Tuesday, October 30, 2007

Stone Mountain

Sunday we took a trip to Pinggu, a mountainous area north of Tianjin and east of Beijing. We travelled a beautiful road winding through many villages. Occasional mountain peaks had tall lookout pagodas perched at the top. One mountain had a giant gold Buddha seated at the top. Stone Mountain is really not very high, but the only acceptable way to climb it is straight up the stairs that are built into the mountain. Thousands of stairs (unfortunately, not an exageration). Some stairs were very narrow and steep, others were wide and shallow. You really had to watch every step as the size and steepness varied. It was a cold, windy day with occasional snow flurries on our climb! We didn't make it all the way to the top, I'm afraid. This picture was taken from our highest point. Note the path where we began in the bottom left corner.

Friday, October 26, 2007

No Water

Here is where I usually enter my apartment complex. Do you think this has anything to do with the fact that I woke up Wednesday morning to find out I had no water? Luckily water service was restored by Wednesday night. Trying to get back to my apartment at night when it's dark is very tricky. I'm glad I brought a flashlight!

Thursday, October 25, 2007

Immunization Check






On Monday we went rural again! This time was for what they call an immunization recheck. A village is chosen at random, and workers from the provincial CDC go to that village to check children's immunization cards. The child's immunization card is compared to a log kept by the township hospital, where immunizations are given. This check has already been done by the local CDC, hence the "recheck". This is primarily a quality evaluation of record keeping, but has the added benefit of speaking to the villagers and reminding them of the need to immunize their children. We caught up with a group of villagers with their children at an impromptu clothes sale by the side of the road. The picture on the left shows the man handing over the immunization card for the child in his mother's arms next to him. The mother to the far left is being scolded because her son is behind on his immunizations. The picture on the right is of two CDC workers comparing the immunization card with the log book.

Tuesday, October 23, 2007

Starbucks!


By Friday I was getting a little cranky. 2 whole weeks without my Starbucks! I rarely go more than 12 hours without my Starbucks, so you can see the trouble I was in. Anyone who knows me knows I always carry a thermos of coffee around with me every day. So, I went to Starbucks.com to search for locations in Tianjin. There are 9! One appeared to be close to my apartment, so I decided to explore. Saturday morning I rose bright and early, did some laundry, cleaned my 2 room apartment, got groceries, then headed out on my quest. After walking about 1 1/2 miles THERE IT WAS!!! The familiar sign. It looks like a Starbucks anywhere in the US. Same menu (in ENGLISH!), same set up, same prices! The people behind the counter spoke English! I've decided this will be my weekend treat. In fact, it's now Sunday afternoon and I'm sitting in Starbucks drinking coffee and writing this. LIFE IS GOOD!

Monday, October 22, 2007

Drying food


Here is a picture of corn and sunflower seeds drying on the road. This village had wide streets with plenty of room to drive. Some villages we drove through covered the entire road, making driving a challenge!

Rural Doctors Clinic


Here's a picture of one of the rural clinics we visited. Note the drying corn outside.

Hospital Visits

I spent Wednesday, Thursday, and Friday visiting various hospitals in the Tianjin District. The visits were to learn how communicable disease surveillance works so that we can come up with a plan to improve reporting. For a little background, Tianjin is on of four municipalities in China that answers only to the National Government. Tianjin Municipality consists of the city of Tianjin with a population approximately 6 million, and the surrounding rural area, with a population of about 4 million. First we visited a children's hospital in Tianjin City. Another thing you need to understand is that there are very few private doctors. If your child is ill, you take them to the children's hospital for outpatient evaluation. No appointments, just masses of sick children arriving and waiting to be seen. The outpatient department at this hospital sees about 3,000 sick children each day! On Thursday we travelled to a district about 70 km north of Tianjin City. There we visited a county hospital, a traditional medicine hospital, and a township level hospital. Friday we went VERY rural and visited a township hospital (no inpatient or lab services) and rural clinics in a district about 30 km south of Tianjin City. A few things struck me in these visits: 1. The complete lack of documentation. As far as I can tell, other than an occasional outpatient log, no paperwork is filled out unless the patient is admitted to the hospital. 2. There is no standardization to diagnosis. As lab confirmation is rarely performed, the diagnosis is purely clinical. I was amazed that in a rural clinic with no labs the doctor could diagnose shigellosis. Does this just mean dysentary? How does he know it's not campylobacter? 3. The drying food everywhere. Corn and sunflower seeds were laid out on roads everywhere to dry. Imagine a 6 lane road (3 lanes each direction) with 2 lanes on each side covered with drying corn and sunflower seeds. Who owns all this food? How do they pick it all up when it's dry? Just sweep it up with a broom? I watched cars run over the edges, children run through, dogs squat in the middle, flies and spiders crawling through the food. Do they wash it later? Then we went to lunch and everyone started eating sunflower seeds. I have to say that I had a very difficult time eating the sunflower seeds. I certainly didn't use my teeth to crack open the shell!

Tuesday, October 16, 2007

A Chinese Wedding


Sunday was another eventful day. First I went to Xu Wenti's home to learn to make chinese dumplings. While my dumplings were certainly as tasty as any other, they were not nearly as decorative looking. I couldn't seem to master the art of folding and pinching the dough closed in a visually appealing manner.
In the afternoon we went to a wedding. The bride is a colleague of Wenti's husband, both working in public health education. I thought the wedding would be very different from US weddings, but it was much the same. It was kind of like a combination wedding and reception. While we all sat around the dinner tables, the wedding was performed. The ceremony involved the exchange of vows and rings. Then the ceremony leader asked the bride and groom questions about how they met, the first time they held hands, things like that. Influential people in their lives (their fathers, bosses at work, teachers) came forward and gave them advice. They cut the cake, drank some wine together, and that was about it. During the dinner the bride (and groom too I think) changed clothes 6 times. The original wedding dress was typical western. 2 of the subsequent outfits were traditional Chinese. I don't think the bride and groom ever sat down to eat. They circulated and changed clothes the whole evening!

While the bride and groom circulated and changed clothes, we feasted! An amazing amount of food. It is tradition to continually toast the bride and groom at your table. They had some special "white wine" to toast with. I choked on the first toast, making everyone laugh. The "wine" was 50% alcohol, 100 proof. As you can well imagine, it was a very happy reception!

Monday, October 15, 2007

Laundry, Crabs, and Grapes


Friday night I decided it was time to tackle laundry. I have a new washing machine in my apartment, and the only instruction I was given was to move it into the bathroom when I wanted to use it. So, I opened to the lid and found a variety of parts and instructions NOT in English. I managed to screw a grate on the bottom (no screwdriver, I used a table knife), attach the water hose to the faucet, and the drainage hose to the drain in the floor (once again, no screwdriver). I have to say it was one of the proudest moments in my life when I started the first load and NOTHING leaked and EVERYTHING worked as it was intended. Amazing. The only thing missing from the instruction sheet was the happy woman with the laundry basket.
On Saturday we went to Hangu District to pick grapes and catch crabs (see map of Tianjin) . What a lot of fun we had. This trip was planned in coordination with the influenza conference on Friday. There were 2 buses full, about 100 people, on the trip. It took about 1 1/2 hours to reach our first destination. It was a place to catch crabs. We sat around a pond dangling pieces of pork in the water. When the crabs started to eat, we caught them in a net. It was somewhat difficult to pull the line up, scoop a gyrating crab into a small net, and not fall in the pond all at the same time. I think I caught about 8 crabs (see picture) although I threw them all back. After lunch we went to a vineyard to pick grapes. They were delicious! I paid 12 yuan (less than $2) for about 8 bunches of grapes. A fun day out in rural Tianjin. Tomorrow I have been invited to a wedding!

Friday, October 12, 2007

It's Friday!

What a busy first week of work. I thought it might start slow, but that was not to be. My assignment Monday was to put together a presentation on surveillance in the U.S. and compare it to surveillance in China. Wenti and I have been working together on this. Then on Tuesday at 4:30 PM I was asked to talk about influenza surveillance in the U.S. for a meeting they are having today to kick off influenza surveillance season. So, I have managed to pull together two presentations quite quickly. Thanks to all you at home who sent me information and slides. Hopefully I will do justice to both topics.

In the midst of all this I have been trying to get registered at the police station. The law states that all foreigners coming in to work must register within 24 hours at the local police station. We have been trying, but every day it seems they need something else. Thank goodness Tina came with me the first day. No one spoke English there, so I couldn't possibly have done this myself. She has spared me most of the problem which means she has been going to the police station every day trying to accomplish this task. Hopefully today is the day it will be done!

The epidemiology division is a wonderful place to work. Everyone speaks English quite well! I'm very impressed. Everyday someone brings me some different foods to try. My favorite was something they said was a new species of date. It was the size of a large nut, and tasted like an apple. Very delicious! I have also been given cookies, cakes, roasted chestnuts, and sweet potatoes to eat. And it's only been 4 days!
The CDC is a large campus of at least 8 different buildings. The newest one that I am working in is just 1 year old (see picture). To the right and behind my building is the rest of the CDC buildings. On the grounds there is a tennis court, basketball court, and some various exercise equipment. Every morning when I come in people are out playing and exercising. There's usually a group playing what we call hacky-sack, although their bag has 3 feathers on the top. My epi group does yoga after work. I have not stayed for yoga yet because I want to make sure I can find my way home before it's dark. Maybe next week.

Wednesday, October 10, 2007

Picture Day, Tuesday, October 9, 2007


We had our picture taken today. Here is the epidemiology section I am working with. A very fun group of people who have made me feel so very welcome.

My Apartment



This is my apartment building in Tianjin. I am the third door down on the left (behind the red vehicle). I am on the fourth floor.

Monday, October 8, 2007

Shopping, Sunday, October 8

Wow! Now this is a Supermarket! It's about a 10 minute walk from my apartment. It is a very interesting walk with one paved lane shared by the mostly one-way car traffic along with two-way bicycle and pedestrian traffic. There is packed dirt on one side, but it had rained early this morning so there were many puddles to navigate around. We explored three floors of shopping. The ground floor has individual shops with various items such as jewelry, home decor, clothing, and specialty foods (such as a tea shop). The second floor held housewares, clothing, toiletries, and toys. The third floor was groceries. Think of a small mall on the ground floor with a Meijer's stacked on top. Moving ramps allowed you to take your shopping cart from one floor to the next.

I had thought shopping would be difficult as I would have difficulty deciphering labels and prices. This was not the case. While some labels remained a mystery to me, most of the time I could figure out what the product was (of course, I had Tina there to translate for me). All prices were written in numbers, not chinese characters, so that was also not a problem. Because I spent a certain amount, I took my receipt to a station where I could get either 6 eggs or a 2L of Coke for free! I took the Coke :)

Tomorrow (actually today as it's 2 AM) I'm off the the police station to register and then on to the CDC!

Arriving in China, Saturday, October 6

I have arrived in China! The flight from Detroit to Beijing (with a quick stop in Tokyo) took about 18 hours. Navigating through the airports in both Tokyo and Beijing was very easy. There were no lines at either quarantine, immigration, or customs. I waited maybe 3 minutes for my luggage. We landed at 9:15 PM and I was out the door at 9:40. I have never had that kind of service at Detroit Metro! Tina from the Tianjin CDC was waiting for me right outside the door with a driver and a bottle of water. An EXCELLENT welcome. Only very important people get picked up from an airport 2 hours from their destination with a driver.

We arrived in Tianjin close to midnight. My apartment is very nice with all new furnishings. Someone had stocked the refrigerator with some food and bought all the toiletries I could possibly need. All in all, an incredibly generous and thoughtful welcome. Well, it's 2 AM and I'll try to get some sleep. Tina will be here at 10 AM to take me shopping!