Family medicine education has opened the doors for us to come to China, and I have now been to three different nursing homes with our medical team. As I have done nursing home work for over ten years in the US, I have some familiarity with this area of medicine and how it can provide ample opportunities for teaching geriatric principles of medicine to the family medicine residents. These forays into the medical arena are like a breath of fresh air for me as I temporarily take a break from our formal Mandarin language study and venture into areas that are more familiar to me! In my more reflective moments I think these medical opportunities to serve and teach have kept me “sane”! 🙂
The group that goes to the nursing home consists of a driver, 3 to 4 family medicine residents, a physician assistant, 1 or 2 attending physicians, a nurse, and support staff. Normally there are 11 to 12 people piled into a mid-sized van that also contains medicines, medical equipment, patient charts, and textbooks.
On the 30-60 minute drive there is joyful conversation that often breaks off into exuberant laughter. Most of the conversations are in Mandarin so even in this setting I can improve my listening skills. The residents speak varying levels of English, but all of them understand that the medical training they receive will be in English which is an advantage for them. Often we will sing songs on our way to the nursing home and we may have times where we “lift up” the work we are about to engage in with the nursing home residents.
Once we arrive at the nursing home we are warmly welcomed and ushered into an area where we will see the ambulatory patients. I am used to seeing patients in a private setting, but that does not happen here. We often “set up shop” in the foyer of the nursing home or in a public meeting room in the building. I am told that medical records are not emphasized in China in general, yet in our program we stress the importance of this to the residents as this is a way to follow patients over a long period of time, track patient outcomes, provide information for other medical providers, document exam and test results, and keep a record of medicines among other things.
Many of the same issues that I had to deal with in the US are present in the nursing homes here – diabetes mellitus, hypertension, chronic lung diseases, pressure ulcers, death and dying. There are many people here who have heavy crosses to bear but yet they find a way to smile. The first nursing home I visited was one comprised of buddhist people who came to be seen if they could walk. If not then we visited them in their rooms. One notable visit was to see a patient in the “waiting to die” room. A Chinese physician colleague and I were ushered into this room which was quiet except for the soft music playing on a stereo. The walls were bare other than some pictures of buddha and there was two family members present. They wanted to see if there was anymore we could offer medically for this patient who was unresponsive and breathing in a shallow way. My Chinese colleague held the hand of the dying patient and spoke directly into this person’s ear with calm, gentle words. All the dialogue was in Mandarin so I am not sure all that transpired but in the end the family weighed their options and chose to just make their loved one comfortable. How many times did a similar scenario occur in my previous practice? This was not uncommon for me, and although in a different cultural context, there is still a need for hope, compassion and love!
The second nursing home had a large fish tank in the public exam area where we established our “headquarters”. I saw at least 3 patients with skin ulcers of various sorts there. As in each location we go for charitable work the family medicine residents see the patient first and then come to me or another attending physician to tell us about the patient, offer a diagnosis and explain what they think should be done for the patient. I am told by one of the family medicine residents that this particular nursing home seems to have more problems with patients having skin sores. This is a challenging issue anywhere (US included), but we recommend antibiotics and dressings for the skin ulcers. I am thankful that we have medicines available in our possession to give at no cost for the patients.
The third nursing home I have visited so far has 4 floors and approximately 180 residents. After setting up in the foyer of the entrance way I am called up to the top floor to see an acutely ill man who has a fever of 103 and shortness of breath. He lives in the mentally handicapped area which has a metal sliding gate that I walk through and see the light bulbs hanging from the ceiling. After entering another room in which there are approximately 15 to 20 beds I find this dear man laying on his side in bed. The family medicine residents with me check this man over and then I confirm their diagnosis of pneumonia by listening to his lungs with my stethoscope. Already the nursing staff is giving him an intramuscular antibiotic which seems appropriate, so we just add some medications that will help him feel more comfortable as he recovers. There are many eyes on us as we engage with this patient and I am conscious of how important it is for me to be able to communicate in the Mandarin language effectively. Of course, this provides more motivation for me to get back to my studying and to apply what I am learning.
Another thing that stands out to me is the large number of people who smoke cigarettes and do so in all kinds of places. There is cigarette smoke in restaurants, stairwells, grocery stores, apartments and yes. in every nursing home that I have gone to visit.
As we all pile back into the van after spending 2 to 3 hours at each nursing home there are grateful faces and smiles from the appreciative nursing home residents and nursing home staff. I still have a lot to learn about how good continuity of care can be applied, how more consistency in taking prescribed medicines can emphasized and how we can help the souls of the people we serve. One very encouraging development in the nursing home work is that a non-medical team typically goes into the same nursing homes on a different day and deals with some of the “heart” issues that are rising to the surface. As the medical team we go in and till the soil so to speak, and then the nonmedical team comes in and plants the seed or harvests the fruit of much labor done previously! There is much to be excited about and thankful for!