Alexa's China Trip

Fond Farewell

2007-11-12T21:32:00.001-08:00

Well, I made it safely back home to Los Angeles, after a fond farewell to all of my new Chinese friends in Chengdu. It was an incredible month, and I learned so much. I look forward to putting all this new information into practice with my patients at home (well, maybe not the fire needling...). I'd like to say a very special thank-you to all of the folks in Chengdu who made this trip unforgettable: all of our teachers at the hospital, our interpreters Jenny and May, Mr. Xie and his family, Dr. Zhang and his family, the "mei nu" (beautiful girls) who worked in the administrative office, the doctors and nurses who took care of me when I was sick, our hotel staff, and the poor waitresses at all the local restaurants who patiently helped us when we tried to order dinner every night. I miss you all already!

For those of you who would like to see more pictures, I am currently sorting through the 800+ photos I took in the last month, and will soon be posting the best of them online. Please check back in a few days for the link.

Oh, and one more thank-you: to all of you readers who faithfully following along in my journey! Xie xie!

A random assortment of pictures

2007-11-07T04:47:00.000-08:00

Hi Readers,

Well, my China trip is nearing its end, so today I'm sharing some pictures that didn't make the cut with earlier blog entries. Enjoy!

Getting ready for a children's art class at People's Park

Always good advice

A bustling Saturday at Jing Li Road, a shopper's paradise (also where I got food poisoning).

A patient doing her own moxa in the dermatology clinic. When I took this picture, I pondered trying to explain the concept of "bagging one's own groceries" to the Chinese doctors, then I decided just to keep my mouth shut.

A family enjoying the lake at People's Park

Beyond Chengdu

2007-11-06T03:39:00.000-08:00

This weekend we finally got to see some of the area beyond our city of Chengdu. Dr. Zhang and his daughter Yao took us to the Dujiangyan Irrigation Project, a village about 2 hours outside of Chengdu.

The irrigation system built there over 2,000 years ago is a testament to Chinese ingenuity. Li Bing, prefect of Sichuan at the time, decided to put an end to the devastating annual floods that plagued the region, and designed an irrigation system that is still in use today and has made Sichuan the most agriculturally prosperous region in China. Li Bing and his workers had to break through one sizable rocky hill to allow the water of the Min river flow onto the Chengdu plain, then they constructed a man-made island levee to divert some of the river onto farmland. Mind you, this all happened in the 3rd century BC. The enormity of the undertaking really hits you when you're standing on a man-made island with a foundation of bamboo and rocks, knowing that it has been there for 2,000 years and will probably be around for at least 2,000 more.

The beautiful hillsides surrounding the river are dotted with temples honoring Li Bing and his workers. We hiked along the stone pathways, savoring the fresh air and the ever-present sound of the Min river flowing along its course, a constant reminder of Li Bing's revolutionary engineering feat.

Priceless

2007-11-05T05:43:00.000-08:00

Three days in a private hospital room: 300 RMB
One abdominal ultrasound: 41 RMB

One physical exam and bloodwork: 256 RMB

One ECG: 18 RMB

Ten liters of intravenous fluids: 337 RMB

One 300-meter ambulance ride: 82 RMB

Getting all of the above for less than $150: priceless

Yes, today I paid the Chinese hospital bill for my food poisoning episode and the total came to 1034 RMB, or about $138. If anyone has any insight into how much these services might cost in an American hospital, please share!

A sea of Ju Hua

2007-11-03T05:43:00.000-07:00

Today we journeyed to People's Park with our professor Dr. Zhang and his family. It's a beautiful huge city park with something for everyone: carnival rides, tai chi practice, karaoke, tango lessons, tea houses, impromptu chorales of traditional Chinese music, paddle boats, and a dedicated grove of trees where parents can scope out potential mates for their children (there are even signs indicating that this is the express purpose of this grove).

As luck would have it, we came to People's Park in midst of the 2-week annual Chrysanthemum (Ju Hua) Festival. The park was positively filled with chrysanthemums - there were thousands of them everywhere.

So here's a quick Chinese herbal lesson (my students should know this - Ju Hua is one of the herbs we learn in my class). Ju Hua is sweet, bitter and cool, and enters the Lung and Liver channels. It releases the exterior, so it's used to treat the common cold. It also benefits the eyes, and can treat red eyes and blurry vision. Recent studies have even shown that Ju Hua is effective in treating hypertension. So what are you waiting for? Celebrate the fall season and immerse yourself in a sea of Ju Hua - it's good for you!

Our little corner of Chengdu

2007-11-02T07:57:00.000-07:00

Hi Everyone,

I have to apologize for the sporadic posts and pictures lately. Between burning my face and being hospitalized in a foreign country, it's definitely been a week to remember. I haven't had many opportunities to take pictures in the last several days, so today I'm just posting some photos of our neighborhood that I've collected during our time here. It's a residential area that is active at all times, day and night. There are small shops and eateries, and everyone is friendly. It seems like many of the locals have become accustomed to the sight of Lisa, Prajna and me walking down the street, and many people shout out "Hello!" and wave when we walk by.

If you're wondering, the jars in the second picture contain different herbal medicinal wines. Prajna tried one yesterday, and apparently it tastes mostly like grain alcohol and very little like anything related to herbs, medicine, or wine. But hey, they promote longevity. To your health!

Meet the Jetsons

2007-11-01T06:32:00.000-07:00

Truly, we are living in an amazing time. Scientists have sent a man to the moon. Doctors can replace a diseased heart with an artificial one. A microwave oven will bake a potato in under 5 minutes. And tonight I got to video conference with my sister's third-grade classroom halfway around the world in Woolwich, Maine. How cool is that?

Thanks to Skype, during this little adventure I have been able to talk to my husband face-to-face every day, chat with friends and family, and answer my sister's students' questions about pandas, acupuncture, and how to safely cross the road in China. It sure makes me feel a lot closer to home, despite that 22-hour journey to get here.

Now I'm just holding out for a flying car.

Integrative Medicine at its finest

2007-10-31T05:32:00.000-07:00

Well, my recovery from food poisoning is now nearly 100% complete. I feel MUCH better, thanks to the care I've received at my Chinese hospital. It's actually a great example of how they apply integrative medicine here. I presented with an acute, severe condition that needed to be rectified immediately, so the first line of treatment was Western medicine, which is fast and effective in emergency situations (would you call your acupuncturist if you had just broken your leg? I don't think so). So I was pumped full of fluids, electrolytes, antibiotics and vitamin c for two days. Now that the bug is out of my system and my symptoms are relieved, it's time for TCM to do what it does best - restore balance, strengthen the body, and generally get things back in prime working condition. I'm taking a delicious (seriously!) herbal formula to strengthen the Spleen and Stomach, tonify qi, transform dampness, relieve distension and promote digestion. For you TCM folks, it's basically Xiang Sha Liu Jun Zi Tang with a few extra treats thrown in.

So tomorrow it's back to Internal Medicine, this time as an observing doctor and not a patient! I'm looking forward to being back on my feet, learning more, and of course taking more pictures (other than the IV bottle dangling over my head).

Inside the belly of the beast

2007-10-30T06:23:00.001-07:00

It's week 3 of our trip, my week to be in the Internal Medicine department. I've been in Internal Medicine, alright...as a patient.

I started feeling nauseous Sunday night, then I was up most of the night with symptoms that told me something was seriously amiss with my digestive system (I'll spare you the details). By mid-morning Monday, I realized I needed to call for reinforcements. Lisa gave me an acupuncture treatment, and Prajna came from the hospital with Jenny, May, Mr. Xie, and Dr. Yang in tow. After a quick exam from Dr. Yang, they decided to bring me to the hospital, where I got hooked up to fluids. My lab results confirmed my suspicions: food poisoning and acute enteritis.

So I've been hooked up to an IV for the last two days. I'm exhausted, and I'm going to keep this brief for now, but I will tell you this - I am receiving excellent care from my Chinese hospital. Mr. Xie's wife has been making me rice porridge, his daughter brought me flowers, and the staff are so attentive and kind. I feel like I have an extended family here looking out for me - it's truly been a blessing.

Panda-monium!!!

2007-10-28T04:32:00.000-07:00

What's black and white, an endangered species, the national treasure of China, and quite possibly the cutest animal on earth? You guessed it - the Giant Panda! Pandas are native to only three of China's provinces, with the largest number by far residing in Sichuan. The image of the panda is ubiquitous here - it appears on everything from keychains to cigarettes. About 200 pandas are kept in various zoos and research centers throughout China, and most experts agree that their numbers in the wild have dwindled down to just 1000 or so individuals.

So this weekend we got to experience the quintessential Chengdu tourist activity - gushing over a panda. We journeyed to Chengdu's Giant Panda Breeding Research Base with our friend Joanna, who has lived in Chengdu for 2 years but never seen the pandas, so it was a new experience for all of us. It's a beautiful base, with huge lush habitats for the pandas to roam freely in. The base holds about 50 giant and red pandas, and we saw about half of them, including four giant panda babies. We weren't allowed to photograph the babies, ostensibly so they are not disturbed, but really I think it's because their cuteness would probably be too much for your camera lens to handle.

All Better

2007-10-27T00:27:00.000-07:00

Hi Everyone,

Just wanted to let you know that my face is all better. Herbal burn ointment is amazing!

Here are a few other updates:

I found out that my crazy-looking fruit is called Guai Zao. Mr. Xie at the hospital told me that you can cook it with wine and make an herbal wash to expel wind-dampness, and it's especially good for treating joint pain.

In the comments on one of my entries, Denesa asked if the doctors in oncology see good results using TCM to treat the root of disease. So I talked to some of the doctors yesterday to get their opinions. The most telling testimonial came from Dr. Wang, one of the young oncology doctors. She is a Western-trained physician, and before she came to this hospital she never believed in TCM. But now, after working in an integrative setting for six years, she has witnessed the benefits of TCM first-hand, and always encourages her patients to take their herbs.

A hard day's work

2007-10-26T06:48:00.000-07:00

It's Friday, so we got to have a little fun at the hospital today. While I've been in Oncology all week, Prajna and Lisa have been in Dermatology. One of the treatments in Dermatology is a mini-facial with steam, facial massage and an herbal mask. Since it was slow in the dermatology clinic, Lisa declared a "spa day" and the three of us, plus Jenny and May, got to practice the mini-facial on each other and experience its benefits first hand. I do acupuncture and herbal facials on many of my patients back home, so it was a treat to be on the receiving end (and to all of my facial patients - I'm bringing home some new tricks for you).

So that was the good part of my day. The not-so-good part happened later in my room, when I slipped while carrying a kettle full of nearly-boiling water, and it splashed up...into my face. Yeah, not good. Fortunately I'm in China! I called Prajna, and after a five-minute walk, we were in an herbal pharmacy, where I purchased burn ointment and promptly slathered it all over my face. If you're wondering what's in the ointment, it's the "Three Huangs" (Huang = yellow) - Huang Lian, Huang Qin, and Huang Bai, herbs that clear heat, dry dampness and relieve toxicity. The ointment is indeed yellow in color, and it smells strangely like Thai peanut sauce. I feel (and look) much better now, and I'll always remember "shao shang," the Chinese word for "burn."

An Herbalist's Dream

2007-10-25T06:40:00.000-07:00

I've always been impressed with the herbal lab we have at Yo San University. It has a huge selection of herbs, from Ai Ye to Ze Xie and everything in between, including the perennial favorite, dried gecko on a stick.

Well, yesterday I got to see the pharmacy that every herbalist dreams of. Nearly all of the hosptial's patients take raw herbs, so the pharmacy serves hundreds of patients a day. One bag costs about $1.50, and for a little extra money the hospital will decoct them for you.

The pharmacy is a busy, bustling place - while we stood there gawking and taking pictures, the half-dozen workers in the lab buzzed around us, measuring and dividing up the various animal, vegetable and mineral products there (about 500 single herbs total). The pharmacy manager Mr. He showed us around and patiently let us browse through the heavy wooden drawers. The smell of the herbs was so reminiscent of Yo San, if I closed my eyes, it almost felt like I was back home.

It's the law

2007-10-24T07:09:00.000-07:00

The chart notes in the hospital's patient files are all written in fountain pen. I learned this when one of the young oncology doctors and I were exchanging English and Chinese words for simple things we could point to, like "lab coat" and "pen." She pointed to my ballpoint pen and said that she couldn't use that kind of pen to make notes in her patients' files. When I asked why, her reply was, "It's the law!" Enough said, I guess.

Other observations from this week:

All of the doctors in the oncology department are young and exceedingly attractive. It's like a Chinese "Grey's Anatomy."

There aren't any wheeled stands to hang an IV on. Patients who want to get out of bed have to walk around with one arm hoisting their IV bag overhead. That would get old.

The nurse-call alarm in the oncology ward plays "It's a Small World After All." How apropos.

Anyone's guess

2007-10-23T04:44:00.000-07:00

Here's a food I've never seen before (not the persimmons - the crazy looking thing next to the persimmons). One of the vendors was selling it at the local farmer's market, and it looked so interesting I had to give it a try. I asked Jenny and May if they recognized it, but all they could offer was that it is some kind of fruit. After tasting a tiny piece, I can tell you that the only thing fruit-like about this substance is that it is sweet, but it is completely woody and fibrous. It is like eating a sweet piece of tree bark. Not surprising, actually, considering what it looks like. If anyone know what this "fruit" is, I'd love to hear.

The oncology department

2007-10-22T07:37:00.000-07:00

Today began my week in the oncology department. Jenny is my interpreter this week, and we spent the morning with Dr. Wang, the Dean of the department, in the outpatient clinic. It was a lot like the dermatology clinic in a way - hectic, loud, patients and their families barging in and out, interrupting, clamoring for attention, and crowding into the room (at one point I counted ten patients standing around in the tiny intake room, in addition to Dr. Wang, Jenny, another student and myself). But the difference of course, is that many of the patients here are very ill. They come to the oncology outpatient clinic to get herbs to support their bodies through varying stages of cancer.

What I found interesting is that some of the patients don't know they have cancer. Their families want to protect them and don't want the patient to lose hope, so they just keep the diagnosis a secret. This can be a delicate situation for the doctors. Today, Dr. Wang chose not to admit a very ill elderly man with advanced lung cancer to the inpatient ward, knowing that the patient would probably wise up to what was going on if he ever struck up a conversation with the patient in the next bed. Another family went so far as to rip down the sign on the doctor's door that made reference to oncology.

In the afternoon Jenny and I reviewed case histories in preparation for tomorrow's rounds through the inpatient ward. I wrote down no less than 28 herbs I had never heard of, the majority of which have been shown to have anti-cancer and anti-tumor effects. Interestingly, the base formula was almost always the same - the famous Si Jun Zi Tang (Four Gentlemen Decoction), a formula to tonify the qi. There were major modifications of course, adding any number of those 28 new herbs.

The hospital is an integrative Western medicine and TCM hospital. What I noticed in both the dermatology and oncology departments is that Western medicine is usually prescribed to relieve the patient's symptoms, what we call the "biao" or "branch" of the disease, while TCM is used to treat the "ban" or "root." In other words, doctors rely on Chinese herbs to correct the underlying imbalances that are causing disease, and use Western medicine to provide temporary relief. It's inspiring to see such conviction in the power of herbal medicine.

Get this camera

2007-10-22T04:33:00.001-07:00

Hi Everyone!

I just want to thank all of you who have been reading my blog and leaving me comments. It's so nice to know that I have friends and loved ones following along with me in this amazing journey. A couple of people have asked what type of camera I am using - it's a Canon PowerShot S5. My experience in photography is zilch, but this camera is pretty much idiot-proof and takes stunning pictures. I highly recommend it!

Tea Time

2007-10-21T16:06:00.000-07:00

Nowhere in China more than Sichuan better represents the culture of drinking tea; it is a way of life here. As a lover of tea myself, Chengdu's tea culture is something I've been looking forward to immersing myself in.

The art of drinking tea dates back 3,000 years. Traditionally, tea houses functioned as a center for social life, a place where people read poetry, watched opera, played ma jiang, gossiped about their neighbors, and even had their ear wax removed (a service still offered by some of Chengdu's tea houses). The neighborhood around our hotel has a few rather high-end tea houses (apparently, South Chengdu is where the rich people live), where a cup of tea costs as much as a one-hour massage at a nearby store front (about $3 - a rather pricey cup of tea and a preposterously cheap massage).

But this weekend we had an authentic Chengdu tea house experience. Not only did I get to enjoy the most amazing cup of jasmine tea I have ever tasted, I got to enjoy the company of new friends even better. We went with May and her boyfriend Jun, and little did we know that they are both tea experts - Jun is quite a connoisseur and May's father is a quality control officer at a famous Sichuan tea company. May and Jun educated us on the proper way to drink tea and the significance of the lid, the cup, and the saucer (representing heaven, man, and earth). We lounged in huge wicker chairs in a beautiful open tea house, just taking a break from a busy day of sightseeing and shopping, and taking time to slow down and appreciate life's simple pleasures. We talked about politics, culture, relationships - all those things you're supposed to talk about when you sit down to tea with new and old friends. Now I love tea even more.

Temples of Chengdu

2007-10-21T02:01:00.000-07:00

After five long and tiring days of being in the hospital, we wanted to take advantage of the weekend get out and see the sights of Chengdu. Everyone has been talking about what a beautiful city it is, but we've pretty much been confined to the 15-minute walk between our hotel and the hospital.

On Saturday we went to Wuhou Temple, which was initially built in 223 AD, and contains shrines to leaders of the Three Kindgoms period (220-280 AD). On Sunday we journeyed to Wenshu Temple, Chengdu's largest Buddhist temple, which was originally built during the Sui Dynasty (605-617 AD).

The temples are actually part of large city parks. Lush greenery envelops the parks - willow trees, ginkgos and bamboo are everywhere - and there is a sense of serenity and repose from the truly bustling streets of Chengdu outside, as the choking diesel fumes of the city's motorists give way to the redolent air of incense within the temple parks.

Why we have traffic lights

2007-10-20T05:44:00.000-07:00

The yin and yang of hot pot

2007-10-18T16:10:00.000-07:00

The Chinese have a saying, "Shi zai Zhongguo, wei zai Sichuan" (China is the place for food but Sichuan is the place for flavor). Huo guo (hot pot) is a traditional Sichuan dish, similar to fondue, but instead of dipping your food into chocolate you dip it into a bubbling vat of fiery spiced oil. We've been wanting to try hot pot, but there's no way three Americans could manage that on our own without some help from the locals - drawing a picture of a bowl of noodles is one thing, but trying to do the same with traditional Sichuan hot pot is quite another - so last night we invited our interpreters Jenny and May for a hot pot dinner to thank them for all their hard work.

The restaurant, Tong's Fish Head (yes, our meal did contain fish heads) featured a menu with English words AND pictures, but we let Jenny and May do the ordering, and since we are American wimps, they chose half spicy/half mild. The mild side was the yin: a nourishing chicken broth seasoned with tonifying and calming herbs like Da Zao (jujube fruit), Gou Qi Zi (goji berries), and Tian Ma (gastrodia rhizome). The spicy side was the yang: a fiery oil full of Chuan Jiao, the famous Sichuan pepper.

I've been warned repeatedly about the red-hot spiciness of Chuan Jiao (aka Hua Jiao), which gives Sichuan food its distinctive flavor. In TCM, Chuan Jiao is an herb that promotes digestion by warming the spleen and stomach. Its hot and pungent properties protect the body against internal dampness and stagnation caused by the region's high humidity and rainy weather. It's actually the primary herb in a formula called Da Jian Zhong Tang (Major Construct the Middle Decoction), which treats abdominal pain. I was expecting Chuan Jiao to taste hot like a jalapeno pepper (not a favorite flavor of mine), but its taste is more complex than a simple burning sensation, and I'm actually developing quite an affinity for it. One mildly annoying side effect, however, is that it leaves my tongue feeling quite numb after eating it, which explains why traditionally Chuan Jiao was used as an anasthetic for tooth pain.

Fire Needling

2007-10-17T07:42:00.000-07:00

I know what you're thinking, "Fire needling...surely that can't mean heating up a huge needle over an open flame until it's red-hot, then poking at a patient's skin lesions with it???" But guess what, that's exactly what fire needling is!

Fire needling is the treatment of choice for many conditions I'm seeing in the dermatology clinic. It has three functions: it relieves inflammation; it promotes the discharge of pus; and it relieves itching. The treatment principle in Chinese is called "yi re yin re": using fire to conduct fire (out of the body). Judging from the grimaces I see on most patients' faces and one woman's repeated cry of "Oh my God" as she squeezed May's hand, it also hurts like hell.

Dr. Huang and one very amenable patient let me give it a try yesterday afternoon.

As promised...

2007-10-17T04:13:00.000-07:00

...pictures of the hospital!

1. The entrance to the dermatology clinic - the characters are the "three treasures': jing (essence), qi (vital energy), and shen (spirit)

2. The pharmacy waiting area where patients pick up their herbs and Western medications - just like Rite Aid, huh?

3. Statue of Zhang Zhong Jing (author of the magnum opus Shang Han Lun), outside the entrance to the inpatient building

4. Lisa, Prajna and myself with our interpreters (and lifelines) May and Jenny

5. The hospital's main waiting area

6. The rooftop patio

Day one in the hospital!

2007-10-15T05:18:00.000-07:00

Monday morning: Lisa, Prajna and I reported for duty at the hospital, after a 300-meter walk from our hotel and several trepidatious minutes trying to cross a busy street during rush hour. We met up with Mr. Xie and our interpreters, Jenny and May.

Mr. Xie led us on a grand tour of the hospital, which included an outpatient ward for children with cerebal palsy, a comprehensive TCM and Western medical pharmacy, a rooftop garden and tai chi patio, and the nicest hospital waiting room I have ever seen (it's outside, surrounded by greenery - can you imagine that in the US???). I know what you're thinking - Gee, wouldn't it be nice to see pictures of all these things? Well, yes, it would, but I'm having some firewall challenges at the moment - I'll try to get you all some visuals ASAP.

After the tour, Jenny took Prajna and Lisa to the oncology department, and May and I headed off to Dermatology. I really didn't know what to expect. I do a lot of cosmetic dermatology in my own practice in Los Angeles, but a hospital in China is a whole different story. I started to get a little nervous as visions of flesh-eating bacteria filled my imagination. However, much of what I saw today were ailments that seem to plague all cultures: dermatitis, psoriasis, and of course, acne.

The most immediate difference I noticed is that the western notion of patient confidentiality simply does not exist in a Chinese hospital. May and I sat in an intake office with our teacher, Professor Wu, as patients came in and described their conditions and Dr. Wu wrote formulas. During each intake, other patients wandered in and out of the room, interrupting, listening in, making comments, craning their necks to see what the doctor was writing, even trying to see what I was writing. The only time the door was closed was when the doctor needed to do a visual inspection of a young male patient who complained of genital itching. I guess there is some privacy.

And so it begins

2007-10-14T04:09:00.000-07:00

After a tearful goodbye to my husband, I arrived in Chengdu this afternoon, 22.5 hours after my departure. I was met at the airport by Jenny and Mr. Xie, who helped me check in to my hotel. We then met up with Prajna, one of my fellow Yo San grads who is also participating in the externship. Jenny and Mr. Xie took us on a walk to exchange money and show us the hospital where we'll be working. On our walk, the streets were filled with some expected sights (stands of fresh produce, people playing mah jong outside a storefront) and some unexpected ones (a cat on a leash watching the mah jong game).

I get the sense that Chengdu is not really prime a destination for foreign travelers (my first clue may have been when no one in America had ever heard of Chengdu). Prajna, who arrived a day ahead of me, had ordered dinner the night before by drawing a picture of a bowl of noodles. Hmmm, maybe I should have spent more time on the plane studying my Mandarin phrase book and less time watching Will Farrell movies.