fast food takes over China

Hallelujah, my diarrhea has run out of steam!

Back to eating all sorts of funky things...

I am trying out this new way of posting to my blog via email... This
helps me bypass the web restrictions while I am traveling in China,
and allows me to post on the go from my iPhone. Boy, technology sure
is cool.

This post is dedicated to the Chinese Colonel (doesn't he look Asian?
Different from the american colonel, right?) and it's legions of fans
that line up to get jook (rice porridge) and yo tao (oily Chinese
fried dough sticks) every day. There's a KFC on almost every corner of
a Chinese city these days!

There are also scores of cute fast food shops popping up every where
in China. They are distinctly Chinese: or example, i had a lychee
seaweed passionfruit drink at an adorable place called Happy Lemon in
Beijing.

Hello, massive obesity epidemic!

when you're sliding into home, and your pants are full of foam...

...diarrhea, diarrhea!

I have been battling some serious loose stool and bad gas cramps for the last 3 days nicely summarized by this version of the diarrhea song:
"When you're walking like CP3O
and your crap looks like radicchio
Diarrhea, Diarrhea"

I should have known that eating 3 yuan (that's 40 US cents a bowl) street food throughout the weekend would result in this mess!

I suspect that the following cold noodle dish near the Taoist Golden Temple may have been source of the culprit microorganism. It's supposed to not be spicy, but you may notice how red the sauce is! Food is *spicy* in Yunnan. Perhaps I got too brave and felt so Chinese that I allowed myself to eat raw, not-recently-cooked cold street dishes. I don't even want to imagine how long and where these noodles and pickled veggies may have been sitting before I ate them.



After 2 days of pain and waking up with a fever yesterday, I decided it was time for some cipro antibiotic for perhaps ETEC (traveler's e coli diarrhea). When I told my work colleagues about this, they all laughed at me. "Cipro is useless! It won't do a thing against the bacteria in China!"

Bad news: since people randomly take antibiotics on their own from any old pharmacy on the street (without prescription, of course), there's a ton of bacterial resistance. That's why cipro might be useless here; it has been widely available and unregulated, so resistance to this medication is rampant. I still have loose stool after 2 doses. Hmmm.

I'll see where this goes... single case study on the use of cipro against traveler's diarrhea in China.

Hopefully this won't happen (I'm still working full force while here!):
"Now you think you're feeling better
but you keep on getting wetter:
Diarrhea, diarrhea....!"


P.S. You can check out more lovely renditions of the diarrhea song here: www.diarrheasong.blogspot.com

hooray! i'm blogging in China!

I made it to Kunming! As you can see in the photo above, Kunming is a large urban center with loads of people and concrete. If you squint through the smog, you can see some mountains in the background. I'm hoping to get to one of those hills this weekend. It's May Day (International Labour Day, Worker's Day) in China, so I don't have formal work duties on Monday. This is great because I have been working my butt off over the last several days (and in the weeks leading up to this trip). Yay for 3-day weekends!




Michael Pollan would approve of my breakfasts in China! Almost all of what I eat has a single whole food ingredient: bok choy greens, snap peas, soybeans/tofu, watermelon, honeydew, some fruit I don’t know the name of which has white flesh and small black seeds that come out in my poo.

I am slowly settling into life here. The downside of jet lag is that I get up each morning exactly at 5 am, and since I am going to bed at midnight because I am working late at night, that means 5 hours of sleep each night. It's not quite enough for me. The upside is that I have enough time before I go to the hospital to do sitting meditation for 30 minutes, yoga for one hour, and sometimes 30 minutes of deep relaxation thrown in. It's a great way to start my day, and I think it keeps me grounded amidst all the work intensity.




Above is one of the Yunnan special treats: rose petal cakes. It consists of dry flakey dough with fragrant sweet rose petals inside. The best part is that I bought it from a bakery next door to the apartment I will be moving into tomorrow called RAMBO Bread Works. GRRRRrrr…

In terms of work, it has already been interesting, rewarding, and a big (though good) challenge on this trip. I don’t have any pictures of me at work (since I am often running around at the hospital), but perhaps later.

I enjoy this work. I am tired from my 12 hour days, but this work definitely feels meaningful in a big way. I saw a bunch of patients yesterday, and feel more grounded to be connected with patients (who really put up with a lot here, as witnessed when the 27 year old man totally discolored and wasted from his advanced liver disease, TB in his lungs and belly, and another painful disease – MAC- smiled and shook my hand and told me how grateful he was to be examined even though it hurt like hell), and also happy that I can offer concrete, practical and real help to the clinicians. There are of course internal politics and power issues I need to navigate, so it will yet to be seen what we can accomplish. I have already a list of concrete interventions that I think we can help with, including big things like task-shifting to community organizations and small things like hand sanitizer. It's great to see it all coming together in a real, tangible way.




This Chinglish bag from my hotel room contained the Ethernet cable I’m using right now to tunnel to my blog (boy, that was an interesting challenge!). It says how I feel sometimes: while the internet miraculously connects me to you from around the globe and allows me to do this international work, it is also the “Non-Gift” that keeps me from being fully present to my environment. With that said, I’m going to upload this post, turn off my computer, and go out to explore the May Day parade and the temples of Kunming!

happy tiger year!

Grrrr....

food fun II

OK, guess what this is:



above: a tea egg chick fetus, a Hangzhou delicacy. Yes, the chickie fetus gets eaten with the rest of the egg. Beak optional. (Is this vegetarian or poultry? Hmmm...)

below: Bruce Lee has a fast food chain in China! (Boy, is he turning in his grave?) My cousin says that it's quite well-received among the young people. They can get meals like "healthy ginger chicken stew" there. I got the red bean rice balls. Pretty tasty... for fast food.







More to come: I have a bajillion food photos and will sift through them and post more soon.

Shanghai'ed: favorites

Here are some of my favorite images from roaming around Shanghai:



above: in an alleyway of the painfully hip commercial art area called the Taiking Road Art Centre



above: the view of Pudong River from my hotel room. Yes folks: that's SMOG.





above: one of the many the Mao Tse-Tung tribute sections of the Shanghai Chinese Propaganda Museum, though this one had an impressive collection of mini Mao statues that filled a wall.



above: OMG! A Smart Car in Shanghai! Modernization to the max.



above: Crazy Harajuku-type fashionistas populate Shanghai too.

the cake that fell from the sky

Above: China is the proud home of the world's fastest train, which I took from Beijing to Shanghai, a 9 hour trip.

"the cake that fell from the sky and landed in my lap"

My China Pangaea colleague Thomas uses this saying when something awesome unexpectedly happens.


After working 150 hours in the last 10 days (that's about 15 hours a day for 10 days straight), sleeping 5 or less hours per night, inhaling several metric tonnes of second hand smoke and being exposed to endless gobs of public spittle, double dipping at restaurants and a society with poor hand-washing and general hygiene, I of course have gotten sick with some respiratory viral infection.


I've been hacking up some mean yellow-green-black mucus, and I reckon that some of it is pollution and cigarette smoke related. Now I know why I have a bunch of Chinese women patients who have never smoked themselves but have bad lung cancer. China is a giant lung cancer and respiratory illness factory for anyone living here.


Back to the cake. Finally I have a little break from the intense work meetings and I have a bit of freedom to work at my own pace. I find that I am far more efficient this way. I decided to take the fastest train in the world, the EMU (I think it might stand for electro-magnetic something) from Beijing to Shanghai. The train was very comfortable, and I initially slept well on my soft sleeper bunk, lulled by the hum and soft movements of the train. But at 5 am I awoke with a hacking cough that wouldn't stop, and felt terrible for my 3 bunk mates: men who were rather surly to begin with. After getting off the train in Shanghai, I carried my 45 pound suitcase and 25 pound backpack up and down several flights of stairs during morning rush hour. Passengers blocked me in on the subway train and wouldn't move so I could get off, so I yelled at everyone to give way and pushed through, throwing in a couple English cuss words along the way. By the time I reached Eton Hotel, I was sweaty in my big down coat and long underwear (good for -10 degree Beijing but not for Shanghai), tired and sick, and generally pissed at the bad manners of my root countrymen.


I expected it, but my face fell nonetheless when the man at registration told me that check in is at 2 pm. It was 8:30 am. I was dying to rest without carrying luggage around. Then the cake fell from the sky: he told me that he'd allow me to get a room anyway...and then the sprinkles came down: since the non-smoking room I wanted was not available, he gave me a free upgrade to a better room with a view of the Huangpu River ...and free breakfasts. Awesome!!!



When I arrived on the 27th (non-smoking) floor, I was greeted by a statue of the Boddhisattva Guanyin (above). I have arrived. I am home!

Hurray for cakes from the sky.

food fun

Chongqing's hot pots are famous for being "han la!!!" (very very verrrrry spicy). Not being brave enough to go ALL RED, I decided to do it socialist democratic style and get the yin-yang half-and-half, with one side spicy and the other not. I dunked probably a pound of mushrooms into this pot... quite lovely. And amazingly, I was able to handle the red side just fine.

not for vegetarians


This street-side noodle vendor in Chongqing sells 200,000
bowls of sour-spicy chewy yummy yam noodles every day! It's also known among the men as the place to spot "pretty noodle-slurping ladies"...

this is what liberation looks like

The Liberation Monument in Chongqing stand in a city center square with a Rolex clock at the top and surrounded by massive multi-level shopping centers and street vendors. Somehow in China, the free-for-all-capitalist market coexists with so-called communist propaganda... and nobody seems to bat an eyelash at the irony.


Kunming is one of the most diverse cities in China. There's a large Muslim population in the city... and it was quite interesting for me to be among Chinese Muslims speaking Mandarin. This is a picture of an Islamic restaurant that I ate a tofu dish at (what, no lamb? yes, they were quite horrified when i asked for a vegetarian dish.) ... right next door one of the hundreds of KFC.

one foot in the future and a butt stuck in the past

This is the beautiful, well-resourced AIDS Care Center for Yunnan Province, which has 230 AIDS ward hospital beds and HIV viral load and genotype capability. The clinicians here are older, experienced and well-trained. They are supposed to provide support to all the HIV/AIDS care sites in Yunnan province. It's a castle on a mountain. They have one foot in the future (and definitely want both feet in the future soon).


These are two of the young doctors at the Kunming city Infectious Disease Hospital AIDS ward. Their ward looks nothing like the AIDS Care Center, and resources much fewer. A career in infectious diseases, and especially HIV/AIDS, is *not* a prestigious one in China. There's a ton of stigma simply for being around people with communicable diseases. (Though it certainly hasn't stopped millions of Chinese people from openly picking their noses and publicly spitting up in the streets.) I've been told that sometime doctors end up in the infectious disease department because they couldn't get a job elsewhere after medical school. Hopefully some of these young doctors will be inspired to do good work in the realm of HIV/AIDS care. I see part of my job to make HIV/AIDS care and treatment cool and sexy. Everyone will want to do it!

Compared to the AIDS Care Center above, most other HIV/AIDS treatment sites are quite under-resourced. Despite the rapid development in China, with all the glitz and shine of new cars and high-rises, the public health infrastructure here remains old, poor, ignored, and deeply entrenched in cadre politics. There are more doctors and better facilities in China than in Kenya and Tanzania, but the level of care at many places resembles much poorer and less experienced cousins in Sub-Saharan Africa.



I brought my stethoscope for what...? I spent countless hours in meetings such as this one, watching one powerpoint after another. It was necessary and good to meet all the public health and hospital leaders - and understand their perspectives and data... but I definitely experienced serious powerpoint burn-out.

fun with Chinglish

This is the tea that shouts in the morning, "Boy Sophy, you look terrible today!"


For China's new super-rich class: Just in case it's not enough that you're a top manager, you can also be first-class. If that's still not enough, let's be clear that it's only for the few. Gotta keep out those commoners!

i've died and gone to Pretz heaven

So much Pretz, so little time.



above: my cousin Qing and me with GIANT POCKY. Chinese people looooove their snacks. Yum!

In other news....from the January 27th "China Global Times" newspaper:
-legislation has been introduced in China and advocates have hit the streets to ban the eating of cats and dogs
-a competition has begun to decide on the renovation of Bruce Lee's house in Hong Kong
-a man in Wuhan has sued his barber 100 yuan for cutting off his 3 lucky 20-year-old mole hairs

here's to an auspicious start in China!

an auspicious start to my HIV work in China: here's a pack of condoms (the orange box) with all the bathroom sundries in my hotel room. Go STD and HIV prevention!


i'm not sure what guatting a fly entails, but i am sure that the fly won't like it, even if i do it carefully.

We just finished my first meeting with the Chinese CDC managers, HIV
partner programs, and Gates China (a highly political and powerful
group of people in the world of HIV in China), and it seems to be
friendly and supportive of us visiting the sites in Chongqing and
Kunming - and identifying true areas of change. Gates says that they
will tie their funding to if the organizations respond to the gaps in
an effective way. This means that we might be able to have a real and
positive impact! Yay!

Now I just found out that Blogspot and Facebook are censored here
(social networking is dangerous for the country's stability...) so now
I am asking Young Whan to help me post these blog entries. Thanks to
the best-partner-blogadministrator ever!

Somewhere over the Bering Strait

Wow. Sitting still for 12 hours is hard.
It would probably help to think of it as a sit,
zazen meditation practice.
Rather than a long-ass flight from San Francisco to Beijing.

Maybe it’s because I’m older now,
and I’ve worked a regular week at clinic,
standing and doing pelvic exams and running around all day,
my arm perpetually lifted and gripping a pen
filling out the bajillion referral and approval forms,
the full-page notes that I write for each patient I see,
the prescriptions and ‘indigent’ medication program papers,
the endless labs and imaging studies.

It will be interesting to do something entirely different.

For the next two weeks it will be a whirlwind of meetings
with various partnering organizations in the
Chinese HIV public health world.
Running around means
going from San Francisco to Beijing to Chongqing in 24 hours.
Instead of gripping a pen
I will be tapping away at my laptop keyboard.
I won’t have back-to-back patients
but back-to-back officials and administrators.
My frustrations will not be focused on
why I can’t get a specialty service for one patient
but rather why no one with HIV in all of China
can get adequate specialty care.

In both places, diplomacy matters.
Remain calm and carry on.

In a hurricane,
if I freak out and get exhausted,
I miss the calm clarity of the eye of the storm.

I need to learn to see and accept things as they are
so I can properly identify where
we can make constructive change.

Baby steps,
slow and steady.

Tanzania photos, July-Sept 08, album #2

Click on the photos below to see a larger slideshow!

poo irony

I spent two months in Sub-Saharan Africa, eating local food at street stands and at roadside holes-in-the-wall and had perfectly fine poops. Solid, every dang morning.

Then I come back to the US, eat some gourmet food at fancy restaurants, and have the most violent cramping diarrhea ever.

Go figure.

Nairobi’s not so bad after all…

OK, I have a bad attitude towards Nairobi. Historically I haven’t had any particularly good experiences with being in Nairobi. After all, my first night in Nairobi was spent running away from shady men in the street and in a hostel that ended up more like a giant brothel, dodging cockroaches with my suitcases barricading the door so that no one could break in. But I still think I’m unfairly dissing on it. I bet that the way Tanzanians talk about Kenya has also seeped into me. During the British colonial period, Kenya was given lots of attention and resources while Tanzania was completely neglected. Kenya also had a much more violent independence, Mau Mau uprising, and a more free-market/capitalist/fend-for-yourself post-colonial period. Tanzanians frequently will tell me that they think Kenyans are rude, in a rush, and don’t speak proper Kiswahili. Underlying all those sentiments is probably an element of bitterness about Kenya’s attention from the UK and their English fluency.


After writing my previous blog entry about being stranded in Nairobi, I had a perfectly lovely day in the city center. I tried to load Kenyan Zain cell phone vouchers to my Tanzanian Zain sim card – which didn’t work – but two really nice women worked with me for an hour to try to figure it out. I went to an internet café and a phone booth without any other wazungu in sight. I also found a wholesale wood crafts store and bought up a collection of beaded hand-carved bowls and spoons. Approximate Air had put us up in the Hilton Nairobi, so I spent the remainder of the evening swimming, in their sauna, and eating ceviche and fresh salad greens in their dinner buffet.


Though I would still certainly avoid being out on the streets at night.

Not a bad day in Nairobi after all. In fact, it was quite enjoyable.

Thanks, Nairobi!

stranded in Nairobi!

Within Tanzania, we use an airline named "Precision Air." We call it Approximate Air.

In the two months I was traveling in Tanzania, 3 planes were canceled, and the delay was anywhere between 4 hours to a day and a half. I thought we had it bad till I saw an angry group of Tanzanians who had experienced 3 canceled flights in a row to Tabora, and at the time, it was only flying 3 times a week - so they had been delayed a whole week!

I was of course skeptical about flying from Kilimanjaro to Nairobi on Approximate Air to connect to my flight to London. But it was the only direct flight. All week I was extra careful about everything: I confirmed the flight in person - twice - called again right before the flight, and asked about the flight statistics (they gave me a load of rubbish, but I figured I would try). I told my colleagues, "The LAST thing I want at the end of this trip is to be stranded in Nairobi."

So here I am, stranded in Nairobi.

...along with a group of angry, obnoxious Americans who had just spent a week hiking on Mount Kilimanjaro. It was a bit shocking to be surrounded by rude Americans again - after my two months among polite Tanzanians. At least there were a few Canadians and a Swiss dude to buffer them.

I missed my connecting flight to London by 10 minutes (the delay ate up the 3.5 hour layover I was supposed to have)... so now I a hoping to get on the flight tonight. It's a 9-hour overnight, and I will be annoyed if I can't get a window seat in order to sleep. They won't allow me to select seats ahead of time.

Nairobi is not on my list of favorite cities. It's not safe for women, especially at night, and has a large share of East African violence and theft. I've had to stay in Nairobi several times in the past for transit reasons, and now I try to avoid it when I can.

I had to cancel my one-day in London, which is a little sad (alas, no fashion month events)- but after two months of travel, I am just eager to go home and see family and friends.

I am trying to practice equanimity and peace with where I am. I know it doesn't sound like it... but I am still doing morning meditation on this every day. It gets heavily challenged when travel mistakes happen, and I have to change what I want to do and where I have planned to be. It also gets challenged every time I get treated like an alien creature. It's difficult to feel like a part of a community.

Let me go home!

Shimbwe Village: where there is no doctor

[above: Fides, Regina, Luciana and their families in Tesheni sub-village]



[above: a short video of Joelle and Beatus describing their work]

Last Saturday Joelle brought me along her round of home visits in the Tesheni sub-village of Shimbwe. She is coordinating the health program of the Minjeni Women’s Project, a small and very grass-roots organization started by a Tanzanian woman from Shimbwe who became a nurse. Joelle makes her rounds with the sub-village leader – in Tesheni, Beatus came with us and helped to identify where the sick people were.


We weren’t just seeing patients in the rural village – we are seeing patients in the rural sub-village. We hiked on the slopes of Mount Kilimanjaro on narrow, steep, packed-dirt pathways to get to the mud-brick homes. It is absolutely, incredibly beautiful. We are surrounded by lush mountain flora, waterfalls, and small family shambas (farms) with mixed crops of coffee, corn, and greens. If it was rainy season, I would have fallen multiple times and been covered completely with mud while evaluating people. Mud-covered, huffing and puffing Sophy, seeing patients where there is no doctor. And no electricity. And no running water. Thank goodness for Purell hand-sanitizer.


Yee-haw! It sounds super-cowgirl-medicine till I tell you that we traveled there by a beat-up mini-van from the bustling international town of Moshi.


Contrast this with the patients that we met at Ushetu lower-level health centre in Kahama District. People still walk 50 km on foot in the hot, dusty Shingyanga region to get to Ushetu. It takes them three days to get to their nearest clinic. This is an improvement; they used to have to walk 80 km to get to Kahama District Hospital before the HIV antiretroviral roll-out, just two months ago. I would be almost afraid to go there and uncover all the untreated illnesses there – it seems overwhelming.


Shimbwe village, on the other hand, is in the rural Moshi district. It’s a 30-45 minute, 800 shillingi daladala ride away from Moshi town and the regional referral hospital of Mawenzi and national referral (and private religious) hospital of KCMC. Yet it’s clear that the people who live in Shimbwe don’t have access to adequate health care.


I can identify three main reasons:
1) Health care is costly: 800 shillingi for each way of travel is still prohibitively expensive for people, particularly single or widowed mothers who also have to care for numerous children and barely make 2,000 shillings a day to support their entire families. At KCMC, people have to pay expensive registration fees. At many health facilities, they are also asked to pay bribes to be seen the same day. Unless they are HIV-infected, they have to pay out-of-pocket for their medications.


2) Getting to the facilities is arduous for those who are ill: People are simply too sick to make the journey down to Moshi town. They are also often turned away due to long queues. People often wait from the break of dawn only to be told at closing time that the clinician doesn’t have time to see them.


3) Even if people are seen by a clinician, the quality of care is often deplorable: Negligence, missed diagnoses, and mis-management abound. It’s sad but true, and individual clinical officers and medical officers are not entirely at blame for this phenomenon. It’s probably due to a mix of crappy clinical training (i.e. A physical exam? Differential diagnosis? What’s that?), poor pay (i.e. good people leave $200-300/month clinical jobs to take cushy office jobs with NGOs that pay at least 3 times as much), and poor conditions (i.e. who wants to be a doctor when you can’t even get a basic lab such as a gram stain or creatinine level?).


Back to Tesheni. We saw five patients that day. Home visits take a long time but are great because you can see the context in which a person lives. It’s a distinct privilege to get such a snap-shot into a person’s life. One woman had been subsisting on only ugali na ndizi (corn mush and banana) for the last few years had developed leg pain and weakness to the point of not being able to walk during her pregnancy. Her baby has significantly deformed legs. I think they have malnutrition, manifesting as B12-deficiency peripheral neuropathy for the mom and Vitamin D/calcium deficiency rickets for the baby (by way of Mom’s vitamin deficiency and breast feeding). If I’m right, we can treat this – and cure them of their symptoms. The sad thing is that this woman had spent a small fortune going to KCMC to be evaluated over the last year– only to be diagnosed with “hysterical ataxia” (a disrespectful way to say that a woman can’t walk because she’s nuts) and “weakness of unknown cause.” You would think that a national referral hospital of Tanzania would be able to diagnose a nutritional deficiency.


Another woman complained of coughing since 1995 and a constellation of vague symptoms, including abdominal and back pain. I think she has peptic ulcer disease, and we will give her triple therapy for helicobacter pylori.


It’s truly rewarding to do home visits in a place like Shimbwe, where there is no doctor. And where there is very little access to good doctors. Hopefully in this very short visit we have helped a few people with curable diseases.

KA: Kitenge-holics Anonymous

Hi, my name is sophy, and i’m addicted to KITENGE!!!! Yeah!

[above: Rita, the amazing tailor-seamstress-textile-artist, and me - with the bags she made with my design sketches]

[above: Joelle sporting a hoodie made out of kitenge]