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What’s The Status of Medical Care in China?

Our firm does a regular business for clients in the pharmaceutical and medical apparatus business. It’s interest work and pays well, but it isn’t particularly interesting to discuss. Unless I want to create a set of rules and advice for other lawyers like: a) don’t pay off the government officials, even though they are putting their hand out, b) choose locations to do business where other, established US and European firms are located so there’s an understanding of what they are doing and an unstated agreement to let them operate without excessive interference. But, I don’t want to go that route, since it isn’t very interesting, or informative, or telling.

The more interesting topic is a peek at what you get when you see a doctor in China, or at least here in Xining, Qinghai. I get calls from my parents, especially, inquiring about how my young boy is doing. They have their doctors and hospitals back in Maryland that they know and trust, and make the logical leap to asking me about what my child’s “personal physician” here in China says about how he is doing, and how his various checkups are going. I keep telling them that China has no personal doctors, only large state run hospitals, but they don’t seem to understand that, and the question keeps popping up over and over again. And, in fact, I am wrong: here in Xining, we have well trained, reliable doctors. And, in a further point of fact, this group of well trained, reliable doctors are all foreign.

My crowd of foreign friends here includes a few of the foreign doctors. They come from the USA, the UK and South Africa. They are mostly, but not completely, religious Christians, and they were trained in some of the top US schools like Harvard. And they all work in the Red Cross Hospital (青海红十字医院) here because, I was told, the other hospitals in town felt like they didn’t need foreign experts.

The foreign doctors are all funded by foreign, mostly religious organizations like this one. They get paid locally by the Chinese hospital, but just a penance of USD $500-$1,000 per month, depending upon how many hours they work, and they generally hold clinics a few times a week. One doctor, a Swiss surgeon here, is a legend not only because he is well respected by the other foreign doctors, but also because he and the other foreign doctors are the only ones who are willing to help after hours and on weekends. Chinese doctors only work during official work hours, and never take a private call.

Patients who visit any doctor at the hospital, including the foreign doctors, pay very little, about USD $1.50, for a full consultation. The foreign doctors, unlike the Chinese doctors, don’t make commission from the medicines they prescribe, and thus try to choose the correct, rather than the most expensive, medicine. The truth is that Chinese doctors get paid such a paltry salary that they can’t survive without such commissions.

The medical system has endemic problems. One huge, recurring problem is the fact that Chinese patients are accustomed to demanding that they get a shot, any shot, whenever they have a perceived illness. For instance, our cleaning lady complained of dizziness after she felt a minor earthquake here a few weeks ago, then said the whole episode caused her to have a rash, then promptly found a doctor to give her a shot of something and said she was cured. But, the foreign doctors don’t give shots when patients ask for them, but rather only when a shot is needed. This causes conflicts, especially when patients, or more likely their parents or grandparents, get angry with the doctor’s advice to rest or change their diet, rather than a shot. Who wants plain advice, after all?

Other problems are that Chinese rarely research their medical problems on their own, so they don’t and can’t have conversations with doctors. And Chinese doctors don’t tolerate patients who have their own opinions about their illness or treatment. Finally, Chinese patients, and doctors, prefer using Chinese medicine. They justify this based on tradition or custom or advice from elders, and dismiss the concept of data or research that supports the effectiveness of western medicines.

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The System Won’t Change: You Will

My law firm avoids billing clients in China since while our clients with domestic Chinese offices are plenty and always pay us on time, the Chinese government has set up so many obstacles to transferring US dollars out of China that it isn’t worth it. There are literally multiple bureaus and taxes that have to be first notified, give approval, then incredibly have to see documents that don’t exist, like a contract for services with a fixed dollar amount, and other related documents. In a word, it is so close to impossible to legally transfer money out of China that the whole trade deficit issue is a permanent losing argument for the USA.

And, if I were to have to explain quickly how things work here, I would say: The system in China won’t change. You adapt to it.

And, so today, another example. My family will be flying to the USA via a third country, and the first leg of the trip is a domestic flight, from Shanghai to Beijing, followed by a seven hour layover. I shouldn’t have purchased the ticket but what’s done is done. As it so happens, my wife, who is Chinese, needs to get a visa to the third country, and that is issued at the embassy in Beijing, only, and I prepared the (huge) paperwork to get the visa in advance, sent it a week in advance by China’s state owned (and only) nationwide express mail service EMS, with a promise by the post office were it was sent that it would take 3-4 days.

The embassy opened on the 7th, and since I sent it on Feb 1, there was enough time. But on the 7th the tracking system showed it as in Beijing but undelivered. When I called to ask why, the answer was the usual: we don’t know, but it is busy and will hopefully be there soon, but could take longer. Whatever. Infuriating. But this is China. It wasn’t delivered on the 8th either, and I called the embassy, and from them, rather than from the multiple people I spoke with at the customer service number for EMS I learned that EMS didn’t even start delivering until the 9th. In other words, nobody told the customer service reps about the fact that no deliveries were happening in Beijing.

Then the next problem then arose: with a two delay getting the visas, there wouldn’t be enough time to get the passports sent to Shanghai, where they would be used by my wife and child to jump on a plane and return to— where? —- Beijing, so instead lets just change or update the reservation so that they will accept my wife’s China ID card, which is used for all domestic flights anyhow, to take this domestic flight, then she will pick up her passport in Beijing during the seven hour layover. The travel agent added her ID number to the reservation, but while I called to confirm with the airline, I was told that the rule was, alas, a Chinese rule– the type that has no purpose but can never be modified: my wife would have to have her passport in hand for the Shanghai-Beijing flight, even though her ID card is sufficient for all domestic flights, and there’s no logical reason for this.

And, boy, did I ever complain. And complain. But I have been down this route before, like all foreigners in China, and this is a country that brooks no grey area, no discretion, and no variance from rules that make no sense. Now, I am in a fix. Do I rely on a express service that operates with arbitrary schedules and customer service reps who don’t know anything? What would you do?

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What Is A Chinese Banquet

We were invited by Chinese friends to go their very loud, fun near year’s banquet (that’s the Chinese new year), and my boy Leo must’ve been held by everyone there. See the video, followed by one that shows the outside of our house on the day after the Chinese New Year–see what the firecrackers do to the place we live.

The banquet

The day after

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Where Do Chinese People Live?

I joined a Chinese friend who runs a car repair shop to drive home his employees to the next city over, Guide, about 110 KM, or 65 miles. It is a tremendous ride that requires a crossing of the 3800 meter mountain in between. Although I’m obviously glad I don’t live this way, it is nonetheless incredible to see these amazing houses where people live here. And they were all so nice to us. I took a video at each of the homes of the employees we visited, and here they are, along with personal commentary that I hope you enjoy.

Here’s the first…

Here’s the second one…

And another…

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Fresh Milk in Xining

I am not posting regularly, and everyone who has a young child can understand why: its more fun spending time with my boy than doing anything else. I love hanging out with Leo. He’s five months old already, and we swim, laugh, dance, sing and hug, over and over again, and I love it. And I think he does too.

There is, just so you know, plenty to write about here in Xining, and I’m just taking pot shots at topics that occur to me by writing about one or another. It used to be a passion. Now, its just something I do when it occurs to me. I’ll write today about one right now, fresh milk, that has nothing to do with Xining in particular, but is interesting nonetheless.

Our second aiyee started work today. She will come to our house every day except Sunday and she replaced another one who expected to be paid for doing barely more than what I could do by spitting on the bathroom mirror weekly, then rubbing it with the back of my hand. The house was a mess with her, and she couldn’t take directions. This new one we found because some foreign doctors here have employed her for a while, took a vacation, and posted a notice on the bulletin board that foreigners– all 600 of us– in Xining share, in an effort to get her some employment and business in their temporary absence. Their posting also noted that she makes and sells muesli around town, and frankly that’s one of the things that I crave here in China. I can find the standard fare of cereals at the two import stores here, but since its an effort to find fresh milk, I haven’t purchased any of the sugar cereal–not worth the effort.

But, she arrived today and brought her muesli, and we bought a couple packets, since it was good and we are glad when we can pay people for doing good work (somehow I seem to be funding this entire China and marriage venture, but thats another story), and it really meant that I needed fresh milk, at long last. And here’s where my story starts: fresh milk in Xining.

If you have lived in China, you know what I’m about to say. The Chinese drink milk, in my humble opinion, since they see westerners and healthy Koreans and Japanese drinking it, but they do it their own way, with their own rules and fiction about how things should work. When they aren’t adding dangerous or unhealthy things to the milk like Melamine without telling the consumer, they instead have created a massive industry of Ultra-Pasteurized milk that serves China’s operational style perfectly: it can be stored for a couple months at room temperature without going bad, and obviates the need for the government to provide oversight to the vast majority of the dairy industry as a result. The problem is that it tastes bad, and if you are like me– raised in the USA on gallons of fresh milk– there’s the sneaking suspicion that any milk that sits out so long in packets almost indistinguishable from chewing gum and hard candy can’t be that good for you at the end of the day.

But, that’s neither here nor there, and its not my goal to advise you whether or not you should buy warm milk in China, or elsewhere. Rather, its the corollary effect that I am writing about today: what it is like living in a country that is created around a system where everyone is trying to save a buck at the expense of the consumer, and where the government either can not or will not enforce rules, regulations and laws in the food industry. I am speaking of what happens when consumers like me want to buy dairy products that require refrigeration. There is fresh yogurt here in every supermarket, after all. So, let me tell you what happened tonight when I went to the supermarket to buy yogurt, since this is what will happen to you, wherever you are in China, when you go to the supermarket to buy yogurt, ice cream, or any other dairy product that requires refrigeration.

I arrived at 8:15pm, and the supermarket– one of Xining’s largest– was about to close at 8:30pm sharp. I was there looking for fresh milk, since I assumed a large supermarket here would have it, and when I asked for help finding it, I was pointed to the cases and cases of very warm Ultra-Pasteurized milk, which I quickly passed on as I made my way to the backup choice for making cereal: yogurt. And, there were five different brands of yogurt, each about 1-2 liters, and all were warm. I know yogurt can’t be stored warm, and I read the label and saw in fact that the label of each yogurt said that storage temperature was supposed to 2-5 degrees Celsius, which sounded about right, except that the entire refrigerated section of this major grocery story was dark and warm. It wasn’t just that it was warm, it was so warm that it was obvious that the store prepared in advance for the 8:30pm closing by shutting down refrigeration at least a few hours beforehand, so that there was no noticeable difference in the temperature of the yogurts that were sitting in the dark large refrigerated section and, say, the dry bags of peanuts that were in the middle of the store. The entire store from refrigerated yogurt to the packaged meat sitting nearby in the same dark refrigerator to the crackers on the other side of the aisle were the same temperature: warm, very warm.

And, that’s what triggered my question to the lady who showed me where to find the dairy section: “Why isn’t the yogurt or the milk cold?”

To which she replied, very matter of fact-like: “Because we close in 15 minutes.”

And that is why when you come to China you, too, are unlikely to ever eat cereal, even if you get lucky, like we did, to find delicious fresh muesli.

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Our Four Week Wedding Invitation (April 1-May 1)

In the nearly six years I’ve lived in China, I’ve only managed to convince a handful of friends to fly across the various oceans to visit me (now us, since admittedly me has become three of us). So, I’m now resorting to more desperate and creative measures: Though I registered my marriage with the Chinese government more than three years ago, I am nonetheless entitled to use the leverage of a wedding to compel everyone to visit, not least because I attended all of your weddings over the years without making any excuses. We have booked a four week, multi-stop wedding that will begin on April 1 in Colombo, Sri Lanka and end about a month later in my new hometown of Xining, in western China and we look forward to seeing you here. The annotated Google map of the route is pasted below. There’s no need to RSVP– just show up for all or part of this journey. Note that this is a no-gift wedding, so please don’t give or send us anything since we don’t want or need it. Just show up. We look forward to seeing everyone. Jeff/Wu Jun/Leo


View Jeff, Wu Jun and Leo’s Wedding Map in a larger map

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Hot Water in Xining: What Happens When Nobody Asks… “Why”

One of the themes of my work in China, including this blog, is the cultural issue of how Chinese are raised never to ask why or question authority, and the consequences of that. The ramifications are everywhere, and I’m seeing them again here in my new home in Xining. Last week, the management at this living area, which is Xining’s most expensive and most luxurous, posted a notice that electricity would be down for the entire complex, more than 2,000 apartments, from 10am until 5pm. I asked why, and how old and sick people would survive without even an operating elevator in buildings that are more than 15 stories tall, and the standard answer, which I now accept, was essentially, “Well, we posted a notice, so you were aware of this, so its up to you to deal with it…”

And now this week, the latest is how water heaters here, which are individually installed in each apartment but are pre-selected and bought en masse by the management, are now snapping at night since whoever ordered these things never either discussed it or thought twice about, but should’ve bought ones that can withstand sub zero temperatures. No discussion, and now most of the people here have no hot water. Here’s the video…

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Getting a lock fixed in China

Let this be a lesson to any to-be-renters. First the video…

Here’s the progression of events:

We moved into Xining’s nicest apartment complex, and rented an apartment for about USD $275 a month from a local retiree who obviously made a lifetime investment, and were are his lucky tenants. I knew after living in China for nearly six years that whatever has been installed in this apartment would obviously and certainly be the cheapest possible fixtures that China had to offer in this apartment. But that was ok. I have money to pay for fixing it.

But it still has managed to piss me off, so I am writing about it.

First the furniture. We bought our own furniture on Taobao, China’s ebay. My wife somehow thought it was a good idea to ship about 1,000 pounds of wooden furniture with a queen size mattress 3,000km to this edge of China, and when it did arrive, she had to engage in protracted negotiations with the delivery people to get it from the train station to here, since it was so heavy. Then me and the driver of the tiny delivery vehicle that carried it the last few km had to make 15 trips up 10 flights with the furniture, which when unpacked was only slightly less complicated to assemble than a nuclear power plant. No instruction manual, thousands of slabs, multiple boxes. And so I found someone to assemble it, and he did, and now a week later we have furniture, but the bed is already beginning to snap.

But I am digressing. I want to tell you about the locks in this apartment. As the video explains, we have five indoor doors, and our landlord obviously paid a total of less than USD $3 for all the locks in the house, including installation, since now a week later three don’t work. But the story here is what we did about it. My general rule for getting anything done in Chins is to assume that whatever the rule or law is, and whoever has responsibility for doing something, makes no difference, and that the work is going to be done wrong. The concept of work pride has not yet permeated the culture here.

So, after a few days of locks falling off, I decided the logical and only course of action was to pay someone from a lock shop to fix it. Duh. But, my wife persuaded me that the more proper, Chinese way to handle this would be to see who had responsibility at the get go. The lock company? The landlord?

And, so we called the landlord yesterday, got a reply question whether we really needed locks and door handles, or could get by without them (wife replied diplomatically that we need them to prevent our kid and dog from getting into places they shouldn’t, my reply would have been more direct like this: shut up idiot and fix the locks), and we got an early morning visit from the landlord today. He’s a nice fellow, about 55, retired, and from my perspective a trip out here from the city where he lives to fix a lock that he could pay someone less than USD $5 to do was a waste. But whatever.

So, his first question was, again, whether we needed functioning locks. We answered the same. Then he tried to fix one of the locks himself, which he couldn’t really do because it is broken and requires tools. And so we talked and talked, and after two hours (I no longer lose my temper in these conversations, unless I am having the conversation myself, but in this case my wife was talking with him) it was agreed to call the management office to fix this, even though that would involve a fee of about 50 RMB (USD $6), with the question of who would pay that being left unsaid. Two hours later, the management office lock guy didn’t come bye, the landlord mentioned that he could find someone for 10RMB ($1.50) on his own, and left, and was immediately followed, like we were watching a sitcom, frankly, judgment by timing and sequence of events) by the management lock guy, who spent thirty minutes explaining to my wife why any effort to use such cheap locks were barely as likely to succeed as a full court push to sell a licensed copy of Microsoft Windows in this city, and he left, undoubtedly wondering why my wife didn’t pay him, and my wife was also thinking first about how much to avoid paying him, and then only about how to get the locks fixed. Money first, here, after all.

Then, again, like a sitcom, the landlord reappeared, even as my wife was calling him with the expert conclusion that the locks would have to be replaced, with a guy who obviously was not happy about the measly 10RMB (USD $1.50) that the landlord obviously had told him he would pay him, presumably only if he succeeded in getting the locks fixed. He did not like Jack sniffing his leg, and he took five minutes to tell the landlord that the locks were, as we’ve been told repeatedly in the course of our 6 hours together (now approaching 2:30pm), useful only as tire chains, if they were connected to tire chains, and nothing else.

Then another one hour talking, about the baby, with the true thought passing through the back of my wife’s and the landlord’s minds that the other person has enough money to pay for this, since as I’ve said money is also first and foremost in the minds of my wife and whomever she is speaking with, the the landlord concluded that he would in fact have to get a locksmith to fix this.

And I went to sleep. And thirty minutes later he called my wife, and asked if I wouldn’t mind terribly walking half a mile to my car and driving him into the city to find the locksmith.

To which I said, as I rested comfortably next to my infant son, exhausted from long nights feeding him and struggling to get enough air here at 2,200m: “Yeah right”

And that’s why now at 9pm, the locks are seriously broken, the dog can get into the kitchen, and it’s why I made the video above. Good luck to you renting an apartment in China.

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