Saturday 7 April, 2018
Letter from China No. 8: Final thoughts
Hello again, one last time, Friends, Readers, we are on our way home. Yesterday we flew from Sanya to Beijing, a 3 hour 40 minuteflight on a Hainan Airlines Boeing 737. Today I am writing this sitting in a Hainan Airlines A330on its11 hourdirect flight from Beijing to Calgary. It may surprise many of you to know that this Great Circle Route involves flying over very little water. It does not cross the Pacific Ocean. Rather it heads NNE over China and Russia, along the west shore of the Sea of Okhotsk, north of the Kamchatka Peninsula, andover the most eastern part of Russia's Far Eastern Federal District. The only significant water crossing is at the narrow part of the Bering Sea. The last part of the flight will take us over land, flying across Alaska, passing just north of Anchorage, over the southwest tip of the Yukon Territories, to the east of Juneau, across northern British Columbia and finally along the eastern edge of the Rockies down to Calgary. Getting on the aircraft in Beijing was quite an experience. Flights to San Jose (California), Seattle, Bali, Saipan and Calgary were all loading through the same boarding lounge at the same time. It was Bedlam. There were people everywhere and overwhelming noise from the general hubbub of excited conversation, confusion over changing gate numbers and conflicting instructions being given on an electronic message board, over a loudspeaker and by multiple members of airline staff shouting. The announcement that the Calgary flight was 'now boarding' saw the slogan 'Calgary Stampede' redefined! But, we made it, and ended up on the right flight!
Farewell to the Far East!
I am reflecting on the past 5 weeks we have spent in China. It has been an amazing, fantastic, remarkable experience. We have travelled extensively and seen such a lot. We started by visiting many of the major tourist attractions of China but we then had the unique opportunity to live and work in the general community with our Chinese peers. We have learned Chinese geography, travelling by air, rail, road, water and foot. We have experienced many aspects of Chinese culture, visiting museums, historic sites, theatre, shows and other live performances. We have explored city life and been into the country. We have eaten Chinese food: almost all good but often containing things we would probably shy away from at home. We have been entertained and been the recipients of Chinese hospitality and friendship. And it has been the greatest pleasure and privilege to work alongside, and amongst, a group Orthopaedic Surgeons, and their supporting staff, who are so obviously functioning at a very high level academically and clinically. The morale amongst the staff, in the Orthopaedic Division, clinic, wards and operating roomswas tangibly high.
We learned a lot of things along the way.
LANGUAGE: Chinese is the written language. Mandarin is a spoken language, spoken in many parts of China but not, by any means, all over. Most people can read Chinese but there are many spoken dialects which cannot be understood. Wenzhou has such a dialect and some of the surgeons could not understand the local people. But, maybe, my home in UK is no different. As a medical student in Edinburgh, I once had to have an interpreter help me understand a patient from Leith. And I cannot do Durham or Bolton at all. We learned to read some Chinese characters: 'way in', 'way out', 'toilet', 'China', 'Wenzhou', 'big', 'people' and some numbers. Chinese characters do not work the same way as our letters of the alphabet. They are more like little pictures or images. It would have been fun to have had the time to learn more. The spoken language was much more difficult. The pronunciation seemed to change as we moved from city to city and we could not keep up.
FOOD: Great. It had been a worry before we came but it turned out that there was nothing to be concerned about. Oh yes, there was some weird stuff but we managed well. We ate well but I still lost some weight, maybe because I had the opportunity to exercise quite a bit too. Al warmed me about the duck tongues. These seemed to be a 'right of passage' in coming to Wenzhou. We tried them and they were good. Peking duck, of course - excellent. Snake head stew, eel, turtle, yellow fish, pickerel, shark stomach lining, cow stomach, all turned out to taste fine, although the texture of some was a bit off. I could not eat the chicken head I found on my plate once, nor the goose stew served in the hospital cafeteria (which did not serve the best Chinese food), nor the chicken feet. We loved the chestnuts, and all the fruit and vegetables we found: mango, melon, dragonfruit (two different types: red and white), oranges, apples, coconut, starfruit, longan and pineapple. There was great hot pot, very hot Sichuan dishes and freshly made noodles. The food from Shanghai is very sweet.
DRINK: This was also a worry as neither of us drink much alcohol. Al warned us that they toast the guest repeatedly and this can result in a lot of alcohol being drunk. Dr. Jiang told me that they used to try to get the visiting professor drunk but those days are now in the past. Drink was not a problem. They still toasted the guest and we found it was socially acceptable to sip (rather than down-in-one) a little red wine with our hosts. It all worked out really well and everyone seemed to be very comfortable. We were taken out to dinner with a particularly 'boosy' crowd one night. Everyone respected each others drink preference. We all had fun and it was a great evening.
SMOG AND FOG: In my early 'Letters form China' I noted that the country was very smoggy. There is no doubt that the air is thick and visibility very poor over most of the country but we have come to realise that this is probably more related to water vapour (fog) in the air rather than pollution and smoke (smog). We did see heavy industry and belching chimneys in the middle of some of the major cities but we also saw a thick atmosphere in places where there was no industry. Additionally, the air did not smell of smoke. We noticed that there appeared to a lot of things being done to try to clean up the atmosphere. The motor scooters, which were a prominent form of personal transport everywhere, are now all electric. I also heard (no, I should saw 'did not hear') cars, which were obviously electric - not vary many but more than at home. Train travel is all electric. Huge numbers of new trees have been planted everywhere.
CITIES: The cities were, by and large, very large and clean. Traffic congestion was really bad, an impossible problem, in Beijing and Shanghai but not such a problem elsewhere. Wenzhou was busy but the traffic moved reasonably well. The roads in the cities were frequently wide tree lined boulevards. We saw the roads being frequently washed with water. We knew when it was happening in Wenzhou because of the pretty little tune, like an ice cream truck, that the street cleaning vehicles played. We saw a lot more city parks than we first thought existed. Xi'an was beautiful, Chongqing and Shanghai also. But Wenzhou has to be seen to be believed. A lovely city full of parks, gardens and interesting, tree lined streets.
WENZHOU is situated along the south side of the Ou River, a broad estuary flowing into the East China Sea, which is not far off. The river is tidal, so the direction of the water changes from time to time. It is the same type of river as the River Yarra in Melbourne, where I lived for a year, as a Fellow in Microvascular Surgery. The Australians said that the water in the River Yarra is brown in colour because it flows upside down, with the mud on top and the water on the bottom. The Ou River in Wenzhou was the same. In Wenzhou there is a very long waterside park all the way along the Ou River: running path, grass, trees, many in blossom when we were there, and, in the evenings, people flying kites, that had lights on, twisting and turning in a type of crazy dance as they darted and cavorted in the up and down drafts over the river. In the river there is a lush green island playground with pagodas, gardens, playgrounds and historic buildings. A lovely place to go, by short ferry ride, on a warm Sunday afternoon. Then there is Nantang Park, running along one of the many inland waterways that run through the city. Dr. Jiang told me that this was conceived, planned and created by the previous mayor. It is a huge, picturesque place of beauty and relaxation right in the centre of the city. It has street performers, restaurants, art galleries and places for open concerts. There are pretty bridges over the water and lovely gardens. Wenzhou, like other Chinese cities was a mixture of old, intermediate and very modern. Right next to the hospital were some very old streets, some of which contained a vibrant street market, where it was possible to buy all kinds of things and many different types of food, cooked or uncooked, dead or alive. I was unable to identify many of the foods and commodities for sale! Much of the old town had been knocked down to be replaced by huge new buildings, many of which were stunningly designed and ultra futuristic. Dr. Jiang said he hoped they would keep some of the old town so that it would not be forgotten. There was a really quaint peculiarity about our hotel in Wenzhou. It was in the city centre but every morning we heard a cockeral, which started to crow at between 04.30 and 05.00. We never worked out where it was and there was certainly nothing that looked like a farm visible anywhere near where we were.
MEDICAL SYSTEM: I was told that there were no general practitioners. This may be true but I think the statement needs to be interpreted with care. I think there are general practitioners but they do not work as individuals or in small clinics, as they do in Canada. I think they are based in community hospitals, which are probably like big walk in clinics or medicentres. As I found out more about the hierarchy of the medical system, it seems that there is a kind of rating system, perhaps not formal, but as the people in the system see themselves. When I asked about the quality of different medical centres, I think the answer I got reflected geography and politics more than quality of care, teaching or research. The big city centres (Beijing, Shanghai, Guangzhou) were rated at the top. Then provincial capitals (Hangzhou in the province of Jhejiang, in which Wenzhou is located). Then the university centres in big cities like Wenzhou. In the cities, there are also non university general hospitals as well as hospitals, which offer less specialised services at two or three different levels. I think these are where people go when they need general practice type of care. I was also told that there are medical practitioners, who are not fully qualified doctors. They are like medical technicians and they provide some of the services for which people would visit a general practitioner in Canada.
TRADITIONAL CHINESE MEDICINE: I did not see this practiced at the 2nd Affiliated Hospital. Everything I saw was the the same type of medicine we practice in Canada. The anaesthetic machines were just like ours and the anaesthetic monitoring equipment was like ours (except that the readouts were in Chinese characters!) The type of surgery I saw done was as done in our hospitals, from the pre-op assessments, to the peri-operative care and post -operative management and follow up. When I asked about Traditional Chinese Medicine, they laughed and said 'the physiotherapists use some acupuncture and it may be good for pain conditions'. Very much the same as is done in Canada. They said it does not cure medical conditions. They did, however, give me some for the common cold, which I had for two or three days when we first arrived in Wenzhou. It worked far better than the 'Western medicine' common cold medication I was using!
ENGLISH: When we got to Sanya for the last few days of our stay, after being more than 4 weeks in China, we encountered the first Caucasian people we had seen since we first arrived in Beijing. Our trip to China was a total Chinese emersion experience. The people have been wonderful. People have come up to us and stared, taken my photo or said 'Hello, how are you?' in English. This seems to be all the English most people know because they lookedrather blank, whatever answer I give. Others, however, spoke more English and engaged us in conversation wanting to practice and improve what they knew. In the hospital, most of the junior staff could speak English quite well. They said they did 10 years of English in school. The thing they found difficult was pronunciation and speech. I think this was because there are so few natural English speaking people here. It is all leaned from books. Their English is, by and large, English English, as opposed to North American English, although they get some of their spellings a bit mixed up. One day I got off the lift (English English) on the 6th floor and the sign read 'Pediatric Orthopaedic Surgery'. A number of years ago, the Association of Bone and Joint Surgeons presented me with with the Nicolas Andry Award. In giving the named lecture, I explained how Nicolas Andry had developed the word Orthopaedic in the 18th century. It comes from the amalgamation of the Greek words Orthos (straight) and Paidion (child). Much of the history of Orthopaedic Surgery has been concerned with straightening out deformed children. The modern word Paediatric comes from the same root. Hence, I winced, when I read the 6th floor sign 'Pediatric Orthopaedic Surgery'. We found that people in China made great effort to communicate in English. Most restaurant menus were in Chinese so ordering a meal was a challenge for us but many of the servers had the ubiquitous iphone with built in English/Chinese translator software. So we managed reasonably well. We were careful to always carry a business card from our hotel, as a lifeline, so that we could take a taxi back if we got lost.
NORMAN BETHUNE.
I have not yet written about Norman Bethune himself in these 'Letters form China'. It would be remiss not to say something about him because I came to China as the 2018 Norman Bethune Scholar. Norman Bethune was a Canadian but is better known in China than he is in Canada. He was born in a manse in Gravenhurst, Ontario, on March 4, 1890. He qualified MD from the University of Toronto in 1916, after which he moved to UK, did a short stint in the Royal navy, and then went on to do post graduate training. In 1926, whilst practicing medicine in Michigan he was diagnosed as having tuberculosis. This caused him to move to Montreal and practice thoracic surgery. He is known in Canada for the work he did between 1929 and 1936, inventing and redesigning medical and surgical instruments for thoracic surgery, and writing 14 papers on innovations in thoracic surgery. He became increasingly interested in the socioeconomic aspects of illness. He thought that everyone had the right to good health care, regardless of their position in life. He proposed radical reforms of medical care and health services in Canada, based on social equity, but he was ahead of his time and those changes did not come about till years after his death. He seems to have been a man of strong personal convictions and decisive actions. In 1936 he went to Europe to fight fascism in the Spanish Civil War. He organised a mobile blood transfusion service on a 1000 mile front, something which had never been done previously and which saved many lives. He returned to Canada to raise more funds but became interested in helping the Chinese with the problem they were having with the Japanese invasion. He regarded this as part of the same strugglehappening in Spain. In 1938 he joined the Chinese 8th Route Army in the Shanxi-Hobeiborder region. He adopted the people and the cause as his own. It is recorded that he worked tirelessly, treating his own and enemy soldiers alike and teaching what he knew to local medical personnel. He died accidentally of septicaemia in Tang County, Hebei, China on November 12, 1939.
The Chinese know Dr. Bethune as Bai Qiu'en. One evening, at one of the formal dinners we attended in Wenzhou, a man came up to me and spoke about Bethune. The man was not a physician. He said that earlier in life he had been in the People's Liberation Army. He said they worshipped Bethune because he had made a difference. He went on to tell me that one of the things that is most remembered about Bethune is that he treated his own and enemy soldiers alike. He was greatly respected for this. He was also a tireless teacher and has been credited with laying down the foundations, which started modern medicine in China. The main reason why he is so well known in China is that, after his death, Mao Zedong wrote an essay entitled 'In Memory of Norman Bethune', in which he urged people to emulate his spirit of internationalism, his sense of responsibility and his devotion to others. This essay made Bethune's name almost synonymous with Canada, in China. Chairman Mao's essay became one of three prescribed articles for all Chinese people to read during the cultural revolution. This is still how Chinese people see Canada and Canadians. It is a great reputation for us to have. It has been a privilege for me to be able to play a small part in continuing the process of medical education, friendship and good will that Norman Bethune brought to China from Canada in the late 1930's.