Heritage Snapshot Part 231: Learning in China Goes Both Ways

LOMA LINDA>> As experienced by other Loma Linda professionals, learning at Sir Run Run Shaw Hospital in Hangzhou, China went more than one way. “Some of the things I learned from my Chinese colleagues included unique approaches to patient care,” said Dr. Kathleen Clem, former director of the international emergency medicine fellowship at Loma Linda University Medical Center. “If a patient came in with an asthma flare, they’re having trouble breathing. They would use all the same medications that we use in the U.S.” But Clem said she noticed that they would be holding the patient’s arm in a different way and their hand in a different way. When she asked her colleagues, “What are you doing?” They answered, “This is Chinese medicine.” Clem learned that Chinese medicine is highly appreciated by the Chinese people because it is viewed as safe and without side effects. Recently, China has combined modern technology and traditional medicine, which is not folk medicine, but a discipline with observations and experimental trials. “They were using acupressure as they were trained in medical school to supplement the medications that I was giving,” Clem said. “I absolutely don’t have any training in that; I don’t even know if it works. But the patients got better, so I certainly wasn’t critical. I just decided they may know something I don’t know. This is a culture that has been around a lot longer than 200 years. There’s no way I was going to try to refute something that might be complementary to what I was teaching." Also, because there was no organized approach to trauma care, resuscitation responsibilities were ambiguous, adding confusion to resuscitation efforts. Clem said she helped develop a team approach to the resuscitation and evaluation of trauma patients. She helped emergency personnel define where different team members stood and what their different resuscitation roles would be in an organized fashion. When she left China, she said she was pleased with how well the care of trauma patients was orchestrated. One person was in charge and everybody else seemed to have defined roles. In a report to the July 1998 Annals of Emergency Medicine, Clem and her colleagues reported: “On return visits to (Sir Run Run Shaw Hospital) evidence of refined resuscitation practices demonstrated by improved patient assessment and stabilization techniques could be seen. In addition, there was an enhancement of trauma skills, particularly in airway management. Airway management skills now include rapid-sequence intubation and spinal immobilization." “After returning home, the LLU team learned that the SRRSH team successfully managed a multi casualty incident," she said. "A bus accident sent 13 patients to the ED simultaneously who were triaged and treated, including five critical patients, with no fatalities. The LLU team made every effort to respect Chinese culture and to implement those concepts that would have long-term benefit. Consultant working strategy was to suggest ideas, wait and observe in order to assist only with ideas that the Chinese embraced as positive." The report continued to say, to facilitate the education of the emergency medicine residents, the LLU staff developed a core curriculum for a five-year residency program in emergency medicine. The five-year program length was chosen because emergency medicine is a new specialty in China and the education committee believed that a shorter training period would not be sufficient until patient volumes increased. In 2015, a graduate of the Sir Run Run Shaw Hospital emergency medicine program, one of 300 Chinese to come to Loma Linda University Medical Center, shadowed Clem. She brought a beautiful silk scarf to say thank-you for starting the program. It says, “A flower, a world to see rainbow through clover.” “It’s so uniquely Chinese as a translation. But it just means a lot to me,” Clem said. “What I was most impressed with, even though she was shadowing me and could not participate in patient care, her understanding of what was going on was spot-on. To know that Loma Linda had been able to start a program to develop the curriculum, and now it’s being continued by purely Chinese educators and doing fine, is gratifying. I am very pleased to know that it’s taken on and has a life of its own. It’s successful.”