Jackie Xu, Duke University
This
past US summer 2017, I studied with Tiantan Hospital in Beijing, China. “Tiantan” means
“Temple of Heaven”, referring to the hospital’s close proximity to the tourist
site—though I think it is a fitting location for a healthcare center as well.
Walking
through the glass doors of the Tiantan’s stroke center research unit on my
first day, I was amazed by the depth and breadth of healthcare work
concentrated in one location. The hospital itself is a restless place with
patients constantly streaming in and out, and Tiantan has also set up a vibrant
learning environment for its trainees. The entire stroke unit meets every
morning to review patient cases together. Every other week, the director of the
neuro-intensive care unit leads journal clubs. I was fortunate to have such a
supportive environment to learn and explore, working with students, clinical
trainees, health care providers and faculty at Tiantan and its affiliated
Capital Medical University on understanding stroke care in China through two
research projects – one quantitative and one qualitative.
After
taking a few days to settle into my summer home, I approached my Tiantan mentors
with my qualitative research project plan. This was a project to understand how
to increase stroke patient medication adherence from a health systems perspective. Data from the Chinese
National Stroke Registry and other stroke cohorts already identified adherence
as a problem. My question was, “What are the system barriers and facilitators
to improve stroke patient medication adherence after hospital discharge?”. This
included a plan to complete interviews to collect opinions and perspectives from
multiple people with roles aligned with this problem—including patients, acute
and community-based healthcare providers, pharmaceutical company
representatives, and Ministry of Health officials. The idea of a qualitative
study received mixed responses from the clinical research mentors.
On
the one hand, my mentors were interested in exploring qualitative methods, not
commonly used in China’s medical research practices. On the other hand, they
worried about the level of rigor in qualitative interview methods and expressed
concern over the ability to publish results with this type of data.
At
first, it was frustrating to receive this feedback. Although I am an
undergraduate student with little prior experience related to stroke, the data spoke
for itself—medication adherence is a pressing issue for stroke patients in
China. Previous studies led by Tiantan faculty demonstrated a need to
understand system barriers and means to improving medication adherence. I held
the rooted belief that I had an important research question, vital to improving
the lives of stroke patients in China. Yet at the same time, I knew that I
didn’t have the full picture. My position both as an undergraduate student and
an outsider to this community left me doubting myself about what I didn’t know.
However,
as I learned more about the research landscape in China, I came to a greater
understanding of Tiantan leaderships’ perspectives on qualitative and
quantitative research. Despite China’s extraordinary economic and technological
advances, the quality of research coming out of China is still being
scrutinized[i]. In efforts to clear
doubts over data validity, clinician scientists in China put forward Herculean efforts
to master English and apply for prestigious fellowships abroad, maintain an 8am
to 8pm work schedule, employ personnel to support improved data quality, and manage
large clinical and research infrastructures proportionate to the size of the
population (really large). Yet, research from China still remains under
question.
Contextualizing
my environment propelled me to build the case for qualitative research as a
valid and valued method of study with Tiantan and its affiliated students and
faculty. I presented the journal club’s first qualitative study, answering many
questions afterward. I branched out of
my immediate Tiantan network to build a team of project advocates. Along the
way, I listened to concerns of clinicians and was mentored for a related quantitative
study on medication adherence post-stroke. We successfully exchanged research
knowledge and experiences.
Both
projects came to fruition. Shadowing at inpatient units and outpatient clinics,
traveling to facilities around Beijing for physician interviews, and eating too
many takeout dinners on late nights with my fellow colleagues, I felt like I
had truly begun to understand the complexities of the Chinese healthcare
system.
I
found that at the core, people at Tiantan were open to new ideas. Inhibitions
stemmed not from fear of novelty but a yearning for professional respect—co-workers
with paralyzing scares of data falsification, journals focused on research from
prestigious Western institutes, and a “globalization” driven and dominated by developed
countries. For China, gaining mutual respect from colleagues was an
evolutionary process.
This
summer, I served as an ambassador from my American-based university and
navigated this new and sometimes enigmatic partnership between two leading
healthcare institutions—Duke and Tiantan—separated by the Pacific Ocean. My
work advocating for qualitative research methods in China taught me how to
identify project champions and engage key stakeholders. Collaboration, and
therefore mutual respect, is the key to research.
About
the Author:
Jackie
is a Chinese-American junior at Duke University studying Public Policy. Jackie
is passionate about creating systemic, sustainable change for healthcare
systems around the world. She serves on the Global Alliance on Disability and
Healthcare Innovation (GANDHI) research team, headed by Dr. Janet Prvu Bettger
at Duke. Jackie loves meeting new people, so feel free to reach out with
questions, comments, or reactions at Jacqueline.xu@duke.edu.
[i] Wan Z. China’s scientific progress hinges on access to data. Nature 2015 Apr 30; 520: 587.
