Aubree Returns to China, Part 1

My friend Aubree (whom many know as Spryte because we met at Girl Scout camp with fun camp-names) lived in China for two years right after college, in a town called Yidu in Hubei Province.  I am actually on an overnight train right now on my way to see her there, although this post won't go up until I reach her and have internet access again.  She came to Beijing for a few days to see where I live now, and then traveled to Yidu a few days ahead of me due to my lab trip to Shanxi Province.  

She arrived on last Saturday night, so on Sunday we had a day together to explore.  We decided to go to the zoo to see the pandas.  I had heard that the zoo was not worth my time, and after going, I would also give it a 1-star rating.  The living conditions of many of the animals were deplorable, tiny cages the size of my bedroom for large tigers, etc, and many people were not very respectful of the animals, banging on cages, feeding them bread and sausage, and being very noisy.  The amphibian house was actually an exhibit of dead snakes, which it took us a while to realize since all the signs were in Chinese!  The whole zoo was a bit depressing actually and we left before seeing all the exhibits.

However, the pandas were pretty cool to see, and they, perhaps because of their fame around the world, had plenty of space and care.  My boss here, Dr. Qiao, warned me that they would be sleeping and boring, and most of them were in fact snoozing away, but a few were active and now I can say I've seen one!

After the zoo, we discovered a cool market across the street and had one of the many confusions which happen in China, involving dinner being at a restaurant of which there were two branches (unbeknownst to us) both of which are near Holiday Inns but across town from each other.  One of our group accidentally ended up across town and then the one the rest of us were at ended up having closes last year and was no longer there!  Oops!  

 We also went to the pearl market, where Aubree knew one of the vendors through a girl who lived in China with her.  Thanks to that 'relationship' we managed to get a great deal on some pearls - real pearl necklaces for $10!  The power of the relationship in bargaining was amazing to see; for a foreigner without a claim on a relationship like that would have faced starting prices of $100 or more for the same necklace; for us, the lady started at about $20.  And she even threw in two free pairs of earrings and a bracelet for good measure!  I think I will definitely be going back to see her sometime this year - any orders?

Buddha and Confucius

Last weekend before my friend Aubree arrived from the US, I had a Saturday free and decided to do some sightseeing in Beijing before the weather got too cold.  First though, I took a class on how to make Chinese dumplings, called 'jiaozi' with Adam, Alison, and her visiting family.  We took the class at the same place as I took Tai Ji, a beautiful old Chinese house in a hutong remodeled as a cultural center.  We spent 3 hours learning how to make and roll dough, combine ingredients for the stuffing, and assemble dumplings.  It was a lot more work than I expected, but would be fun to do with a group for a party in the future!

 After dumplings, I rolled (practically!) to the Yonghegong Lama Temple, which is an active Buddhist temple complex with multiple perhaps 10-15 different temples and an active monastery.  Yet again I was struck at how many devout Buddhists there seem to be in China; there were throngs in the entire complex burning incense and bowing and praying to different Buddha images.  I really need to do some more research about religion in China, as I really thought all religion was frowned on at least and banned at most by the government, but the multiple Buddhist temples and monasteries in the Beijing area seem to say otherwise.

 After the temple, I wandered down a nearby street to the Temple of Confucious, which housed several buildings where Confucius once taught, in addition to the old Imperial University and massive tablets with the engraved names of Chinese scholars who passed the ancient imperial exams.  There were several buildings where various emperors once taught as well.  I mentioned this in my 'strange picture' entry, but it seems to me that the Chinese people have a weird mix of disregard and reverence for cultural relics; they post numerous signs exhorting care and respect for old things, but then do not maintain them in environments conducive to lasting through the ages, or blatantly paint on them, for the sake of an official catalogue.

 The museum of Confucius was also very interesting as it walked through the life of the ancient sage and described his evolution to influence in China.  There was also an entire wing of the museum devoted to describing and exalting the influence his ideas, and therefore China, has had on the rest of the world, with pictures of world leaders 'worshipping' Confucius at various ceremonies.  It seems like Chinese people are very proud of the contributions of their country, but sometimes at least the English goes a little over the top in their descriptions!

The Chinese Vaginal Exam

 During our second day in Yangcheng, the study was gradually becoming closer to fully operational, with 20 women coming to screening appointments in both the morning and afternoon.  Eventually, 80+ women will be screened daily, which is quite a throughput, and after seeing how the exams are conducted, I'm not sure it would be possible in the US without much more infrastructure in the way of exam rooms, exam equipment, and clinicians.  

 Since I am female, it is no big deal if I am in the room during vaginal speculum exams; sadly for Adam (especially since he wants to be an ob/gyn!) he did not have as easy access and was forced to wait in the hallway.  I still thought that my presence could possibly make the woman feel uncomfortable as it would add an extra person to the room and I was hesitant to enter at first, but once I was installed in the back of the exam room behind the 2 examiners and the data recorder, I realized that women definitely have less sensitive privacy barriers in China than in the US.  There were no less than 10 study personnel in the room at once at any one time, with anywhere from 1-4 patients in various stages of undress.  At home, there would never be any more than 3 medical personnel and definitely only 1 patient at a time, and the doctors/students leave the room for her to unclothe.  There is all sorts of elaborate draping to maintain modesty as much as possible, which is nonexistent in China.  One patient would be on the table getting examined, another one next to it with her pants down waiting her turn, another by the chairs with her pants completely off doing the HPV self-collection (inserting a sample collection device into her vagina and swabbing around) and another waiting by the door.  After the vaginal exam, they would get off the table and redress as the next woman got on the table to begin her exam.

 If anyone had trouble with any of the steps, multiple nurses/doctors would approach and cajole and coach them into the appropriate position, which could involve shoving legs lower on the table or using your hands to pull the woman into the best position for the self-test.  There was also no warning before speculum insertion; once on the table the vagina was fair game.  In medical school at home, we spent an inordinate amount of time learning the appropriate technique and language to do a vaginal exam in order to make the woman as comfortable as possible, and it involves and slow and steady approach to speculum insertion, first stating that you will touch her leg, then that it might feel like pressure, etc etc.  The state of things in China certainly made the whole thing seem like less of a big deal and enabled rapid throughput of patients, which is great in a resource-poor setting where there would not be enough clinicians or equipment to enable screening of so many woman in a short time.  It would take some getting used to if I were to ever serve in China as a clinician!

Picture slideshow; more to be added soon:

Yangcheng Day 1

Yesterday was our first day in Yangcheng, in Shanxi Province, and we spent most of the day at the Yangcheng Women and Children's Hospital.  The morning started with the Grand Opening of the research study LCMCCSS - Low Cost Molecular Cervical Cancer Screening Study - with a podium with all the main investigators, speeches, and 3 minutes of firecrackers that left everyone deaf!  Apparently there is a mythical Chinese monster that haunts new beginnings and thus the firecrackers to scare him away.

That was followed by several hours of lecture (mostly in Chinese) explaining the meaning of the study, the techniques, etc.  Some of it would have been really interesting as they were explaining how to do visual inspection of the cervix with different materials, but sadly, I didn't understand much.  That was followed by lunch and then a demo of the study, with 20 women who came to enroll.  I spent the first part of the afternoon wandering around following the investigator from the NIH in the US who was just poking his nose everywhere to make sure things were running ok.  The second part I spent in the lab seeing how one of the HPV detection tests was run.

The evening was spent at a banquet restaurant with everyone involved in the study -  there was loads of local Chinese food followed by karaoke!  The directors of the hospital and other bigwigs got up in front of the crowd and sang - often badly - but it was very hilarious and a fun time all around.  I did not sing but supported another guy singing a Whitney Houston song - yikes!

New Eyes

I meant to mention this in my blog post yesterday, but one thing that was interesting with having Max here was seeing China like new again.  Even though I've only been here two months, many of the things which shocked me on first arriving have become common place now, so it was interesting to get a new little shock when Max exclaimed about them.  The ubiquitous TVs on all the public transportation…the dump hidden from the road by a sheet metal wall…the nasty smell in many areas…the smog…fruit stands everywhere…how new and efficient the metro is…yummy street food everywhere…   

He also noticed things which were new to me, such as: how short everything is - he hit his head perhaps once a day while visiting as everything is just made for shorter people.  He could see all the way down the metro train because he was a good head taller than anyone else on the train!  At the lantern festival we went to, he noticed that the bumper cars were not run by an electric net on the roof like at home, but by a grid of varying electrical charge on the ground.  Apparently very dangerous if anyone fell out - and I would never have noticed!  He also discovered that my bicycle folds in half - who knew!  My epic voyage home on the bus with the new bike was totally in vain - I could have just folded it and gotten on the metro!    On the whole, it was very interesting having him here, it was like moving to China all over again for a week!

Adam and I have just arrived in Shanxi Province, to a small city called Yangcheng, where we will participate in (mostly observe) the investigators' meeting and beginning of a cervical cancer screening trial called START-UP.  On Sunday I might get to pilot my study.  So far, we have eaten enormous amounts of yummy food and now we are staying at a ridiculously nice hotel.  Probably nicer than any hotel I've stayed in at home - there's free bath robes, and complimentary water, flashlight, coffee, tea, hair dryer, couch, internet, etc etc.  I hope the day tomorrow goes as well!

Synopsis of National Holiday and next steps

I do apologize for the long-ish blog silence of updates -- 1 week after returning from Mongolia it was National Holiday here in China and Max, my boyfriend, came to visit.  Holidays in China are such that EVERYONE has the week off, and EVERYONE tries to go home, so that's many millions of people clogging the public transportation system  -- so we didn't even try to beat the crowds and instead stayed around Beijing.  Which after all is the size of Belgium, so there's certainly enough to do!

Over his 10 days here, we went to several large parks in the city with scattered temples, caves, marble boats, lakes, and loads of people.  We got out of the city one day to Fang Shan National Park which has a medium-sized mountain with a Buddhist nunnery and some fantastic views.  (and less, but still sufficient people). That was an adventurous day because it turns out there are 5-10 lines of the same bus number and while we managed to get on one that went to our destination, we got on the extremely slow one that took 4 hours to get there instead of 2!  We went and saw an amazing acrobatics show, the highlight of which was 12 girls riding on one moving bike!  We went camping on the Great Wall which was an amazing experience (except for the SNORING guide who kept me up all night long!).  And we had some nice relaxation time just walking around Beijing, eating Chinese food, playing pingpong, and generally enjoying each other's company.

Tomorrow, Adam and I are going with some other students from our office and our boss, Dr. Qiao, to Yangcheng, a small city in Shanxi Province.  We are starting one of the cervical cancer screening trials and I have developed a survey that I will be piloting on Sunday!  I am super excited about seeing another part of China and getting to really kick off my research.  I might not have good internet for a while, so that is why I might not have posts for a couple days.

In the meantime, enjoy these highlights of my vacation with Max in Beijing: (sorry that the pictures from yesterday somehow got mixed into the same album - just click past them to see vacation pics!)

Funny Signs in China

The Chinese have many signs which make me laugh.  Some of them are just examples of  'what Chinese people think is important is different than what I think is important' - others are just horrible English translations.  One of my first posts was the sign on the shower door at my hotel; here are some pictures of signs I've accumulated since then.

After trying for a day to upload pictures, I've decided there's a bug of some kind - so click on the picture to see a short slideshow of the funny pics - and then once you get to the acrobats, wait until you get to the next post to watch the rest of the pictures!