When the Courts Intervene

These days the news are filled with stories of various laws, bills, and practices brought before the Courts system.  It must be difficult to be a judge, to sit in a position of logic when so many of the arguments brought forth are ones of emotion.  And when it may at first appear that the Courts overstep their boundaries, the reaction can be explosive.

In Germany, a curious ruling was made by a Cologne court: German Ruling Against Circumcising Boys Draws Criticism.  Of course Jews and Muslims are up in arms over this, believing the court overstepped its jurisdiction and invaded religious space.  The court basically ruled (paraphrased) that the child has the fundamental right to bodily integrity and must be able to consent to the procedure if it's not done for medically indicated reasons.  It sounds logical enough.

Now the vast majority of circumcisions are done in infancy or early childhood, when the child cannot of course consent.  By Jewish tradition it happens on the 8th day of life.  Muslim tradition, as I understand it, varies a bit - it could be in infancy or all the way in adolescence (when the child would be able to consent).

So the argument come back, does the child's fundamental right to bodily integrity trump the parents' rights to parent?  To dictate the child's religion?  This is a gray zone, to be sure, and I'm not sure why male circumcision gets such a pass (from a logical standpoint).  Courts have ruled previously that a parent may not tattoo their child.  Courts have ruled that female circumcision (aka female genital cutting/mutilation or FGM) is illegal.  Are those necessarily drastically different?  Tattooing inflicts a permanent mark on the child, but doesn't remove any part of his/her body.  Female circumcision exists on a spectrum - the most "benign" being a simple prick to draw blood from the clitoral hood (or removal of the clitoral hood) to practices way more extreme.

One medical body considered allowing physicians to perform the most benign on the FGM spectrum (pricking the clitoral hood to draw a few drops of blood, symbolically of female circumcision) to assuage parents who come from a culture that practices that, and to ensure they don't take their baby girls to a practitioner who'd do something way more extreme.  That consideration was met with a furious backlash and promptly retracted.  But we're allowed to do more than that to baby boys.  I mean, really now?

For the purposes of this post I'm ignoring the potential medical benefits/risks of male circumcision because the research on that waffles all the time, and whatever potential medical benefits that may be gained are easily achieved with other means (e.g. using a condom, good hygiene, etc).  But these procedures, because they are surgical in nature, do come with very real risks.  In an old Jewish tradition (fortunately not practiced by most - I think - Jews these days), the mohel sucks the blood away from the circumcision wound with his mouth.  This is obviously not sanitary and is against all medical standards.  How 11 New York City Babies Contracted Herpes Through Circumcision.  That's one of the complications of that particular practice.  Now in normal healthy older children and adults, herpes is annoying but nothing more really.  In babies, because their immune systems are next to none, a herpes infection can be deadly.

And when public health officials try to intervene to limit/stop these practices, religious backlash is again furious as they claim they can self-regulate.  Clearly not always.  Circumcision, as my ob/gyn attending once said, has a "narrow therapeutic window."  It's not a difficult procedure to perform, but when you mess up, you mess up big time and you can destroy that kid's life.  That's not a burden I'd like to carry.

If at this point you may think I'm bashing religion, I assure you I'm not.  But when a religion requires modification to a person's body, particularly to a person who cannot consent, there are at least standards that must be met.  I'm in full support of medical/public health/legal bodies regulating such practices to ensure minimal harm.  The Cologne court in Germany may have gone too far, but the issue they bring up is valid: does the parents' rights trump the child's right to bodily integrity?  What if the child grew up and wish he (or she) wasn't circumcised?  What consolation is there then?

On my ob/gyn rotation I met a young first-time mother who asked me, as she was in the last stages of labor, whether her son would get circumcised right after birth.  I tried my best to mask my shock.  I said that the baby must first be observed for at least 12+ hours to ensure he's healthy enough.  I told her if she wished it to be done, it'd happen the following morning.  She asked me again if it'd be done right after he was born.  I reiterated myself.  Her friend suggested she could just leave him uncircumcised, that there's nothing wrong with that - I agreed and said most of the world's men are uncircumcised and the vast majority of them have no health problems because of it.  She considered this for a full 3 seconds before asking me that question again.  I changed the topic, exchanged some polite words, and left.  This mother, in my opinion, shouldn't have had the right to make that snap decision for her son without full consideration of the potential risks/benefits.

Thoughts?  Should logic rule over emotion and tradition?  Did that German court go too far, or simply conform to laws regarding other somewhat similar practices?  Whose rights should respected first?

Here's one last article, food for thought: Circumcision's Deadly Fault Line: Rationality vs. the Metzitzah B'Peh.

Epic Wedding

This post is long overdue. A couple weeks ago I drove down to St. Louis, MO with Michelle for a mutual friend's wedding. Michelle has a relative who lives near St. Louis, so we crashed at his place for the first night we were there.

That first night, we went to the Mehendi ceremony where the women got henna done. The bride's henna was really cool all over her hands.

The following morning was the Christian ceremony (groom's side) at Graham Chapel at Washington University. Though we left early so we could get there early, the universe didn't want that to happen. The highway I took narrowed down to one lane at one point and we were stuck in pretty much stand-still traffic for a good 15-20 minutes. I took the first exit I could find only to find the bridge I had to cross was demolished. I just went back on the highway and surprisingly it was fine after that blockade.

The Christian wedding was pretty sweet and short. After that wedding and taking a few pics, we went to the hotel where the rest of the events were held to attend the luncheon. By the way, almost every meal was provided buffet style with Americano and Indian options. Both were delicious and I was stuffed after every meal without fail. Probably gained like 10 lbs from all that food . . .

Anyway, after the luncheon there was a couple hours' lull as they set up for the Hindi ceremony later that afternoon. Unlike the Christian ceremony, which was about 40-45 minutes long, the Hindi ceremony was about 1.5 hours long. It was really cool though as I had never attended an Indian wedding before.

Finally, after the Hindi ceremony came the reception, which was really nice. Throughout the 2 days, the bride wore a total of 3 dresses, 2 of them being saris. She looked so good in all her dresses! I was so stuffed from the food that I couldn't finish a small slice of cake and attempting to dance was painful. Oh well.

The following morning, Michelle and I checked out of the hotel and decided to see some stuff around in St. Louis before heading back. We first went to the Shaw Botanical Garden where a really awesome tour guide gave us a most excellent tour of the gardens. It was such a beautiful place.

After that, we headed for The Hill area for lunch. But being Sunday and in a heavy Italian district, most places were closed. We did find a pizza place that was open (which was delicious) and then topped that off by going to a gelato place afterwards.

Finally before heading out, we had to see the Gateway Arch, probably the most iconic symbol of St. Louis. We didn't go up to the top but we took plenty of pics around it. All in all, it was a great trip with a couple of minor bumps along the way.

Gender-free?

A person's sex is biological, primarily determined by XX or XY. A person's gender is largely a social construct, or what being of one sex or the other "means."

This may be old news, but it's interesting nonetheless. A couple in Canada decided to withhold their newborn's gender from the world and him/herself. The idea is to let the child discover his/her own gender and decide for him/herself. It's an interesting "experiment," to say the least, and one that has drawn a lot of controversy.

Personally, I think the child will be all right. S/he will figure out gender, as it's been shown that a child's concept of gender is innate and becomes cemented by the time they're 4 or so. A child "knows" if they're a girl or boy. But what does it "mean?" That can be challenged.

I'm not sure I agree with the way the parents are withholding the child's gender from the child and the world. I think they'd be better off treating the child in such away to avoid gendered stereotypes. Because, honestly, gender stereotypes (to me) seem to be getting less distinct and less important. But maybe that's just me. There's a related article on masculinity that's an interesting read.

---TANGENT---
On a completely different note, I came across this recently:


Oh to have a body half as good as that, lol. Yeah, it's totally unrealistic for the vast majority of us to ever have a body remotely like that. And I can accept that. Doesn't mean I/we can't try to get halfway there (which, honestly, is more than good enough). :-P

Btw, Chris Fawcett is HOT. It's mostly his eyes to me, and less his body.
---END TANGENT---

Happy Chinese New Year!

Zodiac The Rabbit by ~Dei--dara on deviantART
新年快乐！恭喜发财！身体健康！

So yeah, I hope everyone had a great day. More posts coming soon (I hope)!! :-P

The Spirit Catches You and You Fall Down

In my medical anthropology course in undergrad, I read the book The Spirit Catches You and You Fall Down by Anne Fadiman. It's a story about an epileptic Hmong girl and the narration of her story from worldviews of her parents and of her doctors.

Imagine my excitement when I learned she was giving a guest lecture at my med school earlier tonight! Of course I had RSVP'd like a month ago in advance. How could I miss the opportunity to meet the author of a book that captured the beginning of a shift within the medical profession? How could I miss an opportunity to hear what pearls of wisdom I may gain from this lecture, especially as I'm involved in the Hmong Health Education Program (HHEP) committee here? How could I, as a med student, not sit in on a lecture so relevant to cultural competency to aid me in better caring for a diverse patient population in the future (especially since cultural issues largely aren't discussed at length throughout medical training)?

It was a great lecture. She was more down-to-earth than I had envisioned. She discussed the conflict that could occur between two cultures due to mis-communication. Indeed, there is a medical culture that contains within it almost everything you'd expect of a culture - it has its own hierarchy, it's own rules, it's own language, it's own special clothes, it's own rituals, and it's own worldview. One thing she said that will stick in my mind is the idea of a Venn diagram of patient-physician communication. There is always overlap, however small. Sometimes the patient, sometimes the doctor, often both, must venture to the periphery of their circles into the area where the two circles overlap - to where there is common ground between patient and doctor. This overlap is (apparently) called the "lune," and we must seek it as both patients and doctors to promote maximal outcome.

Afterwards, I had the luck (and patience) to have her sign my book! Okay, I actually left my original copy back home in another state. But an M4 (incidentally the M4 who started the HHEP) gave me a free copy of her book for the signing, so now I have 2 books and one of them has her autograph!! She drew that Venn diagram in my book, reminding me to find the lune. I also got to take a picture with her. This must be the first time I was so close to a celebrity, lol.

Her work is well-known in medical anthropology and in the medical community. To think that a journalist would have such a profound effect on the way physicians, bioethicists, anthropologists, would view cultural differences and how those differences impact healthcare (Mirrorboy, if you read this take note, maybe one day you'll produce some work that'll be the beginning of a paradigm shift). Unfortunately, formal training in medicine concerning cultural differences is severely lagging, even today.
-----
Now, for the other randomness in my life.

1. Apparently I'm no longer fit (I was never that in shape, but I was way more in shape 2-3 years ago). I judge my fitness by my cardio endurance, and right now I'm at under a mile on the treadmill. This won't do as I used to be able to run 2.5-3 mi. Then again I hate the treadmill as I usually can't run as long on treadmills as on ground (oddly enough). Anyway, exercising has now been bumped up into my top 5 priorities.

2. I participated in the disembowelment of the dead today. After 2 of my labmates left early, leaving just Jon and me in the lab, we decided to disembowel our cadaver so we could expose the posterior (back) abdominal cavity. We stumbled upon a whole new world! After we ripped, tore, and cleaned away the fascia (which one of my labmates describes as being "incredibly satisfying" - it is), we were able to expose the abdominal inferior vena cava (main vein going into the heart), the renal veins leading from the kidneys, and the kidneys themselves. There was definitely something satisfying and exciting as a result of this disembowelment (which, might not be a "true" disembowelment as we just moved all the intestines upward until they sat in the upper chest cavity).

3. It's creepily humorous in lab these days. In order to get at certain things to dissect, one must remove organs and place them all over the place. We had the left lung on our cadaver's face, his massive heart on his groin, his right lung next to his head, and his ribcage and calvaria (skullcap) near his ankles. Yeah . . . organs everywhere. The more one dissects, the less human the body becomes.

Okay, that's all for this episode of anatomy lab. My eyes can't seem to focus tonight, blah.

Mid-Autumn Festival

Today was the Chinese Mid-Autumn Festival (中秋节 - zhong1 qiu1 jie3). It's also more colloquially known as the "moon festival" because one of the highlights in celebrating this holiday is eating so-called moon cakes. I love Chinese holidays because they all center around food (well, almost all). My two favorite holidays are Thanksgiving and Chinese New Years (I think I might've blogged about that before . . . a long time ago).

Because the Chinese calendar is a lunar calendar, the dates of all the holidays change every year. This is annoying as I didn't know today was the Mid-Autumn Festival until a friend IM'd me yesterday reminding me of it. So this afternoon, a friend and I made a special trip to a nearby Vietnamese store to specifically buy a box of moon cakes. And it was totally worth it. Too bad it's cloudy today and I can't see the full moon. :-/ *curses the Midwest*

Also today several of us met with local Hmong leaders to discuss the Hmong Health Education Program that an out-going M4 secured a 4-year grant for. The Hmong are a minority group within the Asian population in the US; they're a minority within a minority. Many of the older generation being refugees from Vietnam that the US oh so carelessly didn't treat well once they were on US soil. Holy crap I never thought it'd be such a daunting task! I mean, I had learned about this special population in my medical anthropology course in undergrad, and I had assumed things had improved for them in the last 30-40 years. Apparently not - they're still just as marginalized, the barriers are still up. The difficulty extends beyond "just" translation obstacles, there are fundamental communication barriers in reaching this population that we as med students are just not equipped to handle.

The M4 kept mentioning all these organizations that we might be partnering up with, but the task of communicating and coordinating all those groups might largely fall to us. And I don't think any of us - the M1s and M2s - expected to be given such a large responsibility. We had thought our main role was to develop culturally sensitive material to be used in radio broadcasting and in handouts/leaflets. Even this is easier said than done, as none of us on the committee (or probably in the entire med school) can translate into Hmong. We'd have to work really closely with specific Hmong community members at length to make sure the material is at an acceptable level of comprehension and accurately translated.

It's annoying that the M4 made many of the initial contacts, so they're familiar with him but not us. And since he's outgoing, that means he's not likely to have a direct participatory role in what happens. That bastard, lol. I think all of us M1s left the meeting feeling like we're in over our heads and the whole "What have we gotten ourselves into?" mentality. But, if we make this work (and we CAN make this work), it'll be an amazing achievement. Truly something worthwhile.

Cancellation in Plans

First of all, to those who wished me a Happy Birthday, thank you!! Especially since I didn't make any announcement of it on my blog.

My birthday was actually pretty meh. I spent most of the time on the road to Chicago with my parents (my brothers stayed home). I celebrated Memorial Day weekend with my uncle's family and my grandparents (who were in town for a wedding). Consequently, I wasn't able to get on the internet long enough to post.

Anyway, as originally mentioned in this post, I was supposed to leave for Beijing on May 31st and come back to the US on June 27th. It was going to be awesome. Well, cancellation in plans. It looks like I'm not going. And here's how it went down.

3-4 weeks ago my grandparents called my great-uncle in Beijing to see if I could stay with him and his family. Also around this time, China was becoming a little worried about swine flu. So my grandpa also asked whether my great-uncle could find me somewhere else to live instead if I couldn't live with him. My great-uncle agreed.

Then suddenly cases of swine flu began popping up in Beijing and especially in Japan. As most US flights into Beijing must first stop by Japan, Beijing was getting nervous. About 2 weeks ago, my great-uncle called my uncle and grandparents to inform them that people were being quarantined as soon as they stepped off the plane if anyone on that plane was suspected to have swine flu. Several hundred people have been quarantined for a week in specific hospitals; granted, the vast majority of those people were fine. It was suggested that it would be better if I didn't go.

Well, my friends JW-M (currently in Beijing) and RZ-F (landing in Beijing soon) both felt it would be fine for me to go, that the Chinese were just overreacting and that I wouldn't really be personally affected. I held my ground against my parents and was still fairly set on going and taking my chances. I suggested that I could stay with JW-M for a week or so and then reside in RZ-F's Beijing apartment, because she'll be living with her relatives. And I could live in a hotel or hostel in the interim as I move between the two places.

My parents were yielding, mainly because my grandparents were on my side all the way to the end. It was looking up. Until yesterday. My grandpa again called my great-uncle and great-aunt to see if they could secure me another place to live while I was in Beijing. My great-aunt had been looking into student exchange-type things, where I'd live with a local family and teach their kid(s) English and they'd teach me Chinese and give me tips on traveling in the area. However, no one wants Americans to live with them. Word by mouth had been passed down through several communities in Beijing to avoid foreigners if at all possible. If an American would to stay with a family, even if the American were a relative, that household would be temporarily "ostracized" until the swine flu hype was over. Social stigma by association - it's a bitch.

With that, my grandparents were convinced that it was best that I didn't go. My grandparents didn't want to "guilt" my great-uncle further into letting me stay with them. My grandparents and parents knew all too well how the Chinese think in this respect, and while they also believe it's an overreaction, it wouldn't be a good idea to go if the people were going to be unwelcoming. And because my grandparents effectively have the final say in the family, that was that. I'm not going. T.T

The "Gay Gene" Part I

I had an interesting conversation with Bob (and briefly with AJ) the other night. Currently biomedical science does not support the hypothesis of a single "gay gene." But suppose a single gene were discovered that overwhelmingly determines sexuality, what would the ramifications be? Would it be a boon or a blow to the LGBTQ community?

In this installment, I will make the argument that the discovery of a single gay gene would be one of the greatest blow to the LGBTQ community, judging by the direction medical genetics is headed. In Part II, I'll briefly summarize the current literature on the genetics of sexuality. And in Part III, I'll posit a possible genetic model of sexuality. Hang on and read slowly, otherwise things might just fly right past over your heads.

First, a review of Mendelian genetics. We have genes that control particular traits. Each person has 2 versions of any given gene (called alleles), one inherited from each parent. Alleles may be dominant or recessive, with the dominant allele of a gene "masking" the recessive allele. In regards to sexuality, let's say heterosexuality is "dominant" and homosexuality is "recessive." If a person has one "hetero" allele and one "homo" allele, that person will be heterosexual. The only way that person can be homosexual is if he/she inherits two "homo" alleles.

Now let's expand upon this model (and ignore bisexuals for the moment - there is a way to make bisexuality "fit" in this model, but the genetics of that is beyond the scope of this post). Let's say a single gene is discovered that overwhelmingly affects sexuality. With this discovery, sexuality is overwhelmingly determined to be "nature" and not "nurture" (a faulty dichotomy to begin with, but we'll ignore that). We can rejoice in knowing that individuals are born straight or gay and have little/no choice in the matter.

Initially this may be cause for celebration, but it won't be for long. If the gene has been discovered then it can be detected. If it's detectable, then it can be found and individuals screened for the "gay allele" of this gene. There is a technology available now, today, called PGD (pre-implantation genetic diagnosis) that allows scientists to screen embryos for particular alleles of certain genes. Through PGD, embryos can be screened so only the desirable embryos are implanted into the womb. If the "gay allele" is undesirable, embryos with that allele can be screened out so no homosexual individuals are born.

Alternatively, genetics is advancing at such a pace that gene therapy may become feasible in the near-ish future. If, through this discovery, homosexuality is viewed as a "diseases state," then research money will flow into the development of a "cure" to "fix" homosexuals and make them straight. Imagine taking a pill or getting a shot and changing your sexual orientation. If this outcome becomes a possibility, then the individual's consent might not even be necessary for these "cures" to be dispensed. If given to a minor before the age of medical consent, parents could force their "gay-to-be" children to take the pill or shot and "make" them straight.

Think for a moment: if you knew that your offspring could be gay, would you want him/her to go through the teasing, ridicule, and whatever emotional baggage comes with being gay because of societal and cultural norms? For most parents the answer is probably no - they would prevent such a future for their child if they could. And if a child is already born, well, a "cure" is on the way. Before you decry the above as science fiction, or say that even if it's a reality it will never happen, it's already too late. Similar cases have already begun. The prime example is deafness.

Deaf parents (the capital "D" is important) often wish to have deaf children so that their children may grow up as a part of the Deaf community. The Deaf community does not view deafness as a disability or a handicap; deafness is merely a normal variation within humans, and deaf individuals have their own culture. Deaf parents might utilize PGD to screen for embryos that may become deaf children, and thus screen out the "normal" children. In contrast, hearing parents view deafness as a disability/handicap. They will go to lengths to ensure their children are as "normal" as possible. This may include PGD, but more often than not they utilize cochlear implants to help their children hear. Deaf parents tend to find cochlear implants an abomination - a means to quash Deaf culture and suppress a minority.

How many parallels do you see between the LGBTQ community and the Deaf community in these regards? Because of this I find the prospect of discovering a single "gay gene" to be a very scary one. It only requires a tiny push from well-meaning genetics to tip into the dark history of eugenics. And I haven't even touched on the issue of health insurance and life insurance yet. Thank God that human behavior is too complex to be controlled by "merely" a single gene.

---TANGENT---
I've begun talking to a new blogger, AJ (yes, a "second" AJ), and have just caught up on his blog: coming out (on the net). Great kid, do go over to his blog, say hi, and make him feel welcomed.

Hey AJ, I apologize that I stuck this blurb at the end of a rather intense post. I just wanted to give you a shout out before I forget.
---END TANGENT---

China IV: There and Back Again

Finally, the fourth and final installment on China. I apologize for my absence from the blogosphere - getting caught up and working on a final project consumes inordinate amounts of time. Feel free to read parts I, II, and III to refresh yourselves.

Before I return to "normal blogging," I'd want to complete my series on China. This post is more introspective than the previous installments, and I apologize if that makes for more difficult reading. There are thoughts and emotions I'd like to scribble down before they become lost in the archives of my memory. Welcome to the journey in my thoughts as I travel "there and back again."

Where to begin but at the very beginning? I had applied to go on this specific trip. I was resolved to go, but I didn't know if they'd accept my application for this trip, being that I'm Chinese. Imagine my excitement when I was selected! But then I starting having doubts and second thoughts. How will they (the Chinese) think and respond to me? What if my spoken Mandarin fails me? What if, what if, what if . . . My mind races, like it always does, always in motion. I then began to wonder what I'd miss during that week in China. Would I suffer from internet withdrawal? How badly will my email build up? Will I be begging and bursting to wank? Will I miss certain foods and drinks? The one thing I knew for certain was that I would not miss the cold. Granted, it was cold in China when we arrived, but at least 20-30 degrees Fahrenheit warmer.

From the outset, I was comforted by the knowledge that another ABC (American-born Chinese) guy was going on this trip. We became roommates for this trip, and his presence - and perhaps our mutual interactions and anxieties - played a crucial role in what this China trip meant to me. We shared this common thread and I think we would agree that we reacted to it similarly. I'll call him DY-M for the rest of this post.
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Flight to China
The flight to China was relatively uninteresting (first to the Tokyo airport at Nerita). I had an entire row to myself! I mostly read The Spanish Bow, the book I had intended on finishing over Winter Break. It's a really good book! I didn't want to sleep on the way to China (or sleep very little) to help combat jetlag. I didn't sit near anyone going on this trip, but that was alright. As my friend said, "When else do you have 14 hours to do NOTHING? Use it to relax, read a book, enjoy it." And that I did.

I did remember getting up once to go to the bathroom and when I returned, a Chinese woman had taken the 2 seats next to me. She was sleeping. -_- I didn't even recognize where my seat was at first! So yeah, I was really annoyed by her.

The flight from Nerita to Beijing was packed! You can read about it a little more in the second installment here. Not much to say.

First Night in Beijing
The airport was surprisingly empty when we stepped off the plane. Then again, we got in around 9pm or so. We were all exhausted. There were still things up from the Beijing Olympics the summer previous and I had taken some pictures (but these were lost). I was highly amused by the exit signs, or what I affectionately called "the green exit man" because the sign was green instead of red, and it showed a stick figure guy running out a door.

We made our way by bus to the Friendship Hotel. This was an amazing hotel, I really wish I had pictures of it (instead of just the lobby below). The first thing I did was call my friend, JW-M, who was studying abroad in Beijing for the year. Then DY-M and I crashed. The bed was SO HARD. I think there was either no mattress or no box-spring. Whatever, my back ached when I got up.

Breakfast was amazing at the Friendship hotel. It was typical Chinese breakfast food - steamed buns, steamed vegetables, stuffed steamed buns, various meat dishes, a nice assortment of fruits. JW-M found the breakfast lacking in China; his opinion that breakfast food is much better here in the US. I suppose he has a point. But we don't have kiwi juice here in the US! Kiwi juice = amazing. It's so green (and tasty)!!

Whirlwind Tourist Day
The next day was our "whirlwind tourist day" where we visited the Great Wall, the Imperial Palace, Tiananmen Square, and Laoshi Teahouse. You can read more about it in the the first installment here. But here are some more pics anyway. :P

The Great Wall!

The Imperial Palace!

It's a dragon-turtle in the Forbidden City!

Across from Tiananmen Square!

By the time we got to the Laoshi Teahouse we were exhausted and on the verge of falling asleep. It was the first place I encountered the infamous squat toilets. I managed to refrain from using a squat toilet throughout the entire trip. Go me! Anyway, the food was amazing as usual. And we saw a kind of screen play (not exactly sure what it's called) before going upstairs for a cultural show (which we were all doing the head bobbing dance of sleepiness).

Omg, look at this food!!

Screen play thing.

Roommate Bonding
That night, and almost every night, DY-M and I bonded a bit (in the most non-sexual way, of course). We constantly talked about how exhausted the day made us, haha. We almost always went to bed between 9pm-11pm. We discussed about what it was like being ABCs in China. We were both impressed by how we seemed to blend in relatively unnoticed. This may be because we're usually juxtaposed by our non-Chinese friends on the trip, and we were always together to cover for the holes in each other's linguistic skills. This usually worked pretty well. Often times, the Chinese people we interacted would come to us first because they knew we knew Chinese and English, and could translate for them. It did feel good being "useful" as an ad hoc interpreter.

DY-M did get to practice his Chinese more than me, oh well. My spoken Mandarin is better than his, simply because he didn't learn Mandarin until undergrad (he speaks Cantonese at home) whereas Mandarin is more native to me. We watched a comedy sit-com on the CCTV. I was able to understand maybe 80% of what was spoken, and he understood about 60% (so he says) but was able to understand what went on due to the context. That's pretty impressive, in my opinion.

I'm really glad he was my roommate. We shared a certain connection by the singular fact that we are both ABCs. And he was a really sweet guy - always really nice, smiling, and helpful. But that's part of his personality as well as his life philosophy. It didn't hurt that he has an amazingly fit body. ;-) There was something about him, some kind of comforting aura, that almost made me come out to him (for no real reason).

Tianjin
We spent the vast majority of our remaining time in China in Tianjin, about 2 hours south of Beijing by bus (but only 30 minutes but their new amazingly fast high-speed train). The first day we were in Tianjin, we ate at the famous GoBuLi Restaurant. The food, again, was amazing. This place is known for their steamed buns and dumplings. I had pictures, but they were lost and were unrecoverable. :-( But a couple did survive:

We spent most of the week observing and working with the Tianjin CDC (TJCDC). You can read all about it in the third installment here.

While we were technically on "lock down" when we were at the hotel, some of us did sneak to the nearby Chinese Wal-mart to buy some things. DY-M bought a pair of unhemmed pants, so he had to get them tailored. There was tailor who did 15-minute pants alterations. She had the thickest Tianjin accent ever. DY-M asked me to come along for (linguistic) support, just in case. We both had problems understanding! This little old grandma person next to us in line just laughed at us.

On our way to Wal-mart.

Food!
I felt that this warranted its own category. Not much to say here really. Just that, the first few days I knew every dish in front of us (or at least I could identify what animal/plant it came from). As the days wore on, I became less and less familiar with the dishes as they became more and more local/regional.

I'm not actually sure what this is. o_O

Last Day in China
The last day in China we went to Ancient Culture Street in Tianjin. It was basically a long street with a lot of street vendors. I met up with JW-M for the second time during this trip (the first time was in the Friendship Hotel that first night). It was nice catching up, somewhat. There were so many things to buy/bargain for! I didn't know what to get and whom to get it for. I ended up getting a jade turtle bracelet for SR-F, two silk scarves - one for my researcher's wife and one for AG-F, a solar-powered apple thingy (it moves its leaves up and down) for my researcher, and a tea pot of some sort. I had gotten 2 scrolls earlier - one that went to RZ-F and one that I'm keeping for myself.

We stayed in a hotel near-ish to the Beijing airport the night before we left. Several of us went to a karaoke club/bar place. It was actually pretty cool! DY-M did much of the talking in Chinese, but I was there as backup should my "services" be required. I'm actually not sure I could've held my own as well as he did. After we went back to the hotel, DY-M wanted to get a pedicure/foot massage and convinced me to go (his older brother introduced him to pedicures/foot massages when they were in Thailand visiting an uncle, he also tried convincing others to go as well). When we got to the place, it was rather expensive and kind of sketchy, so we called it off.

Our flight was early in the morning (around 8am I think). I was actually woken by one of the hotel staff. He had very limited English but needed to communicate with some of the people in our group who had already started going down to breakfast. It took my auditory system a moment to calibrate to his accent before I could acquiesce to his request. Basically, he wanted me to let everyone know that they were supposed to check out before heading down to breakfast to make things quicker and smoother, as the staff needed to check the rooms before we left.

Flight Back Again
The Beijing airport was still pretty empty, though not as empty as when we first arrived. We lounged in the airport for a while. I talked to my roommate (well, I suppose now we weren't roommates) for a bit before boarding the plane.

On the flight from Beijing to Nerita, I sat next to a really cute French guy. I thought he was Australian at first from his accent, but no, he's from France. No idea where he picked up that Australian-like accent. The moment he said he was french, the Japanese guy next to him with a fro (what Asian has a fro?!) started talking to him in French. And they talked in French the whole flight!! Grrr, he was my French guy to talk to. You totally stole him Japanese fro-guy. Also, there were two babies bawling almost the entire flight. They sat all the way towards the front of the plane whereas most of us sat near the back, but we could still hear them all the way down the plane.

The flight from Nerita back to the US was rather uninteresting. There was a choir group of Korean girls on the flight. They took up a lot of space on the plane, and the plane was completely packed! I was mildly surprised that the Korean girls didn't know English, as I assumed they were from South Korea that was occupied by the US for a while (and was heavily influenced by both good and bad aspects of American culture). Our flight actually arrived back in the US about an hour early, which apparently is very unusual.
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That was some of the highlights of the trip not mentioned in the previous 3 installments. There's so much more I could say. But perhaps now's the time to answer the question posed at the beginning of this post: What did this trip mean to me? It meant discovery, adventure, and escape.

I discovered that I could hold my own if I absolutely had to. I also discovered that the Chinese liked talking about me to each other when they find out I'm an ABC. At lunch in both Dagang and Jixian, some of the CDC people were talking about they were surprised I could understand and speak Chinese. I'm not sure they realized I could hear and understand everything they said. They toasted to me for that, haha. Red wine - toast away. White wine - it'll mess you up.

The entire trip was a super-condensed adventure. The Great Wall, the Imperial Palace, the CDC, the mountainside, Ancient Culture Street, karaoke, every moment was alive. There was so much to do, and we were so tired at the end of each day (so much so that I didn't even feel the urge to wank once the whole trip). For the first time in a very long time, I felt like I was alive and in this world, in this moment. And this brings me to my last point.

This was my escape. It was an escape from my daily life. It was an escape from being chained to my laptop and the internet and all that entailed. I did not miss the internet at all while I was in China. It was an escape from the academic stresses. Here, among the few people who went and among the massive populace, I - in a sense - escaped from who I was. It was like suspending reality in once place in the world to experience life in another. It was . . . relief.

Now, some final parting pics:

China III: On Assignment

I sincerely apologize for not having posted in so long. It's been a hectic month. It's about time that I finish my China posts, only 2 more to go! This post is about the reason why I was in China in the first place, and is of great personal interest to me, though some/many(?) readers might find it boring.

As I've already mentioned, I went with 11 other students as a part of a trip sponsored by the school of public health. Our principal goal was to observe and experience another health care system and immerse ourselves in another culture. I was a part of the measles vaccination group.

On the second day (Sunday) in China we met with officials at the National China CDC (Centers for Disease Control). The building was cold and pretty old, and the hallways were unheated. Interestingly, though there was a "No smoking" sign immediately upon entering the lobby, a couple employees were smoking under the sign! That kind of stunned us. We were then guided to a meeting room (actually heated!) where we were served hot tea. Constantly. It was really nice, actually, as the tea kept you constantly at the edge of wakefulness.

We learned a little about the history of the China CDC. Though it had existed for decades, it had received very little funding. Then SARS hit. Suddenly, the government put a lot of money into the public health infrastructure and the CDC was basically built over the span of 2 years. In these 2 years, China was able to do things that our US CDC has failed. China has also been preparing for the avian flu for quite some time now.

The pinnacle of their achievement was a real-time surveillance system of all diseases occurring within their borders. Doctors and hospitals would report any communicable diseases to the nearest level branch of the CDC, that then relayed the report to higher CDC levels until it reached the national-level CDC. Thus, as soon as a communicable disease was diagnosed, it would be reported to the National CDC within hours. By the next morning, there would be a report of the previous day's disease occurrence on the desk of the health minister. The ability to know where and when diseases occur is an amazing achievement, especially for a population as large as China's. Our CDC had contemplated creating such a system, but after the bio-terrorism funds were pulled from the CDC some time after 9-11, all progress in this technology has stopped. As such, we have rather poor disease-tracking ability here in the US compared to China.

Later that day we went to the Tianjin CDC about 2 hours' drive away. It was much newer and in better condition than the National CDC (though, they're going to be completing the new National CDC facilities in the next 1-3 months now).

We were shown around the Tianjin CDC, which was really nice on the inside as well. Too bad many of my pics of the inside were deleted. I did, however, manage to get this pic from the lobby of the Tianjin CDC:

Chinese New Year ftw! Year of the ox!! :P

Monday through Friday was spent learning about how the Tianjin CDC (TJCDC) measles campaign worked. In December 2008, the TJCDC undertook a massive measles vaccination campaign. There were billboards, songs, poems/rhymes, advertisements, and text messages notifying people to get free measles vaccinations. Note: In China, people get 4 measles shots, 2 that're bundled into the MMR shots like here in the US, and 2 stand-alone shots. The result? They were able to decrease the incidence of measles of 500+ cases in the first 7 weeks of 2008 to less than 20 cases in the first 7 weeks of 2009 in Tianjin. All in the timespan of a month! I doubt we could achieve this level of efficiency (or public reach) in the US.

It was intersting to note that most vaccines are free to the Chinese citizens. In fact, they were very surprised that the US didn't offer free vaccines to anyone (only at a reduced rate for low-income, and/or paid for by insurance or out-of-pocket for everyone else). They were a little taken aback when we told them that the HPV vaccine (for genital warts/cervical cancer in women) wasn't free. I believe it's not even covered by most insurances in the US.

On Tuesday, we designed questionnaires to ask parents of infants on whether or not their child received the measles vaccine. On Wednesday, we went to the local CDC in Dagang (大港) District. From there we went to a vaccine clinic. After doctors administer the vaccine, infants and children go to an observation room for 30 minutes to make sure there are no adverse reactions to the vaccine. (We don't do this here in the US - you get vaccinated and then sent along your way, if you have a reaction, go to the ER.)

Baby in the observation room.

Then we went to a nearby hospital. Interestingly, there was someone smoking near the "No smoking" sign in the lobby. Seriously, what's wrong with people?! Here we looked at hospital charts and records to see if infants were being vaccinated in the hospitals. There are 3 places to receive vaccinations: hospitals, clinics, and health/wellness centers.

Hospital charts.

Before we left the hospital, we saw the "floating baby" room. Basically, parents would bring their young infants (a couple weeks to 2 months old) here and their babies would float in a tub of water at a specific temperature. The nurse would attach a flotation device to the baby's neck so the baby could move around in the water. After "playing" around in the water for a while, the nurse would give the infant a massage. The whole point of this was to get young infants moving to promote movement and general health. It makes some sense, and allowing babies to float in water allows for movement with no impact.

In the afternoon, we located an infant with measles. Measles is so rare now in the US that doctors being trained today are likely to misdiagnose it as something else. Crazy, huh? Since we only had 2 measles shots as opposed to 4 (2 should've sufficed for us anyway), the CDC people who accompanied us didn't want to take chances; so they had us wear face masks.

It's hard to see (the red rashes), but this smiling kid had measles.

After we had examined the child, we went into a nearby neighborhood with our questionnaire to sample parents with infants at random. Every child has a record of his/her vaccine record in a little red book that is usually kept by the parents (relatively few parents in the US have a record of their children's vaccine records). Thus all parents and doctors have a copy of which vaccines had been given, as well as the dates of when future vaccines are due. Doctors will then call to remind parents to bring in their child when a vaccine shot is due.

On assignment, looking for babies to interview.

The little red book of vaccines opened up.

On Thursday we did the same thing in Jixian (蓟县 - Ji County). Again, we went to a local clinic.

However, we didn't end up doing much more than that, because we had a LONG lunch where we also had white wine. Okay, seriously, that stuff will mess you up. It's not actually wine. It's more like, vodka with 32-50% alcohol content. I had like, 2 double-shots of that stuff and I had to stop (I could've handled more, but I ate WAY too much). We were NOT in good shape after lunch to interview people. And it was getting late. Friday was basically a debriefing.

If there's one thing that impressed me about China's health care system, it is the close relationship between the health fields. All the health fields - medicine, nursing, public health, etc - are united under a common banner. Members of the different health fields spend part of their time training together and getting used to working with each other. In the US, each field is separate and independent of each other. No wonder why doctors, nurses, and public health officials sometimes don't get along very well. There's certainly an air of efficiency in China. Sure, our hospitals are generally in much better condition; sure, our medical technologies blow China's out of the water; but at least they know how to work together to get a job done.

China II: Through Foreign Eyes

The plane transfer from the Tokyo airport at Nerita to Beijing was the first instance during the China trip that our group probably felt a culture shift. The flight attendants spoke in English, Chinese, and Japanese. I was amused (and perhaps relieved?) when the flight attendants defaulted to Mandarin Chinese when speaking with me. Perhaps I wasn't so out of place after all. Then imagine stepping off the plane into the Beijing airport - the signs all in Chinese with English below, and the people overwhelmingly Chinese.

For most in our group of 14, I'm sure they immediately felt the reality of being in a foreign country where English was not the primary language. For me, less so. It's difficult to describe - I could still feel myself in a different country on a different continent, and yet it didn't feel totally unknown to me. In a way (terrible analogy coming up) it was like a ridiculously massive Chinatown. More than culture-shock, I was filled with a sense of adventure. I attempted to read every sign I could. I didn't do too badly, as I could usually get the gist of what many signs were about even if I could not read them outright. It's strange to be able to understand a word (character) but not know/remember how to pronounce it.

Still, there were notable departures from the US. A country steeped in thousands of years of history is about to accumulate a rich cultural tapestry that continues to evolve and progress. You could feel the ancient as it resonates to the current day. In comparison, the US almost feels raw, too young, and without a unifying thread. Of course I know this isn't really true, but everything's relative.

Some things of note - cultural differences - with accompanying pictures. These pictures are but imperfect glimpses of China through foreign eyes.

1. Everywhere you went, the ancient contrasts with the modern. Iconic old-style gates adorn many street corners as high-rises and skyscrapers tower in the background.

A typical Chinese gate in Beijing.

High-rises in Tianjin.

2. There is an interesting atmosphere within China. People are constantly striving towards progress, to become a developed first-world nation and leave the third-world behind. Yet, traditions are strong and the culture is proud.

An assortment of Chinese instruments. And a cello in the back. :D

Okay, this is just epic. The 2 standing women have a platform candle-holder thing in their mouth that holds up 3 candles, and they're supposed to sing through their teeth without letting go of the candle-holder while playing a drum with one hand and a snap thing in the other. And then they do all this while being in sync with each other. I wasn't technically allowed to take a pic of this.

3. There is a kind of bluntness in China that I found quite amusing. There are things people aren't afraid to write or say to your face.

Yes, it said that in the hotel room. LOL!!

4. I'm convinced that babies and young kids are cuter in China than they are in the US. It might have something to do with what they wear. I also found it particularly interesting that babies don't wear diapers in China. Instead, there's a flap over their butt (if there's a flap there at all). I see babies with their bare butts. Not too sure why it's this way . . . and I didn't take a pic of that. But, cute babies!

I kind of "stalked" this kid for a minute to get a pic. Too bad she fell asleep on her dad.

He wanted to hold our tour guide's pink flower. :)

The child is wearing a ladybug coat!!

A cute kid in Ji County (蓟县 - Jixian) in Tianjin.

5. Perhaps the most culturally different thing is the dichotomy between how homes look on the outside compared to how they look on the inside. Outside many apartments look run-down with trash everywhere. If you were to view these places through the "lens of the US" you would think people of low SES (socio-economic status) lived in these dwellings. But the moment you walk into these homes, you'll be in for a shock. Inside these homes are immaculately clean, the furniture nice if not always new, and all in all better condition than my apartment back near campus. Does. Not. Compute.

Yes, it looks that trashy everywhere in some places.

Apartments in Dagang District (大港) in Tianjian.

6. The CDC people were very open when talking with us. We were surprised that they were willing to talk about so many topics. For example, they suggested that we visit Tibet because it's so beautiful there, and many people make Buddhist pilgrimages to Tibet. The national government may censor a lot of things, but most people don't seem to care unless it interferes with their daily life. It seems the Chinese are very apolitical and could care less about politics, again, as long as it doesn't interfere with their daily lives.

7. The Chinese have a different definition of ethnicity than we do here in the US. There are dozens of minority groups in China other than the Han Chinese, that consists of well over 90% of the populace. To a foreigner, everyone looks Chinese. But there are subtle differences in culture, clothing, traditions, and dialects.

8. The bikers in China are fearless. They will ride their bicycles right up next to cars and buses without any kind of body protection. Traffic in China defies the rules observed in the US. You go if you have the green and you see a chance. As my friend JW-M says (he's studying abroad in China for a year right now), "It's all about the intent. The moment you're nice and try to let people go, confusion and chaos arises. That's when accidents happen. As long as you move with intent, everything will work itself out."

9. KFC, yes, Kentucky Fried Chicken, is everywhere. So is McDonald's. Apparently, people in China treat KFC like we do with Starbucks. People will buy a chicken sandwich and sit in the KFC for hours while on their computers, reading a newspaper, or studying. Supposedly the food served in the Chinese KFC is better than the food served in KFC here. Same goes for Pizza Hut, which is actually a big deal there - it's sit-down with table service, and actually really nice. We didn't go while we were there, but the thought amused us.

Another gate somewhere in Ji County.

Weird ass statue. I don't understand this.

Yes, there is a KFC in some remote area in Ji County.

10. What else? There aren't many fat people in China. I think it's because people walk EVERYWHERE. Traffic sucks because there are tons of cars, taxis, trucks, and buses. But the safety signs on the highway are highly entertaining. Too bad we were moving too fast for me to take pics of them. And yes, air pollution is a huge issue in China. We definitely experienced some of it (though not at its worst). Interestingly, there were signs for green energy and green technology everywhere. There were many trees planted outside Beijing, like almost an entire forest full. I think this is presumably to help against the sandstorms that blow into Beijing in the summer and to prevent the desertification due to the encroachment of the deserts to the north and west. "Arbor day" in China actually means something.

I do not have enough pictures to do justice to all the "differences" and interesting things we saw in China. There's so much that I haven't even begun to touch on. This is only a sample of China through foreign eyes. Though my eyes may not be as foreign as many of you readers looking at these pics.

I'll finish this post with a couple of pics: Wang Leehom on a water bottle. XD Stay tuned for the next post of Aek in China!! :P

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Really quick, I caught up on a "new" blog: southern inebriation. Go over and say hi if you haven't already!! :D
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