I cannot believe that it has been
almost a month since I have arrived to Shanghai! With the lack of a stable
internet connection, I have not been able to continuously post blogs- so I jot
down some key things I have done and I am posting now.
Work has stayed busy, and still
remains a little vague over here. It appears that China’s idea and
understanding of Epidemiology is quite different than that of the US. Overall,
however I continue to work on data assessment and mathematical modeling related
to type 2 diabetes (T2DM). My boss is currently in route to Bangkok and I will get to
meet with her maybe a few more times when she returns before I leave the
campus.
Yesterday, May 11th I
presented a PowerPoint presentation to the Epidemiology department during their
research preparation seminar. I am not sure how much they actually understood-
but it was a nice experience.
Some Fudan U. faculty kindly arranged
some site visits for us. These are always all day affairs that are very tiring-
but very interesting. I went to visit An Ting town in the area known as
Jiading. We were able to visit the village clinic as well as the community
hospital.
Getting to these sites were a bit
challenging. We all rode in a 20 year old manual van that was soo hot!!! The
driver would try to pick up speed in the van on the highway but because of the
van’s age, the transmission would slip and so alas we jerked down the road and
arrived at our first site- the Shanghai CDC office. We were so nauseous upon
arrival.
At the CDC we spent quite some time
discussing the most prevalent and severe Public Health concerns of China. The
number 1 is SMOKING! Around 50% of men in the Chinese population smoke. Only 2%
of Chinese women smoke- as it is considered un-lady like. Consequently, with
the high rates of smoking and the poor air quality due to pollution, lung
cancer is one of the leading causes of death. TB and Multi- Drug resistant/
extreme drug resistant tuberculosis
(MDR/ XDRTB) are not far behind. There is even current research that has
suggested that smoking is probably a factor involved
in increased susceptibility to TB and as men have higher rates of TB, this is a
hypothesis worth researching. But sadly with the inequality issues, it may just
be that there are higher rates of diagnosis among men than women. Dr. Xu, my
boss primarily works on conducting focal education groups related to TB in
Shanghai and she has found that many women will not seek treatment for a
persistent cough. Additionally, the family will first treat men and children.
Women are not as valued members of the family, because they do not bring in as
much money into the household. Type 2 Diabetes, is next- with higher prevalence
among younger persons. There are many factors associated with this- but China
is struggling to implement a program to curb the rates of obesity and T2DM. Some
of the key factors related to the increase in T2DM is beta cell dysfunction,
reduction in exercise/ labor intensive jobs, and food changes. The CDC reported
that they will try to assemble a model similar to the “Healthy Cities Program”
in the US. There is lots of work to be done on T2DM!!
Next, we went to the village clinic.
It was quite small with only 5 rooms total in the building, but not to be
fooled- this town clinic serves over 5,000 people! It was also interesting to
find out that the “Medical Assistants” who work there have no more than high
school and 2 years medical training. The pharmacist who works there will only write
prescriptions for a couple of weeks -3 weeks at most- so that patients will
come back to the clinic for follow up and also to receive more medication upon
return. This is a way of increasing compliance among the towns peoples and the medical
personnel believe that they can better establish a relationship with the
patients as well as assess baseline treatment vs. 3,6,9 etc. weeks out.
About 20 minutes away from the village
clinic, we were able to visit the community hospital. This hospital was built
in 2009- and is beautiful and larger than Queens Hospital in Honolulu, HI. This
hospital serves 6,000-10,000+ individuals. We saw many families that had
brought -mom, dad, grandma, grandpa, aunties and uncles all to come for the 1
child to be vaccinated. With the one child policy in China- Children are
revered and mostly well taken care of. Boys are still highly valued all over
China- but as I have learned, in particular in the city of Shanghai women are
now becoming quite prized, but this is among my generation only. The patient
privacy issue is very different from the US. We were able to see farmers
receiving the ancient Chinese practice of ‘cupping’ and there is a room
dedicated to receiving IV fluids. In this room everyone who needs an IV will
come and sit for hours receiving treatment with up to 100+ other individuals.
After seeing this room- I expected to see a dialysis room constructed in similar fashion. But never saw
one, so I asked the WHO Shanghai director about why there was no dialysis room.
He said that dialysis would be at a third tier medical facility and that many
do not get the dialysis treatment they need. I was mostly interested in T2DM
patients who have kidney failure as a secondary complication- yet his response
was that secondary complications to T2DM are much lower in China than in the
US. I am interested in finding out why? Currently the study I am working on
collected data on over 30 T2DM secondary complications & comorbidities , so
I am working on conducting some statistical models and analysis to see what the
rates of T2DM secondary complications look like in 4 major cities of China.
Lunch with faculty in Jiading was
interesting. They kept trying to serve me shrimp and steak… neither of which I
will eat. BUT I was told that Xialong Bao originated in Jiading province so I
was able to try the “original!”
On June 7th I attended a
lecture series on T2DM and TB in China with Georgetown University students at
the Handan Fudan campus. ( This is the main campus) My boss Dr. Xu spoke on TB
and her associate Dr. Wang spoke on T2DM and nutrition. Gtown kids are just so
smart that the conversations were interesting, and at least somewhat of a
distraction from the heat. As it was close to 100 degrees F with 80% humidity
that day. The premise of Gtown coming to visit, is that one professor at Gtown
also works with the World Bank, and the World Bank plays a large role in loans
given to China to help with epidemiological outbreak surveillance and
availability of medications.
In the world of being a tourist- I was
taken to a Hot Pot House last night. To my delight- a gentleman came to our
table and hand pulled noodles for the soup. It was such an impressive show. He
was actually twirling the noodles above his head and around his waist as if he
was doing a ribbon dance!
Well…. I think your caught up for now-
