Gibran M.

Public Health Volunteer

Fuzhou, China

The first time I traveled to China was in the summer of 2006. I neither spoke the language nor had any knowledge of its history or culture, but I was excited to volunteer as an English language instructor in Pinghu, an underserved rural town one hour outside Shanghai. Teaching English to underprivileged high school students and traveling to indigent, remote countryside villages in Anhui province, I was impressed with the unquenchable thirst for knowledge my students displayed. At the end of the summer, I returned to the U.S. with a burning interest in Chinese culture, history and society. Despite being a neurobiology major, I enrolled in Mandarin lessons, and took classes on Chinese philosophy, history, and film. Two summers later, I returned to China as part of the Harvard Beijing Academy, an intensive, nine-week Chinese language program. During a one-week social study project, I interviewed young artists, a retired soldier, musicians, college students, and elderly men and women, all whom had a distinct perspective on China's modern cultural, social and political history, and the socioeconomic revolution that is rapidly changing the face of the nation. Visiting the capital during the fanfare and excitement of the Olympics deepened my interest in modern China, but I felt that in order to gain true understanding I needed to submerge myself in the life and culture of the majority of Chinese by living there for an extended period of time.

I chose to major in neurobiology because of my passion for science and medicine. During my senior year of college, I decided to combine my love for medicine with my interest in Chinese culture and society after graduation. During my previous visits to China, I had traveled with other American students. I lived in dorms with fellow foreigners, and outside of the classroom I mostly interacted with them. Despite the sea of historical and cultural sites, Beijing felt more Western than Chinese. Oftentimes, when I tried to speak to a stranger in Mandarin, he would respond in English. Yearning to immerse myself in the language and culture, I decided to volunteer in a rural hospital serving an indigent population. Speaking to professors, teachers and other acquaintances from my time in Beijing, I was introduced to Zhang Xiuyu, the charge nurse at the County Hospital of Yongtai, a rural hospital one hour outside of Fuzhou. However, despite my excitement and time spent planning a year abroad, as a graduating student I was unsuccessful at finding sources of funding. Thankfully, I found the Christianson Grant and was ecstatic when I learned that financial circumstances would not prevent me from being able to undertake a year of service in China. I am eternally indebted to the Interexchange Foundation for making this life altering experience possible. During the summer of 2009, after graduating with a Bachelor of Arts degree in Neurobiology, a minor in East Asian Studies, and a language citation in Mandarin Chinese, I left Los Angeles for Fuzhou.

Arriving at Fuzhou Changle International Airport, I was met by my host parents. My host father was a Communist Party member in charge of the provincial grain program and was the brother of Nurse Zhang. My host mother was a retired accountant. Both lived in Fuzhou, one block away from the city's beautiful West Lake, an artificial lake originally built in the 3rd Century that had served as the Min Emperor's residence. During the day men and women lined the benches of the lake playing mahjong, and at night dozens of elderly couples danced to ballroom music.

Traveling to Yongtai County, I was overwhelmed by the glaring contrast between the relentless development of metropolises like Shanghai and Beijing and the poverty of the Chinese countryside. Despite having studied the equivalent of four years of Mandarin in college, arriving in Yongtai filled me with uncertainty. The countryside home overlooked rice fields and a flowing river. Along the river were forested mountains with altars built into the mountainside by local families to honor their ancestors. Chickens roamed the front porch and rice, cabbages, and other vegetables were cultivated in plots contiguous to scattered homes. My host father and his entire family had pooled their savings together to build a new house. The family had moved into the home two years prior from a very old and modest house adjacent to it, where my host father's grandparents had first lived. The old, crumbling countryside homes were full of history. The walls were replete with fading slogans such as "Ten Thousand Years for Chairman Mao" and "In agriculture, learn from Dazhai," a village in Shanxi Province which was held up as a model of collectivization during the Cultural Revolution. My host parents had met in the same rice fields during the chaos and violence of the Cultural Revolution. Universities and schools were closed down and urban youth were sent to the countryside to learn from the peasants and become true revolutionaries. My host mother was sent from Shanghai to the countryside, where she met my host father, a young farmer at the time.

When I arrived at the County Hospital of Yongtai, patients and their families stared at me like I was an alien from another world. I often had a similar experience during my time teaching in Pinghu, where at one time a group of construction laborers simultaneously stopped working and intently stared at us laowai (foreigners) as we passed by. This did not happen in major cities like Beijing or Shanghai, but in rural areas like Yongtai people are still awestruck when they see a foreigner. Although I did not feel awkward by the attention, at first I feared my presence would prove a distraction to the patients and their caregivers. I shadowed Nurse Zhang around the medical walk-in clinic, helped with medical records, and escorted patients to their appointments.

After several days, my host father returned to his work in Fuzhou. I had originally planned to live in Fuzhou with my host parents, but soon realized that the distance and infrequent bus schedule made this impractical. I stayed in the countryside home, and volunteered at the hospital daily. However I realized that the language barrier was greater than I had expected. I had communicated with Nurse Zhang mostly through my host parents' daughter, so I was unaware that she and the rest of the family living in the countryside spoke little Mandarin.

Despite Mandarin Chinese being the official language of China, every region has a local dialect, and most are unintelligible from one another. Fuzhouhua is spoken in Fuzhou and surrounding counties and is not intelligible with other Fujian dialects, let alone standard Mandarin. Although I was able to communicate and understand basic ideas, perform simple tasks at the clinic, and learn by watching and shadowing, I felt that the language barrier was preventing me from learning in depth. It had taken over two years of intensive coursework to learn Mandarin Chinese, so I knew that even with complete immersion and focused study most of the year would go by before I felt competent in Fuzhouhua. I spoke to my host mother who contacted Dr. Weiya, a radiologist working at the Fuzhou Traditional Chinese Medicine Hospital. Also known as the Fuzhou People's Hospital, it is an affiliated teaching hospital of the Fujian University of Traditional Chinese Medicine. I was thrilled by the possibility of interning in a foreign medical academic environment at a hospital dedicated to an alternative medical philosophy, which I would not have exposure to as a future student in an American allopathic medical school. A couple of weeks later, after receiving approval from the hospital administration, I returned to Fuzhou.

I began my internship at the Fuzhou Traditional Chinese Medicine Hospital shadowing Dr. Xiao, a leading pediatrician of Fujian Province who employs both Western and traditional Chinese medicine. Initially, I was perplexed by his stated diagnoses of several patients. Having previously shadowed physicians at the pediatric urgent care unit during college, I had witnessed common illnesses that affect children, discussed cases and treatment with attendings, participated in routine check-ups, and helped record vital signs. Like pediatricians in the United States, Dr. Xiao used a stethoscope to listen to heart and lung sounds. However, he rarely ordered chest x-rays, blood tests or other invasive procedures, and focused with unusual intensity on external diagnostic methods such as the patient's pulse and the color of the tongue.

He explained to me the concept of meridians, channels that connect the different Chinese "organs" and through which qi (pronounced "chi") flows. Disease, he stated, is most often caused by disharmony in the flow of qi, a disruption in the balance of energy and homeostasis of the organ pairs. He often assessed severity of disease by inspecting the veins of the index finger and pushed blood away from the fingertips to observe the speed of circulation. When I shadowed pediatricians in the US, diet was rarely mentioned. In contrast, Dr. Xiao often diagnosed the patient's illness as caused by eating too much meat or other nutritional imbalances. Instead of reliance on modern drugs, he prescribed dietary changes or common fruits, herbs and vegetables as medicine.

What I heard and witnessed went against my concept of medicine as a young, constantly evolving evidence-based science. However, I was fascinated by this new perception of the human body. When Dr. Xiao mentioned the liver, he did not mean the physical, anatomic structure of Western medicine, but rather referred to a holistic philosophy in which organs are defined by their interrelated functions and relationships to other organs of the body and its environment. Traditional Chinese Medicine avoids costly and invasive procedures in favor of increased emphasis on the medical history and an extended physical examination. With an impressive power of observation and deductive reasoning, Dr. Xiao turned minor, almost imperceptible indicators into diagnosis and treatment.

At first I was skeptical and even dismissive of what to me sounded suspiciously like the type of medicine practiced by curanderos in Mexico, traditional healers who employ herbs, physical therapy and religious rituals in curing illness. Fascinated by cosmology and technological innovation from an early age, I saw their approach as pseudoscience in conflict with modern evidence based medicine. However, shadowing Dr. Xiao I realized that he and other medical professionals at the university hospital saw Chinese medicine and Western medicine as complementary, not antagonistic. There was no reluctance to using Western treatments if they were deemed necessary or more effective in treating a particular condition. Often the two were used in conjunction, such as when an antibiotic was prescribed to treat an infection combined with herbal medicine and a change in diet in order to maintain health. As I learned more about Chinese medicine, I realized I had been quick to judgment and that linguistic and cultural differences prevented me from appreciating its insights. Poor translations and the natural desire to find equivalence between Western scientific medicine and Eastern theories hindered my understanding.

After shadowing Dr. Xiao for several weeks, I became interested in learning more about therapies frequently employed in traditional Chinese medicine that are considered alternative medical treatments in the West. The hospital's Department of Physiotherapy consisted of specialists in acupuncture and tuina massage therapy. Dr. Wang and her student interns were glad that I showed interest in learning about their profession and warmly welcomed me.

I try to think of myself as someone open to new cultures, ideas and beliefs. However, when I thought of a specialist in alternative therapies, I imagined someone who had apprenticed with an elderly practitioner of the old and outdated art, and felt that less intellectual acumen and clinical experience were necessary. Yet there I was, interning at a hospital affiliated with a major university dedicated to the advancement of traditional Chinese medicine, composed of almost ten thousand undergraduates and doctoral students, over two thousand faculty, and research institutes in constant collaboration with international institutions of higher education.

One day an elderly woman diagnosed with insomnia walked into the ward. Dr. Wang carefully went through the medical history and examined the patient. She then told the patient that she needed to come in for 30 minutes of acupuncture therapy for the next five days. I was intrigued by the range of maladies treated with acupuncture, and was particularly interested in the location of the acupuncture points used to treat this illness. Dr. Wang inserted acupuncture needles in her wrists, legs and head. To my surprise, she brought out a small electronic device with several wires and electrodes coming out of it. The machine had knobs that were turned, I assumed, to change the amount of current. The electrodes were placed on several of the acupuncture needles and the machine was turned on, providing strong stimulation to the acupuncture points lying along the channels through which qi is believed to flow. I found it interesting that in traditional Chinese medicine most illnesses and their cures are always brought back to the idea of imbalance in the flow of energy throughout the body and disharmony between the individual and the environment.

In mid-February, I returned to the countryside with my host family to celebrate the Chinese New Year. Spring Festival is China's most important holiday. We began the week-long holiday by spending a day in Qingyunshan, a famous national park so named because its waterfalls are so tall they "reach the clouds." However, my favorite part of the holiday was the traditions associated with it. We cleaned the house in order to make way for good fortune during the new year, and decorated it with red lanterns. We then adorned the entryways with duilian, lines of verse along the sides of a door wishing happiness and peace during the year. Afterward, we constructed an altar filled with sweet dishes to Zhao Wangye, the kitchen god. The sweet food is supposed to bribe the god, so he does not tell the supreme god of all the bad things the family had done the previous year. We prayed to the family's ancestors and burned paper money, which is supposed to the reach heaven, so they can use it. During the night, there was a parade and the village youth performed kung fu moves and the dragon dance. Finally, there was a procession with the village gods throughout the town, and the new year was received with a fireworks display. A few days later, we returned to Fuzhou.

After shadowing physicians who specialized in traditional Chinese medicine, I decided to work with doctors that focused on Western therapies, and began interning with Dr. Lu and Dr. Weiya in the radiology department. Dr. Weiya proved to be a great teacher and mentor. One of our first patients was a child who needed a chest x-ray. Dr. Weiya pointed to white spots in the lungs and explained to me that the patient had tuberculosis. She described how the hollowness of the lungs produces black image in the x-ray and so white in the lungs is a sign of disease. Despite its difficulty, she attempted to teach me the medical terminology used to analyze and write a summary of findings in x-rays and other scans. I began studying Western medical anatomy in Mandarin using images on the computer.

Despite my ability to communicate with the majority of doctors and students at the teaching hospital, I was disappointed by the fact that some of the patients, especially the older ones, spoke only the local dialect. However, most patients were surprised at seeing a foreigner interning at the hospital and would often ask my fellow students if I spoke Chinese. Because of this and as a result of the strict regulations in America regarding patient contact, in China I had more interaction with patients and was able to do and learn much more than when volunteering at hospitals in the United States.

Everyday we helped treat about two dozen patients. We often saw babies with respiratory problems, children who had injured their hands or legs while playing outside, middle aged men and women with problems in their stomach or pulmonary issues, such as emphysema, and elderly men and women with a broken ulna or other bone fractures. One of the most memorable cases was of a middle aged man who had severe respiratory illness. Upon using the video x-ray machine Dr. Weiya looked dismayed and sent the man for further testing. The tests confirmed her fears. The patient had lung cancer. I was not present when the news was broken to the patient, but knowing that the simple x-ray had been crucial in providing the initial diagnosis, I felt the weight of vigilance in dealing with human lives. Had Dr. Weiya been less diligent or someone less experienced analyzed the x-ray, perhaps the diagnosis would have been missed, delaying treatment for someone who desperately needed it.

My experiences volunteering at the Fuzhou Traditional Chinese Medicine Hospital made me realize that, as a physician, I will have the privilege of healing and caring for my patients during their most trying times. Many professions experience the satisfaction of helping others, but only as a doctor will I have the joy of witnessing the direct impact of my actions and decisions. Rendering care to people daily and knowing I am helping save lives will be professionally and personally fulfilling. I learned that through doctor-patient relationships based on trust, empathy and compassion, I will be able to treat and educate my patients, and, reciprocally, to learn from their medical conditions, as well as their cultures, values, and experiences.

I feel that my experience volunteering in a foreign hospital serving the medically indigent has ideally prepared me to serve the underprivileged as a physician. Having lived and studied in different countries, and interacted with people from varied socioeconomic and educational levels, I have learned to listen, understand, and connect with people from different backgrounds. My time in China has inspired me to be a physician who considers the clinical as well as cultural and socioeconomic factors in rendering care and successfully advocates both for his patients and for improvements in the healthcare system to provide for the uninsured and underinsured.

I went to China trying to discover an unfamiliar world. And, undoubtedly, there were countless cultural differences and linguistic misunderstandings. However, below the superficial differences of culture, language, history and politics, I began to feel that my host family was no different from my family in the States. My patients and their families had the same fears and emotions regarding their health as those in America. Our fundamental needs, desires and concerns were the same.

My year volunteering in China sparked a new interest in international medicine and global health. I was transformed from being solely concerned with my immediate community to looking at problems on an international scale. I aspire to not only become a great clinician, but also take a leadership role in medicine promoting cultural awareness and efforts in solving the most pressing health problems facing the global community. I want to obtain a second degree in public health with an emphasis on global health, and have gained interest in serving in a developing nation upon finishing my medical training by volunteering for an organization like Doctors Without Borders.

Returning from China, I pondered how detrimental the barriers we create are, based upon accidents of history and geography. The infinitesimal amount of difference in our genetic makeup has hindered global understanding and the progress of humanity. Before living abroad, I had thought of global problems from the perspective of a citizen of a developed nation. I was saddened by the poverty, hunger and death caused by inequities in access to basic healthcare in other nations, but felt those tragedies were distant, unrelated to my daily life. After all, I was an American. The farmer struggling to make ends meet in Yongtai was Chinese. I came to understand how these arbitrary distinctions perhaps numbed my sense of moral duty to contribute to the improvement of their lives. This became the meaning of global citizenship to me. Like the overwhelming emphasis Chinese medicine places in connections and interrelationships of organs systems to one another and the individual to its environment, I came to comprehend that human beings, regardless of culture and nationality, are inextricably linked.