Post-Quake HIV/AIDS Prevention Planning

May 12 caught the Chinese off-guard. Much like September 11 in the United States. Many in China still refer to the earthquake by its date. Others refer to the catastrophe as the “Wenchuan Earthquake” (pinyin: Wènchuān dà dìzhèn) after the earthquake’s epicenter in Wenchuan County, Sichuan province.

The hard work of rescuing and treating the injured is over. Tents have been struck for those who lost their homes. Schools have been re-opened, if only for the purpose of giving the children an opportunity to step back into a routine that is familiar to them.

Others, including doctors who aided in the rescue work, hospital directors, community leaders, representatives of civic organization, researchers and health experts from several global agencies, including UNAIDS gathered for two days this past weekend to revisit their disaster relief efforts and to provide input to newly drafted guidelines for HIV/AIDS interventions in emergency settings. Many who spoke of their experience added that they wished such guidelines had been in place when the disaster struck. I was invited to attend. One of the students in my Global Health Challenges offered to serve as my interpreter.

China is still considered a country with a low infection rate. Many people still presume that the problem is confined to intravenous drug users. Still, a recently published UNAIDS report indicates that more cases of HIV/AIDS are identified in heterosexual populations each year.

As a result, professionals at the Conference remain concerned for careful monitoring at the earthquake site for possible new infections. The earthquake not only toppled poorly built school buildings, but also collapsed hospitals and clinics. When the upper floors collapsed, the weight of the cement also crushed sterilization equipment and other laboratory supplies. For several days there was not running water. One surgeon described his worry that their work may possibly have spread the disease. The need was so great – the resources so few. The surgeons worked 12 and 15 hour shifts; moving from patient to patient, having doused their hands in disinfectant and changing their surgical gloves.

The earthquake also left behind broken families and shattered relationships. The social chaos in the first days and weeks was unimaginable. Within a short time, the thousands who had lost their homes were housed in tenements of bright blue tents. The hospital director attending the Conference commented on the observed but quite unexpected sexual activity in the closely spaced tents. “Unexpected,” commented the hospital director, because the tents were placed so close together that there was little to no privacy.

The lack of guidelines for HIV/AIDS interventions in emergency settings meant that little thought had been given to the most basic means of prevention. The draft guidelines which address issues ranging from coordination and to shelter and site planning to health, education and behavioral communication change, are meant to remedy this oversight. No one had planned ahead for the earthquake, just as no one anticipated the events of 9/11. The Wenchuan EQ was a wake up call for health professionals in western China. The Guidelines, when published in January 2009, will set standards for HIV/AIDS preparedness for China and countries around the world. I was honored to have been included as a participant at this important global review.

An Adventure in Sichuan Cuisine, October 17, 2008

On Thursday, after hosting the first session of the “Professional English Corner” I was invited to have lunch with my Teaching Assistant, Gao Bo, several of her graduate classmates in Preventive Medicine and their Faculty Advisor. We walked from the campus to Jin Guan Tang, a Sichuan restaurant just a few blocks away. The restaurant, like many others, is situated on the second floor, saving space on the street level for small shops.

As is typical in this area of China, at least, the dishes arrive one at a time, but seem to never cease to arrive. For today’s lunch, Dr. Li chose the following dishes:
Pickled lotus root (delicious)
Whipped sweet potato deep fried and stuffed with sweet bean paste
White radish and smoked pork
Chopped pieces of duck with red peppers and scallions
Steamed fish topped with sliced onions and scallions
Diced eggplant in a delicious sauce
Long stemmed mushrooms with green peppers
Toasted deep fried sesame rolls, and
Kung Pao chicken topped with large chunks of hot red pepper!

Just a few dishes, I would say! I am amazed at how much food is served for these lunches and dinners. Some guide books say it is a type of compensation for the scarcity of food available to anyone during the Cultural Revolution. Others say it is the Chinese sense of graciousness. By any standard, the meal was more than ample for the six of us.

The occasion of the luncheon was the one-month birthday of Maye’s (Zhang Min) new little baby boy. In keeping with the local custom, Maye had invited her graduate school classmates and her faculty advisor and me out to lunch to celebrate the day. I assume from the conversation that she would also host another meal for her family and friends. We chatted a bit about the baby; I asked to see his photograph. He was just precious – seemed to be smiling, already, at one month. Maye told me his Chinese name – but its multiple vowel sounds quickly escaped my memory. She also told me that he didn’t have an English name yet, but wondered if I would chose one for him. I was in a Peter mood; it is a name I’ve always liked; and, so I think little Zhang’s English name is now Peter!

Sichuan Food is famous the world over. The meal that we ate on Thursday was testimony to the freshness of the foods and the range of flavors. The pickled lotus root was delicious; -- I’m a pickle fan almost anywhere. But, the steamed fish – which is the next to last dish usually served – is absolutely delicious. There are two things that make is so good. First, is that the fish must be steamed above the water, in a sauce flavored with soy and other spices. Second…and key…is choosing an absolutely fresh fish to be steamed. One friend described how you can run your finger across the fish’s scales and know exactly how fresh the fish is. Another, jokingly –maybe—described grabbing a live fish from a tank to be steamed as he entered a restaurant.

Sichuan food is spicy … "hot" also comes in many flavors. I notice that the food is cooked with large chunks of hot red and green peppers, but typically these chunks are not eaten. Rather, the peppers are used to flavor the food. There is one peculiar little spice that I have never seen before; it is slightly larger than a pepper corn but has a prickly skin; it goes by the name “hua jiao.” It gives the food an unusual hot, slightly prickly taste. A touch of it is delicious. However, I did make the mistake of taking one of these little guys and chewing on it. What a surprise. Now when I tell my Chinese friends that I call this little seed “Chinese Novocaine” I always get a lively chuckle.

Still, the freshness and the flavors of Sichuan Cuisine guarantee every meal will be a delectable adventure in taste!

Traveling South to Yunnan Province (October 8, 2008)

Everyone is on the road during the week of vacation that surrounds China’s National Holiday, celebrated on October 1. As everyone in China has a weeks vacation, the holiday has earned the title “Golden Week.” I was no exception. I took to the airways to travel south to Yunnan Province to the garden city of Kunming. The city is actually what I imagined that Kunming would be. Smaller in scale; a bit more attention to design in architecture; color in buildings; being at higher altitude helped, too.

Kunming is located just over 6000 feet above sea level; the weather was a bit cooler and the air a bit fresher. But the real delight is that the altitude allows the smog to blow away each day and the earth’s blue sky to shine for most of the day. It was also nice to see a hill or two – I hadn’t realized just how flat Chengdu is until I got to Kunming. It is smaller in scale and population than Chengdu; it also has a reputation for having a year round spring time climate, like Northern California, I suppose. As a result there is an abundance of flowers that grow there, including orchids and a very large botanical garden. I imagine it is lovely in the springtime.

Yunnan Province is home to many of the nation’s minority groups – one third of its 42 million people belong to one of 25 registered minorities, among them the Hui, Yi, Miao, Tibetan, Mongols, Bai, Wa and Naxi peoples. The northern Han Chinese, the majority population, is the 26th group in China. To keep knowledge of the traditions and material culture of the minority groups alive in the minds of the Chinese people, the Yunnan Nationalities Museum has recently re-opened at an outdoor site10 kilometers south of Kunming city. The Museum, itself, is an outdoor walk-around park, something like out theme parks. Walking from site to site is pleasant, as the walkways are landscaped with a variety of the more than 400 types of flowers commonly grown in the area. At each site visitors walk are greeted by members of the community dressed in their traditional costume. Minority representatives at several communities played traditional songs or treated the visitors to a ceremonial dance. For me, the tour of the Yunnan Nationalities Museum provided an introduction to the range of traditions and to the fervor with which these traditional people adhere to them. Further evidence of the respect accorded these recognized ethnic minorities, all non-Han groups in China are allowed to have two children in urban areas, and three or four in rural areas.

While elaborate costumes are not commonly seen on the streets today, in Kunming and in surrounding communities it is not unusual to see brightly colored embroidered baby carriers used to tie babies a Mom’s back.

With a graduate student friend from Sichuan University who lives in Kunming, I also visited Xī Shān, also called the “Sleeping Beauty Hills” of Kunming. There is a beautiful winding road up the mountain. Because it was holiday week, everybody, including the huge tour busses wanted to go up the hill. We walked a mile or so, caught the views, and then turned back. But I must say it was an eye-popping experience to watch the tour buses try to pass each other on a lane and a half road!

At the Kunming airport on my return journey, it seemed everyone was buying boxes of fresh fruits or bunches of flowers to carry back to Chengdu and other places with them. I joined in and bought 10 apricot roses – it must be a Chinese dozen – for 10 yuan (6.86 yuan=$1US). In my apartment, they reminded me of the “Golden Week,” and my trip to Kunming for several more days. It was good to be home – even if it was already home away from home!

On the Road in Chengdu, 9/20/08

Traffic! Where to start! How to begin! I prefer to think of traffic as being governed by a set of rules established perhaps during the Ming Dynasty when the Great Wall was extended by some 600 miles and much codification took place to protect the Empire. Then, probably only people filled the roads, whether with chariots or not!

Today, there are people on foot, bikes, bikes with small motors attached, motor bikes, cars, taxis and buses. Or, perhaps there are buses, taxis, cars, motor bikes, bikes with motors and without and people on foot for the latter order seems to govern the right of way. It’s a wonder that more people are not hurt!

I’ve not hit a car yet, but I’ve turned several times and found myself face to face with a motor bike rider. Today, I turned to avoid a motor bike and ran into the woman sweeping the street. We both laughed!

There is one particular intersection that also makes me laugh, sometimes out loud, each time I go there. It is the intersection of Renmin Lu (Renmin Street) and the gates to the HuaXi Campus of Sichuan University. Renmin Lu is a large thoroughfare in Chengdu, with three lanes of traffic in each direction – plus – a bike lane for bikes and motor bikes in each direction. It is actually quite beautiful with a wide median planted in a variety of grasses, and some begonias and marigolds. It also is lined with the most beautiful tall evergreen trees – a type of weeping cedar I would guess. However, it is filled with traffic at most every hour of the day.

The cross street connects the two sides of HuaXi campus. When the traffic on Renmin Lu stops, the cross walk is filled with all manner of feet accompanied by back packs, bikes, electric bikes and four-wheeled vehicles that are making left turns into one of the gates from Renmin Lu. It looks like a veritable free for all. It is a free for all! I’ve walked it, and dodged the other walkers and skipped around the bikes and electric bikes and watched with amazement as the left-hand turning cars make their way through the masses.

One evening I must have commented to a new friend here as we were crossing the intersection something to the effect, “This is crazy!” She asked me this past week if I remembered making the comment, and, then, asked me to explain to her why I thought it was crazy! I was left speechless. Gratefully, the taxis began honking its horn and my sputtering attempt at an answer was drowned in a chorused cacophony of sound! Whew! That was a narrow miss! I wonder what the cute little cocker spaniel riding along in the bike basket (above photo) would have to say!

I did buy a bike last week, at one of the so-called second hand shops. Second-hand shop is a euphemism for the widely known, poorly kept secret “stolen bike sale stand.” One student said to me, “we know they’re stolen, but we’re students what can we do.” During the Fulbright Orientation we were advised to buy the oldest bike we could – so that we’d be more likely to have it for the duration of our stay!

A bike is wonderful. The city is completely flat. None of the ‘ups and downs’ of Chapel Hill to worry about. Riding across campus is just good fun; only a few cars of residents are allowed on campus, so the roads are just for us bikers and a few rickshaws. Here, on campus the fabled rules of the Ming dynasty still seem to make some sense.

From the Beijing Paralympics, on site -- 9/13/08

At first, it was just a passing thought. A moment later, I made the decision. The unit I teach on the Americans with Disabilities Act, with a focus on workplace accommodation, is one of the more compelling units of my course on Strategic Management of Human Resources. I was going to see the Paralympics!

I asked my Dean and he responded with enthusiastic support. I bought a ticket. A Fulbright colleague in Beijing offered me one of the tickets she had been given to the wheel chair tennis event by her University. A second Fulbright colleague in Beijing kindly invited me to stay with her in her small but cheery apartment. I was off.

The Paralympic athletes were inspiring, perhaps even more so to me, than the athletes who competed in the Olympics. When I complained to myself about my hurting feet, I was reminded that each of the Paralympic athletes had first to overcome a personal disability before even beginning to take up a sport or train for the Paralympics.

Watching the wheel chair tennis matches took my breath away. It's a game I have played and one that my Dad excelled at. I know the challenge of anticipating where the ball will come and getting my feet there before the ball has come and gone. But watching the players seated in wheel chairs meet the ball in a timely fashion was something that I could hardly imagine.

The first match played in center court was between two guys, one from France and one from Chile. Natch, I applauded for the Chilean, throwing in a few Spanish cheers. However, he was clearly outpaced in both speed and strength by the Frenchman, who had taken the gold in a previous Paralympic match. The next match was between two young gals -- a blond from the USA and an African from South Africa. It made for some torn allegiances, to be sure. They were both very good players and had some long, deep in the court volleys. Because they hit the ball with less force than the guys, the ball travelled more slowly; the long volleys and the movement of the chairs positioning and repositioning was really a beautiful site to see. The South African won several games and the first set was long. However, the American player eventually took the set.

We walked around the other tennis courts and watched gals and guys from the States, Canada, China and Germany engaged in matches. Even though I think of myself as reasonably aware, the experience was still an eye-opener. These matches were not the finals so there were no medals awarded.

However, we were also able to get tickets to the Judo event – the finals. We watched several excruciating hours of judo wrestling, men and women, in two weight classes. These athletes were legally blind, category 3 – that is, some of them had some peripheral vision, but that was their maximum visual ability. The judo was hard to watch; several times I was relieved when one of the refs from the sidelines approached the main ref and said something. The matches calmed down a bit, when this happened. ‘Just not my sport! BUT, well worth watching to be able to watch the awarding of the Bronze, the Silver and the Gold medals in each of the categories. Each of the winners was escorted by a sighted person to the medal stand, and the medals were placed around their necks with the same elegance and honor that appears on TV. Only, the athletes had to be helped on and off the stand by their sighted assistant. What an inspiring moment, whatever the sport.

And Beijing ... wow! What a city. Wonderful, but not a city for those who tire easily. I, in my impulsive way, of course, wanted to "do" the city in a long weekend! But my feet rebelled. Simply impossible. We did see the Forbidden City, now the Palace Museum, and Tiananmen Square across the boulevard. I took a bus tour of the city, so saw the location of many other monuments and skyscrapers and some old and some rebuilt “hutongs” (old neighborhoods build down a winding alleyway) as well. It is curious to observe the Chinese apparent preference for razing old buildings and building models of old buildings in their stead, instead of renovating and preserving the old building, themselves. Still, every street, no matter how high the skyscrapers, is lined with trees. It seems that landscaping arts is the one art form that escaped politicization in earlier epochs. On the ground, from the sidewalk, the streets can be quite pleasant.
It was a short trip, but seeing a couple of events at the Paralympics made it very worthwhile. My best to you! Deborah

Settling In to the University, 9/5/2008

My home away from home is beginning to look a little more like my pad. I’ve found a few dishes and glasses and a French press for making my morning coffee for the kitchen and some silk throw pillows for the living room. Irony of Ironies is that I found most of the things at IKEA -- the Swedish department store that imitates Danish modern design; that has moved much of its manufacturing base to China.

I am getting the drift of the city of Chengdu. It is good to be able to go out and around. When I go more than a block or two from my building, the Foreigners’ Guest House, however, I carry a set of file cards with notes on them in Chinese and English. Please take me to .... It's a bit humorous, the blue-eyed woman who seems not to be able to read, but so far it seems to work. I made several outings on the weekend, and am back in my place with absolutely no fantastic stories to tell about the outings. One day, I’ll write about the traffic. For today, suffice it to say that no news is good news in this case.

My role at the university is taking shape, too. I’ve given my first class, an introduction to policy and practice challenges related to global health. Course registration is a little less organized in China than in the States, so I really had no idea what to expect. I didn’t know whether three or a hundred ‘n three students would show up. In the end, there were about 60 who came to hear and choose. My teaching assistant, Gao Bo, a doctoral student, told me that she was very pleased with the presentation. So, I was happy too. I didn’t know! From my informal conversations with students before class began and in the Q&A period, there seems to be a wide range of English language skill. This is as we had been cautioned at Orientation. But still, I wasn’t sure how to hit the mark. Gao Bo thinks that there will be 45-50 students who complete the registration process. If I can get them talking, even among themselves in small groups, I know I will learn quite a lot. What a privilege to be here among these talented young people!

Dean Ma Xiao of the School of Public Health also extended a kind invitation to me to a welcoming dinner. As those types of events go, it was excellent. The people of Chengdu seem to be very grounded, very personable, and just plain friendly. In some ways they remind me of the people of North Carolina! Neat! Dean Ma talked a little about his visit to the rural country side last week, where he is seeking to identify a possible research site. His own professional training is in health promotion and behavioral health, and the focus of his proposed work is on HIV. It will be interesting to talk more with him in the coming weeks about his work.

Another of the dinner guests had recently returned from Rochester, where she did a year’s post graduate study in a Suicide Prevention Center there. She is interested in doing some research on mental health among the migrant population in Chengdu, using the CDS screening tool for depression as a measure of mental health status. She, also will be interesting to talk with more in the next weeks.

I am also beginning to better understand my role and the roles of my colleagues as Fulbright Scholars. Some of this is subtle, but clues here and there are giving me a better picture of expectations of our time in China, painted as they are in the understated strokes of a Chinese artist painting ranges of receding mountains shrouded in a thin cloud. One key clue I found was in the background description of the U.S. Ambassador to China, Clark T. Randt. Mr. Randt is a lawyer, fluent in Mandarin Chinese. He has lived and worked for more than 20 years in Asia; he has lived for extended periods of time in both Beijing and Hong Kong; is a member of the New York and Hong Kong Bars; and a recognized expert on Chinese law.

He has been more in legal practice than in the University, but I thought it noteworthy that he is fluent in the “local” language. His background and his position also help me to understand why about half of the 18 Fulbright Scholar Awards to China for the 2008-2009 year are lawyers or political scientists. Interesting, no? There appears to be tremendous pressure – a full court press, maybe – to move China’s law to be more systematic (rational?) and transparent. The Fulbright Scholars are assigned to posts in Beijing, Xiamen, Sichuan (where I am), Shanghai, Hangzhou, Wuhan and Tianjin. You may not know all of these cities; I don’t either. But the spread of cities helps to make the point that this is a nation-wide effort.

It is also becoming clear that as China grows as a global power, it is seeking membership in some global consortia, such as the WTO. I gather from several conversations that membership comes with certain requirements. Accountability is at the top of the list, but not because it leads the Roman alphabet!

I am glad to have started classes. I feel a little like I am playing catch up with the semester in Chapel Hill. I know that my semester will be different, challenging, wonderful, frustrating, and, above all, an adventure in global understanding. I feel humbled by the opportunity to be here.

I continue to note curious little quirks. There is one that seems to fit with this narrative. I went into a rather upscale shopping mall, just to see what it was like. First, I noticed that all of the shop clerks said, “Good morning” to me, in English … translating from the Chinese word “Ni hǎo” even though it was 7:30 in the evening! Then, I found myself chuckling aloud when I rode the down escalator and noticed a sign where one could have caught one’s head leaning to examine some pricey scarves between floors saying “Please take care of your head!”

We’ll do. I hope you are each well and enjoying your work and the cooler fall weather. With best wishes, Deborah

Onward to Chengdu! (August 29, 2008)

This is an adventure! I arrived in Chengdu on Wednesday evening (August 27) via China East Airlines, accompanied by my “waiban” (an assistant from the University’s International
Office). A driver from the University picked us up at the airport. He was a bit grumpy at the sight of my luggage, but otherwise the arrival was smooth, if strange and a bit overwhelming.

Breakfast time on Thursday morning came before I knew it. I dressed and went downstairs to the dining room that is part of the guest house. There was a buffet spread on the center table. I had a bit of everything, though I must admit that I didn’t know what anything way. I pretended it was chopped peanuts mixed with celery strips. I don’t think it was. But, pretending gave me a sense of being on top of it all, something I definitely was not.

The parts of Chengdu that I have seen seem to live up to its lovely reputation. The campus of Sichuan University is mostly built of brick -- so it immediately reminded me a little of Carolina, right down to the red bricks used for many of the paths across campus. There are many trees and fewer cars than in Shanghai. At the north and south gate to the University, there is a policeman who makes it his business to enforce what the stop lights already say. But his presence does make it much safer for pedestrians to safely confront the sea of bikers and cars.

My apartment is small, with a living room and bed room and small balcony. The bathroom has the necessities, including a washing machine. The kitchen … well there must have been a page missing from the Orientation handbook! Not a pot; not a pan; not a dish or a knife, fork or spoon. Not even a pair of chopsticks! There is a refrigerator and a gas hot plate, but no oven. How will I bake those brownies that I brought along? All of this is fixable – stores have many of the identical pots and pans that we buy at home, at a half to a third the price. My “waiban” was surprised that I planned to do any cooking while I am here – after all, Sichuan cooking is known all over China. I guess these different assumptions were the first of many cross-cultural moments I will have.

The apartment does have quite a good internet cable; a high speed cable replaced the earlier version just a year or two ago. This will certainly come in handy.

The Orientation for the Fulbright Scholars and families in Shanghai on Monday and Tuesday was very well done. We had speakers from the Consulate and the Embassy, from the Fulbright Program and from among past Fulbright Scholars. There was a separate program for the children – about 10 in all. They went to the Aquarium and a number of other places that kids would enjoy. Both they and we became quite good friends in even this short time. We were spoiled – there is a new complex in Shanghai, where many of the Consulates are housed. Part of the complex is a hotel, the Portman Ritz Carlton. Our rooms were lovely and each had a wide screen TV for us to watch the Olympic Closing ceremonies and the Theatrical Spectacle Opening in Denver, aka the Democratic National Convention. Just outside the main door of the hotel, to the right was a Starbucks. A good relatively inexpensive start to the day.

There are lots of curious things about China – one of them is that the entire country, from east to west – is in the same time zone. As a result, in Shanghai, in the east, the sun comes up at about 5 or 5:25. Here in the west, or southwest, the sun doesn’t rise until closer to 7:00 am. Yes, in fact, the hours of the work day has been adjusted in parts of the country to adjust for this particular curiosity.

There will be more to tell, I am sure. I am grateful that the Internet enables us to keep in touch, even across 12 or so time zones. I hope you are all well. My best wishes to each of you.