Of Poking, Sucking and Bumming Around in a Shanghai Hospital

As you may have read from my previous posts, I did my elective work in Shanghai for four weeks last December and January. Overall, my elective term in Rui Jin Hospital has been a bit of a mixed bag. While there have been intriguing, interesting and eye-opening moments, there have also been hours of boredom and frustration.

Acupuncture:


I did the first two weeks of elective in the acupuncture unit. The opportunity to see the coexistence and cooperation of both Western and Traditional Chinese Medicine has been one of the greatest reasons for my choosing to go to Shanghai. Eye-opening it has indeed been. Much as we were shocked to see the depth the needles go into (up to 2-3 inches in some areas), we were also quite impressed by the acupuncturists' firm knowledge and understanding of Western medicine. In fact they devote a good proportion of their training years in Western medicine alone. A patient presenting with fatigue would first be examined for thyroid function and blood sugar among others, by the acupuncturists themselves! They can also order X-rays, CTs and interpret them. So it's been both comforting and surprising to learn that Chinese medicine practitioners are not as ignorant as some might believe them to be - in fact the irony is on us to not know more about them.


Despite the novelty, we found that we couldn't do much in the unit and soon enough it became a drag to spend time day in day out. As the needle insertion involves a level of dexterity and special techniques, we were not allowed to perform it on the patients. So all the time we only got to stand and observe the procedure, and occasionally we were called upon to remove the needle after the treatment. The only other thing we got to do is applying and removing suction cups, which is a procedure where a heated glass jar is applied onto acupuncture points and left in place for a few minutes via vacuum suction.


Overall it's an interesting experience, despite the lack of practical opportunity, I would recommend medical students with an interest in Chinese Medicine to spend some time in the acupuncture unit. However, we found that two weeks were a tad too long for the purpose, so a one-week stint would have probably been a better option.

Cardiology:


I chose cardiology due to my interest in the specialty. I was assigned to an attending who was stationed at the CCU, which I later found to be simply a fancy term for post- and pre-operative observation area for pacemaker insertion. There were also some occasional paroxysmal Atrial Fibrillation patients who were there for either pharmacological or electrical cardioversion. But basically that's all the patients I got to see in the 10-bed unit.


Unfortunately the experience over the two weeks have been rather uninspiring, to put it mildly. The unit (and I suspect the hospital as a whole) is not familiar with the concept of elective terms, and I was treated as a transparent passive spectator of the department most of the time. In my two-week stay in the department, I only got involved with the daily 20-minute ward round with zero to little teaching, as well as observing a few angiography, an EP study from afar and a couple of permanent pacemaker insertion. Most of the other time, I was left to my own device sitting in a room with some junior doctors and research students. My attending was hardly within sight at any time.

In general medical students don't get to do much ward duties or get involved in any active patient management, so all this made the experience very bland. By day three I was already looking forward to the end of it.

General:


If you are looking for an action-packed or highly educational elective then this hospital is the last place you want to be. However, it did offer me a very personal insight into China's healthcare system which is sophisticated and chaotic at the same time. If exposure is what you value in your elective then it's not too bad a place. Shanghai is a shopping haven and food paradise, and the surrounding cities such as Hangzhou and Suzhou are all very captivating.

If you want some better teaching and more enthusiastic staff who speak better English, I heard that Huashan Hospital (also in Shanghai) is better in these regards. Choosing surgery units is also recommended as you do get to see a lot of cases including the rare ones - remember, even if a rare condition has a prevalence of one in a million, China has 13,000 of them.

Crazy Transportation in Shanghai

In a city as populated as Shanghai, a good transportation system is essential in keeping the city functional. In fact, they need to be damn good at it to get the 12 million people moving about without being stuck on the street for three hours at a time.


Shanghai has one of the best public transportation systems in the world. Its subway network currently operates eleven metro lines and it has a daily ridership of more than 4 million. Its bus network is even more staggering - there are more than 1000 bus routes in operation in the city, and they connect various points of the city very efficiently. In general, for a long distance travel, people first take metro to get to the vicinity and change to a bus to reach the destination. The bus fare is 2 yuan per trip while the metro fare is between 3 9 yuan, so it's very affordable.


Our very first encounter of Shanghai's public transport began with the awe-inspiring Maglev train (Magnetic Levitation train). Operating at a top speed of 431km/h, the 30km journey from the airport to the city area is done in a mere 7 minutes and 20 seconds. The journey was extremely smooth, and the idea that you were travelling at one third the speed of sound right on the ground is simply exhilarating. This project is making a loss, unfortunately, with its current ridership and the ticket price of 50 yuan per journey, it's simply not able to recoup its 1 billion US dollar construction fee. In fact this line is more of a technological showpiece than an economical instrument, and the Chinese name of the train reflects that - it's called 上海磁浮示范运营线, literally "Shanghai Magnetic Levitation Demonstration Operation Line".


Unfortunately the Maglev doesn't send you right to the doorstep. We needed to catch a cab from the Maglev terminal to the place we were staying in. Contrary to all the evil story you might have heard about China and its cunning people, the taxi drivers in Shanghai are surprisingly honest and professional. For this we must thank the very strict regulation by the government. As you can see in the picture above, the driver's number is displayed clearly (in fact more clearly than Melbourne's counterpart) and you can lodge a complaint about the driver by calling a number right next to it (not in this picture). Every passenger also has the right to request a receipt which contains the number and the detail of the journey.

The unique thing about taxis in China is that they all have what they call an "anti-violence screen" that separates the driver completely from the passengers. The transparent material is also supposedly bullet proof. I came across this shield device in all the cities I have been in China, so I suspect it's a norm all over the country.

The taxi price is very affordable, the starting price is 12 yuan for 3km, and each subsequent km only costs 2.40 yuan. It's also rather comfortable; but fresh foreigners in the country would be shocked by just how reckless the drivers can be. Red lights often mean nothing to the driver who's taking a right turn, and sudden sharp manoeuvres are preferred over rule-abiding driving. In Shanghai, a pedestrian who's crossing an intersection showing green light would be mercilessly honked by a taxi who's taking a turn when it's red light for him. Taxi drivers are in turn honked by truck drivers, who are in turn honked by bus drivers. This is the traffic rule of Shanghai.


Speaking of bus, we have had our good share of experience about it in Shanghai. As we live a fair distance from the hospital, every morning we have to catch a bus to work. The journey takes about 30 minutes on normal days, but it can take even longer on a busy day.

You would have thought that buses were heavy and there were more inertia to it and it is therefore harder to manoeuvre and therefore the drivers need to be more careful and courteous. Wrong. None of the above (except the heavy part). In Shanghai you don't get to sit on the bus most of the time. You stand from the beginning to the end. When you are standing, not holding onto the rail with BOTH hands is fatal. As you might have guessed from my previous ranting about the "road ranking", the buses are the king of Shanghai's bitumen road because there are simply so many of them. So they do all sorts of dangerous thing with impunity because people have to respect them. In fact, I am surprised that with all the speed and tricky manoevres I witness, I have yet to witness a single accident involving buses. It's not that I want one to happen, but it's just surprising.


When it comes to danger, nothing beats the danger faced by cyclists in China. Numbered in the millions in each city, cyclists are the second lowest in the road ranking, just slightly higher than the pedestrians and the tourists. In their daily commutation, they have to weave in and out of cars and buses on the road. Most of these bikes are not your developed country road racing bikes; many of them are worn-out olden-day bikes which have probably been passed on for decades. There are so many cyclists that there's an industry in China where technicians basically just sit at every road intersection waiting to repair a passerby's bike.


There you have it, the multiple modes of transportation in Shanghai. I have not covered a few things like the ferry service which connects the two sides of the Huangpu River. There are also the long-distance train service which deserves another discussion altogether. So in short Shanghai has a transportation system that works, as long as you can live with its eternal congestion and the lack of courtesy on the road. Perhaps it's the lack of courtesy that makes it work, if people are all as polite as Melburnians we would probably have dead gridlocks throughout Shanghai.

[Photo] Snowing

1/200s - f/5.6 - 50mm - ISO 200
Zhujiajiao （朱家角）， Shanghai, China

I was in Shanghai for five weeks in December and January for my hospital elective works.

Elective work is basically a four-week duration in which all medical students arrange to practise in a hospital of our own liking anywhere in the world. Xuan Ni and I chose to go to Shanghai because we wanted to see some Traditional Chinese Medicine in action alongside modern medicine. Besides, Xuan Ni's cousin who lives in Shanghai has generously agreed to accommodate us for the entire duration. Since both of us have never been to China, Shanghai appealed to us as it is often touted as the most vibrant and metropolitan city in China (we will get to that part in other posts). So off we went.

This picture was taken in one of our outings in Zhujiajiao. Located at the Yangtze river delta, Zhujiajiao is one of the many canal towns near Shanghai that has been transformed into a tourist attraction. There are people who still live in the canal town community, so it's a living town and it's more authentic than some artificial versions found in other attractions. It was a wonderful experience for me as I preferred the rustic feeling of the small town to the hustle and bustle of the megacity in Shanghai proper.

This picture depicts the main canal of Zhujiajiao in a heavy snowfall. We were extremely lucky to come across snow on that day; in most years there is no snowfall around Shanghai. I shot this from a famous bridge called Fang Sheng Bridge. With a combination of a rowboat, a canal, some traditional architecture and some tinge of yellow, I hope to portray an image of China of yore, which is what Zhujiajiao is all about.

A Nightmare

I had a nightmare the other day.

I was sitting in the back row of a maths class in my high school. It was a classroom of about 40 students. As usual, at the front was a maths teacher who was rambling on some basic principles nonchalantly. He was also making some random irrelevant political remarks.

The air was as stale as last week's white bread. It was so boring that I was staring blank into the space. Some people were taking notes of what the teacher said. Some copied it verbatim. I couldn't be bothered.

As if realising the staleness of the air itself, the teacher suddenly decided to stir up the air by running a spot-check on our notebooks. With raised eyebrows he inspected our notes, barely giving any appreciation for those who jotted down his excellent political remarks word-by-word. You just can't expect him to do that.

Then he came to me. And my book was blank.

"HOW DARE YOU not paying any attention in my class. You are so disrespectful. You will be deducted five points from the final maths exam for your conduct!"

I was absolutely horrified.

Flushed with indignation, I retorted,

"You were just teaching basic things, why should I copy down what you said? If you said one plus one equals two, should I copy that down too?! Give me back my five points!"

He ignored me. I sat down trying to contain my pent-up anger.

Ten minutes later the class went on as usual. I continued to not take any note and the girl in front continued to write down everything.

And then he decided to do another spot-check.

He came to me.

And I woke up.

Image Credit: Teachers happy to get more work, responsibilities for Teachers’ Day « Nose4news

p/s: This is a real dream. And for some reasons that teacher is En. Ilias for those who know him :P

[Video] If the Earth Has Rings Like Saturn's

Do want!

[Photo] Peeking Through

What's beyond the blind?
1/80s - f/3.5 - ISO 400 - 50mm

Big Boob Blooper - A Story on FAIL Journalism

This is about a news article in The Star (published on November 12, 2009) that turned out to be a fake news fabricated by a supermarket tabloid 6 years ago.

To save myself the trouble of telling the whole story again, let me attach the complaint letter I wrote to The Star here:

Dear The Star Editor,

I am writing with regards to the news on  "a study in the US showing that women with bigger breasts were found to be smarter". For your information, this is a fake news which was reported in World Weekly News back in Nov 4, 2003. Yes, from six years ago. The original news is available here. You can verify that this "news" is identical to the one reported in The Star.

Evidence that this news is fake:

1. World Weekly News is a supermarket tabloid renowned for its outlandish cover stories often based on supernatural and paranormal themes and an approach to news that verged on the satirical.
   
   
2. Note the informal language this article is written with.
   
   
3. Read the previous and subsequent pages. Note the trivial and exaggerated writing.
   
   
4. A search in Google Scholar (Google's academic journal search engine) for published articles by Rossdale in chicago returned no matching result. Google Scholar is a comprehensive academic search engine so the lack of matching result implies the non-existence of the study.
   
   
5. A search for "yvonne rossdale" in Google shows only copies of the original article from World Weekly News. If you browse through some of the results, there are many websites in which people have pointed out that Dr. Yvonne Rossdale does not exist.
   
   
6. A search in Google News for "chicago breasts" shows that only The Star and Hindustan Times (which in turn copied The Star I believe) are reporting on this news. No other major news outlet is picking up on this "study".

I am absolutely appalled by The Star's negligence in verifying the authenticity of the news before the publication. This fake news has now been disseminated widely over the Internet, and your company's negligence is responsible for the misinformation. It is mentioned that this news is compiled from Sin Chew Daily which in turn is quoting from a Singaporean paper, but I have not been able to find the articles in Sin Chew or any Singaporean paper. I would like you to point me to the original article in these papers, so that I can forward this email to them as well.

More importantly, I would like The Star to publish a correction in a conspicuous corner as soon as possible. I fervently hope that in the future your employees remember to verify all news with primary sources (isn't that in Journalism 101 by the way?) before publication lest your reputation deteriorates.

Thanks.

Regards,
Chang Yang Yew

Let us see how The Star responds to the hoax story they have published.