outdoor Workout Parks for Adults.
On another note, the day was quite short because after the surgery, there was just paperwork for the doctors to do, so I had two choices: go home or go into the OR alone into random surgeries using all of my ten words in Mandarin while scrub nurses chased me out of their rooms….needless to say I chose the former. While I got back early, I wanted to make the most of the day, so after an early dinner, I headed out to the “Ancient Culture Street” of Tianjin, which was built in the 80’s but depicts China several hundred years past. This is supposed to also be a great shopping area for cultural types of things. I was at first sad to find that everything was closed with the exception of two or three shops, because there main business occurs on weekends. However, I decided that I was not going to let a small change in plans deter me from enjoying Tianjin at night, and so I just followed a road that crept along the Haihe River that divides Tianjin. I soon came along a little wharf that had some frozen desserts, which I quickly bought since it was still quite hot and humid, even in the early evening. See the picture below to see me by the riverside.
Just after some shopping, enjoying the Tianjin Riverside.
I then crossed over the bridge you see in the distance on the right in the image above (the bridge while I am on it, along with some Tianjin skyline can be seen below). The things I came across as I continued along the riverwalk were quite amazing: line dancing parties, children playing everywhere, a man singing traditional Chinese music while making popcorn (attracting a huge crowd), street dancers, dozens of very small dogs, middle-aged men fishing, many couples taking professional engagement pictures (or perhaps those kinds of pictures are just normal in China), and bootleggers, among many other things. There was even a man on a bike who thought I was Muslim and greeted me with “As-salamu alaykum” and played Arabic music, and after I courteously replied “Boo yao” (‘I do not want’, one of my ten words/phrases), he continued to follow me, switching to a classic Bollywood song on his stereo. I’m not sure what his intentions were, and though he was interesting, I continued on, not wishing to try and find out. The night continued on like that, and I found that not knowing a language makes traveling and learning about culture much more fascinating in many respects: you learn how body language differs in each culture, you are forced to appreciate things based solely on their intrinsic but superficial qualities, and you have the chance to form your own pure opinions about a culture, without the influence of anyone else. I’m not sure which I enjoy more: learning about Chinese medicine or experiencing Chinese culture!
Beautiful Tianjin at night!