Arrival in Riobamba

Today I had a nice quiet morning in Quito. Quito reminds me a lot of Lima, Peru, where I spent a summer 4 years ago. They both have colorful boxy houses on the side of mountains.

Quito also has a statue of the Virgin over looking it.

They both have remnants of colonial architecture all over the place. I also even saw a Chifa

(a Chinese restaurant), which were plentiful in Lima. Interestingly lots of Chinese people immigrated to parts of Latin America once China opened its doors in the 1980s, I think it was easier to get visas, and people at that point just wanted to get out of the country.

good for what ails you

Overlooking Quito

I mostly walked around El Centro or Old Town because I didn’t have a ton of time before leaving for Riobamba.

This picture made me think of China. I don't know why, but there it always seemed to be women doing a lot of the cleaning and maintenance work on the streets, whereas in the US I feel like its more men, or maybe evenly split.

On the way to Riobamba...

This is our driver Segundo, who is Andean and lives in Cacha, near Riobamba.

I got to Riobamba and met my super nice host family. There’s 6 of them in total! I convinced the girls (ages 9, 12 and 23) to play a couple games of SET with me! It was fun :)

find the set!

Here’s some photos of my room. It’s nice!

view from my room

Anyhow, tomorrow is my first day at el Hospital del IESS, (which sounds like “yes” to me when I hear it) in the Emergency Department!

Margaret

Margaret in Ecuador!

Hi guys!

At the suggestion of some friends, I'm gonna try to update this blog while I'm in Ecuador...
For those of you that don't know, I'm doing a one month Emergency Medicine rotation in Riobamba, Ecuador through an NGO called Cachamsi (cachamsi.com if you want to check it out). I'm super excited!

Today is my first day in Ecuador and I just arrived in Quito, the capital. Unfortunately my road here was a tad bumpy. Had a series of plane delays which led to me getting here late at night. Since I was warned multiple times about fake taxi cabs and had to listen to this English teacher sitting across from me talk about how she was kidnapped last time she came through Quito, I was a bit apprehensive...

Luckily I befriended an Ecuadorian man, Luis, and his 18mo old daughter on the plane and he let me use his phone to call my hostel to let them know I'd be late (and I got a friend to email them too. Thanks, friend!) and then when his family came to pick him and his daughter up, they insisted on taking me to my hostel even though it was 30 minutes out of their way. So I squeezed into a car with 5 other people and a bunch of luggage and made it to the hostel...People are so nice! Though they definitely made fun of me on the drive over, because I kept trying to read the signs on the side of the road, and apparently some of the words I was saying sounded like cuss words...whoops!

Things seemed to be going well except I found out that Bank of America suspended my debit card, I'm not really sure why, and when I called them using skype, they wanted me to go into a Bank of America branch to fix it. When I explained that I was abroad, they were less than helpful. Oh well, I'm sure it'll all get sorted out, eventually!

Anyhow, time to catch some sleep. I'm taking a car from Quito to Riobamba tomorrow (4 hour ride) and I get to meet my host family! (Yes, I have a host family! I opted for a homestay.)

Hope you all are well!
Margaret

Happy (Western) New Year!

New Year’s Resolution: To post more on my blog, so people will know I am still alive. I’ve been up to a lot since I last posted. Been on 3 trips to different provinces in China. Had my mom and sister come out and visit (yay!). Got really cracking on my research projects. Had a fun Christmas and New Year's (tho neither is really celebrated in China.) And more… I hope all your holidays went well and that you are all now refreshed for 2010. You guys got any New Year’s Resolutions?

btw this post didn’t have pictures to go with it, but the future ones will!

Without further ado….

Random happenings in Beijing

Though my trips thus far have been fun, living in Beijing is pretty crazy, itself. I’ve had some unexpected and unusual things happen since I’ve been here.

In particular, there was a rather memorable incident a couple months ago….I was exiting the subway with one of my friends when I noticed a young migrant worker lying down on the sidewalk, using his pack as a pillow. He looked to be taking a nap in the warm midday sun, and I was about to walk past him when I noticed that his face was twitching. As I took a second look at him, he began slowly raising his arms and legs up and moving them in a curious manner. It was at this point I suddenly realized…he’s seizing!

I have witnessed 2 seizures in the past, both in the hospital when I was on the wards. In both cases I ran over to the patient, all while calling for help and help was usually soon there. But here, standing on the street in Beijing I was at a loss for what to do. Typically, there’s not a ton for you to do during a seizure, and they’ll usually end on their own. You should not try to restrain the person. You shouldn’t put something in their mouth. You can move stuff out of their way if they might injure themselves on it. And once the seizure is over, you just wait for them to come out of their post-seizure (or post-ictal) state on their own.

My first thought was to call 911 and then realized I wasn’t sure which number to call, as there seem to be multiple different emergency numbers in Beijing. Then I realized even if we got this man to an ER, I wasn’t sure what would happen. Would he be seen? Usually they require payment first. Would his migrant worker status cause him problems? Could he get arrested? Did he even need to go to the hospital? You don’t have to go to a hospital for every seizure. If it was his first then he should go. There’s lots of things that can cause seizures, which should be worked up and often can be treated. If he’s an epileptic he could be started on anti-seizure medication (which I’m not sure if he could afford). Maybe he was already on medication? If the seizure didn’t end and he didn’t regain consciousness he definitely needed to go get treatment. Or if he hurt himself during the seizure he should go to the hospital.

A German man appeared and began telling us in broken English to call an emergency number which shocked my friend and me out of our indecision, and as there was too much we didn’t know about this man’s past medical history, we called for an ambulance… only to be put on hold.

At this point a crowd had begun to appear. An older migrant worker began saying that this man often had this happen and would be fine within 30 minutes. We asked him if he knew if this man took medicines, if he knew if he was epileptic. He just shook his head and then when we asked him if he knew this man personally, he said no.

Another woman began calling the police. An older, distinguished-looking man began trying to give the migrant worker candy, thinking his condition might be related to hypoglycemia. The man in question had stopped seizing long ago and now was attempting to get up, all while waving the candy away and saying “没用”，or “no use”. (Note: During a seizure, you don’t want to give people food until they’re fully recovered --don’t want to risk choking). He looked sleepy, confused, post-ictal. He did not respond to questions being pelted at him by the crowd: Are you ok? Are you epileptic? Do you want to go to the hospital? He waved everyone away and abruptly got up and walked away leaving his things behind.

At this point we were taken off hold, but said an ambulance was no longer necessary. The lady calling the police said they were already on their way. The crowd dispersed leaving the older distinguished-looking gentleman staring at the migrant worker’s pack saying he would tell the police what happened.

My friend and I left for the lunch we were late for, all the while pondering if we did the right thing (that is, not much.)

That same day while taking a cab to a mountain on the outskirts of Beijing, our cab hit a motorcyclist. Luckily no one was injured. Our driver and the young motorcyclist began yelling at each other. The woman sitting on the back of the motorcycle who was thrown to the ground got up and began brushing herself off and picking up the 3 large boxes that were tied to the sides of the bike. The voices of the men were getting louder and louder both saying one should pay the other. A crowd had gathered (as they often do), and they seemed to be siding with the younger motorcyclists. We weren’t really sure what was going on or if this would ever end, until the driver pulled his trump card. He said he could call the police, and quickly pulled out his phone and began dialing. This clearly scared the young man who started saying they should just forget the whole thing. The older driver wouldn’t back down and eventually got the young man to agree to give him about 500rmb ($75) to fix the dent on his bumper from hitting the bike. The two got into the taxicab and drove to the nearest bank, while we got in another cab and left the scene.

Beijing, it’s an adventure.

Trips: part II

South Korea

So Oct 1^st is a national holiday in China. People get a week off (though strangely they have to make up some of the days on weekends---imagine telling American kids they have to go to school on Saturday…) to celebrate the nation’s founding. This year was an even bigger deal because it is the 60^th anniversary of the founding of the People’s Republic of China. For weeks leading up to the celebration, Beijing would close down the roads around Tiananmen to practice for the parade, one day would be the kids practicing, the next would be some floats, the next the tanks and missiles…BUT, unlike in the US, you can’t just camp out the night before and watch the Macy’s thanksgiving parade. In Beijing, they blocked off the parade routes which was much of the center of Beijing. Everyone from work seemed content just to watch the whole thing from home, it’s a better view anyway.

Tiananmen square was still lit up at night even in the week after the parade.

Beijing also tightened up its security, going so far as to stop all flights coming and going to Beijing for a day during the holiday. And they also mandated all people using trains and buses going to Beijing to have their IDs and a permit (something which caused me some issues—see earlier blog).

Anyhow some friends and I decided to escape the madness/lockdown in Beijing, and we headed for the place with the cheapest plane ticket from Beijing---South Korea! To be honest I had never really thought about visiting Korea, I wasn’t sure what there was to see, but man, I soon discovered there was a TON of things to do there.

So in our 7 day vacation we visited Seoul, Busan, and Jeju Island. We took planes, trains, buses and even a ferry within the country.

Here are some snapshots from the trip:

We visited the DMZ (demilitarized zone) between North and South Korea. It's a 4km wide swath of land separating the two Koreas. Here we could look through the binoculars and see the flags of the 2 countries facing each other. The North Korean flagpole there is the tallest in the world. They both also had "propaganda villages" which had speakers mounted on the both sides blasting propaganda at each other up until a few years ago.
Here is one of the fences between North and South. People leave signs and messages expressing their hope for reunifications. We also got to go inside some incursion tunnels or "tunnels of aggression" which were dug by North Korea to invade South Korea. So far 4 have been discovered and it's estimated that there might be 20 more out there...

The weirdest thing for me visiting the DMZ was how touristy it was. You basically had to take a tour bus and you were bussed from site to site with a guide, and people hawking memorabilia. oh capitalism.. I wonder what the Northern side is like...something tells me it's not the same.
Here is Gyeongbokgung, one of the big palaces in Seoul. It was beautiful with a garden attached and 2 museums! As I was repeatedly told, it was a lot like the Forbidden City, though smaller, and maybe better maintained (it was after all recently restored.)

On Jeju Island we hiked up Hallasan, a volcano. This pic is of the top where there's a crater. It was a steep climb and we had a time limit since they close the route a few kms from the top at 12:30pm and we didn't get there until 10:40am. By the time i climbed the 9.6km ascending 2000m up, I was tuckered out.
The beaches on Jeju were nice, it made me miss bonfires at Corona Del Mar though... I also was bitten 50 times (literally) by something in the water and had a wicked allergic reaction (luckily no throat closing up though...)
Jeju Island is also home to some lava tubes which are formed from... you guessed it... lava! specifically lava coming from volcanoes which flows under the surface and eventually cools leaving a tunnel. pretty cool! This pic is from Manjang Cave which was ginormous and is also a UNESCO World Heritage Site.
Another pic from Jeju island. It's so pretty.
Some hungry kids eating a delicious Korean BBQ meal.
This is from Busan, which is the second largest city in Korea after Seoul. It's a port city and thus fishing is a big part of its economy.
here is the Jagalchi Fish market in Busan. It really big and has lots of seafood, some of which I recognized and much which I did not. We actually saw this eel-like creature with a sucker mouth which we unknowingly ordered later at a local restaurant. We eventually deduced it was lamprey eel which is a parasitic fish which sucks the blood of other bigger fish...eeew.
A ocean-side temple in Busan.

Check out this kimchi flavored chocolate...

Anyhow, been back in BJ for the last few weeks, enjoying being home and catching up on work (and blogging!). I'm leaving soon for another trip to Yunnan in Southern China where I both get to work with this NGO which is bringing doctors to do cleft palate surgeries, and I get to visit some physicians and hospitals which collaborate with my lab!

Trips: part I

Once again I’ve fallen behind on my blogging! I’ve gone on a couple trips since I last wrote and they were super fun.

The "Wild" Great Wall

One of China’s greatest treasures, built on the blood and sweat (and some say actual bones) of thousands upon thousands of Chinese laborers...it’s quite a site to see. There’s lots of different sections you can visit, and my previous visits had been to more tourist-y sections. However, this trip we went to Jiankou, a technically restricted section of the wall which is unrestored. There was no one selling a “I climbed the Great Wall t-shirt” up here!

gotta love old signs. debar clamber.
this section was called eagle flying upward. we managed to clamber :) up it

It was a pretty difficult hike, lots of climbing with hands and feet. There were some sections which looked like a forest, with nature reclaiming what man had tried to subdue. Other parts were so broken down we had to go a different route. On a funny note, while my friends and I felt we were doing some pretty difficult climbing, we kept running into this elderly Chinese man picking up trash who would ask us why we kept going the harder way.

new sign. lots o corn.

We stayed with Lao Zhao at his house/bed&breakfast. Many of the farmers here know they can do a good business with people wanting to see a section of wild wall.

obligatory jumping picture.

Being me, I got into a little trouble on my second day there. I ended up having an ENT problem (of the 5-year old variety—long story), but thanks to a friend of a friend I was able to see a doctor super quick and with no hassle once I got back to Beijing. In China, it’s all about guanxi!

Henan and Shanxi Provinces (or how we snuck back into Beijing)

I got back from Henan and Shanxi Provinces about a week ago, and let me tell you, it’s nice to be back in Beijing. Especially since I almost didn’t make it back (more on that later).

The trips themselves were great. In Linzhou (meaning Lin Sub-prefecture)—it was formerly Linxian (Lin County) but it got too big and had to be renamed—we got to take part in a conference commemorating 50 years of esophageal cancer research there.

Linxian- even though it's a city, corn is being harvested in every free plot of land.

There’s a super high rate of esophageal cancer there (back in the day 140 per 10,000 people-that’s really high). We got to see the screening program our cancer hospital does there (imagine colonoscopies but for your esophagus), and even got to see an esophageal cancer surgery. It was a big tumor and required three incisions (chest, abdomen and neck). HIPAA is not such an issue here, and I took lots of pictures, I posted the less gruesome ones.

Unfortunately, this lady had severe dysplasia in her esophagus.

Can you read the film?

Positioning the patient.

But man, talk about speed and skill, from first incision to esophagus took less than 10 minutes! I suppose it helps when body habitus is not an issue and anatomical landmarks are very clear. Plus the surgeons in Linzhou are experts at this kind of surgery. 95% of the surgeries that this hospital does are related to esophageal cancer, so they get lots of practice. About 1000 such surgeries every year. People from other countries come to this hospital for esophageal cancer treatment and training. The whole surgery and hospital stay costs about 7000RMB for the most complicated procedure (about $1030 USD). And the government covers a pretty substantial part of it for Chinese farmers, something like 70%.

Here are some men playing chinese chess. It's a very common sight to see people randomly on the sidewalk playing this game or poker.

Next we headed to Xiangyuan and Chengzhi in Shanxi Province. The bus ride there was 4 hours of winding mountain roads, but we made it safe and sound, all while watching 1980s movies in which the Japanese are always evil.

On the bus to Shanxi.

In Xiangyuan we have a cervical cancer screening program site. I was constantly amazed by the efficiency of the health care practitioners here. Between two gynecologists they saw 130 patients in one day for screening. That’s a lot of pelvic exams. On another treatment day, one of the gynecologists did 26 LEEPs alone! I did a couple gyn exams myself and was glad I could still find the cervix.

I hope that biopsy specimen is ok.

It’s crazy how different attitudes toward exams are in China. The women have their pants half down as they walk into the room, don’t mind as 15 people filter into the room and take pictures of the procedures as they are half naked, and when told they might have to have a procedure done for precancerous lesions, they just say go ahead and do it without much deliberation. One interesting thing I found was that though these women were bused in from rural areas, they all wore their crazy-tall high heeled shoes to the screening. Maybe they were dressed up, or maybe they just like high heels. I don’t think I could stand in those.

The Heels and the sandals the ladies have to change into.

We also went to visit a museum about the “War of Resistance against Japan” which was from 1937-1945 and blended into WWII, when Japan tried to take over China. There was a famous battle fought at Taihang mountain in the province. They had some pretty gruesome pictures and illustrations of Japanese atrocities against China. I think in some ways the Chinese like to emphasize the gruesome more than in the US, pictures of rotting dead bodies and drawings of Japanese soldiers roasting babies over fires aren’t something I’ve seen in US museums, but to be fair I haven’t gone to too many history museums.

They liked displaying lots of guns in the museum.

Here is what the gift shop at the War of Resistance Against Japan museum sold. You have Mao cards, ancient Chinese emperor cards, and lots of Hello Kitty cards (made by the Japanese company Sanrio.)

During the trip we got to meet with hospital directors, mayors of towns, and were treated like 贵宾(gui4bin1) or VIPs. We were wined and dined, and when we went to visit one hospital, we even had a photographer follow us around and take pictures of us touring the building. Talk about undeserved attention.

This is the photographer taking pictures of us.

This noodle dish is a Shanxi province specialty, 荞麦灌肠 (qiao2mai4guan4chang2), it was so yummy!

The trip was progressing smoothly, until we tried to return home. You see, in my last post I talked about the very complicated process of getting our residence permits. Though we had gotten approved to receive our permits, they took our passports (uh oh) and said they needed them for a week to process. We had to leave for our trip while they still had our passports. We thought that we would be ok with copies of our documents, but when we tried to board a plane to Beijing, we found out we were wrong. Then we were told that starting on 9.15 all trains and bus stations would also be checking people’s IDs (not a common practice) and that it would be very hard to get into Beijing unless you were a Chinese national with a Beijing residence ID. This was all in preparation of 国庆节 (guo2qing4jie2), or National day. This October 1^st is the 60^th anniversary of the founding of the People’s Republic of China. Maybe in response to the ethnic violence in Xinjiang, or maybe just because it’s always like this, the government is seriously hiking up security measures in its capital city. Anyhow we were in a pickle, trying to figure out if we would be allowed back in Beijing at all.

However, in China it’s nice to have friends in high places, and after an extra day in Shanxi, we got the hospital director of the hospital we were stationed at and the director of the local public health bureau to contact the local police department who issued us a letter stating we were who we claimed we were with some important red Chinese seals/stamps. We even got a police escort(!) onto the train back to Beijing and so bypassed the ID checking. So our journey back ended well, with a few scares along the way. As my Chinese friend was telling me, in China it’s always like this. You have lots of problems, then magically a phone call or a letter comes with the right Chinese stamp, and suddenly everything is good again. I only wonder what happens when there is no one for you to call.

Taking Care of Business

So I’ve been a bit lax in my updating! Things have picked up here, and it’s been hard finding time to blog. In the last few weeks I’ve been taking care of logistic type things, figuring out more stuff about my project(s) here and generally exploring Beijing.

First big item I had to take care of was the residence permit business. When we last left off I was told by my local police station to go register at the big public security bureau. In order to register you need about 7 pieces of paperwork, most of which I had, but I was missing the physical exam form! So I had to way to the outskirts of town (where they send all the foreigners) to a designated building to get examined. The physical exam is a process. Lots of waiting in line: to register, to pay, for each of the 6 exam rooms. The exam consists of: taking your BP, your height and weight, a quick look in your mouth, a quick eye exam, a chest x-ray, an EKG (more on that later), and bloodwork. I was pretty amazed by the efficiency of the whole process and how docile the entire foreigner population was (myself included) with being poked and prodded.

Ok, the EKG was maybe the one place where I felt a little violated (just slightly). You go into a room with a curtain drawn for some privacy and a middle aged Chinese women talks to you in rapid Chinese. She told me to take off my shoes and lie down on the table. Then she said something about my shirt which I didn’t understand. She clarified this by grabbing my shirt and lifting it up to my neck. She then said something else I didn’t understand, which she also clarified by pulling my bra all the way up off my chest. I was recovering from this shock when she started squirting my now naked chest with cold water. Then she started attaching the EKG leads, which are kind of like suction cups (hence the water). She then kept shaking my ankle and telling to me to relax while laughingly saying I must never have done this before. She was quite right.

As for the bloodwork, the phlebotomist was excellent, though I think I kind of insulted her when I asked to make sure the needles were new (yes, I’m paranoid). Oh and though they don’t say what they’re testing you for, when I got my results back it turns out they test for syphilis and HIV (informed consent, take that!). I spent some time discussing with my friend the purpose of this whole exam. Some stuff was obviously to stop sick people from staying in country, but other stuff (vision check?) I wasn’t sure of.

After I picked up my physical exam results, I came with what I thought was everything I needed to the public security bureau, ready to get my permit. But alas! It turns out one of the forms I had was wrong, and I was missing some stamp on the other one. I spend the better part of a day tracking down this stuff, only to be told when I came back that something else was wrong. I wasn’t quite clear on what happened, but after an hour or so of waiting as this poor man made about 10 phone calls to someone or another they accepted my paperwork. Hopefully I’ll be able to pick up the finalized document sometime next week.

Other than that and work, I’ve been having fun with friends, checking out cool
bookstores and food places and parks near me. Parks in Beijing are beautiful, the whole water, tree, rock aesthetic is awesome. Tomorrow I’m off to a meeting in Linxian which has a super high rate of esophageal cancer and then Shanxi where they’re currently doing some cervical cancer screening/treatment programs.

Oh and I want to say a quick congrats to all my classmates who have now decided what kind of doctor they’re gonna be, that is so cool!!!