Medicine

Medical care in China: part two. This is the story of four hours in an… | by Anna Ka | Jan, 2022

Anna Ka

This is the story of four hours in an orthopedic clinic in a remote district of Shenzhen, China.

Nearly all medical care in China is hospital-based. You have a problem? You go to the hospital. Six weeks ago I broke my toe and found myself in an ongoing relationship with Dr. Ouyang, an orthopedist on an inpatient unit on the fourteenth floor of Fuyong People’s Hospital. I added him on WeChat so that we could communicate more effectively. When I rebroke my toe a week and a half into my recovery in a bike accident, I messaged him first. Ice it, he said. When I saw him on Christmas Day, I brought two large saran and bubble-wrapped apples with shiny stickers from the shop down the street.

Yesterday I saw him for the last time. He studied my x-ray carefully, talking to himself in low tones. Hen xiaode. The break is reduced, very small now. You can walk, he said, and bear weight, but don’t run or play sports. I beamed, relief and exhilaration flooding my body. A weight I had been carrying for six weeks fell off me in an instant.

Before I left, I asked him about my knee, which had taken a beating over the past six weeks with my altered, toe-sparing gait. “You can get a hyaluronic acid injection”, he said. Just go to the 5th floor orthopedics clinic. Just like that. I went straight away. It was mid-morning, and when I turned up they told me there were no more numbers for the morning, and to try again in the afternoon. I had plans in the afternoon, so I set my sights on the next day, today.

I arrived today with my social insurance card and phone translation cued up and at the ready. “I was told to come here to see a doctor about my knee”. The triage nurse asked me to scan a few health codes, and once I had proven that all my codes were green, she printed out a receipt with a QR code that I could use to pay and a number. Room 504, number 32. I sat down in a chair in one of the rows of chairs arranged DMV style in the large open waiting room and checked the monitor. Room 504 was currently seeing number 4. I settled in for a long wait.

I passed the time doing language lessons on my phone and shuffling through a fat stack of flash cards I had made of the current vocabulary set I am working on. I carry these with me everywhere I go. It has been a real game changer for long public transport. What used to be a tedious hour long trip is now barely enough time to get through all the studying I wanted to do.

A few times the numbers went in reverse order. What was an 8 was now a 6. Each time this happened I panicked briefly, then saw the numbers slide back up the scale in the correct order and let out a breath. I walked around and found the room. While every other room had the door closed, the door to 504 was open and a line of people spilled out. I repositioned myself to a chair right outside the room, not wanting to miss my turn.

14–22 went quick. Ten more to go. A few bathroom trips, language lessons, and many surreptitious glances from people around me later, it was finally my turn. The speaker blared my name, but unprepared to handle the foreign script it spoke each letter aloud. “A-N-N-A-K-A”, over and over. I felt the eyes of everyone in the waiting room on me as I walked to the room.

I stood in the line at first, unsure of what to do. Finally I nudged my way in and held my receipt out as if to say “look, the weird name you’re hearing is mine, I belong here now, you are looking for me”. The doctor saw me and waved me in. No one left the room. The door remained open. Two or three other patients sat in chairs in the small room and the entire line of people waiting to be seen stayed watching my interaction with the doctor. So much for doctor-patient confidentiality or privacy of any kind.

The doctor asked if I speak Chinese. Yi dian dian. A little. He laughed. I showed him my prepared note on my phone of my situation. He read it out loud. My stomach twisted at this, my medical information being read to an audience of strangers. A collectivist culture on full display. He remarked that Dr. Ouyang and him were classmates. I wondered how many Dr. Ouyangs work in the hospital, because the one I saw was a couple decades younger than this doctor, but kept my thoughts to myself.

He said they didn’t have cortisone but I could get a hyaluronic acid injection. I figured it was worth a try. Hao-a. I gave him my social insurance card and he made the order and printed out another receipt. He then said a lot of words, of which I understood that he wanted me to come back after doing something. I figured I should pay first, so I went, stumbling a bit with my hazy understanding, to the counter to pay. The receptionist also spoke a lot to me, of which I understood little. I suppose I could have used my phone’s translation app more, but I froze a bit in the moment and just said I didn’t understand. Bu hao yise. Wo bu ming bai. Wo ting bu dong. This elicted a lot of smiling and laughing but no real solutions.

I took my receipt and went back to 504, back to the line. I waited for a while, watching along with everyone else as the doctor reset a man’s broken pinky finger and put a splint on it.

When the doctor saw me, he took me out of the room and back out into the waiting room, speaking loudly to me. Everyone was now blatantly staring at us. His tone became more urgent. A wash of confusion came over me, thick and dark, dulling my listening acuity even further.

He peppered in what English words he knew, but it wasn’t enough. He held up his hand in the gesture for 2. “Yes, second floor, I got that, then what?” I asked. His response washed over me. “Bu ming bai”, I said. “Bu ming bai”, he replied. At this, everyone laughed, as though we on a sit-com and the audience had just seen the laugh prompter go off.

The doctor gestured broadly to the audience, as though asking if anyone could help. A middle aged woman moved to pull down her mask then thought better of it. She said “go second floor get medicine”. Get medicine? For an injection?

From the moment I walked into the clinic I was painfully aware that this is a system that is as normal as the air we breathe to everyone here, and even asking them to explain how things work is a bit of an odd and misguided question. I had asked the triage nurse what the number meant and she circled it and said this is your number, with as much emphasis as I’ve ever heard in spoken Chinese. So, of course you go and pick up your own medication and deliver them to the doctor to give to you, just like you do with your x-rays. How else could it possibly work?

I took the stairs down to the second floor. The elevator was far too slow and crowded when I first got on it to go to the clinic and I did not want a repeat of that experience. When I got to the second floor, I felt a tap on my shoulder. A man silently pointed towards the pharmacy. He walked with me, taking my receipt and showing it to the person at the window. Not this window, it seems. He took me to the second window, and watched as I moved through the line. The pharmacist took my receipt and handed me two boxes, a box with the injection and a box of NSAIDS, presumably to take following the shot.

The man then held up a silent “5” gesture, to which I nodded, and followed me back up the stairs. He was also a patient but had taken it upon himself to help out this clueless foreigner. I typed out a thank you message on my phone and showed it to him. He waved his hands in the standard “bu yong” gesture meaning no, no need.

Back to the line. I had arrived at the clinic at 2:30pm and it was now 5:30pm. The lights shut off in the waiting room and halls. The triage nurse came into the room and told the doctor everyone was leaving for the day. Still, the line moved, and the doctor saw patients.

Finally, at close to 6pm, it was my turn. The doctor took me into a treatment room where, finally, blissfully, I was given some privacy for the injection. I rolled up my pant leg and he studied my knee. He then took out the syringe and the instructions that came in the box and looked them over. I have to admit I died a small death at this, but I also really wanted to see if this would help a knee that is just not responding to anything else I do for it and had its metaphorical teeth kicked in for the past six weeks. I put my fears to the side side.

He poked around at my knee for quite some time, then finally administered the injection. Though it didn’t hurt at first, the last of the volume to go in was quite painful, especially as he was withdrawing the needle and pushing more fluid in bit by bit. 2/10 would not recommend.

I asked if I could add his WeChat so we could communicate and I could get any follow up instructions or questions asked and answered, and he agreed readily. I followed him to his office and he scanned my personal QR code, with, of course, an audience watching our every move.

I limped a bit out of the hospital, knee stiff and full, marveling at the entire ordeal and a bit too at my own brazen attitude towards self-experimentation.

My Chinese tutor, who I’d been messaging through all of this for support, said she would help me register on their platform for an appointment for next time so I don’t have to wait as long. It seems this course of treatment is 4–5 weekly injections. I may or may not go for that, we’ll see how this week plays and how my knee feels.

In the US, this process would likely have taken weeks if not months. I would have had to call, get an appointment, possibly have a referral beforehand, be seen by a medical assistant then a physician assistant or nurse, possibly never meeting the doctor, and drive out to a separate clinic location multiple times, once for an assessment, then again for the injection. Here, I showed up without an appointment and three and a half hours later walked out with the procedure done with. Certainly there are pros and cons to each system, but I am truly amazed at how centralized, collectivist, and efficient a system like this can be.

Now let’s see how my knee fares.


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