Each year, the employees of the University get a free health
check. This is performed at a small
hospital/clinic on the Medical School campus.
It takes all morning and is very extensive. Oh and it is completely free! So last year I decided to take advantage of
this to experience Chinese Healthcare for myself.
This exam would cost a lot in the US as it includes many –
usually separate – tests and procedures.
The blood draw included testing
for lipids, cbc, several hepatitis B antibodies, and a CA125 test for
women (used to detect ovarian cancer)
and PSA test for men. Other tests
include, an EKG, Chest X-ray, Eye exam,
glaucoma test, pap smear, blood pressure, and an ultrasound exam for thyroid,
breast, abdominal aortic aneurysm, and ovaries.
First you sign up online for your appointment. There is a two week period and each morning
approximately 300 people are seen. When
you arrive, you check in and enter a large room with benches and examination
room doors off all sides. China still
uses doctors and nurses for all healthcare so technicians are not part of the
healthcare scene. The physicians are
both male and female but nursing is still pretty much an all-female profession.
Another thing I should point out is that China doesn't have
HIPPA laws and your information is shared with anyone near enough to see or
hear your results. Although, the written report was given in a sealed
envelope. Privacy also has a different
meaning in China. The number of people
in the country and the number of people served by the clinic is a single day
doesn't allow for the kind of privacy you have while seeing a doctor in the US.
First we had our blood drawn, I was given two q-tips to hold on the puncture
afterwards to stop the bleeding. This
didn't work very well for me and I bled for quite a while and got a nice big
bruise on my arm.
When we went to the ultrasound room, there was a queue on
the bench outside the door. Inside the
door there were 5 chairs along with the nurse at a computer and a bed with a
drawn curtain. The patient was on the
bed with the doctor, as he examined the patient and looked at the ultrasound screen, he
called out the findings to the nurse who then typed them into the report. So the 5 people in the chairs, the person
waiting their turn behind the curtain and the patient on the bed all hear the
details. No one but the doctor and next
patient can see behind the curtain.
Since all patients for this were female, the ladies seemed okay with
this. The doctor spent about 10 minutes
with each patient. Far less time than would be allotted in the US for an ultra
sound exam of anyone one of these areas.
I have heard Western doctors here say, ‘The Chinese doctors won’t miss
anything big’. The doctor picked up
the inflammation in my thyroid and the cysts in my breasts.
The EKG (ECG) was performed by a very old machine and a
dated technique. I had clamps on all 4
limbs and then the machine had suction cups instead of leads. I have been told by US doctors that this is
completely acceptable. The doctor
looked at the strip (graph) right there and noted my inverted T-wave. This usually means you have had a heart
attack. I always have to explain that I
haven’t had a heart attack it is an infantile anomaly. Hard to do when you don’t speak much Chinese.
For the Pap smear, there was more privacy, but not much
time. Patients were told to take one leg out of their pants and panties and hop
up on the table. It was all over in
about a minute. I told my Gynecologist
this story. He roared with laughter and
said he should try that kind of assemble line medicine.
Several other things I noticed. The blood pressure was taken by the small
modern automated machines. These are
very popular in the US but not considered the most accurate. I was surprised a troop of nurses didn't take
the blood pressure. I also noticed that
almost everyone there had a systolic pressure close to 140. That is the cut off for high blood pressure
in the US. This is interesting because
the population here is chronically dehydrated and they eat a very high salt
diet. Not sodium chloride but mono sodium
glutamate.
I refused to be weighted because I didn't want “the whole
world” to know how much I weighed. Again
no privacy. This caused a stir of course. And my Chinese colleague got to explain this
to the nurse. (I'm just that crazy laowai.)
Because my friend had to help me
with the language I had even less privacy than the other patients. I had to adopt sort of an “out of body” mind
set to keep from being mortified with embarrassment. This year, when the health checkup came, I
politely refused saying I have to do it all in the summer in the US.
As you can see there are some pluses and minuses to this
system. The CA 125 blood test for
ovarian cancer is expensive, about $175 in the US. It is NOT used nearly enough in the US, yet
here every women received the blood test and for free. In the US, ovarian and uterine cancer are
STILL not detected early which puts women at greater risk. Personally, I am glad to see independent
testing labs springing up in the US where a patient can get his own blood
workup.
|
Ultrasound of Thyroid with inflammatory areas
highlighted. |
I have been on Thyroid medication for more than a decade. Yet, I have
never had a Thyroid ultrasound. I asked
my doctor in the US. “Do you just assume
that all women with low thyroid hormones have Hasimoto’s Disease.” (That is the name of the inflammatory thyroid
disease.) She said no and sent me for an
ultrasound. While it doesn't change my treatment,
it is important to know that you have a chronic inflammatory disorder because
it can lead to other inflammatory problems.
One the minus side, the speed at which these tests are
performed means that they are not very thorough. A small breast cancer could easily be
missed. Many of the exam rooms did not
have paper on the table and there was no cleaning between patients. This is typical for China. Yes the doctors do where gloves for say a Pap
test, or rectal exam but may not for a less invasive test. I have always thought that because of the
sloppy cleanup between patients, it would be very easy to spread disease
here. I have had other expats tell me the same thing in x-ray and MRI rooms, no cleanup. More people in the population wear masks here. That is good if a sick person is trying not
to spread their germs to others. If you
wear a mask to keep from getting sick then you also have to make sure that you
don’t touch an infected surface or person. Thus it is less effective.
Smoking is still very
popular here so while a chest x-ray every year may seem excessive, it is necessary. Hepatitis B – the viral kind – is also very
prevalent here. There are 400 million
people in the world with Hep B.
One-third of them live in China.
There are vaccination programs now to protect kids, although the rate of
vaccination is not yet high enough to really control the disease. It is common for a mother to pass the disease
before birth. There is a lot of
discrimination against Hep B carriers.
They can be turned away from schools and jobs. There are laws to prevent this kind of discrimination
but it still exists. I am unaware of any
programs to vaccinate adults. I sure the
vaccine is available here but I don’t think there is the education or the
motivation to make this a priority in China.
I think the employees at the University are grateful that
their employer provides this service for them.
I know that other large companies also do this but it certainly isn't
universal. Of course, the University
Employees are also going to be more educated and seek out healthcare when they
have a problem. However, the scope of learning here is very narrow;
you can’t assume that education in one field connotes education about health or
the body. China is still very much in
the era of “the doctor knows all” and questions are not asked.
China has a large population of people who are self-employed
or employed on a more temporary basis and thus would not have access to health
care or health insurance. Health insurance
here is relatively new. It is generally just catastrophic care (with a lot of
exclusions) and for those with stable employment. The employer is required to pay
80%. The Chinese Government’s goal is to
have 85% of the people covered within the next few years. That is not realistic at all. But then numbers can be manipulated to say
anything.
All in All, An interesting experience but not one I'm willing to repeat.