Orphanage Adventure

Today my parents left to return home, leaving me with an empty apartment once more.  In an attempt to stave off the post-visitor blues, I decided I was going to go see an orphanage named Harmony House where we will be expanding the Magic Hospital Storytelling program.  I had quite the adventure getting there, as I didn't really know quite where I was going, managed to find the long distance bus station, get a ticket, get on the bus, and then realized that I didn't have my phone to call the orphanage director upon arrival at the bus stop as I was directed.  And then I realized I didn't actually know the name of the stop I was getting off and it wasn't listed anywhere on the bus.  And then instead of leaving at the time listed on the ticket, the bus trawled for passengers in one gas station after another...for 20 minutes...then 10 minutes...then 15 minutes...as it got slowly later and later, past the time I was supposed to meet Lily.

Eventually, I managed to get the nice girl next to me to lend me her phone, called Lily, who picked up after a frightening 7 rings, who then exclaimed that she'd called me 3 times and sent me an email trying to cancel my visit!  All of this, of course, just after I'd left my apartment, with my phone sitting on the desk.  She very graciously told me to come on, and sent the orphanage driver to pick me up at the bus stop.  It wasn't really a bus stop actually, more like a corner, and I spent a scary 10 minutes wondering where the driver was, but he showed up eventually, and I made it to the orphanage at last.  

 I've never actually seen an orphanage, even in the US, but after recently reading Jane Eyre, my experience today was reassuring.  There was a cozy play room with oodles of toys, a rack of coats hanging up, and upstairs 4 rooms with cribs and beds and a nannie in each room.  Lily seemed very fond of the children, picking them up and playing with them during our tour.  And she is determined to get volunteers to play with them; after expressing concern about my 2.5 hour journey to get to the orphanage, she offered the services of her driver every week to pick up the volunteers in Beijing!  Her dedication was really inspiring, she has already adopted one of the children from her orphanage and was obviously very involved in providing a warm, happy home for them.  I am looking forward to returning to play with the kids!

ps. pics from "The Tiggelaars in China" coming soon...

Quick Update

My parents just arrived in Beijing for a 10-day Christmas holiday, so the next couple days might be fairly blog-less, just fyi.  Today we went to the Forbidden City, Tianenmen Square, and Wangfujing street where everyone was shocked at the grossness of the food on offer, including snakes, tiny squid, sea urchins, and seahorses.  I think the most shocking thing of the day for my mom though was the baby split pants - babies here wear pants with a hole on the butt so they can pee and poop at will, which they do pretty much anywhere, including grocery store floors.  I don't understand how this is compatible with being held by adults, but hey, it must because I don't think people would stand for constant soiling of their clothes.  I've heard Chinese babies are potty-trained at an insanely early age!  We have a full range of activities and sightseeing lined up for the next few days, including a trip to Xi'an to see the Terracotta Warriors.

 Right before my parents got here, Adam, Alison, and I went on a trip to a 'yearly forum' for all the epidemiology departments affiliated with the Peking Union Medical College.  It was a cross between a farce (sitting in hours of lecture in Chinese when everyone knows we can't understand, plus giving lectures of our own in English that no one understands/cares about) and hilarity (the hotel had hotsprings, bowling, karaeoke, etc) -- please see Adam's blog post about this as we had a hilarious towel adventure that would take too long to relate now. http://faruppereastside.blogspot.com/2010/12/our-trip-tobeijing.html (Thanks Adam!)

And one random picture to share: on the way to CICAMS to go on the trip, I realized that the city government has again decided to tear up my neighborhood for construction...but that doesn't stop the residents from going about their daily business, including shopping for vegetables literally inches away from a trench being dug for pipes!  DIC! (Dude its China!)

Research Update

I thought as I head into the holiday season and my slightly stolen holiday with my parents and sister (there's no real 'Christmas vacation' here, but I'm not gonna hang out at the office my parents in Beijing!) that I would recap what I've done in my research so far this year.  As most of you probably know, I am working in the department of epidemiology at branch of the Peking Union Medical College, called the Cancer Institute, Chinese Academy of Medical Sciences, or CICAMS for short. I am on the team that focuses on cervical cancer, and I have several projects on different aspects of detection, prevention, and awareness, which I will outline here (sorry for the length!).

1) Review paper about serology and DNA prevalence of HPV (the virus that causes cervical cancer) around the world.  My US mentor gave me this project to work on in July, before coming to China, so I would have a project from the beginning and something to work on when things are slow around here. She seemed to think that this would be a quick project but it has been anything but; however, I have come a long way.  I have finished finding new papers to include the results of, have written the results and discussion sections, and am currently editing, formatting, and designing tables and figures.  We hope to submit this to a journal in the next month or so.

2) Survey about women's response to cervical cancer screening and results from screening tests. I designed the study based on prior studies done in this area in the US, visited the site where the study would be carried out earlier this semester, and it is currently underway in Yangcheng, Shanxi Province. Designing this survey took multiple attempts and revisions, especially since I don't speak/read Chinese and it was hard to communicate exactly what I was trying to ask!  Grace, an awesome grad student in the epi department who is in Yangcheng is helping me input the data into a database and will translate it for me.

3) Sexual debut in China paper. Sexual debut, or the age when a person first has sexual intercourse, is an important fact to know about a population when dealing with a sexually transmitted disease like HPV, especially when there is a vaccine.  The vaccine will only be effective if we vaccinate girls before they become sexually active.  The Chinese government is currently deliberating about approving the vaccine (already approved in a large part of the world some time ago, just approved for men in addition to women in the US last year) so now is the time to really figure out the age of sexual debut, so a national vaccination program can be designed that will work. The epi department did a survey assessing the age of sexual debut in thousands of women last year, and the data was just waiting for someone to write up.  I have written a manuscript with Shangying, Adam's Fogarty twin, and we are waiting for input from other authors (people at the research sites) before we submit to a journal.  Our idea was to submit this week, but as tomorrow's Friday and I will be gone afterwards, I imagine we will submit sometime in early January.

4) HIV-HPV screening trial.  HIV infected women are much more susceptible to HPV infection, and thus cervical cancer, because they have no immune system to fight the virus.  Now that antiretroviral therapy can extend the lives of HIV+ women, they are living long enough to die of cervical cancer.  There is a large population of HIV infected women in Yunnan Province, and we are designing a trial to test different screening methods in this population.  We also want to see the effects of antiretroviral therapy on the progression of cervical lesions and cancer; this is a new factor in the recent past and the scientific community does not completely understand it yet. I have written the protocol for the study, designed the data collection forms, and met appropriate people in Yunnan last month. We hope to launch the study at the end of February. I also have some data from a pilot study in this same population with 95 women that I am currently analyzing to publish a short descriptive paper.

5) VIA/VILI paper - VIA/VILI stands for Visual Inspection with Acetic acid/Visual Inspection with Lugol's Iodine, and is a very cheap and easy screening method for cervical cancer.  Its a great technique for resource poor areas, and has been shown to be much more effective than no screening at preventing cervical cancer death.  There have been many studies proving its worth in other areas of the world, but none in China so far.  Several years ago the Chinese government launched a pilot screening program using this technique, and data has been gathered about the number of cases of cervical cancer and lesions among those screened.  I have written a first draft of a paper about this, but we are currently waiting for all the field sites to send their data to the epi department so we can finish.

And that's it folks, that's what I've done at work in the last 4 months!  Nothing finished yet, but a few things nearing the end of the tunnel, and many more things getting going.  I hope to have a very productive year!

Random tidbits

Just some random tidbits of my life recently that I thought photo-worthy.

A interesting/scary menu in Pingyao...my favorite, and all-too-true for my culinary experience in China, is on the upper right.

No idea...

Out to dinner at a German-looking Brazilian-BBQ name actually very Chinese food restaurant with some people from work and Lara right before she left for Thailand.

The world's largest and smallest citrus fruits, I could not resist taking a picture. The one on the left is called a youzi, or Chinese grapefruit.  The one on the right is a really small Clementine (I think).

Nan Shan Skiing

On Saturday I decided to try out Chinese skiing with Esther, another Fogarty scholar and a friend of hers named Ionel who she met in Beijing. I had heard that the ski resorts around Beijing were not that great, and its true that it was very very small even compared to the resort in Kentucky and not very steep, but I still had a great time getting my ski legs back for the day.  I consider it my trial run before skiing in Harbin for the new year at the mountain where the Chinese Olympic team trains, which I figure will be sufficiently steep!  They play commercials and music from speakers throughout the park, people occasionally cut me off while skiing like they do on the roads here, and the lift attendants were much stricter than at home with whistles and directions to go here and there, but otherwise it was pretty much like skiing anywhere else in the world.  I have been so sore for the past few days!

Ionel is also a boarder

The slopes of Nan Shan Ski Resort

Esther and I 

Esther having a great time learning how to snowboard!

Hua Xin

Today I went on my first visit with Magic Hospital to a hospital called Hua Xin, in the northwest part of Beijing. A lady named Pauline has been visiting once a month and she offered to let me accompany her to see what a visit is like. The hospital looked surprisingly new, and the children's floor was clean and nice, but not very bright-colored.  We went into a small toy/play room, and Pauline spread out the toys she had brought, including home-made playdough.  There were three parents with little babies, and a few 6-7 year-old patients, and one nine year-old patient.  

It was interesting to see the way the parents and nurses interacted with us while we were there.  Part of their reticence might have been the language barrier (Pauline's Chinese was better than mine but not by much), but they seemed much less likely to jump into the activities the way American parents would. We read several stories, and I admire Pauline immensely for having translated The Very Hungry Caterpillar into pinyin so she could read it along with the english!  The parents just sort of sat there, they didn't seem willing to say anything or try to get their kids interested in the story. After reading, we played with playdough and had a drawing session.  I feel like at home, parents would have sat down to draw too, talked about the pictures, and tried to get their kids interested, but not so here.  They just watched us drawing, and trying lamely to talk to the kids (one of them turned out only spoke a dialect of Mandarin and couldn't understand a word we were saying anyway). Even the nurses just stood in the background, if they weren't holding one of the babies. They did get excited though about my hand puppet frog that I learned how to make in high school - there are now 6 or so Chinese people in Beijing who can make versions of Chuck! 

 Overall it was a very fun time despite not being able to communicate in words with the kids that much; kids are still kids and they enjoyed make believe and excited voices even in another language. Loads of smiles go a long way with sick kids everywhere.

Pauline and I with a very precocious patient who knew way more English than I know Chinese

Magic Hospital

During the past two months I have become involved with an NGO in Beijing called Magic Hospital, which is a program to support sick and/or underprivileged children.  (outdated website www.magichospital.org, new one coming soon) We have many different programs at varying institutions around Beijing, all of them hospitals, orphanages, or schools for migrant children (which are not funded by the government and hence perennially short on supplies and resources).  Some of the programs we sponsor at hospitals are clown visits, art teacher visits, santa visits, an abracadabra program which is basically like Make-A-Wish, and something called 'Inner Olympics' which awards outstanding courage in the face of chronic illness to inpatient kids.  We also have several programs focused on orphanages and migrant schools such as Outdoors Days, a music enrichment program, and english teaching.  

 I have been brought on board as a coordinator for the Storytelling Program, a new program which is really more like Playtime visits for kids in the hospital. It reminds me of when we used to visit the playroom at the vandy children's hospital with APO.  Basically the idea is for groups of volunteers to plan out a 1.5-2 hour visit with storytelling, crafts, songs, puppets, etc to entertain the kids and provide a little distraction from why they're in the hospital. 

I am currently in the midst of negotiations with big children's hospital in Beijing, Er Yan Suo, to try to get our program started there.  I went to a meeting last week with the director of a floor, who ended up being very busy and giving us instead to his head nurse.  She listened to us, was very excited, and then said she had to ask her boss, who said she needed to have a meeting with us and have an official proposal.  We had a meeting with her tonight, and it seemed to go very well…until we got to actually ironing out details of when volunteers could come.  It turns out they really don't think weekends are a good idea - they don't have any staff there in the leadership who can make decisions in case of an emergency…and they have the busiest inpatient load of all week…(does that seem like a bad combination to anyone else?!)…and really only T-R afternoons are good.  Despite the fact that most volunteers are students or working and can only volunteer in the evenings or on the weekend!  It was an interesting cultural experience, as the nurse administrator was reluctant to actually say anything specific, she wouldn't say weekends were impossible but wasn't willing to acknowledge what I was saying about volunteer availability.  It was frustrating at the time, and eventually we ended with a hazy, "I'll talk to other nurses and important people and let you know".  The Chinese lady from Magic Hospital who was at the meeting with me told me that Chinese people are reluctant to make any definite answers for risk of being wrong/having to change it, which just screams at me as ending a meeting without all the important stuff being worked out.  Its hard to get used to, but hopefully all those important people will realize that a volunteer program with no volunteers isn't very useful it will work itself out.  It will be interesting to see what happens!

Pingyao

Adam, Alison, and I went to Pingyao this weekend, a small town in Shanxi Province east of Beijing.  Pingyao's claim to fame during the Ming and Qing dynasties was its banking, the first draft banks in China.  Today its famous for still being stuck in the Ming and Qing dynasties, as it was deemed too small and insignificant for the government's mass modernization programs, and thus managed to keep its old architecture and city walls intact.  

One of the main streets of Pingyao Old Town

A Ming dynasty courtyard and room

In some ways, there is value to being old, or to representing the past in how you look or how you do things, so that people can learn from and about the past.  Certainly trying to purge everything old and start anew, as Mao tried to do in China with the cultural revolution, risks losing many valuable memories and lessons from prior peoples and customs.  At the same time however, its impossible not to move on, people can't live in the Ming dynasty and in 2010 at the same time, so some of the juxtapositions are quite strange.  Gigantic 5-star glassy hotels just outside the ancient brick and earthen city walls…barefoot people whizzing around on electric bikes right next to horse-drawn carts…incredible dust and palpable coal soot in the air due to rampant coal heating…dirty children playing in the dust with chickens instead of being in school…grotesque religious imagery in a place devoid of fervour and filled with tourists...

Some statues which can only be representing hell...shudder

In some ways it would be good for Pingyao to move into the future a little - certainly better for the lungs of the inhabitants - after Pingyao, Beijing pollution looks sunny!  Its hard for me to see how the children of a village so stuck in the past can plan to move onward into modern things and ideas, but perhaps it was just hard for this foreigner to see past the coal dust to the true heart of 21st century Pingyao.

The back of the Wang Family Mansion outside Pingyao

Pingyao at its prettiest - at night, with lanterns flanking the shopfronts

Pingyao here we come!

My boss suggested that I take my parents to Pingyao when they come for Christmas, but the scheduling didn't work out...so instead I am going with Adam and Alison this weekend.  Pingyao is a UNESCO world heritage site in Shanxi Province, and is supposed to be a time-warped image of old China.  There is an ancient city wall, residences, temples, and a 1400-year-old underground castle!  We are doing a hardcore weekend trip: overnight train Friday night, arrive Saturday and sightsee, overnight in hostel, sightsee Sunday until 6 pm when we catch the overnight back to Beijing to be at work on Monday morning.  I will update with pictures and stories when I return!

Great Chinese Signs Strike Again! :)

A sign in a park in Mangshi - I'm not exactly sure how to do that!

Lijiang Old Town was full of helpful tidbits of advice for tourists...this was among the funny ones.

You can have orderly rubbish, just not messy rubbish.

Stepping on the grass is a life and death matter, didn't you know?!

My favorite so far - my name plate at the 70th Anniversary Party for the Gejiu Hospital - it says 'American Expert'!  Haha!

Chinese Thanksgiving

The last several days have been filled with Thanksgiving activities, despite not being home for family festivities.  At work, all the Chinese students were very curious about Thanksgiving; I guess they have heard about it on American TV but don't really understand the reason behind the tradition or how people celebrate.  Adam and I did our best to explain, both about the tradition dating from the pilgrims to the more modern opportunity for families to get together and be thankful for each other and for what we have, and Adam brought in a pumpkin pie to share that he made (it was fantastic! - and the Chinese students thought so too!)

On Thanksgiving night here, some of the other Fogarty students in Beijing and I went to a thanksgiving dinner at an American Diner in Beijing.  They were advertising an American-style thanksgiving dinner, and while it was not as good as my family's recipes, it was decent and nice to have appropriate food on the actual date.  They also had quite nice wine on the table :)

Dinner at Lily's American Diner on 11/25/10

Yesterday, was my actual Thanksgiving however; I hosted a potluck dinner with Fogarty people (mostly American), people I have met through Lara who are in Beijing studying Chinese (mostly foreigners not from America), as well as a few Chinese students from our office.  I have recently acquired a mini oven, so I was able to bake a few Thanksgiving mainstays, namely pecan pie and broccoli casserole, with many substituted ingredients and last-minute adjustments, but they turned out in the end.  Alison made a yam bake, and other people contributed tasty dishes as well.  I also managed to buy a turkey from the diner we had been to on Thursday, so our Thanksgiving feast was pretty authentic!  It was a really good time, it was fun to introduce our traditions to so many people who had never experienced it before, and the food was a hit with everyone.  After eating, we sat around talking and enjoying each other's company and playing games.  It really felt more like the Thanksgiving I was missing at home than going out to eat on the actual day.  

Our Thanksgiving potluck feast

And I now have quite a bit of leftover turkey to eat...hot browns anyone?? :)

Yunnan Recap

 I have pretty much written about my entire Yunnan vacation with the exception of my last day in Kunming, the provincial capital.  It was actually more stressful than necessary due to my excursion across town to see the Bamboo Temple, which had about 500 extremely lifelike statues of arhats, or wise men.  Unfortunately, I was unable to find a taxi willing to bring me back across town afterwards, and the minibus driver that I finally found got lost and had to ask for directions twice and eventually shoved 10 RMB at me and told me to get out of her bus!  It would have been funny except at that point I was stressed about making my plane back to Beijing…but it turned out fine, and I have a new appreciation for Beijing taxi drivers,  as they do not blink an eyelash at hour to two hour long slogs across town, where I had trouble finding one for a 20-minute hop across Kunming!

 I made it back to Beijing around dinner time, and a really nice Chinese lady and her daughter who sat next to me on the plane offered to bring me home, as they live quite near me.  We chatted in broken Chinese in the car on the way back, with many pauses for frantic dictionary looking, but it was a pleasant end to a long journey.  Even nicer was being greeted by dinner when I came back - Lara is still at my apartment for another week and had cooked up a feast to greet me!

 Overall, I had a very fun as well as productive time in Yunnan: I met some people essential to my research, got one of my projects back on track, and got a dataset I can actually analyze.  On the fun side of things, I saw an entirely new part of China that was very beautiful, had clean air, and was not nearly as cold.  I also met some nice people along the way, something i feel happens easier when traveling alone.  I saw more of rural China than I have seen so far, and caught glimpses of the farming life as I cycled through the fields or sped by in buses or cars.  I also now appreciate the government heat in Beijing; it is actually hot in my apartment right now, whereas in Yunnan, although the outside temperatures never drop as low as they will here, temperatures in the 40s at night are quite enough for a cold bedroom!   

As nice as traveling always is, it has been nice to return to Beijing, to my own bed and space, to a good friend waiting for me, and to a work and everyday life routine. 

Please check out the Picasa web album below for pics from my entire Yunnan trip!

Lijiang

Lijiang Old Town

Lijiang is a small maze of cobblestone streets about 175 km north of Dali, and it has about 4 million tourists a year.  Its apparently the UNESCO world heritage protection list, although when the Yunnan government wanted to build a big amusement park just north of town UNESCO threatened de-listing.  Its true - there were many tourists - even some fellow-foreigners - and much of the town was the same 10 shops over and over again, but there was a certain quaint charm about the winding old stone streets and rickety-looking buildings that still made for a pleasant stay.

Two waterwheels at the north of the Old Town

Lijiang from above

On my first day in the area though, I headed off by bus to see the Tiger Leaping Gorge, one of the deepest gorges in the world, with the mountain peaks about 3900 m above the waters of the Jinsha River.  The whole gorge measures 16 km long, and I was excited to hike about 4 km of it at the beginning, just to have some amazing views and to say I'd trekked in the gorge, before turning around and heading back to catch the last bus back to Lijiang.  I met a British boy on the bus from Lijiang to the gorge in the morning, Scott, which turned out to be the saving grace of the day, since we never managed to find the hiking trail!  When we got off the bus, we were 'taken straight to the trail' by a local trying to scam us into riding some horses...and then we walked on the road towards the trailhead on the map...and walked...and snagged a ride with another mini-bus, who took us to the point on the map where the trail branched off, and then promptly told us the trailhead was 2 km behind us!  We walked back, at least next to the Gorge on the road by this point...asked a couple people, and was told the trail branched up just past that car...and there were no signs.  We walked up the road for about an hour, and finally gave up when the trail gave no sign of actually going along the Gorge in the right direction.  We ended up returning to Lijiang together, despite Scott's original intention to sleep in a guesthouse along the trail, and had dinner at a Tibetan restaurant back in Lijiang.  I did manage to still see the Gorge, it was stunning, and I met a really nice guy who I talked to a lot, so it was altogether not a terrible day anyway!

Me in Tiger Leaping Gorge

Ancient pools in Lijiang town - the top is for drinking, middle for washing vegetables, and bottom for washing clothes

My second day in Lijiang I spent wandering the town, saw the Black Dragon Pool Park which is the spring for the town's ubiquitous canals, and spent a lovely hour inside the most well-done museum I've been in so far in China - a tiny free one about the locally dominant minority group, the Naxi.  There were many rooms showing their costumes, their pictographic language (the last still used in the world), their religious ceremonies (very nature-centered), and their methods of subsistence.  I also got some of my Christmas shopping done!  That evening after an enjoyable dinner I caught the night sleeper train back to Kunming, the provincial capital.

Black Dragon Pool Park

Naxi traditional clothing

Dali

Last Tuesday, I parted with Dr. Qiao and Adam to do a few days of sightseeing in northwest Yunnan by myself.  I took the overnight train from Kunming to Dali, an ancient town which ruled part of southeast Asia under a kingdom called the Nanzhao Kingdom, ruled by the Bai people, who are today still a substantial minority in the area. Dali was the end of the famed Burma Road, which served as a supply line for Chinese troops blockaded by the Japanese during WWII.  Today, it is a quaint little oldtown which has the added bonus of still having real people living in it, with real jobs and several schools.

Dali Old Town with Er Hai Lake in the background

I had a very full day on Wednesday as I arrived at 6 am.  I stayed at a hostel called the Jade Emu and I must give them a shout-out for letting me check-in and have my room at 7 in the morning!  I then took a cable car up the nearby mountain called Cang Shan, which had spectacular views overlooking the town and the large lake, Er Hai Lake, on the other side.  I spent about 5 hours hiking up and down little creeks, a gorge called 'the Cang Shan Grand Canyon' and seeing little temples and caves.  I actually ran into a party of French people and spent most of the day with a guy named Emmanuel with whom it was fun to practice my French!

Zhonghe Temple on the top of Cang Shan - remarkable for its painted wood carvings on the door panels

Picture taken by Emmanuel on the path around Cang Shan

In the evening I descended the mountain by cable car and walked around in the old town, did some shopping and got some famous Yunnan coffee at a little Tibetan Cafe.  Apparently Yunnan is quite famous for its coffee, and it was indeed the first real coffee I've had since moving to China.  I actually ended up getting Indian food for dinner at a little place called Namaste, which was awesome - its the closest I've ever been to India, after all!

Old Town Dali on a busy street

The next day, I took a bike from my hostel and biked down the hill to Er Hai Lake.  After one minor disaster with getting off the bike (I've never ridden a racing bike before, with the high bar - good thing I had a helmet on!) and getting lost several times, I managed to make it to the lake and had some pristine views across the water to some pagodas on the other side.  I even had the pier to myself for several minutes!  After biking back uphill, I got a bus towards Lijiang, my next destination in Yunnan.

Er Hai Lake

Burma...almost

On our last day in Mangshi, we started out in a Chinese operating room and ended up with our backside's in Burma!

 In the morning, we accompanied Dr. Zhang and Li Rong (my Fogarty twin, also a gynecologist in Chongqing) to the operating room to observe a oophorectomy (taking an ovary out) for a tumor.  It was interesting to see because of the differences yet fundamental similarities between the OR in China and in the US.  All of the differences were due to lack of resources, which all combined together to make undergoing an operation a scary prospect, but definitely still better than living with a potentially fatal cancer.  There were still a surgeon, a first assist, and a scrub tech (who was verbally abused by the surgeon, just like at home!).  They ran through a quick checklist before making the incision, although there were no nametags or wristbands on the patient.  The patient was awake with spinal anesthesia due to the cost of general anesthesia, and could definitely still feel her abdomen up to about 2 minutes before the incision.  There were no intra-operation fluids, no antibiotics, and in general, nothing invasive on the patient other than the actual operation.  There were MUCH fewer operating tools; apparently they  have no autoclave so all the scalpels, clamps, etc are thrown away after every surgery.  And lastly, the most noticeable thing was that the room looked just like every other room in the hospital: dingy, poorly lit, and with bad ventilation; it just had a operating table and light in the middle of it.  Definitely no positive pressure here!  However, the tumor was successfully removed in about half the time it would have taken at home, and as far as I know the patient is doing well.

After our 2-hour 'workday' our boss whisked us off on a car trip to Ruili, a small town on the Burmese border.  We went to a park in the middle of nowhere with a very tall waterfall, and in typical Chinese fashion, had about 2 minutes to look at it after taking nearly 2 hours to get there!  It was very impressive however.  After that, we went to the major checkpoint between China and Burma - we could see a huge building with a Burmese flag waving, and a small stone boundary marker.  Dr. Qiao seemed determined to get us onto Burmese soil, and the Chinese border guards, after scrutinizing our passports, said they would let us over, but they weren't sure the Burmese would let us back.  Adam and I decided not to risk it - being in Burmese prison is not on my to-do list for this year!!  But we did get to stand on the border next to the marker and take pictures - so I'd like to think my backside was in Burma!

 We spent the rest of the day making short touristy stops on the drive back to Mangshi - 2 more china-burma border checkpoints, all of which were equally unwilling to let us pass, a Dai village with houses completely made out of interwoven wood strips with holes everywhere (good thing it does not get cold there!), and multiple jade and petrified wood shops.  The Dai are a minority that are from the southern chinese-burmese border area, and they have different language, housing, holidays, etc from the dominant Han people in China.  In fact, there are nearly 20 minority groups who hail from Yunnan, and I will learn about a few more of them over the course of my trip!

Mangshi Workday

 After driving back to Kunming with much less to-do than on the way there, we flew to Manshi on Saturday evening and were met by officials from the hospital.  They took us  to an awesome Yunnan restaurant which was all outside, under individual thatched roof bamboo huts, and the food was the best Chinese food I've had so far.  A wide variety of tastes, including fried silk worms and purple sticky rice were all surprisingly good!

The next day we went early in the morning to the Mangshi Women and Children's Hospital, who are going to be the host of one of the projects I am working on.  In brief, HPV is a virus which causes cervical cancer, which begins as a small irregular cervical lesion and works its way up to cancer in a small percentage of cases.  It has been shown that women with HIV develop more cervical cancer than other women, which makes sense if you consider them as having little to no immune system to fight off the HPV virus.  However, it is not well known what the affect of antiretroviral therapy has on the evolution of HPV infection in HIV-positive women.  The study in Mangshi is going to be a small comparison of groups of HIV-positive women, some with experience with ART and some without, and we will compare the incidence and evolution of cervical lesions and cancer over the course of one year.

It was interesting to see the course of the preparations for the study.  In the morning, they had a planning meeting for the study, and there were actually patients present to give their input on the procedures.  I feel like at home the hospital and visiting scientific experts would not have an important meeting to plan details of a study with patients present!  They might have the patients present later, for an information meeting, but the details between the involved contributing parties would already be resolved.  

 Another step for me with this project is that Dr. Zhang, the gynecologist from Kunming who will be overseeing the actual clinical work of the project, has already done a small pilot study in Mangshi.  She wants my help to publish her results and actually gave me the data to work on!  This is the first real data I have seen in China so I am super excited for this opportunity!  Dr. Zhang seems really nice and I'm excited to get to work with her as well as Vik, from the VIGH at Vanderbilt who is the foreign PI on this project.

 Over the next few days, prepare for more of a travel journal as work temporarily ceases for some vacation in Yunnan! 

Birthday Celebration

Our second day in Yunnan started out way too early, considering our late arrival to the hotel the night before.  Chinese breakfasts at hotel seem to be very similar to other Chinese meals, with cooked vegetables, meat, noodles, etc.  Congee is one exception; it is a rice porridge similar to oatmeal, into which one can put pickled vegetables (eew), meat (not so good at 7 am) or fruit (pretty nice).  After breakfast, we went upstairs to a conference room with a podium and nametags...including ours!  We knew we were giving presentations but Dr. Qiao had neglected to mention the reason for the symposium...or even that there was a symposium...for the 70th Birthday of the Gejiu Tin Mine Hospital!  We had to sit in front of the crowd and introduce ourselves, then relocate to the front row of chairs so they could set up a podium and projection screen for presentations.

After giving my talk (on Medical Education in the US, Dr. Qiao's direction and sadly nothing to do with Gejiu or lung cancer (the main illness treated by the hospital for many years)) I was told that the local newspaper wanted to interview me.  I went downstairs to the lobby and talked to 2 very pleasant newspeople for about 30 minutes, with a translator who kept insisting on answering for me instead of telling me the questions!  They asked me all sorts of awkward questions, such as, "what do you know about lung cancer in Gejiu?" (I had just found out it was a big problem the day before) and "Why did you choose the topic of your presentation for the lung cancer symposium?" (my boss told me to...)  It would have been embarassing if it wasn't so funny, and plus, I could blame my nonspecific answers on the language barrier ;)

After lunch, we headed off to the main hospital building for a huge performance to celebrate the birthday.  There were songs, dances, and mini plays depicting tin miners dying of lung cancer and a team of nurse/dancers swooping in to the rescue.  It was really quite dramatic and emotional at some points, with some of the songs being very good, if belted out about 100 decibels louder than necessary.  My eardrums hurt for at least an hour after leaving!  We were also introduced as 'Visiting American Experts' and were constantly shown on the video cameras, which were broadcasting live, so we had to work very hard at paying attention and being appropriately amazed/pleased with the performances.  It was very interesting however, and much better than sitting in Chinese meetings all day!  Too bad American hospitals only celebrate their birthdays by hosting expensive black-tie galas!

Travel to Yunnan

Adam and I have recently traveled to Yunnan Province, a southern province of China which borders Burma and Tibet.  We are currently in a town called Gejiu for the 70th Birthday Celebration of the Lung Cancer Hospital, where Dr. Qiao has assisted with some research and treatment for the past 10 years.  

Our travel here on Thursday was an interesting and hectic day - we met at CICAMS at 6:30 am, went to the airport by private car and caught a plane to Kunming, the provincial capital of Yunnan.  On the way, Dr. Qiao had told us we would be interviewed by a reporter for the China National News, but in reality she was just coming along to get a story in Gejiu and did not ask us any formal questions.  The plane was about an hour late leaving, so we arrived in Kunming around 1:30 pm.  We had a hurried lunch, then rushed off so we could visit the Stone Forest on our way to Gejiu.

The Stone Forest is an impressive collection of karst stones, some little, some really big rocks with sharp, spiky edges, all piled up together.  There are lines in the rock from where prehistoric ocean levels were at different times, and there are fossils to be seen if you look closely enough.  There were rocks labeled as 'the Elephant' and 'Sword Stone' etc, and there was a pavilion on top of one of the formations which allowed a magnificent view of the whole park.  It was really quite impressive, and apparently one of Dr. Qiao's favorite places as he wanted to take us there.

We left there around 4 pm, with the intention of arriving in Gejiu by around 6 or 7 pm.  We got about an hour out of town however and hit a massive traffic jam...and sat...and crept forward 2 inches...and sat some more.  The driver kept getting out of the car and back in to go look down the road, and we would pass a car, then inch back into line, then sit some more...  Eventually, right before dusk, we got to a police car who said the road was closed due to a traffic accident and we had to turn around.  We managed to turn around...and then hit another traffic jam going the other way.  It was dark now, and cars were honking and angry.  As we were pulling off the road to get on a little bypass to Kunming, another car cut us off and we had a minor scrape on the fender, much to the chagrin of our driver as it was a new car - not even license plates yet!  We managed to get onto the little side road, and all had to pile out of the car to make it lighter so it could make the sharp turn onto a little bridge...only to realize that the bridge had a problem with it blocking the way as well.  The driver had to back down a hill very slowly on a dirt road full of holes to get back onto the highway.  

We ended up following a tour bus also going to Gejiu on a really bumpy back road for about an hour to get to another highway.  By this point it was dark, and at some point we lost the tour bus, requiring many stops and asking for directions.  We didn't get to Gejiu until 1 am, but we were so glad when we finally made it!

 I have my old computer on this trip and I forgot that it does not have a SD card reader slot, so I'm afraid that while I can leave text posts, I won't be able to post any pictures until I return to Beijing on the 21st unless I get lucky -- sorry!  More to come on our day in Gejiu.

Zen Meditation

 Last week I went to a Zen Meditation class at a Chinese cultural center here in Beijing.  I did not really know what to expect and know almost nothing about meditation techniques, but was interested to learn.  The meditation session was led by a young buddhist monk who had a very quiet voice.  We began the session with slow hand movements standing up, matching them to our breathing.  We then sat on the mats, covered up with the blankets, and used different meditation techniques over the next hour and a half, with several slow meditative stretch breaks interspersed.  The one that worked the best for me was to concentrate on my breathing, in and out, but I definitely need more practice.  At first there were lots of thoughts flitting around in my head and I had to keep reminding myself to think about my breaths.  Gradually, my mind became calmer, but I was still aware that I was having to force myself to concentrate - I was aware that I was forcing myself to be aware in other words, instead of just being aware of breathing and nothing else.  Near the end of the meditation, we did a walking meditation, taking slow steps around in a circle while concentrating on each step and on our our bodies felt.  It indeed felt wonderful to stand up and move after sitting for so long.

After the walking meditation, we sat back down and the monk asked us if we had any questions.  There were several questions about posture and technique of the meditation - indeed your back is supposed to be 'naturally' straight, which was quite uncomfortable for a long period of time.  Then we started talking about the zen state of mind you should have during meditation, which Zen Buddhists believe should carry over into your everyday life.  The 'zen' way when confronted with a phenomenon, a thing or a person acting a certain way, is to 'neither reject nor attach' but to just accept it for what it is.  Don't get angry and push it away, or cling to it as something you like, but try to view it steadily and objectively.  The monk said that over much time and patience, your own subjective view of things would slowly dissipate and you would be able to see the real truth in things.  There is a Truth, that is the same for everyone, it just might be unable to be seen because it is clouded with our own attachments or negative feelings towards it.

I know almost nothing about Zen Buddhism or the philosophical tenets that it teaches, and this session made me eager to learn more.  The idea of one single Truth, to be found in everything, seems strange to me.  Perhaps I am too scientific, but I feel like by observing a phenomenon, the very act of us watching and thinking about it, perhaps acting on it, can change the phenomenon; and thus, it is not an immutable truth separate from us.  There is a physics principle about this called the Heisenberg Uncertainty Principle; you can't know where an object is and how fast its going at the same time, because by knowing both things you've changed it with your observation.  I have more of a gut feeling about this too; I feel like there are so many different ways of viewing the world, each of which can be true for the person viewing them, depending on their background and culture and intellect.

I did feel very relaxed and at peace after the session, and intrigued the philosophies behind the meditation.  I will hopefully be able to return soon.

More Awesome Chinese English Signs

For your amusement...

We think this one was to keep random people out of the computer closet...we're not sure though

Don't stand in the emergency exit

I think this is my favorite

These were random signs on a wall in Cuandixia.

Cuandixia

On Sunday I had a date with my friend Lara, my former roommate from Grenoble, to go to a little Ming village named Cuandixia.  We also went with some friends of hers named Serena, Kitty, Mai, and Audrey who are all studying English in Beijing.  As everything here, it took forever to reach; I left my apartment at 5:30 am and we arrived at 9:30!  The bus ride, however, was enjoyable with stunning mountain scenery and a comfy seat.  

We spent about 6 hours in Cuandixia, and really that was enough time, as there was nothing much to do besides walk around and poke our noses into courtyards.  It was very beautiful, relaxing day however and was a peak into the past with ancient housing and temples, fields and wells, and agricultural equipment.

During our time there, we hiked up a little hill to an ancient temple that had older Buddha statues than I have ever seen.  I thought at first they were meant to represent an Emperor, as the style was so different than the average Buddha, but apparently they are just an older line of Buddhas.  (Oops on taking the picture then, I wasn't trying to be disrespectful).  

There are 76 courtyards in the village, and pretty much every house was built around an inner stone courtyard.  Most of the houses advertised themselves as inns, definitely the tourists' affect on the environs.  It felt a bit weird literally walking into people's houses to have a look, but that's what all the other tourists were doing and no one seemed to mind.  We also hiked up the mountain across the road from the village and had a fantastic view of the valley with the surrounding mountains.  Overall it was a very fun, if long, day!