2009 PFIG Recipient Andrew Case

Career Administrator

Andrew Case
College of Arts & Sciences 
Cognitive Science and Physics 
2010 Graduation Year

Internship: Huaxi Hospital of Sichuan in China

Notes on the first week 

Though I have been in China for nearly two weeks, today officially concludes my first week of work at the Huaxi Hospital Center for Cancer Research and Therapy, in Chengdu , China . Before arriving in Chengdu , I spent a few days studying Chinese while living with a Chinese family in Wuhan , Hubei province. Now I am living and working with Dr. Nianyong Chen, PhD, a Sichuan-born oncologist who spent 6 years working in the United States , including two years at the University of Virginia.

Huaxi has begun to take on a grandfatherly role for me in this massive city. The hospital began providing care for people throughout Sichuan province long before my grandfather was even born – long before the trappings of America were strung up and flaunted on every street corner. Today these western symbols - coca-cola banners and posters of Kobe Bryant - are certainly prominent, but they hardly eclipse the deeply engrained culture of Chengdu . This is a culture that I discovered at first to be very Chinese: street vendors waking at 4:30am, no food taxes or tips, and incessant crowding/jostling/honking/spitting, to mention a few. Yet at the same time it is distinct from other Chinese cities I have visited. These people are fiercely proud of their almost unbearably spicy food, abated only slightly by special mouth numbing peppercorns. In addition, they live up to their easy going reputation - shuffling, pausing, chatting on their way to work, sometimes only to take a two hour lunch break a few hours later, nap included.

Of course the hospital I work in is a bit of an oddity in the city it cares for. Not only has it been providing western medical care since before my grandfather was born, but it operates at an alarmingly fast pace. Every morning I work my way through streams of sick people, some having traveled over a hundred miles, entering, exiting, or just waiting and hoping to be seen. It seems to operate at maximum capacity now, and I simply cannot imagine how the hospital handled patients in the Sichuan earthquake in May last year, only 50 odd miles from the earthquake’s epicenter.

I arrive at the oncology ward in time for our 8am staff meeting, where the day’s schedule is hurriedly read in local dialect for everyone to take note and abide – except for me, because I can hardly understand a word. Fortunately, this schedule has had little to do with my daily duties. I am Dr. Chen’s personal foreign exchange student, with a pictured ID badge that says just about that. My first morning I shadowed him as he examined 30 patients in an outpatient clinic to determine whether or not they even qualified for inpatient status. Since then I have been working with his graduate assistant to prepare a journal review of the role of the ligand-receptor pair CXCL16-CXCR6 in cancer metastasis. This has proven to be a daunting task, not only because I am the only native English speaker in the department, but because Dr. Chen expects the review to be submitted to the Journal of Leukocyte Biology by the end of the month. Needless to say, I have not only been forced to address questions of cross-cultural medicine in my first week here, but have also been confronted with molecular biology at levels I never even dreamed of.

Midway 

The apartment in which Dr. Chen and I live is literally in the geographic middle of Sichuan University . To the west is Huaxi, with its five in-patient buildings and one outpatient building. To the east is the traditional Sichuan university campus, which merged with the hospital and medical school three years ago. Dr. Chen's apartment is conveniently tucked away on the seventh floor of an alley-side apartment building. We are directly across the street from the hospital itself, and the daily interaction of patients, street vendors, white-robed care givers right outside our window is always entertaining.

Thus far, my time at Huaxi has been marked by two distinct objectives. The first has to assist Dr. Chen's graduate research assistant in preparing a journal review for submission to the Journal of Leukocyte Biology. The second, of more personal interest, has been to research the mechanisms by which western medical resources (staff training, equipment, and pharmaceuticals) find their way to Huaxi Hospital , China 's most inland prominent hospital. "Find their way" is the best description for this process, precisely for its aimless, wandering connotation – I have yet to discover any one guiding force that delivers these resources to Chengdu . Instead, they seem caught up in an ever-developing tangle of government policy, academic research, hospital administration, private corporate interest, and crowds of sick people from both the city and countryside.

My research efforts have therefore been concentrated on tracking down those agents outside of the hospital that are involved in my hospitals resource chain. The hardest to contact, and set up interviews, have surprisingly been ones who speak my language: foreign medical equipment powerhouses in Chengdu like General Electric and Siemens-Nokia. I have had some luck Varian Medical Systems, a medical equipment manufacturer that is responsible for about 50% of China 's radio-therapy equipment, and has 70% of the US market share. Coincidentally, they have a manufacturing plant in Charlottesville which I plan to visit when I when I conclude my internship in the US.

My inquiry at smaller Chinese companies has been better received, in part because I think these private Chinese businesses are simply curious about me, the only westerner at the world's largest hospital. They even seem flattered that I want to interview them in their native tongue. I had the opportunity on Tuesday to interview an IV needle retailer who has recently grown her start-up to a 23 person private company that deals primarily with Huaxi, the largest government-run business in town. I learned that recently the route for most medical supplies shifted from Hong Kong based distribution systems to Shanghai based distribution systems. Accordingly, I plan to travel to Shanghai for the last few days of my time in China to take my research questions to reps at Shanghai offices. Ms. Zhuo, the private medical retailer, has accordingly offered to help me this week set up appointments with medical equipment companies in Shanghai.

Still, the highlight of my week was the discovery of the Australian based western medical care provider, Global Doctor. With eight offices throughout China , Global Doctor employs foreign and native doctors and nurses to provide western-standard care to a largely foreign cliental. Because many of the Global Doctor staff members are both domestically and internationally trained, Global Doctor has become an invaluable resource for me as I begin to try pin down the differences between the Huaxi medical system here and the Eastern Virginia system I will explore when I return to the US . I am excited about the day I will spend this week shadowing Dr. Allen Liu, and general practitioner at Global Doctor. Still, the crowning achievement of my time in Chengdu would be a trip to the hospital at Mianzhu, the center of the May 12, 2008 Sichuan earthquake. I hear the conditions in this area are markedly different from modern Huaxi, and desperately hope I will have more success in the coming week gaining access to this rural medical center.

Final Reflections

My experience in Chengdu this summer may have been the most transformational summer of my life. I was at once overwhelmed by the vastness of the global medical field, and at the same time grew confident in my interest in one day finding my place in medicine. I am now fairly certain I want to do health consulting in some capacity, hopefully with a Chinese component, and probably want to study public health in graduate school – someday.

My direct work with Dr. Chen and his research assistant drew to a close when we finished preparing the review of the CXCL16-CXCR6 paper for submission to the Journal of Leukocyte Biology. My editing work was tedious, but I now appreciate the sense I developed of the demands of medical research. Before this summer, I already knew research often required repetitious lab work, but I did not realize that medical research requires constant survey of other work, that research in today’s world of internet journals is one giant collaborative effort. I also learned that I could never be a lab based researcher because of my dependence on people – their reactions, problems, and hopes – for inspiration in my work.

Finally, this last portion of my internship (the weeks of August leading up to the start of classes) was probably the most productive portion of my time in China as far as my own public research was concerned. In Chengdu, I had the opportunity to interview a number of Chinese medical equipment representatives about their Chinese operations and learn about the mechanisms that bring medical resources (both human and material) to China from Europe, South-East Asia, and the US. I also interviewed a number of foreign doctors in order to compare foreign and domestic standards of medical care. My internship concluded with a tour to Beijing and Shanghai, during which I met with doctors and managers working at International SOS and Parkway Health, both leaders in western-standard healthcare delivery (and evacuation) in China. These were likely the most meaningful days of my internship as I was able to get a sense of what type of medical work Chinese-speaking foreigners like me might do in China beyond the stereotypical MD role. This is something I hope to explore over the next few months as I look for work in Chinese healthcare next year.