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.

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.

Heading to Nanjing

Flight in and Shanghai

Well, I made it to China with no missed connections, which had been a major source of stress for the past month or so. However, I did not see the other person from our group that I had expected to be on the same flight. The flight in Portland was delayed an hour but my layover in San Francisco was plenty long to make up for it. I wandered around and bought some Imodium for an extortionate price.  They know you are trapped when you are in the airport and frankly the prices go up after security because they know it is a pain to go back out again. I went through security three times.
I wish airports had a yoga room or someplace to stretch and get your legs up over your heart between long plane rides. As it was I tried to stretch near the gate without attracting too much attention to myself.
I had a bad moment when the in flight display enroute to Hong Kong said the flight would last 16 hours. That would have put me getting in after my connection to Shanghai left, but more importantly I would have gone stir crazy and possibly wrecked the plane by that point. As it was we had a very nice flight at about 12.5 hours. This was the first leg with a Chinese airline. The flight attendant spoke good English but when I asked for a screwdriver to drink she said “I’m thinking I am screwed.”
The in-flight entertainment was fine, but I think I played bejeweled too much because the flashing lights caused a blood vessel in my eye to burst.

At the Hong Kong airport they had all sorts of Chinese patent medicines and every possible liniment for sore muscles instead of the aspirin etc they sell at such stands in the states. I thought it was awesome but overpriced. I finally got on the plane to Shanghai where they offered me my second dinner in three hours. I passed on everything but the red wine and coffee ice cream. Customs didn’t inspect my stuff at all and the baggage claim was shockingly fast but hard to find. I couldn’t read any of the signs so I followed people whom I recognized from my flight.

I was relieved to find our group leader and Chinese Liaison, Dr. Wang, waiting for me with a bus. It was midnight, China time and the other student from our group had missed his connection in San Francisco due to the fog there, turning his journey into a 40+ hour monstrosity. We took the bus back to the hotel in Shanghai, which was a nice place but has the most confusing light setup I had ever seen. By the time I got to my room it was about 2am and I unlocked the door and groped for the light. After about 15 minutes of bumbling about in the dark I finally figured out that you have to insert your key card in the light and leave it there, then push the correct combination of other buttons. Some are for the fan, some the bathroom, one the TV and one the room light. There were several banks of the suckers and when I finally fell into bed I felt like I had really accomplished something with my day.

Key in the light?

So Confusing!

Shanghai to Nanjing

I woke to a beautiful view of the bridge and river across from my room at the hotel. I then went downstairs for the continental breakfast, which made it abundantly clear that I was now in fact on a different continent. It was delicious, but I wasn’t entirely sure what some of it was. There seemed to be a lot of very salty pickled veggies and some good dumpling type things (Bao Zi?) as well as a sweet porridge and a millet porridge I liked.

Almost the entire group was at breakfast except for my poor companion still on the plane. Some of the others were full of interesting stories about seeing a monkey drinking coke in Hong Kong and a massage place in the hotel. After breakfast we found that the massage place was closed and I noticed that the ‘elevator with a double window” I had seen the night before was really an elevator with a mirror in it. Also, the “park” across from the hotel was just an overgrown green triangle of land. The flora even in town was quite beautiful though, reminding me of California quite a bit. There was a river flowing through town and a school with students in identical track suits sitting on some gym equipment near a track.

The traffic was crazy of course, a mix of bicycles, scooters and cars all packed together. Traffic laws in China seem to be more of a suggestion than a rule. If you want to ride or drive on the wrong side of the street or go without a light it seems that no one will stop you. The honking is constant. There does seem to be a lane that is mostly bikes, scooters and pedestrians almost everywhere. It is divided from traffic but apparently cars or taxis can go in it if they want to.

We spent a lot of time at various herbal pharmacies pointing at things and trying to figure out what they were in English. My favorite find was a manikin that looked like it had been to the crash test dummy hospital. Apparently they sell a brace for just about every part of the body.

Eventually we all bought water and loaded our luggage on the bus for Nanjing after meeting up with our last member to arrive. We saw the Shanghai World Financial Center, the 3^rd tallest building in the world, some factories, a brief glance of Suzhou and some nasty bathrooms on our way to Nanjing. Many of the toilets here are holes in the ground (they do flush) that require you to bring your own tissue. Eventually we reached Nanjing and checked into our hotel, which is quite nice.

3rd Tallest Building in the World!

My room has a view, a shower that mostly works, a teapot that was fine once I scrubbed it out with iron wool, a comfortable bed, a fridge and a TV. The only thing not up to American standards besides my tea kettle is the carpet. There are no non-smoking rooms in China, so there are cigarette burns and a floor in China is never walked on barefoot or sat on. My room doesn’t smell like smoke though and has a live plant and some fancy plate decorating the alcove above my fridge so I am happy with it. My only complaint was that the internet connection did not work at first. By the time we settled in we were all starving and walked to a restaurant decorated with pictures of Chairman Mao doing all sorts of wise and remarkable things. The décor was dated and no one referred to anyone else as “comrade” as far as I could tell, so I think that was just their thing. The food was good but so spicy that I was drinking other people’s beers and anything else I could get my hands on to try to put out the fire in my mouth until the rice arrived. I went to bed excited for my first day of clinic the next day.

Coming Soon, Frances in China

When I was young I was fascinated by Marco Polo and his journey to China. It wasn’t quite as interesting as botany or martial arts, but as far as academic subjects went, I never minded writing papers about him.  Little did I know that I would eventually end up in China myself. By the time I was ready to choose a career, my interests would all converge and send me to the Oregon College of Oriental Medicine (OCOM). Once it became apparent that that acupuncture and Chinese herbology were my life path, it also made sense to go back to the birthplace of these ancient healing modalities. I don’t know how the trip will turn out, but I’m sure there will be plenty of surprises. I hope to bring back some amazing medical knowledge to help my patients in the future. Therefore, I am now taking my limited knowledge of Mandarin and heading to China with fourteen other students from OCOM!

It is 10:10pm the night before my 7:35 take off. I am finishing up packing and asking myself questions like: How strong is the coffee in China? Can I buy Immodium in bulk? Should I take my bike helmet to China even though no one uses them? Which clothes do I want to abandon in Nanjing to bring my sweet haul back to the states? How many novels can I read on the 14 hr flight? And perhaps most importantly: Where is my towel? Seriously people, it should be a fun ride. Stick around because I expect the posts to get a lot more interesting soon.

P.S. I will not have phone service in China and Facebook is blocked by the "Golden Shield", so email, Skype and this blog are the best points of contact with me.