Village Stethoscope

The highlight of my time in China was definitely my clerkship with China California Heart Watch. Run by Robert Detrano, M.D., of UC Irvine (although I think he's retired now), it's a nonprofit organization that does heart health checkups in rural Yunnan, giving out free medicines, as well as sponsoring rural kids with heart defects to have surgery. They also do some research as to the correlation between enlarged hearts and high blood pressure.

My job, as a clerk, was to take blood pressures, take interviews (for the research - the questions ranged from diet and smoking habits to marital status to previous conditions to the importance of distance when choosing a doctor), scribe ultrasound results, tell the nongmin (after ascertaining that they were indeed nongmin - farmers - for their questionnaires) that taking Amoxycillin for absolutely every ache and pain was a very bad idea, because strong bacteria would grow big, very big, and then KILL YOU (my Chinese is still rather crude, must admit), and of course, to partake in the ubiquitous call of XIAO HEEEEEE - Xiao He being our intrepid local offical, and Naxi hua translator. Also my pengyou.

Basically, I got to play doctor, and hang out with the elderly of each village. Our research dealt with 50-70 year olds, so that was the general age group we saw. The Putonghua of that age group was mostly pretty bad, so I learned the most important terms in Naxi hua - we had a lot of Naxi minority people, because they're the major nationality that lives around Lijiang - namely, "Take off your clothes", "Take off your shoes", "Eat", and "Breathe". For the interviews, I did a lot of "Xiao HeeEEeeeeEE!"-ing.

Most of the men smoked ridiculous amounts a day - we measured in packs, and the average was 2, but we did get a fair number of 1 pack a day and 3 packs a day. I remember the one guy who proudly cackled that he only smoked 2 a day, 2支 not 2包. We asked him three times just to make sure, we were so amazed. They also drank a lot... an average of 10 shots of baijiu a day. Most of them pre-gamed the clinic, so their blood pressures were probably artificially high, although... is it really artificial if they drink constantly throughout the day anyway?

The rule was, if the blood pressures were below 140/90, to tell them it was normal; if they were between 140/90 and 160/100, to give them the "少吃盐巴" (eat less salt) speech, which was basically lifestyle modification that they were quite unlikely to follow; and if it was above 160/100, which we still had a lot of, to send them to the doctor who'd generally give them hydrochlorothiazide.

If they had any sort of heart pain or problems - lots of people had "心跳", meaning "heart jumps" or "heart beats", by which they meant that their heart beat too quickly sometimes, usually during physical stress - they were generally listened to by the doctor, and if something sounded amiss, they'd get an ultrasound.
All the research patients got ultrasounds, too, to look at the thicknesses of the walls and the size of the left atria and ventricles. Ultrasounds were extra exciting and mafan because they had to be done in a dark room, and the portable machinese weren't too clear. It was also rather difficult to explain to the nongmin that they had to lie on their sides, facing away from the doctor, but close to him, and to open their clothes...

Actually, it was hard to get them to take their clothes off in the first place. They'd always cackle, the old ladies especially, and insist that no, no, their clothes were perfectly thin enough or loose enough to pull up - when they were wearing 3 layers of long-sleeved shirts under their blue outer Naxi coats. And then you'd convince them, and they'd stand up and scold and cackle and take off layer after layer and you'd not understand anything because your Naxihua is limited to four phrases and wow - Putonghua is really worth nothing in this instance, isn't it.

But it was marvelous. The confusion was great. The potatoes and la zi that we had for lunch almost every day - or the baba that replaced them - all of them were delicious and solid and simple, and the la duzi that accompanied most of us throughout our stay there was just an unfortunate effect of our weak sauce digestive tracts. The bathroom of our hotel was a bunch of maggot slots, but that was okay too, after a while. At least with la duzi you were done in there sooner, right?

We lived across the street from rice fields, next to a gas station that had a couple of tiny corn plots in the back. For sunrises and sunsets, I'd sit on the wall dividing our hotel yard and the gas station, either drinking my morning tea or sipping my evening beer, and marvel at the mountains, clouds, fields, mountains! that surrounded me. Entrancing.
And then the mianbaoche would arrive and we'd load up the medicines and ultrasounds and then pray for a long ride so that we could enjoy the scenery and rest before the madness began...

On some days, we saw over 100 clinical patients and 25 research ones. That's 6 clerks, 1 or 2 doctors, plus Shanshan. That's 2 tables, a research and a clinical, 2 blood pressure cuffs and 4 stethoscopes and 2 or 3 interviewers and 1 or 2 traffic control people and a very, very busy Dr. Detrano who would gruffly put off his lunch until 1 or 2pm, until all the research ultrasounds were done. 还有病人！我不要吃饭！

And on some days, we only had 5 or 6 research patients, maybe 15 clinical ones, and had time to play frisbee, lose the frisbee, find the frisbee, get fed delicious sugary baba and the customary yeyu and la zi, and then walk down the hill back to our valley, a two hour hike of lovely...

We also saw kids with heart defects. That's harder to write about. One day, we didn't go to a village, but had the kids' clinic in the hotel... I think 9 or so kids came? With murmurs, or who had had murmurs... some kids had had holes in their hearts when they were younger, but it had closed by itself. They were the lucky ones.

There was a 14 year old girl with a murmur so loud that I could barely hear her breathing from the front. You could feel the murmur clearly with your hand... a "palpable thrill". Grade 4. There was a 5 year old meimei, Lisu minority I later found out, who solemnly double-barrel picked her nose while getting ultrasounded, while Adam made ridiculous faces at her from behind Dr. Detrano's back, using his stethoscope as a monocle... she needed surgery as soon as possible, before her pulmonary artery stenosed. Patent ductus arteriosis... her pulmonary artery and aorta had a connecting hole. She came back to Kunming with us, and I got to go to the hospital with her to get her a proper ultrasound.

There was a girl with some neurological problems who we didn't extend any aid to, because the organization only gives money to otherwise healthy children. There are so many children, Dr. Detrano explained, that we must choose somehow.

There was an adorable little girl with two pigtails who also needed surgery, who had a hole between her atriums, I think. Her dad looked so very sad. All the parents looked lost and heartbroken, and wouldn't you, knowing that your kid was going to die early, at 20 or 30 even, unless they got this 20,000-30,000 kuai surgery, and you earned 2,000 or 1,100 or 700 kuai a year?

ChinaCal pays for about 1/3, insurance generally pays for 30-38%, and the patient's family have to come up with the rest. They usually do, Dr. Detrano says.

We also did some school screenings. Only one kid out of the 3 schools that we screened turned out to urgently need surgery. His mom, too, was shaking and crying. 700 kuai a year, I think.
Tyler remarked that he had more money than that right then in his backpack. I did, too.

There's really no way to dig myself out of that sad note, is there? I shouldn't even try. It was a fun experience, I learned a lot, I saw a lot of cardiology that I would never see in the medical training I plan to follow... but in the end, it's sick people. It's sick old people, it's people with heart failure, it's kids with holes in their hearts.

The annual budget of ChinaCal is $50,000. One-third of a catheter surgery (that goes in through a vein) is $980; one-third of open-heart surgery is $1470. Even a relatively small amount would make a significant difference, especially once you realize that a good percentage of the families sponsored earn $100-$200 a year.

http://www.chinacal.org/