Another article from Professor Debra

Conditions That Compel People to Explore Traditional Chinese Medicine Treatment at the Huai Hua Red Cross Hospital for Difficult and Chronic Conditions in Southwestern China

Purpose: To discover the physical and psychological motivations that compel patients and loved ones to explore and use Traditional Chinese Medicine at the Red Cross Hospital for Chronic and Difficult Conditions, the sacrifices each patient and family makes to do so and whether it is effective in a transnational, culturally and linguistically diverse social setting.

　

According to the World Health Organization 2002 Policy Perspectives Publication:

　

Populations throughout Africa, Asia, and Latin America use traditional medicine (TM) to help meet their primary health care needs. As well as being accessible and affordable, TM is also often part of a wider belief system, and considered integral to everyday life and well-being. Meanwhile, in Australia, Europe and North America, “complementary and alternative medicine” (CAM) is increasingly used in parallel to allopathic medicine, particularly for treating and managing chronic disease. Concern about the adverse effects of chemical medicines, a desire for more personalized health care and greater public access to health information, fuel this increased use [Appendix A]

For the past six years, persons from over two hundred countries with difficult and chronic conditions, i.e., diverticulitis, cancer, and incurable autoimmune diseases such as Systemic Lupus Erythematosis (SLE), Multiple Sclerosis (MS), Lou Gherig’s Disease (ALS), have been motivated to explore the options Traditional Chinese Medicine (TCM) offers them at Huai Hua Red Cross Hospital (Ming, 2006). Since these conditions are chronic and often times incurable, they have led many patients and/or their family members to seek and decipher complex, baffling, and, obscure medical information and to explore options encountered beyond the diagnostic and treatment scope generally available to them. Despite their diverse cultural backgrounds, many persons reach this intersecting destination at the time-honored tradition of TCM and the Huai Hua Red Cross Hospital for Difficult and Chronic conditions. Due to a rare invitation from Dr. Ming, the International outpatient director and Vice President of this hospital, I have been granted an eight to ten-week opportunity to research and experience its methods.

According to Dr. Ming (2005), patient testimony, and case studies posted on the hospital site, many of these patients have never experienced these methods. They complete the online consultation questionnaire and, admittedly, anxiously await the herbal prescription and treatments suggested by Dr Ming and his staff. Since many of these patients have complex, and/or advanced conditions, intensive, comprehensive Traditional Chinese Medicine treatment (WHO, (Jia), 2005:23) at the hospital offers what it argues is the 'last and/or best hope for recovery or symptomatic relief (Dr. Ming, 2006). Although the journey to this hospital in Southwestern China poses many obstacles and necessitates many sacrifices, patients and their family members cast aside geographic, linguistic, and cultural displacement and endure a rather arduous journey.

Methods:  I plan to discover the patents' motivations and sacrifices through three avenues: experiencing treatments, which I have used for 8 years, patient interviews, and quantitative data. I believe my onsite experience will provide both a unique vantage point and the best opportunity to discover the motivations for patients and family members to endure the arduous and intensely personal journey to this Traditional Chinese Medicine (TCM) in China and the sacrifices they made.  This location and intermediary placement will yield access to patients, families, and professionals.  Therefore, I can also discover whether the 5,000-year-old methods employed by the TCM professionals are effective from the doctors’ and patients’ perspectives and how these methods are viewed by the patients. This will also allow me to learn how patients view health and illness from a cultural perspective. According to Penn et. al.:

An individual's belief about the cause of illness could determine who is to conduct the diagnostic interview, what expected treatment modalities might entail, efficacy of treatment for diagnosis and treatment and whether the victim is stigmatized by the illness.
To gather this information, I will employ a variety of traditional anthropological methods. I both experience treatment methods and observe them. To supplement participant observation, I will conduct formal and informal interviews and evaluate case studies. Those interviewed will include the International Outpatient Director, Dr. Ming, his assistants and staff, TCM students, approximately 20 patients, and their family members. Since I also have access to many case studies conducted at the Huai Hua Red Cross Hospital and Dr. Ming’s assistance with records and TCM explanation, I will also use this information to substantiate and enrich my research. This will illuminate how TCM and the patients view illnesses, life, death, and recovery.

Participant observation, entering the community, is extremely effective in this arena, since many of these patients are foreigners, have stepped beyond their comfort zones and face both the uncertainty of this environment and the obstacles chronic and difficult diseases pose within everyday life. At a time of such uncertainty and vulnerability, a“shared history,” in this case, experience with chronic illness, the journey to this hospital, and a shared community within the hospital affords a strong rapport-building factor. Since mealtime is shared in a family setting in Traditional Chinese style at the hospital, these gatherings yield invaluable time and opportunities time to share experiences in an informal setting. Furthermore, participant observation is the method cultural anthropologists use to understand peoples and their culture. It affords the time, place and methodology to learn from people, to discover what Spradley (2003) terms the hidden principles of another way of life. This shared two and a half month experience and place yield the opportunities to discover how these peoples view illness and the journey (Nolan, 2000), how they arrived at this place and why. This method allows the discovery of these terms and experiences and, ultimately, how the application of these principles addresses cultural perceptions and disease-identification (Farquhar, 1996), and is particularly useful in globalized transnational settings. Additionally, teaching English to hospital workers will also yield insight to classification of disease, cause and treatment.
Participant observation yields invaluable nuances and discovery of perceptions of disease but must be weighed by the case studies, medical understanding and evaluation of such, and the tangible knowledge available through archives. Case studies provide valuable insight within both the Eastern and Western medical realms and provide additional comparative data. (Reading them often illuminates the culture of the medicine.) Expert explanations provided by Dr. Ming and his assistants will also highlight and detail obscure concepts. Combining medical and cultural methodology will provide a balanced view of the motivations and treatments, the outcomes through the TCM doctors' and patients' eyes, and reveal "hidden" cultural concepts.

Results: Besides the medical conditions that motivated these patients and their family members to come to the Red Cross Hospital in China, I also expect to discover the other factors that led to these avenues of exploration. Among these factors, I believe I will encounter the effect of Traditional Chinese Medicine (TCM) doctors and practitioners emigrating from China and the effects of China, consequently, opening its doors to foreigners exploring TCM methods. I also expect to find the World Health Organization (WHO) endorsement of Traditional Chinese Medicine and acupuncture, in particular, as a motivation for more persons to explore, investigate, and use the treatment options it offers (WHO, 1978-2006).

To share this information, I plan to present my findings at the Rall Symposium, the ACAA and the National Conference for Undergraduate Research (NCUR). If the opportunity allows, these presentations may also include Dr. Ming or one of his assistants. I also intend to share my written work with the National College of Acupuncture and Oriental Medicine (NCAM). With Dr. Krystal’s assistance and guidance, I also plan to submit these findings for the 2007 yearly meeting of the Society of Medical Anthropology and to the American Anthropological Association for the publication Anthropology News.

Personal Goals (Short term): To explore the culturally diverse views of illness, treatment, outcomes, and the particular relevance of Traditional Chinese Medicine in an ethnically plural setting with respect to chronic and difficult conditions currently managed and treated by Western Medicine with significant side effects and toxicity concerns (WHO, (PPO), 2002).

　

Many conditions motivate these patients from two hundred countries to experience these methods. Therefore, it is important to see how these views of illness and treatment intersect, as well as how they differ. Since the 2005 World Health Organization conference in Thailand deemed chronic illness the focus of 2005-2006, this study may illuminate hidden aspects of culture and medicine midst Globalization.

Concurrently, Western Medicine is exploring how ethnicity, culture, and medicine relate, particularly concerning conditions and unequal distribution of disparity among minorities (Penn, 126-7,2000). It is also the focus of many studies within forensic and medical anthropology. Because Chinese medicine formulas and treatments are highly individualized, prescribed according to a pattern of symptoms rather than according to disease identification (Hadady, 1996), these applications within a culturally diverse community, addressed in a holistic fashion (WHO, 1978:14), comprise the facets of a current two year National Institute of Health (NIH) cancer treatment study in China (NIH, 2005). Therefore, I hope to serve as a cultural bridge, lending understanding of illness and healing, and how it is viewed within a culturally and linguistically diverse community, through the international lens midst globalization.

Long term: In the Age of Globalization, when West meets East in the field of medicine, my unique background will assist in achieving open dialogue and the exchange of cultural, medical, and technical information. Ethnicity, culture, and medicine have led me to explore Traditional Chinese Medicine in this context long term. I plan to use this study as a base for further study through another grant based study, future fieldwork, a part of a Graduate education, the Fulbright Scholar Program, or a more in depth indigenous peoples Lupus study. I may also later explore the recently discovered Qing Dynasty documents that reveal the tracks of Systemic Lupus Erythematosis through their society and their methods of treatment.

Concerning chronic diseases, specifically autoimmune diseases, (which rise, according to the American Autoimmune and Related Diseases Association (AARDA, 2005) at an estimated 200% annually within the United States since 2002, I hope to shed new insight and understanding onto the triggers of such diseases, alternative treatments, and the sacrifices such illnesses require of both the patients and the family members. Since autoimmune diseases are so difficult to diagnose and treat, this investigation and study may promote more open dialogue and explore such facets as culture and medicine, environmental health and, ultimately, yield less suffering.

Personal Application: The need to promote global understanding and medicine has always motivated me. Upon returning to school, I engaged in Chinese history, language, and culture classes to help me understand the roots of the Traditional Chinese Medicine that I was and am concurrently studying and using in my daily life. Although this coursework was not required, I felt it would yield invaluable insight with regard to cultural concepts. Through this coursework, I also studied ethnicity, culture, and medicine, biomedical ethics, physical and cultural anthropology, and conducted several field studies including: Lupus in the Sioux Indians (which stimulated interest at the Indian Health Service in the US and in Canada), Why Chinese Americans Study Chinese Language and the Diglossic and Triglossic Situations it Creates in their Homes, and The Shinnyo-en Temple.

 As a non-traditional student, I have walked many paths. Throughout most of my adult life, serendipity and many life situations revealed many unforeseen paths and avenues of discovery and learning than I could have ever anticipated. As a freelance writer and researcher, I contracted for: medical organizations, including JAMA and the AMA, doctors, and governmental agencies (Government Services Agency), BP Amoco, where I reviewed, edited, and wrote Material Safety Data Sheet reports in several languages (French, Italian, German, Spanish, Portuguese, Chinese) in the toxicology lab, translated a novel for a Cuban man, penned petitions for human rights organizations addressing the UN council, researched for the World Health Organization, and studied people and culture informally. I also served as a bilingual aide for 120 students daily at an elementary school and currently help ESL students edit their papers.

Perhaps, the most life altering experience occurred as a direct result of an unexpected journey to a Chinese medicine/tea shop where they spoke only Chinese and I spoke only formulaic Chinese. This quickly led me to a circle of Traditional Chinese Medicine (TCM) healers from China and merely propelled my exploration and formal study of TCM, Chinese language, history, and culture. Although I have written case studies for both medical doctors and Chinese Medicine doctors, including Dr. Zhengang Guo who is both an M.D. and a seventh generation TCM healer, shared my experiences with patients and professionals, served as a liaison for many new TCM patients, worked on Alternative Medicine legislation issues with Henry Hyde’s legislative assistant, educated legislators and patients, and studied Western Medicine formally and informally since I was nine, these experiences were mere stepping stones to this research.  They have provided me with the necessary tools do conduct this intensive field research, but I am still the “understudy” in this arena. This study will mark the first time that I will study TCM in China.

From these varied yet intertwining and sometimes encompassing experiences, I have acquired the capacity and skills to communicate in linguistically and culturally diverse situations, collect, and analyze interviews and data. As a student and a patient of Traditional Chinese Medicine (TCM), I can illuminate different aspects of treatment and diagnosis in this hospital where its practice is unbridled.  I also understand the path of these patients and these families since I stepped onto a similar path many years ago, when I made such a choice, not knowing what to expect. Upon this experience, I can build bonds that most persons could not. Combined with my Anthropological field study experience and training, my enhanced multi-cultural, linguistic, and Chinese cultural knowledge, TCM studies, Chinese-American community involvement, and Chinese language study, I feel I can offer a unique insight into the concepts that elude the Western world and illuminate aspects that all people share with regard to illness, suffering and the motivations to improve their conditions amidst adversity.

Bibliography
American Autoimmune and Related Diseases Association

2006        Accessed on 12/2006-2/19/2006 at: http://www.aarda.org

Provides research information, statistics, NIH and legislative updates.

　

Angrosino, Michael

1986        Health and Illness in Sociocultural Perspective in A Health

Practitioner's Guide to the Social and Behavioral Sciences. Pp.53-64.

Auburn Press.

Angrosino, from his own participant observation in a mental health care facility, details the cultural view of illness and its role in a health care setting.

1986 Life Histories in A Health Practitioner's Guide to the Social and    

Behavioral Sciences. Pp.79-81. Auburn Press.

　

This details how life histories provide ethnographic data and highlight cultural concepts.
 

Chrisler, Joan C. and O'hea, Erin L.

2000         Gender, Culture, and Autoimmune Disorders in Handbook of

Gender, Culture and Health. Richard M. Eisler and Michael Hersen. Pp.

321-342. First Edition. Mahwah: Lawrence Erlbaum Associates, Inc.

　

This highlights the current discourse surrounding autoimmune disease, factors, incidence, and belief systems of different cultures.

　

Farquhar, Judith

1996        Knowing Practice: The Clinical Encounter of Chinese Medicine

(Studies in and belief graphic Imagination). First Edition. Boulder, CO:

Westview Press

This Researcher/ University of Chicago Anthropology professor highlights the differences in knowledge required to practice and understand Traditional Chinese Medicine (TCM). Through her journey of discovery at Guangzhou College of TCM in post Cultural Revolution China, she details how the college translated these concepts to its students, and how their understanding of patterns of symptoms was and is crucial to diagnosis and treatment.

Hadady, Letha

1996  Asian Health Secrets: The Complete Guide to Asian Herbal

Medicine. First Edition. New York: Three Rivers Press

This acupuncturist/herbalist culturally "translates" Chinese, Indian, and Tibetan

herbal medicine concepts. She shares her journey across post Cultural

Revolution China in search of medicinal secrets and the cultural insights she

gained. Her experience provides the proper lens to view these medicinal

aspects and contrast Eastern and Western methodologies of diagnosis and

treatment. She also details the alignment and harmonization of mind, body, and

spirit.

　

Han, Henry, Miller, Glenn E, Deville, Nancy

2003        Ancient Herbs, Modern Medicine. First Edition. New York: Bantam

BooksThis provides insight about the combination of Traditional Chinese

Medicine and Western medicine. He details Yin and Yang principles,

acupuncture techniques, chronic and debilitating illness, common ailments and

diagnostic differences.
　

Ming, Dr.     

2006        The Huai Hua Red Cross Hospital Accessed on 12/2006-2/19/2006

at: <http://www.tcmtreatment.com/hospital.htm>

Patient form accessed at: http://www.tcmtreatment.com/form.htm

Patient case studies: < http://tcmtreatment.com/hospital01.htm >

　

This details case studies, provides patient contact information, patient letters, treatment details, and Chinese Medicine information.

　

Mc Curdy, David W.

1995  Using Anthropology in Conformity and Conflict: Readings in

Cultural Anthropology. James Spradley and David W. McCurdy, eds. Pp.

415 -427. Eleventh edition. Boston: Allyn and Bacon.

　

The applications of Anthropology within everyday life situations are highlighted and explored. Mc Curdy explains its applicability in marketing, the uses of observation for research and design and how culture filters into every aspect of routine, including utensils we use and design.

　

            Penn, Nolan E., Kramer, Joyce, Skinner, John F., Velasquez, Roberto J.,

            Yee, Barbara, W.K., Arellano, Letticia M., Williams, Joyce P.

2000   Health Practices and Health Care Systems Among Cultural Groups in Handbook of Gender, Culture and Health. Richard M. Eisler and Michael Hersen. Pp. 105-138. First Edition. Mahwah: Lawrence Erlbaum Associates, Inc.

This Chapter highlights the incidence of disease and cultural views of health concepts among different ethnic and religiously connected ethnic groups.

　

World Health Organization
1978    The Promotion and Development of Traditional Medicine

2001    Traditional Medicine: Growing Needs and Potential.

2006   Accessed on: 12/2005-2/19/2006 at: <http://www.who.int>

2006    Traditional Medicine: Definitions.

2006 Traditional Chinese Medicine Could Make "Health for One" True (Jia)

Complementary/alternative medicine (CAM) The terms "complementary medicine" or "alternative medicine" are used inter-changeably with traditional medicine in some countries. They refer to a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system.

Acupuncture is the insertion of one or more needles into specific locations called acupuncture points. Acupuncture is one of the oldest forms of healing known to mankind. It originated in China nearly five thousand years ago.

　

Cupping is an ancient Chinese method of causing local congestion. A partial vacuum is created in cups placed on the skin either by means of heat or suction. This draws up the underlying tissues. When the cup is left in place on the skin for a few minutes, blood stasis is formed and localized healing takes place. Cupping affects the body up, penetrating the surface up to four inches into the tissues.

Gua Sha: Gua Sha is a method of treating repletion heat distention patterns. The skin on the back, limbs or other area of the body is lubricated and the scraped with a ceramic spoon or similar objective. The area is scraped until the red papules become fully visible to releasing heat.

Moxa: The prepared leaves of mugwort used in a technique called moxibustion. Moxibustion is heat therapy preformed by a method of burning moxa (prepared mugort) to heat the skin or a needle that is inserted. Moxibustion is commonly used in Chinese medicine to treat cold and dampness disease.

　

Tuina: Tuina is a form of Chinese bodywork, which its origin dates back to 100B.C.. Bodywork has always been an integral and respected tool of a TCM practitioner. The hand techniques within this system can manage qi flow within the human body thus having a wide array of healing possibilities.

Herbal medicines

Herbal medicines include herbs, herbal materials, herbal preparations and finished herbal products, that contain as active ingredients parts of plants, or other plant materials, or combinations.

　

·        Herbs: crude plant material such as leaves, flowers, fruit, seed, stems, wood, bark, roots, rhizomes or other plant parts, which may be entire, fragmented or powdered.

·        Herbal materials: in addition to herbs, fresh juices, gums, fixed oils, essential oils, resins and dry powders of herbs. In some countries, these materials may be processed by various local procedures, such as steaming, roasting, or stir-baking with honey, alcoholic beverages or other materials.

·        Herbal preparations: the basis for finished herbal products and may include comminuted or powdered herbal materials, or extracts, tinctures and fatty oils of herbal materials. They are produced by extraction, fractionation, purification, concentration, or other physical or biological processes. They also include preparations made by steeping or heating herbal materials in alcoholic beverages and/or honey, or in other materials.

·        Finished herbal products: herbal preparations made from one or more herbs. If more than one herb is used, the term mixture herbal product can also be used. Finished herbal products and mixture herbal products may contain excipients in addition to the active ingredients. However, finished products or mixture products to which chemically defined active substances have been added, including synthetic compounds and/or isolated constituents from herbal materials, are not considered to be herbal.

　

Traditional use of herbal medicines

Traditional use of herbal medicines refers to the long historical use of these medicines. Their use is well established and widely acknowledged to be safe and effective, and may be accepted by national authorities.

(WHO Traditional Terms 2006, et. al)

Appendix B

Interview questions (based on patient liaison experience and the focus of study) will include:

　

What is the nature of your illness or condition? What caused it?

　

How long have you had it? How were you diagnosed?

What led you here? How did you discover the Huai Hua Red Cross Hospital?

What other methods have you tried? What was your prognosis?

What did you have to do or sacrifice to come to this hospital?

What are the challenges of being here? (Answers may range from weather, familiar food scarcity, etc. - may illuminate cultural displacement.)

Is it frightening for you to try acupuncture, cupping, moxibustion, etc? (Appendix A)

How are you treated differently at the Huai Hua Red Cross Hospital?

Has the treatment been effective? Does it meet your expectations?

Although the hospital has some translators, what are the difficulties in communication? (This will include both the linguistic difficulties of verbal and the hidden, non-verbal communication. The latter, gestures, in particular, most often discovered through observation of instances or through the storytellers themselves.)