“I am leaving this experience with a renewed sense of hope”
By Alex Conway MED’25
I spent four weeks in Chongqing, China, working at the First and Second Affiliated Hospitals of Chongqing Medical University (CQMU). It’s hard to explain in a single reflection what a wonderful and meaningful experience it was, but one thing I can say is that it was an absolute highlight of medical school.
I spent my first week on the gastroenterology service, where roughly 40% of our patients had H pylori, 20% had some kind of functional disease, and 5-10% had liver toxicity secondary to overuse/misuse of traditional herbs. In addition to participating in inpatient rounds and outpatient clinic, where there are up to 100 patient visits per day, I got to see several upper and lower endoscopies and participate in medical student Problem-Based Learning (PBL). Unlike at Geisel, where we conduct PBL with PowerPoint slides alone, PBL at CQMU involves a group of 15-20 students going to an actual patient’s bedside to collect the history/physical exam before discussing diagnosis and treatment as a group. This real-time, real-life structure seemed to spark emotional buy-in from the students.
I spent my second week on the cardiology service, where I got to see more congenital heart disease than I had in all of medical school. This included end-stage tetralogy of Fallot in a 50-year-old man and end-stage patent ductus arteriosus in a 40-year-old woman, neither of which had been surgically repaired. In addition to helping me listen to these rare abnormal heart sounds during morning rounds, my preceptor coordinated one-on-one teaching in the cardiac catheterization lab, echocardiography lab, nuclear imaging lab, EKG reading room, and biobank. It was interesting to see that because a lot of the technical equipment they used comes from the states (e.g., from companies like GE), and the procedural read-outs were a mix of Chinese and English.
I spent my last two weeks on the obstetrics service. I got to scrub into C-sections, watch amniocenteses, and witness several vaginal births. Many laboring women opted out of neuraxial anesthesia and were able to stay mobile right up to the point of their vaginal delivery. They often squatted in front of a mirror with their contractions for visual feedback of their pushes before getting back onto the bed for the final moments of labor. I was amazed that the C-section ORs used green cloth instead of blue paper to mark sterile territory. This included the gowns, which had a convenient kangaroo pouch built into the front to rest your hands. Most of the surgical setting was similar to that in the US (e.g., scrub techs/nurses do instrument counts at the end of the surgery), but some small things varied (e.g., a curved needle rather than a straight needle was used to do the final skin closure for low transverse C-sections). Unlike in the US, fathers are typically not allowed into the OR for C-sections or invited to cut the umbilical cord for vaginal births. It also remains illegal to disclose the sex of the fetus to expecting parents. This law was created in response to disproportionately high abortion rates of female fetuses, which was itself a reaction to China’s ‘one-child policy’. Although China now has a ‘three-child policy’, parents are still prohibited from knowing the sex of their baby before birth. As a result, when a baby is born and displayed to the mother, she must verbally confirm the sex of the baby.
Patient rooms were fairly similar to those in the US (motorized beds, bedside monitors, communal bathrooms and wardrobes, small nightstands, etc.). Most patients had 1-2 roommates with intervening curtains for privacy, but on the OB service, patients could pay extra for a single (“VIP”) room. Unlike in the states, where nurses are responsible for helping patients transfer, eat, toilet, etc., patients are responsible for finding their own caretakers for those tasks - usually family or friends, though they can also hire outside help.
One of my goals for this experience was to learn how/if traditional Chinese medicine (TCM) is integrated into Chinese hospital systems. It turns out that TCM is relatively siloed from ‘Western’ style hospitals, at least in Chongqing. Patients can independently pursue TCM treatment (e.g., herbal remedies, acupuncture, etc.), but these therapies are not typically nor reflexively integrated by Western-trained providers in a hospital setting. Luckily, patients in China don’t need a referral to see specialists and, therefore, can access a TCM provider without first needing to see a general medicine practitioner.
When I wasn’t seeing patients, I was exploring the streets of Chongqing — I found tiny alleyways with more noodle shops than leaves on a tree, public parks filled with foxglove, riverside bike trails, and bustling pedestrian streets lined with luxury brands, among other sights. I also dove headfirst into the food scene and got to try rabbit head, pig aorta, pig feet, cow intestines, duck heart, blood tofu (coagulated pig’s blood), frog, and more. A big shout out to my professors, resident/PhD friends, and English teacher friends who took me out to eat! Those meals are some of my fondest memories and gave me a rare opportunity to give back to my hosts by serving as an impromptu English teacher. There are few foreign tourists/expats in Chongqing, so Chongqing-ers rarely get to hear/practice English with a native speaker.
Although much of my clinical learning was conducted with the translational help of my hosts, this experience also offered me a chance to hone my Mandarin skills. I started studying Mandarin in kindergarten and ultimately majored in it in college. I never thought it would be possible to combine Mandarin and medicine - and I would not have been able to realize that dream without the support of Dartmouth’s Center for Global Health Equity. The institutional relationship between Dartmouth and CQMU made all the difference, as did the funds to support my airfare and visa fees. As I progress on my journey of becoming a family medicine physician, this experience will continue to inform how I approach not only global health, but humanity as a whole.
Finally, this reflection would not be complete without acknowledging the tense geopolitical relationship between the US and China. Despite that strained relationship, I am leaving this experience with a renewed sense of hope. My interactions with people in Chongqing — patients, providers, and even strangers — were overwhelmingly positive, curious, and simply… human. People were eager to ask questions about life in the US, share their culture and food, and help me at every turn. It is that generosity and kindness that gives me hope. It restores my faith that even in the midst of higher-level power struggles and media fearmongering, the goodwill of human-to-human connection can shine through. I continue to correspond with my Chongqing friends through WeChat (special shout out to Salman, Marissa, and the Commune Crew!) and I sincerely hope that the strength of this ongoing partnership between Geisel and CQMU enables the next cohort of CQMU students to come to Dartmouth.
