Snapshots from Beijing

We managed to find some time to take in some sights in Beijing while we were there, in between looking at houses & schools. Here are a few of the more interesting shots:


External View of the Forbidden City
Some of the buildings inside were closed off for repairs. A bit disappointing.




Square inside the Forbidden City
Notice the worn out stones on the floor. Looks familiar? I think I saw it (or a facsimile) in a Jackie Chan or Jet Li movie. Or in a trailer of a Chinese epic... Those stones have probably been there for hundreds of years. Uneven & bumpy, could be hazardous for walking if you are not careful.




Speaks for itself!
The place to go to broaden your mind & expand your horizons!




East meets West, Old meets New
Want a cuppa Java? How about a Heineken? All available in the Forbidden City!




Ad on Bus Stop
This was an honest to God, true blue ad seen on the back of a bus stop along a busy street in downtown Beijing! I did a double take when I saw it. I guess this is the place to go if you want to become sterile? Looking at the Chinese words, I think it's for abortions & contraception (Chinese experts out there, jump in here to correct me if I am wrong).




Snacking in Beijing
Seahorse? Starfish? Bugs? Worms? How about live spiders (not in picture)?
I think I'll stick to satay or french fries, thank you very much. :P

Scoop

After reading the mixed reviews received by this Woody Allen movie, I decided to go ahead & watch it anyway (OK, OK, I admit it...Hugh Jackson was a BIG draw for me ☺), & managed to convince my guys to come along with me.

We watched it at the new mega-movie theatre at the spanking new mall called Vivocity (we're still trying to decide whether to pronounce it as Vi-VOc-i-ty -which rhymes with velocity- or Vi-VOH-City - derived from the Latin word "vivo" meaning life, I think).

I'm glad we did watch it, although it didn't blow me away. It showed my kids that comedy needn't always be the slapstick & pie-in-my-face kind that is typical of Jim Carrey and the SNL alumni like Adam Sandler, Rob Schneider & Mike Myers.

The dialog was, well, typically Woody Allen-esque, with witty comebacks & self-deprecating humor although Mr Allen's frequent stuttering (whether intentional or not) got a bit stale & annoying after a while. Scarlett Johanssen showed her versatility with her portrayal of eager, naive journalism student, Sandra Pransky, hot on the heels of her first scoop. Hugh Jackman didn't really shine here, although he looked mighty fine in Speedos (*GRIN*).

Sidenote: we were very impressed with the movie theatre. We were in Cinema Europa which is supposed to have a bigger screen, & allow movie-goers to enjoy the movie in an elegant & intimate setting. It was indeed very comfortable, & more "high class" than the regular theatres (tickets DID cost $1 more); but I wished that the seats could have reclined a bit more.
Sigh...which reminds me that I AM going to miss movie-going when we are in China...

Oh, & by the way, my kids actually enjoyed the movie & found it funny! I guess they are smarter than I think...heeheehee...

EEEWWW!!!

I came across this article on Medscape to which I subscribe. My very vivid imagination conjured up images I would have rather not imagined as I read it...ugh...read on, if you dare...

Circumcision, Religious Freedom, and Herpes Infections in New York City
Posted 10/17/2006
Howard Markel, MD, PhD

If you ever find yourself in the coffee line at a medical conference, be prepared to eavesdrop on a gaggle of doctors exchanging the medical equivalent of "war stories," wild tales of clinical misadventures and treatment plans gone awry. It was precisely at such a venue that I heard what easily qualifies as one of the strangest — and scariest — medical tale of recent times.

It actually began in 2004 when the New York City Department of Health received reports of 3 newborn, male babies who contracted herpes simplex virus (HSV-1). All of them required weeks of hospital care and intravenous injections of powerful antiviral medication. Tragically, one of them died from the infection.

Unlike a mere cold sore or an embarrassing, painful crop of genital blisters, herpes for a newborn is truly a life-and-death matter. Aggressive and relentless, the herpes virus can destroy an infant's brain in a matter of days. Every pediatrician who notices any type of blister on a newborn's body shudders as he contemplates whether its cause is merely an abrasive blanket or, far worse, a harbinger of a systemic infection with herpes.

But the story only gets stranger. Using a mixture of detective work and medical acumen, the New York City Department of Health figured out that all of these babies contracted herpes shortly after undergoing a ritual circumcision by the same mohel, the religious figure in the Jewish faith charged with conducting the ancient and spiritually important ceremony called a bris.

Under Jewish law, the mohel is required to draw blood from the circumcision site, ostensibly to remove what the Old Testament refers to as "impurities" and what we might interpret today as germs. The thought, back then, was that a flow of blood away from the circumcision site would carry these potentially dangerous entities away from the baby. But the traditional way to do this, a practice called Metzizah bi peh, calls for the mohel to use his mouth and suck out the blood.

To be sure, this peculiar means of viral spread remains rare. Nevertheless, there have been 11 cases of male babies who contracted herpes following circumcisions that included Metzizah bi peh reported over the past 5 years in New York, Canada, and Israel. In 2005, there were 4 infected babies in New York City and all of them were circumcised by the same New York-based mohel (who only recently was persuaded to take a prolonged vacation from his line of work).

According to Dr. Thomas Frieden, New York City's Commissioner of Health, coincidence is not an explanatory option. "There is no reasonable doubt that the practice of Metzizah bi peh has infected several infants in New York City with the herpes virus, including one child who has died and another who has evidence of brain damage," said Dr. Frieden.

Given that more than 70% of all adults 40 years of age or older are infected with the herpes simplex virus; that the mouth is the most common site of HSV-1 infection; and that most adults with oral herpes do not know whether they are infected, typically do not have symptoms, but can still spread the infection to others, one can begin to understand the potential public health problems associated with such a tradition.

Indeed, this is precisely why the Chief Rabbinate in Israel and the New York-based Rabbinical Council of America, which serves more than 1000 rabbis in the United States and Canada, began urging all mohels to avoid the potential spread of infection by using a tiny, sterile glass tube to draw the blood instead of putting their mouths directly on the circumcision wound. The overwhelming majority of mohels working today follow this interpretation of the custom.

Yet the ultra-Orthodox Hasidic Jewish community persists in adhering to ancient law precisely as it was written. That is, after all, what "orthodox" means. And despite the hedging and explaining by their less orthodox counterparts, Hasidic rabbis insist that performing the bris exactly as it was described in the Bible is essential to what it means to be Jewish.

So when the New York City Department of Health proposed a voluntary ban on the practice, the Hasidic community tersely told the government agency not to interfere in their religious beliefs or practices. Indeed, the ultra-Orthodox Hasidic community, one that has a great deal of political clout in New York City politics, has pledged to fight any health edicts restricting the ancient practice with the proverbial tooth and nail.

Even if such a law could be written, how would you enforce it? After all, the bris is almost always performed in the parents' home, out of the view of the health department or a police officer.

Certainly this means of contracting a deadly infection is rare. Only 7 cases of mohel-related herpes have been reported in New York since 1998, and each year there are 2000 to 4000 circumcisions performed in that city alone. But rare does not mean nonexistent. No one can deny that this practice presents a real and serious health risk.

Just as frightening, there have been reports of other Jewish parents who, while less exacting in their religious practices, hired ultra-Orthodox mohels without knowledge that they practiced the potentially risky Metzizah bi peh procedure.

Dr. Frieden, the same public health crusader who managed to get cigarettes banned from all public spaces in New York City, admits that negotiating the rocky shoals of this controversy represents the "most delicate issue I have had to deal with."

"My ideal would be to inform the community so that they stop doing this and a large part of the Jewish community has accepted it," Dr. Frieden explained to me in an interview. "But this issue is far from over and it is still going on among those who are most Orthodox. If it were simple, we would have dealt with it simply."

That's an understatement. It has been years since I studied Talmud, but I know what my Rabbi would have uttered in response to this quandary of Biblical proportions: "Oyyyy."

Howard Markel, MD, PhD, George E. Wantz Professor of the History of Medicine, Professor of Pediatrics and Communicable Diseases, Director of the Center for the History of Medicine, University of Michigan, Ann Arbor; author of When Germs Travel: Six Major Epidemics and the Fears They Have Unleashed (Pantheon Books)

Disclosure: Howard Markel, MD, PhD, has disclosed no relevant financial relationships.

Medscape Pediatrics. 2006;8(2) ©2006 Medscape

Wanderlust (II)

I’ve always wanted to see & experience new places. When I was young, I used to imagine myself under the Big Sky of Montana, or enjoying the sea breeze on the Greek Isles, or skiing the slopes of the Alps. Perhaps it was a presage of what my life has become as an adult with my own family.

We’ve moved multiple times in the last decade and a half, two of those moves halfway across the globe. I consider myself a global citizen, my ideas, perceptions, & values having been shaped (& still being shaped) by diverse & varied life experiences. An old classmate from Medical School commented recently that I have had a somewhat unusual life, compared to the rest of my cohort.

I don’t think this kind of life is for everyone. I know a few of my closest friends are befuddled at how I can do what I do. But it’s not that strange or unusual a lifestyle after all. There is a small percentage of the people of the world who are quasi-nomadic in nature. Their jobs bring them to different parts of the world, often far & vastly different from their home country. Their families are relocated every few years. Previously, these were mainly military families who went where they were directed to go. Now, with the globalization of so many companies, businesses are expanding to places all over the world, sending their senior managers to these places to help run their organizations. And these employees bring along there spouses & kids to unfamiliar environs.

Their kids are known as third culture kids. One usually finds these children in international schools, getting to know kids in the same shoes, from other cultures & ethnicities. And because they don’t live in their home country, they develop a unique culture of their own, assimilating views & opinions from their international friends.

I don’t think I would consider my kids TCKs. Half their lives were spent in their passport country, while the other half in their mom’s passport country. And part of the latter was spent assimilated in a local school while the other part in an international school. Perhaps a more suitable term would be “Different Cultured Kids”. I am not sure how this will affect them as adults. With our impending move to China, doubts & fears of settling into & living in such a different country arise, especially for my children, as they have to make new friends & get used to a new school. Heck, I will have to make new friends as well!!! And make do with less English movies/books/TV programs (sigh).

Despite how daunting the move may be, what I am sure of is that ultimately, their experiences & my own, will be unique and enriching. At least, we will be able to learn proper Mandarin!

Driving you crazy

And I thought driving in Singapore was bad.

I literally feared for my life while traversing the streets of downtown Beijing as a passenger as well as a pedestrian. This is what I learnt about traffic in Beijing:

A) Pedestrians DO NOT have right of way, no matter what color the little man is on the traffic light. It’s survival of the fittest as far as crossing the road is concerned. It seems like you almost need to have a death wish or at least faith that The Force Is With You. Even the pavements are not safe – you may suddenly find yourself leaping out of the way of a cyclist who decides that the pavement is a quicker (& less risky) way to get to his destination.

B) Horns in China are activated when you depress the brakes (& I suspect the accelerator as well). You honk when you need to let your fellow motorists/errant pedestrians/cyclist know to “Watch out, I am coming”/”Get out of the way”/”Move, you idiot”.

C) Cyclists are an entity unto their own – they have their own traffic rules which basically states that anything goes as long as you don’t get knocked down or don’t knock down anybody else.


Thank God I don’t have to drive when we move there.

goodbye, old friend.

just when i thought i was all cried out,
the tears start to flow again
trying to fill the void in our lives.

goodbye, old friend.
go in peace.

In The News

Pg H3, HOME Section, The Straits Times, October 18, 2006
Dispute Mediation helps both patients and dentists – Patients avoid legal bills and dentists pay less for insurance

by Salma Khalik

Hmm.

I didn’t realize that the Singapore Dental Association’s Ethics Committee handles mediation in patient-dentist disputes.

I wonder why the Singapore Medical Association doesn’t have a committee to do the same? Or at least facilitate the formation of a committee to do the same. I, for one, know that it is sorely needed.


Pg 23, World News, The Straits Times, Oct 18, 2006
Fast Track to Citizenship: Join the US military

This is an article taken from Reuters.

I find it ironic that PRs/immigrants in the United States are literally dying to take up US citizenship while Singaporeans & PRs here try all ways & means to get out of doing NS, or at least, to get their PES rating downgraded.

So much for patriotism, eh? It’s no wonder that the ICS responded to a reader’s suggestion to allow dual citizenship with this letter:

Oct 14, 2006
Singapore not ready for dual citizenship

I REFER to the letter by Mr Bertrand Teo Ming Shan, 'Can ICA be flexible in dual citizenship case?' (ST, Sept 27).

Dual citizenship is a policy that has to be considered carefully and thoroughly.

We have yet to reach the stage of nationhood where a Singaporean with a second citizenship would still retain his identity and loyalty to Singapore as his homeland wherever he goes, with his second citizenship being only of secondary importance.

Lim Jing Jing (Ms)
Senior Public & Internal Communications Executive
Immigration & Checkpoints Authority


Pg 20, World News, The Straits Times, Oct 18, 2006
Disabled girl without a home.

This story is about a girl named Charlotte Wyatt who was born 3 months premature in October 2004. Her parents had fought in the courts to require that doctors provide artificial ventilation if her condition worsened. I guess they succeeded, because she is still alive, albeit with serious brain, lung & kidney damage. Her treatment apparently costs close to S$900 a day; she requires 3 litres of oxygen every minute; she is fed & medicated through a nasal tube. Her parents are now separated (apparently due to the strain of coping with this situation), & now, social workers are looking for foster parents to look after Charlotte as both mum & dad are unable to do so.

I had previously blogged about this issue of sustaining life at all costs as part of an earlier entry.

Is it worth it?


Live Cell Therapy???

And finally, I spotted an ad in the Mind Your Body section of the papers for an organization called Villa Medica Asia which is “one of the few approved clinics to administer the live cell therapy”. A google search revealed that indications for this therapy which involves injection of animal derived cellular material into the patient, includes a whole host of conditions, ranging from exhaustion to menopause to retarded development in children! Wow!

Hmm (again). I wonder how MOH/SMC/SMA will respond to this amazing & miraculous treatment.

Wanderlust (I)

We will pay a visit to our ancestral homeland this week, my husband, our sons & I. This is part of our preparation for our eventual move there…a reconnaissance, if you will. This will be the very first time that I will step foot into the Middle Kingdom. I have never felt any pull to this country before. Any interest I've ever had to visit comes from a sense of wanting to experience different cultures & lifestyles, rather than from a need to “find my roots”.

Years ago, our forefathers left this continent for foreign shores, either under threat of persecution, or to seek their fortunes. Some planned to return after they had made their fortune, while others planned to grow roots in their new home countries.

Those who did not return spawned generations who developed their own culture, some very different from that of their ancestors. There are those who say that this is a bad thing. I disagree, as I believe that culture is a dynamic organism, which evolves & changes with the times. It is part of progression. This is not to say that we should forget the achievements of all those who have gone before us. But we shouldn’t dwell on the past & hold on to old practices & beliefs just because they were what our ancestors did.

I know this will be an eye-opening experience for us. I think it will show how different, and yet how similar, we all are, as human beings. I said the same thing about what I learned while living in the USA. Some will think that I am being deliberately paradoxical, but I’m not. Honestly.

Medical Tourism

Looks like Singapore is not the only country outsourcing its medical services. Dr Parker blogs about this phenomenon happening in the USA, where healthcare costs are ridiculously high, thanks to high insurance premiums & (IMHO) high litigation rates.

Unsurprisingly, this is creating a lot of unhappiness in the medical community & the patient's union. Quality of care, medical liability & follow-up care, especially in the face of possible complications are issues which have been raised & understandably so.

This particular patient is supposed to go for rotator cuff surgery & cholecystectomy in India. He would also go sightseeing on a two day tour that includes a visit to the Taj Mahal. The cost of the operations would be only 1/5 of that in the USA - a huge savings for his employer. But question is: who is going to take care of him if he develops complications post-op? Will the American insurance company still cover him for any medical care received as a result of such complications?

I know of someone whose brother, suffering from renal failure & undergoing hemodialysis for the past 20 years, decided to travel to China for a kidney transplant. It cost him about $60,000. Apparently he was hospitalised for a week before being sent home. He did develop post-op infection & required ICU care. His original nephrologist here refused to manage this problem, & he had to seek treatment in a different hospital.

Now we all have heard of the dubiosity (is there such a word??) of organ transplants done in China, & how the origins of these organs are rather hazy. (From executed prisoners? Sold by someone in need of money?) But aside from that, is it ethical for a doctor to refuse to give treatment to a seriously ill patient, who developed complications from such a procedure? No, I say. We may disagree with the patient's decision to go through the procedure. But we should not punish the patient by making life harder for him after.

The medical communities in countries where healthcare costs are escalating have to examine all these questions ASAP. Outsourcing is NOT going to go away. Especially in a world where money talks the loudest in most cases.

DNR

Here is an interesting entry about CPR & DNR in response to a New York Times article, The Last Word on the Last Breath.

I was surprised that an actual analysis was done & published in the NEJM on survival rates in CPR on TV!

I remember how dismal the success rate was during my stint in A & E oh-so-many years ago. Most of the patients who were admitted collapsed had already been down for more than 15 minutes. At that time (I don't know about now), the paramedical staff in the ambulances did not do intubations on the field. So most of the time, our efforts in the department were basically "going-through-the-motions" for a reasonable amount of time, before pronouncing death. Most of these collapsed patients had pre-existing co-morbidities & elderly or were victims of severe trauma, so our efforts were not unexpectedly futile. I remember the sickening crunch of breaking ribs while I did chest compressions, especially in the elderly & frail.

The only time I managed to bring back a patient was a gentleman in his 50's suffering from an acute exacerbation of COPD, who, right in front of my eyes, desaturated & went into ventricular fibrillation. Immediate CPR was instituted, & he was successfully resuscitated & immediately sent up to the medical ICU (whose MO was not terribly happy with accepting this very ill patient, but hey, what to do, A & E in those days were not equipped or staffed to monitor patients requiring close monitoring).

Even in the wards, many family members still insisted on going all out for the patient in spite of how gravely ill that patient was. Perhaps they didn't realise how traumatic CPR can be on an already weakened body. I can certainly understand why letting go is hard.

When my time comes, I will make sure that my family understands my wishes & let me go in peace. I admit I have yet to sign an AMD nor have I made a living will. It's one of those things which one keeps putting off, thinking that one still has time to do it. I really should get off my a** & get it done...

Heartbreak

I am an emotional wreck. We have made the heartbreaking decision to put down our very old, very large dog whom we’ve had since she was a pup. She has not been doing well since we moved into an apartment over a year ago. Arthritis, cataracts, incontinence – diseases of age – afflict her & makes it hard for her to get up & walk on ceramic tiles, & she leaks pee if you don’t bring her downstairs fast enough. Hard for everyone.

I’ve been putting off this decision while desperately trying to find a good home with a garden for her to enjoy her last years with some degree of comfort but alas, in a country where most people live in government housing that disallows dogs beyond a certain size, it has been a futile effort. The fact that she is almost 11 years old, weighs 80 lbs & has these health problems don’t help either. It would be hard to find anyone willing to accept a pet like this, & not fair to burden someone else with these problems. We looked at a no-kill shelter to see if it was an option but seeing how overwhelmed they are with the number of dogs they have to foster, we didn’t see how our dog could be happy in that kind of situation.

Euthanasia is emotion-ridden. I think my reluctance to face this ultimate decision is partly for selfish reasons too. I don’t want to go through the trauma of loss & grief. Tears have come at the most unlikely moments. But I need to also think about the quality of life issue. Should I, due to my selfishness, allow her to go on like that? It breaks my heart each time I see her trying to struggle to get up so that we can bring her down for her toilet break. I suspect she has some degree of heart failure as well, as she pants really hard from just walking less than 100 m.

This is hard, and it involves an animal. How much harder would it be if it involved a human life. I can’t imagine how Dr Kevorkian did what he did, although if you look at it in a cold, clinical & detached way, it sounds like a logical solution to an existence wrought with pain & suffering. Problem is, as human beings, we aren’t cold or detached when it comes to a loved one. At least, we shouldn’t be. As for being clinical, well, the arguments for and against euthanasia among the medical community have been & will always be an ongoing & controversial one.

Stop crying, aliendoc.

Note: In my opinion, euthanasia & the Advance Medical Directive are two different issues.

Compassion

"At the behest of Amish leaders, a fund has also been set up for the gunman's wife and his three children." YAHOO! News: Donations to Help Amish families (AP)

If one could find a silver lining behind the darkest of clouds, this would be it. The compassion shown by this gentle community for the family of the man who killed their young is something that should be emulated.

The Amish live in Lancaster County, Pennsylvania. I remember making road trips to this picturesque area, our car often having to follow behind horse-drawn buggies on the streets. Parking lots included areas of buggy parking. Towns with unlikely names like Bird-In-Hand & Intercourse (!!!), restaurants with names like "Good & Plenty" and "Plain & fancy", featuring traditional Amish (& very fattening) food like fried chicken, Chow Chow (a vege dish), Shoo-fly pie (so named, because its sugar content attracts flies!)...all these bring back fond memories of our lives in Pennsylvania. The Amish eschew modern conveniences like automobiles & electricity, and dress in plain clothes, the men wearing the characteristic broad-brimmed hats. They still speak in an old German dialect (despite the misnomer Pennsylvania Dutch, they originated from Germany, fleeing persecution because of their religious teachings.

Live Long & Prosper

Not for these people. First this. Then this. And now this.

Despite being married to an American & having lived in the US for several years in a typical suburban neighborhood, & pretty much assimilated into the lifestyle there, I still don’t get the obsession of some Americans with the “right to bear arms” portion of the Constitution.

My husband has tried explaining it to me from the perspective of American history & how, when the constitution was first written, it was meant to protect the citizens from tyranny. I can understand that scenario back in the 18th & 19th century, when lawlessness was rampant & there were no proper law enforcement agencies in existence or available to those living in remote areas of the country.

But now, in the 21st century, I don’t get it. I know that there ARE responsible gun owners. But there are also nutsos out there who, due to warped reasons of their own, decide out of the blue, that he needs to kill some people.

Then there are kids out there as well, hormone-ridden, angst-filled youths, trying to get by in the stressful times of modern day living, who have easy accessibility to their parents’ guns or rifles, who one day decide that it would be cool to use their fellow schoolmates as target practice.

I guess having been brought up with Asian values which places society above self (for the most part, anyway), it’s hard for me to support this “right to bear arms” argument. If I had to choose between that & an innocent’s right to live, it’s a no-brainer.