Family Medicine Faculty Visit China in Continuation of Exchange Program

In August, three Department of Family Medicine (DFM) faculty — Valerie Gilchrist, MD; Sandra Kamnetz, MD; and Kenneth Kushner, PhD — traveled to China as part of an ongoing exchange program between the DFM, Columbia University, and Beijing's FuXing Hospital and its affiliated Yuetan Community Health Services Center.

 

They visited community health centers in Beijing and Inner Mongolia, participated in a national community health symposium, and most important, had the rare opportunity to influence-and be influenced by-the health care system of the world's most populous country.

 

Observations from Inner Mongolia

 

After landing in Beijing, the group traveled about 650 miles to Hohhot, the capital of China's Inner Mongolia region. While touring several community health centers, they observed many differences between primary care in regional China versus North America.

 

View a Slideshow of the Department of Family Medicine Faculty Trip to China

 

Integrated Medicine the Norm

 

One notable difference is that what Westerners call "integrative medicine" is the norm in China. All clinics practice Traditional Chinese Medicine (TCM) — which includes herbal medicine, acupuncture, Tui Na massage, and other "alternative" treatments — in addition to Western allopathic medicine.

 

In addition, community health centers all offer integrated physical therapy and rehabilitation services, and many also offer dental services.

 

Clear Public Health Mandate

 

Community health centers in Hohhot, like in the rest of China, also have a clear public health mandate. Each clinic has doctors who are responsible for the health and well-being of an apartment building, neighborhood, or other sector of the community.

 

Those doctors perform home visits and follow-ups, order prescriptions, and maintain records of each interaction. In China, patients and physicians expect this; in North America, similar outreach visits would be voluntary and not necessarily captured in a patient's medical record.

 

Outstanding Public Health Education

 

Department of Family Medicine faculty were also impressed with the public health education efforts in China. In addition to free condom dispensers in the halls, several clinics had cabinets displaying appropriate food portions (similar to our food pyramid).

 

Clinics also had posters showing the importance of staying on blood pressure medications, immunization schedules, and remarkably, a complete formulary of available medications, with prices.

 

(And later on, in Beijing, Dr. Kamnetz and Dr. Gilchrist would also observe vending machines that dispensed nicotine patches to discourage smoking in public places, such as the Bird's Nest Olympic stadium.)

 

Back in Beijing

 

After two nights in Hohhot, the faculty returned to Beijing, where they toured more community health centers around the city — and worked in a little sightseeing, too.

 

The Beijing Symposium

 

The primary purpose of their visit was to participate in the Sixth Annual Symposium on General Practice and Community Health Services.

 

The educational conference brought together over 600 generalist clinicians, administrators, and government representatives from all over China.

 

With the aid of an interpreter, Dr. Gilchrist gave two presentations: one on asthma management by family physicians and one on hypertension. Dr. Kamnetz spoke on protocols and guidelines, and Dr. Kushner spoke on depression and clinical practice.

 

Kathleen Klink, MD, director of the Center for Family and Community Medicine at Columbia University, also spoke about health care reform in the United States and the Patient-Centered Medical Home.

 

Dr. Kushner Appointed to Editorial Board

 

While in Beijing, Dr. Kushner also met with the editors of the English version of the Chinese Journal of General Practice. He and Department of Family Medicine Professor John Frey, MD, were recently named to the journal's editorial board, and Dr. Kushner also now writes a column for the Chinese edition of the journal.

Benefits in Both Directions

 

Although this was the first visit to China for Dr. Gilchrist and Dr. Kamnetz, other DFM faculty, residents, and fellows have make the trip in the past. The exchange program also includes a 2- to 4-week medical student rotation, plus visits to Wisconsin by Chinese physicians.

 

According to Dr. Kushner, who spearheads the effort, "this exchange benefits us as well as our Chinese colleagues. It offers both groups opportunities for continued education, greater cultural understanding, and joint research on healthcare problems."

 

Bringing Knowledge Home

 

Dr. Gilchrist takes that sentiment one step further. "As we look at our institution's transformation into a school of medicine and public health, we as a department need to develop a section of community health," she said.

 

"That includes looking at other systems that are more focused on population and community health," she added, "and taking back lessons for our environment."

 

Giving Expertise Back

 

And in the spirit of reciprocity, one way to give back is through shared research aimed at reducing the incidence of cigarette smoking in China (according to the World Health Organization, 35 percent of adults in China smoke).

 

For example, the group is looking into collaborating with the UW Department of Population Health Sciences (who recently performed some studies investigating smoking among family physicians in China).

 

At the same time, health officials there are working on a public health initiative to change the public's perception of smoking. "Unfortunately, they don't have the protocols to teach physicians how to effectively help patients stop smoking," Dr. Gilchrist said.

 

"We, however, have outstanding resources at our Center for Tobacco Research and Intervention," she continued. "Perhaps we could develop shared research projects that further support that initiative."

 

So although this collaboration is a work in progress, one thing is certain: each group has its strengths, each has its weaknesses, but both have much to learn from one another. 

Date Published: 10/13/2009