This is the first of two parts. Coming Friday: In China, health care in rural areas lags behind that available in cities. But a new program is starting to turn the tide.
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BEIJING — Yang Hu could hardly believe her ears. An American visitor had just asked her parents whether they were proud of her for winning a four-year Chinese government scholarship to study medicine in Omaha.
They said yes, of course. Their daughter was one of the first Chinese students chosen to enroll in the special program at the University of Nebraska Medical Center. Who wouldn't be proud?
Translating for her Mandarin-speaking parents on that summer afternoon, however, Yang was startled to hear them express those sentiments. It's not the Chinese way for parents to brag about their kids in front of them.
“So thanks for making them talk about it,” the 24-year-old said with a smile.
Going to an American medical school is more than a great opportunity for Yang. The program she joined is also a source of pride for UNMC and an example of the med center's growing international reputation.
While thousands of Chinese students already are at American medical schools for doctoral programs, research or short-term clinical rotations, the UNMC program is different. Only in Omaha does the Chinese government pick up the tab for its students to earn a four-year U.S. medical degree or a similar professional diploma in fields like pharmacy or physical therapy.
Besides bringing in tuition revenue, university officials say, they hope the students will establish relationships with UNMC that could lead to future research partnerships and other ties with China, the economic powerhouse that is expected to continue its rapid growth and increasing influence in the coming decades.
“These students will be leaders of Chinese health care,” said Jialin Zheng, a UNMC professor who heads UNMC's Asia Pacific Rim development program. “They will be ambassadors to future collaborations.”
For now, however, they are merely 20-something students wrestling with rigorous coursework, language challenges and an unfamiliar culture.
Yang and her fellow Chinese students have had to adjust to a different educational system and adapt to the American approach to health care.
They have stared blankly at American restaurant menus, worn costumes to Halloween parties and spent Thanksgivings with new Nebraska friends.
One is exploring Christianity after growing up as an atheist. Several have learned to drive.
The experience has “really helped me to broaden my horizon,” said Xin Zhang, a 26-year-old physical therapy student from Xi'an.
Xin and Yimei Huang, a pharmacy student from Chengdu, started at UNMC in 2011. This year, Yang and Lei Yu from Chengdu both entered the medical school.
The scholarship program is one element of the Shanghai-U.S. Health Science Initiative formalized in August when Nebraska Gov. Dave Heineman was in China on a trade mission. UNMC officials describe the broader pact as one of the most extensive partnerships between U.S. and Chinese academic institutions.
UNMC Chancellor Harold Maurer said the med center has ties with China that are envied by top U.S. universities. At a recent meeting with leading U.S. medical schools and the Chinese government, he said, “it was clear that UNMC is probably one of the best known U.S. institutions in China.”
Other schools such as Duke University asked the Chinese about why they were working so much with Nebraska, Maurer said. The answer: UNMC takes good care of its Chinese students and teaches them well. In addition, the Chinese noted, it doesn't cost as much to go to school in Nebraska.
With the new program, university officials have begun slowly, carefully selecting students for their English language ability and above-average test scores.
When fully implemented, there will be 10 new students arriving in Omaha each August — two in each of five areas: medicine, pharmacy, physical therapy, dentistry and nursing.
In an interview in Beijing five months before she came to Omaha, Yang recalled doing an Internet videoconference call with three faculty members in Nebraska. She didn't know that only two applicants would be accepted.
Yang's interests include language, history and the arts as well as science. Her father, Haifan Hu, works in Peking University's library, tending a collection of 80,000 gravestone rubbings. Her mother, Binhua Chen, recently retired as a book editor.
The family's two-bedroom, university-owned apartment in Beijing has a narrow kitchen with just enough room for a two-burner stove. The entry hall holds the refrigerator and table.
In Yang's room, there's the family computer as well as posters of Audrey Hepburn and soccer star David Beckham. The parents' bedroom, which serves as the apartment's living room, has floor-to-ceiling bookcases.
Yang said Chinese people would say that she comes from “a family with the scent of books.”
But she decided to pursue medicine because, in China, science is considered a more prestigious career. After high school, she completed five years at Peking University's medical school, not far from home.
Her parents said they weren't eager to have their daughter leave home for so long, but they knew it was a good opportunity. “She can study technology,” Haifan Hu said. “It will bring more benefits to the patients here.”
Yang's parents take education seriously, and they're not alone. Hu said some Beijing parents bring their children to a nearby parklike area on weekends, hoping the university setting will inspire the youngsters to study hard and be eligible to attend someday.
For the hardworking Chinese students who made it to Omaha, language is a big challenge.
All four students speak English well. If you met them on the street, you would be able to carry on a robust conversation.
But the UNMC students have to take their English to another level every day by absorbing medical terminology and complex subjects during class lectures. It's even trickier when the professor tells a joke, speaks in slang or uses a cultural reference to make a point.
Lectures are recorded, so students can listen again to hear a part they didn't catch. Lei said she has replayed some passages as many as 10 times before finding a classmate to explain. “It's good, but the process is some kind of painful.”
Lei, 26, has realized that she thinks in English more often these days, murmuring fragments of English sentences to herself about the weather or what she should wear. She thinks her Chinese has gotten worse because she falls into English sentence structure.
Hard as it is, Lei said, learning medicine in English is important. Most Chinese doctors have been trained in Chinese, she said, so they have limited exposure to medical developments that are published in English. When she returns to China, she plans to urge more English-language medical training.
Xin also has felt the language frustration. She uses the dictionary in her smartphone a lot. Once, as she prepared for a test to demonstrate her CPR skills, she feared she might embarrass herself by stumbling when counting aloud. So she rehearsed the numbers, too.
For Yang, the challenge is more than language. She says she lacks life experiences and perspectives that American students take for granted.
When professors talk of protecting patient privacy, for example, Yang doesn't see why family members shouldn't be informed.
But the Chinese students know they are here to learn American ways.
In the U.S., medicine tends to center on patients: how they feel, how they view their diseases, what outcomes they expect.
In China, where doctors tend to be specialists who have little time for each patient, “It's, 'I'm the doctor. I'm leading this interview,'” Lei said.
Yet China currently is working to develop more family practice physicians and shift its health care system away from hospital-based specialization, Zheng said, and that's one reason China created the new program with UNMC.
In addition, China's medical schools don't have the same sort of physical therapy certification and instruction as in America. Xin said she expects to take what she learns and help develop similar educational practices for physical therapy in China.
Meanwhile, Yimei is learning about how to keep patients from suffering side effects from drug interactions. That's a skill that is in short supply in China, Zheng said.
Yimei had never heard of Omaha before she applied to the UNMC program. She looked on the Internet and saw a picture of a vast prairie under a rainbow. The idealized image didn't look anything like her home city of Chengdu, with its persistent smog. For the most part, she has liked Omaha — rainbows or not.
But she was disappointed to learn that Omaha had no subway, making it hard to get to an Asian grocery store to buy food. So after nearly a year, she bought a used Ford Focus and learned to drive — something she had never done in China, where cars are a luxury for many people.
Yang, meanwhile, didn't venture far from her apartment near campus or her medical school studies during her first semester. She felt the pressure to do well at UNMC, didn't relish going to bars and didn't have transportation of her own.
Her mother arrived for a visit in November and mainly stayed in the apartment, which Yang shares with another Chinese student. It's larger than the Beijing apartment where Yang lived most of her life.
After her last exam earlier this month, Yang was worried. She hadn't finished one section of her Cellular Process final before time expired. “I'm really mad at myself.”
A week later, however, she got the news that she had passed. “Not so good, not so bad,” she said.
Or as her Chinese classmate, Lei, said with relief at the end of the semester: “I survived.”
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