Here in northwest China, a cancer diagnosis is often considered to be a death sentence. Most of my students’ contacts with cancer have been with terminal cases, so it’s no wonder they are confused. Many of the people they know who have died of some kind of cancer were in their 50’s at the time of their deaths.
When I ask them for more information, they tell me that the disease was too advanced at the time of diagnosis or that the medical treatments were too expensive. Occasionally, I simply hear, “the treatments didn’t work.”
These stories make me incredibly sad for my students’ sake. We see and hear a lot about China these days and much has been said about her fast development. However, for the vast majority of China, the rapid rise and higher income levels has also increased stress and pressure.
China has universal healthcare. What this means is that everyone is supposed to be able to see a doctor at an affordable price. That’s it. When someone needs to see a doctor, they go to a hospital (typically, early in the morning), stand in line to register to see a doctor, pay the fee (varies according to the type of doctor, usually 5 – 15 yuan) and then wait for their number to be called to see the doctor. One does not make an appointment for a time! You can register to see the doctor at 8:00 in the morning, but you may not see him/her until 3:00 in the afternoon! There are no stand-alone clinics or independent doctors’ offices. They are all at the hospital.
The universal health care does not cover the cost of tests and/or treatment. Consider that a yuan has the same spending power in China that a dollar does in the US. A simple blood test (CBC) costs 41 yuan. If you want your glucose levels checked during that same blood test, it will cost more. Medications can range from the very cheap to the very expensive. X-rays are about 100 yuan. CT scans are 323 yuan. MRIs are 1200 yuan. All tests and treatments are out-of-pocket. The universal health care only includes doctors' visits. While there are some who have medical insurance, the coverage is typically for accidents only and not for illnesses.
The medical system in China is one of “payment first, treatment second.” For example, in November 2010, when Art had his head injury, the ambulance picked him up and brought him to the emergency room of our choice. (I had called some doctors and found which hospital was best for head trauma and asked Art’s friends who were with him to direct the ambulance to that hospital.) The ambulance insisted that a friend ride with Art so that there would be a guarantee of payment. While that was understandable, what was extremely different was when the ambulance arrived at the hospital, the emergency room insisted upon a 500 yuan deposit before anyone would even look at Art. This was a man bleeding from his ear and vomiting all over the place and the main issue was about money. Thankfully, the friends had taken up a collection before Art was taken to the hospital and they had exactly enough money to pay the ambulance and ER deposit. Later, after I got there, I was required to place a 10,000 yuan deposit for Art’s admission to the hospital. I didn’t have that much money on me and I had to negotiate a smaller deposit by submitting Art’s passport as collateral.
Such a system means that people often delay going to a doctor for the more serious concerns in their lives. Most people will run to the hospital for the slightest sniffle and cold in order to receive a magic “IV solution,” but typically, the more grave the situation means the longer they wait. (For some reason, an IV seems to be the “cure-all” for most ailments. This could be a simple glucose solution to antibiotics (that don’t work against viruses), but it makes both the doctor and the patient feel like they have “done something.” )
Traditional Chinese Medicine (TCM) has somewhat of a role in health care here, but not as much as people would believe. Most people want western medicine (which is rather ironic, because in the West, many people are seeking TCM!). The difficulties with TCM is that very few people really know what’s in the herbs and solutions. Many of them may help one part of the body, but end up being toxic to another. A friend of mine last year took some TCM for something and she ended up allergic to whatever plant was used and spent two days vomiting.
Medications are available over the counter, most of the time without a prescription. Or, if a prescription is needed, a “doctor” in a little room will write one for you . . . without an examination! The assumption is that if you know the name of the drug you need, then you must have gotten it from a doctor. There is rampant abuse of antibiotics here and just like the rest of the world, there will be a build-up of antibiotic resistance and “superbugs” that are harder to defeat.
Narcotics are tightly controlled . . . to the point where they might not be available. Morphine is almost unheard of for pain relief. If a patient is in pain, then the patient typically needs to just “gut it out” or . . . given an IV! Mothers giving birth via caesarian section live in fear that they won’t be given enough anesthesia in the epidural so they “bribe” the anesthesiologist with a “red envelope” full of cash. The underground network lets them know how much that should be in order to guarantee the right dosage.
Because doctor fees are controlled by the government, it’s not uncommon to bribe a doctor for better care as well. In some large cities, you may arrive at the hospital at 6:00 a.m. to register for an appointment, but if you pay an extra 300 yuan, you can be seen right away. For those who don’t have that kind of money, they simply have to wait . . . and wait . . . and wait.
Health care is very unequal in China. What I’ve written here is true for my city in the northwest . . . a rather undeveloped area in the big picture. This may not be completely true for the large mega-cities on the east coast. However, I’ve spoken in depth with many, many students from all over the country and they’ve told me nightmare stories of their families’ medical experiences.
Just like in the United States, health care here in China is a hotly debated topic and one that has no easy answers.
As I personally interact with people, I deliberately bring up the subject of death. Death is a “taboo” topic in Chinese culture . . . it’s not really talked about, especially among younger people. People are afraid that I’m going to die and they don’t know what to do with this fear.
My response to them is this: “I don’t believe that cancer has changed the hour of my death. I believe the time of my death was determined before I was born. However, cancer is changing how I live.”
I go on to tell them that we are ALL going to die . . . none of us live forever . . . and that death is not something to be afraid of. I have an incredible peace about my life after my death and how it’s going to be so much more amazing than my life before death! Does this mean I want to die tomorrow? No, it doesn’t! However, none of us are promised a tomorrow. We have no guarantees. I remind them of how at noon on May 12, 2008, everyone ate lunch, but at 2:30 p.m., over 50,000 people died in a devastating earthquake in Sichuan province. Two hours earlier, they had no idea that their lives on this earth would end.
The question for all of us isn’t about our deaths . . . but about our lives. What are our hopes? Our dreams? What is the foundation for our lives? Given the role of money in Chinese society, I ask my students and friends if making money is indeed, the most important thing in life. If they *knew* they were going to die in a year, then what would their goals be? What would they want to accomplish before their deaths?
These are wonderful conversations that I am so blessed to have with people. Having cancer has given me so many opportunities to *really* talk to people. This is all a part of God’s very good story for our lives.
What are *your* hopes and dreams?