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.