Reflections on a Trip to China

By Jason Horay

I recently had the great honor to teach a public health course at Dalian Medical University in China. The course addressed behavior, social factors, and health promotion theories related to individual and population health. The class is part of an overall requirement for Chinese students, mostly physicians and nurses, working toward a Master in Public Health (MPH).

While reflecting on my two-week trip to China, outlined are the behavioral, cultural and public health lessons I learned.

Air quality. The environment plays a major role in well-being. To walk outside, breathe clean air, and exercise is something I didn’t fully realize how grateful I was to have until I arrived. In China, the air quality is poor, and many Chinese people spend their time outdoors with masks covering their nose and mouth. I began to question my own health and if my constant cough and watery eyes were related. I learned the quality of the air is affected by manufacturing and heating with coal in the winter months.

Food. I was courageous and tried almost everything that was placed in front of me. Dalian is located on the coast of North China so the variety of seafood was plentiful. Despite the supply, food preparation and food storage continues to be a major concern in China. I also learned from my students that “gutter oil” is an issue. This is a situation where food establishments reuse old oil, leading to contaminated food, all in an effort to save money. In addition, the population in China is six times that of the US, making it hard to provide so many people with nutritious and heart-healthy food options. It seems as if most of the food is mass-produced. Nutrition labeling and the concepts of GMO-free or organic don’t exist.

Movement. In Chinese culture, there is less emphasis placed on physical activity than in the US. For women, it is typically thought as non-harmonious and not modest if one performs physical activity. Body movement occurs through exercises like yoga, Qi Gong and Tai Chi. A colleague and I led the class through a resistance band training exercise, which most had never experienced or even heard of. They were excited to try new movements and also take home the bands as our gift to them.

Connection. The Chinese are the most hospitable and friendly people that I’ve met. They develop deep connections with family, friends, and in my case, strangers. Sam Lee is a Chinese PhD student who was assigned as my translator. We quickly became friends, and he displayed such respect and honor toward me. China is such a gift-giving culture. I had students bring me various Chinese teas, snacks, and local beer and wine. Students were extremely curious, yet respectful, and often asked me questions about my life in the US compared to China. Beyond questions of everyday living, students inquired about healthcare, medical insurance, and malpractice insurance. Most students have never traveled to the US and the communist-controlled media limits access to Western life. Other than a few American movies or TV shows they have watched, I became these students’ connection to American culture.

Culture. There is no prominent religion in China. It helped me further appreciate the term spiritual well-being and allowed me to think more broadly about the term. The people taught me that it includes having a deeper purpose and a meaningful life. A few have stated that helping others can make you feel happier, as it brings a sense of inner pleasure.

Tobacco use. While smoking is on the decline in the US, it is the complete opposite in China. Sixty percent of Chinese men smoke. Smoking is allowed and prominent indoors (i.e., in hotels, restaurants, and schools). The smell of smoke permeated buildings, taxis, and even all the clothing I packed. It even surprised me to see Chinese people who wore masks, lifting them up to smoke.

Public Health. This is a broad term to summarize a few observations. Although the toilet system is not one that I was used to, I was surprised that hand washing is not prevalent or encouraged. There is no soap or running hot water at the Medical University. When asked to list 12 public health habits as an assignment, several students (physicians and nurses) stated that they need to work on routine hand washing. Other items on the list included spitting indoors and outdoors, daily teeth brushing, stress management, garbage removal and recycling, and reducing the use of disposable cups and disposable chopsticks.

Social media. No Facebook. No Google. No Instagram. Yes. It was a challenge not to mindlessly check these outlets on a daily basis, but I became content and appreciated the break. It allowed me to fully appreciate my surroundings and connect with the people I was with. As you can imagine, there was a deep communication disconnect between Chinese and English. The Chinese WeChat app allowed me to type a statement in English and have it translated into Chinese. This technology allowed me to get my coffee cup refilled, navigate around the busy city, and find my son a Chinese sports jersey. In the US, we challenge, protest and speak openly about our political leaders. However, in China, they are encouraged to trust their government without question.

I am so grateful I was able to travel to a new land and learn about the personal and cultural differences and similarities. Going into this trip, I expected to make a small impact on the well-being of a group of health care providers, possibly leading to more widespread change in China, but instead I felt the greatest impact was on me. Despite being 8,000 miles away from Raleigh and with numerous cultural differences, I was reminded that we are all humans trying to make a difference, connect and love others, and leave a legacy for those we love.