Parting Shots...

Well, as I head out of China, and into Africa, I thought I'd use the camera to tell a bit of the untold story so far. Please forgive the atrocious formatting... I was trying to get creative, and blogger and I had a difference of artistic opinion. Hopefully it's ok now... Last week a group from BIPAI came to Kunming for the purpose of conducting some training and for hashing out the details of our proposed collaboration. By now, you probably all know the upshot. The situation isn't really ready for the project we'd initially proposed, hence the departure for Africa. It's been a bit tense with all the intrigue, and certainly a hassle. After spending the last 5 weeks finding a place to live and furnishing it, we've now spent the last week revoking our leases, selling our furniture, and eating at lots of farewell banquets. Of all of us, Ella has been the least frustrated by developments, remaining blissfully unaware of the politics and intrigue. She'll be flying with Hyunjoo to Korea for about a month to visit family before joining me in Lesotho. We've also spent the past week taking pictures, documenting the things that we hadn't yet had the chance to document. The big building on the right is where Hyunjoo, Ella,and I lived--on the 13th floor (less unlucky in China than in the US). We were above a big department store, which made for a fair amount of noise, but it was a fun location. Here i am with my mighty steed. Although looks can be deceiving, this is NOT a girls' bike... really... With all the stop-and-go biking and dismounting that goes with it (the bike lanes are insanely crowded and nobody obeys laws or common traffic courtesy), the Chinese prefer their bikes to have limited potential for genital trauma, hence the low cross-bar. This is the bike parking lot for our building where my bike found its home during our brief time together. Despite the limits on religious freedom in China, there is certainly a lot of evidence of religion. Kunming is a much more Christian place than one might expect, with lots of foreign missionaries (unoficially, of course), and a lot of local Christians. This church was just across the street from our building. I also saw a number of mosques, as Kunming has a pretty sizable Chinese-muslim population. This doesn't imply unlimited religious freedom, but there is a certain degree of tolerance for sanctioned religious groups. We also spent the past week catching up on many of the things we had planned to do after settling in--trying to live all the fantasies we'd had about what our lives in Kunming would eventually be like. For Hyunjoo, this meant getting some very inexpensive massages and hiring someone to entertain Ella for a few hours. For me, I had always been looking forward to spending more time at Cuihu (pronounced tsway-hoo), aka Green Lake, Park. Cuihu is the place where old people congregate to do the things that old people do--exercise, drink tea, play Mahjong or card games... ...and most of all perform. Cuihu is kind of a gigantic open mic amateur night for all the elderly people in the city. The old folks come with their instruments, their microphones, and their very powerful amplifiers... while leaving their sense of shame, embarassment, and privacy at home. Like any open mic night, the results are mixed, from the truly inspired to the truly horrific. For all these reasons, this is my favorite place in Kunming. It's great for people watching, and for the fact that everyone is just doing what they enjoy without worry of what others may think. The photos of the following performers are just a few examples of what makes Cuihu great. Working on his raspy country-blues vocal cords? Although this is primarily a place for older folks to perform, this girl was certainly the cutest performer. Did I mention none of these performances are done for money. There aren't any jars or hats passed around. People simply get together out of camaraderie and a love of performing. Often a love that exceeds talent, but that just makes it more charming. We also bid farewell last week to the HIV treatment clinic in Kunming. Despite our relatively minor role in the clinic, we were sad to leave some of the people. This couple are a formerly-retired husband and wife team of doctors who came out of retirement to work for this clinic, caring for HIV/AIDS patients. They are so loved by their patients that they are continually invited to weddings, funerals, graduations, and even to preside over separation of property when their patients get divorced... I think I'll stick to my slightly more Western limits to the physician-patient relationship. Finally, here are a couple of the younger doctors at the clinic who are also following in the mold of their older mentors. Although I'm eager to go somewhere that I'll actually be able to see a meaningful number of pediatric patients, I'll definitely miss this group, and hope that they're successful in their HIV/AIDS treatment efforts in Yunnan. The province needs more dedicated doctors like these, not to mention the political will to make their work as successful as it can be.

...and Parting thoughts

I think it's fair to say that I have a love-hate relationship with China. Although, maybe I should emphasize it more, given what follows, my love for China should hopefully be obvious, ... Arguably the most enjoyable year of my life was spent in Taiwan (culturally, if not politically, China). In the mainland as well, particularly in the smaller cities and the countryside, there is just so much to appreciate--the scenery is incredible, the people are amazing, and the food... despite all the fear-factor type snacks (which I've mostly avoided), we've made amazing new culinary discoveries every day here. My current favorite is a wild fiddle-head fern that the Dai minority people eat. And since we've been in Kunming, we've constantly had people who were friends of friends go out of their way to treat, entertain, and take care of us. For those things, I'mincredibly greatful, and will always love the people of China. As far as the more negative feelings, things get more messy. This is the second time I've had to abandon professional plans in China due to barriers placed by "collaborators" for reasons that were never transparent... The first was when I had planned to do dissertation research in China toward a PhD in public health (in the end I decided to get a masters degree instead...). I was going to take part in a multicenter rotavirus surveillance project, under the auspices of the International Vaccine Institute in Korea. My job was to involve coordinating data collection between 6 or 7 hospitals, visiting each one to ensure consistency of data collection, then assembling and analyzing the data. Those plans fell through a month before my planned start date when the Chinese collaborator (whom I never met), refused to allow the project to continue if there was a foreigner (me) in a supervisory role. It was clear that he never had any interest in letting me be involved, but that wasn't made apparent until plans were well under way. Fast forward to today. I am now a bona-fide pediatrician, with something meaningful to contribute for the good of Chinese kids, not just a research project. I am backed by an organization with tremendous depth of expertise, an amazing international track record, and a lot of capital. There is also a very pressing need for pediatric HIV care here, with an estimated several thousand kids infected in this province... [I have edited the middle of this post, cutting out some sections that are too sensitive to keep on a public site. If you would like to read the entire blog, please e-mail me. Suffice it to say that we are unable to do the clinical work here that we had originally hoped, primarily for lack of identified patients, despite the estimates of thousands of infected children. ] Although my role is a small one, I do think that our leaving is a big loss for China, and is symptomatic of a major problem within the Chinese bureacracy. I will still be able to go to Lesotho, see lots of children, hopefully impact their lives and make a meaningful difference. I also will get to travel and reap the cultural rewards inherent in this experience, so although I'm frustrated, I'm really not losing out. I wish I could say the same for the HIV positive kids in Yunnan.

Moving from fall in the Spring City to spring in Southern Africa

Well, we're pulling out of China. I guess the writing was on the wall. The government officials we've been working with haven't been able to provide what we need to be able to care for kids in Yunnan province. In fact, they haven't been able to provide the kids that are supposed to be here. Without kids to see, a clinical pediatrician isn't very useful, and there's no tangible plan to identify the many infected kids out there, and no clear role for us even if they were identified. So, it's "zai jian" (aka adios, sayonara, adieu). We'll be heading to Lesotho once we sell our things and get our rent back... assuming all goes well. In Lesotho, the new clinic is seeing plenty of kids, so there should be plenty for us to do. As frustrating as this process has been, and as sad as it is for the HIV positive kids in Yunnan, it's also exciting that we know we'll be able to see a lot of kids and make a difference in Lesotho. I'll write more later. For now, here's a Houston Chronicle article about the Pediatric AIDS Corps and what they're doing in Southern Africa

Lost in Translation

We all know that piracy of movies, CDs, computer games, and brand-name clothing is commonplace in China, and is done much better than it is in New York. Near Yunnan University, for example, there's a big bootleg movie store just 2 doors down from the local police station. I'll neither confirm nor deny personal use of such products (70 cents to one dollar per disc!!!). Anyway, here's a quote from an article about US movie studios suing a Chinese firm that allegedly sells pirated movies. Even when things are translated correctly, they may still sound funny. "China's IPR [Intellectual Property Rights] protection efforts will carry the full force of steel, and will definitely not be as soft as bean curd," Premier Wen Jiabao said last week.

Hotel Hygeine

Last weekend Megan and I went to the city of Ruili, and to Longchuan county, two sites along the Burmese border that are among the hardest hit by HIV/AIDS in China. I am still processing some of the things that we experienced some disheartening, and some very encouraging. I'll post about them later, but for now I have a few amusing items to share. The border area is a hotbed for drug injection and prostitution and Ruili once had the reputation for being quite the Wild West fronteir town. Things have cleaned up somewhat since then, but the economy is still pretty heavily dependent on the "oldest profession". On the right, is the "24 hour beauty and health maintenance massage parlor" that sits in the lobby of our hotel in case anyone needs a backrub at 3 AM... The phones in the guest rooms have on/off switches!? It soon became clear why: In the first 5 minutes Megan was in her room, she got 2 calls from ladies soliciting gentlemen requiring companionship. It's now mandatory for hotels in Yunnan to provide condoms in rooms as part of the program for AIDS prevention. They charge for them, of course. And, the Chinese entrepreneurial spirit being what it is, not only are condoms sold, but a variety of other pleasure and prophylactic products. The placard on the left was in one hotel bathroom, in Chinese and Chinglish. You can click for a larger image, but I'll provide highlights from the Chinglish text, because reading it was the most fun I'd had in a while. Mouth Antiseptic-Oral condition is actually a mirror for the healthy condition of the whole body... it is a good healthy habit to maintain oral sanitation. Spraying your mouth with Gargarisma every day can remove unpleasant odor and keep mouth sanitary... Clean-Tooth--Outstandingly effective special Double-whitening recipe... Antibacterial Towels [these are for wiping your naughty bits...] The product is 100% cotton, convenience for use, can prevent illness of infect effectively. It is the best ware to travel or get about. Antibacterial Underpants and Sock--special material and technology, antibacreria, venerelate, deoderant. changing and washing frequently are good habit for health habits. Washing-Liquid--DIANS Washing-Liquid can quickly enter the private parts skin inside the exoenzyme, and kill the fungi, bacteria. Availabely kill various sexually transmitted disease germ, prevent the in fection.Can become to defent the germnatural cover.And construct the health environment and prevent the germ irruptive. Water-based--Advanced directiongs and technology , particularly fitting the character of the eastern human's hair.while keeping the hair wet,it make easier to camb the hair to shape.l Condoms--More security,more funny. Wet turban [no explanation follow this one...] Below is the in-room "mini-bar" in another hotel, including: his-and-hers disposable underpants, two varieties of "Indian Saint Oil", one described in Enlgish as "Joy Woman Sex Oil", Man Lotion and Woman Lotion, Condoms, and, "Compressed Hygeinic Towel--soak before use" I wonder if part of the reason for very limited condom use among prostitutes and their clients is that some people actually believe compressed hygenic towels and DIANS washing liquid might prevent AIDS... Any MPH students out there need to do a KBAP (knowledge, beliefs, attitudes, practices) study? Who comes up with these acronyms?? The funny part is, despite all the hygeine products, one of the hotels didn't even have a top sheet to put between your body and the (presumably unwashed) comforter. Not comforting... Well, my lightweight travel sheet should be coming from the US with the next group of people to visit from Houston, so I'll at least have my dry turban saint body wrap before my next hotel adventure. In the meantime, maybe I'll try the Gargarisma. And, now for something completely different: Here I am being fitted for a skirt.

Settling and Unsettling--to Africa after all

It's been a while since I last posted, so you'll all be treated to two postings today! Since we left the hotel things have been a little bit of a roller coaster. We moved into our apartment, which we've generally been happy with, a few minor maintenance issues aside. Perhaps the most exciting homefront event was crushing my toe with a headboard while rearranging Ella's room. Nothing broken, but it looked pretty gross (the picture doesn't do it justice, fortunately)... We've also purchased bikes (well, Megan and I did--Hyunjoo is appropriately scared of the traffic here). We've got cell phones, made a few friends, figured out where to buy things. We've eaten tons of excellent food, and begun to use public transportation. All in all, we've started to settle. Having gotten basic needs taken care of, the next task was to get to work. To that end, we've had a few meetings with our local contacts at the clinic where most of the HIV patients in Kunmming are treated. There are estimates of well over 1000 HIV-infected children in the province--most far from the capital. But there are very few that have been identified, even fewer receiving life-sustaining treatment, and just a handful seen at the clinic in Kunming. Given the lack of current patients, our contacts had hoped we could see some adult patients, do some translating, and help with some training, with seeing children being a rather small component of what we do. Well... Our primary purpose in coming here was to treat and care for children with HIV. We're pediatricians, and would like to spend most of our time in the clinic. So, it's been a bit sticky trying to figure out how we're going to proceed. We've suggested some patient identification strategies, but the response has been lukewarm, and it's not clear why. So, we're taking a few weeks to get used to how the clinic operates, see children when they're available, and adults when they aren't, and are reading through a bunch of Chinese documents on HIV/AIDS policies and programs. It's been slow, and not exactly what I'd imagined, but I've learned a lot. I have learned how to say things like, "the appropriate government agencies at the county level and above should implement the AIDS control and prevention policies as dictated by the national council". This week, in clinic we actually saw a new pediatric patient whose mother had been avoiding starting her on therapy for fear that it wouldn't help. When she heard that there were some American pediatricians here, she decided to give us a shot, and we convinced her to start the child on antiviral medications. The mother's primary concern wasn't actually that the girl had HIV, but that she "acted more like a boy than a girl--anything you can do about that?" Ummm, yeah. You can love her... a lot. From a clinical perspective she was doing quite well--nice and chubby, with a boderline profound level of immune suppression based on her CD4 T-cell counts. Fortunately, the only real evidence of her infection was a lot of enlarged lymph nodes, and repeated itchy eruptions on her skin. The kids we've seen so far have all been pretty healthy. I get the sense that the sicker ones that had been identified have all died for lack of therapy. In her case, it was pretty rewarding to have started at least one child on therapy in the first week that we've been seeing patients. That said, for us to be effective, we'll need to find a lot more patients, and those discussions will need to involve our higher-ups from Baylor and our local collaborators. There's a group coming in 2 weeks. Hopefully we'll clarify a number of the patient identification issues, and establish what our role will be and how we can reach the patients in the countryside. In the meantime, we're taking a trip to Ruili this weekend, a town that sits along the Burmese border. It was the first place in China where domestically-transmitted HIV was identified, and is the hardest hit part of the country. We'll meet a few doctors and their pediatric patients to get a sense of the situation there. Then, in about 3 weeks, Megan and I are off to Africa for a month to get some more clinical experience--Megan in Botswana and me in Lesotho. The Baylor-operated Centers of Excellence in those countries see more kids with HIV each day than the total number of kids receiving treatment in all of Yunnan province. So, we're hoping to learn a lot in a short time to bring back with us to China. While we're in Africa, Hyunjoo and Ella are going to spend the month with her family in Korea. It will be hard to be apart (again), but I think given the amount of change Ella's already been through, it will be much easier for her to be in Korea with family than relocate to Africa for a month where everything will be foreign again. Finally, we'll come back to Kunmking in the beginning of November to help with a three week training session about pediatric HIV treatment. Hopefully by that time, the kinks will have been ironed out and we'll be able to get to work in earnest seeing patients here. Although it's frustrating to not be able to do what we'd come here to do, I'm confident that it's possible to get around whatever the obstacles are and do what's needed in terms of providing therapy here. It just takes a while to navigate the bureacracy. I'm sure there's an ancient Chinese proverb that would apply, but I just can't think of it right now.

A day at the lake

Last weekend, we got a call from Zhang Xiaoming (pronounced just like it's spelled...), the brother of our very good Chinese friend from Connecticut. He and his family happen to live in Kunming, and have been very kind and helpful, particularly when it comes to feeding and entertaining us. At any rate, last week, they wanted to take us with them on a family outing to Fuxian Lake, so we of course agreed. Our first stop was a restaurant where they'd reserved a stewed duck the day before. But, the special item on the menu was fresh fish. A bucket full of bullheads to be exact. I generally avoid fish here, since it's not close to the ocean, and the freshwater tends to be polluted, but these were raised in a pretty pristine lake, so we went for it. If you've never seen 1.3 kilos of bullheads before, feast your eyes: After being cooked up, they looked much more appetizing: The spicy bullhead stew was actually the tastiest item on the menu. The fish were mostly head and bones, but the meat was quite tasty, despite the work involved in getting it. The sauce was super spicy, and laden with the Western Chinese spice "hua jiao", also called Sichuan pepper corn. It's basically a seed that numbs your tongue when you eat it. It's an odd sensation, but one I've gotten to like quite a bit. Ella decided to serve us: And also serve herself:A good time was had by all (Zhang Xiaoming and family): After eating, we decided to take a look around the lake. It is incredibly clean, unlike the stereotypical polluted Chinese waterways. The lake has a rule of no motors to preserve it's current state, and in the areas where there's no swimming, the water is crystal clear down to the bottom. There's quite a bit of fishing, swimming, and just people hanging out: It's also been developed for tourism, and there were strings of cars from Kunming filled with Chinese families out for the weekend. We decided to join them at one of the developed beach areas. The Chinese idea of how to enjoy a beach is a little different from the Western concept. It seems to include mostly little tables set up by the water with lots of snacks, and rental of tacky self-propelled boats. That said, the scenery was quite pretty, and there were plenty of friendly people around. Hyunjoo got herself a little wet... While Ella and I joined Xiaoming and his daughter, Lulu, for a more total-immersion cultural experience.After we were worn out, we finally headed back to Kunming, most of us sleeping in the car, and finished the day off with dinner at a Korean restaurant.