The UCLA Department of Anesthesiology and Perioperative Medicine is committed to promoting global health through education, patient care, research, and advocacy. Residents, fellows, and faculty participate in promoting global health through:
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Resident Rotation in Hangzhou, China
Through a partnership with the Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), UCLA anesthesiology residents have the opportunity to participate in a clinical and educational rotation at SAHZU, a tertiary medical center. Founded in 1869, SAHZU is one of the largest hospitals in Zhejiang province practicing Western Medicine. With over 3,200 inpatient beds, 60 operating rooms, and a volume of over 60,000 surgical cases per year, residents participate in a wide range of clinical experiences, including cardiac anesthesiology, neurosurgical anesthesiology, pain medicine, traditional Chinese medicine, and more. Residents attend and participate in morning conference, journal club, and case discussions as well as learn different techniques to anesthetize patients. SAHZU provides an invaluable experience for our residents, who immerse themselves in a different healthcare system with a different patient population and different resources. They return home not only with a rich and memorable cultural experience, but also with a new perspective.
I was recently given the opportunity to travel to Hangzhou, China, and participate in an anesthesia international elective at the Second Affiliated Hospital of Zhejiang University (SAHZU). The cultural and clinical experience in China was remarkable, and truly a once in a lifetime experience. This busy teaching hospital was founded in 1869 and consists of 3,500 hospital beds with a surgical volume exceeding 60,000 cases per year.
I had the privilege to work with attending anesthesiologists, resident anesthesiologists, and medical students. We worked together as a team and provided excellent anesthetic and perioperative care. I worked with Dr. Chen and the Multidisciplinary Pain Medicine Team at SAHZU. I rotated through the pain medicine clinic, where we evaluated and treated complex pain syndromes. I participated in myofascial pain procedures, minimally invasive herniated disc repairs, and radiofrequency nerve ablations.
During the international elective at SAHZU, I was afforded the opportunity to visit Beijing and the Great Wall. Photographs rendered in textbooks do not accurately depict the true presence that this structure beholds. The Great Wall and the surrounding landscape provided an environment that encouraged self-reflection:
Walls are often built to provide barriers as a means to separate the human race. The purpose of the wall may be national security or political rhetoric. However, the basic premise still holds true: to separate human beings into “us” versus “them” indirectly provides a symbolic structure that nurtures divisive and nationalistic views. China is the most “foreign” place I’ve ever visited including a different and unrecognizable language, cuisine, and culture. However, my clinical and cultural experience in China demonstrated that we, as people, share common goals and values. If we, as individuals, are able to put aside the easily recognizable and superficial differences, we will then begin to appreciate the similarities. Differences do exist between our healthcare models; however, there are powerful similarities that we share as human beings, physicians, and anesthesiologists. We work extremely hard and make personal sacrifices in order to deliver exemplary medical care to our patients, to ensure their health and well-being, and provide them with a better quality of life.
Photos, from top: Dr. Kwiecien with SAHZU colleagues; Dr. Kwiecien in Shanghai; View from the Great Wall.
Dr. Le recently returned from Hangzhou, where he learned about cultural differences in pain management and hospital operations, all the while enjoying the culture and sights of the region.
What drew you to the SAHZU Rotation?
I was interested in seeing a different health care system. Considering that China has the largest population in the world, I wanted to see how its health care system handles such a demanding patient load while still providing quality medical treatment.
How did patient attitudes and expectations differ at SAHZU?
The patients at SAHZU were extremely different than patients in the United States. This became most apparent at the chronic pain clinic. In the United States, we’re in the midst of an opioid epidemic. There's no concern in China about a possible opioid epidemic. In fact, patients at the chronic pain clinic had to be persuaded, at times, to take medications prescribed for their pain. It's a cultural belief in China that medications are inherently unhealthy and they should be avoided, if possible. Symptoms such as pain were tolerable compared to the possible side effects of medications.
In the operative setting, patients were more cooperative, as well. Patients tolerated awake central lines and alines with no sedation, including drugs like midazolam or fentanyl. In fact, I never saw the use of midazolam to treat anxiety before surgery. Patients also expected to have pain after surgery, and the administration of postop pain medication in PACU was exponentially lower there. All of these factors made it easier to take care of patients in the operative setting.
What was the most surprising aspect of your rotation?
The most surprising aspect was learning about Traditional Chinese Medicine (TCM). I was fortunate enough to spend a day with a traditional Chinese doctor who treated pain, headaches, strokes, hearing loss and wide variety of other ailments. I saw him perform cupping, acupuncture, tui na (a massage modality that balances the body’s energy) and other treatments. TCM is a well-respected field in China. Doctors who practice TCM go through rigorous years of training, just like doctors who practice western medicine. Patients have the same level of respect for doctors who practice TCM.
How did the different resources available to you at SAHZU impact the care you provided?
Most of the drugs and medical equipment I use at UCLA were also available at SAHZU. However, there is a culture of using different drugs and anesthetics. For example, all surgeries performed there are done under total intravenous anesthesia (TIVA) instead of inhaled anesthetic. This includes heart transplants, lung transplants and basic cases like thyroids. This is not to say that they don't have inhaled anesthetic - all their machines have sevoflurane attached - they just choose not to use it. Regarding equipment, they are definitely less wasteful there. Surgical gowns and drapes are washed, re-sterilized and reused. Also, central line and aline kits have the bare minimum inside to perform the task required. There are no additional syringes, needles, wires, clamps or sharps holder inside. It became more challenging, at times, to perform certain procedures without certain items in a kit. I learned how to perform central lines without an ultrasound and thread alines without the use of a wire.
How will this rotation impact your future?
I will always cherish learning about the culture of China, and the kindness I received from everyone I met, both inside and outside the hospital. I was encouraged during my rotation to learn about the culture of China by visiting different cities, museums and sites. During my weekends off, I visited the Great Wall and Tiananmen Square in Beijing, the Terracotta Warriors in Xi'an, the Yuyuan Garden in Shanghai, and Yellow Mountain in Anhui. Everyone I met at these places was extremely welcoming.
This rotation allowed me to grow as an anesthesiologist. By seeing how little opioids were administered in the China, I realize treating pain is not solely about administering analgesic medications, but more about managing a patient's expectation of pain. If you can manage their expectation of pain, you can better treat their symptoms and prescribe less opioids. Furthermore, it made me more interested in learning about cultural differences in pain tolerance, and culturally-sensitive methods to treat pain, like TCM. Taking care of patients in a different country and culture was an experience of a lifetime that will forever change my practice in anesthesia.
The first day of my rotation at the Second Affiliated Hospital of Zheijang University (SAHZU) in Hangzhou, China started with Grand Rounds, as it did every morning. It was conducted entirely in Mandarin, as expected. Fortunately, I was seated next to a resident, Dr. Chen, who spoke enough English to quietly translate so that I wasn’t completely lost. As I was sitting there, wearing my floral skull cap and wondering what the next month would entail, I was handed a microphone. Nearly 100 residents and attendings turned their faces toward me, waiting. Dr. Chen looked at me with a big smile and said, “They want you to talk.” “Talk about what?” I said. “Just talk,” he said. So I talked. And I told them how excited I was to be there, what a great opportunity it was, and how fortunate I was that UCLA allowed me to combine my two passions - travel and medicine - into an unforgettable rotation.
For four weeks, I went to Grand Rounds every morning. Nearly every day, the microphone was handed to me, requesting my opinion on different topics in anesthesia, specifically focusing on our practice at UCLA. My presentation at the end of the rotation on pediatric anesthesia was broadcast to over 15 hospitals.
It was fascinating to see anesthesia practice in Hangzhou. At over 3200 patient beds with a surgical volume of more than 100,000 cases per year, efficiency was a hallmark. Central lines and arterial lines are placed in a preparation room prior to surgery. All patients are sent to PACU intubated. The operating room beds have wheels attached, which makes transfer to ICU less cumbersome.
Hangzhou is a scenic city, an apposition of the contemporary and the traditional. The high-speed train will take you to Shanghai in under an hour, travelling at more than 300km/hr, while just fifteen minutes from the hospital you’ll find yourself in the West Lake area surrounded by pagodas and old temples against a hilly backdrop. The food in Hangzhou is renowned as one of the best cuisines in China.
The faculty at SAHZU were as eager for me to learn and appreciate Chinese culture as they were for me to practice anesthesia. I was encouraged to take trips on the weekends. I travelled to breathtaking Huangshan in the Anhui region (my legs are still sore) and went to Shanghai twice. This was my fifth time in China, and after spending four weeks, I finally was able to pick up some of the language basics. Of course, I still depended on Dr. Google Translate and my co-residents Dr. Chen and Dr. Wu, without whom I would probably have been ordering duck tongue at the cafeteria, unintentionally.
This was a valuable experience for me; I grew as a person and as a physician. I would highly recommend this rotation to future residents.
Further Reading: The Role of Anesthesiology in Global Health
Our physicians and nurse anesthetists regularly participate in medical care around the world. Our department supports charitable work as well as educational travel by our faculty and staff. Read more about our about our recent international work:
Clockwise from left: Our faculty, residents and staff in Vietnam, India, the Phillippines, and Guatemala.
The UCLA Anesthesiology Visiting International Scholars Program is one of our Global Healthcare Initiatives and aims to foster global collaborations through the horizontal sharing of understanding and experience. Visiting international scholars have the opportunity to observe in the operating room or research, attend our Grand Rounds and Resident Didactic Lectures and tour the UCLA Simulation Center. We regularly host international scholars for visits lasting up to four weeks. Read some of their stories.
Dr. Woo Young Jo
Dr. Jae-Woo Ju
Dr. Vesna Durnev
Maria Angelini, MS
Xiangming Chen, MD
Mohammad Gharavifard, MD
Reza Jalaeian Taghaddomi, MD
Hongmei Wang, MD
Jun Chen, MD
Mohammadali Attari, MD
Hamish Gray, MBChB DA FRANZCA
Dr. Jae-Woo Ju, 2016
"I am a senior resident from Seoul National University Hospital, South Korea. I had an opportunity to observe clinical anesthesiology in November 2016 with the help of Dr. Aman Mahajan, the chair of the UCLA Anesthesiology Department.
During my stay, I observed cases in the main OR of Ronald Reagan UCLA Medical Center. As I was a resident and did not decide my subspecialty yet, I observed various fields of anesthesiology, including Cardiothoracic Anesthesia, Liver Anesthesia, Neuroanesthesia, and outside OR anesthesia. I was lucky because it helped me to see a lot of new and different materials and anesthetic approaches, which highly deepened my understanding of anesthesiology. I asked to attendings and residents numerous questions, but they were very friendly and kindly answered to every one of my questions. I was impressed by their academic and dedicated attitude.
I also attended simulation sessions at UCLA Simulation Center, and it was the most exciting experience during my stay. During the sessions, residents used state-of-the-art manikins to experience very rare and critical cases. I really wished to have this cool, amazing program in my home hospital.
Thank you for letting me to visit UCLA Anesthesiology and have this wonderful experience. Please send my regards to everyone, especially Dr. Aman Mahajan, Dr. Jure Marijic, Dr. William Alexander Edwards, and Ms. Shevaughn Marchese".
Dr. Jae-Woo Ju
Senior Resident Anesthesiologist
Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital,
Dr. Manoel de Souza Neto, 2015
"Last year, I spent two amazing and interesting weeks at UCLA. During this time, I had a chance to be with spectacular anesthesiologists and friendly medical residents. It was a nice experience to learn and exchange experience with them. It's a really a good place to be".
Dr. Manoel de Souza Neto
Hospital do Coração
São Paulo, Brazil
Dr. Vesna Durnev, 2014
"I would like to thank you for the opportunity to share my sincere thoughts about my two-month educational visit to UCLA Department of Anesthesiology. It was a great pleasure to be part of your department and learn more about your health and educational system. I was really impressed with the facilities and all the program activities with your residents. You offer so many benefits and opportunities to your students and it was obvious you are dedicated to excellence and committed to your outstanding program".
"I greatly enjoyed talking to my colleagues. Residents were very friendly, answering all of my questions and helping me to accommodate more easily. The courtesy from the staff I greatly appreciate. It was very interesting and beneficial to visit the Wednesday Grand Rounds and Resident Lectures, and all these high quality activities for upgrading clinical skills and knowledge. Thank you again for offering me the chance to visit your program and meet with you and your fellow faculty and residents. Please pass along my gratitude to them especially to Prof. Barbara Van de Wiele".
Dr. Vesna Durnev
Board Certified Anaesthesiologist
University Clinic of Anaesthesiology, Reanimation and Intensive Care
Skopje, Republic of Macedonia
Dr. Pimwan Sookplung and Rungruedee Jansin, 2013
"We are Dr. Pimwan Sookplung, an anesthesiologist and Rungruedee Jansin, a nurse anesthetist working at Prasat Neurological Institute, a tertiary care hospital with 300 beds in Bangkok, Thailand. Besides the service, we also provide an academic setting such as residency training in neurology and neurosurgery. We applied to be visiting clinical observers in Neuroanesthesia for 3 months during June - September 2013. After the activity, we realized that the UCLA Anesthesiology Department is one of the best places practicing advanced Neuroanesthesia, intraoperative neurophysiological monitoring (IONM) and anesthesia for interventional neuroradiology".
"We met Dr. Johanna C Schwarzenberger, Dr. Barbara Van de Wiele, staff anesthesiologists, fellows, residents and all the department secretaries. Everybody was very kind and nice to us. We mainly observed in the OR of Ronald Reagan UCLA Medical Center with Dr. Barbara Van de Wiele focusing on anesthetic management in brain tumor surgery, endoscopic pituitary surgery, epilepsy surgery (awake craniotomy), neurovascular surgery (clipping aneurysm, EDAS), deep brain stimulation, microvascular decompression, spinal surgery with intraoperative neurophysiological monitoring (IONM), and interventional neuroradiology. Furthermore, we visited the UCLA Medical Center Santa Monica campus to observe more on spinal surgery with intraoperative neurophysiological monitoring (IONM)".
"When we arrived back at our institute, we shared these experiences of advanced anesthetic technique and monitoring with our colleagues and adapted the protocol of anesthetic management for better patient care. It was really a great experience and hope we can have a good opportunity like this again soon".
Dr. Pimwan Sookplung
Prasat Neurological Institute
Our department, known for providing world-class patient care, research, and education, attracts many international physicians to study and visit here, either as researchers or observers. Often, the visitors are interested in the work of our busy liver transplant service.
International doctors who wish to perform research must apply for an Exchange Visitor Program J-1 visa. The minimal period of study is six months. Those who simply want to observe our clinical operations or research may spend as little as a week or several months here, and can visit as tourists with a B1 or B2 visitors’ visa. International physicians come from a wide range of countries including China, Thailand, Korea, Taiwan, Singapore, Canada, and Egypt. We have also hosted physicians from Europe and Latin America.
In 2017, five international researchers have worked with our liver anesthesia group.
In 2018, we anticipate hosting three more physicians from China and Thailand. For the international physicians, the main purpose of study at UCLA is to use what they have learned here to advance patient care, research, and education in their home countries and institutions. We are happy to see that many UCLA care models and methods have been embraced by the international physicians who have studied here.