Health Center Meetings

Tuesday was spent visiting with medical officers to determine whether having a diabetes program collaborating with the MoH programs makes sense.  First we visited with the director of one of the hospitals.  They only do inpatient and so did not feel a peer support group or general practitioner training was appropriate since their hospital mostly has specialists.  They reported seeing many people with advanced diabetes with complications like vision impairment and those needing amputations.

Next it was to the local health office which overseas the community health centers.  They were much more open to the idea of our programs, including possibly integrating some prevention curricula into their pre-existing school-based programs.  However, upon leaving, my colleague mentioned that we still need the national level MoH buy-in whose approval trumps what is done at the district level.

This evening I was invited along to dinner with the CD and his friends.  We went to a seafood restaurant (we had seafood last night and lunch today as well).  You pick your seafood from the freezer, and your vegetables from the cooler and they cook it up for you.  And like last night you sit in a covered area outside which is nice.  The fish and lobster, grilled eggplant, greens and a variety of spicy condiments were very good, though apparently did not agree with the CD's digestion.

Island Hopping

I am sitting near the equator in a beach front hotel in Balikpapan, East Kalimaten, Indonesia.  Wasn't quite expecting it but it's a great way to end this long trip.  My time in Indonesia started in a chaotic fashion even before arriving.  The itinerary of this last leg changed daily and when I was dropped off at the Beijing airport early Sunday morning, it turned out that I was left at the wrong terminal - but with shuttles running in between.  With a bit of rushing managed to get through all the various steps to get to the flight gate with time to spare.  I was met in Jakarta by a PH staff member and enveloping humidity. 

Monday morning, the country director (CD) and I set out at 6a to make our way through Jakarta traffic to the ministry of health for a meeting about our assessment.  We'd been invited by a diabetes sub-director to meet with the NCD director.  After several hours, chatting with the former's staff, we were finally informed that the latter was not available and had forbade her staff from accompanying us on our assessment trip (though we'd be told to bring our bags packed to get on a plane).  In the end, we decided to go to one of the sites anyway (where I am now) because our CD has many contacts here and it was at least one of the locations the MoH staff had pin-pointed as being a province where they would support our work.  

No sooner had we set foot in Balikpapan, and it became apparent that the CD is very well known.  He was warmly greeted by many of the hotel staff (where he was a hotel doctor), and when we went to the hotel seafront restaurant, an Australian voice called out his name and said "This man saved my life" (from thyroid cancer).  This trip is looking up.  Hopefully our meetings over the next few days will yield the outline for our project to be successfully implemented.

Bookends

This 3+ week trip started with giving a speech about NCDs and today the trip ended with a speech about NCDs.  Actually ended with two speeches. The first was a last minute request to give a welcoming speech this morning to help kick-off a health worker training on cervical cancer prevention followed by my NCD and its complications talk in the afternoon.  From what I can tell both went well.  I even had a brief interview with a journalist.  

This afternoon I had to myself which was a nice way to end this trip.  Did a little shopping inside a mall while a large, dark thunder storm hit.  When I came out a couple hours later, the once hazy sky was clear, the temperature had dropped, the humidity was gone and you could catch the rare glimpse of actual clouds and intermittent blue sky.  There may have even been a real sunset.  Tomorrow morning early I start on the third leg of this trip to Indonesia.  

Coming to the end

A fairly uneventful week but good none-the-less.  The highlights having been meeting up with my graduate school friend and former housemate FanFan last night for dinner and then spending the day on Friday with two colleagues hitting a few places they thought I hadn't seen. The last time I saw FanFan was the last time I was in Beijing, and the time before that was when she left Boston after grad school.  Since then she's been entrenched in the government working on internal communications about food safety.  Soon she will be finally starting a new position where she hopes that one day she might actually get to take a vacation.

Today started with a walk around the Olympic Park to see the Water Cube, Birds Next and the LingLong Tower.  The temps today reached into the 90's but it was tolerable to be out at that time of day briefly.  They then took me to an enormous lunch at a nice Szechuan restaurant.  This may have been because they learned that I like spicy food.  Afterwards, through horrible gridlock traffic we made our way to the Silk Market.  I wish I had remembered that I had been there before...in fact there is a blog entry about it back in Jan. 2008.  For those familiar with my dislike of shopping, you will not be surprised that I last about 15 minutes and that was only to be polite since we'd driven the whole way there.  Crowds, aggressive vendors, stall after stall of clothes which honestly did not appeal.  I'm pretty sure the only people who go there are tourists and foreigners - in fact, my colleague who has lived in Beijing for 10 years had never been there until today.

Beijing - so we meet again.

Beijing is hot.  Beijing is huge. Beijing is polluted.  But for some reason I feel far more at ease here than I did in Shanghai.  Possibly this is because 4 1/2 yrs ago I spent about 5 weeks in Beijing.  In fact, that trip is what inspired me to start this blog. Or maybe because moving on to Beijing signals my trip coming closer to returning to DC.

On Monday, two of my Shanghai colleagues and I boarded the high-speed train to Beijing. It made me think of the bullet trains in Japan - which I remember being even faster, and that was back in 1995.  Upon arriving in Beijing, I was handed-off to my Beijing colleague and the office driver who deposited me at my hotel.  Later I had dinner with some of the Beijing staff and then was dropped off at a nearby park - which I found is great for an early morning run.

Tuesday consisted of presentations at the office so I could learn more about the programs I support and they could hear about the projects I support.  I also ventured out to the Rotary Club of Beijing's lunch meeting.  Overall a good experience and I was awarded the farthest visitor gift as well as convinced them to give me a banner even though my club does not have on yet.

China = Disneyland + Vegas

My final week in Shanghai was rather uneventful.  Except Friday night when the American fellow and I went "out" in Shanghai.  However, instead of out, it was actually for an extended walk.  This was partly because she wanted to show me a temple that is sitting in the middle of modern sky-scrapers - it's a little surreal as you'll see in the photo. Turned out to be an exhausting evening (we took some wrong turns) but for my last free evening in Shanghai it was good to get out and see some things.

This past weekend, we tagged along with a group of rural medical trainee fellows who have just finished their year in Shanghai and will soon be returning to the far reaches of China.  We took a 5 hour bus ride to a place that translates into Thousand Island Lake.  The lake was formed in the 1950's when they dammed a river and flooded the area.  The size of lake is on par with the size of Singapore.  Before we got there, we stopped for a lakeside lunch, tour of a cave, toboggan down from the cave, and raft ride on a small lake.  Tourism in China is a finally tuned machine.  All the tour bus groups were shuffled through in a timely fashion - photo opts at appropriate moments which you buy afterward (I did not partake) and then  you are off on the bus again.  In the evening we ventured into the town of Chun'an which is on the Thousand Island Lake, and happened upon their Saturday night fountain show, the square where people were practicing public dancing, and a random fireworks display.

Day two was similar.  Several tour groups board each boat, you go to three islands.  Each one has different amusements that you can pay extra for similar to a carnival, or you can walk around and look at the scenery.  Easier said than done.  There are hundreds of people and each tour group has a guide who is screeching into an amplified microphone - often at the same time.  Between the crowds and the deafening noise, it was really quite an experience.  But my group was very nice, the time out on the boat between islands was pleasant as well.

Shopping & Dining

The group rose early and departed for the rainy bus ride back to Kunming.  But before we were done with Jianshui we had to stop for "Across the River" noodle soup.  It is one of the dishes famous in this area.  The difference is the noodles are added later instead of being cooked in the broth.  I guess it prevents them from getting soggy.  You add all sorts of things to the very hot soup: raw egg, raw chicken (both cook instantly), pork skin, tofu, congealed blood (looks like brown tofu), hot pepper, vegetables etc.

Upon arriving in Kunming, we had lunch at a Muslim restaurant - a large population in this part of the country, and then spent the rest of the afternoon shopping.  Jade is particularly well known in this region - most of the people you see are wearing at least one piece.  Any thoughts I'd had about picking up a few items for gifts or myself were quickly squelched when I realized that jade is more expensive than any jewelry I've ever priced (which admittedly is few).  Even a plain jade bracelet from a street vendor cost $100.  Once you walked into a reputable store, the price could climb to $10,000.  I have no idea why.  I was told the prices have doubled in recent years - I suppose similarly to how gold has also increased.


Some of our group had spent the afternoon touring and meeting with administrators at the Kunming hospital and so it made sense that we would be hosted for our farewell dinner.  The restaurant was located in a beautiful old multi-floored ornate wooden building with center courtyard and lit paper lanterns.  This was probably my second favor meal - but unfortunately was too stuffed to really do it justice.  But I did manage to try fried bees - which besides their unnerving resemblance to the living creature did not consist of much more than a crispy fried exterior (the top dish.  The other three are goose liver, goose stomach, and a root).

Jianshui in a Day

It is not lost of on me that even though this is an outreach medical trip, in fact I am part of a Chinese tour group.  We do everything en mass, there is no free time, and every minute is scheduled.  I don't know that I've done so much in so few days.  Exhausting but not a moment wasted.

This morning began with the opening ceremony announcing the collaboration between the two hospitals.  Then was a morning of health screening and education.  Unfortunately, again, not knowing the language I observed and people watched instead of being much use.  What was interesting was the attendees tended to be from the minority groups and there is obviously much more pediatric medical need than what this small hospital is equipped or trained to provide.  Especially interesting were the number of special needs children who were brought to the event by parents or grandparents.

After an enormous lunch we spent the rest of the day, as a group, being tourists.  We visited a Confucian temple and an historic house and gardens.  And then it was straight to a large dinner and finally to an after-dinner show which was a sort of cabaret of song and dance in colorful costumes based on the traditions of the various minority groups in the region.

  

Escape to Yunnan

This Memorial Day weekend in China took me to Yunnan Province - located in the very south and bordering several countries including Laos and Vietnam.  We were joining a hospital outreach visit to a local hospital in the "small" town of Jianshui - a four hour drive south of the provincial capital Kunming.  Early Saturday morning we flew three hours to Kunming and got in a bus for a four hour drive south.  The lunch we had on the way was the best food I've had this trip to China which supports my theory that it's not that Chinese food has changed, but that I'm not very partial to the Shanghai style.

Jian Shui has a population of  over 500,000 with 30% being minority populations.  After a meeting with the hospital administration and quick tour of the pediatric wing, we piled back in our mini-bus and headed to the old part of town to a restaurant located on the grounds of a 700 year old temple.  This the Jianshui hospital's opportunity to show their hospitality which translated into a very large dinner with a never ending variety of dishes accompanied by never ending toasts of wine and "corn wine" (I suspect sorghum) which invariably led to people breaking out into both drinking songs and traditional ballads, which led to more drinking.  It would have greatly helped to have been able to have understood the narrative that went with the festivities.

Out and About Town

Yesterday was a fairly uneventful work day.  However, two colleagues and I ducked out early and taxied over to the Fabric Market.  A week prior they had ordered clothing made and were going to pick them up.  I tagged along and was introduced to a new level of shopping induced stress.  The indoor market is floors of stall after stall - each one a combined fabric, tailor and clothing shop.  You look at the styles hanging on the front of the stall, and then when you see something you like, you pick out the fabric, haggle a price and before you know it they are measuring, recording and taking your deposit.  Exciting and nerve-wracking.  I had heard that cashmere coats are the thing to get made here.  And with my colleague's assistance with the fabric and haggling, I go next week to pick up a new coat.  Hopefully it will be a success and not an expensive cultural experience.

Today's big outing was to visit the Shanghai Rotary Club.  As a DC Rotarian, I am supposed to make up club meetings while traveling.  I opted for the smaller, informal lunch "fellowship" meeting which was near work.  Only four of us showed, but it was still an interesting experience and I came away with the requisite club flag to bring back - like a war trophy - for my club's growing collection.  Interestingly, the man who had the flag went to law school at Willamette, had several Oregon connections and his sister and I were born at the same hospital in California.  With his driver, he gave me a ride back to work and insisted if I ever had any problems while in China I was to call him.  Yep, that seems to be the Rotary way.

Safety in numbers

An acquaintance warned me that when I venture out into Shanghai, it helps to say to oneself "Everyone is just trying to survive" in order to accept the crowds, pushing, lack of queues and general pedestrian and traffic mayhem.  It also occurs to me that because of the sheer number of people, perhaps the lack of general safety has resulted from just that - there are so many people.  Case in point, I was warned my first day, and reminded for several days thereafter, that no moving vehicle stops for pedestrians.  As observed in other parts of Asia, the bigger you are the more right of way you have in the traffic hierarchy.  It is a concept that is pretty easy to absorb once you've navigated a few intersections.

The other lack of safety I became keenly aware of is that during the night, or in some ways this is a rather skewed view of safety, we are literally locked in the guesthouse.  Two mornings in a row I've tried to go for a run and encountered a u-lock bolting the front door closed.  Both times the sleepy manager has appeared to unlock it.  I followed an "exit" sign to another door and found that it too was locked.  However there do appear to be smoke detectors and fire extinguishers (or boxes labeled as such) so if we are locked in at least we have the means to do battle (should the warden, I mean manager, become asphyxiated).  

Food Service

Second day in the office was fairly uneventful.  In the afternoon my RD colleague took me to visit the nutrition department and learn about what they do, who they are and what changes had been made due to the program that Hope is implementing.  Previous to the project, the nutrition staff primarily were in charge of food service management.  Now they do nutrition screenings on high risk admissions and also perform outpatient services.  For example, every Friday they have an pediatric obesity clinic.  They have also developed a variety of educational materials for parents on how to provide nutrition for their children with special health needs (i.e. oncology, cardiac).  In addition, I learned that do be a dietitian in China one requires only a certificate program and it is unusual for them to have an undergraduate degree.  Because of this, in this department there are three staff with PhDs in nutrition who oversee the work of the rest of the department and handle more complex calculations such as IV and tube feedings.

And speaking of food service.  Today was my first exposure to the staff cafeteria.  I had been warned to turn off certain senses before entering but was not really prepared for the onslaught of chaos and, shall we say, debris.  The food itself wasn't so bad, but the tables were covered with thin plastic which was changed between each group of diners in order to clear away bone, gristle and what ever else had not passed the palatability test.

This evening I ventured out on my own taking three separate subway lines and following detailed directions to meet two friends of my new DC housemate for dinner.  Both work for international companies and have been temporarily living in Shanghai.  It was very interesting hearing about daily life as an expat and an enjoyable evening out. Equipped with the hospital address in Chinese, I took a taxi back and managed to also find my way to the guesthouse.  

Making the Rounds

First day in the office.  It is rather handy to be staying and working on location at the hospital where we have our programs. Still suffering from jet lag, I was up at 3a and out running at 5:30a.  Even caught a bit of the solar eclipse at 6a.  Already a productive day. 

Most of the work day was spent in meetings with various visitors from the US to talk about safe medicine practices in China.  The first group was from a pharmaceutical donor and it was very fascinating learning about the complex subject.  Everything from monitoring ingredients, to hospital handling of medicines, to patient awareness raising to establishing feedback and tracking mechanisms were covered.  Contamination, counterfeit and fake medicines are major concerns as far as patient safety as well as damaging reputations of using safe medicines.  Even now in China, the health care system is fighting to change the population's perceptions of proper medical care.  For example, the parents of children who come to this hospital don't feel they've been properly treated unless the child receives an IV, when really most medication can be taken in pill form at home.  (Photo is HOPE founder Dr. Walsh - a statue on the hospital grounds)

As part of our meeting, we took a short tour of the hospital, visiting two critical care units, a patient floor and the pharmacy.  Later we met with a US gov't official who works on the same subject matter.  A very different kind of meeting.  

Although fading fast, Connie and I ventured out this evening to experience a bit of the city finding ourselves at a nearby shopping mall where we had a decidedly disappointing dinner and did a bit of shopping.  Unfortunately I had to stay up for a 9:30p conference call and then promptly fell asleep.  

Shanghai'd

Two bright spots on a cloudy Sunday.  The rain stopped.  And I had a tour guide of sorts.  As immense luck would have it, we have a corporate fellow working in our Shanghai office.  She has been here for 2 weeks and speaks some Mandarin. Both are excellent assets for showing me around Shanghai.  She had already tried out the metro and been to a few parts of town.  We started off taking the metro to Old Town, browsing through the shops before heading to Yuyuan Garden (also surrounded by an old style shopping area).  The place was packed with mostly Asian tourists.  Then we headed via Nanjing Rd shopping area to the Bund - the water front on the western side of the city.  On a sunny day, the views would have been amazing, but even on this dreary outing, it was pretty spectacular.  On the Bund side, the buildings have an old, colonial style, and on the opposite, newer side of the river, the financial district has a glassy, space age look.  Most notable is the Oriental Pearl Radio & TV Tower.  It's pink.  And to either side are large world globes.  In addition there are numerous, uniquely shaped skyscrapers and two mega-malls.  We took the ferry from the Bund across the river which provided some great views of the city.  With any luck, I'll make it back for the lit-up nightscape.  With extremely tired feet we made it back to our little corner of Shanghai to recuperate and get caught up for my first day in the office tomorrow.

Film, Food & Forum

One and a half years since my last posting.  Somewhat speaks to the less than vibrant travel schedule I've had though I did neglect to write about the surreal trip to Dubai last December for the international diabetes conference.  But without further ado, I declare this blog reinstated.  The inspiration - a long awaited work trip to China.  I will be in Shanghai 2 weeks and in Beijing for one week.

Our story picks up three days in.  Having long ago learned that sleep just wouldn't happen on long-haul flights, I instead caught up on movies.  And lots of them.  Six in fact.  I mean really it's very time and cost efficient since I never get to the theater back home.  Unlike my last trip to China, my new org sent a driver to pick me up from the airport which saved me from having to latch on to a fellow traveler to find my way to a taxi.  I was dropped off at the guesthouse at the medical center where our office is located and once I'd oriented myself to the new digs i.e. figured out how to turn on lights, checked the kitchen for breakfast items and picked a bedroom, promptly passed out.

The next two days were spent in a community health center worker forum, where I gave the plenary talk, and then a day of program partner presentations, evaluating and signifying the end to the program.  It was a three year chronic disease management program that focused on continuity of care, training health workers and developed patient education materials for COPD, heart disease, sleep apnea and stroke.  Fortunately my talk was about 12 hours after I arrived in country - jet lag had not kicked in and the caffeine had not worn off.  My colleague provided translation.

Food, food, food.  My colleagues had been kind enough to have some items put in my apartment.  There were eggs, yogurt, oatmeal (I think someone tipped them off on that preference), milk, bread, cheese and fruit.  All good.  There was a hot plate and microwave.  Also good.  There were two plates, two tiny bowls and a pair of chop sticks.  However the hot plate was in Chinese and pressing buttons randomly did not seem to heat it.  Then I realized I had to eat yogurt/oats with chop sticks.  In the end it worked but with creativity.  Turns out the hot plate heats without "heat".  And I bought a spoon at Walmart. Less fun but more efficient dining has resulted.

For the two days of meetings we were somewhat spoiled with fancy lunches - the kind where you stuff yourself on ten-fifteen assorted dishes only to have another ten be brought out.  Friday evening was a going-away dinner for an American visiting doctor which involved the same parade of food.  Pacing yourself isn't in the realm of possibilities, and so it was understandable when Saturday I didn't feel well and hardly ate much. I've been promised that the rest of my dining experiences, while less ornate, will be on a much smaller scale for which my stomach and I are very thankful.