Saturday, November 18, 2017

Chinese medicine clinical rotation Part IV of IV




The #1 suggestion I can make about any TCM program in China is to learn Mandarin!!!! Without some level of language you will be at the mercy of your translators. They will work their tail off for you but realistically in a seven to eight hour clinic shift no one can stay on point the entire time. And even with university taught translators, Chinese and English are not 1:1 languages. I’ve been amazed at how often the Chinese dictionaries have the most bizarre translations for simple terms. Scurf? Oh, that’s dandruff. Swirls? Vertigo. We spend a lot of time during clinic sessions looking up words that just don’t quite translate, so they’re learning on the job just as much as you are sometimes. There are clinic advisors and doctors who speak English, but they are there to treat patients, not translate the consult word for word. So out of a 5-15 minute intake you may only get the main symptoms, and you will miss some important details. Having the vocabulary to at least understand what questions are being asked will keep you and your translator on track, and if there’s a response you don’t understand you can follow up later. “Laoshi, the 40 year female with thyroid cancer spoke at length about her digestion, and I didn’t get it all. Can you explain a bit?” 


Most of the doctors really enjoy teaching, so they will bring up important points to you and your translator - interesting pulses, or tongues, and symptoms or specific patterns. As my concentration is herbalism, they especially like to bring up esoteric text or point out how few herbal text have been translated to English. While the TCM education is the foundation here, every doctor I encountered had their specialty - Fire School, Pi Wei Lun, Shang Han Lun, etc. Also, I’m blown away by the general level of education with my peers. If I haven’t heard of a formula they all immediately chime in the source - Jin Gui Yao Lue for example, or some historical figure. I’m completely inspired by their scholarship!!

So, where to start learning Chinese? I suggest everything you can get your hands on :) Rosetta Stone for pronunciation and character recognition, Pimsleur for pronunciation and hearing everyday phrases, the Wiseman Chinese medicine vocabulary books, and every single podcast, and online video you can handle. At the very least, look at the Asking Songs, and translate them yourself. I’m working on a translation, and will post it when I’m finished. I’m cross referencing my translation with clinic notes so that it is accurate with current Mandarin vocabulary and TCM terms.



There’s also a very serious course with Nicolaas Herman Oving, but it’s more geared towards reading Chinese medicine text. I have no doubt it would also be helpful:


As a sidenote, Duolingo just released their Mandarin Chinese app so I’ll jump into that as soon as I get home!!


TCM clinics in China are like nothing you’ve ever experienced. First, in my experience most doctors either prescribe herbs or perform acupuncture and moxa. Rarely do they do everything in one clinic the way we do in the states. They may refer out to another doctor, or maybe an herbalist will drop some needles in a patient during a consult for expediency, but generally its herbs or needles/moxa. Secondly, clinics in China are crazy. The patient is almost never alone, the room is filled with unrelated people, sometimes as many as 10-12. There’s yelling, running commentary, phone calls, texting, video games, constant interruption of the doctor, and the ever present line-cutting. HIPPA? Hah!!! Average patient load in a 3-4 hour session is between 15 to 40, but one doctor that I work with sees 100 patients in an 8 hour shift. There have been several fights in clinic waiting rooms as people try to jump the line or visit a doctor without an appointment. In many cases one person makes an appointment, but brings the records for a family member and expects the doctor to also write an herbal prescription for them as well. They generally have pics of the absent family members tongue. Also, acupuncture clinics are a lot like community clinics in America, but a lot louder. The patients are all in one room, and usually know each other. They banter and talk most of the time. It’s a like a weekly bridge club. “How’s your hemorrhoids, how’s your prolapsed anus, is your husband alive or did the cancer get him”, you know all the regular chi-chat.



If the doctor is popular, there are probably anywhere from 4-8 students observing. As a foreigner you sit, keep quiet, and stay out of the way. The university even sends out a memo before you arrive about clinic etiquette. At some point people will engage with you, but generally it’s expected you will not interrupt. The doctor will ask, when they are ready, if you have any questions, and if they feel you’re up to it, see if you have any answers when quizzing their own students. No one brings a laptop, all student notes are handwritten. Once in a while an iPad might come out to look something up that needs a larger screen then the phone, but its rare. As a foreigner in a Chinese medicine clinic you will draw a certain level of attention anyway. This where a little language skill can bring you some peace, and some respect. 

Clinic dress codes are very casual. You will be expected to wear a white coat, but underneath you can be comfortable. Most of the other students wear jeans and sneakers, teachers and doctors usually a button down shirt. I keep it business casual, I always wear black pants and a button down, and never sneakers. 

I would say the hardest thing to deal with is loneliness. The translators and teachers are great, but at the end of the day they want to get back to their lives. Which leaves you alone in a hotel or apartment with your loved ones in a different timezone and on a completely different schedule. I’m super active and walk the entire city, but there are many lonely moments, and social media can actually be of help here. If you’ve got friends around the world, someone is awake with you. Blogging, posting pictures on Instagram, FaceTime, all these things help you stay connected to your world. Interestingly, I see quite a few Americans and Europeans here, but rarely does anyone engage. It’s almost as if people pretend not to see each other as speaking to a non-Chinese person will ruin their “authentic” experience.

Its important to remember that China is not one experience, like the language and Chinese medicine, its a massive melting pot of ideas and cultures all under one umbrella. Every time I see someone say that “China is this way…” or “this is what the Chinese do…” I think hmm, maybe they only visited one place. Every city, every family, every clinic and teacher has their own take on things. There’s even a saying, if you’ve visited Beijing, Hong Kong or Shanghai you still haven’t seen China. It’s completely true. In addition, change is on warp speed here. Something that was happening 2 years ago will be gone, and the whole country will have shifted. That being said they are really into Kenny G, remakes of 80’s classics, and torn jeans right now…

In the end, this is completely worth it. I’ve seen around 1,000 patients in 5 weeks, my Mandarin has improved immensely, and I’m laying the groundwork for future trips and research projects. I absolutely recommend DAOM programs to aspiring TCM students, and wholeheartedly suggest that TCM practitioners visit China in whatever capacity they can. You have to be ready for change, and the unexpected, but it can be absolutely life changing. 



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