My second-to-last column. My last column, about my transition to residency, will appear in June; prepare your elegies now.
Stomach Cancer: Venturing Into the Belly of the Beast
By Zackary Sholem Berger
I've come to Fuzhou, a city of 5 or 6 million people in southern China, to help along some research into gastric cancer. Fujian Province, of which Fuzhou is the capital, records more cases of the cancer than anywhere else in the world.
Fuzhou isn't a bad city to call home for six weeks — the length of our stay — but it's not for tourists. The city rates just three pages in Lonely Planet China. And for an observant Jew coming to China around Passover, Fuzhou is even less hospitable, with the nearest Seder hundreds of miles away.
But any city, anywhere in the world, harbors innumerable, unexpected sights and sounds; any place, touristed or not, can become an interesting destination. I haven't fallen in love with Fuzhou, but for me it's certainly brought about a fascination with China, one that I hope will lead to understanding.
What's my work here like? An intelligent, energetic, talkative bunch of medical students, all women ("girls," they suggested I call them in Chinese), are abstracting the medical information from patients recently diagnosed with gastric cancer at Fujian Provincial Hospital. Sitting in the hospital's dusty, badly lit document room with its shelves full of manila patient folders, I'm making a database of this patient information. All the while, I'm being entertained by the side conversations of the medical students and bemused by the passing tableau of Chinese street life outside the window: a brass band on a flatbed truck, on the way to a funeral procession; the daily full-volume medley of patriotic marches from the loudspeaker of the high school next door.
Most worthwhile are the accidental discoveries. I have learned that Chinese university students aren't allowed to get married, and that Chinese doctors in various specialties learn on the job, rather than taking another post-doc after graduation (as is done with fellowships in the United States). To my new colleagues I provide, in return, strange facts of American life. I try to explain (in my halting Chinese) that my search for vegetarian restaurants does not mean I'm vegetarian, merely that I eat animals slaughtered according to rules stipulated by the Bible.
Whenever I take a detour on my way to work through the various hospital buildings, I am reminded that the difference between China and the United States is in large part just more people. While a hospital in the United States aims to be like hotel, a hospital in China can only look like a train station — masses of people waiting for their names to be called and tripping over each other's packages.
The bald data of the gastric cancer patients tell the same story over and over again: A man in his late 50s or early 60s, from Fuzhou or Changle (another city of Fujian Province, unluckily known as the world capital of gastric cancer), is diagnosed with advanced disease. This is awful, because gastric cancer caught early is much more treatable. Even worse is the repetition of this pattern. It means that no matter what statistical regularities pop up in these case series, Changle will remain the world's gastric-cancer capital for the foreseeable future.
This might lead to frustration. What's the point of small-scale clinical research when faced with an insurmountable problem? China's public health picture doesn't make matters much easier. For one thing, there's little to no health insurance here, so the health care you get depends on how much money you have in your pocket. If a sick person shows up at the door of a hospital where the costs are too much for her to pay, she will be treated there only until she's well enough to be transferred somewhere less expensive. Fujian Provincial Hospital is a top-of-the-line facility, and the poor go somewhere else. If the gastric cancer cases I'm reviewing here are disheartening, I can only imagine what it's like for poorer patients.
Any casual look around the Chinese streets leads to other sobering public health realizations. Cigarettes are everywhere. (At a banquet in my honor, a hospital vice president and I drank a toast to the defeat of Big Tobacco. In the name of all Americans, I apologized for our exporting the problem.) Bicycle riders go helmetless. As China undergoes a transition from an economy of scarcity, with lack of hygiene and widespread infectious disease the main public health problems, to an economy of abundance, new causes of death vault to the top of the list: heart disease, stroke and diabetes.
In short, it's a huge country with huge problems. From a health care perspective, you can't accomplish much of anything in six weeks. Sometimes, though, tangible accomplishment is not the goal. The aim of my visit is to make a brief first acquaintance with a country of a billion people, and, in particular, with Fujian Province, which has sent 300,000 immigrants to New York City over the past 25 years. When I walk the streets and see the people — fixing their bicycles in the open air; squatting on sidewalks, cleaning piles of scallions; polishing shoes, placing hot bowls of soup with noodles into huge ceramic jugs to keep them warm — I count myself lucky to have made the trip. I hope to do my best for Fujianese patients, whether they're in New York or in China.
Zackary Sholem Berger has now eaten in the best vegetarian restaurant in the world. Write email@example.com, and he will tell you how to get there.