Summer research adventures in China

Penn Med Voices took a (much needed) hiatus this summer. Now we’re back, with many more stories to share! First up, Christopher Magoon, an MS2, writes about his summer doing ophthalmology research in China.

As a second year medical student, the hospital still feels like foreign place.  Every time I enter the building, I am met with unfamiliar words, sights and smells.  This was especially true this summer, at Zhonghsan Ophthalmic Center (ZOC) in Guangzhou, China.  As a top-tier ophthalmic hospital, ZOC handles hundreds of thousands of patients each year, many of whom travel great distances to seek care.  More so, in interactions great and small–directly and indirectly–the people within ZOC also grapple with central questions facing modern China:  “How do you provide healthcare for 1.4 billion people?…In a socialist country?…With a capitalist system?”

I came to China to work with Nathan Congdon, MD, MPH, a professor of Preventative Ophthalmology at ZOC and a leading researcher in blindness prevention in the region whose work has been by featured in NPRThe Wall Street Journal, and Chinese State Television, among others.  With funding from Penn’s Global Health Program, I spent nearly two months living in Guangzhou, working with Dr. Congdon and his team.

Two other ZOC members and Magoon discussing a report on diabetic retinopathy at a hospital training session two hours away from ZOC—Shaoguan, Guandong Provence, China. Credit: Christopher Magoon
Two other ZOC members and Magoon discussing a report on diabetic retinopathy at a hospital training session two hours away from ZOC—Shaoguan, Guandong Provence, China. Credit: Christopher Magoon

Like many in China, Dr. Congdon’s team works doggedly to keep up with a country that is changing at breakneck speeds.  China’s stunning rise in wealth, urbanization, and technological prowess has yielded rises in obesity, income disparity, and more health care demand.  This produces a public health situation that is, frankly, difficult to grapple with.  Broadly speaking, Dr. Congdon’s team conducts research to understand how and why barriers to care exist, and what various stakeholders can do about it.

Within this swirling landscape, it is easy to underestimate what is at stake.  China has seen unparalleled progress in many categories of health metrics, yet the gains still hang in the balance.  China’s population is aging rapidly, and as a result of the one-child policy, many Chinese will have to bear the costs of both parents’ healthcare needs without the support of siblings.  As China has developed, it has seen a concordant rise in diseases that are familiar to more affluent settings:  diabetes, cardiovascular disease, and obesity.  These chronic diseases are costly and time consuming to manage.  Perhaps of greatest concern, China’s income disparity has yielded a massive number of people who are feeling left behind and angry, with few formal avenues for recourse.  This anger often spills over into the hospital wards, as patient attacks, and even murder of doctors, is commonplace across the country.  In 2012, Chinese hospitals averaged 27 attacks per hospital per year.

While true, this grave picture hardly colored my experience at ZOC.  Though the hospital was often bursting with people, this was no different from my subway ride to the hospital, or even the cafe where I met my Chinese tutor after work.  Patients were nearly uniformly appreciative and attentive when undergoing treatment.  Far from focusing on high-level problems, our team worked on getting excellent data on smaller questions: “What do diabetic patients in rural China think about the doctors and equipment at their rural hospital?  What about in the bigger hospitals in the city?”

ZOC member provides training and treatment for local ophthalmologist—Shaoguan, Guangdong Provence, China. Credit: Christopher Magoon
ZOC member provides training and treatment for local ophthalmologist—Shaoguan, Guangdong Provence, China. Credit: Christopher Magoon

 

Most of my days were spent in our modest office on the 4th floor above a mall that sold household appliances; like many organizations in China, ZOC has outgrown their main building.  I shared the office with statisticians, residents, physicians, postdocs, fundus readers, IT experts, and others who formed our team.  There are many projects going on at once, and I pitched in where I could: editing documents, translating from Mandarin into English, and working on a review article of interventions for non-communicable diseases in low- and middle-income countries.  When not in the office, I studied Chinese.  Though I’ve spent years learning the language, there is always more to know, especially focusing on medical vocabulary and 汉子, the written characters.  In many ways, studying Chinese is similar to being a medical student—the more you learn, the more you realize how far you have to go, while still creating amazing opportunities.

Coming back to Philly to begin my second year of medical school, I feel lucky to have been able to experience this different system, with its unique set of challenges and solutions.  Yet I am reminded of the fact that our own system suffers from parallel ailments:  inequality, chronic diseases, and increasing costs.  On both sides of the Pacific, there are no easy answers—but ample reason to ask precise questions.

Christopher Magoon is a second year medical student who lived in rural China from 2011-2012 working for a rural education non-profit, after graduating from Yale University with a history degree. In his spare time Chris enjoys learning medical Mandarin, building tables, playing squash with his learning team buddies, and being an all-around cool dude.

 

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