Fudan Medical School, Shanghai (China)
Impressions of Fudan
- Elaine Phua - medical student from Sydney Medical School, undertook an Extramural with Fudan University in 201213
- Hugh Caterson - medical student from Sydney Medical School, undertook an Extramural with Fudan University in 201213
- Howard Yu – medical student from Sydney Medical School, undertook an ILA at Huashan Hospital, Fudan University in 201112
- Pok Fai Wong - medical student from Sydney Medical School, undertook an ILA at Huashan Hospital, Fudan University in 201112
Elaine Phua - medical student from Sydney Medical School, undertook an Extramural with Fudan University in 2012--13
"In 2013 I spent 4 weeks in Shanghai working in the Zhong Shan Hospital (中山医院) which is a public hospital attached to the Fu Dan Medical School. My time there entailed working in the gastroenterology department for two weeks and two weeks in the cardiology department. The doctors were very friendly and gave me the opportunity to experience patient care in other related departments like cardiothoracic surgery, the abdominal and cardiac ultrasound unit, the gastroscopy suites and the outpatient clinical setting.
The patients come from diverse backgrounds with some from the city of Shanghai who are civil servants or own small businesses. There are also a portion of them from the countryside. The patients are humble and appreciate ongoing medical care even in accommodation that is half the size of that in a Sydney hospital but packed in with seven other beds of patients and their relatives. Patients are very accepting to be examined by groups of up to 10 students.
The level of knowledge and expertise of the doctors who supervised me was vast and current. Many of the professors had overseas experience and fluent in 4-5 foreign languages. The medicine practised was up-to-date with current research and technological advances in many fields. The same can be said for the medical students there who work very hard and have a strange knack of memorizing detailed facts, drug names and doses.
In terms of the role of Traditional Chinese Medicine (TCM) in their patient care, medical students have mandatory training in this area and attend weekly TCM pharmacology lectures as well as practicals in acupuncture. On the wards, doctors sometimes prescribe TCM products as PRN medications for symptoms like flatus, constipation, diarrhoea and so on.
The facilities of the hospital are greatly stretched given the high number of people seeking medical care. The emergency department is constantly full of patients and relatives of patients to the point where there is hardly any available floor space to walk on and patients' beds are placed so close to each other that they're almost touching.
Despite having 17 floors of outpatient clinics, the waitlist to see a specialist doctor is very long and patients treasure their appointments like gold. Part of the reason to this long waitlist is the fact that there is no established form of primary healthcare in China and patients do not have the option of seeing a General Practitioner to obtain advice and a referral. Instead they either present to the Emergency Department or they book an appointment to see the specialist in the body system they think is most relevant to their symptoms."
Healthcare in China also places a great financial strain on the patients and their families. At each step of the way throughout their stay in hospital, patients have to make payments before proceeding to the next step. For example, if the inpatient gets their blood taken and sent off for tests, they would have to foot the bill before the results will be made available to their doctor or them. Despite this being a public hospital, the cost of a hospital stay still places a significant strain on an average middle income family. This makes me appreciate the help from government policies that enable our patients to get the best healthcare they need regardless of their financial status.
Being in Shanghai was a great experience. Outside the hospital, which is situated in the French Concession, there is a lot to see and do. Shanghai is a cultural hub and you get a variety of food—from the cheapest and simplest of barbecue skewers and takeaway noodles from the roadside stalls to the expensive fine dining restaurants where the menus are littered with Chinese delicacies and exotic meats. As Shanghai is a popular city for expatriates to settle in, you will also find pubs, bars, cafes and restaurants owned and run by foreigners to cater to the expat community living there. The train system and low cost of the taxi fares makes getting around very simple and convenient. There is also the possibility of travelling to neighbouring towns made possible by the bullet train that links the rural Chinese towns to Shanghai. In short, this is a great city to spend a month in especially while doing a medical term where you get to meet a variety of local people."
Hugh Caterson - medical student from Sydney Medical School, undertook an Extramural with Fudan University in 201213
"Shanghai is an amazing city and I had a fantastic time there. I was awed by the size of the place, one doctor told me that there are over six thousand skyscrapers in the downtown area and Wikipedia tells me that Shanghai is the most populous city in the world, being home to twenty three million people. Despite this, it is still easy to walk down quiet streets lined with sycamore trees and visit beautiful parks and gardens. The city is fit to bursting with roof top bars, restaurants of all varieties, French cafes, expats and street markets.
Food is a highlight and is very cheap. Street stall food is abundant, delicious and cost next to nothing. Conversely it is possible to have a full Chinese banquet for about the price of a Sydney take away meal.
The accommodation for international students is in the international dorm at the Fudan Medical Campus sited next to Zhongshan hospital. The rooms are well equipped and cost roughly ten dollars a day. Ideally the campus is situated on the edge of the very trendy French Concession district, undoubtedly the most desirable place to live in Shanghai.
Fudan University is linked to many hospitals around Shanghai but the two major sites at which they take international students are Zhongshan Hospital and Huashan Hospital. Both are huge by Australian standards and it is fascinating to see how the Chinese health system, so different to our own, manages to deal with such vast numbers of patients.
All the patients speak Mandarin or Shanghai’s Wu dialect. I do not speak either of these languages but luckily most of the doctors can speak English to at least some degree. The hospital will place you with a supervisor who is confident in English but this in no way means you will be able to converse well with patients. For this reason I suggest that it may be best for those who only speak English to apply to surgical or obstetrics departments where interesting procedures can be viewed regularly. That being said, I spent my whole placement in an internal medicine unit and enjoyed my time there and gained some knowledge.
I strongly recommend Shanghai as a place to visit and I think that the set up through Fudan University is perfect (even if they can be somewhat difficult to contact via email). Go to Shanghai, eat fried dumplings at Yang’s dumplings and drink a French beer at Café Des Stagiaires."
Howard Yu – medical student from Sydney Medical School, undertook an ILA at Huashan Hospital, Fudan University in 201112
"I was attached to the Department of Integrated Traditional Chinese Medicine at Huashan Hospital. During the placement, I spent time in the Traditional Chinese Medicine Respiratory Clinic and also conducted biomedical research on the cytotoxic effect of a natural compound on melanoma cells.
The respiratory clinic was a great place to observe the patient-doctor relationship in modern day China. One thing I noticed was that patients are given much more discretion in the choice of their own treatment. Doctors appeared reluctant to be seen as forcing particular treatments upon their patients. This was especially pertinent in the Integrated Traditional Chinese Medicine department as doctors would often ask their patients explicitly whether they preferred traditional herbal prescriptions or more expensive western medicine prescriptions. Although strange to me, this system seemed to work with the end result being satisfied patients receiving treatment.
The lab environment however, was not as foreign as the clinic. During my time there, I met a number of very interesting and passionate doctors and researchers who have imparted to me a great appreciation of the importance of medical research in the clinical practice of medicine.
From the familiar setting of the research lab to the not-so-familiar clinic experiences, this placement has broadened my understanding of what it means to be a doctor in a global context."
Pok Fai Wong - medical student from Sydney Medical School, undertook an ILA at Huashan Hospital, Fudan University in 201112
"China currently represents one of the world’s most rapidly developing countries in the areas of science and medicine. Having never visited mainland China, whilst being of Chinese descent, it was an obvious exchange destination for me to learn about its culture and to engage with unique medical topics such as ‘integrative medicine’. Indeed, Traditional Chinese Medicine (TCM) is practiced together with Western allopathic medicine in most Chinese clinics and a substantial proportion of current research into TCM phytochemicals is produced by China.
Based at Huashan Hospital of Fudan University, the focus of my four week placement was on conducting biomedical research in the Department of Integrative Medicine. I worked closely with an assistant professor and fellow Sydney Medical School student, Howard Yu, to investigate icariside II, a natural compound derived from the Chinese herb Herba epimedii. Specifically, we studied the molecular pharmacology behind the synergistic anti-cancer activity of icariside II and paclitaxel in melanoma cells. Paclitaxel is more commonly known as Taxol, which is one of the most widely used chemotherapy drugs. The essence of our study: the ability of a TCM phytochemical to augment the pharmacological activity of and reverse drug resistance to an existing medication is, in fact, a core theme of integrative medicine in China.
Interestingly, China’s contribution in biomedical research has significantly increased over the last two decades and is continuing at a growing rate. This has been attributed to China’s increased expenditure on research and development. However, it’s believed that funding is being spread too thinly and I was disappointed to learn that many Chinese physician-scientists often had to personally fund their own research projects.
Through the course of my placement, I was also given the opportunity to observe TCM procedures such as electroacupuncture for the treatment of Bell’s palsy, and fire cupping and tui na, a form of manipulative therapy, for the alleviation of chronic pain. It was interesting to witness healthcare delivery in a place where TCM is perceived by the general public and many doctors as being a treatment strategy that is complementary to and potentially better than allopathic medicine; the reason for this being the incredibly long history of the TCM system. Indeed, patients at Huashan Hospital may frequently be moved between conventional medical departments and TCM departments, and there is much crosstalk between the various departments. However, a substantial amount of coordination of care still relies on patient input. For instance, in consultations patients may be given the choice of conventional medications or Chinese herbal medicine.
Besides the research and clinical exposure, I was also invited by my supervisor to attend a small scientific conference in Hangzhou, a city southwest of Shanghai. There, I experienced the beauty of the West Lake, one of China’s most notable scenic attractions, and visited the Fuchun Mountains.
As a newly industrialised country, China offers a unique environment in which the complex interplay between science, society and medicine can be explored. Living and studying in Shanghai has undoubtedly been a positive personal and academic experience. It has been a definite highlight of my time at medical school so far, and I strongly recommend all current and future Sydney Medical School students to consider undertaking exchange studies in China."