Recounts His Clinical Global Health Elective Experience in China
Ashish Gurung, MED'25
"Coming into this elective, I expected only slight differences in clinical care with most of it regarding language and culture. However, it was the advanced clinical protocols that left a strong impact on me."
As part of the global health elective organized by the Center for Global Equity (CGHE), I ended my fourth year at Chongqing Medical University (CQMU) in Chongqing, China. Through this experience, I was able to further my education in medicine through the lens of my Chinese teachers and peers. It challenged my medical education experience and the norms that I was taught. I leave Chongqing with great admiration and respect for my colleagues and increased confidence in my ability as a soon-to-be resident.
My time in Chongqing was divided equally between two different departments: the Coronary Care Unit (CCU), which served as the cardiac intensive care unit, and the Infectious Disease and Viral Hepatitis (IDVH) department. A commonality in both settings was the complex disease pathology present in many of the patients. Most patients admitted to the CCU had atherosclerotic cardiovascular disease (ASCVD) with multiple complications such as arrhythmias, heart failure, and ventricular aneurysm. In my IDVH rotation, patients with chronic hepatitis B would also have late-stage cirrhosis or hepatocellular carcinoma (HCC). The language barrier served as an additional challenge for me as I navigated the complexity and volume of patients we saw. However, watching my counterparts efficiently run the service with excellent teaching by the professors was reassuring. Professors in both departments made a special effort to teach the residents/students and included me in the teaching by summarizing key points in English.
I was really interested in how doctors there diagnose and treat patients. When doctors strongly suspected someone was having a heart attack, they always did a cardiac CT-Angiography (CT scan of the heart's blood vessels). After heart procedures, patients got the usual blood-thinning medications like aspirin and Plavix, but they also often used another blood thinner called Indobufen that's approved in China but not in the United States. When patients had liver problems - either from hepatitis or damage caused by medications - doctors gave them IV treatments made from natural ingredients like licorice root extract, milk thistle extract, and other plant-based compounds to help heal the liver. For patients with long-term hepatitis B, doctors regularly checked two specific blood markers, alpha fetoprotein and PIKVA-II, to watch for early signs of liver cancer. For patients with severe heart failure who had too much fluid building up in their bodies, the heart unit used a filtering process to remove excess fluid directly from the blood, rather than using the more intensive continuous renal replacement therapy that's common in the U.S. I was introduced to an artificial liver machine, which would assist patients with acute liver failure during their recovery. I felt like I was at the cutting edge of medical practice during my month in China. The fluid integration of biochemistry and innovative technology into the disease management workflow made me greatly respect my Chinese colleagues. Coming into this elective, I expected only slight differences in clinical care, with most of it regarding language and culture. However, it was the advanced clinical protocols that left a strong impact on me.
One of my goals with this elective was to learn about practicing medicine in different cultural contexts. Cultural competency is an important skill for any physicians, but especially for those practicing in the U.S. due to the diversity in our patient panels. While the disease processes were the same, I was intrigued by the cultural nuances of care. Patients with late-stage cancer or other terminal illnesses were not informed of their disease. Instead, the attending took a family member aside to discuss prognosis and goals of care. When advanced, more expensive interventions or other life-sustaining measures were being discussed, there was a frank discussion about their cost with the family member. Due to the large volume of patients, doctors would see 50-60 patients in an afternoon, and there was a decreased sense of privacy when discussing general medical diagnoses. With my U.S. medical education, I found some of these things disconcerting. I was concerned about patient autonomy and privacy. However, as with other cultural norms, I realized that the values we learn are also cultural. What I found concerning was normal and appropriate. Observing the healthcare interactions of Chinese patients reminded me of how my parents take care of my grandparents as they navigate the U.S. health system. Like my parents, many other families are used to a healthcare model that does not fit the one taught in our classroom. I am grateful to have seen different healthcare models, which remind me that I need to be adaptable to the patient and their family in the future.
I am indebted to CQMU and CGHE for helping me with this experience. It has broadened my worldview on modern clinical medicine and how we can apply cutting-edge research in clinical settings. Additionally, it has reaffirmed my belief that I need to keep an open mind as my education is just starting. I should not hold onto values taught in the classroom as fact, but rather a perspective through which to practice medicine. Outside of the hospital, Chongqing has been amazing. The food is right up my alley in terms of spice, and the modernized charm of the city is something I will rave about to anyone who will listen. As U.S. citizens and medical students, we do not have a lot of exposure to other cultures, but I strongly believe that it is an important aspect that students should consider expanding their worldview and perspective on medicine.
