June 14, 2004
Overmedicated in China
Getting sick in a foreign country can be a scary experience. Especially since your mind is frequently as affected as your body. When malaise sets in, things that use to matter to you are suddenly unimportant. While you might know what to do, you often don't feel compelled to do it. Common sense often takes a vacation.
Several years back, when I was traveling in Colombia, I fell sick with typhoid fever. While the disease sounds scary as hell, in its initial stages it is really quite easy to treat - with a strong course of antibiotics. I had waited about a week before I went to the doctor - still well within the "initial stages" but, due to my "malaise" I had not taken good care of myself. I had sensed I might be sick, and blamed the local water and food. My solution? Eat only bread and drink only bottled coca-cola for about 4 days. This was not a smart move on my part, and never would have happened if I wasn't feeling so bad. Needless to say, I was severely dehydrated and immediately admitted to the hospital.
I was lucky. Not only did I speak Spanish, but my doctor spent part of his medical training in America, amazingly enough, in Indianapolis, my home town. The city where I fell ill had once been the home of a famous drug cartel in Columbia, and as a result a lot of money had been put into the city, which was apparent in the very modern-looking hospital where I was staying. After four days I was released, ordered to stay in town for at least another week, and felt well on my way to total recovery.
About 10 days ago, I started to feel sick. My throat was sore, and I was feeling very tired. Initially, I thought nothing of it. I was teaching a lot, and I figured the added strain had to do with using my voice so much. A few days later, ignoring my better judgment, I made an overnight trip to Beijing. I took the local train there and breathed in heavy cigarette smoke for 3 hours. Then, instead of resting my voice, I spent the afternoon and evening talking to other travelers I had met. The next morning, I was miserable. I could hardly teach my class that night, and the next day I woke up suffering from laryngitis.
The headmistress of the school, Miss Zhao was quite concerned. Even before I lost my voice, she inundated me with various medication - western and Chinese. First, some herbal throat lozenges. Second, some Chinese herbal tea that looked and tasted like a dirty fish tank. Then, two mystery pills from her stash of prescription drugs. Did I mention that Miss Zhao is NOT a doctor, a nurse or anyone with any medical training whatsoever?
I tried to tell her that I would be ok. That I had lost my voice before and just needed to rest. But, this is not how the Chinese deal with sickness. "I never get sick," she said. "Not in 10 years." I think this was her way of showing me her credentials - for giving me prescription medicine without a prescription or any sort of qualifications.
The next day I was not feeling better and was give two more types of medicine. That evening she suggested I go to the hospital with one of the teachers. I was not keen on this idea, first because I was sure I only needed rest, and second because I was kind of scared of Chinese hospitals. I demurred, saying we would see how I felt the next day. The next morning, I was about the same and not given a choice - a teacher called to say he was coming to take me to the hospital - now.
The hospital looked clean enough. After a few minutes, the doctor came into our room, took a look at my throat for all of 10 seconds. I showed her the medication Miss Zhao had given me, to see if she thought they were a good idea. She said something in Chinese. Steven, the teacher translated: "She says you need to get a blood test, ok?" My eyes were wide with fright. "No," I said, without hesitation. A story about used needles flashed into my mind. Combined with the bad press China received during the SARS crisis, a blood test seemed, to me, an unwise choice. Steven looked surprised. Eventually, after much coaxing, he convinced me to go have the blood test. In my head, however, I determined I would survey the blood testing room, and if it was even the least bit scary, run like hell. After all, I was not Chinese so "saving face" was not a real concern for me.
It turned out the blood test was just a finger prick, done with a small metal object that was hermetically sealed and seemed fine. A few minutes later the results were in and the doctor told Stephen that I had a viral infection. She prescribed an anti-viral medication, but told me to keep taking the medication I had been taking - including the antibiotic Amoxicillin. This confused me as I knew that viral infections, like the flu, were not treatable with antibiotics, while bacterial infections were. If I had a viral infection, why should I keep taking the antibiotics? I was very suspicious, especially when I did not get a satisfactory answer from the doctor. Steven took me home and said he would give Miss Zhao the prescription, and she could fill it for me. I had been lucky to have Steven with me. His English was the best in the school and I trusted him. If I had gone alone, communication would have been a nightmare.
A few hours later Miss Zhao presented me with the drug, which thankfully had an English translation, at least for the name. I did an Internet search on the drug, Ribavirin, and found out it was used for (1) severe lung infections in children, (2) for people with Hepatitis C, (3) had once been used as an HIV/AIDS drug, and (4) was currently being tested for its effectiveness against SARS. One Web site said it should not be used in women of childbearing age, ever. Another said any woman using the drug should be on at least two forms of birth control, and continue for 6 months after treatment. Oh, and did I mention the drug was not FDA approved for either the common cold or the flu - and normally only administered under medical supervision?
Needless to say, I thanked Miss Zhao for the medication, took it upstairs and vowed to flush the doses down the toilet. Still, I was hesitant. Was my sickness clouding my better judgment? After all, a doctor HAD prescribed the medication. I was torn. Logically, I should follow the doctor's advice. But, my gut was telling me something else completely. I decide to get a second option - and a third, and a fourth. I emailed three friends - one who was a doctor, another who was a nurse, and one who's mother was a doctor. I was advised not to take the prescription medication.
It's been four days since I went to the doctor. My voice returned the day after the hospital visit, While I am still nursing a mild cold, I feel fine. The only medication I took was some over the counter Tylenol Cold to help with my symptoms, and some of the herbal supplements that Miss Zhao gave me - including Ban Lan Keli and Ganmao Qingre Keli. (Internet searches proved they were common and popular over-the-counter Chinese herbs for colds - one as a preventative and one as a remedy.) Otherwise, I rested, drank lots of liquid, and, as an after thought, popped a few zinc tablets.
It was amazing to me, however, that even after giving me 4 different pills, and as many herbal remedies, if I did not immediately say I was feeling better, the solution Miss Zhao came to was to give me more medicine. Each morning and each evening I was offered yet another drug - all of which I politely declined, saying we should see how the medicine the doctor gave me worked first. It seemed that the concept for waiting for something to take affect was missing from the her belief system.
Miss Zhao's philosophy was this: "If we have small disease, if we don't have fever, we don't need to go hospital." She said this to me as she showed me the two large boxes, located by the piano, which were full of every drug imaginable. "We have many medicine," she said. No kidding - it was a regular pharmacy in there!
I know Miss Zhao was acting in what she thought was my best interests, and I sincerely appreciate her care and concern. However, I have learned that you must never underestimate your gut - especially when traveling. While there is no scientific explanation for a "gut feeling" most people can name several experiences when trusting their gut helped them more than a potentially questionable authority. I too can name several. Even though my rational mind was telling me that the doctor must be right, my gut was telling me to proceed with caution.
My faith in doctors is not shaken by this experience, even though I do believe the doctor who told me to take the antibiotics and antiviral medication together was wrong. I believe that in most cases, a doctor does know best and is medically trained to offer the best advice and medicine to cure what ails. But, I also believe you should educate yourself about the medicine and drugs that you are taking, and not just agree out of ignorance. If the doctor had spoken English, I would have asked her a lot more questions, especially about alternative medication. Since she did not, I was forced to use the Internet and my own trusted sources.
Bottom line: Educate yourself, seek professional advice, and trust your gut. Oh yeah, and ALWAYS get a second opinion!