Hang-en cave

Hang-en cave
(credit: National Geographic)

Monday, March 30, 2015

To Peru I go!

Whew! This last year has been absolutely, totally insane...and it's about to get crazier. 

In July, I moved to Colorado last year to begin an MPH program at the Colorado School of Public Health. It's been awesome so far! It's such a joy to be surrounded by people who want to make a difference in the world.

So many people around the world don't have access to clean water, sufficient food, or proper healthcare. Every day, people die from preventable causes. In my little corner of the world, in my own little way, I aim to change that. 

In November, I started working with CU Peru (www.cuperu.org), an organization that works to empower and educate village health workers in the Peruvian Amazon, and things have really taken off from there. 

In the region where we work, transportation is limited to boat, and travel from one village to another can be really expensive and time-consuming (gasoline runs above $9 a gallon, and travel time can be hours depending on how many times the boat breaks down). Patients can get really basic care from a health promoter in their village, but to get further care they may have to travel to a health post in another village up to 7 hours away. And sometimes, when they reach the health post, the provider isn't there even though it's during normal working hours; then they've just wasted precious time and money, and even endangered their health. 

I've been working over the last several months to develop an automated text-messaging system that can help with this problem: the "Out of the Office" SMS system. With this, village health promoters can text the health post before they send a patient for care and find out when the provider will be in during the next two days; that way, the patient and promoter can plan when the patient will travel to the health post. I will be pilot-testing the system this summer, and then we plan to scale the system to villages all throughout the region, especially ones that are more remote, and to expand the scope of the messages (for example, sending malaria test results to providers via text, saving them a several-hour trip to the laboratory, communicating disease outbreaks to providers and other PSAs, or interfacing with the early warning system for disasters). Additionally, if we get this system working, it could put pressure on the cell phone companies and government to improve the technological infrastructure for these remote areas.

The technological infrastructure is there. Our design is ready to go. All I need now is funding to do it! For that, I've set up a GoFundMe page here: http://www.gofundme.com/allisonmaytag . Any amount would be greatly appreciated!! And whether you donate or not, I would also ask you to share this link.

You can follow where your money goes at my GoFundMe page, on my Twitter account (@allison_maytag), or here.

I'll keep you posted with all of my adventures! Thanks for your support!


Thursday, May 22, 2014

So it begins

Hi all,

The first full day is done! A team of us (me, my coworker, and two of the Chinese students who are helping us this week) went back to the airport to meet the students and help them take the maglev(!!! why don't these exist everywhere?) and subway back to the hotel. Man, those things are hard to navigate with luggage, though.

It's hard to remember just how many people there are here. We've already had to force our way onto the subway to make sure that everyone went together. I think I've adjusted to it already this year, and it seems like things (especially traffic) is less chaotic than last year. Maybe it's because I'm actually pretty relaxed so far this trip--I'm not constantly counting heads or worrying that someone's too far behind---and certainly a part of it is because there's a huge conference happening this week in Shanghai. Putin's in town!! What that means for us is extra security everywhere: there are police directing traffic, military on the street corners, and the SWAT team was in the hospital today (just watching, don't worry!)

We had our first day of shadowing today at Huashan Hospital today, which really meant we had a tour of the hospital from 9:30-10:30, then had a break until 2:00pm. Like last year, we're split into three groups and rotating through inpatient, outpatient, and pharmacy. For the inpatient and outpatient areas, we see the foreigners' clinic, which is renowned for its traveler's care...and also exactly like a Western clinic. Because it's more expensive (Chinese nationals can also go if they can pay), patients have the luxury of scheduling appointments for within the week and physicians are able to spend more time talking with the patients and they have better equipment, as well has their own CT scanner and lab. Physicians there see about 15 patients in a half-day. By comparison, physicians in the "common" areas see 100 each by noon.

My group visited the inpatient ward first, where we met with a dermatologist to hear a case presentation of a patient with acute epidermal necrolysis as a result of a SEVERE drug eruption. Basically, this poor man had been in the hospital for over a month because 75% of his skin fell off. The dermatologist had spent some time in Vancouver and was able to talk about the differences in treatment between China and the rest of the world. A drug eruption is a severe immune-mediated reaction to a medication. China differs from most of the rest of the world in treatment of TEN, choosing to treat with steroids which is at the very least frowned-upon in the United States. Steroids block the immune reaction, which can keep TEN from progressing. However, your skin is the first line of defense against infection, and without it you're extremely susceptible to everything, so you need your immune system to combat bacteria. The team of doctors treating him had to implement an intense regimen of steroids, antibiotics, and sterilization to keep him healthy as he healed. We got to see him doing some physical therapy today, so all is well--they don't think he'll have any lasting damage.

As we talked with the dermatologist after the presentation, she brought up one of the themes we'll see a lot of during these two weeks: China is not a good environment for a physician. She was really frustrated by the limitations of the equipment they have and the amount of time they can spend with patients, because they don't actually get to see any of the fruits of their labor.

We went to the outpatient ward next, which was basically like the doctor's office in America. After about an hour, we were released to see the normal clinics on other floors, which are incredibly different. One of the students described it as a DMV--you take a number, wait in an enormous waiting room, go to the admitting desk or physician room or pharmacy window or operating room when your number gets called, then do it all over again until you can finally leave.

It's an interesting conflict of cultures over here. It seems like some of the solutions to problems are so easy, but there are huge social barriers. For example, Huashan built two sister hospitals in different areas of the city to try and alleviate the patient load on the main campus...and they're empty. Huashan has some of the best specialists in the country, and that's a huge draw. People are worried that they'll miss out on the caliber of care if they go to one of the sister hospitals, so they sit empty while the main campus is overwhelmed day after day.

Tomorrow, we have a morning of shadowing in the pharmacy (I've never seen it before!) and then another reaalllly long lunch break. In the afternoon we'll meet with an adjunct health policy advisor to Harvard to talk about healthcare in China--I'll have more to report after that, I've got a lot of questions prepared.

I still have 14 students! I took a lot more pictures today, and found a new favorite food: yams covered with sesame seeds and caramelized sugar. SO. GOOD. But for now it's off to bed! The jet lag's hitting me pretty badly tonight, and there's a lot to do tomorrow.

Good night!!

Tuesday, May 20, 2014

Into the West (so far I ended up East)

Well, not really. Most people (including me last year) expect to fly over the Pacific to get to China. Instead, we actually flew over Canada and Russia.

I woke up around 3:30am CT on May 19th and landed at 2am CT on May 20th--crazy. I left my apartment at 5:30 with a really cheerful taxi driver who had a lot of opinions on WPR's report on nursing homes 'dumping' of residents and the comparison of Switzerland's minimum wage vs. the United States'. He got me thinking a lot about where it's appropriate for the government to get involved and when to let the market take over (isn't that the question of every politician ever?) but it'll be interesting to compare the US with China in that respect. China is an interesting amalgam of political communism--the official governing body is the Communist Party of China, which is written into the Constitution of the People's Republic of China--and economic capitalism, allowing for the formation of institutions where the government has little to no power.

The problem with flying to China, at least for me, is that I can't sleep on planes, but my eyes get too tired to read. So, instead, I made use of my incredible ability to binge-watch movies and caught up on some that I'd never seen. They seriously shouldn't make such a good selection available if they want anyone to sleep on a fourteen-hour flight.

When we landed, I booked it through customs and immigration to try and find my coworker, who'd landed an hour earlier. One thing that I'm not sure I've noticed in any other country is the awareness of illness: there's a list of symptoms that might prohibit you from entering the country. And public health enemy #1 right now? The Ebola virus. Given China's track record with dealing with infectious disease outbreaks (SARS, random zoonotic flus) though, I'm not too worried. There was an actual horde of people waiting for arrivals--they formed a maze that went almost to the exit before I could break through.

We got to our hotel around 5:30 last night and spent a little bit of time setting up base camp, then wandered off to the grocery store to find some snacks--nothing too exciting, though (mostly ice cream!).

Today we'll have a pretty relaxed morning scoping out restaurants and hospital sites for the students and running some errands. Then the students land and the fun begins!

It's good to be back.


Students: 14, currently en route and arriving tomorrow!
Pictures: 0 so far. I had my camera body with me on the plane, but I packed my lenses (yes, plural!!!) in my luggage.
Movies: Her, Gravity, The Great Gatsby, Forrest Gump, Lincoln (I can't sleep on planes...how many movies is it socially acceptable to watch in a row?)

Wednesday, May 14, 2014

China: Take 2

It's getting to be crunch time right now. I'm leaving for China in basically 4 days to lead the second round of a global health field course. I led it last year (my posts from that are still on this blog), and I'm not going to lie, it was rough. It was my first time to China and my first time in a position of such authority for such a long time.

As a leader and a course organizer, the trip is your baby. You've spent months planning every detail and ironing out every glitch, and you want nothing more than people to enjoy it and learn from it.You carry every joy and every smooth moment and every bump and every complaint on your shoulders, and you feel responsible for everything that goes wrong, no matter what it is. I have no idea how teachers and moms do this all the time--I know I do a LOT of things that "were a good idea at the time" that magically worked out (h/t guardian angel) but I was a nervous wreck last year...partly because of all the things I've done.
(credit: Mladen Bielicki)
As a teacher, or a parent, how do you trust that your kids will make good decisions or bounce back from their bad ones? Or how do you know when you've taught them everything you can and it's not your fault if they don't learn it? How do you just...let go?

Is there a class on this in education school?

Anyway, that's something that I'm going to be working really hard on this trip. Nobody got killed or thrown in jail or in too much trouble last year...I was a wreck the entire time thinking that someone would get stuck by themselves somewhere in Shanghai with no way to contact me, but it never happened.

I am so excited for this year's trip. Seriously. You have no idea. I LOVE to travel, and new cultures are seriously the best. Part of the reason I am so excited to go into public health is because I love to look at a person and find out what shaped them--and culture is obviously a huge influence on somebody.

China is so strange compared to America. There are people everywhere, and apartment buildings go as far as you can see to try and house all the people. Shanghai has a population of 24 million people, and Beijing has a population of 18 million. By comparison, Chicago has 7 million--that's the size of Shanghai's migrant population. A city the size of Chicago moves in and out of Shanghai every. single. year. It's mind-blowing.
And the food is so different. Last year, we laughed in the first restaurant we ate at when we saw this on the menu:

...and then we saw things like these:

Like, whoa. I ate boar stomach and jellyfish and sea slugs and caterpillars and a goose head at one point. And now I get to gross tons of people out when I regale them with my culinary adventures. The architecture is phenomenal, too--a lot of the more historical buildings are filled with really intricate woodwork and carvings.

Last year, I had two rules for my students in China: one was based on my own experience as a study abroad students, and the other was based on Mulan, which was pretty much the extent of my knowledge of Chinese culture (I'm terrible, I know). But they worked out pretty well! This year, I have a new addition to my rules for China:

1a) Don't do dumb things.
1b) Don't jump off a mountain to make a wish come true.
2) If the Huns invade, fire the dragon cannon at the mountain.

I think all of this will suffice for our trip: I'll add in things as necessary, but the students seem pretty great. We're doing the same program as last year, talking about how to provide healthcare to all 24 million of those people in Shanghai while shadowing at hospitals around the city. Another interesting aspect is the huge difference between being a physician in the United States and being a physician in China. In China, at least from what I observed and hear from the physicians is that it's not a very well-respected profession--patients often argue with their doctors and blame them for failed treatments, and physicians make a mid-level salary--and physicians very, very rarely get the emotional feedback of establishing a doctor-patient relationship or even being able to see that they helped their patient during their five-minute appointment, since they typically don't see them ever again. Would you still want to be a physician under those conditions? Some students last year struggled with the question. I'm interested to see how the students react this year. How about if you add in the dimension of violence? In 2010, there were something like 17,000 violent attacks against physicians. (If you want to learn more, the Lancet has a good article here  and the Wall Street Journal here). A lot of the things we'll see will force the students to consider what is crucial to patient care, how to provide high quality care to an incredible patient load, and what effects policy reform and the government can have on the health of citizens.

I'm excited to take all of them (and you guys) on this journey! I hope I'll have some good stories to share with you along the way.

Friday, May 2, 2014

On wanderlust

wan·der·lust: a strong desire to travel

Wandern was my favorite word to learn in German. First, because it means to hike--and hiking is one of MY FAVORITE THINGS TO DO. (There's just something about using your own two legs to get to somewhere remote, some tiny piece of land that maybe nobody's stood on before, or maybe lots of people have stood on and experienced that same visceral thrill of awe and wonderment--it's a way to connect to God and to people and to nature.) Wo kann man wandern

But mostly because it has the word wander in it. There's a sense of mystery, of discovery, of the unknown in "wandering" vs. "walking". When you wander, you don't have to commit to any path or any destination--you just explore and experience. You soak in the journey. Where you go and how you get there is entirely up to you. 

Wandering is how I got to know the secret spaces on my undergrad campus--lunching in hidden spots in the woods overlooking the lake, sneaking backstage in the theater after-hours, and reading a book nestled among flowers. How I ended up reading Atlas Shrugged sitting on the edge of a cliff overlooking the Rhine and walked through a cowfield in Switzerland. How I thought I might be killed by men with machetes in the mountains of Honduras and ended up making friends, and bonding over knitting with a Chinese woman at an outbuilding in the Summer Palace in Beijing. 

Wandering is the best.

It's both an escape and an opportunity. The way I see it, it's an escape from the safe and known into a chance for growth--and I'm all about that these days. And you don't have to jetset across the world to be able to scratch that itch to travel. (Of course, at the moment I have the inexplicable urge to hop on a plane to Paris.) Sometimes all it takes is looking at where you are with a fresh perspective. Strolling around the city you've lived in forever and taking a different way home, or driving down that street with a weird name, or stopping in the hole-in-the-wall to see what it's like.

Right now, I'm chafing at the bit to get to Denver and start settling into my new home--I've been waiting for so long for the next step in my life to finally materialize that I just want it to be HERE. I don't want to be patient anymore. But I'm trying to remember to take the time and wander--not just beeline for the destination.

For so many of my friends, they just want to know. They just want to know what their career is going to look like, who they're going to marry, what their life is going to look like, and they forget to take the time to wander. Me too.

Take the time to enjoy. Take the time to grow. Go placidly amid the noise and the haste.

Wednesday, April 30, 2014


I've been spending some time with the story of Peter walking on water lately, imagining myself as one of the disciples on the ship. Watching my Lord walking on water with a mix of awe and confusion at the impossibility of it all. Not understanding but believing and trusting.

Joy as Peter steps out of the boat and finds himself standing, walking towards Christ, then a wave of jealousy that it wasn't me--I wasn't the one called, and I wasn't the one who responded--and finally relief that I get to stay in the boat, in my safe place still governed by the known laws of physics.

It's so easy to stay in the safe and the known. It's peaceful, because we know what to expect. But should that be the litmus test for what we should do? In the discernment process, I've been told to follow peace. Peace is of God, and peace will lead us to God. For some people, that might very well be true--there have certainly been a few times where I know that I've been just hit with that divine peace.

But for the most part, God's will is terrifying. Lead everyone you know into the desert. Have a baby, maybe the child of God. Step out of the boat. Die on a cross.

God's people are incredible in what they've done, and by all rights absolutely insane. Following the will of God seems less like chasing peace and more like jumping off a cliff without a parachute...and praying to high heaven that He'll be at the bottom.

There's a reason it's called a leap of faith.

And that landing? Man, there's nothing like it. When you land, you've done something amazing, something good, true, beautiful, that you've never thought possible. You've had an adventure.

I've got a few adventures lined up this summer. I'm going back to China with 14 students--that's not as scary this year as it was last year. I've been teaching a class on public health in China for them since spring break, and we've had a lot of really good discussion. Today was particularly interesting--what makes something Western medicine, and what makes something traditional Chinese medicine? What's the line, the objective definition? It's going to be something interesting to ponder.

The really scary adventure is moving to Denver. I've always had my safety net back in Wisconsin. Now I'm uprooting and taking my entire life to a city 1000 miles away, where I've spent maybe a week in total and I know all of two people...and I hate big life changes. Ho boy.


Sunday, July 21, 2013

Epic Blog Post the First

Hi everyone,
Sorry it's been such a long time. It's been really a whirlwind week.
So, last week I landed on Thursday night in Xiamen, CN, after flying to Shanghai from Detroit. Taking a domestic flight was entirely different from an international one. For one, going through the security line only involved me taking out my laptop, not my bag of liquids and not my shoes. For another, and more major thing, flights are delayed A LOT. Our flight was first delayed 10 minutes, then the gate was changed, then it was delayed another 10 minutes, and then we finally boarded the plane. There was no line or any sort of order to the boarding; it was just everyone mobbing the entrance until they got through. Despite the mad rush, the plane was quite empty—maybe 60% of the seats were occupied. We also sat on the runway for an hour and a half, waiting to take off (I'm not entirely sure why, because my 24 hours awake had finally gotten to me and I fell asleep). I heard something about air traffic congestion, though, so I think that might have been it.
I spent a lovely few days in Xiamen with my friend. We went to a dim sum restaurant as soon as I got in, which was the perfect food for coming right off the plane, and then we had a drink (gin fizz!) at her friend's bar, and then I finally checked into my hotel around 12:45am. They were kind enough to book a really, really nice hotel room for me, and I had an incredible night's sleep. One thing to note: beds here are very hard, even in the hotels. My friend picked me up in the morning and whisked me off to a little touristy island between Xiamen and mainland China (Xiamen is on its own island), which was nice; nothing too much to note, except for a quite nice shopping district. AND I got to become my own tourist attraction—I had a number of people, both children and adults, ask me to take photos with them. Then we got lunch, ran a few errands, and packed up to leave for a hot spring resort outside of Xiamen for the night. We had a hilarious dinner at the resort (I can now say that I've "stolen" a tub of ice cream from a Chinese hotel with the president of the Asian division of the company that fixes engines for Boeing; I didn't quite catch the name, but I'll look it up) and then spent the rest of the night in the different hot springs. Each one had different herbs in it as part of traditional Chinese medicine, and also to change the scent. It's not normally my thing, but it was really relaxing. On Saturday, I woke up around 10 to find out that I had to pack quickly so we could head back to Xiamen; a typhoon was coming. When there's a typhoon on the way, they shut down the bridges to Xiamen, so if we didn't move quickly we would get stuck on the mainland until the storm blew over. It made land near Fuzhou, about 100mi away, so we were fine—we had sushi with the owner of my hotel while it rained and gusted. Oh, and did I mention I crashed not one, but three weddings? My friend's coworkers were at one in our resort on Friday night, so we stopped by because they wanted to meet me. Then we went as guests to another one; Liou's mom's friend's daughter was getting married to a British man, and his family had no one to talk to—that's where I came in. So we stayed for the cocktail hour and the ceremony, then Liou and I went out to find a really delicious dinner for my last night in Xiamen. I can't even tell you all the things I had, but they were all amazing. We also got mango and peanut shaved ice at a café near my hotel and stayed up talking for a while.
                I caught my flight back to Shanghai really early the next morning. Well, it was supposed to be really early. Sunday was the day students were arriving! So I was going to meet the first one at the airport at 9:30 and then we would both be picked up by one of the students from the lab here in Shanghai. Alas, it was not to be—my flight, scheduled for 7:55am, actually took off at 12pm first because of the typhoon and later because of air traffic congestion.  So I went and found a café to hang out in in the meantime while my colleague tracked down the student and bundled him off to the dorms. I eventually landed about 30 minutes before the other students started arriving, so I had at least a little time to get myself organized and switch from vacation into instructor mode. We trundled to the dorms and the hotel, dropped off our things, and immediately got back on the bus for The Silk Road Restaurant, a halal restaurant. We FEASTED. Food here is all served family-style,  so everyone gets to try everything and the cost is nothing compared to the United States. It was so delicious, and again, one of the perfect meals for getting immediately off the plane.
                We spent the next day touring around Shanghai. Two things to note. One, it is really hot. Like really hot. It's been in the mid – to upper 90's every day this week, and today it was 100 without factoring in humidity. Two, it's HUGE and  CROWDED. The population of Shanghai is 24 million people, and the transient, migrant worker population alone is the size of Chicago. High-rise apartments are going up in all directions, and personal space, lines, and traffic laws are not concepts here. We went to the top of the Shanghai World Financial Centre, up to the 100th floor, where we ran into some students from Iowa State University and had a lot of fun taking pictures in front of the huge glass windows looking out over the city. We had lunch and walked around quite a bit more—I don't remember what all we saw, but I have a lot of pictures that I'll add in later!
                Tuesday was our first day at Huashan Hospital. Huashan is Shanghai's top third-level (the equivalent of our level one hospitals, like UW or Froedert) hospital, and is one of the best in the country. In a nation with 30,000 hospitals, that's pretty good; they also have the top neurology and dermatology programs in the country. They have 875 doctors and 1166 nurses, and various other administrative personnel, which sounds about right for a hospital as big as Huashan in the US. However, at Huashan 10,000 patients walk through the doors every day. The waiting areas look like zoos—there are lines and mobs of people all over the place, waiting to be seen by a doctor or even waiting to get an appointment for a month away. The students were split into three groups, and I tagged along with the one that shadowed at the Huashan Worldwide Health Center—the foreigners' clinic—while the others visited inpatient and nursing. To be perfectly honest, it was exactly like a US clinic, and exactly what I didn't want to see. Patients were mostly foreign residents or people on business trips, the clinic had state-of-the-art technology, and the doctors were able to spend a considerable amount of time with each patient. The inpatient clinic was the same—really nice rooms and a higher doctor-patient ratio, with all the amenities of an excellent U.S. hospital. I spent the second day with the nursing group while the other two groups went to the pharmacy, and that's when things got really crazy. The students had gotten to pick individually where they wanted to shadow, and the head nurse allowed me to sort of glom on to whatever student I wanted. I spent the morning with two students in the ER—that's where all of the public health problems started to sink in. You hear about all the health problems China has, but until you actually confront it it's hard to understand, and it's hard to understand the complexity of each issue. In the ER, physicians from different specialties set up shop in an exam room, and patients went in to see them, rather than the doctors going to the patient; the doctors also spent 1-2 month rotations on ER duty since emergency medicine isn't a specialty here. We had to step around people set up with IV bags in beach chairs while they waited for CT, or there wasn't room in the 19 chair IV administration room, and the CT scanner itself was insane. Each patient had about 3 minutes, no prep time, no  post-scan time. As soon as one patient was done, he had to get off for the next patient to be loaded on, and the bed was cleaned for maybe the first three patients we saw. Patients that could walk loaded themselves on, and patients that couldn't—for example, we saw a lot of bedridden head trauma patients—family members, and maybe one ineffective orderly, transferred the patient from the gurney to the bed and back again. Ambulances were also coming in all the time—the ER was equipped with one trauma room that all ambulance patients went to, and behind that was an ICU with nine beds for patients who were too unstable to transfer to the real ICU. While we were there, there were three patients: we're not sure what happened to one, but we later found out that two of them had been hospitalized two weeks for multiple sclerosis and were on ventilators—but without an electronic system, the ER had no way to know if there were beds free in the ICU to send them up, so they just stayed in this tiny windowless room for weeks with maybe 10 minutes a day with one family member. We also got to see one ambulance patient come in—an elderly man had congestive heart failure and was complaining of dizziness and shortness of breath. What we've come to expect in an ER, either through experience or TV shows or whatever, is doctors rushing in to assess the situation, pulling all the bells and whistles to get the best information as quickly as possible. What we saw was utterly different. For one thing, the family was at the bedside, and there was no effort made to move them so the doctors could actually get to the patient. For another, the doctors were using technology that was probably from the 80's: they were using a portable manual blood pressure cuff that I had learned to use in Biocore lab, and the EKG electrodes stuck on with these bizarre suction cups and the results were printed out like a seismogram instead of being displayed on a computer (apparently UW also uses one of these to teach physiology students).  The ER is also vastly understaffed; the nurse we were shadowing had trained at Massachusetts General in Boston, one of the busiest hospitals in the United States. She said that the ER in Boston was staffed by 200 people, all nurses, doctors, receptionists, techs, nurse assistants and case managers. Huashan ER is staffed by nurses and doctors totaling 15, and they see 600 patients in a day; case managers, which normally handle patient education and discharge instructions, don't exist here, and nurse assistants are very rare.
                We went to the Jing'an Temple, which is an ancient Buddhist temple in the middle of Shanghai, over our lunch break. For the afternoon, we dropped the other students off at their wards for the afternoon: a few went to the ER, one went to the neurology department, and two went to the neurosurgical trauma unit (traffic is, again, insane here and nobody wears a helmet on a bike or moped). At the last one, each nurse cared for nine patients, and there were four to five beds in each room. To my surprise, the nurse educator arranged for me to have my own shadowing experience, so I asked to see the infectious disease ward (where they treat people with severe bacterial infections), such as meningitis or non-pulmonary tuberculosis. The head nurse and a physician showed me around the ward—four patients to a room, except for the isolation room, and family members all around each bed—then we sat and talked about their experience as healthcare providers in China. The nurse had also trained at Mass Gen, so she had some comparison, but we couldn't get very far because of the language barrier.
                We visited the north and east branches of Huashan Hospital on Thursday with my boss and the Director of International Collaboration of Huashan Hospital; both the hospitals were much newer and surprisingly MUCH less crowded. They were in the growth period where they were trying to establish trust with the people: because the main campus had been around for so long and had such a great reputation, people would rather go there despite the older equipment and bigger crowds since they don't trust the doctors yet. Dr. Lin, the doctor from Huashan, posited that it would maybe take 10 years before they were at capacity. Thursday night, my boss took us all out for yet another feast and then to a bar on the 87th floor of a hotel in the Bund (one of many downtown areas in Shanghai). The skyline of Shanghai is absolutely incredible, and we stayed up there talking until fairly late at night.
                On Friday, we went to the first "prevention clinic" in Shanghai, and possibly in China: it was a little room in a building filled with different tests to assess fitness. It had a good deal of patrons, mostly the elderly, and several consultants were available to meet with patients about their results to help them make lifestyle changes. After we left the clinic, our guides took us to Jingan District Central Hospital, associated with the clinic, and we had a presentation and a Q&A by a panel of doctors and health officials about anything we wanted. The hospital was what they called a second-level hospital—they could provide basic care at a reasonable level of quality, but they were working with the third-level Huashan Hospital to increase their skills and abilities. They were also working on developing a central electronic record system to communicate with Huashan and within their own hospital. At the very end of it, they gifted me a set of beautiful porcelain zodiac figurines—they're incredible, but they're also REALLY heavy, and I'm still trying to figure out how to get them to Beijing and then home. After Jingan District Central Hospital, we finally visited Fudan University Eye and ENT Hospital—where our sister lab is! The lab was in an old converted synagogue, and the hospital was still really crowded for being so specialized. THEN after that, we went shopping at a market in the subway, where everybody found at least something to buy, from Beats headphones to dresses and Uggs, for really cheap. Whether or not they're actually real remains to be seen, but everyone seems pretty satisfied. Friday night we had a free night—some students went out, and others stayed home to get a good night's sleep (me! But I still stayed awake until I got a call that all of the students were home safe).
                We left for a weekend in Suzhou and Wuxi, satellite cities of Shanghai, on Saturday. Just to give some perspective again, Shanghai has 24 million people and is considered a megacity. Wuxi and Suzhou each have a population of 7-8 million people and are called satellite cities—the Chinese version of suburbia. My boss had some connections with government officials in the cities, so we were quite literally given the royal treatment. We had a diplomatic bus sent for us (that's where I'm writing this from), and our entire visit was planned out for us and treated. I've never had so much food in my life. We had an incredible four-course lunch at a vineyard in Suzhou, complete with wine-tasting, and were guided around the Suzhou Silk and Embroidery Museum, the Suzhou Museum, and the Suzhou Gardens by an agent of the Suzhou local government, a bodyguard, and a professional photographer. After speeding through everything, we hopped back on the bus and traveled to a lakeside restaurant (entirely shut down for us) for another four-to-five course dinner. We spent the night in what was probably a four-star hotel, but I didn't spend any time enjoying it aside from having the best night's sleep of my life. I actually didn't move all night, and 7:00am came wayyy too early. In Wuxi, we went to this Buddha Wonderland theme park, where we saw all of the various incarnations of Buddha, including an 88m bronze statue, and a Tibetan monastery. ALSO WE WORE BOOTIES EVERYWHERE. They were awesome and had gold swirls. They were the classiest item of clothing anyone wore, because little did we know that we were having lunch in the palace with a famous opera singer, served with wine from her private collection. She gave us each beautiful bracelets from the gift shop downstairs and swept off in her ballgown as we watched from our tanktops and running shorts. I also got yelled at for trying to kill a bug in the bus while we were still on the grounds; oops. Wuxi is famous for its ceramic artistry, especially its teapots (the region is also famous for tea), so we spent the early afternoon in a ceramics museum—we stopped and watched a woman making the foundation of a pot and enjoyed some tea—and trundled off to the bamboo forest for snacks—it was storming, so we weren't able to do any hiking or exploring. Then we were treated to yet another elaborate meal at a hotel before we left for Shanghai. I'm now sitting on the bus attempting to digest the massive quantity of food in my stomach; we're about an hour out from Shanghai, and all of the students are asleep. So glorious.
                Days completed: 8
                Days to go: 7
                New foods eaten: jellyfish, crocodile, octopus, boar stomach, bullfrog, pigeon, pig tail, goat, sea cucumber, Chinese caterpillar (costs more than the price of gold), turtle, fish head, goose, duck
                Students: still 15. Loving China, loving life, learning health and Mandarin.
                Other notes: Chinese toilets are adventures in themselves, as is tracking 15 people on the subway during rush hour—I've literally never felt closer to humanity before.

This week we'll visit a traditional Chinese medicine hospital for two days, spend one last day hanging out in Shanghai (read: shopping) and then take the bullet train to Beijing to shadow at one more hospital and play tourist until Monday, when everyone departs.

I'm working on a post about all of the problems that China faces in the public health department, just to try and describe some of the complexity and the incredible scale of each problem; I'll hopefully have it up soon!

See you guys in a week!