Farewell

My time is over and I'm packing to leave Tianjin. I have had a wonderful experience these past 10 weeks. I found the people warm and friendly, welcoming me into their workplace and into their lives. They made me feel a little less like a stranger and a more like a friend. I will always cherish the memories of this time.

SARS

I have been talking to some people here about what it was like living in Tianjin during SARS. Tianjin was involved in the SARS outbreak of 2003. People living here were very afraid. Everyone wore a mask when leaving their homes. Streets and malls, usually packed with people, were deserted for months. If someone coughed while standing at the bus stop, people literally ran away. I haven't heard about food or any other shortages, though I would be surprised if none had existed. Universities closed their campuses. No one was allowed in. One of the epidemiologists here was completing her masters degree at that time. She left one day to visit her parents, who lived nearby. She was not allowed back in. All her books and clothes were in her dorm room, and she had no access to them for 2 months. She tells about how the students would congregate at the University gate and play badmitten with anyone outside. Another epidemiologist here was getting her masters as well. She did her studies for those 2 months by email.

Some good has come out of this time. Public health in China was placed in the spotlight. For the US, public health was strengthened in response to 9-11 and the anthrax mailings. In China, public health has been strengthened in response to SARS. I've been out talking (in a manner of speaking) to rural village leaders, as I've written about in previous blogs. They all know about communicable disease reporting. The oft-repeated statement from the leaders is "Before SARS, no one knows about disease reporting. After SARS, everyone knows."

We talk about and plan for a situation like this with pandemic influenza. China has lived it, and become stronger.

Friends

I was involved in a food-borne outbreak investigation last week. Unfortunately, I was on the wrong side of this investigation. Four of us in the epidemiology division became ill within 6 hours of each other last week. I was well cared for during my misery. Two non-ill epidemiologists came to my apartment to check on me that first day. They insisted on finding lunch. When they couldn't find an open restaurant (it was 10 AM), they went to a supermarket, bought the ingredients, and made soup for me in my apartment. I felt a little less miserable lying in my bed listening to my friends cook for me. This is just one more example of how far everyone here has gone to make sure I have a wonderful experience.

Doctor Education

We have spent a few days each week visiting rural doctors to evaluate communicable disease reporting (see blog of 11/16). The doctor in this picture (white coat) is 27 years old and has been working for 9 years. So, I asked how much education he could have if he began working at 18. This is what I was told.

He probably didn't have good enough test scores to get into high school, so he went to a vocational school where he learned to be a doctor. All doctors at the township level have this level of training. The next level up in the health care system is the county level. After graduating from high school, medical university is a 5 year program with a bachelors degree. This completes the training for the county level doctors. After the bachelors degree you can continue on to a 3 year masters program. Graduates from the masters program work at the provincial level hospitals. Finally, if you go on to get a PhD in clinical medicine, you are allowed to work at a national level hospital. If someone is truly ill, they do not go to the township level hospital. The township level hospital is for minor illnesses and routine visits, such as childhood immunizations and family planning. I was fortunate to visit all levels of hospitals during my stay here.

Confucian Temple

The Confucian temple in Tianjin was built in 1436. Unfortunately, it was closed because of damage to the structures inside. I was able to look inside, where workers were busy making repairs.

Mumps

I spent Thanksgiving day at a rural school investigating an outbreak of mumps. The school has set up a classroom in a house near the school to teach the students who are excluded from school with the mumps. In the first picture, 7 fifth grade children with mumps are seated around a table doing math. The second picture is of their classroom at school. You can see many empty desks. The boy in the front on the right has recovered from the mumps and returned to school. Interestingly, the empty desks are all clustered around him!

Survey

On Monday we visited another rural clinic in an effort to improve reporting from the rural doctors. 60% of the population is rural, and very little communicable disease is reported from the rural areas. We developed a questionnaire to determine the perceived barriers to reporting. There are 3 parts to the questionnaire. One for the village clinic doctor, one for the township hospital leader (where disease reporting into the computer system from the rural areas is supposed to occur), and the final part for the village leader. In the picture the CDC worker is administering the questionnaire to the village leader (seated on the bed).