I was so honoured to go to the University of Cincinnati to study for 8 weeks this summer. We cherish this chance very much , we won’t have this wonderful experience in our medical student’s life without the cooperation of UC and CQMU(Chongqing Medical University) . So, we thank all of you and our university for what you’ve done for us.
On May 24th, we started our journey to USA, even though our flight was delayed, but we arrived Cincinnati safely. In the first week, we prepared our permenant badges. People there are very friendly to us,especially when we got lost ^-^. Our schedule was arranged after we settled down, we can choose the subjects which we are interested in . Actually we can rotated in an adult hospital, but our major is pediatric, so after talked with Dr. Lehmann, we preferred to stay in CCHMC for 2 months.
When I saw the CCHMC at the first sight, I was so surprised :how can a hospital built so beautiful and lovely ! I can still remember the moment when we arrived the welcome center in B location, I was attracted by the large picture which shows the sun, the ocean, and some animals. Of course, in the following 2 months, I also saw some other lovely decoration all over the hospital. Then I found that, the CCHMC is not only a hospital, but also a fairyland to the children.
In the two months , I observed in two departments, one is NICU in UH, the other one is Hematology/Oncology. I used to rotate in NICU in Children's Hospital of Chongqing Medical University( CHCMU), so I can compare the differences between each other. But Hem/ Onc is totally new for me, so I think it's much difficult for me to observe there at first. In the following, I will talk something separately by department.
In NICU , there are some differences from CHCMU.
1) the NICU is connected with the obstetric department, so we can get the detail information of the sick baby more easily, and we can also treat the baby more quickly.
2) there is a group work for the patients: attending, fellow, resident, medical student, nutritionist , pharmacist , lactation consultant, respiratory , nurse, and also the parents. This kind of teamwork is much more efficient. And the parents also can help to treat their own baby, which maybe called family centered care.
3) they emphasis breast feeding, especially for the very early premies. There is a milk bank in Ohio. The babies whose mother can not pump enough milk after they born the baby can get the donated milk from the bank, then they can get some antibodies or more proteins or some other nutritions from the the breast milk. And they encourage the mother breast feed the baby as if the baby can live without too much oxygen.
4) they calculate the TPN in a different way, firstly follow a TPN form, then combine the condition of the patient, and with the help of a pharmacist , we can get the number of each nutrition.
5) they add the milk fortifier into the breast milk to give the baby enough vitamins, energies and some other nutritions.
6) they use CPAP more. If a premie is going to be delivered, the resident on call, the fellow and a practiced nurse will go to the OR or delivery room to wait for the baby. After the baby was delivered, they will give the baby CPAP immediately . The use of CPAP can help to reduce the oxygen toxicity. And there are bubble CPAP and regular CPAP, the former is much betterit because can provide more gas exchange for the baby .
7) when the baby was admitted into hospital, the parents are allowed to visit their kids and accompany them as long as they want. They believe that with the parents’ hug or kisses or visits , the kids can feel the love from the parents, and it helps the baby to recover more quickly. So dose the nurses. When they feed the babies with a bottle, what they do is just like a mother dose, to hug the baby, to shake the baby , which seems very harmony.
8) the baby get circumcision when they are in new born stage. Most of the baby will do that operation before they leave . So one of the attending made fun of me, he said after I go back to china, I will be a competitor to the urinary surgeon.
9) for the residents, there are conferences every day, which are held by different fields, but their aim is to get a better treatment for the baby. One of the attendings also requested that every resident could give us a little talk after the morning rounds, the topic is decided by themselves. I also had a talk at that time.So I think it's useful for the residents to learn more. And what’s more, there are neonatal grand rounds every Friday, some fellows will talk about their research in the rounds, most of them are about clinical research. I can still remember some topics such home birth, the mortality of premie in different hospital in Cincinnati, fetal therapy and so on. Besides the things above, there are fetal therapy meeting every Thursday. The fellows will choose some typical cases to report, then the specialists ( including neonatologist, cardiologist, pulmanologist, genetics, ultrasound doctors, radiologist ,surgeon and so on) will discuss together about the fetal’s problem.
10) it seems that the infection of the GBS is much more common than China. And for the little babies, they use the vancomycin /tobramycin at first, which can control the infection more strongly.
11) I met one case when I was in NICU. The mother is 23 weeks GA, but she has incompetence cervical, and the baby is easily to get out. According to the basic rules, it’s hard for less than 23 weeks premie to survive, so if a premie is less than 23 week, the doctors won’t do the resuscitation, and for a premie who is over 23 week, his parents will decide whether to do the resuscitation or not. So for the mother above, the attending and the fellow talked with her and her family member about it, and finally they decided to not to do the resuscitation .
12) in NICU , the baby whose mother is addicted to drugs is more common than China. Those babies will get abstinence syndrome easily. So the baby will use methodone and with a lower dose day by day. The nurse will give a score to estimate the condition of the baby everyday, only if the baby get the lowest score, we can discontinue the methodone.
13) the high risk clinic is very interesting. Most of the patients are premies with chronic lung disease , or got the surgery when they were in new born stage. Some babies went home with a nasal canular, or NG tube or gastric fistula. So they should come to the clinic to see whether they take the pills on time and how they during their life at home. If they are getting very well, they will be followed up until 2 years old, if not ,maybe they need a longer time.
Those points above are what I have learned in NICU, and maybe there are some other differences or advanced knowledge that I haven’t know,but I believe that it’s already a wonderful experience for me.
I was in Hem/Onc department in the second month. Before I went to CCHMC, I haven’t been to the Hem/Onc before, so I think it must be challenge for me. But the people there are very nice to me, so I still learned something when I was there.I spent time in clinic and in-patient department half and half.
1) in this department, they divided the patients into 3 groups,one is hematology, one is liquid tumor, and another is solid tumor. Hematology include sickle cell disease, anemia, hemophilia, thalassemia, ITP, G-6-PD and so on. Liquid tumor include leukemia, lymphoma. Solid tumor include all kinds of blastoma ,tumor and some other masses.
2) in clinic, I visited patients with fellows, attendings. Some of the patients are following up, some of the patients are getting chemo therapy (including IV, intrathecal infusion), some of them getting bone marrow biopsy or lumbar puncture.
3) I also went to the OR to see how to harvest the bone marrow. The procedure of harvesting is the same with the bone marrow puncture, but with a larger amount and a longer time, and it must be done in the operation room. When they think the BM amount is enough, they will send a BM sample to the lab to check the exact cell number firstly, then decide to continue it or stop it.
4) in clinic ,for the patients who get chemo therapy, they had a schedule to show the treatment for 1 month, the nurse and the parents can get one separately. So they can cooperated each other very well.
5) in every clinic room, they are decorated as many animal rooms, so the patient may feel much comfortable and less nervous. It’s the same that’s why the doctors don’t wear the white scrubs.
6) the relationship between the patients and the doctors is very harmony. The doctors treat patients very nice, sometime they play with the little kids, sometimes they play jokes with the older kids or adult patients, sometimes they touch they patients gently and softly, so the patients fell relax when they are visited. With a good mood may help patients recover more quickly.
7) in the in-patient room, there is a specific room called play room. There are many toys, videos, books, electronic games in that room. For those inpatients, they can use all the things in that room to kill time and keep a good emotion. There will be some other specialist of child life and volunteers to paly with the patients. Sometimes the doctors will visit the patient in that room and paly with them, so that the doctors can get a well cooperation with the little patient.
8) I was moved by some photos on the wall of the bone marrow transplant department. Those photos showed some patients’ lives after getting BMT, which touched me most is the 3 brothers and their sister. The 3 boys were diagnosed with the X-linked lymphoproliferative disorder. So their older sister and another strange girl donated the bone marrow for the 3 boys. And when I was there, the parents brought the 3 boys to the hospital for following up, the 3 boys looked very well, and they also brought an album which recorded how the 3 boys’ lives in hospital and after discharged. The 3 boys also took a photo with the strange donor, the father said after they got BMT more than 1 year, they can contact with the donor. And the parents thanked for the doctors and nurses and other colleagues for helping them when hospitalized. I think that the patient’s health and happy life is what we want.
9) they accept some adults patients as well, for the Hem/Onc in CCHMC is good at threating that kind of diseases. So the adult patients can also get a well treatment there. And some patients are following up until they become an adult. I think this way can help the citizens to get a better use of medical resources.
10) when I was there , I thank for that Dr. Absalon gave me a chance to stay with an adult patient alone for a while, so I can chat with him about how’s things going from his last visit, and then I can practice writing a SOAP. I followed up the same patient until I left Cincinnati. I also chatted with some other patients with the permission of the fellow and the parents. I cherish the chance to talk with the patients, because I think the patients are best teachers for us.
Finally , I spent a happy life in CCHMC and Cincinnati. I met so great teachers, so nice friends and so excellent medical environment. There are many differences between each other indeed, I also exchange our daily life and my medical experience in China with them, maybe the friends in USA can not understand our life , I think it’s decided by national conditions, we can not change it right now, but we have the aim to do it better. Because of this unforgettable experience in Cincinnati, I believe that “I can also change the outcome”. And I also hope that our first experience may help the two universities with a better cooperation.