Maggie in the Middle Kingdom

Antibiotics! For Everyone! And Everything!

I have long been galled by the easy availability of antibiotics in this country, but I recently saw it taken to a new extent. I walked into a pharmacy hoping to find some ibuprofen. I told the pharmacist that my back hurt and that I was looking for an anti-inflammatory. After we spoke for a few minutes and I felt confident that she understood my problem, she pushed a box across the counter to me. I bought it and only later realized that it was Ampicillin, an antibiotic often prescribed for infections of the sinuses, bladder and kidney.

It's as if pharmacists here are TRYING to create the next great superbug.

A Little Chinese Medicine

If I ever get some kind of infection or break a bone, I’ll head straight for the best Western hospital in Kunming. But when my back pain (I'm blessed with a few herniated discs) flared up recently, I went to see a traditional Chinese doctor. As far as I know, Western medicine treats herniated discs with physical therapy (not available here), painkillers (have some, avoid taking them) and surgery (hope to never need it).

I went to the doctor with my friend Jenny, who’s here studying Chinese medicine. We went to the Yunnan School of Traditional Chinese Medicine. The small building surrounds a courtyard that has a strong smell of medicinal herbs. We paid 7 yuan to a receptionist and she sent us to Station 6 to see a doctor. The first thing that struck me was that no one considers your time with the doctor a private matter. We sat down together to see him, and the patients waiting behind us sat on a seat in the same room, or stood in the doorway (there was no actual door).

You Want Moss With That?

The doctor looked at my tongue and took my pulse in both wrists. They are supposed to know how to determine all sorts of things from feeling your pulse—whether you are sick, pregnant, etc. But disappointingly, he asked me what was wrong. Maybe he was worried I wouldn’t be able to understand what he said. Anyway, I told him my back hurt. He pulled out a sheet of paper and wrote the names of about a dozen different herbs on it. I took my list to the pharmacy, where a woman in a lab coat retrieved my moss, licorice, jujubes, and whatever else. I then took that to a little lab where they cook it all into a drinkable concoction (pick it up in two hours—not too bad for a place where they actually have to MAKE your medicine. I’ve waited longer for someone to count out 30 pills for me at Duane Reade). They give it back to you in perfectly sealed bags; each dose is about one cup and a half. It tastes bitter, but it’s drinkable.

Knead it Out

After dropping off our herbs to be cooked, we went up to the Tui Na/Acupuncture room for some more immediate relief. The room smells of the herbs cooking downstairs, and again, you can forget about privacy. Everyone gets their treatments in one room, without even a curtain to separate you from the person next to you.

There seem to be two kinds of massage here: tui na and an mo. An mo is what I’ve been getting at the blind person massage joints, and it’s not bad. Tui na is medical massage. It's harder than an mo, and uses a lot more elbows and kneading. It seems to have a fair amount in common with Swedish massages I’ve had in the past, and is much more satisfying than an mo. It's also specific to your ailment; my friend’s massage was not the same as mine.

“How Many Needles Are You Using?”

After the massage, Jenny asked for some acupuncture. I watched the acupuncturist put the needles in, and watched her lie there with them sticking out of her body. I really wanted to try, out of both curiosity and the desire to feel better. I asked her if it hurt, and she said, “Not at all.”

“Fine,” I said. “Let me try.” I lay down on my stomach, and he put the first needle in my back. It hurt—not so much when it pierced the skin, but once it was in. I grimaced, and he put in another. It hurt again. “Ni yao yong ji zhen?" (“How many needles are you going to use?”) I asked through gritted teeth. He told me five. Fine. I could take that. Four went in my back, and one in my foot. I could hardly feel the one in my foot, but the ones in my back really hurt.

“Oops,” said Jenny. “I forgot yours would be going in a painful place.” I’m actually glad she didn’t tell me, because I might not have tried otherwise. The pain was the same as what I’d felt the past few days whenever I tried to tie my shoes or get up after sitting down for a long time, so it wasn’t exactly anything new. It just wasn’t something I expected to feel while lying down. It hurt more if I took a deep breath or tried to talk loudly. After about five minutes, the acupuncturist tweaked my needles a little, which hurt some more. After another five minutes, he took them all out. I think I asked three times if they really were out, because I still felt like they were inside.

Immediately after, I felt a little sore, but as we walked across town I started to feel better. The relief, which was definitely worth the pain and the 60 yuan I paid (for the tui na and acupuncture together), lasted two days. I have been back twice in the last week. The second time he put a needle in my neck, which was a little scary. The whole thing basically amounts to an hour of torture, but it is definitely helping with my pain. So there you have it—I am officially hooked on having a guy throw needles in my back.

You Deserve a Massage—Every Week

Yesterday, I went for my first massage since getting here. I know, I know, I can't believe I waited so long either. But until my first checks start coming in, I've been saving my yuan for down payments on my apartment and classes. I've been very stiff, though (thanks to Chinese beds and a pulled hamstring), so I decided to indulge myself with a little Zhongyao (Chinese medicine). To my surprise, an hour massage was just 30 RMB, or about four U.S. dollars. And if I buy a card for several sessions, it gets even cheaper.
Therapists, interestingly, are almost all blind. It's traditionally one of few career options for the blind here.

Getting a massage is just part of life for locals, part of the health care routine. It doesn't come with all the trappings we're used to at most places in the States—you know, aromatherapy candles, dimmed lights, soundproof rooms with calming music or nature sounds piped in. There's much less privacy and less drama surrounding the experience. But the place I went to (about one minute's walk from my apartment building) was clean and comfortable, and the therapist took fresh towels and a sheet from a closet to put on my table. For four bucks a pop, I'm happy to forego the frills.

Two Comforting Discoveries

After a month of off-and-on, sometimes-moderate, sometimes-severe stomach pain, I was about to throw in the towel and either go see a doctor or try OTC antibiotics. But a woman on my soccer team had suggested I try eating a yogurt (LGG brand, with live lactobacillus cultures) so I decided to try it. I started feeling better almost immediately. This yogurt (available at Carrefour) is a little expensive but it will now be part of my regular diet. And I recommend that anyone coming out to visit me steel your stomach by eating a similar yogurt, or taking a probiotic, a few days ahead of your trip.

So that's discovery #1. The second one was when I went to Richland International Hospital (in the photo below), to see an American doctor for my visa physical. A woman met me at the front door of the brand-new hospital, whose lobby was more like a hotel, and showed me upstairs to see the doctor. And who should walk out the door, but my soccer teammate, the same one who recommended the yogurt. So not only do I have a home remedy for stomach ills, but I get to see an American doctor every Monday night.

(The bad news is the government will only accept a physical from one certain hospital in town, so tomorrow I have to go to a real Chinese hospital).

Antibiotic Nation

My Chinese friend Harvey got sick recently. He went to the hospital and was up and about with us the next day. One of the American college students at Keats remarked that when sick the Chinese always seem to go to the “hospital” (often this just means a storefront clinic), get an IV of something, and get well quickly.

My first thought was that they were just getting IV fluids; when the body’s supply of electrolytes and nutrients is depleted by illness, a heavy dose injected straight into the bloodstream can speed recovery. But later that evening I gave it more thought and wondered if they weren’t getting antibiotics through those IVs. 

A quick Google search turned up this article from Time magazine in 2005. Apparently, I was correct (probably; it IS an old article). The Chinese are in a love affair with antibiotics. I even discovered that, although over-the-counter antibiotics are supposedly illegal here, they can be bought at your friendly neighborhood pharmacy, for 10 yuan (that's them in the photo, 100 mg tabs of Levofloxacin; instead of bringing a prescription, I just had to bring a dictionary so I could point out the word for "antibiotics").

While this is somewhat good news for me personally (there’s an appeal to the idea of prescribing myself antibiotics instead of trying to visit a doctor who doesn’t speak my language), it’s bad news for the state of health care globally. The overuse of antibiotics leads to the creation of drug-resistant bacteria; thus the constant need to develop new antibiotics.

I mentioned the Time magazine story, as well as my discovery about cheap over-the-counter antibiotics to two American college students at Keats, thinking it would start an interesting conversation. But they just gave me an “Mmm hmm.” The information apparently meant nothing to them. I don’t think there is widespread awareness among Americans about the challenges that overuse of antibiotics creates for public health, but at least in the states, this issue is held in check somewhat by the requirement for a doctor’s prescription for antibiotics. But even if they really required a prescription here, it would solve the problem: 70% of drug prescriptions in China are for antibiotics, compared with roughly 30% in the West, according to the above-mentioned story.

And here are a couple of other scary facts from an ABC Radio report by Norman Swan: “The National Food and Drug Administration says three-quarters of out-patients with colds and 79% of in-patients in Chinese hospitals are given antibiotics… They also stop taking the drugs once they start feeling better, instead of finishing recommended courses. This allows the strongest bugs to survive, mutate and develop resistance.”

It’s understandable why the Chinese would want easier access to antibiotics. It’s easy to pick up some nasty stuff here: Even in Kunming, a relatively developed city that’s the capital of its province, people drink only boiled or bottled water, and skin peaches and plums before eating them. But the rampant use of antibiotics will only worsen the problem, creating super-germs that can easily be exported. Bird flu gets the headlines, but it seems likely that a potent bacteria strain will make a trip around the world first.

Personally, I, of course, have gotten sick since coming here.  Very early on, after a week of mild stomach issues and less-mild sinus issues, I resorted to the course of ciproflaxin that my doctor had prescribed me before I left New York. It fixed me up right away. Last week, my stomach started to go sour again. After a few days of recklessly maintaining my same adventurous eating habits, I’ve decided to try something new. I’m eating nothing but soda crackers, bananas and chicken soup. I’ll give my body a few days to see if it can beat the bug. I have the idea that maybe my body can learn to fight some of the bacteria here. Of course, if this goes on a few more days, I guess I’ll hit the antibiotics.