Impressions from China - 366

The Bird's Nest Olympic Stadium

It's been a year & a day since we landed in Beijing. The first few months seemed to drag on, due to occasional bouts of homesickness & frequent attacks of frustration as we slowly got used to the different ways of how things work here & the very different mentality of how Chinese think(I use the word "Chinese" here in reference to mainland Chinese as opposed to ethnically Chinese) .

Then as we made friends & discovered where to go to buy safe meat, & got used to having to wash vegetables & fruits so that we don't get poisoned, & figured out the best & cheapest massage places to go to & found things to do in school & with friends, the time has flown by.

These are things that I have realised in our time here (in no particular order)...

• I have yet to learn how to cross a busy Beijing street without going through a panic attack...

• I have learnt to watch where I step to avoid dubious-looking splotchy patches on the ground which, more often than not, turn out to be emissions of the oral, hacking kind...


• I have learnt to be patient with Chinese excuses & reasons they come up with when something goes wrong in the house that they can't readily fix...


• I have learnt that an electrician here may not neccesarily know much about electricity, & a plumber here may not know much about the priniciples of piping...


• I have learnt that if I add a "rrrrr" to the end of every noun/phrase/sentence, & pretend that I have marbles in my cheeks, I can do a halfway decent Beijing accent...


• I have become more confident in my use of Mandarin as my ears slowly attune to the local accent, although I am still far from proficient...


• I have learnt that Northern Chinese food, dialects & even facial features differ greatly from the Southern ones that I am used to in South East Asia...


• I have learnt that being Chinese is not a homogeneous condition, but something far more complicated than what has been argued about in Singapore (i.e. learning how to speak Mandarin does not neccesarily automatically make one more Chinese)...


• I have learnt that the mainland Chinese & the Overseas Chinese may as well be two distinct cultural entities altogether, for all their differences & despite their similarities (as I said...complicated)...


• I have learnt to apply lip balm at least twice a day to prevent chapped lips in the very dry & very cold Beijing winter...


• I have learnt that when one is deprived of good TV programs & good movies, one's attitude towards pirated DVD's drastically changes. (I think Hollywood movie studios/producers have to approach this "problem" from a different direction)...


• I hate the fact that most restaurants still do not have "no smoking zones"...

I'm not sure how much longer we will be here. At the moment, I am still ambivalent about staying here long term. The air quality & health issues certainly play a part in how I feel. (Last Thursday/Friday, the air quality index apparently reached a horrendous 421!!!) On the other hand, I know that if we do stay on, it will be an enriching & eye-opening experience.

Happy New Year to all!

Season of Cheer

It's strangely quiet now after two weeks of a full house filled with the sounds of, well... just family. It's amazing how one gets used to the ambient noise of chatting, xboxing, guitar-playing, cooking that was present during the two weeks when family was here visiting & spending the festive season with us in chilly Beijing.

The below freezing temperatures were not enough to temper the hearty warmth generated by family love & togetherness.

Home truly is, where your heart is...& mostly, one's heart is where one's family is, no matter where you are geographically.

Have a Happy 2008 everyone.

Tis The Season

Christmas is...

...Love...
...Family...
...Warmth...
...Togetherness...
...Presents...
...Good Food...
...Good Company...

...no matter where in the world you happen to be, if you are with your loved ones, Christmas is always more meaningful.

Wishing everyone out there: Love, Family, Warmth, Togetherness, Presents, Good Food, & Good Company this holiday season!

Numb

It is a sad day indeed when one seems immune to feeling anything when something like this comes up in the news. Especially when it happens within a week of this.

How many more will it take before America wakes up?

The right to bear arms indeed.......tell that to the victims' families.

Impressions from China - First Snow

Woke up to a blanket of white this morning...

A lot of it has already turned to gray slush especially on the streets because of the traffic & the salt that was strewn over it.

Here's hoping for a White Christmas!

Impressions from China - I Beg Your Pardon?

...Chinglish...Singlish...
...Pidgin English...

To me, the common thread in the above 3 variations of "English" is the fact that it is, for the most part, incomprehensible to foreigners.

A typical example of a telephone conversation here in Beijing:

Customer Service:
"HellogoodmorningthisiscustomerserviceNancyspeaking!"

Me:
Uncertain pause...
"Uh, hello? Who's this again?"

Customer Service:
"HellogoodmorningthisiscustomerserviceNancyspeaking!Iamcallingaboutyourcomplaintaboutyourdoornotlockingproperly"

Me:
Another uncertain pause...
"Can you please repeat in Mandarin?" (spoken in Mandarin)

Not only do they tend to link every single word & every sentence together without any punctuation whatsoever, but add the Chinese accent to the mix & they might as well be speaking a foreign language altogether.

I admire the fact that many Chinese are learning English in an attempt to keep up with the rest of the world; and there are many who speak excellent English. But then there are those who are not quite up to par as far as spoken English is concerned, which leads to a lot of confusion when they attempt to do so, from the foreigners' point of view.

Similarly, many foreigners in Singapore (including family & friends of mine) who cannot understand the "English" spoken by the average man-in-the-street/waiter/salesperson in Singapore. And it saddens me to hear the repeated insistence by certain circles in Singapore that speaking Singlish should be something we should be proud of.

I don't think we should abolish Singlish. It is a unique "dialect" & instantly recognizable by fellow Singaporeans wherever you may be in the world. However, if the children of Singapore speak Singlish at the expense of knowing & speaking proper English, then it IS a problem.

MOE's introduction of teaching English to pre-school teachers is a good first step. I just hope that they are taught PROPER English, both written and spoken.

Better

“Better” is a book written by Atul Gawande. He is a general surgeon working in Boston & also an assistant professor at Harvard Medical School & the Harvard School of Public Health. He writes about performance in Medicine, what it takes to be better at what we do as doctors, and how do we measure this ‘goodness’, for lack of a better word.

He uses real-life examples to explain his points of view, which is one reason why this book is so immensely readable, especially for doctors. It could be you or me that he is talking about.

An interesting issue he raises is that of litigation. As we all know, it has become an almost nightmarish situation for doctors practicing in the USA as far as litigation is concerned. Malpractice insurance premiums have skyrocketed especially for specialties like obstetrics & neurosurgery.

On the other hand, there ARE patients who have suffered as a result of medical errors. What recourse do they have if not for malpractice suits? Gawande highlights an approach that has been used by vaccine manufacturers which seems promising.

See, previously, the vaccine manufacturing industry was threatened by lawsuits from patients who had suffered from side effects of vaccinations. Out of the millions of patients helped by vaccination, one in ten thousand is affected by side effects. Like anything in medicine, there are always risks involved, even for the most mundane procedure. These victims would then file for damages (talking billions of US$ here). Because of these lawsuits, some vaccine manufacturers went out of business, prices of vaccines hiked up, stockpiles dwindled (you get the picture).

So the US government came into the picture. A 75 cent surcharge was imposed on each vaccine. This money went into a fund for children who are harmed by the side effects. A panel of experts had come up with a list of known injuries from vaccines, & whoever suffers from any of these injuries would be compensated, whether the injury is due to negligence or bad luck. Those still unhappy can still sue but apparently, few have.

Putting this in practice for physicians is a monumental task. Who would qualify for compensation? How do you put a dollar amount to an injury or disability or death due to medical error? Would doctors buy into such a scheme?

Another interesting issue he raises is that of falling income of doctors, mostly due to the fact that health care costs are managed mainly by insurance companies. Doctors not only have to deal with managing their patients, but now are faced with having to tread through the oftentimes obstacle-ridden course of managed care. End result: they lose money. Unfortunately, this seems to be happening in Singapore as well. Ironically, without insurance, many, including the well-to-do, would have a hard time covering health care costs. Medical care IS expensive. I don’t know the answer to this dilemma.

Picking & Choosing

This is an interesting article about recruiting & retaining physicians.

This was written by an American author for the US scenario, but I wonder how much of this would be applicable to the Singapore situation. With the "shortage"of doctors here, can the employers be so picky & use the guidelines listed in the article? ("Employers" here meaning the large group practices in the private sector & the two clusters that run the government polyclinics, which all seem to have a perpetual shortage of doctors).

I really doubt it.

Winter - a random post

I like Winter.

It's a refreshing change to feel the crisp air after a summer of drenching humid heat.

Except when it gets too cold & the chill goes right into your bones & your teeth can't help but chatter & you can't help but shiver to generate more heat to keep warm.

Layering helps. Except that when you enter a heated building, you have to peel off your gloves & scarf & hat & heavy jacket & sometimes your sweater, so you end up with your hands full which makes shopping damned inconvenient.

No, I really do like Winter & am actually looking forward to the first snow of the season, whenever that may be. Especially if I can look at it from the inside through the window of my toasty warm house.

Awesome Talent

I saw this video clip on the Ellen show today & was blown away by this 14 year old girl's talent...

Aaaawwww....

This is an amazing video of a grateful lion - a modern day version of David in the lion's den. This lion remembers & hugs his rescuer...how sweet is that???

Tree Man

This is the worst case of warts I've ever seen!!!

A real-life Ent - poor guy...I hope he finds a cure. Or at least some way of keeping it under control.

Oldies but Goodies

"There is no age limit for applications."

I was pleasantly surprised to see this in a recent mass mailing I received from a certain medical association calling for applicants for specialist traineeship.

2 years ago, in a similar letter (I guess they send one out every year), I noticed an age limit in place for applicants. When asked by a director in the public health institution I was working in at the time whether or not I was going to apply for traineeship, I gave him a wry smile & said that I was too old. Admittedly, I was flattered by the look of surprise on his face when he realized that this lowly M.O. was already the mother of a teen & a pre-teen (at the time) & already over-aged for such lofty ambitions (sarcasm intended).

So why the change in policy now? If I had to make an educated guess, I would say it is to try to make up for the perceived lack of doctors in the public sector. Whether or not this will make more senior doctors step up to the plate...we can only wait & see.

I am glad the age limit has been abolished (for now, anyway). After all, in this day & age, 40 is hardly considered over-the-hill. Yes, the eyes may be starting to go a bit, & some of us need reading glasses to read the small print; and the reflexes may not be as good as, say, a decade ago. But the brain power is still there. Plus the added years of experience of practising general family medicine I think is a huge advantage.

But I wonder how this will affect the teacher-trainee relationship, especially if the trainee is one who was already practising medicine when his teacher was still struggling with the PSLE! It will be interesting, to say the least!

So does this mean that I am considering applying? Nah...not right now. But who knows? Five years from now, when I am an empty-nester, I may reconsider it. But by then, the policy may have changed again...

NOT Tit for Tat

This is what they do for us...

...& this is what we do to them...

So, who are the animals here?

Impressions from China - Trash talk

There seems to be a lot of China-bashing going on these days. The recent rumor that China is banning Bibles from the Olympic village next year is another instance of black-mouthing. Although the official religion is atheism here, Buddhist temples, Muslim mosques & Christian churches DO exist; and as far as I know, believers of these mainstream religions are allowed to practise their faith freely.

I personally have not seen any persecution of people who worship in churches here. There is a church service held every Sunday in the clubhouse here that is very well-attended by the expat population. I have yet to see any police raids on the place. Worshippers walk around freely carrying their bibles to & from service.

So I really don't know where the rumor started from.

Impressions from China - An Olympic Celebration

Last week, my sons' school celebrated International Day with a special focus on the upcoming Beijing Olympics. I was there, & it was pretty cool to be part of the festivities as well as a part of the Olympic flag which was made up of students, teachers & parents.

We also made it into the China Daily news...

Zagat for Docs?

Hmmm....what next? Michelin stars to rate doctors?

I have no issue with rating doctors...as long as it is done fairly. But when this is driven by an insurance company, it becomes quite suspect, really. After all, the bottomline (i.e. $$$) counts A LOT for these companies.

Impressions from China - Autumn in Beijing

You know, if you take away the gray haze, Beijing really is quite beautiful...

This was taken from the Mutianyu section of the Great Wall on a clear blue sunny day in mid-October.

Here is another view, this time, of mountain ranges adjacent to the Great Wall.

Awesome.

My attempt at an artistic shot - taken from one of the ramparts on the Great Wall.

In contrast, here are some pictures taken on a typical hazy day. These were taken in the Fragrance Hill & Summer Palace environs*.

View from Fragrance Hill.

This was taken on the grounds of the Summer Palace.

*for non-Mandarin speakers or those who are not terribly fluent (like yours truly), Fragrance Hills & Summer Palace are not user friendly at all. First of all, these places cover acres of ground with directions mainly in Chinese (& not very well placed either!) So if you go, make sure you hire an English-speaking guide.

The picture below was also taken at the Mutianyu section of the Great Wall, but at the end of October. As you see, the leaves have started turning red & yellow. What a difference two weeks make.

And to top it all off, a beautiful Autumn sunset by Roma Lake, near where we live. (This picture was taken by my fledgling photographer 13 year-old, showing off his recently acquired skills learnt during his Digital Photography module in school).

Plantar Fasciitis

Boy, what a pain this is.

I just read this article from Medscape about Plantar Fasciitis.

I am sure GPs will agree with me that this is one of the most common foot problems seen in their clinics. And treatment can be difficult as well as it tends to drag on or become a recurrent condition in some patients.

The article mentions most of the modalities of treatment we would generally use (although now, I tend to discourage patients from getting steroid injections into the affected area....damn painful, & also not advisable) but seems to have left out NSAID’s for symptomatic relief.

Oh, and I think they could have mentioned CROCS as well…. :)

Tough Calls

How does one make such a decision?

Oct 22, 2007

Weigh options when saving premature baby

I REFER to the article, 'Saving tiny tickers' (ST, Oct 11).

It is indeed heartening that medical advances allow the babies mentioned to enjoy a new lease of life.

Infant mortality has been reduced drastically because of the excellent medical care and services provided by Singapore's health-care workers.

However, we should not use the plain vanilla number of initial infant survivals as the basis of a job well done by health-care professionals.

This holds true, especially for extremely premature babies.

With advances in medical treatment, younger and younger 'premmies' are able to survive.

However, some will have disabilities, from minor to major, because of their early arrival and subsequent damage to their brain and under-developed organs.

If a baby is severely brain-damaged, where his quality of life in future is likely to be almost non-existent, should the doctor go all out to save the baby, just so he is alive for another painful day?

Or should the doctor let the baby die with dignity, through compassionate inaction?

Who should be the one to make such an important judgment call on the treatment (intensive, moderate and just enough to prolong the life, letting go) for the tiny patient?

For parents, this dilemma can be very much be like that of the relatives of a brain-dead patient.

It is therefore important that a clear standard set of rules and guiding principles be provided and adopted for extreme premmies' treatment, as this is a sensitive and grey area where emotions, and personal and religious morals and convictions play a big part.

It is important that the parents have a say in the premmie's treatment and can make informed decisions.

This is because, as parents, their decisions will be based on what is best for the baby.

Doctors should not be biased against their young patients' parents, even when the parents' views and opinions differ greatly from theirs.

Doctors should also respect parents' decision on treatments offered to the baby, even if they disagree with the parents' decision.

At the end of the day, it is the parents, not the doctors, who will have to care for the disabled child.

Thus, treatment options should be scaled towards what the informed parents want.



As a resident working in the NICU, I grappled with such dilemnae almost daily. Why save the premature, especially the severely premature, when the child eventually develops disabling conditions like cerebral palsy, bronchopulmonary dysplasia, ROP, all requiring long term medical care, with questionable quality of life. And the caregivers, having had to deal with the heartbreaking situation, are now saddled with a huge hospital bill, & look forward to a life time of probably repeated hospital stays & visits & seeing their child suffer.

But as a resident, one sworn to save lives, we pretty much did our damnedest to save even the most premature of babies until we knew that there was nothing much else we could do for him. I don't remember any one of the parents trying to stop us from doing so. I sometimes wondered why.

But then I became a parent. I then realized that the love one has for one's child, even unborn, is undescribably all-encompassing. I understand now, why these parents would want the doctors to try their damnedest, no matter how disabled or how much suffering their child might end up with. In a way, it's a selfish kind of love.

In any case, it's a tough call to make. To save or not to save. You tell me.