2011 Grant Recipient 
China
DNP Program, School of Nursing
The student will be involved in ongoing international collaborative research projects related to child health, nutrition, obesity, and chronic diseases (e.g., type 2 diabetes, metabolic syndromes, cardiovascular diseases) in China. These include observational, cohort studies and interventional trials (e.g., school-based obesity prevention studies). The projects provide training and research experience in data collection, data management, data analysis, and research reporting/paper writing. These projects may potentially provide publication opportunities as well. Some of these projects involve large population samples (from several thousands to millions of people) and different target populations such as: children, adults, and twins. The National Institute of Health (NIH) funds several of these projects.
Personal Narrative:
I was born and raised in southern California and never visited China prior to the field placement award; therefore, when receiving the notice that I was going to the country where my parents were born, I was elated with great joy. I soon realized upon my arrival to China that my knowledge base about the culture and current state of economics and healthcare in that country were outdated and inaccurate. The associates at the Nanjing Municipal Center for Disease Control and Prevention (CDC) facility of Nanjing, China were kind enough to correct me of my inaccuracies and highlight the experiences of the Chinese people. Over the next five weeks, I enriched my perspective on the culture, history, and the people of China. The Chinese have overcome several hardships and obstacles in the past. There have been countless events that have tested the strength, intelligence, perseverance, and patriotism of this nation. The citizens of China had to continually rebuild and reinvent themselves after such events like the Nanjing Massacre and the 1976 Tangshan earthquake. One of the most recent and devastating natural disasters that tested the resilience of the people of China was the 2008 Sichuan earthquake. The 2008 Sichuan earthquake is considered one of the top 21 deadliest earthquakes killing 69,197 people, injuring 374, 176, and leaving 4.8 million homeless (1, 2). The deadly earthquake measuring 8.0M left the nation vulnerable to public healthcare issues, anticipated economic decline, mass media coverage, and criticism of the nation’s government. Despite this adversity, the citizens of China banned together along with foreign allies to rebuild the country in terms of: economics, technology, healthcare, and infrastructure. The government of China was praised for their openness in media coverage, warm welcome of foreign aid, and quick recovery due to the devastating event. In spite of these obstacles, China is now considered an industrial powerhouse for producing clothing, footwear, computers, agriculture, and automobiles (4). China is ranked as the world’s second largest economy by gross domestic product (4). These characteristics of strength, resilience, and reform are also applicable to the public healthcare system in China. In 2005, The New Rural Co-operative Medical Care System (NRCMCS) was introduced to the healthcare system, which made healthcare more affordable to the rural poor. This allowed another 685 million Chinese to gain access to affordable healthcare (5). Secondly, the public health system in China has made huge leaps in eradicating several public health issues that affected the health of the citizens in China. By employing health policies in the 1950’s, several diseases related to sanitation and hygiene were controlled and even eradicated. Such policies like pests control, preventative measures against cholera, typhoid fever, and scarlet fever, and improved water quality and waste management are a few of the key examples in the reform of the public healthcare system in China. However, over several decades, new public health issues have emerged that pose a risk to the health of the Chinese. As the nation continues to develop in economic wealth, affects of Westernization and affluence begin to burden the health and lives of the Chinese. The public health sector in China is seeing growing trends in: HIV/AIDS, respiratory disorders and comorbidities attributed to environmental pollution, obesity, and increased tobacco smoke consumption/use (6, 7, 8, 9, 10). According to Qian, Min, Gao, Tang, Xu, and Critchley (2010), 49% of men and 3.2% of women in China consume first-hand tobacco smoke (11). The rate of tobacco smoke consumption can be as high as 66.8% of male residents in rural settings in China (12). As a result of these growing public health problems, the staff at the CDC in Nanjing, China initiated a healthy living campaign to control tobacco smoke consumption and exposure. The public health division at the CDC in Nanjing, China recently received a research grant from Emory University for a “No Smoking” campaign project and they are in their first year of implementation. The primary objectives of the project emphasizes on the following key points: 1) to ban smoking on all primary school campuses, 2) to provide educational sessions to the students in primary schools that smoking is harmful to ones physical well-being as well as to those around them, and 3) to provide education to parents of the health implications and repercussions of first and second hand smoke exposure through parent/teacher conferences, educational seminars, posters, and pamphlets. Long-term goals of the CDC in Nanjing, China are to ban smoking in public sport arenas as well as all public areas like restaurants, office buildings, and etc. The growing rates of adult and childhood obesity are also becoming a serious public health issue in China. The prevalence rate of overweight and obese Chinese has reached 50% in adults and approximately 20% in children in major cities of China (13, 14, 15). Therefore, the vice director of the CDC in Nanjing, China, Xu Fei, PhD, collaborated with Youfa Wang, PhD, an associate professor at the Johns Hopkins University Bloomberg School of Public Health, to study the growing trends of obesity and attributable comorbidities seen in both the United States and China. In collaborative efforts with Youfa Wang, PhD, and Xu Fei, PhD, I assisted with two literature reviews regarding the physical education and physical activity system in China compared to the United States. Drafts and publications of both reviews are still pending. Lastly, my understanding and experiences in global health is novel at best; however, this field placement stimulated my interest in global health research and validated my career choice in nursing. I have been a practicing nurse practitioner for three years. A colleague in China requested my services as a pediatric nurse practitioner. His one-year-old daughter was seen several times at the hospital for an acute illness. The child was discharged with antibiotics and two days later the child presented with a full body rash that was not itchy or painful. These consecutive events frightened my colleague and he turned to me for help. Pictures and text in Mandarin, Chinese were sent through emails and phone text messages. As the history unfolded on the child’s presenting symptoms, differential diagnoses started to fill my head. I started to cross off the differential diagnoses one by one as more of the story started to reveal itself. Finally, the remaining diagnoses that were left were clear in logistics. I sought out to reassure the family of the diagnosis and its self-limitation without treatment. I searched the Internet for similar pictures and information regarding the diagnosis for the parents to read. That night the parents thanked me and took my advice to monitor the child and to seek care of a healthcare provider if questions or concerns were to develop. A few days later I saw the colleague and was thanked once again for the sound advice given. The child was better and the illness had resolved on its own. I saved him time and money from a midnight run to the emergency room due to panic and fear. It was this defining moment that I understood my placement in China and in nursing in general. Even though the conclusion of the journey may not have met the original objectives intended, I am thankful for the opportunity given because it gave me a chance to self-reflect on my own personal goals as well as validate my duty and service in pediatric nursing. References:
1) Casualties of the Wenchuan Earthquake. (2008). Retrieved from http://news.sina.com.cn/pc/2008-05-13/326/651.html.
2) Agence France-Presse. (2008). More than 4.8 million homeless in Sichuan quake: official. Retrieved from http://www.reliefweb.int/rw/RWB.NSF/db900SID/PANA-7EPG6V?OpenDocument.
3) Xinhua New Agency. (2008). Magnitude of SW China earthquake revised to 8.0. Retrieved from http://english.gov.cn/2008-05/18/content_981724.htm.
4) CNN. (2009). China passes Germany in economic rankings. Retrieved from http://edition.cnn.com/2009/WORLD/asiapcf/01/15/china.economy/index.html?iref=topnews.
5) Carrin, G., Ron, A., Hui, Y., Hon, W., Tuohon, Z., Licheng, Z…Xuesheng, L. (1999). The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties. Social Science and Medicine, 48, 961-972(12).
6) Honolulu Community College. (2001). Smoking will kill one third of young Chinese men. Retrieved from http://home.honolulu.hawaii.edu/~pine/Phil110/chinasmoking.html
7) Didi, K.T., (2010). China’s Tobacco Industry Wields Huge Power. The New York Times. Retrieved from http://www.nytimes.com/2010/06/11/world/asia/11iht-letter.html
8) Kennedy, B., (1999). Serving the people? CNN. Retrieved from http://www.cnn.com/SPECIALS/1999/china.50/dispatches/09.23.health/
9) People’s Daily. (2000). Obesity Sickening China’s Young Hearts. Retrieved from http://english.people.com.cn/english/200008/04/eng20000804_47271.html
10) Avert. (2006). HIV and AIDS in China. Retrieved from http://www.avert.org/aidschina.htm
11) Qian, J., Min, C., Gao, J., Tang, S., Xu, L., & Critchley, J.A. (2010). Trends in smoking and quitting in China from 1993 to 2003: National Health Service Survey data. Bulletin of the World Health Organization, 88, 769 -776.
12) Kelly, T.N., Gu, D., Chen, J., Huang, J.F., Chen, J., Duan, X…He, J. (2008). Smoking patterns and sociodemographic factors associated with tobacco use among Chinese rural male residents: a descriptive analysis. BMC public health, 8, 248 -248.
13) Ji, C.Y., & Working group on Obesity in China (WGOC). (2007). Report on childhood obesity in China (4) prevalence and trend of overweight and obesity in Chinese urban school-age children and adolescents, 1985-2000. Biomedical and Environmental Sciences, 20, 1-10.
14) Mi, J., Cheng, H., Hou, D.Q., Duan, J.L., Teng, H.H., & Wang, Y.F. (2006). Prevalence of overweight obesity among children and adolescents in Beijing in 2004. Zhonghua Liu Xing Bing Xue Za Zhi, 27, 469-474.
15) Wang, Y., & Lobestein, T. (2007). Worldwide trends in childhood obesity. International Journal of Pediatric Obesity, 1, 11-25. Photo Album:  | Qin Huai River in Nanjing, China. |  | Nanjing Massacre Memorial Hall-Rememberance of the 300,000 victims affected |  | Dr. Sun Yat-sen Mausoleum (???). Resting place of the leader of the 1911 Kuomintang revolution |  | 2010 Expo in Shanghai, China |  | The skyline of Pudong in Shanghai, China |
|
