“The death of Nick Castle, a 23-year-old volunteer in China, raises serious questions about Peace Corps medical care.”
I don’t see this at all. The volunteer was an adult, teaching in a Chinese university. If I was in this same situation where the Peace Corps medical personnel wasn’t treating my illness I would consult colleagues or friends to find a good local doctor for treatment (and unlike the U.S. doctors there don’t charge crazy prices).
Depends on the doctor and where said doctor works, whether a state-run hospital or private. And insurance for expats here isn’t priced at the nickle and dime level.
I was a Peace Corps volunteer in China, and my heart goes out to the family.
Dr. Gao was my doctor, and she was always sweet and competent. I’ve seen volunteers go through illnesses from minor to large, and all of the volunteers I’ve known have received appropriate care.
That said, I could see how the medical office could be unprepared for an emergency. Like a student health center, it primarily handles minor illnesses- and as you can imagine, diarrhea is very common. Volunteers undergo an intensive health investigation prior to arrival, so complex issues are very rare. Anything complex either calls for follow up with a local provider, or evacuation to a regional hospital with Western standards of care.
There are no Western standard hospitals in Chengdu. The hospitals are Chinese hospitals-- meaning they are crowded, do not have English speaking staff, and provide treatment according to the Chinese paradigm. They are usually well equipped, but some of the medical processes that are common in China are not the way we would do things here, and some are potentially dangerous. I think there is a strong tendency to insulate volunteers from that if at all possible. They just aren’t good places to be.
In all, my take this was a tragedy. Could a different doctor have diagnosed a rare, potentially novel viral illness in an environment where odd stomach bugs are routine? Maybe, I don’t know. Could taking him to a Chinese hospital ASAP have saved his life? Maybe, but if it had been a routine illness he would have been put at risk for hepatitis and other hospital-spread infections.
I look forward to any improvements Peace Corps can make to the medical system, but I also know that volunteers go to remote areas and there are dangers associated with that. It’s not study abroad or a vacation- volunteers live and work for two years in places that may be days away from the Peace Corps offices. The risks are very real and should not be downplayed. There just isn’t a way to make that 100% safe.
One of my nephews worked teaching English in China, a job he had zero qualifications for other than speaking English. He was hospitalized with dysentery twice during his stay.
(He eventually was expelled from China. The shady company he worked for had gotten him a tourist visa. He awoke to cops pounding on his door, ordering him to pack his bags and go.)
Most foreign teachers in China teach “spoken English,” a class that focuses on games and guided discussion that builds verbal fluency and acts as cultural exchange. Grammar, pronunciation drills, and other aspects of the language are taught by Chinese teachers. So really, being a native speaker is enough.
Peace Corps volunteers teach at teacher training universities, and may take on more formal classes as well as external projects. I managed an English language library and ran a women’s career club.
There are a lot of shady English companies out there, and there are good ones as well. For a lot of volunteers it can be demoralizing seeing private foreign teachers making so much more money than we did, but at least we didn’t have those hassles.
Later in the article they mention the area is known for novel zoonotic diseases that aren’t currently tested for. In any case, whatever the situation, it was very unusual.
A healthy young person who’s undergone intensive medical investigation going back five u
Reading the article, it sounds as though there were some issues getting him help even after it was clear his was seriously ill - they called for the Peace Corps’ vehicle to transport him to a hospital, but it was in use by the county director and no one “felt empowered enough” to ask her to let them use it. I accept that due to the nature of the PC, the medical care may be substandard, but they really couldn’t ask to use a vehicle in an emergency?
Of course, the Peace Corps is a large organization, and having problems in one branch of it doesn’t mean the whole thing needs fixing. Still, I agree with the boy’s parents that his life could have been saved (and if the comments section on that article is anything to go by, there are lots of near-misses with volunteers). Either way, it’s an awful tragedy.
What do you mean by “Chinese paradigm”? I know (because I’ve been living in China since August of 2012) that there are TCM hospitals and “western medicine” hospitals. I haven’t had to be treated at a hospital here yet; however, for the two physical exams I’ve had (one in Zhanjiang and one in Beijing), the procedure was pretty much what I experienced in Cartersville, Georgia other than having to walk a lot more to get the things done here. There was also the additional procedure here of having an ultrasound done–for the first one, I cracked up the nurse performing the procedure by telling her that I can guarantee I’m not pregnant and am not interested in knowing the gender of the child" (I’m male). In both hospitals, the staff were professional and polite. Maybe I’m just lucky. Another thing:Oddly enough, a fair number of younger Chinese of my acquaintance consider TCM to be, and I quote, “Pure and utter BS, a bad relic of the past, needs to be wiped out”.
I’m not accusing you of anything; after all, different people have different experiences, and I’m sure that Beijing is a bit different than Chengdu. I’m just curious about your experience in Chengdu and when it was. Plus, I have a lot of admiration for the Peace Corps. When I was in the military, many of my fellow service members derided the PC, but I think they were idiots for doing so.
I was there starting in 2008. I think the key difference here is between Beijing and the interior. While Chengdu is a large city, it is not a particularly international one.
When I arrived at my site (a city of thee million people not far from Chengdu), I was taken to the best of the three hospitals to meet the doctors and rehearse what I would need to do in an emergency. It was then and there that I resolved never to seek care in my city-- and I say this as someone who has spent time in African hospitals.
The hospital was wall to wall crowded and the place was so full that patients lay on beds two rows deep along all the hallways, follow after floor of them. A thick fog of smoke, coming from doctors, patients and relatives, hung in the air. The doctor proudly showed me the MRI machine, and then took me on an unexpected tour of the new traumatic head injury unit, where I saw a lot of things I will never unsee, and that make me sick to think about even so many years later.
Chengdu does have better hospitals than that, but my experiences in Chengdu health facilities were not confidence inspiring. As much as I love China, this is a place where people skim oil out of sewers to supply hot pot restaurants and put poison in baby food to save a buck. This is a place where someone got caught selling fake peas in the market. For anything more invasive than a checkup, I would generally avoid local health facilities except as a last possible resort.
Some people die. Some people get mysterious illnesses, some are misdiagnosed, and some die. Some die anyway, with the best possible treatment. Even at 23, and they don’t have to be in China. I had a friend about that age who had Christmas dinner with her husband at our house,. Three days later she was in a hospital in a coma with a kind of meningitis, and was dead in two months without ever regaining consciousness. This was not in China, it was in Kansas.
The more I read about this, the sadder I feel. Mostly I want to give thanks to the volunteers who take on very real risk serving their country, with very little celebration or acknowledgement, and above all to the local staff who make Peace Corps work. They make local wages, earn few benefits, and work around the clock to to ensure hundreds of volunteers stay safe and effective in very challenging environments.
I truly hope the dialog around this focuses on the failures of the system and how it can be improved.