Cultural Differences Between the US and Taiwan

            It’s interesting to learn about some of the cultural differences between the United States and Taiwan.  For example, in the Chinese culture, it is good luck to have a baby born in the year of the dragon (a dragon baby). Because of this, more couples have been having children and there has been an increase in invitro fertilization. This increases the chances of complications and many of the women end up having premature twins or triplets. In fact, my preceptor was saying how many of the babies are ~1 kg (2.2 lbs) when they’re born, with the smallest baby being 600 g (~1.32 lbs!). My preceptor mentioned that this is why more children are admitted into the NICU and PICU this year.

            Another difference is that patients in Taiwan prefer to take their medications in an oral formulation, rather than another formulation even if it is more effective. For example, when treating asthma in the pediatric population, we use inhalers in US. However, in Taiwan, inhalers are not used very often. Instead of albuterol, they use procaterol HCL, which is also a short acting beta agonist. At NTUH, it is available in an oral and liquid formulation. The usual pediatric dose for a child is 25-50 mcg BID; or initially 0.5 mcg/kg/dose with a maintenance dose of 0.5-1.25 mcg/kg/dose daily or BID. In Taiwan, patients prefer that people do not know that they are taking medications so for them, using an inhaler is very obvious. It also makes them feel that the condition is very severe. Thus there is a negative stigma around the use of inhalers, especially in the pediatric population.

            Another interesting thing is that in Taiwan, corticosteroids are not prescribed as often because many patients have a negative view on them. This refers to any route of administration such as oral, topical, or inhalation. It is particularly not used often in the pediatric population because many parents fear that corticosteroids will stunt their child’s growth. This ends up changing the way that asthma is treated in the pediatric population as well. Normally in the US, if a short acting beta agonist isn’t enough to control the asthma, then a low dose inhaled corticosteroid is the next step.  Instead, pediatricians will prolong the use of procaterol (their oral equivalent to albuterol) until they absolutely must use an ICS. The pediatrician I was working with was more likely than the other doctors to prescribe an ICS, as long as the child was older. It was interesting seeing the pharmacist’ perspective on this because they do practice evidence based medicine. While they do understand that ICS’ should be utilized more often, they are also aware that patient compliance will be very low if an ICS is prescribed since it is inhaled and is a corticosteroid. It is the pharmacists’ goal to have more improvement in the area of patient education. 

Hello/Goodbye PICU! My preceptor, Johnny's new PICU preceptor, and another pharmacist took us out to dinner to send me off and to welcome Johnny.