Paediatrics in China: hospitals and orphanages
Cheryl Pui-Yan Au B Med Sci* |

*Medical student, The University of Sydney

IWith generous funding from the Australian Chinese Medical Association, I was able to go on a four week medical elective to Xi’an, China, with Shaanxi Agape Community Care Association. This is a Chinese non-profit, non-government organisation that works in partnership with local Chinese people and overseas volunteers to provide medical care within Shaanxi province. This organisation has a strong focus on providing community care to vulnerable populations in western China, especially orphans and children with disabilities. The organisation also provides services such as rehabilitation programs, counselling, community health education, child support as well as medical/nursing training for rural village doctors and community health workers. As an Australian born in Hong Kong, I chose to go to China not only to learn from and contribute to its healthcare but also to experience the rich culture that my home country has to offer.

I did this elective with three other medical students. Our two main supervisors were a general practitioner from Sydney, Australia and a paediatrician from San Francisco, USA. They provided supervision and teaching and I was able to enhance my theoretical knowledge and clinical skills in medicine. We attended ward rounds at the paediatric department at the nearby Shaanxi Provincial Hospital which allowed me to practise examination skills as well as history taking in Chinese Mandarin. It was definitely advantageous to have some Mandarin listening and speaking skills as most patients do not speak English at all, and doctors spoke limited English. At times, we had a translator from the organisation who was very helpful. We also examined patients attending the cerebral palsy rehabilitation clinic and performed health checks at orphanages and foster homes in both urban and rural settings. As well, we helped out at a village healthcare worker training CPR session.

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)

Figure 1. With the staff at the paediatric department at Shaanxi Provincial Hospital

In addition to seeing interesting pathologies, I was able to establish working relationships with local Chinese doctors and to observe the healthcare system in China (Figure 1). From my limited exposure to the Chinese medical system, I think that the development of the healthcare sector is quite far behind economic development in China. There are some fundamental challenges facing the current Chinese healthcare system. Firstly, a significant portion of China’s urban and rural population is without access to affordable healthcare. Rural areas are particularly hard hit with around 40% of the rural population unable to afford professional medical treatment (1). I was able to go to the monthly free clinics run by Agape at various nearby villages, which were very welcomed by the locals (Figure 2). The access issue is not restricted to rural patients, with 36% of the urban population also finding medical treatment prohibitively expensive (1). A high proportion of the population is uninsured in China, and thus they have to pay for medical services out-of-pocket (2). It was fairly standard to see long queues of patients lining up to pay and register at the counters before getting blood taken, tests performed, and before being seen by the doctors at clinics. Additionally, there are economic incentives to over-prescribe drugs or diagnostic services. The typical hospital in China receives less than 10% of its income from the government, and thus hospitals are 'forced' to generate the rest of their income from services and drug sales (3, 4). As there are no strict government guidelines in terms of the types and number of drugs to be prescribed for each illness, it was not uncommon for diseases to be over- or inappropriately-treated (3).

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)

Figure 2. The village clinic

Despite this, what impressed me most during my elective was the orphanage at rural Han Zhong, set up by an overseas special education professional to provide training for orphaned teenagers and young adults with special needs, ranging from vision impairment, crippled limbs to mental retardation. I was very impressed by the job training facilities available at the orphanage – a staff canteen, convenience store and bakery which provide on the job training for the students. It highlighted the long journey of rehabilitation for children with special needs to reach their potential, which for some, is independent adult life. This would not be possible without the dedication, love and support that the Chinese staff members showed for these children who had been abandoned by their parents due to some disability.

Additionally, Agape runs an advocacy and support program called ELIM for children and families affected by HIV/AIDS. What I wasn’t aware of before going on this elective was that there is an HIV/AIDS pandemic in China (5). In China, the number of people affected by HIV has been estimated at between 430,000 and 1.5 million, with some estimates going much higher (6, 7). During the 1990s, in many rural areas of China including Shaanxi Province, up to millions of farmers and peasants were infected with HIV through participation in state-run blood collection programs in which contaminated equipment was reused (5).

The rapid spread of HIV infection in China is having a devastating impact on the country's children, and threatens to become an epidemic with significant social and public health repercussions. ELIM is a program for all infected children, not only those orphaned by parental loss but also those affected due to societal impacts (8).

For many children who have been affected by HIV/AIDS, fundamental rights of non-discrimination, survival and development are being compromised. This stems from a fear of HIV/AIDS and a lack of understanding of how HIV is transmitted. We visited a mother and her daughter who were both infected with HIV/AIDS. They had experienced discrimination and exclusion from their community as a result of the widespread and pervasive stigma against HIV/AIDS sufferers. Their neighbours did not allow them to leave their house and sprayed pesticides on their door and window frames. Other parents and teachers refused to allow the daughter into the local school. Through the ELIM program, both mother and daughter were able to relocate their home to a different community and the daughter now attends a nearby school.

In conclusion, I was able to fulfil my learning objectives and I highly recommend this elective to medical students. Having some rudimentary Mandarin is very helpful. Besides developing my knowledge in paediatrics, adolescent health, community medicine and rehabilitation, I was exposed to public health and ethical issues that are very pertinent to healthcare not only in China but globally. My elective experience was varied and allowed me to see different aspects of a doctor’s role. It is not only confined to consultation but also education, mentoring and advocacy. As a Chinese-Australian, I was able to make some contribution to the healthcare program for orphans and disabled children in Xi'an. In particular, it is encouraging to know that local Chinese organisations are working to improve Chinese orphans' health, education, and quality of life. I hope to return one day and make a more significant contribution.

To find out more information, visit http://www.agape.org.cn/eng or email enquiries@agape.org.cn

References

  1. Chinese Ministry of Health. China Health Statistics Summary. www.moh.gov.cn. 2005.
  2. Chinese Ministry of Health. China National Survey on Health Service www.moh.gov.cn. 2003.
  3. Hew C. Healthcare in China: Towards greater access, efficiency and quality IBM Institute for Business Value 2006.
  4. Huang C. Ambitious health system sickened by rising costs. The Standard November 2 2002.
  5. World Health Organisation Representative Office in China. HIV/AIDS Situation in China. 2010; Available from: http://www.wpro.who.int/china/sites/hsi/.
  6. Steinbrook R. The AIDS Epidemic in 2004. New Engl J Med 2004;351(2):115-7.
  7. UNAIDS. China Epidemic and Response. 2010; Available from: http://www.unaids.org.cn/en/index/page.asp?id=197&class=2&classname=
    China+Epidemic+%26+Response.
  8. Xu T, Wu Z, Duan S, Han W, Rou K. The situation of children affected by HIV/AIDS in Southwest China: schooling, physical health and interpersonal relationships. J Acquir Immune Defic Syndr. 2010;53(Suppl 1):S104.