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China 2013: Thoughts by Kristin Richter, MD

At the beginning of 2013, I was mid-way through my PGY-2 year at Indiana University (IU). Halfway through my residency training process, I felt like I had a good handle on my clinic, patients, and the inner workings of Methodist Hospital in downtown Indianapolis which was now my home. I had no idea that just before Thanksgiving, as luck would have it I'd be traveling to Hubei province, China to take part in a team effort to bring knowledge and medical supplies to a special needs orphanage in Xiangyang, China. A completely unfamiliar environment, language, and a unique set of roadblocks lay just ahead of us. My friend and colleague, Justin Ramanauskas and I were two PGY-2 medical residents who would be joining a group of four Pediatric residents, a Peds Cardiologist, a Peds Developmental Specialist, and a Family Medicine attending physician on our journey to China. Needless to say, we were excited.IMG_0068.JPG

As soon as we landed in Beijing, we were met by one of the adoption agency's guides named Shirley. Her agency was closely partnered with the orphanage we planned to work with, and she joined us in order to learn more about the health of children who could potentially be adopted from the orphanage. She had already spent many years working in collaboration with various teams from IU who were planning on moving further inland to the Hubei province of China, to the city of Xiangyang, where an orphanage full of children were awaiting our arrival. A quick note about Shirley - she was a lifesaver. Quick-witted, in perfect English, she would steer us around the sites in Beijing, where we stayed for a few days prior to getting started at the orphanage. Having previously attended university in the USA, she had the unique quality of being able to function well in both worlds. This was immensely helpful to us as we scrambled to pronounce Mandarin properly, without inadvertently insulting anyone.

After a few days exploring Beijing, we took a small plane a few hours west to arrive in Xiangyang, where we were introduced to the orphanage director and assistant directors. From there, the real work began. We spent long days examining the children of the orphanage, many of which had special needs like Cerebral Palsy, Down's syndrome, or Autism. We made treatment recommendations, fitted kids with braces, and working alongside our staff to identify any new concerns. Many children were very healthy, IMG_4033w.JPGand had fallen into the hands of the orphanage due to unsightly birthmarks, or a slight physical ailment. The one thing that both Dr. Ramanauskas and I noticed was how well the resources seemed to be used at this particular centre. They made due with very little, but they also had many hard-working and invested caregivers who seemed to know each child inside out. It was very much a labor of love, as we later found out that being a caregiver wasn't a lucrative job, it demanded long hours and didn't pay well. The entirely female staff were the backbone of this orphanage, and through their efforts, many of these children were able to be listed for adoption both within China and internationally. They are making changes to each child's future and we were privileged to witness this.

We also spent a significant amount of time teaching the caregivers about basic pediatric concerns. Scabies, for example, ran rampant throughout the infants of the orphanage. After our talk on scabies, and the treatment options, we could see visible understanding on the faces of the caregivers, and I felt confident that this would soon be an issue of the past. Permethrin cream and washing in hot water were two small changes they could make, and we were assured by the director, who was a strict but also very caring woman, that this would be done without issue. I think the clinical exams, EKGs, and echocardiograms that we were able to provide served a purpose. The teaching that we were able to accomplish will likely leave an even larger footprint; and I was proud to be involved in that substantial effort, as a lot of prep work went into our presentations prior to landing in China, including translating pamphlets into theIMG_0048w.JPGir native Mandarin.

In conclusion, yes, we climbed the Great Wall. We went to night markets in Beijing. We rode rickshaws in old neighborhoods called 'Hutongs' through old Beijing. We saw where history happened years before in Tiananmen Square. We also met some amazing children at an orphanage that you would never see as a tourist. We did more than 50 Echocardiograms, read on site, on many children born with Down's syndrome. We played with kids young and old, we thanked their tireless caregivers, and we taught the medical staff (through translators) in a series of lectures given to the nearby medical community. We learned more about developmental pediatrics in those few weeks than we probably would have at home in a year. We shared so many unique experiences at the orphanage and beyond that will only help to broaden our skills and continue to humanize the field of medicine. I know it helped renew my passion for healthcare at a time in my training when it was difficult to see the finish line. To China and the children of the orphanage, I'll say 'xie xie'.

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