In August 2017, Ms. Ma, a pregnant 26-year-old Chinese woman, jumped out of the hospital building on the day of her labor. At first, the hospital claimed that the tragedy was largely the responsibility of Ma's family members, who allegedly refused to allow her to have a cesarean section despite the unbearable pain. As the case went viral online however, Ma's husband claimed that it was the hospital that insisted on a natural birth, refusing to give their permission for the surgery. The whole incident turned into a Rashomon as no one knows what truly happened.
Although the news has passed for a few months now, it lingered in our minds and prompted us to think about a question in a time of which patient-doctor relationship is becoming increasingly hostile in China: what is going on inside the maternity wards of Chinese public hospitals? What does it take to deliver a baby, for both the women and the medical professionals inside the system?
To find out the answers, we interviewed around. Today, we want to share with you the stories of our interviewees.
Xiao, 36, media company executive
“How could the doctor and nurses be so rude and careless to their patient? ”
When I got pregnant five years ago, I initially planned to give birth in the U.S. At the time my husband was offered a job that required him to be relocated to California for a few months, so we thought, why not have the baby there? A number of our friends had already did it and highly praised their experiences, some even recommended us with specific hospitals and postnatal care centers.
Eventually, we didn’t go. Instead, we settled with a public hospital that was near our home. The decision was partially to satisfy my mother-in-law, who wanted to be with us for my pregnancy and labor, and partially due to my own concern. I was already 32 and a “high-risk pregnant female (高危产妇) ”, so giving birth in a familiar environment without language barrier might be a safer option.
At first, it seemed to be a right choice. After getting myself registered with the hospital around the end of my first trimester, I began to go for prenatal check-ups every month. The hospital was always busy with nurses and doctors hustling around for the endless mother-to-be, and I had to wait at least an hour every time to be called in for my session. But overall things went pretty smooth, and my health condition remained stable for the entire pregnancy.
It was past midnight when my water broke. Having rehearsed this moment in my head for hundreds of times already, I calmly showered, packed my bag and got going to the hospital with my husband. When we arrived, the nurse asked us to sign some documents and put me in the pre-delivery room, a giant ward filled with at least 30 beds for those who were about to deliver. All personal electronic devices were prohibited, and family members were not permitted to stay with me any longer. When I got out of the ward looking for restroom, the nurse, who was playing her phone at the front desk, pointed a direction down the corridor without lifting her head and shouted, “go find it by yourself!” In the face of her indifference, I felt like I was a fighter in a horrific journey all alone.
Around 5 a.m, my cervical dilation was finally wide enough for labor. I was asked to walk into the delivery room - yes, to walk in. There was a woman already lying on a delivery bed, giving birth. Listening to her terrifying screams, I climbed to the delivery bed all by myself.
During the entire delivery process, the doctor and nurse never smiled once. All they did was to hasten me to push quicker and harder in an almost condemning way, as if I wasn’t trying hard enough. Finally, after an hour of both mentally and psychically painful laboring, the baby was out. After taking down some general measurements, the doctor put my baby boy on a bed and went away. There he was, my little boy, lying on a tiny bed 5 meters from me with no one checking up on him, until we were finally sent back to the ward two hours later.
Back in the ward was more disappointing, negligent practices. During labor, my hemorrhoids broke, causing so much lingering pain that I could no longer lay flat on bed or wear anything on my lower body. Yet the doctors and nurses expected me to be fully capable of taking care of my son alone; they would only come for routine checks, never offering even just a caring word for my pain. Once a nurse shouted at me to put some pants on, can you believe it? In front of all the other people, including males, in the multi-person ward!
At the end of the third day, the nurse instructed me to check out from the hospital. I wasn’t fully healed at the time, so I asked if I could stay for another day or so. “No,” she rejected my request right away, “our ward beds are very limited. You have to leave now.”
So I left, and swore to myself to never go back. If I am having another baby, I’d definitely go to the U.S or at least have it in a private hospital. Giving-birth should be the most beautiful memory of life, yet my public hospital experience turned everything grey. How could the doctor and nurses be so rude and careless to their patient? To this day, I still don’t understand.
Tong, 28, education center employee
“There seemed to be some dirty businesses going on.”
A week after my due day, there was still no sign of the baby coming out. So I went to the hospital - one of the most reputable, 3A maternity hospitals in Beijing - for check-up. “Go back home, get your things, and come back to stay until your labor.” The doctor commanded.
I ended up staying in the hospital for three days until my water broke. The doctor prescribed me with oxytocin, assigned me a bed in the pre-delivery room, and took my cellphone away for the entire three days. Losing touch with the outside world, all I could do was to wait, sleep, and wait some more.
Three days later, the doctor decided to break my water by hands. Afterwards the cervical dilation finally started, thank god!
The delivery process went rather quick, and my baby was born after 2 hours of labor. I then stayed in the hospital for another three days until checking out.
Although both my pregnancy and delivery experiences were smooth, I cannot stop to remain suspicious about some of the conducts of the doctor. When I went in for prenatal check-ups, the doctor lectured me repetitively about the advantage of natural childbirth over caesarean, so much that it almost felt like brainwashing. Also, she kept prescribing me with vitamins, calcium tablets and lotions in high doses, which was definitely excessive. During my post-delivery stay in the ward, everyday random outsiders would pop in offering services from prolactin message to general nursing care. How did these people gain access to the ward? Perhaps they had a secret deal with the hospital? There seemed to be some dirty businesses going on.
I’d definitely prefer a private hospital if I could choose again. The public hospital was simply too crowded, and although the doctor for my prenatal check-ups was nice, she simply didn’t have much attention to spare. I used to think there is no need to spend too much money on delivery, yet having stayed in that multi-person ward for three days, I’d rather spend more money in exchange of privacy, decency, and transparency.
Inside the Obstetrics department of a public hospital in Xiangyang, Hubei, pre-labor patients had to sleep in the corridor due to ward bed shortage. (photo from: Sohu)
Sun, 40, gynecologist of an AAA public hospital in Beijing
“Thinking in the patients’ shoes, I totally get why they are always angry inside the hospital. But being a doctor, I do what I can do.”
I graduated as a med student in the 1990s. Back then, no one in my class wanted to get in Obstetrics & Gynecology - everyone knows it is the busiest department, and the pay is minimum to say the most.
But I didn’t have much choice. Not many 3A hospitals in Beijing were hiring college graduates that year. When I saw one of my top-choice hospitals had places open for its O&G department, I immediately applied, and got my residency. I ended up staying in the same hospital for over 20 years until this day.
My first 10 years of work experience was solely in Obstetrics. As the youngest in the department, I had worked in both the emergency room and the delivery room. To say it was busy is an understatement; about five years into work, my hair was already turning grey, and I started to develop symptoms such as palpitation and migraine. When I got pregnant at 30, everyone warned me that I wouldn’t be able to carry my baby, since most female doctors in our department had suffered miscarriage. I eventually made the decision to leave Obstetrics and transferred to the outpatient clinic of the Gynecology department during that pregnancy.
But working in the outpatient clinic wasn’t that easy too. Once a patient registered with the wrong doctor and I kindly told her she needed to re-register at the reception. Knowing she had to spend another hour waiting in the long registration line, the patient and her family cursed me with the worse language I’ve ever heard and kicked our office door until it broke. Verbal insults and physical conflicts are frequent in our department; as doctors of public hospitals, we simply have no choice but to accept them all.
Everyone knows how limited resources are in China’s public health system. For a large, reputable public hospital like ours, every day we treat patients from all over the country, from urban elites to peasants who’d travel thousands of miles and camp inside the hospital just to see us. For a normal work morning, I have to treat at least 50-80 patients, which means only about 3 minutes for each patient. Meanwhile, patients have to spend hours in line for registration, to run around the entire hospital to get the relevant paperwork signed, and to wait endlessly before being called in by nurse. Thinking in the patients’ shoes, I totally get why they are always angry inside the hospital, but being a doctor, I do what I can do.
Photo from: CGTN
Zhang, 37, attending physician at the department of Obstetrics & Gynecology of an AAA public hospital
“Are we immoral by accepting grey income? I don’t think so. ”
When I first started as a doctor, it was definitely a highly respected career in the hearts of the Chinese people. Today, it is no longer the case. Most patients come to us filled with hostility and suspiciousness, thinking that we are cold-blooded bastards who’ve been bribed so much that we are millionaires. That’s simply ridiculous.
I will give you an example of how my workdays are like. For a normal 16-hour shift in the maternity ward, we usually have to deliver at least 20 newborns, in which three involve caesarean sections, two operational rescues, and at least two D&C (dilatation and curettage of uterus). If two of my shifts were scheduled back to back, I’d have to work nonstop for more than 30 hours, and the stress - both mentally and physically - is beyond description.
Looking back to my career journey, there were definitely bright memories that made me proud of my job - I could still vividly remember the first mother and child I saved during my shift! However, there were also endless moments that I got so frustrated by dealing with difficult patients and their family members. They hold such conspiracy theory against us, thinking that we are trying to steal money from their pockets out of every opportunity possible.
Most people have forgotten an important fact here: us, doctors of Chinese public hospitals, earn so, so, so little. Our “sunshine income”, aka those we get on a regular basis from the hospital, is even less than those who work as physical labors. I will give you an example: a few month ago, a colleague of mine showed me her salary slip. She had over 10 years of work experience and got 4,000 RMB (626 US dollars) that month including both basic salary and bonus. Of course, the bonus might be more if it’s a big year (in China, birth rate is directly correlated with the Chinese zodiac signs. For instance, in the year of Sheep, birth rate tends to be low, which means relatively less workloads for obstetricians and gynecologists), still, how is this income level enough? We work the toughest job and get so poorly paid that it’s almost like a joke. Without the grey income from patients and pharmaceutical companies, how do we support our families who live in this expensive city? I don’t think the publics have ever thought or cared about this question.
Do we take red envelopes and other grey income? Yes; Do we treat patients based on how much they give us? No way. We might prescribe the patient a drug with a higher commission if it’s actually good quality (Medical drugs are prescribed by hospitals instead of third-party drugstores in China. Many pharmaceutical companies would therefore negotiate underground deals with doctors, intentionally markup the price to profit both sides), but if it is ineffective, no matter how high the profit is to our end, we would never prescribe it. The same goes for red envelopes: if patients offer, we would take it; if they didn’t, we wouldn’t ask for it. Are we immoral by accepting grey income? I don’t think so. We have our bottom lines.
Nowadays, while working full-time in this hospital, I also take part-time jobs from private hospitals to earn some extra money. More and more colleagues of mine are leaping into the private sector in recent years, earning at least double of their previous salaries. In fact, only a few of my college classmates are still remaining in public hospitals like I am.
I’ve considered leaving too, why not? Private clinics and hospitals are popping up so fast in the city. Patients, or, as we all call them today, consumers, now have more choices than in the past. So should us doctors.
(cover photo from: scmp)
According to news, by this January, the number of private hospitals in Beijing had reached more than 4,000, occupying 63% of the total number of hospitals in the city.
When Yan and I first discussed this week's article, we were mainly interested in the process of giving birth, and the varying dynamics of human relationships involved. After these interviews, we've come to realize that we missed an important understory for the big picture: the drastically shifting landscape of public v.s private healthcare options in China, and the many changes it is bringing to the Chinese society.
In a certain sense, our four interviewees - two middle-class working moms in Beijing, and two medical professionals from top-ranking public hospitals in the country - are direct beneficiaries of this shift. Although they are currently using and working in the public healthcare system, they now have the options to opt-out, to choose in between public or private based on personal preferences. For Ms. Ma, the pregnant woman who jumped out from the fifth floor of the hospital, and the majority of the Chinese population however, such is not the case. Public healthcare is the only option they could rely on, and the system, which is way overburdened and has suffered structural undersupply for decades, is desperately in need of stronger, more effective reform.
It feels like we've accidentally got ourselves into a big, complex topic that's beyond our current understanding, so we better leave things off now and go do some more research. Anyhow, hope you enjoyed this week's story, and see you with our next one.
Biyi and Yan