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Behind the Wall — Second thoughts on China
Behind the Wall - Second thoughts on China LESLEY DAWSON MSC MCSP DipTP THESE impressions were gained when I led the second CSP study tour of China in 1990. It would be superfluous to reiterate all the statements made by the first group, so I will attempt to give our views, and details about any visits which were different from those made by the first group.
School Visit A personal visit was arranged for me to the Xian Medical College and I met some of the teaching staff. I learnt that every Chinese doctor does 40 hours physiotherapy ( 2 0 hours theory and 20 hours practical) in his basic training. In addition to this a one-year course is run after graduation for any doctor wanting to specialise in physiotherapy. This one year consists of 1,600 hours of which two-thirds is theoretical and one-third practical. The teaching is very didactic and examinations consist of multiple choice questions and practical examinations similar to the old CSP Intermediate Examination.
General Impressions We were impressed with the general standard of health care in the cities we visited. Although obviously not at the same level as the National Health Service in the United Kingdom, when one considers how far the Chinese have come since 1948 they have moved 'light years'. There are no such persons as physiotherapists as we know them, but the doctors and nurses who have done specialised training in physiotherapy are beginning to offer a good service. The emphasis is still very much on 'shiny machines' but there were a few promising signs of a move towards community-based rehabilitation (CBR). The China Rehabilitation Research Centre in Beijing had sent one of its staff on the CBR courses at Wuhan run by one of the tutors from Hong Kong Polytechnic. One of the tutors at the Xian Medical College had also attended a similar course. We felt that the setting up of a centre for research in rehabilitation was itself evidence of openness to new ideas. It is obvious that the lack of what we would see as 'routine' surgery for disabled children is holding up their rehabilitation but the medical and nursing care they received was excellent. The government policy of allowing couples who have a handicapped baby to leave the child in an institution in order to have another normal child obviously does not help to get disabled people back into the community. We were able to engage in 'true' cultural
Physiotherapy, April 199 1, vol77, no 4
exchange in some centres where they asked us what treatments were popular in the United Kingdom. Some group members were able to show their Chinese colleagues photographs of their departments and patients. On one occasion one member of the group was asked to demonstrate some Maitland mobilisation techniques.
Conclusion
Above: One of the visiting group being treated by a traditional Chinese doctor at the Norman Bethune Memorial Hospital, Shijizhoung. He is 'focusing energy through her body' Below left: Rehabilitation gymnasium at the China Rehabilitation Research Centre, Beijing Below right: The group with Dr Wong, head of the physiotherapy department, and her staff outside Shaanxi Provincial Hospital, Xian
Chinese 'physiotherapy' is very open to new ideas and they are very keen to make closer links with the United Kingdom. However, I know that they also already have links with Australia, Hong Kong and New Zealand. This search for new ideas seems to be piecemeal, which in such a large country could easily lead to fragmentation and conflict of ideas. It would also be criminal to import Western models of health care into China - it is important that the Chinese find a culturally relevant model which will take into account their strategies already used, such as barefoot doctors. I would suggest that if the United Kingdom is invited to help with rehabilitation planning in China that we offer to help set up a multi-national consultative group to help the Chinese plan for themselves with help from outside.
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School Visit A personal visit was arranged for me to the Xian Medical College and I met some of the teaching staff. I learnt that every Chinese doctor does 40 hours physiotherapy ( 2 0 hours theory and 20 hours practical) in his basic training. In addition to this a one-year course is run after graduation for any doctor wanting to specialise in physiotherapy. This one year consists of 1,600 hours of which two-thirds is theoretical and one-third practical. The teaching is very didactic and examinations consist of multiple choice questions and practical examinations similar to the old CSP Intermediate Examination.
General Impressions We were impressed with the general standard of health care in the cities we visited. Although obviously not at the same level as the National Health Service in the United Kingdom, when one considers how far the Chinese have come since 1948 they have moved 'light years'. There are no such persons as physiotherapists as we know them, but the doctors and nurses who have done specialised training in physiotherapy are beginning to offer a good service. The emphasis is still very much on 'shiny machines' but there were a few promising signs of a move towards community-based rehabilitation (CBR). The China Rehabilitation Research Centre in Beijing had sent one of its staff on the CBR courses at Wuhan run by one of the tutors from Hong Kong Polytechnic. One of the tutors at the Xian Medical College had also attended a similar course. We felt that the setting up of a centre for research in rehabilitation was itself evidence of openness to new ideas. It is obvious that the lack of what we would see as 'routine' surgery for disabled children is holding up their rehabilitation but the medical and nursing care they received was excellent. The government policy of allowing couples who have a handicapped baby to leave the child in an institution in order to have another normal child obviously does not help to get disabled people back into the community. We were able to engage in 'true' cultural
Physiotherapy, April 199 1, vol77, no 4
exchange in some centres where they asked us what treatments were popular in the United Kingdom. Some group members were able to show their Chinese colleagues photographs of their departments and patients. On one occasion one member of the group was asked to demonstrate some Maitland mobilisation techniques.
Conclusion
Above: One of the visiting group being treated by a traditional Chinese doctor at the Norman Bethune Memorial Hospital, Shijizhoung. He is 'focusing energy through her body' Below left: Rehabilitation gymnasium at the China Rehabilitation Research Centre, Beijing Below right: The group with Dr Wong, head of the physiotherapy department, and her staff outside Shaanxi Provincial Hospital, Xian
Chinese 'physiotherapy' is very open to new ideas and they are very keen to make closer links with the United Kingdom. However, I know that they also already have links with Australia, Hong Kong and New Zealand. This search for new ideas seems to be piecemeal, which in such a large country could easily lead to fragmentation and conflict of ideas. It would also be criminal to import Western models of health care into China - it is important that the Chinese find a culturally relevant model which will take into account their strategies already used, such as barefoot doctors. I would suggest that if the United Kingdom is invited to help with rehabilitation planning in China that we offer to help set up a multi-national consultative group to help the Chinese plan for themselves with help from outside.
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