My earlier bout with tenosynovitis had cooled off several months, but had announced its return soon after my arrival in Wuhan. After a month of tolerating it, I decided it was time to seek medical help. Secretly I hoped Chinese physicians might have some alternative approaches of coping with the malady — which I believe, without much supporting evidence, to be an autoimmune glitch.
In fact, Chinese medical practice is of two minds: traditional and Western, without a lot of overlap. Zhejiang Medical School (where I taught for a year in 2007) is decidedly Western in its M.O., with traditional studies relegated to a separate Institute. In effect, treatment options are already settled by the time you walk in the door of a particular clinic.
Nor did I choose which door. That was built into the mission of the Girl-Friday in the International Office commissioned to assist me. But that’s alright, because the point of this note is not to compare traditional vs. Western outcome in the treatment of tenosynovitis, but to narrate my trip to the clinic.
I’ll begin with the forty-minute bus ride on a typically crowed, bumpy, swerving Chinese bus, which afforded standing room only. My reasons for including this detail will become obvious later.
A short walk beyond the bus stop brings us to the outpatient clinic of a major, right-bank (of Yangtze) hospital. Outpatient clinics are the standard mode of primary medical care; private or small-group practices are not permitted, and nobody has thought, apparently, to market HMOs to the Chinese.
Being a newcomer to this clinic, the first queue was to get a “clinic book” — my new, portable medical record. Five yuan was the fee. Next queue was to sign up with a particular clinic, based on your complaint. A quick chat between my interpreter and a nurse (hanging around for the purpose?) suggested “internal medicine” was appropriate.
We find our way to the internal medicine clinic, where a nurse points out the consultation room. The door was open, and a consultation in progress, but it soon became clear that to maintain ones place in the queue, I had to jostle my way into the room and deliver my appointment-slip to an assistant, who, awkwardly, was sitting at a table on the far side of the physician and his on-going consultation, and that in a none too spacious room. Thus, my appointment slip was put to the bottom of the assistant’s pile, with perhaps three or four above it.
An exact number is hard to ascertain, since body counts are deceptive. At any one time, there were several people in the room — beyond the physician and his assistant — some, probably most, of whom were on-lookers. I would surmise that a typical patient was accompanied by several family members, quite willing to add their commentary to the information flow of the consultation. But I also deduce that there was more than one such patient-plus-entourage groups in the room at a time, for the simple reason that, as one group left, another patient took his seat in the examination chair from among those already in the room.
In fact, I waited in a chair just outside the open door, and was eventually invited in — along with my entourage, Girl Friday. Her interpretive services really weren’t needed, for the physician spoke excellent English. This didn’t surprise me, since, from my experience at Zhejiang University Medical School teaching medical students, I knew of the generally high level of English among these students. Indeed, I got the feeling that he was proud-as-pink of rendering his judgements in English.
That judgement was a high-fidelity echo of the American physician’s pronouncement: you must immobilize that wrist; it will never heal if you continue to use it. Though, unlike my American physician, he did not prescribe or suggest a splint to help me with that unrealistic discipline. He did, however, scribble out two prescriptions, one for an anti-inflamatory drug, the other for an over-the-counter cortisone creme. The scribblings were mostly not Chinese, but in that quasi-Latin used to describe drugs and dosage. I daresay any American pharmacist could have dealt with it. The entry into my clinic-book is in Chinese.
Now dismissed from consultation, and clutching a few addition sheets of paper, we made our way back downstairs to the cashier queues. Total charge: 55 Yuan, about $8.00, along with a receipt that enabled me to collect the prescribed remedies from the adjacent pharmacy.
The first challenge to the immobilization discipline presented itself on the bus ride home. Packed as usual, with the inertia of erect bodies lurching in unison with the linear and centrifugal accelerations of the bus, my common-sense prescription overrode the professional one: hold tight with both hands. We arrived back on campus just at lunch time, and soon faced challenge #2: chopsticking with my left hand. Admittedly, chopstick action does irritate that thumb tendon. But faced with the choice of sinister starvation vs. dexterous pain, I succumbed again to practicalities — though for the subsequent month I walked around campus with a soupspoon stuck in my shirt pocket, which utensil handles Chinese cuisine reasonably well, even with the left hand.
So much for process. What about outcomes? Well, eventually my American physician sent me to an orthopedist, whose course of two injections of cortisone gave relief for a few months. The Chinese physician’s anti-inflamatory-plus-external-cortisone gave partial relief as long as supplies lasted. But, now depleted, the problem is back. Perhaps it’s time to time to seek out a back-alley acupunturist. In any case, I just jotted down the Chinese for Ibuprofin in preparation for my next encounter with an apothecary.
As for my indignation regarding medical confidentially, I just swallowed it as I mouse-clicked to publish my medical record on the world-wide-web.
