Sunday, March 29, 2009

China III: On Assignment

I sincerely apologize for not having posted in so long. It's been a hectic month. It's about time that I finish my China posts, only 2 more to go! This post is about the reason why I was in China in the first place, and is of great personal interest to me, though some/many(?) readers might find it boring.

As I've already mentioned, I went with 11 other students as a part of a trip sponsored by the school of public health. Our principal goal was to observe and experience another health care system and immerse ourselves in another culture. I was a part of the measles vaccination group.

On the second day (Sunday) in China we met with officials at the National China CDC (Centers for Disease Control). The building was cold and pretty old, and the hallways were unheated. Interestingly, though there was a "No smoking" sign immediately upon entering the lobby, a couple employees were smoking under the sign! That kind of stunned us. We were then guided to a meeting room (actually heated!) where we were served hot tea. Constantly. It was really nice, actually, as the tea kept you constantly at the edge of wakefulness.

We learned a little about the history of the China CDC. Though it had existed for decades, it had received very little funding. Then SARS hit. Suddenly, the government put a lot of money into the public health infrastructure and the CDC was basically built over the span of 2 years. In these 2 years, China was able to do things that our US CDC has failed. China has also been preparing for the avian flu for quite some time now.

The pinnacle of their achievement was a real-time surveillance system of all diseases occurring within their borders. Doctors and hospitals would report any communicable diseases to the nearest level branch of the CDC, that then relayed the report to higher CDC levels until it reached the national-level CDC. Thus, as soon as a communicable disease was diagnosed, it would be reported to the National CDC within hours. By the next morning, there would be a report of the previous day's disease occurrence on the desk of the health minister. The ability to know where and when diseases occur is an amazing achievement, especially for a population as large as China's. Our CDC had contemplated creating such a system, but after the bio-terrorism funds were pulled from the CDC some time after 9-11, all progress in this technology has stopped. As such, we have rather poor disease-tracking ability here in the US compared to China.

Later that day we went to the Tianjin CDC about 2 hours' drive away. It was much newer and in better condition than the National CDC (though, they're going to be completing the new National CDC facilities in the next 1-3 months now).

We were shown around the Tianjin CDC, which was really nice on the inside as well. Too bad many of my pics of the inside were deleted. I did, however, manage to get this pic from the lobby of the Tianjin CDC:
Chinese New Year ftw! Year of the ox!! :P

Monday through Friday was spent learning about how the Tianjin CDC (TJCDC) measles campaign worked. In December 2008, the TJCDC undertook a massive measles vaccination campaign. There were billboards, songs, poems/rhymes, advertisements, and text messages notifying people to get free measles vaccinations. Note: In China, people get 4 measles shots, 2 that're bundled into the MMR shots like here in the US, and 2 stand-alone shots. The result? They were able to decrease the incidence of measles of 500+ cases in the first 7 weeks of 2008 to less than 20 cases in the first 7 weeks of 2009 in Tianjin. All in the timespan of a month! I doubt we could achieve this level of efficiency (or public reach) in the US.

It was intersting to note that most vaccines are free to the Chinese citizens. In fact, they were very surprised that the US didn't offer free vaccines to anyone (only at a reduced rate for low-income, and/or paid for by insurance or out-of-pocket for everyone else). They were a little taken aback when we told them that the HPV vaccine (for genital warts/cervical cancer in women) wasn't free. I believe it's not even covered by most insurances in the US.

On Tuesday, we designed questionnaires to ask parents of infants on whether or not their child received the measles vaccine. On Wednesday, we went to the local CDC in Dagang (大港) District. From there we went to a vaccine clinic. After doctors administer the vaccine, infants and children go to an observation room for 30 minutes to make sure there are no adverse reactions to the vaccine. (We don't do this here in the US - you get vaccinated and then sent along your way, if you have a reaction, go to the ER.)
Baby in the observation room.

Then we went to a nearby hospital. Interestingly, there was someone smoking near the "No smoking" sign in the lobby. Seriously, what's wrong with people?! Here we looked at hospital charts and records to see if infants were being vaccinated in the hospitals. There are 3 places to receive vaccinations: hospitals, clinics, and health/wellness centers.
Hospital charts.

Before we left the hospital, we saw the "floating baby" room. Basically, parents would bring their young infants (a couple weeks to 2 months old) here and their babies would float in a tub of water at a specific temperature. The nurse would attach a flotation device to the baby's neck so the baby could move around in the water. After "playing" around in the water for a while, the nurse would give the infant a massage. The whole point of this was to get young infants moving to promote movement and general health. It makes some sense, and allowing babies to float in water allows for movement with no impact.

In the afternoon, we located an infant with measles. Measles is so rare now in the US that doctors being trained today are likely to misdiagnose it as something else. Crazy, huh? Since we only had 2 measles shots as opposed to 4 (2 should've sufficed for us anyway), the CDC people who accompanied us didn't want to take chances; so they had us wear face masks.
It's hard to see (the red rashes), but this smiling kid had measles.

After we had examined the child, we went into a nearby neighborhood with our questionnaire to sample parents with infants at random. Every child has a record of his/her vaccine record in a little red book that is usually kept by the parents (relatively few parents in the US have a record of their children's vaccine records). Thus all parents and doctors have a copy of which vaccines had been given, as well as the dates of when future vaccines are due. Doctors will then call to remind parents to bring in their child when a vaccine shot is due.
On assignment, looking for babies to interview.

The little red book of vaccines opened up.

On Thursday we did the same thing in Jixian (蓟县 - Ji County). Again, we went to a local clinic.

However, we didn't end up doing much more than that, because we had a LONG lunch where we also had white wine. Okay, seriously, that stuff will mess you up. It's not actually wine. It's more like, vodka with 32-50% alcohol content. I had like, 2 double-shots of that stuff and I had to stop (I could've handled more, but I ate WAY too much). We were NOT in good shape after lunch to interview people. And it was getting late. Friday was basically a debriefing.

If there's one thing that impressed me about China's health care system, it is the close relationship between the health fields. All the health fields - medicine, nursing, public health, etc - are united under a common banner. Members of the different health fields spend part of their time training together and getting used to working with each other. In the US, each field is separate and independent of each other. No wonder why doctors, nurses, and public health officials sometimes don't get along very well. There's certainly an air of efficiency in China. Sure, our hospitals are generally in much better condition; sure, our medical technologies blow China's out of the water; but at least they know how to work together to get a job done.


mstpbound said...

wait you were in Tianjin!!!! My cousin's uncle lives there. Do you know about the main cancer/oncology hospital in Tianjin? He is the department chair there. Anyway, I went to visit him two summers ago, and he took me around to see patients and see surgeries. Now that I think back, I think I saw some patients with serious ascites from Hep B-induced liver failure. When I was there, he also took me to that big restaurant downtown, the one that only makes gobuli stuffed buns (baozi)? Did you have any? Tianjin is famous for that, right? The buns are supposed to have 18 petals, and there are things that I forget about them... :) :) ok also, that sleepy horizontal kid's father in your previous post? totally sexy shoulders. :D

James said...

I really agree about the vaccine's being free. Shouldn't we all want to protect ourselves? I have no issue with my tax money being used for that. Tack on a couple extra cents, it won't break me.

I also love the idea of a vaccine book. I hope you brought me one back!

Mike said...

:::puff::: ::::puff:::: :::standing under the no smoking sign:::: ::::puff::: :::puff::::

Does our government have any plans to do what the CDC in China is doing?

How did the whole interviewing work? Weren't most of the people in your group unable to speak Chinese, or were you like partnered up?

Cool post... it was really interesting to read.

I actually have a little vaccination book from Kaiser that is supposed to be brought to every appointment? You think I use it? No. I can tell you where it is, but I don't use it and haven't since probably 1996. hehe

naturgesetz said...

That system is impressively efficient. The reporting, especially.

And the floating babies are an interesting concept.

Aek said...

mstpbound: Yup, I was in Tianjin. ^_^ We didn't see any oncology departments, but that's alright. Yeah! The CDC took us to GoBuLi restaurant. It was really good! I had several pics, but I lost most of them when my SDS card died. :(

James: Lol, the Chinese vaccine book doesn't apply to you!

Mike: No, our government has no plans to do what the China CDC did, at least to the best of my knowledge. We had CDC officials accompany us to act as translators during the interview. I didn't figure out how to say "measles" in Chinese until the 3rd day, lol.

naturgesetz: Yes, the floating babies are awesome!! :D

James said...

Awwww... :( *still wants one*

tracy said...

"Floating Baby Room"...i love it! The babies and kids there are sooo cute!

Thanks for a wonderful tour, Aek...and now we know the story of the "White Wine" :)