Hang-en cave

Hang-en cave
(credit: National Geographic)

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!


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