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.  

Am I in India?

I have been in New Delhi for almost four days but it really doesn't feel like it, or at least not like the India I experienced six years ago. Granted that was budget travel in the very, very south and this is a work trip in the north. But still, one would think when you are in a foreign country it would feel like it.

Since arriving, albeit exhausted from a painfully long flight after spending five whirlwind days in Boston, I observed a refresher course for diabetes educator master trainers. It was interesting for sure, however I quickly removed myself from sitting at the front of the room, as I was falling asleep and having a terrible time appearing engaged. The women attending are nurses and dietitians from health centers through out India. They have been trained to train other allied health care professionals to be diabetes educators. Globally, India has the leading number of adults with diabetes yet, they are only now developing the diabetes educator role.

Saturday evening, we attending a lighting ceremony, where 50 monuments through New Delhi will be caste in blue light as a symbol of joining together to fight diabetes - blue is the official color of World Diabetes Day. Various who's-who were there including the new Danish Ambassador to India and his wife and daughter. After this event, we went to the Russian Center for the premier of a movie about three children coping with type 1 and type 2 diabetes. Despite it being almost entirely in Hindi it was very easy to follow. It was a very late evening since everyone was given a chance to speak. After 10p we finally had the buffet meal. Unfortunately, I tried the desserts because early Sunday morning I awoke with that telltale feeling of food poisoning. I blame the tepid custard. So that meant I missed all the World Diabetes Day activities this morning and the follow-on Child Congress meeting (Nov. 14th is both WDD and Child Day in India).

Over the next two days we will visit our Delhi office, and meet with a few donors. And I will be meeting up with a friend from graduate school who now lives here with her husband and newborn. While I dread the long trip back, I am very much looking forward to getting home after this long trip.