Classroom antics, TCM, and relationships with authority: what teaching in China taught me about being a doctor

screen-shot-2016-12-22-at-6-58-08-pmLast summer, I had the opportunity of a lifetime to travel to Humen, China, to teach English. China’s long history and diverse culture has always fascinated me; having had the chance to learn Chinese for a year at Oxford University, I hoped that I might be able to improve my language skills. Now studying medicine, I went out with the intention to improve my communication skills; this experience was especially useful for improving my communication skills with those who are unable to speak English. I also hoped to get a taster for teaching, as it is important for a doctor to be able to teach your students and pass on the practice of medicine. In addition to this, at the back of my mind was an interest in the differences between Western medicine and Traditional Chinese Medicine.

Week 1

 I am not the first person who has wanted to teach English to kids on the other side of the world, and certainly won’t be the last! I’ve heard stories from overseas teachers that kids ‘hang onto your every word’ and come to worship the ground you stand on. However, as the eldest sister of three, it should not have come as a shock to the system when 40 girls and boys, aged 11-12, with a huge range of English speaking ability and comprehension, in fact did not hang onto my every word! Similarly to how you have to find empathetic ways to communicate with patients, you have to be able to put yourself in your students’ shoes. It really made me reflect on WHAT I had enjoyed learning and HOW I had enjoyed learning at school. It was really was difficult to sustain the attention of some kids, who were nearly fluent in English, as well as that of those who could barely string two words together, in the same class.
I tried to tackle this by planning lessons that I thought I would have found interesting. I planned lessons on sports, food, Harry Potter, superheroes and as a medic, of course, medicine. I tried to make the lessons interactive, and teach them ideas that would stick. For example, as basketball is the main sport in Humen, but people with disabilities are not as accepted and integrated into Chinese society,  in my sports lesson I showed them a video of wheelchair basketball. Seeing their reaction was very interesting; I was able to challenge their perceptions of people with disabilities, proving that this was not mutually exclusive from people who are good at sports.
screen-shot-2016-12-22-at-6-53-21-pmIn another lesson, I taught body parts; this enabled me to grab the attention of kids of all language ability. I asked them draw out a body and label its part. In this manner, each student could tackle the vocabulary at their own level. I made the lesson relatable as I had one volunteer come to the front of the class and I would point to a body part and give them the new vocabulary. The creativity and thoughtfulness that went into most (there were a few jokers in the class) of the drawings was so rewarding.

Week 2 

screen-shot-2016-12-22-at-6-58-20-pmAfter the first week, I felt settled with my class. So I decided to focus my attention on the differences between Western and Traditional Chinese Medicine (TCM). We had some older students at the school, whom I was able to interview. They taught me that the basis of Traditional Chinese Medicine is to balance yin and yang; you have treatments that are coldand hot, and you treat the disease treat respectively.

 

screen-shot-2016-12-22-at-6-58-29-pmSpeaking to students who study evidence-based sciences every day, it was interesting to hear their opinions on Traditional Chinese Medicine. They spoke to me about how one could enter a modern hospital but ask for a traditional prescription. Both of the students themselves were taking traditional medicine for their acne. They told me that Traditional Chinese Medicine works similarly to Western medicine, but in a slower way. So say for a chronic disease, such as eczema, you would take traditional medicine; but if you had an acute disease, like an infection, you would go to a Western hospital because the treatment works faster.

They spoke to me about how one could enter a modern hospital but ask for a traditional prescription. 
During my free time over the weekend I decided to make a trip to a Traditional Chinese Medicine shop. Humen is in South-East China and during the summer it can reach temperatures of 400C. My skin was not used to coping with this heat, and I did get very sweaty and spotty. I was offered some traditional treatment for my skin whilst I was there. Fascinated – but skeptical – I took the sour, dark-coloured jelly. Needless to say, my skin didn’t improve, and later on I was horrified to find out this jelly contained tortoise shell!

Week 3

screen-shot-2016-12-22-at-6-57-29-pmOver the three weeks, we switched classes in the afternoon so that the kids were exposed to variation in teaching styles and content. But I really felt like my class was the most charismatic and enthusiastic, as each student brought a different personality to the class dynamic. And so, leaving the kids was far harder than I ever imagined it would be. On the last day, we had a classroom party where I wanted to sing my favourite Chinese song. I had some help from the older students who taught me the pinyin and translated it into English. Although singing Mandarin is far easier than speaking it (you don’t need to sing the tones), singing Mandarin is still extremely difficult!
Partway through I lost my place, but I was moved to tears when my students started singing to help me find it. This act of kindness really touched me; I had built a relationship with my class.

Teacher-student relationships

What I have had the chance to reflect on most of all since I have returned home is the teacher-student relationship in China, and how this might relate to the doctor-patient relationship in the UK. At Oxford, there was a strong focus on the history of China, and on China’s arguably most influential historical figure, Confucius. Confucius had a following of disciples to whom he taught the cultural significance of being a gentleman as well as a scholar. The cultural emphasis of scholars peaked during the Tang dynasty when the imperial examinations, for those who wanted to enter politics, were at their height. This system of examining civil servants influenced other countries such as Japan, Korea, and some argue, ourselves, starting with the East Indian Trading Company. Therefore you can see how the teacher-student relationship continues to be central to China’s identity.
Whilst I was teaching, I experienced the one-sidedness of this relationship: the teacher is always right. If there was ever a need to shout ‘QUIET’ across the classroom, a respectful silence did follow. (On a funny note – learn what ‘QUIET’ is in Mandarin before you yell it at a classroom of  Mandarin speaking children!) I am sure that in a classroom in the UK, this would not happen.
This is comparable to the paternalistic doctor-patient relationship that was once commonplace in the UK. The doctor would make the decision and overrule the patient. This hindered the doctor-patient relationship as a patient often wouldn’t trust the doctor, and so wouldn’t share information which could be essential to a differential diagnosis. Nowadays in the UK, we are moving towards a patient-focused and shared decision-making process. There is a saying in medicine that if you let the patient talk enough, they will eventually give you the diagnosis.
Nowadays in the UK, we are moving towards a ,patient-focused and shared decision-making process. There is a saying in medicine that if you let the patient talk enough, they will eventually give you the diagnosis.
This made me consider whether students should have more say in what they want to learn – or should teaching be more student lead and self directed? Or would this cause a shift in the other direction to what we experience sometimes in the UK – a  lack of respect for teachers?
Overall, I would like to thank Manchester University Students’ Union for giving me the chance to visit China, something that has always been on my bucket list. I hope you  can see how much I matured over this trip and how much I gained from this experience.
诸事有其好的一面,但不是人人都能看到.

Everything has its beauty, but not everyone can see it.

Confucius

 


screen-shot-2016-12-22-at-6-52-59-pmSophie Ashley is a second-year medical student, and the Non-Portfolio Officer for the MCR Global Health Society. Her travels were supported by the Zochonis Travel Award, awarded through the University of Manchester’s Student Union.

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