By Jessica J. Savage
Chinese physicians and healers face the same patient health problems that confront health care practitioners in this country-hypertension, diabetes, obesity, heart disease, cancer. That was the discovery of one local physician on her journey to Asia earlier this year.
"I really went to see and experience China," says Dr. Denise Leonardi, a family practice physician in Las Cruces.
What the doctor found was a Western influence in the hospitals in Kunming, China, as well as in a side trip Thailand. But she also found traditional Chinese medicine practitioners, in some cases working side by side with physicians and psychiatrists.
Leonardi accompanied Jeanne Gleason of the agricultural communications department in the College of Agriculture and Home Economics at New Mexico State University to mainland China for three weeks in late January and early February this year. The visit gave the family practice doctor a chance to explore health care practices primarily in Kunming, the largest city in the Yunnan border province in southern China, where Gleason was spending a year-long sabbatical.
Now that she's back in Las Cruces and has had several months to absorb all she observed, Leonardi is thinking about her own practice in fresh ways. "I'm open to complimentary medicine because we don't know everything," she says, adding, "I've never made fun of people who take herbs."
Herbal remedies can sometimes work, sometimes not work and sometimes work because of a placebo effect, Leonardi says. "Complimentary medicine doesn't have double-blind studies, even though people get better using them," she cautions.
The physician keeps handy a compendium of natural remedies, which is basically a thick physician's desk reference of natural medicines that is updated annually. "I use it all the time in my practice," she says. "I have to because people use so much of this stuff."
Arriving first in Beijing, Leonardi shopped at a gigantic grocery store filled with fresh vegetables, herbal remedies and teas-"kind of like Super Wal-Marts with a lot more fresh stuff," she says. She saw a tree decorated with roosters to celebrate the Year of the Rooster. She got a sidewalk massage from a blind masseuse.
After a whirlwind tour that included the Forbidden City, the Great Wall of China, the Temple of Heaven and the city of Xian, the Las Cruces women flew to their base camp in Kunming. There arrangements were made for Leonardi to visit medical facilities.
On her tour, she was told of a 10-year study of 10,000 hypertension patients, with control groups in both Western medicine and traditional Chinese medicine. Those taking Western medicine had more control over their blood pressure. The patients in the traditional Chinese medicine group, however, had less co-morbidity-secondary health problems such as headaches or strokes that often show up in hypertension patients.
"They have a holistic approach to illness," Leonardi says. "They treat the organism within the environment."
Traditional practitioners use acupuncture, therapeutic massage and herbs, and their patients have basically the same big complaints as Westerners. "Traditional Chinese medicine can help, but like Western medicine it doesn't cure everything," Leonardi says. "I wouldn't recommend treating cancer with just herbs."
While in China, the doctor learned that acupuncture is successfully used for weight control, rather than primarily for pain relief as it's commonly used here. She does refer some patients for acupuncture, which she notes is sometimes covered by insurance, and for massage, which is almost never covered.
In Kunming, Leonardi was given a tour of a psychiatric hospital by the head of psychiatry, Dr. James Liang. All the patients had IVs and were taken care of by their families right within the psychiatric ward. Patients participated in Western modalities such as behavior and group therapy along with their families. Oddly to Western eyes, medications were stored in baskets right under patients' beds. Physicians and patients left treatment messages for each other on a bulletin board.
Leonardi also had a chance to tour the emergency room and intensive care unit of Kunming's largest hospital. With a population of 3.8 million in the city, the hospital saw approximately 5,000 patients a month, comparable to either of the large hospitals in Las Cruces. "Chinese doctors work very hard," she says. She learned that the ER was capable of emergency respiratory resuscitations and that dialysis was commonly performed. The head physician told her there were 45 specialists in fields ranging from orthopedic to cardiology.
Chinese people tend to go to hospitals as a last resort, only if they are deathly ill or have experienced a trauma, Leonardi says. That's because they could be in the emergency room for days, which would bankrupt most families.
When first experiencing signs of illness, Leonardi says, the Chinese would employ a home remedy or visit the local pharmacy, where they could immediately get a prescription for medication.
If that didn't work the patient would go to one of numerous storefront clinics-a room with a couple of beds attended by "barefoot doctors" or physicians with a few months of training. Or the patient could make an appointment with a physician, which may prove difficult. Specialists are not as accessible in China, Leonardi says, most people don't have insurance and the trauma-care system is not as sophisticated as in the United States.
Some of the Western influence seen in hospitals comes from physicians being trained in the US and then returning to their homeland to practice what they've learned. To become trained in traditional Chinese medicine, a practitioner would go to school for four years to learn internal and external herbal remedies, therapeutic massage and acupuncture. Those trained in a combination of Western and Chinese medicine, however, have the equivalent of a PhD, with five years of medical school, two to four years of residency, and then becoming associate and full professors, with the whole process taking seven to eight years.
"There are no late bloomers in China," Leonardi says. Only the very brightest students who have passed all their tests since grade school are admitted to higher learning institutions such as medical schools. "If they don't pass the tests, they don't go on." Because of this, the Chinese don't like to be wrong, or to "lose face," Leonardi adds.
On a side trip to the rural village of LiJiang, Leonardi was invited into the practice of 82-year-old Dr. Ho, a purely traditional doctor, whose handmade business sign declared in English, "The Most Admired Man." He invited the traveling doctor to come in and review some of his patients' medical records. Red and blue buckets filled with medicinal powders were stored in a pantry, and Ho prepared "healthy tea" for her to take home. With no pension income, the medicine man must keep working to support himself.
In total contrast to rural China-and even its city hospitals-was Bumrungrad Hospital in Bangkok, Thailand, host of an anti-aging conference Leonardi attended. The hospital was completely modern with state-of-the-art technology. Several doctors and nurses Leonardi interviewed there were Thai natives who had gone to the US for training and returned years later to their homeland after practicing abroad for a number of years. The sixth-floor outdoor courtyard was a lovely garden and some of the patient rooms looked like hotel suites. The hospital had a pediatric playroom and a McDonald's.
Everywhere in Asia, in fact, she saw Western influences-Starbucks, McDonald's restaurants-and a blending of Eastern and Western medical traditions in the health care system. Yet, as China and other Asian countries become more influenced by Americans and Europeans, we are also influenced by them in turn. More and more Americans are openly using natural and herbal remedies, and enjoy the therapeutic benefits of acupuncture and massage. Not only are patients revealing these uses to their physicians, their physicians are making these referrals and educating themselves on these practices.
Chinese practices did intrigue the American physician. "If I was 10 years younger and $10,000 richer I would go to China for acupuncture training for weight loss," Leonardi says. Extra weight is the root of health problems such as arthritis, diabetes, hypertension and obesity. She adds, "I would also like to learn herbal medicine."