Going to the dentist in northern China did much more than fix my
teeth: it opened my eyes to some stark differences between North
American and mainland Chinese cultural paradigms and dental
practices.
The first obvious difference is price. Dental work is astoundingly
affordable. Dental clinics abound here in Hohhot,
Inner Mongolia, where I've lived since 2004
teaching English and Russian. I sought out a dentist last week when
an upper filling partially chipped and fell out during lunch one
afternoon. Luckily, my best friend, a 45-year-old Buryat woman,
Irineshka Zhargul, immediately escorted me by bicycle to a nearby
dental clinic. "It's great," she assured me, "I took my son Yura
there to pull out one of his ingrown baby teeth." Together we
pushed open the sliding glass door and peered inside. Dr. Liu, the
owner and head dentist, was sitting at her desk reading an outdated
dental journal. She cheerfully greeted my friend and then waved me
into one of her new, high tech chairs. "You need a crown," the
petite dentist announced a few minutes later, after peering into my
mouth and probing delicately with her pick. "When do you want to do
it?"
?
"Uh," I muttered, floundering, "How much will it cost?"
?
"We have different prices," she explained. "Ranging from 150 yuan
(US$20) to as much as 2,000 yuan (USD$260). I'd advise a middle of
the road price. It will last several years, look good and give you
no problems."
?
"Okay," I replied, "How about the 600 yuan (US$75) crown? I'll come
back in a few days, okay?"
?
"Sure," she responded. "Here, take this tray: it's your own
personal dental tools. Write your name on it. I'll keep it here
until you decide to return. That tray costs 5 yuan (65 cents).
Please pay me now."
?
I paid. Then I decided to prepay for my 600 yuan crown as
well?-- more for myself than for her. I'm actually terrified
of dentists and doctors. Only already turned over cold cash will
convince me to come back.
?
But come back I did, and on a Sunday afternoon. Dentists in China
work seven days a week. Doctor Liu had informed me that she
regularly put in ten hour days, not just to pay off all her bills
but as a matter of course in order to provide convenient office
hours for her patients. "How long have you had this practice?" I
asked her.
?
"Just seven months," she answered. "I work with my husband. My
spouse helps me with customer service. He puts bibs on patients,
gives them each a hand mirror, and sterilizes stuff for me. He pays
bills and employees. I also have two helpers. They can do most of
what I do?-- we are equals. Actually, they are my former
classmates but only I had enough money to start up the business so
they work for me. I borrowed about 100,000 yuan (US$15,000) from my
good friends, not from a bank. Success has arrived but I'm still
sending in monthly payments for my three chairs; each costs 20,000
yuan (US$2500)."
?
I nodded, appreciative of the beautiful little work area Dr. Liu
had created. Her prices were slightly higher than a neighboring
clinic but the hygiene and aesthetics were well worth the extra
cost. Chinese patients pay cash for services rendered immediately
after receiving them. Each service and/or product is itemized and
the patient is free to choose several options and prices. I watched
as an assistant worked on a ten-year-old boy, first giving him an
optional shot of anesthesia (15 yuan?-- US$2), then taking a
quick X-Ray of his ingrown tooth (20 yuan?-- US$2.5). Finally
she worked patiently with pliers to loosen and pull out the faulty
tooth (10 yuan).
?
Upon my return a few days later I received my prepaid 5 yuan tools
and then agreed to an optional pain shot. Then an assistant took an
X-Ray using the small machine in the corner by the door. She gave
me no lead guard, held the film with her finger and zapped
everything. Two minutes later Dr. Liu peered at the picture, and
then she began drilling. First she ground down my faulty molar with
a kind of sandpaper in order to get ready to cap it. When she
finished her tasks instead of applying a temporary crown she
smeared the rough surfaces with a protective coating and sent me
home. "Come back after Friday," she stated. "You'll get a temp on
your return. If you have any pain you can come back sooner."
?
This lack of set appointments, the inability to choose a specific
dentist, and multiple tasking I watched all three dentists perform,
all represent notable cultural differences between China and the
West. Here in China patients simply show up, sit and take the
doctor allotted, unless the problem happens to be very specific. In
the US and Canada I waited for weeks, even months to see my
dentist. Moreover, here a client's entire dental history and
problems are on public display; in the West we value our privacy.
Sending dental records resembles espionage at times. Chinese have
less need for privacy. Everyone in the office, from patients,
family members, and even passersby, all are free to watch if not
step near the dental chair and comment on your treatment. It's a
bit unnerving at first but after three years in China I actually
find it reassuring. For the most part people are alert, friendly
and sympathetic, rather than gawking.
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Significantly, no one in China ever goes to a doctor or a dentist
alone. It is a social affair, with the more the merrier. Family
members stand around to show their loyalty and affection to the
stricken relative, and to be on call in case anything is needed. I
was the only person who came alone. In fact, out of a sense of duty
several students came with me on my second and third visits to show
their respect toward me as a teacher more than to help with
translations.
?
Another notable difference is the sound inside a dental office. It
is as quiet as a library. Dentists do not gossip mindlessly over
your trapped form to each other. Clients do not talk, whine or cry.
They even spit quietly. Normally garrulous family members rarely
speak and if they do they whisper. Fixing teeth is serious and
expensive business. As I lay in the dental chair receiving
treatment only the sound of all three drills whining reverberated
in the room. No piped music floated in the air.
?
Dr. Liu's entire office consists of one small open room with a
plate glass window facing the street and sliding glass doors. White
walls, lots of live plants and big blue Chinese characters adorned
the room. The waiting space offered no magazines so I was reading
the slogans to practice my Chinese. "That slogan says 'We build
strong teeth' and that one states 'Our dentists are of high moral
virtue and good quality'," whispered Shirley Li, my devoted
student, as we waited for my third and final visit. The clinic was
packed. We gazed around the room, commenting on the pretty
interlaced bamboo plants, the ten educational posters (in
elementary Chinese) and the sense of cleanliness and well being in
the room. "There is her price list," Shirley commented, pointing to
the wooden desk where a paper had been taped. I read: cavity
fillings 40-60-80 yuan; fake teeth, leave in 30-40-50; fake teeth,
removable 100-200 yuan; pull tooth, 15 yuan; dentures for elderly
300-1200 yuan; and braces 2000 yuan and up. We patiently waited.
Today all three dentists were currently occupied. Seven clients
sat, including me.
?
"Dr. Liu sure is popular," I remarked, watching her press the drill
pump on the floor with her fashionable stiletto heels. The
diminutive dentist wore no makeup or jewelry but obviously was
raking in cash.??
?
"She dreamed of being a dentist since childhood," a plump matron
next to me quietly remarked. "She told me her mother had terrible
teeth, and she wanted to help her mother. She fixed her mom's teeth
for free."
?
"Good teeth are symbols of success now in China," added Shirley.
"Just like in the Western countries."
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"How much schooling does a dentist need here to start a clinic?" I
inquired.
?
"Dr. Liu went to a special dental vocational school just for a
year. It's not like the West, where you go for years and years.
This school teaches practical application. Besides, every good
dentist goes to refresher courses each year to learn new
techniques, and there are ways to exchange ideas." I nodded,
wondering what these methods were, since no computer sat near the
desk where people paid for services. The office seemed small, about
14x20 square feet. We sat propped against one wall, watching the
three dentists working on patients in the three chairs. A large 12
foot by 8 foot mirror hung on the opposite wall, creating an
illusion of more space and giving the patients a way to watch the
dentists as well. The room smelled slightly of medicinal herbs and
iodine and soap.
?
"Does she own this building or rent?" I asked one of the two
efficient assistants. "We rent," she replied primly. "It's about
1000 yuan a month, but the doctor lives right across the way so
it's convenient for her to walk to work."
?
"What about other overhead?" I probed. "Taxes, liability insurance,
interest rates?"
?
"Pretty low," Dr. Liu interjected. "I pay about 500 yuan to the
government for special liability but no one has ever made a
complaint. And my friends do not charge me interest on my loan. I
have no student debts; only my equipment. I'll be debt free in a
few years."
?
"What kind of profit do you accrue?" I curiously inquired.
?
"I'd rather not say," she smiled back. "But it is certainly not the
money Western dentists make. I work long hours, granted with my
husband here too, but I earn less money than any Western
professional would agree to. The work suits me. I am serving my
country as well as acting as a small business owner." She grinned
and her eyes lit up, and then rolled herself back to peer inside an
elderly grandmother's mouth.
(China.org.cn by Valerie Sartor, April 5, 2007)
