Category Archives: Shantou

Shant-outings*

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*Thanks to Joshua for the oh-so-punny title

As mentioned previously, Shantou is tucked into the coastline of the South China Sea, making it the perfect jumping off point for day trips to the numerous surrounding islands. On our first weekend in China, myself and the other Canadian exchange students took the ferry for 1 yuan (~20 cents) across the Shantou Harbour and landed on the idyllic shores of Queshi island. We were greeted by a woman expertly dissecting pineapples with a machete and neatly skewering the slices onto long skewers. An entire pineapple for 7¥ ($1.5) seemed a reasonable price to pay for a snack as we walked along the island’s meandering paths.

View of Queshi from the Shantou side of the sea

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Our goal was the pagoda we had seen every morning we walked along our side of the harbour. On our way up the mountain, we explored a series of naturally formed granite caverns with such enchanting names as “Rainbow Lying Cave,” “Happy Fate Cave,” “God’s Shoe,” “The Platform for Watching Sight of Flame Mount,” and “Three-Tier Cave Toilet” (on second thought, maybe that last one was 2 separate stops…)

View of Shantou from the Queshi side of the sea! 

Terrifyingly steep steps into the caves!

Lovely lunchtime stop
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Giant Buddha (only after an entire photo sesh with G.B. did we realise we had been sitting in front of a sign that read, in Chinese, that pictures cost 2¥ each… and consequently a terrifying encounter with the giant security guard ensued)

After eating lunch in the pagoda at the mountain peak and paying our respects to giant Buddha back down on the ground, we headed back to the ferry. Before we had even landed back on mainland, we were already receiving WeChats from our host students, inviting us out for an evening of quintessential Chinese cultural fun: KTV.

KTV (aka karaoke) is more than just a past time in China… it’s practically an art form. Whole streets are lined with massive KTV buildings, each hosting a multitude of private rooms where groups can order food & drinks and custom-create a karaoke setlist of K-Pop and the newest Swifty singles. At KTV, the most stoic and shy of students suddenly comes into their own and discovers their latent pop stardom, belting out sexy ballads with no restraint or reserve whatsoever!

Post-KTV, we were up bright and early to board the bus taking us to a village about 2 hours from Shantou. Interestingly enough for a self-declared Communist country, healthcare is not publicly funded in China, and therefore many citizens cannot afford basic medications or even a simple doctor’s visit. Thanks to Guangdong-born Hong Kong billionaire philanthropist, the Li Ka-Shing foundation has instituted numerous charitable works to address health inequities across the country, including the one we were participating in that morning – Medical Aid for the Poor (MAP). Once a month, MAP physicians set up free clinics in villages near Shantou, providing free medications, blood pressure readings, and specialist consults. They also provide home visits for any rural citizens unable to transport themselves to the clinic.

My lunch at MAP won the honour of being the most interesting food I have ever eaten to date: I was so proud of myself initially for trying what I was convinced was liver, since I had never had that before. But when I checked in with my Chinese friend, she blithely corrected me: “Oh no, those are blood clots. Maybe pig? Probably dog.”

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Home visits & tour of the village temple

Since we were spending so much time in “small town” China (remember that Shantou’s population is a mere 5 million), we thought we should grab the chance to see big city China at its most iconic: Hong Kong.

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For being so close to Shantou, it was a headache and a half to actually make our way to HKSAR. A chartered car, a bullet train, a subway, a walk through two sets of customs, and another subway later, we were finally in our Hong Kong home for the weekend – an itty bitty hostel room on the 14th floor. The rule was that some part of each person had to be touching their bunk at all times, otherwise there was not enough space for us all in the room!

Hong Kong had some noteworthy features: milk tea, pork floss toast, the mind-blowing bus ride up to Victoria Peak (call me small town, but I have never seen buildings rising up higher than the surrounding mountains!!), and the hilarious experience of finding our way up to the “Highest Bar in the World” and negotiating with the hostesses and fellow patrons for rented pants so our male compatriots could actually enter the bar (because apparently, while shorts are incredibly offensive and inappropriate, ankle-skimming polyester gems passed around to 3 different gentleman in 1 hour are far, far more acceptable). However, in general, I do not feel the need to go back to HKSAR. I feel so privileged to have spent the majority of my time in “small town” China that actually felt unique, and not simply like a crowded version of any forgettable kitschy American town.

Buildings, buildings everywhere…

The day after arriving back in Shantou from HKSAR, we were again packed into a bus, this time to trek several hours to Nan’ao island, where we spent a lazy day hiking up to yet more pagodas, watching our bus driver carve roast chicken with his bare hands, and getting yelled at by locals for daring to swim in the ocean (apparently, that’s just not done).

All in all, our Shant”outings” made an already memorable exchange even more extraordinary. And after three weeks of this, I still had a week of true holidays left…
(To be continued!)

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Barefoot to White Coat

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Having returned from my three months of out-of-province electives, I settled back into the swing of things at home… at least for the next two months 😉 I was at home just long enough to do some CaRMS interviews for my upcoming residency specialty training, complete my final undergraduate OSCE (a lengthy clinical exam with actors pretending to be patients suffering from a variety of weird and wonderful ailments), and spend an incredible month working with the Program of Assertive Community Treatment (aka PACT), a service provided at home to individuals with severe and persistent mental illness, helping them stay out of hospital and maintain their independence in the community.

March 1 was Match Day, the day where medical students all across the country are informed which specialty program they have been accepted into; or in other words, the day we find out what type of medicine we will be practicing for the rest of our careers. I was beyond thrilled to match to my first choice of Family Medicine – Northern-Remote stream, a specialized Family Med program designed to address inequities in access and quality of healthcare for Canadians living in rural and remote areas, particularly those of Indigenous descent. While every Family Med program across Canada offers excellent medical training, I was drawn to the Northern-Remote stream for its unique decolonizing vision and immense scope of practice. And now, as of July 1, I will be a member of its team!!

“Plan B” theme party on Match Day Eve – Joshua and I showed up as WWOOFers, to nobody’s surprise!

Match Day!!

Even after some epic Match Day celebrations, the adventures were not over! Two days after the Match, I boarded a plane along with three other med students, and two days after that, we landed in Shantou, China, a “small town” of only 5 million people in the Guangdong province, nestled on the coast of the South China Sea.

Our apartment complex and view from my window

Seven minute walk from my apartment to the harbour!

The four of us had the immense privilege of being chosen to participate in an international medical exchange with one of our sister universities. Every day for three weeks, we toured two different hospital wards, ranging from Neonatology to Hepatobiliary to Orthopedic surgery. An English-speaking physician was assigned to us on each ward and would accompany us on bedside rounds of their patients.

The brain tumour research hospital… appropriately shaped.

Shantou “Hospital #1”

Bedside rounds & teaching


There were a number of striking differences in the Shantou hospital wards compared to our Canadian wards, but the most notable by far was the organization of care. In North America, family physicians (known in the past as “GPs”) are the first stop for the vast majority of patients. Sore throats, earaches, slipped discs, period problems, prostate problems, depression, pregnancy… most health concerns can be treated directly by a family doc, but if need be, the patient is then referred to the appropriate specialist for more unusual and complicated health conditions.

This type of healthcare organization, aka with a “primary care” focus, is rare in China, and the vast majority of individuals in China bypass primary care physicians and attempt to access specialists directly for all healthcare concerns. In other words, if you have a headache, you try to see a neurologist. A cough and sore throat? You hope to somehow snag an appointment with a respirologist. Partly this is due to cost: with China’s three-tiered system, individuals are required to pay for most services out of pocket, so patients do not want to risk having to pay a family physician and subsequently pay another fee to a specialist. Furthermore, there is a strong historical component that has cultivated a sense of mistrust towards the idea of primary care.

Several decades ago, the concept of “primary care” referred to farmers in rural areas who received a mere 3 months of training by urban medical professionals, in an attempt to address healthcare access issues for the enormous rural Chinese population (which represented 80% of the total Chinese population during the 1970s and 1980s). While these “barefoot doctors,” as they came to be known, provided some relief to the healthcare crisis, their training and medical expertise was understandably unequal to that provided in tertiary care centres staffed by fully trained physicians. The barefoot doctor system eventually collapsed under economic policies introduced during the Cultural Revolution.

Family Medicine was only introduced as an official specialty in Chinese medical schools in 1999. In 2009, new health reforms were put in place in response to rising public frustrations over difficulties in accessing professional medical care, as well as the steep prices associated with healthcare. The Chinese government instituted a goal of training 300 000 family physicians by 2020; even this impressive number, however, would still only provide 0.2 family doctors for every 1000 citizens (in comparison, consider that there are 1.17 family docs per 1000 Canadians – ~6x more than in China – and that is still woefully inadequate!!)

Some may think that China’s approach to healthcare is actually more effective; after all, cutting out the middle step of a family physician should likely result in faster and better service, right? On the contrary. Since 2009, primary care use in China has decreased, while visits to hospitals and specialist services have increased significantly. And sadly, death from all causes, money spent on healthcare, and inequity between rural and urban health measures have also increased in China. Multiple studies have shown that regular primary care improves health outcomes and reduces time spent in hospital. But unfortunately, in China, people with multiple different health concerns tend to use specialist and hospitalist care over regularly seeing a family physician. Moreover, people with lower incomes tend to have poorer access to primary care services, and therefore are at a higher risk for poorer health outcomes in general.

The partnership between our university and Shantou has been an exciting adjunct in addressing the primary care gap in China. While in Shantou, Canadian Family Medicine faculty and residents were very involved in giving lectures to and leading discussion groups with Shantou medical students and residents.

It was fascinating to discuss both the differences in clinical approaches between China and Canada, but also realize just how many similarities existed between our sites. As one preceptor stated, “We are all just trying to provide the best care possible to our patients.”