6 年時個別計画実習 海外実習レポート
1013652M 金子昌裕
4 weeks in China Medical University [2015/4/1-4/30]
・Basic information about China Medical University	  China Medical University [CMUH] is one of the most historical medical schools in China.
Manchuria medical school, which was built in 1911 by a Japanese company, South Manchuria Railway
Co., and a medical school, which was run by Chinese Workers' and Peasants' Red Army, were merged
to CMUH after WWII. Because of this historical relationship with Japan, CMHU opened Japanese
language course in 1961. At the course, many students have studied medicine in Japanese, and CMHU
have produced not only lots of great medical doctors or researchers in China but also many medical
doctors who got PhD degree and/or license of medical doctor in Japan. Although most of world
famous universities in China are located in Beijing, Hong Kong, or Shanghai, CMHU is the biggest
and most authoritative medical school in northwest area of China [Liaoning, Chilin, and Heilongjiang
province]. For Japanese, we can see some similarity between Hokkaido University and CMHU for
their location, a big medical school in big city appeared in cold, grainfield-rich plain.	  I worked 4 weeks in the first hospital ofCMUH, which is located in the central area ofShenyang, the largest city in Liaoning province.
The hospital faces the Zhongshan park withstatue of Mao Zedong on the north, and there
are Taiyuang street, the second largest street inShenyang, the 5 minute’s walk south from thehospital and Shenyang station, one of thestation for high-seed railway system, 15
minute’s walk west from the hospital. The
hospital has 5 main buildings. 1st and thelargest one have 26 floors for outpatients andinpatients, and others are for laboratory, special
examination, emergency department, or ward
for VIPs. Compared to Japanese hospitals, thescale of this hospital is incredible. Its total bed
number is larger than 3000, and over 10000
patients are hospitalized in a month.
Surprisingly, this gigantic scale of hospital is
not large enough to treat a lot of potential
Photo 1 CMU from hotel room [Ibis hotel 26F]
patients, and they have to wait for months to
hospitalize to busy department ward such as
cardiology or gastroenterology. Of course, except for inpatients, the hospital is also opened foroutpatients, and the outpatient area from 2nd to 6th floor is always crushed with patients and theirrelatives.
・My experiences	  I rotated 4 department, Endocrinology,Infectious diseases, Thyroid and vascularsurgery, and Oncology and spend 1 week
for each department. In theEndocrinology department, I was greatly
surprised in my first visit to outpatient
office. The outpatient work in China isextremely busy, and one doctor
sometimes treats over 100 patients in aday. Although only about 50-60 patientscame to the office when I visited, theoffice is always filled with current patientand his/her relatives, next patient andhis/her relatives, and a patient who wantto ask something to the doctor. On
occasion, the next-next patient and thenext-next-next patient get into the office,and the office was becoming chaotic field(I don’t know where “privacy” or “peaceplace for patient” has gone...). The

Photo 2 Professors at Endocrinology dep.

6 年時個別計画実習 海外実習レポート
1013652M 金子昌裕
aggressiveness of patient to doctors is also the different from typical patient-doctor relationships inJapan. Most cases in ward and outpatient office were diabetes and thyroid disease, but I could see
several rare cases, such as polycystic ovary syndrome, Addison’s disease, Turner’s syndrome, and type
II autoimmune polyendcrinopathy. Because we can seldom see these kind of patients untreated for along time, the textbook presentation of these cases were much interesting for me. Endocrinology
department is also elected as national concentrated center for research, and both basic and clinicalresearch, mainly focused on thyroid disease, are proceeded. The quality of previous publication are
really high and accepted to high reputation journals, such as New England Journal of Medicine, Journalof Clinical Investigation, or J Clinical Endocrinology Metabolism.
The second week, I was supposed to stay only in Infectious disease department, but I also stayed
Rheumatology and Immunology and Communicable disease department. Infectious diseasedepartment treats patients with Fever of Unknown Origin, and it sometimes diagnosis brucellosis,
aspergillosis, typhoid fever, or various parasite disease. These patients, however, usually come insummer, and they are transferred to other department as soon as it is diagnosed. Therefore, I only see
the cases of severe pneumonia in this week. Because of shortness of typical cases, the last two days ofthe week I moved to other department. In Rheumatology and Immunology department I could see
outpatient work of the professor. He is one of the most famous Rheumatology doctor in China, andmany patients from all over China with rheumatic arthritis, systemic lupus, or ankylosing
spondylarthritis came and saw him. Communicable disease department is unique department in China
mainly treating viral hepatitis and HIV infection. This department is separated from other buildings forhistorical and social reasons (hepatitis and HIV infection is thought as “dirty” disease in China.). I
could see several interesting cases, such as AIDS patients with pneumocystis pneumonia or military
tuberculosis, or hantavirus infection, also known as epidemic hemorrhagic fever.
In Thyroid and Vascular surgery department the surgeons operate thyroid and any vessels except thearea that needs open heart/scalp surgery, and they also give Interventional Radiology [IVR] operation
targeted all vasculature. In this 1 week, I could participate in various operations including
thyroidectomy, stripping of varix, abdominal aortic artery replacement, or IVR for chronic dissectionof aortic arch. What is exciting for me, a Japanese medical student, in this department was that I could
work as 1st to 4th assistant and havechances to sew, ligate, aspirate or otherminor process that are done by residents
in Japan.
The last week, I rotated on Oncology
department. Although the departments
giving chemotherapy to patients are
Oncology and every surgical department,
Oncology department treat patients who
did not get benefits from 1st/2nd line
standard therapy or did not accept
standard therapy for medical oreconomical reasons. They have about1000 such complicated cases in a month,and doctors seem to be amazingly busy. It
also have big basic research laboratory as endocrinology department and challenge the mystery of drug
resistance mechanisms or developing
Photo 3 Doctor's office at Oncology dep.
novel drug. My impression is that thisdepartment directly reflects the growing economic discrepancy in China. Relatives of a patient withmetastatic breast caner went to the US to buy recently developed molecular targeting drug that expects
3 month longer life extension. Another patient with metastatic lung cancer decided not to check
mutation profile of his cancer because his economic status and insurance could not accept genetargeting drugs that cost 1,000,000 to 2,000,000 yen per month. One patient who came to outpatient
office with clinically malignant mass asked a professor to prescribe cheap anticancer drugs without
histological diagnosis with “expensive” biopsy. These cases seems to be magnified view of economic
discrepancy in China exaggerated by rapidly advancing chemotherapy trend.
・Two points different from Japanese society
One of the most impressive things I felt in my experience in the hospital is that the patient-doctor
relationships in China. Compared to patient-doctor relationships in Japan, it is almost flat or evenrolled upside down (patient >> doctor). Chinese patients have strong opinion to their sickness, andsometimes they do not believe doctors advice. They aggressively discuss with doctors and only accept
treatment they think as reasonable. They do not hesitate second opinion, and they often tell their

6 年時個別計画実習 海外実習レポート
1013652M 金子昌裕
doctor that they cannot believe their doctor’s opinion and go to another better hospital. If they getsome relationship with a doctor, they think they have right to get advice from the doctor without any
costs at any time. It is almost impossible in Japan that patients without any appointment directly cometo doctor’s office and require checkup, but such practice is a part of daily life for doctors in CMUH. I
don’t think its reasonable relationships between doctor and patient, but I feel such relationships inJapan should shift a little to that in China.
Another thing surprised me is that the percentage of female doctor in CMUH. As you see from thepicture in Endocrinology department, the number of female doctors is larger than that in Japan.
According to doctors and students, this is because social acceptance of gender equality is high, women
do not have to give up their carrier in general, and achievement of women is usually better than men.
This trend is not limited in the field of medicine, and it is broadening to law or other high status
professions. Although in the field of politics Chinese women equality is making problem, we,Japanese, must follow this good example of our neighbor.

Photo 5 中央大街 in Hrabin

Photo 4 大悦城, the biggest shopping mall in Shenyang

・My life outside hospital
There are various department, restaurant, shopping mall around the hospital, and subway station isalso close to the hospital. I could not feel any problem with my daily life in this central area ofShenyang. Famous foods in northeast China are Jiao-zi or other dishes made from grain and pork. In
my impression, restaurants cost more than 400 yen/plate are more or less sophisticated and fit ourtastes. The cheaper restaurants that cost less than 400 yen/plate and serves true home cuisine, however,often fail my expectancy of my tongue…
On weekends, thanks for my Japanese class friends’ help, I could visit other cities in northeast China.
One of them is Harbin. This city is the capital of Heilongjiang province, northern end of china, andhistorically it was developed by Russia. Chinese culture usually re-use existing architectures, and wecan enjoy unique street view. A former Russian residence is used as school, a former bank isdeveloped as department, and a former chapel is re-arranged as museum. At first glance, we feel as if
we were walking in an old street in St. Petersburg, but everyone around us are Asian people, and all
characters are Chinese. It is really unique and funny city view. My favorite spots are night view ofZhonyangdajie Street, and sophisticated atmosphere of Gogol’s bookstore.
As mentioned above, there are lots of difference between hospital in China and that in Japan.
However, the most precious idea I got from this 4-weeks is that we are not the different living things,
human beings. I saw people in China laugh, cry, get angry, and have fun in almost the same situation
to us, people in Japan. Although our societies do not have good impression each other recently, but I
believe this is only caused from our geographical separation or few chance to communicate each other.
We have different and respective culture each other, and we are living in really closely. It is nothingother than waste that we do not want to understand each other. I hope to share my experience in China
with as many people as I can, and tell them what is going on in China, what Chinese people arethinking, and how we are similar to each other.
Finally, I have to say many thanks to Dr. Liu and staffs in student exchange program in CMUH andKobe University, my precious friends of Japanese class, Ms. Teng, Ms. Tang, and Mr. Wan. I cannot
imagine my 4-weeks without their help.