My classmates and I have spent almost two weeks now in Dr Bi's clinic, so we have come to know his patients well. They come everyday for problems with the neck (cervical spondylosis) and lumbar pain. Daily treatment is the norm for musculoskeletal problems in China, which is much more effective -- quite a big difference from how patients come once (maybe twice) a week in our clinic in London. Acupuncture is expensive in the UK, and more often than not patients are paying out of pocket, so daily treatment is not often viable.

It has been such a learning experience to see Dr Bi's needling and massage techniques, choice of points, and how he manipulates necks and backs. But the lasting impression that I have of this bustling clinic is its beautiful communal atmosphere. Photos cannot capture this special quality.

For starters, the patients come everyday so they get to know each other and the doctors and students well. They spend a lot of time getting treated with acupuncture, massage, cupping, guasha (scraping the skin, especially of the back), and electro therapy, usually staying there 2-3 hours at a time. So there is a lot of time to talk, and talk they do!

They talk about how they are feeling and how their treatments are going. They inquire about each other's family, especially their children. When there is a new patient, they are listening to what's going on (because the consultation with the doctor is happening in front of everyone). And they  probably talk about us, the foreign students who are here to absorb as much of Dr Bi's Chinese medicine knowledge as possible in the time that we have.

This morning was particularly beautiful. Dr Bi was alone in the clinic with about six patients. For some reason his students and junior doctors were late to come in, so he had to look after patients by himself. I noticed that the son of a woman patient (he accompanies his mum every day) was helping hook up one lovely older lady to an electro therapy machine -- I guess because he is in the clinic with his mum so often, he knows from observing what to do! 

It is such a stark contrast to how acupuncture is administered in the UK, where you normally treat one patient at a time in individual treatment rooms. I will really miss the happy and healing atmosphere in the outpatient clinics here in Heilongjiang University of Chinese Medicine. Maybe I can recreate this by working in a multi-bed clinic back home?

This week, my classmates and I have been following Dr Bi Xu-wei of a strangely named department called Health Care. I thought at first this would be similar to a General Practitioner (GP) surgery (or primary care in the UK), but it turns out to be a cross between rehabilitation and Chinese massage (tuina).

The majority of Dr Bi's patients have cervical spondylosis (compression of the neck vertebrae) and lumbar disc hernia (or slipped/prolapsed disc). The armoury of Chinese medicine here includes tuina, acupuncture, moxibustion (the burning of rolled up mugwort herb to warm up an area to promote Qi and Blood circulation), cupping, and electrotherapy. Dr Bi is a great doctor to follow because he specialises in conditions that I will see a lot of when I am in practice. He is also very kind and generous with his knowledge.

Yesterday a patient came to see him with a frozen shoulder -- he immediately stuck a needle in her lower leg (Tiakou ST38), quite deep, at least 3 cun (6cm). This was obviously painful for the patient, but at the same time she gained instant relief from the pain -- you could see this in her face. It took me a few seconds to figure out what was happening. I have read about ST38 being used with dramatic results, but this is my first time to witness it for myself.

I often suffer from frozen shoulder, usually when it's cold and I'm too busy and have no time to exercise and stretch. I have a vested interest in frozen shoulders! Today I asked Dr Bi to look at my right shoulder, which has been aching for the past six months. He said it's not frozen but I might have cervical spondylosis. 

Dr Bi then needled two points on my hand (Sanjian LI3 and Hegu LI4), again going in very deeply. The sensation was electric, and like yesterday's patient, I got instant relief from the ache. He massaged my upper back, neck and shoulders and mobilised my shoulder, and now I am walking around like a new woman, a complete fan of this great doctor.

Later on he told me and my classmates -- after he had shown us a secret point near the thumb for headaches -- that he doesn't mind sharing his secrets with us because we are from the UK. I gather that he doesn't share so readily with people from Harbin because competition in the hospital is quite fierce! 


 

This week my classmates and I found outselves in gynaecology. Yesterday we were with Dr Han Feng-juan, a lovely woman who is clearly a leader in her field but has a warmth that is just what you want in your gynaecologist. I also found out that she is the director of the 4th floor gynaecology ward, where we were this morning (although we followed a different doctor).

Dr. Han is well-known for treating polycystic ovarian syndrome (PCOS), dysfunctional uterine bleeding, irregular menstruation, for giving pre-natal care (especially for those with a gynaecological condition) and for "holding" the baby to avoid miscarriage.

She had a very busy clinic yesterday morning. She was quick and efficient, but clearly gave her patients a lot of attention and care. We saw many many cases of Kidney Deficiency, especially in problems of irregular menstruation or amenorrhoea.

But what struck us the most is the lack of privacy, especially for a place as intimate as a gynaecology clinic. At the back of Dr Han's office is an examination table with stirrups (very old fashioned!), separated from the main area with a pink room divider. Every so often, Dr Han got up to examine a patient, who had been prepped by a student and had undressed and climbed on to the table. Bearing in mind that the clinic is heaving with patients and relatives, it soon became apparent that it's considered normal for other patients to look at what's going on behind the screen. I know that the Chinese have a different concept of privacy, so I tried not to feel too sorry for the patients. At least men were not allowed in the room!

This morning we did the round of the 4th floor gynae ward with Dr Zhang and two of her students. I think we saw a total of 20 patients. There were a few cases of surgery (an 82-year-old woman with vaginal tumours, and a woman in her 30s who had a hysterectomy) -- but the vast majority of patients were there because they were in the early stage of pregnancy and had threatened abortion (in danger of miscarriage). The standard treatment seemed to be lots of rest (with an average stay of one month in the hospital), injections of progesterone, and Chinese herbs. 

Clearly there are big cultural differences between China and the UK for this sort of problem. My classmate Sharmin said that in the UK, women with this condition would simply be told to go home and rest. And then there is the argument that if your foetus is not strong enough to survive the first trimester, a miscarriage is (probably) nature's way of "healthy-baby selection".

Our translator said that in China, the pressure to have a baby is so strong, it (probably) overrides this ethical dilemma. There is clearly a strong demand for this service, such that someone like Dr Han has made a reputation for being able to "hold the baby".

And then there are other issues like artificial progesterone being injected into women's bodies. What implications does this have for the baby and the woman's health later on? I would love to see research into this.

Finally, I took a photo of a woman in the ward who was being fed a mountain of baozi (stuffed buns) and noodles by her mother (or maybe a mother-in-law?). I asked her permission for me to take this picture. I found her so beautiful, especially as she tucked into her lunch. Ethical dilemma aside, I hope she holds her baby to full term.

P.S. My classmate Kat later passed on a research paper from mainland China that looked into the effects of the use of progesterone in cases of threatened abortion. It found no difference in terms of birth weight of babies between those who were given progesterone treatment and with a control group. Interesting.