Tuesday, October 26, 2010

On wet socks, nuns and the lovesickness carrying pavilion

Day 3: Wednesday September 23, 2010  

No shifts today. As the fifteenth day of the eighth month by the Chinese calendar, there is a national holiday for the autumn moon festival. This festival dates back over 3,000 years to the Shang dynasty. Our self dubbed “Chinese Father”, Dr. Wang, took the day to show us around Nanjing. It was pouring rain, which was a nice break from the heat. I did have to wring my socks out though, and could almost feel myself catching a cold.  The Nanjingians say that such a heavy rain is unusual for them in the fall; it is usually the nicest season weather-wise.
Our first stop was the Buddhist JiMing temple, which dates from the Ming dynasty and is home to nuns rather than monks.

There are still practicing nuns there and we also saw a man doing some sort of ceremony. He was dressed all in black and had a few people accompanying him holding umbrellas over him. He would take one step, announce something in Chinese, kneal down with arms outstretched and palms up, put his head on the floor and then stand up and repeat the process.  I believe he went around the entire temple in this way and it seemed the umbrella holders were folks who had taken pity on him rather than people he had brought along. There were many giant statues of the Buddhas, but it is considered disrespectful to take photos. They ranged from large metal statues to brightly painted ones with fierce eyes and swords. From the top of the temple pagoda we could see the beautiful grounds and also the cranes surrounding it. Nanjing is changing every day; the amount of construction here is phenomenal.

My favorite thing was actually the garbage can that looked like a dragon or maybe a ki lin. It was so cute!

Next we went to the brocade museum. Nanjing is famous for brocade, so we saw the silk worm cacoons and the giant looms that take two people to man them. Brocade must be handmade and it takes about a day for a team of two people to weave 5 cm of cloth.  The pattern is only on one side, but as they are weaving it you can see the pattern reflected in the mirror below the machine. In the past, brocade was most commonly woven from silk and gold thread for the emperor, whose symbol is the dragon. Some local students at the museum wanted to practice their English and shyly showed us around. They pointed out other patterns that looked like the dragon but had only four claws and no tufts on their heads. These are not dragons, so people besides the emperor were permitted to wear them.   

For lunch we went to an awesome Himalayan restaurant, where the food was rich but heavenly. I was freezing as my feet and clothes were wet, but the food made it all worthwhile. In the alley way next to it we saw a great sign about the Communist partay. Read the word bubble...you know you want to.
After lunch we visited Yuejiang Tower, which overlooks the Yangzi river.  This hill was the site of an instrumental battle in the ascension of the Ming dynasty. As I understand it, the first Ming Emperor, Zhu Yuanzhang, climbed to the top of the hill and looked out over the river. He then declared that he had read the river and thus read all of China, so it belonged to him.  

       The view of the Nanjing City wall was also quite good. I guess the Chinese like their walls. There were various amusing signs such as the “lovesickness carrying pavillion”. The paths were more foot reflexology paths, this time with the flower that is Nanjing’s symbol. As we were leaving, folks were readying a stage for what looked to be a swingin autumn moon party. I was sad to miss out on the fun, but the bus was leaving and I was still wet and cold.

Thursday, October 14, 2010

2nd Day of Clinic

Day 2: Tuesday September 22, 2010     Wildlife, Foosball and Moon Cakes

I woke this morning at 6:30am feeling quite comfortable and reluctant to leave my bed. Sleep still in my eyes, I stumbled into the bathroom to wash my face and brush my hair. As I was doing so, I noticed movement on the wall from the corner of my eye. It was something small and black, and my first thought was “great, a cockroach”.  Luckily for my neighbors, I have never been a screamer. Luckily for me, further inspection revealed that it was a really cute gekko rather than an insect of any kind. He is probably eating the mosquitoes too, so I was thrilled by the wildlife in my room.

Upon my descent from the seventh floor, I found that the continental breakfast was almost exactly the same as the day before. I guess five weeks of the same food is still better than having to make or buy my own breakfast. The most popular item among the Americans is a little number that looks like a rice crispy treat but is supposedly made with egg too. Other offerings are rice porridge with optional sugar, milk or really salty veggie bits, a giant pan of tofu, several kinds of steamed white bread, corn on the cobb, more fried tofu, sometimes squash, hard boiled eggs or tea eggs, white rice, stir fried cabbage and noodles. I would never eat this much processed food in the U.S.. The tea eggs are a favorite of mine though, I think they are made by hardboiling eggs in strong black tea and lots of salt. How the flavor gets through the shell I don’t know, but I love it. We have taken to calling this spread the “white breakfast” since it is fairly devoid of color.
Having gotten my bike, I decided to try and bike to clinic with Grant. It did not go well. The route looked clear on the map, but once we got on the road it became abundantly clear that a) not all the roads were on the map, b) the street signs were mostly in characters and not pinyin (the roman alphabet spellings) c) street signs in China are not at each corner but apparently spaced at random and d) no one knew what the heck I was talking about when I tried to ask directions. Grant was the best sort of companion to have on such an adventure, very patient and calm. We finally found our way to the hospital through random alleyways and with the assistance of one kind stranger who spoke English.  I did not feel so calm myself by the time we showed up an hour late, but Dr. Qiao was very understanding. She did advise us to take the bus next time and we got the impression that all the Chinese coordinators didn’t really understand why the crazy Americans wanted to bike everywhere.
Clinic was horribly hot again, making it hard to cool off after our crazy adventure. I would have done anything for some cold water, but Dr. Qiao’s assistant gave us hot tea instead. This is what everyone drinks in China, no matter how hot it is outside. Partly this is because all drinking water must be boiled first and partly it is because it is better for your “Spleen Qi” or digestive function.
Clinic was just as interesting as the day before. We saw some of the same patients and some new. In the U.S. it is most common for a patient to get acupuncture once or twice a week at most, but in China patients expect to come in daily. This is great, because in the past I had often noticed that patients reported feeling better for a few days after a treatment but then their complaint worsened again before their next session. The effect of acupuncture is cumulative, so daily treatments are really ideal for many situations we saw like facial paralysis and severe or acute injuries and colds. Seeing patients two days in a row also helped us track our effectiveness, as there was no time for patients to forget any change in pain or functionality after the treatment.
 I saw a few techniques that were not employed much at OCOM, such as Yang Ci, (five needles surrounding technique) around DU14 for severe back and neck pain. Cupping over needles was another skill that we had been told about but not shown at OCOM. The patients did not seem uncomfortable at all with either technique, and they appear to be quite effective. Cupping looks strange, but has been used in China (and many other countries) since at least 1,000 BC. The way it works is that a burning cotton ball is inserted and quickly removed from a glass cup. The cup is then quickly placed on an area of bare skin to create a suction seal. The cup is not hot or painful, but makes the skin feel kind of tight. After the cup is left there for a half hour or less there are red dots that appear on the surface of the skin. This is the congested blood in the area and the Chinese call it “sha”.  The marks look a bit like bruising in photos, but are much more superficial and not painful. Once the sha, or stagnation, is sucked up from the deeper levels the body is better able to get rid of it as well as any heat or toxins that may have been stuck in the area. The really interesting part is that the more stagnation an individual has, the darker the area under the cup will become. In Chinese medicine a famous principle is “with stagnation there is pain, with no stagnation there is no pain”. Thus cupping is appropriate for a lot of complaints, but I have never seen so many cups used at one time before. Dr. Qiao also uses cupping on the abdomen for weight loss and for cough and phlegm in the lungs. 

After the morning shift Dr. Qiao gave us moon cakes, as tomorrow is the autumn moon festival, a national holiday. These are beautiful cakes with various fillings like red bean or green tea. Most of them are sweet. On the way out of the hospital we saw various other doctors giving each other moon cakes as well. One doctor was actually chasing another, trying to give him a moon cake while the second doctor tried to dodge around people and escape down the elevator. It was a cute chase scene. For the autumn moon festival most people take three days off and go home to eat a big meal with their family “like Thanksgiving” according to Dr. Wang. It is also a fairly romantic holiday, as people sit and watch the moon in the evening. The moon is supposed to be nearest and brightest on this day.

We received more moon cakes from Nanjing University of Traditional Chinese Medicine, our hosts, at our welcome ceremony after lunch. There were speeches and a group photo shot. The room where they speeches were conducted had a life size bronze “acupuncture man”, a replica of a famous statue created by Wang Weiyi (c. 987-1067). This statue was used for Imperial acupuncture exams in ancient China and had holes for 657 acupuncture points. The statue could be coated in thick wax and filled with water. When an acupuncture student inserted a needle in the statue, water would drip out if the point had been located correctly. In a way, I envied those acupuncturists of the past, as my point location exams were conduced using live partners and no two people are shaped exactly the same. 

After the ceremony, they fed us as the big swanky Sheraton hotel buffet. The OCOM group then adjourned to the Nail Bar, a “jazz club”.  Not hardly, at least by Portland standards. But the drinks were drinkable and the murals on the wall were hilarious. In one, Louie Armstrong appeared to be biting his trumpet for some reason. Others featured world leaders playing foosball and drinking beer. It was a full day.

Saturday, October 9, 2010

1st Day of Clinic in Nanjing

Day 1: Monday September 21, 2010

First day of clinical shifts: Three other students (one from Italy) and I were assigned to Dr. Wenlei Qiao’s acupuncture shift at the military hospital 454. She speaks great English while most of the other Chinese doctors work through interpreters, so I feel fortunate. Apparently she came out of retirement to work with our group because she has a personal connection to Dr. Jin from the Oregon College of Oriental Medicine (OCOM). She has taught throughout Europe and started learning acupuncture at age 17. The shift is set up so that she interviews the patient in Chinese and gives us the salient points. We then look at the tongue and feel the pulse and she tells us the diagnosis and what acupuncture points she will use. Then she has us locate the points and put a dot of iodine on them so she can check their locations.
The OCOM students in the group are all Masters of Acupuncture and Oriental Medicine, so we have already been locating points and needling for years. We have passed four national board exams and many more at the college about every aspect of acupuncture, Oriental medicine, western medical precautions and safety.  We have logged hundreds of hours of treating patients in the intern clinic.
However, Dr Qiao is very particular about her point location. Her philosophy is to hit the point exactly and use a smaller gauge needle with less manipulation. This way it is very comfortable for the patient and also very effective. She asks us to locate several of our points a millimeter or two off from the places we learned in school. Then she has us needle the points and makes sure everything about our grip and the angle of insertion of the needle is exactly perfect. She also demonstrates her bloodletting technique, which she does on many of the patients. Most patients in the United States do not like the idea of bloodletting, but many of her patients are return cases that she has treated before. They come back because her treatments work, and because she has a gentle touch. She gets about 10 drops of blood from each point she bleeds, sometimes cupping the area to draw more congestion to the surface. She explains that by letting a few drops of blood out, the microcirculation in an area of pain or swelling is improved.
We have a shift from 8 am to 11 am and then take the afternoon break or ‘xiu xi” for three hours until 2pm. Today we had no idea where to go to eat, so we wandered near the hospital with Alberto, a student from Italy. We eventually found something that looked like noodles at a stand selling pig ear and duck feet etc. I also ate some rolled up thing that they chopped and put into a light broth. My two dishes cost 6 yuan, very cheap. It took a lot of pointing to get our food, as my Chinese is not really up to snuff. The others in our group of four speak no Chinese at all. The vendors seem to use hand signals for specific numbers. These are intuitive until you get up to six. Then I hand them a bigger bill and wait to see what they give back.
 After we got food, we walked forever. It is horribly hot and humid in Nanjing, even in my skirt and tank top. Apparently even the Fu Dog statues were thirsty, because we saw one with a juice box in its mouth.

 We tried to walk to a park I had seen on the drive to the shift so we could sit down. Eventually, Alberto got tired of walking and we sat on a planter hemmed in by bikes in the middle of the sidewalk. It was not clean.
After eating, we walked two more blocks and found the park. It was beautiful, with statues, trees, a lake and an amazing rock structure full of holes that looked volcanic. There were even bridges and boats on the lake and older people playing cards in a pavilion. We also saw older folks holding on to trees and doing knee bends and various other exercises.

The paths were made from rocks set to make nice patterns. You can walk on them to get a kind of rough foot massage. Foot reflexology is big in China. The simple explanation is that according to Chinese medicine each part of the foot corresponds to a different organ or part of the body. Over time blood circulation in the feet stagnates and metabolic waste products build up. By promoting blood circulation in the feet, a person’s overall health is improved.

We couldn’t stay long at the park, because we had two more hours of clinic. They were much like the morning, only hotter, and I envied Dr. Qiao, who didn’t wear a shirt under her lab coat. In the United States such a gesture would definitely be misinterpreted, but the temperature was so high that the patients seemed to think nothing of it. The lab coats here have short sleeves and are much lighter weight too, so I may have to get one. It was probably 90 degrees in the clinic.
After the shift we all went to dinner and had something with a duck head in it that no one ate. I did eat a chicken or duck foot though. Apparently the collagen is good for your skin. They taste like chicken (doesn’t everything?), but they are hard to eat because they are mostly bone. 
Next we bought bikes. I got mine used with a basket, rack and bell for 150 yuan. The exchange rate I got was 1 US dollar to 6.68 yuan, so that was not too bad. Most people paid up to 300 dollars for newer, nicer bikes. I offered 80 yuan for a starting price of 180 yuan and the lady actually laughed at me and walked away. Not sure if that was a bargaining tool or if she had really given up on me. In the end though, that bike is quite comfortable and I got a lock for free. Beth, the group leader, and Ross, another student who lived in Beijing for six months bargained for bikes for 10 people that night. That was something to see! I think Ross enjoyed haggling, he seems to find the Chinese custom of communicating at a yell endearing. They let us test drive the bikes up and down the crowded street, so you can imagine the mayhem. Dodging fruit carts, taxis, other bikes and mopeds while trying out brakes was a one of a kind thrill.  
After the bike extravaganza I went to get foot reflexology. It was really painful compared to the way we do it in the U.S.. The motto here seems to be no pain no gain. The shop also up sold me to a higher price and a better massage than I wanted because they didn’t understand what I said. It was still only about five U.S. dollars for an hour though. My feet felt awesome after that, they had been kind of swollen and painful since the flights. That was enough for one day, so I went back to the hotel and slept well.