ACTCM in China: Women’s Health

Charity Burgess shares a recap of her experience in China while studying abroad. She is one of our six students who is completing a three month scholarship at Henan University. Please note this article contains some graphic descriptions of a surgical procedure.

It’s week-9 here at Henan University of TCM and half of us have been in the gynecology department for a week. This department is peaceful, a big contrast from the rowdy tui na department where we just spent 3 weeks (in which 3-4 patients, up to 15 students and 1-2 doctors crowd a small treatment room socializing while giving and receiving tui na).  There are three beds in each room of the in-patient  gynecology department, but most of them only have a single patient in them, two tops.  In the mornings we follow Dr. Mao, a 35 year old graduate of Nanjing’s TCM university.  He is friendly and it is obvious that he has spent a lot of his time, love and energy studying TCM.  Dr. Mao has only a few patients that are currently staying in the hospital.  He also sees several outpatients to refill or update their formulas based on their progress after their discharge as in-patients.

One of the first patients we see has advanced metastatic cervical cancer.  Lou Meng, our translator, warns us not to say anything in front of the patient about her disease because she is unaware of the severity of it.  In China when a patient has a fatal prognosis the family is notified and they can decide whether or not to tell the patient.  Doctors discourage the family from truth-telling, believing that the news would cause distress to the patient and weaken their potential to survive longer.  Dr. Mao is giving her treatments to ease the painful symptoms she’s experiencing.
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During down time, Dr. Mao is happy to sit with us to discuss the patients we’ve seen, answer any questions we have and test our TCM gynecology knowledge.  He is encouraging, patient and eager to share his knowledge with us.  He calls us over to take a patient’s pulse and asks us what we think.  Being in this department has been a great benefit to my pulse-taking skills.  Since many women with gynecological problems tend to have similar pulses, the pulses have become much more clear and I now have much more confidence in what I’m feeling where before I often questioned my intuition. Dr. Mao has a special skill in teaching and has been impressed with our desire to learn, as well as our knowledge and skill in practice.

In the afternoons, we spend time in the out-patient gynecology department, which is much busier than the in-patient department (but still far more peaceful than the tui na department).  We have spent a couple afternoons following Dr. Liu, a middle-aged woman with a cheerful demeanor.  She has been trained extensively in allopathic and TCM gynecology, and has the credentials to prescribe pharmaceuticals and herbs.  Mostly we have seen her prescribe herbs.

The doctors in this department have their own office where patients will line up and wait for their turn.  There is no privacy for intakes.  No HIPAA here.  Everyone in the office hears all about test results, symptoms and whatever else is discussed with the doctor.  The examination table for pap smears and pelvic exams is in the corner around a little cubical-like divider separating the examined patient from the rest of the office.  The patients generally seem to be at ease with this.  Until one patient comes in with an unwanted pregnancy and is here to schedule an abortion.  She seems uneasy about the whole thing and her husband is clearly taking control of the situation.  Her eyes dart around the room, glancing at each of us, as if questioning whether or not we are friends or foe.  The appointment gets scheduled for tomorrow morning.

When Lou Meng translates the cost of the abortion to be 2,000 yuan (approximately $323 U.S. dollars), I am struck by how expensive that seems for a country that is so concerned with overpopulation.  Lou Meng asks the teacher my questions about how the procedure is performed and why the cost is so high.  2,000 yuan is the price of an abortion with anesthesia.  It can cost less if the woman doesn’t mind suffering through the pain.  Some details about the abortion procedure get lost in translation and I have difficulty understanding them.  Dr. Liu, at this point, asks me if I am interested in witnessing the procedure being done.  Having never imagined that I could witness something like this and being a curious person by nature, I become excited at the possibility.

It takes a couple of days for schedules to line up and a patient to agree to allow me to witness her abortion.  The patient has only agreed to allow women into the room.  Lou Meng and I are escorted into the operating room where we are instructed to change into slippers and put on respiratory masks and surgical hats.  The patient has been pregnant for 55 days.  She and her husband want to have another child, but this embryo is not developing properly.  The doctor has recommended the abortion.  It is a sad situation for the patient and her sorrow is visible and palpable.  The palpable emotion has made me wonder if I have gotten myself in over my head.  Lou Meng turns to me and tells me that she feels very horrible.  I let her know that she doesn’t need to stay and translate for me if it’s too much for her.  She insists that she is ok, but that she feels horrible for the patient.

The patient has chosen the less expensive option and is going through the procedure without anesthesia.  There are three nurses in the room.  One preparing the patient for the procedure, one who performs the procedure and the other who assists them both.  After the cleaning and prep-work, the nurse who performs the abortion does a transvaginal ultrasound, checking for the location of the embryo.  There are then a number of metal tools used, I can only guess what exactly for.  A long and skinny metal tube is inserted after the speculum has been put in place.  She is then injected with a local numbing agent to ease some of the pain.  Several quarter-inch in diameter metal wands are inserted to remove the embryo from the uterine wall.  A suction tube is inserted that vacuums the tissue.  There is blood, as you would expect, and I start to feel light-headed and sweaty.  Once they pull the suction tool out of the patient, they do another ultrasound and discover that they need to clean more tissue from inside the uterus.  My light-headedness has turned into dizziness and I have to excuse myself for the rest of the procedure so I can sit down and breathe.

The whole procedure takes less than 20 minutes and Lou Meng and I are back in Dr. Liu’s office talking with her about how it went.  When Lou Meng tells Dr. Liu that I had to excuse myself from the procedure, she asks if it was my first surgery to witness.  She isn’t surprised when I say that it was, and tells me that if I get to see another I will likely be able to handle it better.  I can’t imagine that I would want to test myself like that.  Once seems like plenty for me.

We discuss the details of the case a bit more.  Turns out that the patient has adenomyosis and is 37 years old.  Dr. Liu doesn’t feel confident that the patient will have another child with such a complicated illness to treat.  I express some sympathy for the patient after this is translated to me, to which Dr. Liu replies, “It’s hard to be a woman.”  I’m usually pretty optimistic about being a woman, but I can’t help but agree with her today.

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