By Candice Hwang, MD, Stanford Global Health Track Resident

When I tell the story of why I want to work in global health, it always comes back to my upbringing in China. I grew up in Shanghai where, in many ways, the quality of life is the same as that in high-income countries. One place that I distinctly remember feeling a difference was in hospitals, where countless people crammed through the hallways, pushing into examination rooms to get seen first, many coming from distant villages to seek the best care possible in the big city. When my grandmother was getting treatment for acute myeloid leukemia, a family member would first need to donate a unit of platelets to the blood bank before it would release a unit of platelets for her to receive. Witnessing the resource constraints and the disparity in healthcare quality between urban and rural parts of China propelled me toward a career in medicine and global health.

After a few early career experiences in Africa, I was eager to turn my focus back to China, which is why I was so grateful for the opportunity that Stanford and the University of North Carolina provided to complete a clinical rotation in Guangzhou. I spent six weeks at two clinical sites: the Guangzhou Eighth People’s Hospital, focusing on care for people living with HIV, and the Dermatology Hospital of Southern Medical University, focusing on STI care.

At both hospitals, the doctors worked incredibly hard. The dermatologists I worked with regularly saw 40 patients in clinic every morning. Their dedication is especially impressive at a time when China’s doctors are experiencing significant pay cuts due to financial strains at many medical institutions. At a community health center that I visited, beyond taking the clinical shifts for which they are paid, many doctors also opted to become responsible for delivering primary care to a surrounding village catchment area. Once or twice a month, they would pay for their own transportation to the village and volunteer their time taking blood pressure, measuring blood sugars, and triaging which patients needed to come up to the city for higher-level follow-up. Some doctors may have signed up initially as a way of building their resume for workplace promotion, but over time, as their relationships with these villagers grew, many now feel deeply responsible for their care, regardless of compensation. In China, being a doctor seems to be inseparable from being a public servant. This level of selflessness is admirable, though I wonder whether this approach is sustainable over the course of a career.   

Sustainability as a doctor is difficult as it stands given the sad stories that we inevitably encounter. In the HIV ward, I learned about a young man with late-stage AIDS and tuberculosis that had disseminated to his intestines. He was in critical condition after a surgery to remove necrotic bowel. He needed a blood transfusion, but the only family member he had was his pregnant wife, who could not donate blood. As was the case with my grandmother, there needs to be a contribution to the blood bank to receive a transfusion. His young wife was trying to cobble together finances to instead buy the blood products he needed. It was heartbreaking. As a new mom myself, I cannot begin to imagine the terror I would be facing if my husband were so severely ill in a hospital, my future with my unborn child was so uncertain, and I was struggling to organize the resources needed for my husband’s care. On inpatient wards in the US, I feel privileged that my clinical care decisions for patients are generally shielded from financial and other resource constraints. If I had to constantly weigh the ethical issue of whether I should step in to contribute, for example, whether I should donate a unit of blood for the patient, then I would be drained.

Of course, being a doctor also comes with great rewards when we can significantly improve a patient’s life. In dermatology clinic, I saw cases of severe plaque psoriasis that were controlled beautifully with systemic biologic therapies. New biologics and other treatments come to market in China not long after they are approved in the US and are widely available in larger cities. Furthermore, these drugs are often much more affordable in China, with some patients even traveling back from abroad to obtain their refills.

Ultimately, I leave this rotation feeling even more committed to being a bridge for exchange of medical personnel, healthcare expertise, and research opportunities between the US and China, at a time when their geopolitical relationship has become ever more fraught. I have found friends, mentors, and research collaborators in China, and I hope to continue to nurture these relationships over the long term. My motivation for working in global health comes from my upbringing in China, and I aim to bring back the skills I have picked up from working around the world to tackle the health system challenges that remain there.