NAME: Viva Tapper and Sheela Choppala
LOCATION OF EXPERIENCE: Beijing, CHINA

Another doctoral student, Sheela Choppala, and I were invited by the Chinese government to speak at a national conference for nursing instructors on psychiatric nursing. The WHO had recently recommended that China add psychiatric nursing to their undergraduate curriculum. Some instructors had a background in undergraduate psychology, but none had any exposure to the kind of program that we are use to here in the U.S. They had no textbook, but were in the process of writing one without access to references.

Sheela and I arrived and were met by our interpreter, Weiqing Quan, who was indispensable on this trip. She is a master's level nurse (one of a handful in all of China) who received her education at U of Hawaii, and currently appointed to coordinate Beijings Community Health as well as teach at Beijing Nursing School (BNS). BSN hosted the conference, which was held at University of the Medical Sciences in Beijing. We were treated very graciously. All our living expenses were covered by BNS. Food was beautiful and abundant. We are vegetarians, and they were very willing to supply our needs for food and bottled water. The temperature was very got -40C. Air conditioning was available, but not always efficient.

After opening ceremonies in which we were formally introduced to the attendees and Ministry of Health officials, we traveled to three psychiatric hospitals by bus with the conference attendees over the next three days. I should preface this with our experience upon arrival at the airport. We were asked to fill out an Infectious Disease Control form. On the form was listed Schizophrenia. This was our initiation to the prevalent Chinese that thought that Schizophrenia is communicable.

At each hospital the administrator, head psychiatrist and head nurse greeted us. All three were large facilities with ~4,000 beds. Usually, the hospital hosts lectured in the morning then presented a lovely feast at noon. The afternoons were spent touring the hospital and grounds. Treatment was humanitarian, but definitely about 50 years behind ours. Very little diagnosis of other than Schizophrenia, some bipolar (new to them), practically no use of the depression or anxiety diagnosis. They use a different diagnostic system, not our DSM-IV. The only SSRI is Prozac, they hadn't heard of the potential for anti-depressants to cause manic symptoms, large use of ECT and injectable antipsychotics. Each hospital demonstrated classic diagnoses to the attendees by interviewing patients in front of everyone. We were dismayed by the literal laughter that occurred in the patient's faces.

Of particular interest to me was the custom of avoiding telling medical patients their diagnosis, especially if it is life threatening. However, they do tell the family. Many complaints were registered about physical altercations between patients and staff in medical hospitals. I hypothesize that patients are highly anxious and unable to express their feelings due to cultural expectations. In fact, we were invited to speak at another city, Hungzhou (2000 miles south of Beijing near Shanghai) where a patient had recently suicided. She was a nurse in the community with lung cancer. Many of the staff knew her, and were devastated when she jumped from the 6th floor of the hospital two weeks before. They had not had the opportunity to hear about suicide assessment, or ethical considerations that we endeavor to utilize here.

Our hosts spend their off time taking us to traditional tourist spots on the weekend (i.e. Great Wall, Forbidden City, Temple of the Heavens, big department store - prices are very low on most things).

We presented a full quarter of undergraduate psychiatric nursing over the next three days. In the evening we consulted with Mr. Liu and Weiqing about the textbook. At the formal closing ceremonies, the Director of the Ministry of Health for Beijing, Wen Shengzhi, presided and invited conference attendees to give feedback, and make recommendations. Many requested more training, and the arrangement of good clinical sites. We also were asked to give our opinions. Later that evening, Mrs. Wen, Wang Shu Peng, the Director of Nursing at the Mental Health Institute at Beijing Medical University, and Dr. Tian Min, the Director of the Division of Secondary Medical Education for the Ministry of Public Health hosted a banquet in honor of the conference. Dr. Tian is in charge of coordinating relationships with nursing schools abroad. All the administrator from the three psychiatric hospitals attended as well. This was a gala occasion. Everyone was very happy about the introduction of psychiatric nursing into their schools, as well as the success of the conference that had just concluded. We were asked to visit again next summer to teach a longer course.

While there, a visit was also arranged with Dr. Luo He Chun, internationally known for his research on integrating traditional Chinese medicine and western psychiatric medicine.

This was a very precious experience. We often had the feeling that we were walking through the doors for the first time. We also felt very thankful to be the ambassadors for our school of nursing, as well as nursing the U.S. in general. Meanwhile, we were very present to not wanting to participate in a hegemonic relationship, and so were cautious about waiting to be asked for opinion, and always prefaced those with this is how we do it in the U.S. You must determine what is appropriate for you in this situation. We were struck by the very graciousness of our hosts, and ease which we felt being together even though we had a communication barrier. I definitely would return if possible, and hope to study Chinese before I go!