Hoi See's Blog

Letters home...

2008-05-21T21:05:00.002+05:30

So, to conclude, I thought that it would be nice to include something called "letters home." These are letters written by our IHP traveling fellow, Casey Welch, at the end of each country and mailed to our homes to update our families and friends on our adventures in each country. I hope that they'll give you a quick summary of the past four months. :)

Geneva, Switzerland - Letter Home
January 27, 2008

Composed by IHP Trustee Fellow Casey Welch

This is how we write the date in Genève. We write manz other things a bit differentlz, too, if we happen to be touch-tzpers and simplz cannot adjust to kezboards on which the ‘z’ and the ‘y’ have been switched. You don’t realize the rather high prevalence (or is it incidence?) rate of the letter ‘y’ until faced with such an obstacle.

Yes, launching this year’s Health and Community program in a foreign country has certainly added an extra element of cultural immersion to the usual orientation of the semester, which we feel has heightened the intensity and excitement of the experience for all of us. The prevailing sentiment voiced is that we were “thrown right into the thick of things”—culturally as well as academically and socially. This challenge has been taken up with gusto and we have managed, collectively, to hit the ground running. Seven days in Geneva has felt like weeks, despite having very limited free time to explore the city. After all, just getting back and forth to classes and attempting to feed oneself in a foreign place are sometimes challenging activities that have the potential to reveal much about the behaviors, ideology and values of the surrounding community.

Take transportation for example: In Geneva, public transport is ubiquitous and efficient, as one would expect from the Swiss. But the reasons for this go beyond merely the precise accuracy of timepieces in the country; another significant contributing factor that allows trams and buses here to operate without undue delay lies in the very functionality of the Genevese society itself. A city made up of 44% foreigners representing over a hundred different nationalities and ethnic groups, Geneva’s civil society relies on consensus in order to survive. That is, by and large people respect the agreements/rules that are made as far as responsibilities and acceptable conduct are concerned. So, while public transport is not free, there is no delay in service that might arise from any system of ticket collection upon entrance because there is none. Therefore, multiple sets of doors can be used simultaneously for both unloading and loading of passengers, who are in turn able to step in quickly because they are not required to present their ticket to a person or machine. Only on rare occasions might an enforcement official ever ask to see someone’s ticket, yet we are told that the honor system in place is seldom violated.

Perhaps the reason few people attempt to cheat the public transport system is because so many of them are wealthy. Based on the shockingly high cost of food and other necessities, we assume that much of Geneva’s populace is quite well off. A personal quest for lunch that wouldn’t break the bank was a daily struggle for most of us, but one which was usually rewarded with delicious and plentiful dairy products. Fondue de fromage was a big hit (at least during the consumption- if not digestion-phase) along with creamy brie, chevre, camembert, gruyere, gouda, and other delectable cheeses. Butter, yoghurt, milk, and cream-based desserts also rounded out a week in dairy heaven. And, throwing down $2 for a tiny hand-made chocolate truffle was undeniably worthwhile.

In addition to personal experiences of eating and getting around, we explored other facets of Swiss cultural behavior more explicitly in our first assignment from the Community Health Research Methods class. In small groups, students conducted field observations and wrote up reports on their findings in areas such as mobile phone use in public space, grocery shopping, and smoking. Julia Bienstock turned the microscope on our group itself, gathering quantitative data on instances of students (and faculty) falling asleep in class (or, exhibiting “the head-bob,” as she terms it). This study resulted in a lengthy in-class analysis of the myriad possible causes of head-bobs, including jet lag, sickness, the presentation style of the speaker, etc., and how one might cope with outcomes that may have similarly numerous confounding factors when creating public health studies. For example, by focusing on the variables for which interventions are actually possible instead of trying to determine each and every precise cause of a phenomenon, observation data can be targeted to become more useful.

Our group’s first attempts at ethnography were happily not our sole source of enlightenment on the life and times of the Genevese society. We were fortunate to have been hosted by locals who direct SIT’s academic program in the city, Dr. Earl Noelte and Anne Borrel. They guided us both literally and figuratively through our Geneva experience and shared their considerable contacts with us. The task of describing the person of Earl Noelte to you who have not had the considerable pleasure of his acquaintance was too daunting for me to face, so the description here transcribed has been supplied by a particularly talented and Earl-sessed member of our group, Miss Glencora Gudger: “Earl is not unlike the Swiss Alps—majestic, refined, and awe-inspiring. Not only did we admire his chic style accentuated by his immaculately tied scarves, but also his astounding intelligence that captured us all. Earl, also an avid figure-skater, effortlessly guided (glided?) us through the Swiss streets with poise and grace. He is not only a former diplomat who has worked in every department of the UN, but also fluently converses in eight languages. Earl’s experience served us well. He was able to provide us with an eloquent and extensive overview of Genevese culture, the UN, WHO and local hospitals. Just ask any IHPer, they’ll gush about every aspect of Earl.”

Truly, a stellar array of guest speakers and site visits were set up for us by Anne and Earl, and the IHP faculty team devoted a great deal of time and discussion to making sense of it all during daily synthesis sessions. With such a diverse student body, there are inevitably some members of the group that are able to follow a given lecture with ease and ask thought-provoking questions on the topic, while others struggle with concepts and new terminology, as their studies have focused on a different discipline entirely. We see this as a great strength of our group, and plan to utilize one another’s varied knowledge bases and skill sets for the benefit of the whole learning community as the semester goes on.

After our week in Switzerland, we now move into the India portion of our program armed with a much clearer overview of the major global players in the field of public health than any of us had had before. We’ve visited with experts at the European Headquarters of the United Nations, the World Health Organization, and the Hopitaux Universaires de Genève; we’ve spoken with people who represent such non-governmental organizations as ICTSD, FOSIT, and Médecins du Monde; we’ve waded neck-deep through a veritable river of acronyms while investigating such topics as the World Bank, WHO, GATT, WTO, IMF, SAPs, TRIPs, TBTs, GATS, UNDP, UNAIDS, UNCTAD, IGOs, NGOs, BRICs, and so many more. We feel we’ve had a good dose of the top-down view of international public health and are anxious to reframe our perspective in India to the bottom-up view, something we’re confident our activist coordinators there will be able to provide!

Au revoir!

Finally, I leave you with some superlatives we came up with after some rather non-technical polling in the airport departures lounge:

Best food in Geneva: a tie between cheese fondue and chocolate

Biggest cultural faux pas committed by one of us: Our collective lack of fashion in such a fashionable city

Favorite speaker: Dr. Bernard Hirschel, Division des Maladies infectieuses, unité VIH/SIDA, HUG. This rather frank and jovial pathologist explained to us the biological mechanisms by which the virus infects, as well as various treatment regimes and their side effects, all whilst wearing this classic, long white lab coat and coming off as an incredibly professional cartoon scientist.

Greatest misadventure: That would be the failed attempt at going to France (which is visible from where we were staying) during our only afternoon off which was endeavoured upon by at least half the group. Nyon was as far as they got, where one student, who wishes to remain nameless, decided to leave behind his/her jacket (with passport inside) when they returned to Geneva. Student X, accompanied by Brooks, managed to re-travel the round-trip train journey in time to successfully retrieve the estranged document, though barely. (They caught the last train of the night coming back from Nyon, on the night before our 7:15 am departure for the flight to Bangalore…) The amusing post-script to that tale was the part where Glencora and Claire were dispatched on a high-speed mission to inform me of the situation and got on the tram going the wrong way. They then proceeded to wait, speedily, at the next stop for the tram that would carry them in the right direction and by that time ended up on the same car that the others they had left were on.

India Letter Home
January 28 - March 4, 2008

Composed by Casey Welch, IHP Trustees Fellow

When you are told your new time zone lies ten and a half hours ahead of EST, you begin to suspect that you are entering a very special sort of place. When a large, unhurried cow is found blocking the path of your vehicle in the heart of downtown Bangalore, an urban center of 6 million people, your suspicions are totally confirmed. (A seeming contradiction to the belief in the holiness of cows, these animals, lacking adequate grass in the city, are usually seen consuming piles of garbage that contain organic matter in addition to plastics of various exciting shapes. Which begs the question: just which stomach does this refuse get stuck in? And while we’re on the subject of animals in roadways, it is also not uncommon to find goats and dogs alongside the cows, with the occasional elephant or camel thrown in for good measure.) Even when you come to India with the expectation that it’s absolutely going to blow your mind, you find that it does not disappoint.

This is a land of stark contrasts: delightful aromas of onion utthapam and coconut chutney intermingle with those of burning plastic fumes; women in flowing sarees of every possible eye-bending shade stroll along dusty, littered streets where 3-foot-deep holes in the sidewalk threaten to swallow them; the addictive melody of the Bollywood hit “Om Shanti Om” competes with a cacophony of horns (not to mention the reversing-music each car seems to personalize here, not unlike the way we do with cell phone ring-tones. You know, so you can hear the dulcet tones of “We Wish you a Merry Christmas” one last time before someone backs over you.) Beyond these sensory extremes, we are simultaneously spiritually enchanted and emotionally assaulted.

Intellectually, we are “crazed out,” as one student put it. One day, five chapters into Yunus's Banker to the Poor, the Grameen Bank is discovered as the be-all and end-all of eliminating poverty. But the next day a compelling feminist guest speaker whose lecture moves us to the point of tears happens to disagree fundamentally with the very idea of microcredit, and we are left reeling. If two such eloquent, compassionate and righteous people can disagree so, then what hope do we have of figuring it all out? As seekers of truth and justice, we desperately resent the impossibility of discovering neat solutions and infallible guidelines for these confounding issues.

It would be futile to attempt to explain in this letter all that we’ve seen and learned in India, but a few dominant themes stand out. First, we gained an appreciation of the issues surrounding access to water in Bangalore by visiting low-income neighborhoods (aka slums) at dawn to see for ourselves what it looks like when 3,000 people share four spigots that only work for a few hours every other morning. Thanks to translation by our friends at the Environment Support Group, we were able to hear accounts from women who start to line up at 2 AM to be sure to obtain their water for the next two days. We then followed the path of the water to its ultimate destination at a secondary wastewater treatment facility, which is a sort of dubious open-air sludge Jacuzzi, as we contemplated the fact that 80% of the problem of water contamination in India is due to untreated domestic human sewage. While enjoying an outdoor classroom at the hotel where we concluded the program, we had to pause five or so times for the noise from the large truck engines laboring up the hill—carrying our water. Meanwhile, at the government Ayurvedic hospital we’d visited in town, we were informed that they were only able to function at half their 100-bed inpatient capacity due to a shortage of water. Some students opted for a bucket bath that night. Others considered it and took a blissful hot shower instead. But they tied this self-awareness into our discussions of public health interventions which revolve around changing people’s behaviors—we understand now that knowledge alone is often insufficient.

Along with access to water, we looked at access to healthcare, both in urban Bangalore and in rural, tribal areas of Karnataka and Tamil Nadu. After receiving a lecture on how the Indian healthcare system is supposed to work, which sounded pretty reasonable in theory, we had a panel discussion with some working poor about where they go when they fall sick, and what their experience is like. The panel consisted of a young auto-rickshaw driver (who worked two other jobs besides, catching intermittent naps totaling roughly four hours of sleep per day), an old ex-farmer, a house maid, and a security guard. The phrase “dehumanizing treatment” appears boldly in my notes. In theory, those who fall below the poverty line—set at 10,000 Rs per year, about $250—are supposed to receive a “yellow card,” which entitles them to free healthcare. Ignoring the fact that a significant percentage of farmers (coincidentally?) earn about 10,500 Rs, or $262 per year, this yellow card sounds like a good idea. In reality, the difficulty involved in obtaining the card deters many who would be eligible, as they would have to miss precious income-earning workdays to wait in line to get it. Even those who obtain the card have difficulties, as it only covers the official, legitimate costs of treatment. As we learned from this panel, there exists an informal but insidious system of “tipping” which must be followed or service is denied. Tips must be given to the person who registers you, to the person who cleans the toilet, to the person who pushes your wheelchair. You must tip to get a decent bed. God forbid you don’t tip your nurse immediately, or she will be intentionally ungentle when finding a vein—or nerve—with her needle. As we were told by a former “Vigilance Director,” of the ten sectors of government for which corruption is analyzed, healthcare is second only to the police, and there are even stories of people being refused urgent life-saving procedures until the doctor’s bribe is paid.

Outrage began to percolate. Dr. Tekur informed us that only 1.3% of India’s GDP is used for healthcare. We also heard that thanks to globalization and Monsanto, 18,000 Indian farmers are committing suicide every year. (That’s one every half hour or so, and those who don’t swallow pesticide are leaving the land in droves.) Madhu Bhushan, a woman’s rights activist, told us that every day in Bangalore, three women die of unnatural causes within the institution of marriage. And here’s the thing with IHP: we could have read these disturbing statistics from the comfort of our college libraries; instead, we learned in our Indian classroom that 60% of women here are anemic and then accompanied a midwife on her rounds and actually saw the yellow eyes and weakness of each woman, in the flesh. We’ve all read before that sanitation and dysentery are major problems in poor areas, but it’s suddenly a lot more real when you walk past the slum a few blocks from your upper-middle-class homestay and actually see a small child experiencing his diarrhea, right there on the sidewalk, outside the atrociously maintained public toilet block. Bearing witness to people living out these statistics cultivated the sort of empathy that will keep us from giving up when problems seem too daunting.

Thankfully, after weeks of grappling intellectually and emotionally with the health challenges facing India’s poor, we were able to spend several uplifting days doing case studies of projects which are managing to affect positive changes in areas that previously lacked adequate healthcare. The personal commitment and dynamism of these projects’ founders inspired us all and provided the glimmer of hope that we needed to go forward. Each has a story as remarkable as the next, but here is one example:

Dr. Sudarshan was a successful urban physician who chose to move to a tribal area that had no access to western medicine. He lived in a small hut while he visited each family in the region, having tea or dinner and chatting with them about everything except health. He learned the ways of the community and slowly gained the people’s trust. After a few men with severe wounds allowed him to suture them, people realized the efficacy of his healing techniques and began to allow him to treat other health problems. He proceeded to eradicate leprosy in the area, and is well on the way to doing the same for polio. In the course of his work, Dr. Sudarshan listened to the community members and altered his own outlook on the appropriateness of care as dictated by the western system. For example, he realized that it is actually for the doctor’s comfort—not the mother’s—that women deliver lying on their backs on a table. In this tribe, women prefer to squat and hold a rope. So there is an option for this at his hospital, which has grown to hold 20 beds and serve many thousands of Soliga tribals. He also realized that the health of a community is inseparable from other aspects, such as education and economic self-sufficiency, so he started a school from which 4 of the 6 students in the inaugural class now hold post-graduate degrees.

While we were exhilarated and heartened by all of our case study hosts, not all of our confusions were put to rest. People in each of these places, in their wisdom, adamantly refuse to hold their methods up as models for successfully aiding communities in need. A cookie-cutter approach is inherently flawed, as every community will have its own unique set of issues and cultural norms which will determine the success or failure of any attempt to intervene. For example, we learned from the Karuna Trust that it is tricky to implement a health insurance scheme when the very concept of planning for the future is absent from the culture. Likewise, it is hard to get proper consent for care of a pancreatitis when the patient you are explaining it to is not aware that he or she even has a pancreas. We are realizing how important cultural understanding really is when it comes to communication, which begins with knowing what the right questions are before seeking answers. To elucidate this point: when given an opportunity to ask us any questions of their choosing, a group of tribal women who had been trained as nurses wanted to know, “What crops do you grow?” We are leaving India with a whole new level of humility as we accept the fact that we are ignorant of many things we may not even be aware we are ignorant of. In a way, I think this is the most valuable knowledge one can gain.

Wow, this is way too long already and I haven’t even gotten to the part about the wild tusker charging us during our journey to Wayanad, when we realized why people dig massive trenches and erect electric fences around their land… Or the bit where we got a flat tire on the way to the Gurukala Botanical Sanctuary and walked the last mile or so, meeting a tea farmer along the way and stopping to chat. He mentioned the price for his tea has been falling, and when a student asked why, he responded with one heavily accented five-syllable word: “glo-ba-li-za-tion.” I didn’t tell you about holding a morning yoga class outside our classroom and having a random dog walk up, stand in the circle, and proceed to stretch himself in an exaggerated fashion… Or the time when we did the hokey pokey with a group of tribal women and life became at once sublime and surreal… I never got to describe our traditional market scavenger hunt, or the silkworm auction… Or the way each virus is represented by a goddess and has its own temple (like the plagueamma and AIDSamma temples)… Or about how the waiter at S.L.V., due to strong personal aesthetic objections, wouldn’t let Michael eat naan without gravy. As in refused… Or the fact that Leo Saldanha, our coordinator, could not be with us for the last two weeks, due to legal action against him as a result of his involvement in a protest to save children’s artwork from bulldozers… Or our visit with the tribal community of Kanavu who celebrate life each night with song and ecstatic dancing, which they managed to elicit from every last one of us...
And don’t even get me started on the food. Oh sweet mercy, the food. This deliciousness was provided, most often, by our incredibly gracious host families, who not only fed and housed us but who also served as invaluable cultural brokers in the wilds of Bangalore. They taught us how to cross the street, how to eat with one hand, how to wear a saree (or a doti, aka manskirt), how to arrange a marriage (applications are involved), how to play cricket, how to consume pani puri, and how wonderful Indian people are. We will miss them, along with Leo, Bhargavi and the amazing staff of ESG.

We thank them all, and we thank you, our families and friends back home who support us from afar.
Namaskar.

p.s. In the spirit of hope, I’d like to leave you with a couple of quotes from Swami Vivekananda, or, as some students call him, “the man”:

“Give me a few committed youths, and I will change India’s destiny.”

“Be not afraid of anything. You will do marvelous work. The moment you fear, you are nobody. It is fear that is the great cause of misery in the world. It is fear that is the greatest of all superstitions. It is fear that is the cause of our woes, and it is fearlessness that brings heaven in a moment. Therefore, Arise, Awake and stop not until the goal is reached.”

p.p.s. Please check out the wonderful work being done by some of our case study hosts, coordinators, and guest speakers here in India:

www.ESGIndia.org
www.karunatrust.org
www.tribalhealth.org
www.navadarshanam.org
www.svym.net
www.sangama.org
www.samuha.org

Letter Home from China
Student observations compiled by Casey Welch, IHP Trustees Fellow

Driving into Beijing from the airport we are greeted by uniform rows of trees lining the roadside, straight as fences, and I wonder if I’m looking at a metaphor. Are the residents of this famously Communist nation forced into similar submission by a controlling government that allows no space for the organic chaos of nature or dissent? After a few days in the city I seek refuge in a park, hoping for a green softness to take the edge off the glass and metal skyscraper cityscape and what do I find? The park is essentially paved. As my reactionary indignation begins to gestate, I look to my left, to my right, behind me, and realize: I am surrounded by wheelchairs. The elderly are everywhere—wheelchairs cluster around the mah jong tables, other folks are using the primary-colored upper body public exercise equipment in the corner, more are tracing slow circles around the fountain with their walkers. My indignation retreats sheepishly as it dawns on me that it is the very paved-ness of this park that makes it a place that can be enjoyed by China’s disproportionately large aging population, --million strong. Oh, the lenses we wear.

Recognizing how easy it would be for me to write our whole group’s “letter home” from China solely from my own terribly personalized perspective, I’ve decided this time around to share the words of others on this wild ride we call IHP. Here is what one particularly eloquent participant had to say:

"Beijing is new and massively designed: every boulevard as wide as a freeway – 3 lanes in each direction plus another wide lane for bicycles, lined with enormous brand new high rises mile after mile after mile, huge emporia, billboards, luxury apartments, university campuses, subway systems. It's also shiny and clean, if you ignore the strange and menacing forms of air pollution: the noxious, choking fogs, the winds blowing toxic sandstorms from Inner Mongolia, the strange grey construction dust that covers everything inside the house even with the windows closed. And yet, I am told, this is nothing. This is a 60% improvement over 10 years ago (gov't statistic, hmmm). In preparation for the Olympics most factories around the city have been relocated elsewhere, subway and bus tickets have been halved to encourage public transit use, and older diesel trucks are only allowed into the city at night.

Great expense has been taken to make the city what it is – a modern, world-class city – and everyone is terribly proud and excited about the future. This summer’s Olympics are the crowning achievement -- international recognition of China's entry onto the world stage as an equal player. All signs of poverty have been swept away somewhere, there is not a beggar to be seen in Beijing, not even a migrant worker in torn clothing, and yet most of China's citizens outside the city live near the poverty line of $2/day…"

Others had sunnier outlooks, of course. Some highlights of home life with host families and exploration in the city included: Aleefia and Nikki teaching their parents the “Soulja Boi” dance, Rachel asking if she could wash her hair and her Mom taking it upon herself to wash it for her, Brooks and Michael sharing a bed with pink pillows that say “Love Story,” the boys teaching English to local teachers who sang back to them “You Are My Sunshine” and having the story and photo printed in Beijing’s largest daily newspaper, Kyle being told her kite was sub-par before being given a sweet one and taught to fly it by old men in the park, Hoi See eating 40 handmade dumplings in one sitting, one of our guest speakers serenading us with a classic Chinese ballad after her lecture, Dana learning that the literal Chinese translation of AIDS is “the loving capitalism disease,” Brooks coming late to tai chi class because he had to help push the broken-down public bus, the tai chi class witnessing one neighbor’s daily goose-walking routine, Sando and Nikki discovering that there is a multi-tiered pricing structure for SIM cards depending on the phone number’s degree of auspicious vs. inauspicious numerology, Rachel realizing after an exhaustive bookstore search that the Lonely Planet’s Beijing guide book is actually banned in mainland China, and so many more…

I think all would agree that some of the most significant learning here in China took place during case study week, when groups of 5-9 students were provided with a short list of contacts and a couple of English-speaking Chinese college students to act as translators and were sent off on their own to investigate different topics of interest. Here are a few words from each:

“With my group, I got a further look into senior care issues. We traveled to a local nursing home where we sang and were sung to by lively, smiling residents, and later interviewed a popular journalist for an elderly health newspaper and a medical research professor about the difficulties the country is facing as it increasingly becomes an aging and elderly society. We also took a trip to a nearby park one morning and observed older community members doing Tai Chi (some groups with swords and fans and practicing Chinese calligraphy on the cement sidewalks using an enormous paintbrush and a bucket of water. The data we collected affirmed that China’s shifting demographics will amount to a huge problem in the very near future. The government’s political persistence with the One Child Policy is beginning to leave more and more of the nation’s elderly without enough family support to provide for their needs (a 4:1 ratio of grandparents to grandchildren.) Additionally, the opening of China’s market to the global economy has introduced a sense of capitalistic individualism which has done everything from pulling younger generations away from their families to pursue their own lives and careers, to increasing the privatization (and thus, the cost) of health care facilities and services, to introducing a drastic and unforeseen inflation in the price of everyday necessities. With policies that demand a decrease in family size for population control, and modernization which undermines Confucian emphasis on familial piety in society, traditional values are being replaced with a new-age way of life that leaves the elderly behind.”

“At a particularly poignant field visit to an NGO which advocates for migrant laborers’ rights, we learned that conditions in China’s factories can be brutal. For example, when it gets close to the Christmas shopping season, a worker’s shift might be 5 days long, or until s/he passes out from exhaustion and is quickly replaced on the line by another laborer so that all the eyes can be sewn onto the teddy bears that will unwrapped by children overseas on Christmas morning. This moving slideshow piqued the interest of a handful of us who were eager to study the issues around occupational health of migrant workers as our case study. We came up with a list of questions and hit the streets with our translators, finally interviewing about 30 migrant laborers in professions ranging from construction workers and maintenance workers, to shop keepers and restaurant owners. As you can imagine, we received quite a range of responses. Basically our conclusion was that the term "migrant workers" comes with a slew of false expectations and preconceived notions that do not hold true in Beijing. Most migrant workers here said that their situation was "so-so" and they "accepted reality." While many of our respondents affirmed that they were always paid on time and all of them were legal and had a permit to be living in the city (and that this was actually an easy process), others noted that very little consideration is given to health when applying for jobs, and few were covered by health insurance. While some were reluctant to speak to us, others were thankful for our research, happy that someone was taking an interest in the issues they were facing.”

From the group who studied the impact of Traditional Chinese Medicine on reflexology and its market: “Unaccustomed to the freedom granted, we approached case study week with both fear and excitement—would people censor their responses? Would we be able to arrange hospital interviews? All these fears were soon allayed as people eagerly talked to us, completed our surveys and agreed to interviews after chance meetings. While some interviews were difficult to get, such as the one conducted at the Beijing Reflexology Department, after an hour of bureaucratic clearances we had an enlightening conversation with the doctors about reflexology and the changes it’s undergoing. Reflexology, which is the physical act of applying pressure to the feet and hands, is based on a system of zones and reflex areas that reflect an image of the body on the feet with the premise that such work effects a physical change on internal organs. Case study week definitely had its perks—especially employing the embodied approach (i.e. getting a reflexology massage!)”

“Our case study on the One Child Policy was a constant but intriguing challenge. We ran up against much reluctance to voice opinions about the policy and were often met with blank stares when we asked about the policy’s impact on family health. We agreed with our informants’ answers that most of the changes in health were highly influenced by changes in socioeconomic development, but we continued to push to find out how the one-child policy changed the scene in China. We tried to dig deeper with less straightforward methods, such as asking people to draw what “family” meant to them. Though one person told us “I don’t want to draw people, I want to draw furniture!” we collected a very interesting assemblage of drawings, some representing one-child families, some still showing two-child families, and others interpreting the prompt in metaphoric terms. Since we can’t show you their sketches in this letter, here are a few quotations we gathered:

“I ate one meal a day—without meat—so that my 15-year-old son could change his cell phone.”
Q: “How long should the One Child Policy last?” A: “That’s the government’s business.”
“The One Child Policy gives parents more time for romantic life.”
“There is more time to be a weirdo… more time to talk to myself.”
“We sacrifice for China and for the world.”
“The U.S. has a large population and will have to enact a similar policy.”
“If there was no One Child Policy, China would eat all of America’s rice.”
“I wouldn’t have had a second child if the first was a boy… A second child is a burden.””

“During our China case study we examined the role of various organizations in prevention of HIV. Organizations that we visited were governmental and nongovernmental and ranged from international (Medecins Sans Frontières, Red Cross, etc.) to local. We examined the barriers that organizations faced working in China, the main ones being stigma towards HIV, lack of support from the Communist government, and lack of funding. We also learned about various programs that organizations had implemented, including fundraising and education for AIDS-affected children, outreach and education in gay bars, and hotlines for AIDS-related information. In the process, we ourselves ended up helping formulate ideas and strategies for the PTE organization (Prevention Through Education) that focused on educating school teachers. Our major finding was that organizations fall on a spectrum with two dimensions: government to NGO and domestic to international, with each facing its own unique challenges depending on its specific position yet also all having to overcome the same challenge of working within the Chinese context. This was a valuable learning experience which we feel will positively affect our future endeavors in the field of public health.”

“My case study group aimed at uncovering the causes of the relatively high abortion rate in China. In the short time available, we collected data regarding the cost of various types of abortions and the details of the national sex-ed curriculum, but in reality it was not the information gathered that enriched our education so much as the process of investigation itself. How unique it is to be able to have conversations about abortion with elderly Chinese women in the park, university students between classes, nurses who think you’re considering an abortion yourself, or a doctor at a community health clinic. I never thought I’d be sneaking around the abortion wards of public and private hospitals in Beijing, or that I’d have a dozen old women surrounding me in a park, all speaking to me in Chinese about their thoughts on abortion and pre-marital sex. It’s these simple and everyday interactions that have become so common on our travels, but still leave me in awe at the end of the day. Partly because of the taboo around abortion in the U.S., we were hesitant at first to approach people on the street about this subject, but it was being pushed beyond our comfort zone that made this experience so valuable.”

* * *

Looking back on what I’ve compiled here, I realize that China does not in fact speak with but one voice, just as our students do not. And in light of the government’s concerted efforts to prevent any deviation from the well-ordered party line (or the fastidiously planted line of trees), that is remarkable. This is, after all, an incredibly vast country that has somehow been shoe-horned into a single time zone—that of the capital. This is also a nation where, in 2007 alone, 200 million pieces of “harmful information” were removed from the internet by a team of 35,000 censors staring at computer screens around the clock in what my colleague refers to as “The Great Firewall of China.” The news that is considered fit to print here is not only printed but is posted on boards behind glass in front of most parks and many other public spaces, just to make sure cost is no barrier to the people getting their daily dose of official spin. But somehow, despite all that, the Chinese manage to view their world from 1.4 billion individual perspectives, many of which are highly critical of the things we take for granted as right and true from our vantage point in the “democratic” West. On the whole, I believe we are all leaving China with a richer understanding of the concept of perception than we arrived with a month ago.

Letter home from South Africa

Composed by Casey Welch, IHP Trustees Fellow, on May 9, 2008

Dear family and friends of IHP Health and Community program participants,

I am tempted to just tell you all that there won’t be a “letter home” this time, since by the time you get this we’ll be back, and instead of reading my version of events you should find a comfortable sofa, put on a large pot of tea, take the phone off the hook (or at least set it to vibrate) and settle in for a long, multi-layered rendering of the IHP experience in South Africa as told by the person who has returned to you. But surely you will do this anyway, and I am just searching for an excuse not to have to attempt the impossible: to do justice in a few pages of text to the profound journey we have just completed. Of course, our 33 students were recently asked to accomplish just as daunting a feat for their final projects—3D models of globalization’s effects on health and community—and they succeeded with flying colors, so I suppose I shouldn’t cower from the task of a little letter-writing. I feel I should mention at this time that one of those final globalization models evolved into an epic installation/performance art piece incorporating a near-assault on every sensory organ and requiring scavenging trips to the scrap-metal yard, more than a Honda-ful of materials (buckets, pipes, boards, wire mesh, cardboard, a life-sized fist made of twine, sand, rocks, plants, incense, a rusted 55-gallon Shell Oil drum, light fixtures, Nutella, and an incredible “book” whose every-textured “pages” presented perhaps all of the various aspects of globalization’s weighty reach). This piece even had a gravity-fed water element, a killer soundtrack, hand-stenciled uniforms, and an interactive response area. It is about as hard to describe as our semester, so I ask that you refer to the attached video file.

Hmm, it appears I have just begun at the end, which is perhaps not the most sensible way to explain to you what we’ve been up to this past month. Let’s rewind to the beginning of our South Africa program, which brought us to Zwelethemba, an all-black township of about 22,000 people that played a significant role in the anti-apartheid struggle in the 1970s and 80s (and is the TB capital of the world!?!) The township’s physical location is in the Western Cape region, only about 90 minutes away from Cape Town by bus, but about a world away from Cape Town’s dazzling display of the “good life” that mesmerizes new visitors at their first glimpse of majestic Table Mountain and the slick, modern properties overlooking the sea. Californians get a distinctly South Central LA vibe from Zwelethemba, whereas the gorgeous, pastel-colored administrative capital to the south is reminiscent of San Francisco. Our arrival in Zwelethemba happened to coincide with school vacation, which coupled with a fairly high rate of unemployment and fantastic, sunny weather led to a preponderance of folks simply hanging out in front of their houses and in the streets at all hours of the day and night. Loud and lively music emanated from every home: hip-hop, reggae, and traditional African rhythms made up the festive soundtrack to one’s daily walk to the far end of town for classes at the local library—a walk which was most often accompanied by a half-dozen neighboring children vying over prime hand-holding positions next to IHPers en route. After a cold, grey, and nearly childless month in Beijing, the new mood amongst the group was positively buoyant; a majority of us mark Zwelethemba as one of the most enjoyable weeks of the semester.

It was not only the dancing, barbecuing, socializing, lively church services, and hair-braiding by little hands that made us fall in love with this community; we were also captivated by numerous field visits and enlightening discussions with panels of locals who generously shared stories of apartheid days, their experiences with accessing the healthcare system (which is free, really) and other serious issues. Our once-sketchy knowledge of recent events in South African history was quickly brought up to speed by watching an excellent documentary on apartheid, reading the published memoirs of our host Thembsy Ngcechwe who had been quite an active organizer in her day, and talking with other host families whose stories of hardship and hard-won victories both shocked and inspired. I for one didn’t know how to feel upon hearing about the peer pressure that accompanied the 1976 children’s struggle. Apparently, when the bands of youth came around to gather for the protests, worried parents could not try to protect their children by hiding them inside the house because if they did so then the next day those same young freedom fighters might put two tires around your child, douse them with petrol and light them up. Yet at the same time, and continuing to this day, doors in Zwelethemba are rarely locked, and any random child wandering into any house will be fed and cared for without question. If you asked an IHP student how many kids lived in their homestay, the answer was probably, “I’m not sure—at least two but sometimes more like seven.” Community ties and networks of extended families run deep here.

Site visits in the area included a trip to a local sangoma (traditional healer who treats everything from stomach cramps to court cases) and to a workshop for the blind and an institute for the deaf. Some students experienced an intimate form of communication with a man who neither hears nor sees, but can understand speech by placing his hands on your lips and vocal chords. We were later treated to a tour of the Rooiberg winery as well as the massive De Doorns grape farm by its charming Afrikaaner owner who let us ride in the back of his pick-up and gave us all a package of delicious export-quality seedless grapes to take home. His claim that the pesticide usage on his land was not at all harmful if proper precautions were taken was later balanced by the views of a panel of grape farm workers back in the township. Those women neglected to feed us grapes, but described for us the conditions in which they must work, including having no provision for maternity leave (if they get pregnant “it’s not the farmer’s problem,”) not being allowed to use the bathroom for half the day, not being paid for sick days, suffering from ailments of the chest from constant inhalation of sulphur in the packing house, and having to strip off all their clothes outside their houses upon coming home from work if they have an infant inside, on account of the chemical residue’s damaging effects on babies.

Zwelethemba residents also proved to be valuable resources outside the classroom, when IHPers undertook a community health survey of new mothers as part of the public health course. With the help of Xhosa-speaking homestay family members, students got first-hand practice at conducting public health field research, and with Karunesh’s expert guidance they presented a quantitative analysis of their survey results. Their posters and graphs were impressive, but I preferred their stories of the actual interviewing process—particularly Emma Lawrence’s, who was greeted at the front door by a completely topless interviewee. She was reassured that yes, she was expected, and this was a perfectly convenient time to do the interview, so Emma proceeded to ask the entire series of questions to a woman who was wearing nothing above the waist. {Emma's field research continued to be memorable during case studies a few weeks later, when she, Allison, and Sando arranged an interview with the host of a health-themed show for 98.2 FM Radio Zibonele in the township of Khyelitsha. They were to be guests on the Saturday morning show, but five minutes before airtime there was still no sign of the host. One of the girls wondered aloud, “If Joyce didn’t show up and we had to host the show, that would just be so IHP.” Which, of course, it turned out to be. The radio debut of the child health case study team ensued, with kids calling in with questions about nutrition as well as requests that the Americans sing them “Happy Birthday.” Fortunately, our omniscient country coordinator Chris Colvin got this all on tape.} In addition to their maternal health surveys, students also got real-world public health experience when a 24-hour ailment marked by intense nausea and vomiting hit the group and rapidly managed to afflict half of its members. Students charted the progress of our mini-epidemic (noting its speed of dispersion and observing that its scope included 70% of households) and attempted to trace its possible source and mode of transmission.

The move to our final homestays in Cape Town’s Muslim Bo Kaap neighborhood provided students with an inside look at so-called “coloured” families’ attitudes toward South Africa’s governance and social structure. Most sensed a tangible resentment towards the ANC from their city hosts, whereas citizens of Zwelethemba had tended not to complain about current politics. Smells of Cape Malay cuisine, sounds of prayer being sung from the nearby mosques, and sights of bright multi-colored paint jobs on every Bo Kaap dwelling provided a feast for the senses that may (or may not) have made up for the emotional challenge of living in a city where muggings are all too commonplace. Cape Town, while beautiful and populated with a diverse citizenry enjoying a high quality of life, is tainted by an undercurrent of fear. The collective perception of risk dominates the psychological landscape: though the city is not under any actual siege, it is a place where electric fencing and expensive security systems are the norm, where no one leaves anything of value visible in their cars which never have their windows down and which lock automatically after starting up, where one must carefully plan every trip to the ATM, where most people won’t walk alone at night, and fear of having one’s property taken away by some armed predator pervades daily life. Country-wide it is commonly accepted by everyone, including police, that red lights and stop signs need not be heeded after dark so as to reduce the risk of car-jacking. It is with unusual pleasure that I can report that this year’s Health and Community group escaped Cape Town without a single mugging! (We did have one break-in, but they’re OK and possessions intact.)

Our proximity to the University of Cape Town afforded us the opportunity to receive lectures from some fascinating academicians. Dr. Andrea Rother opened our eyes (literally) to issues around pesticide policy and labeling that many of us had never considered before. She told us about the bureaucratic challenges created by the lack of communication between different branches of government, such as in the case of lindane, a substance found to be so harmful that it was banned by the Department of Agriculture for industrial application but still remains the key ingredient in a lice shampoo commonly used on children’s heads, because this product falls under the jurisdiction of the Department of Health, not Agriculture. Dr. Rother engaged us in a revealing experiment whereby she passed out samples of the new labeling symbols for dangerous chemicals and asked us to indicate what we thought they meant. We were also asked to rank order what we believed to be most to least hazardous designations in South Africa’s color-coding system for pesticides, and more than half of our college-educated group mixed up the order. It is now pretty easy to empathize with the possibly illiterate population that must actually use these products, especially considering the added fact that 12% of males here are potentially colorblind. Another favorite lecture came from Professor Howard Phillips, whose historical perspective on epidemic disease helped us understand the current trends of AIDS and TB in another light. (Michael Kolbe’s journal entry recalls Professor Phillips as “a totally sweet man who confidently rocked the overhead projector in an age of crazy technology.”) He made us realize that just as we are undertaking a comparative study of HIV/AIDS along a spatial axis by traveling to Geneva, India, China, and South Africa, that likewise there is much to gain by looking for patterns in epidemic disease in one country along a temporal axis. Certain elements prove constant across time and space. For example, every major epidemic is accompanied by society’s tendency to want to assign blame. When the plague hit in 1901, black harbor workers were first to contract it since it spread via fleas on rats coming off of ships. Blame affixed, infected blacks were forcibly removed and isolated into the earliest South African townships, and even after the plague subsided they were not permitted to leave these areas. In the early phases of the AIDS epidemic in the 1990s, the government stopped accepting blood donations from all black people because they were seen as more likely to have HIV; meanwhile blacks were calling AIDS the “Afrikaaner Invention to Deprive us of Sex,” and therefore deprive them of the ability to increase their numbers and power. Professor Phillips also demonstrated how lots of young men on the move provided the means of dispersion of nearly every South African epidemic, with the combination of migrant workers and rail travel being a particularly potent means of spreading Spanish flu as well as TB and STDs.

And now, you knew it was coming and here it is: the obligatory HIV paragraph that no letter home from a public health course in South Africa can be without. While HIV/AIDS has been a theme of study intentionally incorporated into every country we’ve visited, nowhere does it manifest itself quite so prominently as here in S.A., where the adult prevalence rate reaches 20%. The virus’s epic proportions actually make it much easier to talk about with locals than it was in India or China—perhaps too easy, as illustrated in one group’s visit to a men’s HIV support group called Khululeka in the community of Gugulethu. During introductions, one man gave his name and then said that he did not have HIV, whereupon Phumzile, our coordinator’s right-hand man and all-around sweetheart, interjected to finish the joke: “Yeah, he has AIDS! Ha ha! He’s in the final stage!” Good-natured joking such as this may be precipitated by the sheer omnipresence of HIV here, or perhaps it owes to the fact that the triple combination therapy antiretrovirals in wide use have been so effective in keeping people alive that AIDS seems to have transitioned from a fatal to a chronic condition. Either way, this topic that can be considered semi-taboo in other locations is firmly entrenched in everyday discourse in South Africa. The verb “condomize” has made its way into the vernacular of Zwelethemba, where when someone suggests that you “take some sweets” they are referring to the bowl of condoms on the counter. During a speech for Human Rights Day by the former mayor of Cape Town to a secondary school in another township we visited, Nomaindia Mfeketo spoke about freedom and HIV practically in the same breath—reminding the students that if they want to be president, or a lawyer or doctor, that they must be alive to do so and that they should protect themselves. The murmured reactions from the thousands of teens crowded into the auditorium made it obvious that they hear this message every day. But just because there do exist groups like Khululeka and the Treatment Action Committee wearing bright, bold “HIV Positive” T-shirts, and a church in Khayelitsha that has a banner reassuring people that they are still brothers and sisters in Christ no matter what their HIV status, and that the 74-year-old woman sitting next to you will tell you she is HIV+, does not mean that stigma has been erased. In fact, HIV+ mothers (who are provided by the clinic with six months worth of free infant formula to reduce the risk of transmission via breastfeeding) will choose to breastfeed when in public because bottle-feeding is tantamount to disclosure. Many women are terrified of the repercussions of even going in for testing, having heard countless stories of men beating or abandoning their women for tarnishing the couple’s reputation in the community. A woman might travel a hundred kilometers to a community where no one knows her in order to keep the clinic visit confidential. Going beyond didactic public health campaigns that order people to “abstain” or “be faithful” to ones that instruct them to “condomize” will still fail to be effective if people (especially women) cannot advocate for safer sex with their partners. Females are 5% more likely to be infected than males, and in some parts of the country the prevalence rate for women is as high as 60%. A group of journalists in their twenties offered us this startling perspective when asked what they saw as the biggest problem facing Zwelethemba: “AIDS. And it’s not a problem of awareness. People have the education but they are just arrogant. They don’t want to die alone so they go around infecting others.” Fortunately, we then had Chris’s class on behavior change to sort that all out for us.

For a bunch of budding doctors and public health practitioners, I suppose it is a good thing that we’ll be returning home knowing that there is much work to be done. Over the course of this semester we’ve been disturbed, humbled, shocked, confused, awed, and filled with hope in turns, and all of us acknowledge that we have gained far more than we have given back. But I hope that those who have helped us along the way enjoy the knowledge that they have opened eyes, touched hearts, and kicked every last bit of apathy out of this particular group of 33 American students from 22 different universities (picked to travel the world….) To Phumzile, Thembsy, Chris and family, and all of our guest speakers and gracious hosts, we thank you for bringing South Africa and all of its issues alive for us in a way that other travelers barely glimpse as they flit from backpacker hostel to wine tasting to wildlife center. Take it from me, I’ve been doing just that for a week now and the contrast to the IHP experience has reminded me just how special this program is. Reports from other members who have extended their travels in Africa confirm that collectively we now have a hard time looking at tourist attractions in quite the same way as everybody else. (There is now a tour guide in the Kango Caves who will be submitting a complaint to the province’s “Public Protector” that the working hours of employees at the Caves are unconstitutional.) So thank you all, students and faculty, and those of you at home who have supported us—it’s been quite a journey.

All the best,

Casey Welch, for IHP Health and Community Spring 2008

p.s. We had lunch with Archbishop Desmond Tutu. And pounded it out.

So it ends where it all began...

2008-05-19T04:19:00.004+05:30

in Boston...

Just a week has passed since I have returned and already it feels like I never left the United States. Everyday, I'm nostalgic for the incredible excitement and also uncertainty that I experienced while I was abroad. Just a month ago, everyday was a new experience for me. Nothing was predictable and everything was so new. It's nice to be back in a familiar environment where I know how the public transportation system and the mathematical logical side of my brain can have a rest now that I don't have to keep converting foreign currencies back into US Dollars or Hong Kong Dollars. However, I also long for the interesting conversations that I had with strangers that I had to approach when I was abroad for all forms of help from how to get to places to sometimes how much certain things should cost. Already, I wish that I had updated my blog and written in my journal more frequently, because I can already feel my memories slipping away from me so quickly that I can barely remember many of the smaller insignificant frustrations/experiences that I had, such as worrying about being late for class in China because I had forgotten to reset my alarm clock to the correct timezone. I just feel so fortunate to at least have had an education and to be literate, because at least this way, there is some way that I can document my experiences, especially since I am no artist.

So, given that I cannot go back into the past and "re-remember" the experiences that I had, I can at least give you a sense of the realizations that I've had since returning to the United States. Some may call it reverse-culture-shock. But for me, I think that whenever you're away from a place for a significant period of time, you always return with a greater appreciation and awareness of the differences between where you were and where you just returned to.

Here are some of my realizations...

The roads are so wide and the cars actually stay in their lanes. I was just so accustomed to the chaotic yet efficient way that the cars and various other modes of transport of all sizes and shapes were on the road that on the way back from the airport, I couldn't help but feel that everything was so predictable on the read. In India, it's almost like a game of Tetris turned on its side with the transportation fitting together in whatever way was possible whenever there was a red light or during rush hour traffic (rush hour probably equals all daylight hours in Bangalore and sometimes even at 9pm!).
I can definitely feel the difference in population density between the United States and the two most populous countries in the world, India and China. While in the subway/the T, there were actually seats available inside the underground train and there was so much space while I was waiting for the train at the platform. In China, you are usually shoulder-to-shoulder with the people around you and you really need to react quickly to figure out where you're going before you're swept away by the ground. This reminds me of an ocean current, except a "current" of people. There is actually a Chinese saying "ren shan ren hai," which describes how there are mountains and oceans of people.
Boston is such a literate city. While I was sitting in the subway, there were so many people reading the newspaper or a book, or doing their homework. Boston truly is a college city and it's amazing how many people know how to read. I think that it's definitely something that we take for granted and it's interesting how there is instead a pressure to obtain some form of tertiary education. This just shows how much society's standards keep rising and how, in some ways, this is contributing to the gap in literary globally. This experience has definitely given me a greater sense of appreciation for being in college and for having an abundance of opportunities at the tips of my fingertips. However, I also feel a greater sense of urgency to help those who don't have the same opportunities that I have.
Technology is everywhere and there is definitely a big sense of safety in Boston. When I heard the subway for the first time, the sound of metal-against-metal when the train was approaching was so sharp and shrill to my ears. Only then did I realize how accustomed I had grown to the sounds of cars honking with chickens clucking in India and the sound of bicycles in China. Also, people were listening to songs on their mp3 players/iPod. If this had happened in South Africa, your music player would probably have been taken by some invisible hand by the time your first song was over. I suddenly felt like I didn't have to be so on-guard all the time, as I was in South Africa, and constantly watching the people around me. It's strange to relax your sense of awareness of your surroundings after being on "high-alert" for a month.

Some Great Experiences in South Africa

2008-05-08T23:24:00.005+05:30

Was on a South Africa radio show in Kaylitcheya (sp?), a township in South Africa. It was so exciting to be on a radio show for the first time in my life! We were visiting a community radio station and a few of us were just asked a few questions about where we were from and we made small talk with the radio host. It was fun! I was teased about it afterwards but it was worth it!
My friends and I visited Cape Point and the Cape of Good Hope, which people claim is where the two oceans meet at the tip of Africa. It was very windy but just the thought that I was at the very bottom of a continent was incredible. We also went to Simon's Town, where we saw the most adorable penguins! We stopped at a beach on the way back to Cape Town while the sun was setting and took jumping photos! I think that I've set a new record in terms of the number of gorgeous sunsets/sunrises that I've seen.
We went kayaking as part of our retreat through beautiful mountains. It was incredibly breathtaking scenary - picture rays of sunshine dancing on a river and having mountains rise on both sides of you. While it was hard work rowing (now I realize how little muscle I actually have in my arms), it was nice to be able to get some endorphins flowing while also being immersed in the company of good friends and nature. It was nice to kayak with Laura (my Wellesley friend on this study abroad program) and to talk about Wellesley and our experience abroad, especially since we understood each other. After kayaking, I jumped on a trampoline for the first time in n years! I can't even remember the last time I was on a trampoline!! I did star jumps, tuck jumps and all other combinations of jumps that I could think of. I then cart-wheeled and did handstands (or tried to, in my case) on the grass with my friends. To finish off this beautiful day, I rode in the back of a tractor all the way back to our cabin with the wind blowing through my hair and with the sounds of my friends' shouts through the wind. The tractor went through apple orchids and fields right when the sun was setting. It was a perfect day and a perfect retreat experience at the end of this study abroad experience!

Reflecting back...

I was just thinking about the jumping photos that we took during sunset when we were driving back to Cape Town from Cape Point and had a thought. We look so carefree and happy in those photos and just makes me think of the energy of youth! It really made me think about how passionate and inspired the other young people traveling with me on this program are and how confident I am that they will succeed in whatever field or profession they choose to pursue. I am so glad to be part of this group of talented young individuals and to be challenged by their intellect and profound thoughts and yet to also form deep and hopefully everlasting friendships with them. These past four months have really been an amazing experience that I hope to cherish forever.

Anyway, will update more when I get back to Boston. Am flying tomorrow (yikes!) from Cape Town --> London --> Boston! I can't believe that this is all ending so soon. :(

Some inspiring quotes from fellow students

2008-05-04T19:17:00.002+05:30

The study abroad program office recently asked us for quotes about our experiences. Our teacher, Stefi, jotted down some of our comments from our time in India. Some of them are so true. I just thought that I'd share them with you.

“People fighting for their comfort are fighting for themselves. Learning to live with discomfort allows you to fight for others.”

“I’m learning through the eyes of the colonized for the first time. I’ve left every session thinking things I’ve never thought before.”

“I’ve always thought of globalization as an economic thing. I didn’t think of how people’s relationships to each other change.”

“How ‘personal’ is society to us? We are obsessed with individual rights rather than a sense of commitment to our communities.”

“I’m gradually learning when to view things holistically and when to fragment them to understand them better.”

“Learning from people in India, China, and South Africa this semester… I wonder about how much I’ve gained versus how much I can offer.”

“We’ve seen some of the destructive aspects of modernization but sometimes we also see examples of how modernization can actually be sustainable, ecological, and appropriate, like at the Tribal Health Initiative in Sittilingi.”

Cape Town, South Africa

2008-05-04T18:17:00.006+05:30

After leaving Zwelethemba, we returned to Cape Town, where we will spend the remainder of our stay in South Africa. We were put in homestay families in the Bo Kapp, an area that historically was where colored people, mostly Muslims, lived. The Bo Kapp is a beautiful place that is situated on a hill. As the Bo Kaap overlooks the rest of Cape Town, its residents are sometimes teased for being able to see what everyone else is doing.

Living in and moving around in Cape Town has given me many new realizations and has been an intense learning experience, as every other location has been.

Cape Town has given me a new concept of safety. While Cape Town is in some ways known for crime, I never fully realized what that meant until I had to avoid being out too late at night, walking in groups once it gets dark and to always call to let people know of my whereabouts. In some ways, this is in some ways a hassle and limits your independence. However, it has taught me to be flexible with my time and taken the concept of "going with the flow" to a new level. I find it ironic that such beauty and high crime rate can coexist in the same place. This experience has also made me question our perceptions of risk. For example, I have changed my behavior because I perceive my risk of being mugged as high due to my visibility as a tourist and due to my unfamiliarity with the area. In an earlier post I wondered about the obstacles that people faced to change their behavior. Perhaps behavior change comes down to risk perception. We are less reluctant to change behaviors that could possibly give us diseases that might happen in the long-run or worsen chronic diseases, such as diabetes, hypertension and cancer. However, we are very willing to change our behavior in the face of acute infections or diseases, such as SARS. Risk perception is definitely a concept that I will have to think about more in terms of how it impacts our behavior and others' actions in the future.

More on Zwelethemba

2008-05-04T18:02:00.004+05:30

Before we left, we had a wonderful braai (barbaque) with all our Zwelethemba host families and close friends. This was lots of fun and gave us a chance to get together at the end of our short stay in Zwelethemba (a little over a week) and to bond.

Interestingly, the day we left Zwelethemba was my 21st birthday! Apparently, turning 21 is a big birthday in South Africa. I'm not sure why but I think that it is related to signifying a rite of passage. I think that the significance of being 21 in the US is due to the legal issues surrounding being able to drink. In Hong Kong, 18 is a big birthday because it signifies your turning into a legal adult and is also the drinking age. While drinking culture is commonly associated with the UK, this has made me realize how much drinking is part of society in other places as well. Is this due to other countries' gradual adoption of Western values which in turn is a result of globalization?

Mama Eunice was very sweet and made me pancakes, which I jokingly referred to as my birthday "cake." During the last couple of days, I've really enjoyed my stay with Mama Eunice. She's a very hardworking woman who single-handedly raised her children after her second husband died in a car accident when she was still pregnant. It was really nice for me to give her full-body massages at the end of the day. I was so happy to hear that she always felt much more relaxed after my massages and felt more flexible the next day. I've really bonded with her whole family during my stay in Zwelethemba. She's also invited me to come back for her 60th birthday in a few years. Thully is planning to organize the birthday celebrations for her mother then. Hopefully, if the timing works out, it would be incredible to be able to come back to South Africa, especially since by then I will probably have had more time to process my study abroad experiences and live out some of my experiences on my list of, "If I had more time in South Africa, I would..." :)

Zwelethemba, South Africa

2008-05-04T16:28:00.005+05:30

My first impression: children and women everywhere. From talking to my host sister, I found that most people have many children (usually at least 4 or 5) and some people have children when they are still in high school. There are also some families where mothers have multiple children with different fathers. I found this very interesting because around 50% of the population in Zwelethemba is Christian. However, this phenomenon that I'm witnessing is not typical of behavior that I would normally associate with Christianity. Is this behavior contradictory to the teachings of Christianity or perhaps they can co-exist. This is an interesting question that I unfortunately never had the opportunity to fully explore in Zwelethemba.
We had the chance to speak to a community journalism group that came to visit us while we were having classes. As this study abroad program is a public health program, we naturally asked the group about health, in particular about HIV and AIDS. The group felt that one of the largest problems about HIV and AIDS in South Africa is that men don't want to change their attitudes towards having unprotected sex. Everywhere, people are taught the ABCs of HIV: Abstain, Be faithful and Condomize. However, men argue that similar to how you can't have candy without tearing off the wrapper, sex is not pleasurable with a condom on. This example has taught me the limitations of having analogies because they can often be twisted to any purpose. In addition, it reveals the difficulty to change behavior in society. My questions for myself: When people have the knowledge and information, what stands in the way of behavior change? From personal experience, many of my friends know about the merits of healthy eating, but how many of us can actually withstand the temptation of sweets, desserts and other "unhealthy" foods?

Time with my homestay:
Mama Eunice is a very sweet and motherly figure. She always makes sure that we eat a lot of food and sometimes at night, Mama Eunice and her daughter, Thully, make us muffins or pancakes. Mama Eunice's other daughter, Annalin, is also very sweet. She always gives me hugs when I ask for them and is an incredibly fun-loving child.

One of the more deeply-touching moments that I had with Mama Eunice was when she recounted her experiences of apartheid with us. The war against apartheid is known in South Africa as "the struggle." Mama Eunice spoke about how her eldest daughter (who lives somewhere else in South Africa) was always the courageous one and how her son (who lives in the neighboring house) was always timid. During the struggle, everyone in the house had the participate. If your family was not at the resistance, when the people came back, you would be questioned by your community. As part of this resistance, Mama Eunice's eldest daughter and son went out to fight against the government. When they were chased by the police with their guns, Mama Eunice's eldest daughter and son hid in the drains. Her son was crying but his older sister kept telling him to be quiet, otherwise they would get shot and killed by the police.

Another story that Mama Eunice told was how a father sent his son out to town to get groceries. During the time of apartheid, curfews were imposed for everyone. By the time of curfew, the father become worried because his son wasn't back yet. As a result, the father went out in the streets to try to look for his son while trying to hide from the police. He finally saw his son crouched behind something, but they were separated by a street. The father called to his son to cross the street and come home. However, the son said that he could not be seen by the police by crossing the street otherwise he would get them both killed. He cried out that the police were looking for him and asked his father to go home. However, his father kept insisting that they would be okay. Eventually, the boy crossed the street and the father found that his son had been shot. The police found the pair and threatened to kill the boy. However, the father said that his son had only been out to get groceries and tried to explain the situation to him. The father said that he didn't believe that the police would shoot because his son had not done anything wrong. Unfortunately, the policeman paid the father no heed and simply shot his son a couple more times until he died. In this way, the son died in his father's arms while the father was trying to plead his innocence. I could not help but almost start crying at this point.

Another similarly tragic story that comes to mind is a story that I heard from a documentary about apartheid. As a result of the struggle, many so-called colored and black people died. What I was really shocked by was that during these people's funerals, the police would sometimes come and shoot at the people randomly. Most of these people were shot in their backs, indicating that they were shot while running away and while the crowd was already dispersing. I can't believe that people were denied even the basic need to grieve due to political reasons. In addition, the brutality of this oppression, such as the continued shooting while people were running away, is simply heart wrenching. This has really made me rethink everything that I've taken for granted in the past. While I knew even before this trip that we have to treasure material things, such as water, electricity etc.. I now realize even more the need to protect and to value the intangible, such as the right to walk around freely on the streets, the freedom to speech, the freedom to believe in any religion, the freedom to grieve and to celebrate.

It simply astounds me everyday how people can show each other such cruelty and brutality. While we often hear that some emotions are universal, such as everyone cries when they are sad and everyone smiles when they are happy, how can a person have no empathy for others? It is so easy to say that we've changed because apartheid is now a thing of the past. However, these things are actually still happening around the world. It is easy to just choose to focus on our own lives because these things aren't directly affecting us. However, we have to remember that those who are being oppressed often aren't having their voices heard and need a spokeperson for them. I think that when I return to the United States, I will pay much more attention to the political issues and stories of oppression that I hear, such as the Coca Cola issue, the exploitation of child labor, migrant workers and illegal immigrants, and the genocide in Darfur. I will see these issues in a new light because I have heard from the perspectives of some of the oppressed. If these issues can evoke such a sense of injustice from an outside such as myself, I can only imagine what it feels like to be directly affected. It saddens me that I know so many people similar to myself before I came on this trip who often say, "Oh, I have a mid-term coming up so I don't have time to think about these things. Anyway, I'm only one student and don't have the power to change anything. These things will have to come later when I'm a person of standing in society." However, it also gives me a sense of hope that there are students at home who are willing to take time out of their lives to stand up for those who are oppressed and to try to make a difference. I hope that the difference that these students (and other people around the world) make is enough to make this world a place that is a little less violent and oppressive.

First stop: Zwelethemba, South Africa

2008-04-19T15:09:00.004+05:30

Zwelethamba is a township located an hour and a half away from Cape Town. But first off, let me give a bit of history about Zwelethemba and townships. During apartheid, the people of South Africa were divided into three groups: black, colored and white people. Townships were created during apartheid and were where many of the black and colored people were relocated to. Often, these townships were created in areas that had poor land and poor natural resources, such as gold or diamond mines. Even though apartheid was abolished in 1994, townships are still mostly inhabited by black and colored people and perhaps only time will tell if this demographic distribution will change.

My immediate impression of Zwelethemba was that it was nice cozy little town that reminded me a little bit of the US due to the English on all the signs and also of India with the dirt roads and trash on the side of the road. However, the people are incredibly welcoming and hospitable. My host family in Zwelethemba consisted of Mama Eunice, her daughters Thully and Annelin/Phelesa (English/Xhosa name) and Thully's daughter Cecil. Mama Eunice's mission was to make us feel at home and I have to say, she definitely succeeded and completed exceeded my expectations, but I will share more about that in my next post.

China Country Paper

2008-04-16T21:05:00.004+05:30

In each country, we have to write a paper on a topic of our choice at the end of our stay. If you are interested, here is my China country paper:

International Honors Program Health and Community Spring 2008
China Country Paper:
Traditional Chinese Medicine’s Approach towards Sex, Contraception, Abortion and Integration with Western Medicine

Traditional Chinese medicine (TCM) began when Shen Neng, who lived around 2700 B.C., tested the medicinal effects of 360 plants on his own body.[1] Since then, it has evolved in many ways. While traditional Chinese medicine was once used for contraception and abortion purposes in China, it has mostly been replaced by biomedicine over the past century. However, TCM still plays a supportive role for Western abortions and is widely used for post-abortion care in China. To investigate this topic, I will examine traditional Chinese medicine’s perception of sex and contraception and its methods of abortion. We will then explore reasons behind the rising incidence of abortion from a economic, cultural and political perspective and the evolving integration of TCM with Western medical abortions.

Traditional Chinese Medicine’s Perception of Sex and Practice of Contraception

Traditional Chinese medicine has its roots in Taoist thought.[2] Taoism envisioned a duality in life, including two seemingly opposite but complementary forces called yin and yang. The yin force is associated with passivity, darkness, coldness, contraction, flexibility and femininity, while the yang force is associated with activity, light, heat, expansion, rigidity and masculinity. According to TCM, disease and deterioration of health occur when the yin and yang are unbalanced. TCM thus aims to balance the yin and the yang with the use of medicinal remedies, eating habits and sexual activity to counteract an “excess” or “deficiency” of yin or yang.[3]

The main function of sexual intercourse in traditional Chinese medicine is to “nourish the yin, [and] supplement the yang.”[4] TCM-believers are therefore often hesitant in practicing certain Western methods of contraception that would interfere with their seminal and vaginal fluids, as they believe that this interference will cause ill health. One manifestation of this belief is in the lower numbers of males than females that undergo sterilization. For example, in one Tientsin hospital, 14,000-15,000 tubal ligations were performed in comparison with 4,000-5,000 vasectomies over the course of a few years.[5]

The most common contraceptive method advocated by traditional Chinese medicine is the “urethral pressure method,” which involves the suppression of ejaculation by the male[6]. This ancient technique is even mentioned in several government birth control pamphlets as a birth control method.[7] It is based on the idea that ejaculation leads to the loss of germinal essence, or ching. Ching, when refined into chi (one’s life force or vital energy) can help to maintain the body’s yin-yang balance. If the man can successfully conserve his limited supply of ching, the female yin will be nourished by being “stirred up” and the yang will be supplemented by the man’s re-absorption of the vitalized yang ching back into his system.[8]

A less common method involves the use of secretions from the internal organs of a rare animal called she xiang. The organ is worn in a small pouch over the stomach area of the female so that the pouch is in contact with the female’s skin. The pouch has a strong fragrance due to the she xiang’s secretions. Due to national policy to protect the she xiang, only 1000-2000kg of the she xiang’s secretions is sold annually on the international market. This method is therefore seldom used due to the expensive and rare nature of the secretions. In addition, there are concerns that its effectiveness as a method of contraception is not documented.[9]

Use of Traditional Chinese Medicine in Abortion

Traditional Chinese medicine’s approach to abortion usually involves the use of herbal medicinal remedies rather than surgery.[10] For example, dried asparagus lucides soaked in alcohol are sometimes used as cervical dilators to induce uterine contractions for abortion purposes. According to one study, even after using this method 84 times, there were no adverse effects, such as infections.[11]

China’s Ministry of Health issued a directive in 1955 to integrate traditional and Western medicine, including using Western medicine’s reductionist approach to reduce medicines to their basic, essential ingredients.[12] The same approach is now being used in traditional Chinese abortion medicine. For example, tian hua fen or the powdered root of the Trichosanthes Kirilowii plant has been used “for hundreds of years to induce premature abortion” and “facilitate the expulsion of the placenta.”[13] After researching this ancient Chinese abortion remedy, investigators at the Shanghai Institute of Organic Chemistry recently found a chemical called tricosanthin that is effective in inducing late-pregnancy abortions. Today, it has been successfully synthesized and used on at least one million women for abortion purposes.[14] This isolation of active chemicals in TCM herbal remedies mirrors a similar trend in Indian Ayurvedic medicine. In addition, both TCM and Ayurveda have begun to be marketed in pill form, as is common in Western medicine.[15] For example, a famous brand-name pharmacy Tong Ren Tang in China is marketing TCM in pill form and in Tanzania, “ready-made Chinese medical patent formulas which allow for speedy consumptions” are already available for sale.[16][17] This has led to a change in perception towards TCM. For example, Wu Yingkai, a doctor who received his medical training in the United States, felt that the reevaluation of TCM has been valuable and changed his perception of it from being “rubbish” to a field that deserves “a place in medical care.”[18]

Impact of Economics, Culture and Politics on Abortion

The incidence of abortions has increased significantly in the past few decades due to a number of factors: the cultural and economic opening-up of China’s markets, the one-child policy, and traditional values of morality associated with virginity. For example, the national abortion ratio was below 200 per 1,000 live births in 1973. By 1982, the ratio had risen to 584 per 1,000 live births. In fact, between 1978 and 1979, at the time when the one-child policy came into effect between 1978 and 1979, the abortion ratio grew almost 50%. This trend has been found amongst both married and unmarried women.

As a result of the cultural and economic opening up of China’s markets since 1980, the Chinese people have increasingly been exposed to goods and cultural values from outside. These developments have influenced Chinese people, particularly China’s youth, to develop a more liberal attitude towards sex. For example, it has allowed revealing clothes, such as “spaghetti straps,” and soap operas that show physically intimate and romantic scenes to be imported into China.[19] As a result of the appeal of romantic love and the increasing acceptance of close intimacy between lovers, China’s youth has been more adventurous in its exploration of love and sex than previous generations, effectively leading to an increase in premarital sex.[20]

This exploration of love and sex has led to a cultural clash with traditional values amongst unmarried women. In China, virginity, particularly amongst women, has always been highly valued. This can be illustrated by wedding costs. The amount of money spent by the groom on his bride depends, to a large extent, on whether the bride is a virgin. For example, in Wuhan in 1985, the average male worker spends three years’ wages to get married. In rural Tongxi, a marriage can cost 4,000 RMB in 1985 while the average family income is 1,900 RMB. The high wedding cost is rationalized by traditional Chinese culture which dictates that an extravagant wedding would ensure that the bride or groom does not “lose face” and would instead honor his or her “family prestige.”[21] However, if the woman is not a virgin upon marriage, her wedding costs are not borne by the groom but are instead shared between the groom and the bride. The frequency and value of betrothal gifts given after engagement also decrease if the woman is not a virgin. As the frequency and quality of gifts is apparent to everyone in the community, other people can easily see the bride’s “purity,” contributing to the pressure from women’s families and communities to not engage in premarital sex.[22] Thus, women are often torn between the increasing liberalization of attitudes towards sex amongst their generation and the traditional values emphasized by their families and communities. As a result of this conflicting mentality, if unmarried women become pregnant, there is great incentive for these women to terminate their pregnancies, effectively increasing the incidence of abortions.

For married women, there is a political and social incentive to seek abortions due to the government’s policy whereby couples may only have one child. This policy was implemented in 1978 in an effort to control the spiraling population growth. It effectively decreased the rate of the population’s natural increase between 1970 and 1979 from 25.9 per thousand to 11.7 per thousand.[23] This policy gave women who already had one child social pressure to abort subsequent pregnancies. As one mother noted, when she saw other families with more than one child, she felt that these people were not doing their civil responsibility to help China’s population problem.[24] As a result, abortion is used by married women to comply with the government’s one-child policy.

The Role of Traditional Chinese Medicine in Western Abortion Practices

Western methods of contraception and abortion have gained popularity over methods advocated by traditional Chinese medicine. This trend is partially due to the increasing adoption of Western values as part of China’s modernization, and the general feeling that TCM is “unscientific” and “unreliable.”[25] However, with the government’s support and commitment to the integration of both Chinese and Western medicine, TCM still plays an important role in the increasingly Westernized healthcare market.

For example, traditional Chinese medicine offers a potentially more confidential method of abortion than Western medicine does. At biomedical hospitals, a woman is required to register herself at the hospital to obtain an abortion. This decreases women’s accessibility to safe Western abortions. However, as traditional Chinese medicine plants can be homegrown, it is relatively easy for a woman to have an abortion secretly.[26]

Traditional Chinese medicine is also sometimes preferred over Western medicine as it is cheaper. This is particularly true for unmarried women whose abortions are not subsidized by the government in contrast to married women who can have abortions for free. For example, in a private Western hospital in Beijing, an abortion can cost 800 to 2400 RMB (US$115-345) depending on the type of abortion obtained and whether the abortion used anesthesia.[27] This problem is exacerbated by the expensive costs of pharmaceutical products manufactured in Western countries.[28] On the other hand, plants used as herbal medicine in traditional Chinese medicine are often more cheaply available. One reason for this is because there is less money spent on research in TCM than in biomedicine.

Another example of the integration of traditional Chinese medicine and Western medicine is in the use of acupuncture instead of anesthesia during surgical abortions. Some studies have concluded that acupuncture is “safer and less liable to incur complications” than anesthesia as patients can still be awake during surgery.[29] Acupuncture is also less expensive with anesthesia.

While traditional Chinese medicine can induce abortions, for many people, Western medicine is now the preferred medical system used for abortions, particularly due to fears that traditional Chinese medicine may be “unreliable” because its effectiveness varies for different people.[30] Interestingly, perhaps as a result of this trend, TCM has managed to find a gap in abortion healthcare that is not covered by Western medicine and also fits in with its philosophy to promote general well-being. Today, the use of TCM in post-abortion care has gained popularity and is recommended even by Western medical physicians.[31] Depending on the woman’s body, over 500 different types of traditional Chinese medicines, including lotus seeds and dates, can be used in various combinations to help stop post-surgery bleeding and promote general well-being.[32] Many of the medicines used after abortions are the same as those administered after the delivery of children and the medicine is often taken for a month after abortion or delivery.

Conclusion – A Complementary Relationship Between TCM and Western Medicine?

In traditional Chinese medicine, sex is still viewed as a health-promoting activity and there is a belief that contraceptive methods used should not interfere with the flow of seminal or vaginal secretions. In addition, while herbal medicinal remedies were once used for abortion purposes, these remedies have evolved with the influx and integration of Western medicine ideas and are currently being reduced to their essential ingredients. The number of abortions has increased greatly during the past 40 years due to the cultural and economic opening-up of China’s markets, the government’s one-child policy and the traditional desire for “pure” women. Despite the increasing popularity of Western medicine, traditional Chinese medicine still offers a cheaper and more confidential alternative to Western medicine and is widely used to restore women’s health post-abortion. Perhaps with the integration of medical systems in China, both Western and traditional Chinese medicine will be able to complement each other in many areas of healthcare in addition to abortion and have a harmonious yin-yang relationship that will provide comprehensive care to the community in all aspects of health.

Bibliography
Chan, Leonard. "A Brief History of Chinese Herbs and Medicine." Bulletin of the Torrey Botanical Club 66.8 (Nov. 1939): 563-568.

Ching, C. C. "The One-Child Family in China: The Need for Psychosocial Research." Studies in Family Planning 13.6/7 (June-July 1982): 208.

Edwards, James W. "The Concern for Health in Sexual Matters in the 'Old Society' and 'New Society.'" The Journal of Sex Research 12.2 (May 1976): 88-103.

Elderly Retired Park-User. Personal Communication. Beijing Public Park. 26 Mar. 2008.

Hsiang-Yang, H. “hi-Huo Sheng-Yu Chih-Shih Wen-Ta (Questions and Answers on Planned Parenthood Information).” Peking: Jen-Min Wei-Sheng Ch'u-Pan She: 1973

Hsu, Elisabeth. "'The medicine from China has rapid effects': Chinese medicine patients in Tanzania." Anthropology & Medicine 9.3 (2002): 291-313.

I-Hsueh, C. (A Basic Explanation of Chinese Medicine). Ed. by Hopeh New Medical College Ministry of Education. Peking: Jen-Min Ch'u-Pan She, 1974.

Jiang, W., China Academy of Chinese Medical Sciences. 12 Mar. 2008.

Keng, Y. “Tan-Tan Chi-Hua Sheng-Yii (A Talk on Planned Parenthood)”. Tientsin: Tientsin Jen-Min Ch'u-Pan She: 1964.

Koo, Linda C. "A Journey Into the Cultural Aspects of Health and Ill-Health in Chinese Society in Hong Kong - The Importance of Health and Preventive Medicine in Chinese Society." Health and Preventive Medicine in Chinese Society 11.2 (Feb. 1989): 51-58.

Miles, Andy. "Tian Hua Fen, An Integrative View." Dr. Pan's Clinic of TCM. 10 Aug. 2007. 30 Mar. 2008 .

Nurse in Abortion Clinic. Personal Communication. Beijing Wu Zhou Women’s Hospital. 24 Mar. 2008.

Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 24 Mar. 2008.

Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 29 Mar. 2008.

Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.

Tien, H. Yuen. “Sterilization, Oral Contraception, and Population Control in China.” Population Studies 18.3 (Mar. 1965): 215-235.

Tsa-chih, C. Chinese Journal of Surgery 14: 1 (Jan. 1966); summarized in JPRS, No. 36,889 (9 Aug. 1966).

Tsao, H. Unpublished paper. “International Honors Program Health and Community Spring 2008 – India Country Paper: How has the practice of Ayurveda changed between ancient (1000 B.C.) and modern (20th century) times?”, Mar. 2008.

Zhang (Housewife in Beijing). Personal Communication. 21 March 2008.

Zhou, Xiao. "Virginity and Premarital Sex in Contemporary China." Feminist Studies 15.2 (Summer 1989): 279-288.

[1] Chan, Leonard. "A Brief History of Chinese Herbs and Medicine." Bulletin of the Torrey Botanical Club 66.8 (Nov. 1939): 563-568.
[2] Koo, Linda C. "A Journey Into the Cultural Aspects of Health and Ill-Health in Chinese Society in Hong Kong - The Importance of Health and Preventive Medicine in Chinese Society." Health and Preventive Medicine in Chinese Society 11.2 (Feb. 1989): 51-58.
[3] Jiang, W., China Academy of Chinese Medical Sciences. 12 Mar. 2008.
[4] Edwards, James W. "The Concern for Health in Sexual Matters in the 'Old Society' and 'New Society.'" The Journal of Sex Research 12.2 (May 1976): 88-103.
[5] Keng, Y. “Tan-Tan Chi-Hua Sheng-Yii (A Talk on Planned Parenthood)”. Tientsin: Tientsin Jen-Min Ch'u-Pan She: 1964.
[6] Edwards, James W. "The Concern for Health in Sexual Matters in the 'Old Society' and 'New Society.'" The Journal of Sex Research 12.2 (May 1976): 88-103.
[7] Hsiang-Yang, H. “hi-Huo Sheng-Yu Chih-Shih Wen-Ta (Questions and Answers on Planned Parenthood Information).” Peking: Jen-Min Wei-Sheng Ch'u-Pan She: 1973
[8] Edwards, James W. "The Concern for Health in Sexual Matters in the 'Old Society' and 'New Society.'" The Journal of Sex Research 12.2 (May 1976): 88-103.
[9] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 24 Mar. 2008.
[10] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 24 Mar. 2008.
[11] Tsa-chih, C. Chinese Journal of Surgery 14: 1 (Jan. 1966); summarized in JPRS, No. 36,889 (9 Aug. 1966).
[12] Tien, H. Yuen. “Sterilization, Oral Contraception, and Population Control in China.” Population Studies 18.3 (Mar. 1965): 215-235.
[13] Miles, Andy. "Tian Hua Fen, An Integrative View." Dr. Pan's Clinic of TCM. 10 Aug. 2007. 30 Mar. 2008 .
[14] Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.
[15] Tsao, H. Unpublished paper. “International Honors Program Health and Community Spring 2008 – India Country Paper: How has the practice of Ayurveda changed between ancient (1000 B.C.) and modern (20th century) times?”, Mar. 2008.
[16] Hsu, Elisabeth. "'The medicine from China has rapid effects': Chinese medicine patients in Tanzania." Anthropology & Medicine 9.3 (2002): 291-313.
[17] Koo, Linda C. "A Journey Into the Cultural Aspects of Health and Ill-Health in Chinese Society in Hong Kong - The Importance of Health and Preventive Medicine in Chinese Society." Health and Preventive Medicine in Chinese Society 11.2 (Feb. 1989): 51-58.
[18] Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.
[19] Elderly Retired Park-User. Personal Communication. Beijing Public Park. 26 Mar. 2008.
[20] Zhou, Xiao. "Virginity and Premarital Sex in Contemporary China." Feminist Studies 15.2 (Summer 1989): 279-288.
[21] Zhou, Xiao. "Virginity and Premarital Sex in Contemporary China." Feminist Studies 15.2 (Summer 1989): 279-288.
[22] Zhou, Xiao. "Virginity and Premarital Sex in Contemporary China." Feminist Studies 15.2 (Summer 1989): 279-288.
[23] Ching, C. C. "The One-Child Family in China: The Need for Psychosocial Research." Studies in Family Planning 13.6/7 (June-July 1982): 208.
[24] Zhang. Personal Communication. 21 March 2008.
[25] I-Hsueh, C. (A Basic Explanation of Chinese Medicine). Ed. by Hopeh New Medical College Ministry of Education. Peking: Jen-Min Ch'u-Pan She, 1974.
[26] Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.
[27] Nurse in Abortion Clinic. Personal Communication. Beijing Wu Zhou Women’s Hospital. 24 Mar. 2008.
[28] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 24 Mar. 2008.
[29] Russell, Cristine. "Chinese Medicine: Old & New." Science News 116.17 (Oct. 1979): 292-295.
[30] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 29 Mar. 2008.
[31] Nurse in Abortion Clinic. Personal Communication. Beijing Wu Zhou Women’s Hospital. 24 Mar. 2008.
[32] Ren, Xu. Personal Communication. China Academy of Chinese Medical Sciences. 29 Mar. 2008.

More on Beijing!

2008-04-16T20:44:00.003+05:30

Unfortunately, due to the censorship in China, it was quite difficult for me to access my blog. Instead, I will now try to catch up with you on everything that happened in China to the best of my memory while I am in South Africa.

Thoughts/observations/comments:

Karaoke/K-TV/KTV is huge in China. Everyone loves to sing. Interestingly, my friend made the comment that she has never heard a Chinese with a bad voice and she thinks that it's due to the tonal quality of Mandarin. I personally have not come to any conclusions about this. What do you think?
Went to the "new socialist countryside" for a few days at the end of our stay in China. I was surprised that the "countryside" was not actually as rural as I thought it would be. Instead, they were little guest houses fully equipped with small dining areas, sleeping areas, and of course, KTV facilities. I did not enjoy the food in the countryside as much as in the urban part of Beijing. The good thing though is that we still had dumplings in the countryside for one meal, so that made up for it! :)
I didn't realize how many migrant workers there were in Beijing until we heard a talk from a migrant workers' rights worker. The guest lecturer spoke about the severity of occupational health neglect in China and I was so touched that at one point, most of the class including myself and the translator was in tears. One particularly moving story involved a young girl who was around our age who worked in an assembly line in a factory in Shenzhen. The factory doors were locked to ensure that the girls/workers would not steal materials from the factory. Unfortunately, one day, a fire broke out and most of the workers died not from the fire itself, but from suffocation. In memory of his daughter, the girl's father spent a lot of money on the girl's funeral because he said that in his eyes, his daughter was always very obedient to him ("ting hua") and never did anything to anger him. I was enraged that the company that the factory was under got away without any blame. In addition, the Hong Kong manager of the factory got away without any blame while the mainland China manager of the factory only got 10 years in jail. 10 years total amongst 3 people somehow is enough to compensate for the deaths of at least 8 young factory girls. This has really made me wonder about the meaning of justice and the legal system. How just is the law? And to what extent does this question depend on the country and the particular government in place? Is it culture-specific or is justice universal?
Everywhere, I can see signs of the Olympics, such as through the billboards, television etc. I can really understand why the Olympics can evoke such a great sense of pride from the people. Just during my one month in Beijing, I could already feel the atmosphere that is being built up! I can't wait until the actual games start on 8 Aug 2008 (those of you who are Chinese will understand the auspiciousness of this date 08-08-08, right?). It's amazing how much Beijing has prepared itself for the Olympics, including cleaning up pollution, building more subway lines and drastically reducing public transportation fares for everyone and unifying the transportation system. I really am very very impressed. I hope that the world can see the efforts that are being made and that these improvements can be sustained in China in the long-run.

Places visited:

Temple of Heaven
Forbidden City
Great Wall - a restored section as well as an unrestored section.
Beihai Park
The Olympics venue, including the Bird's Nest!!!

All in all, these were all very cultural and historical visits for me and really helped me to connect with China and my culture. It makes me proud to be Chinese and to be able to share the richness of this country with other people. I hope that through the Olympics, more people will have a glimpse of the many traditions and the long history that China has. While I know that the Beijing Olympics 2008 are controversial globally due to a variety of reasons, I hope that the world can just unite in the name of sport and be peaceful during this time. An idealistic thought, I know, but one can still hope. After all, I really think that idealism and big ideas instead of passivity are the beginnings of change.

Capetown, South Africa

2008-04-09T20:36:00.003+05:30

Hi, folks. Here I am in Capetown, South Africa. We are 6hrs behind Hong Kong and 6 hours ahead of US EST (Boston). I may not have access to the internet for a whole week. If you want to contact me, please call my cell phone at 27-73-724-5843.

Quick update on past two weeks

2008-03-22T15:22:00.000+05:30

Crazy thing that happened: I ran into a friend from high school/middle school from Hong Kong in Beijing!!! It was completely random too while I was shopping with my friends! What happened was my friend ran into her friend in Beijing first, and then it turned out that I knew one of her friends. What are the chances of that?

Things I love about Beijing: Practicing my Chinese/translation skills, DUMPLINGS, noodles and all other types of great cheap Chinese food, how welcoming Beijing-ers are and how I really identify that everything that has been presented to me in lecture at school because Beijing is so close to home for me!

Alright, need to run as internet time is running out. I miss everyone!

Beijing...at last!!!

2008-03-22T09:46:00.001+05:30

As you can tell from the title of this post, I have finally arrived in Beijing, settled down and figured out a way to access my blog despite it being blocked by the Chinese government. Of course, the methods via which this has been accomplished with not be discussed here. Instead, a phone call would be very much appreciated... :)

My Beijing cell phone number: 13552690691
Beijing area code (Should not have to use this, but just in case): 10
China's country code: 86

Time difference works out quite wonderfully here. I am in the same time zone as everyone in Hong Kong and 12 hours ahead of everyone on EST time. I know, I've made things easy for you.

So, I found a step-by-step guide of how to call me. Compliments of http://www.travelchinaguide.com/essential/area_zip/

Dialing China from Abroad

To call China from abroad with a fixed telephone, dial the outbound number of your country + 86 (the country code of China) + area code of the Chinese city + fixed Chinese telephone number. To call a mobile phone number, dial the outbound number of your country + 86 + mobile phone number.
To call China from abroad with a cell phone, dial the outbound number of your country + 86 (the country code of China) + area code of the Chinese city + fixed Chinese telephone number. To call a mobile phone number, dial the outbound number of your country + 86 + mobile phone number.

Dialing within China

To call a fixed telephone number in a Chinese city from another Chinese city 0, then area code + fixed telephone number. To call a mobile phone number dial 0 + mobile phone number.
To call a fixed telephone number in a Chinese city from another Chinese city, dial 0 + area code + fixed telephone number. To call a mobile phone number, dial the mobile phone number directly without 0 prefix.
Note: Different countries require different outbound prefix numbers. For example, US and Canada: 011; Europe (including England): 00; Asia: some areas such as Saudi Arabia: 00; others (such as Seoul) are 001; Australia: 0011, Africa: 09…

Week 4-5: Kerala

2008-03-03T12:00:00.002+05:30

Here is a brief update of the past two weeks before my internet time runs out in 15 mins.

So Week 4 we went to the state of Kerala. Highlights were we went to see a botanical sanctuary where we learned a great deal about plants and how to grow a sustainable forest. This was followed by a trip to Kanavu, an alternative education school for the local tribal people which links education with real life. For example, students learn how to dance and sing local songs, martial arts for self-defense as well as how to read and write.

Highlights in Kerala:

Climbing into and out of an elephant trench. The elephant trench was maybe 2-3m deep and 2m wide with almost vertical sides made of bud. The trench was to keep elephants out of the village. We got really muddy and had a lot of fun falling on top of each other.
Being charged at by a male tusker elephant in heat. Resulted in 33+ people sprinting at full-speed back onto our bus that was also just pulling away. For a while, I thought that I was going to get trampled/get killed by the elephant. Had a great laugh afterwards though. Now realize how dangerous elephants can be and how fast they can move.

Week 5: Vacation in the state of Kerala

Brief outline of vacation:

Wayanad --> Calicut (bus) --> Cochin (6-hour overnight train) --> Munnar (few hours drive) --> Alleppey (4 hour drive) --> Fort Cochin (1 hour drive) --> Ernakulum --> Bangalore (12 hour overnight train)

Highlights:

Munnar - beautiful gorgeous tea plantations everywhere. Rowed a boat unsuccessfully. Climbed rocks, trees and even our van.
Alleppey - Went on a beautiful houseboat and boated through the incredibly scenic backwaters of Kerala. Then got into a little boat and rowed through a local village. Reminded me of Venice. Beautiful evening star-gazing with the sound of water lapping onto the shore and a nice breeze. Have never seen so many stars in my life. Was like a clear night at Wellesley x 10 visibility.
Fort Cochin - 500 rupees (around 12 USD) for a room for three people. Generally satisfied as no big bug problem in this room. Lots of walking around and working on my country paper for India at internet cafes. Visited Jew Town - very tourist-oriented area. By far, the most tourist-oriented place I've been to in India so far. Everyone spoke English. Shopkeepers looked like they had mixed blood (Indian + Western??). Overpriced souvenirs, but the type of thing that you would get for friends at home, such as little handicrafts and small samples of spices. Saw a synagogue for the first time. INCREDIBLY hot weather. Impossible to sleep without a fan on and impossible not to be sticky. Reached new stickiness levels and survived.

Okay, that's it for India. Flying to Beijing tomorrow!

My homestay family in Bangalore

2008-02-28T16:43:00.002+05:30

I was just thinking today that I've been posting a lot about the various places that I've been to in India but have not posted anything about some of the most fabulous people in India that I've met - my homestay family!

My homestay mother's name is Anju and my homestay father's name is Sudarshan/Uncle/Sudi. They run a little cafe in a theatre that has the most amazing food. Anju's philosophy of cooking is to cook from the heart and to cook organic healthy homestyle food! Here's a short article about her cafe that explains it better than I can:

http://bangalore.metblogs.com/archives/2007/07/anju_at_ranga_shankara.phtml

Anju and Sudi are both very very warm and friendly people. In fact, we've been joking around ever since Julia (my roommate) and I arrived at their house. For example, one day, Anju didn't come back to sleep for the evening. I asked Sudi where she was and he told me that she was off on vacation in another part of India for the week. Of course, surprise surprise, the next day when I got back to the cafe after school, there was Anju as usual working! Apparently, she had just gone to her brother's birthday celebration (which was in the same area of Bangalore, in fact), had talked until 3am and decided to spend the night there. Of course, Julia and I gave Sudi "the look" when we saw him later. :)

With Anju and Sudi, we've gone for ice-cream, attended a wedding reception and even went to a family lunch with them! I had been warned in Switzerland that we would have no ice-cream in India or China, but wow, the ice-cream place that we went to was simply unbelievable. I think that it's definitely one of the best (if not THE BEST) ice-cream place that I've been to in my life so far. It's name is Corner House. I ordered a "Brown Bomb" which was essentially TONS of fudge on top of chocolate ice-cream on top of a very warm brownie swimming in fudge. Mmm...I was in chocolate heaven! Definitely by far one of my greatest dining experiences in India so far!

On Monday when we return to Bangalore after our vacation, our entire study abroad program will be having a farewell dinner with all the homestay families. Anju has agreed to dress Julia and me up in beautiful saris/sarees. I cannot wait to see what I look like!

Mini-Vacation: Pondicherry

2008-02-25T17:16:00.002+05:30

Following our case study, my group decided to go on a mini-vacation on Pondicherry. It was absolutely magical. It was so nice to be away from the noise and honking of cars in Bangalore and just to have peace and quiet and a laidback pace of life for a few days. We stayed at Pondicherry for two nights and one full day and mainly visited the Ashram, shopped in a traditional handicrafts fair, spent a good amount of time at the beach and ate amazing food, including "forbidden" foods such as steak and fish!!

A few snapshots of Pondicherry:

Sunrise at Pondicherry - Woke up at 5:45am and strolled over to the beach to witness an absolutely breathtaking sunrise. Colors changed from black --> gray --> dark blue --> red/orange --> brilliant rays of sun peaking out from behind white clouds against a blue sky --> glaring brilliant (and hot!) sunshine. Words will do no justice and will therefore leave you all in suspense until I can show you photos when I get back. :)
French colonial influence on Pondicherry - colonial colors of buildings, such as tan, cream, and blue. Also, many European-styled balconies. Lots of French words everywhere. Many places were bilingual in French and the local language.
The Flute-Seller - I'd never seen one person carry so many flutes in my life! The flute-seller that I saw had flutes lined up in circles similar to the sides of a cup and was carrying them on his back. However, the craziest thing was that within this "cup" of flutes were more flutes inside, and even more flutes inside this inner "cup." Of course, while carrying all of this, the flute-seller was also playing a flute to advertise his goods. I am so amazed by the strength and skill of the local crafts sellers in India.
A scene on the beach - After a very refreshing shower, I went to sit at the beach and just enjoy the moment. I remember... the sounds of a flute floating over the sand from the flute-seller, the beating of the waves on the shore and the cool breeze on my face and in my hair, the gentle tones and chatter of the people around me, kids' shouts from the playground behind me, the melodic voices of the people trying to sell fresh flowers, candies or other products... A very sensually-stimulating and relaxing experience.

Case Study - Navadarshanam, Tamil Nadu

2008-02-25T16:42:00.002+05:30

Navadarshanam was the second place that we visited for our case study. Navadarshanam is a community that is dedicated to seeking alternate methods of living to the modern way of life. Their main philosophy is to live sustainably with minimum exploitation of nature and humans. Furthermore, the people believe in a life force that exists in all living things. Thus, if we let things be, this life force has the potential to rejuvenate itself. This philosophy was reflected in the community's attempt to regenerate the forest in Navadarshanam through a policy of minimum intervention as well as their attitude towards health. For example, even though community members may be sick, they try to let their own bodies heal themselves and only seek the help of healthcare systems if there is no improvement. When we were at Navadarshanam, one of the people had a sore throat and was meditating in silence for three days to give his body a chance to rest and heal itself. This has really made me think about how reliant many people are in the world on healthcare. In particular, in the US, the overprescription of drugs has been a serious problem. Just a thought, but perhaps a fostering of this alternate mentality could be a solution to this problem.

Interesing things about Navadarshanam:

To get fuel for cooking, methane gas is used. Methane gas is "made" by mixing cow dung with water. The methane gas is pumped to the kitchen and the remaining slurry is pumped out to the fields as fertilization. Alternate layers of slurry and biomass put onto fields for optimal fertilizer that can regenerate itself.
Polyculture instead of monoculture is used, meaning that multiple plants are planted together instead of only having one crop, as is often the case in the growing of cash crops. By having polyculture, plants can complement each other in terms of the nutrients that they take out and put back into the soil and help each other to grow healthily.
Navadarshanam has a very interesting aura or energy about it. Once we arrived, I immediately felt fresh and rejuvenated. Everything was so green, so healthy and so full of life. I'm starting to really believe in some of the healing powers of nature that I've heard about in the past and used to be skeptical about.
The food at Navadarshanam is incredibly tasty and healthy. It's amazing how you can truly "taste" the freshness and nutritional value in the food that we had. All the stomach problems that I had had for the past couple of days were gone while at Navadarshanam. Perhaps this is an indicator of how great the connection between health and food is, and how much control we have over health simply through our diet.

Case Study - Tribal Health Initiatives, Sittilingi Valley, Tamil Nadu

2008-02-25T15:58:00.002+05:30

For the past couple of weeks, we've been learning about various types of data collection methods, such as different types of interviews, group discussions, focus groups and observation. To give us a chance to put all that we've learned into practice, we do a case study in each country. For my case study in India, six people were in my group and we went to the Tribal Health Initiatives and Navadarshanam in Tamil Nadu,

Tribal Health Initiatives (THI) is an incredibly inspiring place. THI was started by a couple, Dr. Lalitha and Dr. Regi, in India and their vision is to promote health for the tribal community in the Sittilingi Valley in the state of Tamil Nadu, India. Dr. Lalitha (Tha for short) and Dr. Regi spent some time researching various places in India that had little access to healthcare because they knew that they wanted to provide healthcare to those who needed it most. When they decided on Sittlingi Valley, they actually spent a year living in and learning about the area and the tribal community there. I found their story truly incredibly, especially when I heard about their struggles to gain acceptance amongst the tribals and eventually to empowering the local tribal community. For example, they trained women in the tribal community to become auxiliary nurses. The initial batch of women that they trained actually weren't accepted in their villages because the women were 18 or 19 year old girls. Dr. Lalitha and Dr. Regi therefore tried a second time by trained women who were chosen by their communities and were respected in their villages. This was a great success and this second batch of auxiliary nurses have been changing many of the once fatal practices amongst tribals. Meanwhile, Dr. Lalitha and Dr. Regi utilized the first batch of nurses that they trained as a workforce in the hospital that they have set up in the area!

We had the amazing chance to talk to Dr. Lalitha, some of the doctors working at the hospital with her as well as to the auxiliary nurses! It just happened to be that our visit to Sittlingi Valley coincided with the auxiliary nurses monthly training day at THI. At first, it was awkward talking to the auxiliary nurses because of the language barrier. However, both sides opened up to each other when we sang "Lean On Me" to them and in return, they performed their tribal dances and songs. When they asked us for another song, we taught them to do the Hokey Pokey!!! The nurses laughed so hard when we got to the part where you put your "booty" in and put your "booty" out! After all that action, conversation flowed much more smoothly.

Some thoughts about THI:

Absolutely LOVED seeing the doctor on rounds. I was surprised at how Western the medicine administered was. For example, there were assigned scrub nurses for surgeries and everyone had a role similar to the way that it is in allopathic medicine. However, at the same time, there were moments that made me realize the inequality of resources and wealth in the world. For example, when the ambulance/van arrived, the patient was not carried into the hospital in a stretcher but was instead carried in a piece of cloth and wrapped up inside.
Was touched to tears when I watched the introductory video to THI. For those of you who are interested, it is called "The Sittilingi Experiment" and I will be bringing a copy of it back home with me to share with you all. A particularly memorable part of the video was when Dr. Regi said that if you listen to and teach the local people, the local people have the capacity to rise and take care of themselves. It was just so inspiring for me to see other people who have a similar vision as my own actually realize their visions/dreams!
The auxiliary nurses all agreed that healthcare has improved in their communities. For example, through THI and their efforts, birth practices such as unsanitary ways of cutting the umbilical cord, and keeping the mother from breastfeeding her child for the first first days, and not letting the mother eat for five days after delivery, have all stopped. There are now so many more healthy children born in the villages around THI and to see the impact that one couple can have on a community.
Sustainability is so important and can be achieved in more ways than we can imagine. For example, I used to think that medical waste would always be a problem and that it would require costly special waste disposal methods. In particulary, since medical waste often contains contaminated human material on it, I thought that there would be no way to cut down on medical waste since most things would have to be disposable. However, at THI, things such as masks are made out of cotton. These masks can be washed with detergent for sterilization and reused. This has revolutionalized the way that I think about medical waste and about waste in general and I am much more conscious of the waste that I generate now and how it will be treated later.
I have realized the importance of involving the community in this type of project and to keep an open mind. As Dr. Lalitha said, one of her most rewarding experiences was unlearning all the knowledge that her education and upbringing had taught her and to learn from the tribals with an open heart and mind.

Overall, definitely a life-changing experience. Right now, I am definitely considering the possibility of working in a rural area in China where language will hopefully be less of a barrier and to do similar work that Dr. Lalitha and Dr. Regi have done.

1 Feb 2008 - Traditional Market Visit

2008-02-19T16:28:00.004+05:30

I simply love visiting traditional places and learning about how people typically live in a place. I was therefore very excited to be able to visit a traditional market. Everyone on the program was divided into groups and we were given a list of items to purchase at the market. The list of items was interestingly in Hindi to make it more difficult for us. On the bus ride to the market, we solicited the help of a fellow passenger to help us translate all the items on the list into English before we began our adventure. It was quite a cultural experience. Some of the items that we had to purchase included traditional Indian spices, a lungi (a garment for men that resembles a skirt that is often worn during work, such as in the fields), dye used for Vindi (I'm not sure if I am spelling this right but I'm referring the dye used in the middle of Hindu women's foreheads), as well as interestingly, a condom. We had one of our travelling faculty with us who spoke Hindi and we assigned him the task of getting the condom. It was simply hilarious when he played along with us and to the embarassment of the shopkeeper, asked the shopkeeper what flavors of condoms he sold. A very memorable experience indeed both for our group and for the entire class when we retold the story during our traditional market visit debriefing.

6 Feb 2008 - Panel discussion - Where do I go when I am sick?

2008-02-19T16:20:00.005+05:30

This was a panel discussion from various low-income groups including a farmer, security guard and domestic helper. I was very touched by their struggles with the healthcare system and how often the quality of care that people received depended on how much they could pay. For example, one woman spoke about her husband's experience. She was not able to pay the nurse upfront for her services and instead said that she would pay at the end of her husband's treatment. As a result, the nurse inserted IV needles into her husband's arm more roughly than usual, and the woman's husband ended up with very swollen arms and hands. It makes me very sad that while there are inevitably certain additional obstacles that poor people undoubtedly have to face due to their financial situation, people working in the healthcare system still make these people's lives harder simply through their attitudes towards them. When I think of the healthcare system in the United States and its great emphasis on empathy and compassion, I wonder how these healthcare workers developed their uncaring attitudes. Was it because their emotions were dulled over time or was there simply no focus on the need to develop a correct attitude in their heathcare education?

31 Jan 2008 - Bangalore Medical College Victoria Hospital

2008-02-19T16:14:00.002+05:30

Very interesting experience. I was very excited to have a chance to see doctors perform routine examinations on pregnant women. We even saw one doctor examine a women who wanted an abortion. One of the doctors even asked me if I wanted to try to perform the examination on the patient myself. I unfortunately declined as our group was leaving the examination room but I was struck by how different the concept of privacy is between the United States and places such as India. In particular, it was interesting that both the patients and doctors carried on as usual with their clinical visit in a maternity ward in the presence of our group, especially since we had one boy with us.

As I expected given the similar colonial history of Hong Kong and India, the medical school education system here is similar to that in Hong Kong, with students going into medical school to get their MBBS degree straight after high school. This has made me think more deeply about the effect of globalization and colonization in the world.

Week 4 Day 2: Bangalore, India - Update on past few weeks

2008-02-19T16:10:00.002+05:30

I need to apologize for not updating my blog for the past couple of weeks. For around two weeks, my stomach was giving me problems, resulting in symptoms such as nausea and vomiting in the morning. I think that my stomach was just adjusting to Indian food, so I ended up fasting on fruits for a while. I am happy to say though that I believe that I have now fully recovered. My appetite has returned and I am very glad to be able to enjoy good old Indian food again. :)

During my two weeks of feeling ill, we actually were exposed to quite a few interesting experiences. Here is a list of some of our lectures/field visits this week to give you a taste of what I've been learning about:

Coordinator Lectures:

Food, culture and traditions and their relationship with home based remedies (Bhargavi S. Rao)
Water management in Bangalore and its relation to public health (Bhargavi S. Rao)
Right to water in the context of the politics of provisioning of services, privitization and risks to public health (Leo Saldanha)

Guest Lectures

An overview of the structure of governance and roles of central, state and local governments in health care management and delivery (Dr. Subbarayan Prasanna, formerly professor of Urban and Regional Planning and Dean at Indian Institute of Management)
Health care practices in India (Dr. Shirdi Prasad Tekur, community health specialist and pediatrician)
Issues and concerns of women's movements in India and historical overview (Ms. Madhu Bhushan, Women's Activist Group Vimochana)
Status of public health and health care delivery systems in Karnataka - policy, budget, expenditures and challenges (Dr. H. Sudarshan)
Issues around access to formal legal system to women (Rekha, Women's Activist Group, Hengasara Hakkina Sangha)
Faith healing and people's practies in alternative health remedies (Dr. Shirdi Prasad Tekur)
AIDS and HIV in Karnataka - situation and response (Asha Ramaih, Karnataka Network of People Living with HIV/AIDS, Bangalore)
The 3rd gender- transgender desirse, displacement contexts and the question of their human rights (Interaction with activist group on sexual minorities - Sangama)

Panel Discussion

Where do I go when I am sick? Panel of participants from various low income groups including a farmer, security guard, and domestic help

Field Visits

Bangalore Medical College Victoria Hospital
Traditional Market
Slum neighborhood - appreciating access to water dynamics in low income neighborhoods
Visit to water and sewage treatment plant and interaction with officials of Bangalore Water Supply and Sewerage Board

My Phone Number in India

2008-01-29T18:05:00.000+05:30

Yay! I finally got my SIM card.

India country code: +91
My number in India: 9972816318

For those of you in the US (EST): I am 1.5 hours behind your time, then flip the am/pm.
For those of you in Hong Kong: I am 2.5 hours behind your time, NO flipping of am/pm.

Just in case I've calculated my time zones incorrectly (very possible given that I am no longer even sure of which time zone my jetlag is operating in since I've gone from Hong Kong-->Switzerland-->India in the space of 2.5 weeks...), Bangalore's timezone is GMT +5.5.

It also makes me happy that incoming calls on my phone are free! :)

Typical Day in Hostel in India

2008-01-29T17:54:00.001+05:30

7:30am Wake up
7:45-8:15 Breakfast
8:30-9:15 (depending on the day) Begin class/lectures
10:30 - 11:00 Tea Time (The hostel serves something that tastes like Hong Kong Milk Tea and is uber-yummy! It is also crazy boiling hot when they serve it, so I can give me a go on my "things that I can eat or drink" list.)
11:00 most class/lectures
12:30-1:15 Lunch
2:00 More class or lectures (will be field work in the upcoming days which will take the whole afternoon but these days I get out at around 4pm)
4-4:30 Tea time (AMAZING pastries/cakes served. Mmmm....)
7:30-8:15 Dinner Time

I love how there is so much time for food/drink during the day. During my free time, I'm often out looking for a convenience store/internet/payphone etc.. Of course, there's also readings and assignments that I try to do at night when there aren't group activities. All in all, pretty hectic busy schedule, but a very difficult lifestyle as a student from my life at Wellesley.

First Impressions/Random Thoughts of India

2008-01-29T17:44:00.001+05:30

1. Litter and dust everywhere. Respiratory diseases are a huge problem here. The dust actually reminds me of Peru.
2. The sound of rickshaws (little motorcycle-like things that have no doors and function like taxis/cabs in India)
3. My first shower with buckets - so far, once with lukewarm water and the other time with cold water. Very refreshing and enjoyable in different ways, although my current roommate thinks differently.
4. Squat toilets. No toilet paper. We're supposed to use this water container/bucket thing in our hostel to clean ourselves. Of course, I was very grateful that I had brought pocket tissues with me. I also proceeded to buy two rolls of toilet paper at the convenience store the next day.
5. Constant worry at the back of my mind that I have a luggage limit of 40 pounds when I get to South Africa. My luggage is already almost 50 pounds... :(
6. The sound of Azan (sp?) - the call to prayer for Muslims that happens five times a day. In my opinion, it's beautiful and you can hear it from far away in the city.
7. Almost getting run over by cars/rickshaws/various other small types of transportation that somehow manage to get into the tiniest spaces every other second. Traffic here is a little crazy, to say the least and of course, anything with wheels has the right of way.
8. Language difficulties/barriers because I don't speak any Indian language/dialect here. Luckily, simple English works in most places.
9. The Indian head "thing" which involves tilting the head slightly right and left. This can be used to signify either yes or no depending on the context and is really up to interpretation and a real test of my reading of nonverbal cues.
10. Very spicy food and eating with your right hand. I have yet to eat with my right hand because I don't want to risk getting myself sick since I don't know whether the water that is available for handwashing is clean. However, this is probably something that I should try at some point.
11. UV-filtered water/boiled water - VERY important. Constantly thinking about my source of water because it is very very easy to get gastrointestinal diseases in India. Hopefully, my love of street vendor food in Hong Kong has given me a first line of defence. This of course also makes me sad,because I can't eat lots of good food, such as ice-cream, popsicles of pudding, because I can't be 100% sure of where the water is coming from.
12. On a random note, am EXCITED about experiencing more of India in the days to come. I'm sure that I will learn a lot from my homestay family while I am with them, especially about family dynamics and how people in India live. :)
13. Eating out of metal bowls and drinking out of eeny weeny metal cups. The bowls literally look like a flat circle with the sides raised. It's been interesting because I didn't realize how easy it is to burn yourself when you're filling these bowls/cups with hot food/drink. Definitely has given me a greater awareness of the conduction/insulation properties of various materials. :)

Week 2 Day 2 Tuesday - Bangalore, India

2008-01-29T17:30:00.000+05:30

Things have been quite hectic in the past couple of days with us finishing up in Switzerland and packing up to go to India. The past few days in Switzerland were amazing! One woman spoke to us about the differences between Traditional Medicine and Western Medicine and it was absolutely fascinating. She also spoke about how China is one of the few countries in the world that has been able to integrate Traditional and Western Medicine well in society. Did you know that China has a policy to treat both types of medicine equally, such as in terms of funding and advertising? I found that fascinating. The WHO has been working to try to do the same in many other countries. It's particularly interesting to me how even though 70% of the population in India uses traditional medicine, traditional and western medicine are still very much segregated. :( I think that I'm going to explore this topic further and I've chosen to base the three papers that I'm going to write this semester on the integration of Western and Traditional Medicine in each of the countries that I visit.

I am finally going to meet my homestay family tomorrow, which I am very excited about. I will write more when I can. The internet connection is slow in India and often, I have to wait in line for a long time to use it. Hopefully the situation will be better in the neighborhood that I'll be staying in with my homestay family for the next 4 .5 weeks!

Some facts or observations about Switzerland...

2008-01-23T02:44:00.000+05:30

1. Geneva is located in the French-speaking part of Switzerland, so I have been bombarded with French everywhere.
2. A question needs to begin and end with a greeting, such as Bon Soir...(question)...Merci beaucoup. Au revoir. ( Do not know if I am spelling the French correctly)
3. People in Switzerland are very united and community-oriented. There is great emphasis on civil responsibility and not much emphasis on the individual. For example, going to the police or to a lawyer is almost unheard of because people tend to work out problems themselves as they feel that it is part of their civil responsibility.

Week 1 Day 3 Geneva, Switzerland

2008-01-23T02:24:00.000+05:30

Hello. I finally arrived in Switzerland after many hours on the plane and in airports. We stopped over at Heathrow, London, where I found the craziest thing: a hairpod! A hairpod has the same sleekness as the other various variations of pods you would normally expect but it is actually a very compact (and very cool) hair salon! I would post pictures, but due to various technological difficulties, the photos will have to wait. Just to give you an idea of how rare technology or computers are in Geneva, only 49 percent of households actually have computers!

These few days have essentially been jam-packed with introductions and various other orientation matters, including delegating responsibilities, such as confirming airplane tickets, to each member of the group. One thing that I have noticed so far is the incredible diversity in the group of 32 students that I am travelling with. A wide range of universities are represented and everyone has a very unique background. For example, one of the girls has travelled to many places in the world already on her own or with college friends, such as to Bolivia and Costa Rica. Another friend was born in Tanzania and another was born in Liberia! One thing that has struck me about the group is that despite our differences, we really all share a common goal to learn more about other cultures and public health. This has been particularly apparent from the various discussions that we have had everyday on the various issues that we have come across.

These two days, we have heard lectures on the role of NGOs, the state and the civil society in public health, as well as learned more about the World Trade Organization and its function. In addition, at the UN, we learned about intellectual property and the process of patenting, as well the work of the WHO in TB globally. All in all, these lectures have been incredibly rich and while I have not quite managed to digest all the information that has been presented to me, I hope that over the course of this semester, I will grow to have a better idea of how each little part that I am learning about will fit together in the global picture of public health. Each lecture has been followed by a discussion amongst the group about what we learned as well as any additional questions that we have. The format is quite informal and I have been very impressed with the amazing quality of discussion that we have been having and the very creative points and experiences that people have been contributing to the discussion. It has been really wonderful learning about everyone's experiences and seeing how different academic backgrounds, such as economics or health policy or even science backgrounds, can enrich a conversation.

Tomorrow we will visit the WHO. I am so so excited and hope that tomorrow's lectures will be just as exciting as the ones that I have heard so far.

Itinerary and Mailing Information

2008-01-18T03:18:00.000+05:30

Hello everyone!

This is my first post before I leave from Boston to embark on my little tour of the world this semester! To give you a taste of where I'm going to be when/where and how to contact me, here is my itinerary and contact information! I can't wait to share my experiences with you this semester through this blog and will try to update it as regularly as I can! Enjoy!

- Hoi See

International Honors Program
Health and Community, Spring 2008
Week-by-Week Itinerary
December 12, 2007
16 weeks: 15 weeks programming plus 1 week vacation

1 WEEK
Week 1: Program Orientation in Geneva
Accommodation: Group stay in a hostel
*Students are responsible for their own arrival to Boston, Logan Airport.

5 WEEKS (4 Weeks + 1 Week Vacation): Bangalore and Kerela
Weeks 1 and 2: Homestays in Bangalore
Week 3: Case Studies
Week 4: Kerela
Week 5: Vacation
Accommodation: Combination of group housing and homestays
*Arrive in and depart from Bangalore.

4 WEEKS: Beijing
Weeks 1 and 2: Homestays
Weeks 3 and 4: Guest house and rural stay (2 days)
*Arrive in and depart from Beijing.

5 WEEKS (4 Weeks + 1 Week Wrap-up): Cape Town
Week 1: Hostel in Cape Town and Homestays in a Township
Week 2: Homestays in a Township and in Cape Town
Weeks 3 and 4: Homestays in Cape Town
Week 5: Retreat Center in Malmesbury
IHP itineraries, schedules and accommodations are subject to change. Dates refer to local time

International Honors Program (IHP)

Health and Community, Spring 2008

OVERSEAS MAILING ADDRESS LIST

Mail: Mail delivery can require anywhere from ten days to three weeks. Do not send packages. IHP will not forward student mail. IHP cannot be held responsible for lost mail. Addresses and dates are subject to change.

Geneva, Switzerland January 18 – January 26

Student Mail:

Student Name

28-30, rue de Rotschild

1202 Geneva – Switzerland

Emergency Contact: +41 76 244 50 42 (cell number)

Calling from abroad: Country Code (41), City Code (22)

Bangalore & Kerala, India January 27 – March 4

Vacation: Vacation begins the evening of Sunday, February 24 in Kerala. Students are expected to return to their respective homestays by 10:00 a.m on the Tuesday of March 3. The group will gather on the evening of March 3 for a farewell gathering and depart for Beijing on March 4.

Student Mail:

IHP c/o Environmental Support Group

105 East End ‘B’ Main Road

9^th Block, Jayanagar

Bangalore 560 069 INDIA

Emergency Contact:

Emergency Phone/Fax: Leo Saldanha or Bhargavi Rao 011-91-80-2244-1977 or 011-91-80-2653-1339

or Fax: 011-91-80-2653-4364

Alternate Emergency Phone: (Bhargavi home) 011-91-80-2679-0027

Mobile (Leo): 011-91-94-4837-7403 (Bhargavi): 011-91-94-4837-7401

Calling from abroad: Country Code (91), City Code (80)

Beijing, China March 5 – April 4

Student Mail:

c/o Dr. Ren Xu

Main Building, 9th Floor

No. 16 Nan Xiao Jie, Dongzhimennei

Beijing, 100700 China

Emergency Contact:

Hong Mautz, Emergency cell: 011-86-137-1890-6546

Calling from abroad: Country Code (86), City Code: Beijing (10)

South Africa April 5 – May 9

Student Mail:

Chris Colvin and Natalie Leon

(for [student’s name])

7 Alfred St.

Observatory 7925

Cape Town, South Africa

Emergency Contact: Chris Colvin

Cell: 011-27-83-453-9438

Secondary Cell: 011-27-83-454-8567

Land: 011-27-21-447-7605

Calling from abroad: Country Code (27), City Code: Cape Town (21))