BURMA "Be bold for a better Burma" - Stanford Daily, by Jess Yu! [http://www.uscampaignforburma.org/] SCHIP Sign petition against veto on SCHIP expansion bill: [http://www.familiesusa.org/bushvskids/] "Bush calls for compromise on SCHIP" - LA TImes. Quoted: Bush's veto led one Democratic lawmaker to call the president"Ebenezer Scrooge" last week, while a GOP pollster noted that"it will take some superb communications to persuade voters that the WhiteHouse really is on the side of children's health." OTHER "Bush says interrogation methods aren't torture" - NYT
Sign petition to end torture - to be presented to 2008 presidential candidates
"Deadly typhoon hits China" - Washington Post I've had people ask me about this, but don't worry, I'm okay. This is inSE China, not Western China. Thanks for the thoughts, though. "Stanford Stuns No.2 USC 24-23" - I'm stunned, you're stunned, we're all stunned. The bonfire is cool,guys, but please, keep your shirt and shoes on. We have a long year aheadof us.
Part deux (project-related) of my previous post titled, "A long-overdue update," is long overdue as well. But, alas, here it is. So far, we've made two major trips outside of Xining. The first trip was to oversee the first round of vaccinations and the second trip was to help two filmmakers make a documentary of the project.
During the first trip, Yan and I were stationed in Ping An, but also traveled to Le Du and Hu Zhu (all of these are small counties within the district of Haidong, which is about an hour drive from Xining). First, we met with the head of the District CDC in Haidong and explained to him our plans for the trip. Our first goal was to observe a small sample of the first round of vaccinations. Our second goal was to hand out 6,500 pre-education surveys to a random sample of students throughout the district. Our third goal was to arrange for two filmmakers to come the next week to begin making a documentary of the project. Sounds simple, right? Actually, it was a feat explaining this to both the Xining and Haidong CDC heads (most of the explaining is usually accomplished by Yan, who is much more fluent in Chinese, specifically mainland Mandarin, than I am). Even more, each goal came with its own set of barriers. With patience and persistence, Yan and I accomplished goals #1 and 3, but goal #2 turned out to be an utter disaster.
Goal #1: Oversee the vaccinations. (I'll just write about the logistics here, and you can look at pictures to get a sense of what the schools look like.) Though it probably seemed like Yan and I were just taking a guided tour of random schools, we were in fact looking for specific things to ensure that the vaccinations were being carried out thoroughly and safely. (1) Every student must turn in a consent form signed by his/her parent. This serves as proof that the parents know what is going on, and also confirms that the students have not already been vaccinated so as to not waste resources on unnecessary vaccinations. (2) Every student must sign their names off on a chart, so that by the time the second and third rounds of vaccinations comes around, there will be a record of who needs to get a shot. It is very important that every student receives all three shots, otherwise they will not be protected against Hepatitis B for life. (3) Look for proper administration of the vaccination – most importantly, one needle per student. (4) Look for proper disposal procedure – i.e., all needles must be properly re-covered and thrown away in a special container separate from all other waste.
Overall, Yan and I were happy with what we observed at the schools. Unfortunately, it was quite a hassle trying to work out the timing of these site visits. In Xining, we were told that the vaccinations would be going on all month, so we expected that we could pick schools randomly and do surprise visits. When we got to Haidong, however, we found out that each county CDC has its own vaccination schedules and each of the health centers in the smaller counties within each county has its own schedules. Most of the vaccinations were going to be done by the end of the week, and the rest wouldn't start until near the end of the month. In fact, though we traveled to three schools, we only actually observed two vaccinations since the third was already over by the time we arrived at the school! Even more, we were not able to randomly pick schools to observe. Instead, the Haidong CDC took us to schools of their choosing, i.e., it was questionable whether the schools we observed were actually representative of the vaccinations going on province-wide. Nevertheless, the fact that everything was up to par at the schools we visited was enough, and the most we could do, to assume that at least someone somewhere in Qinghai knows how to properly administer these vaccinations.
Something that I've come to accept is that it is impossible for the two of us, Yan and I, to go to every school (crossing altitudes of 4500+ meters and encountering miles upon miles of dirt roads, if we're lucky to have roads) in every small county in every county in every district in the province of Qinghai to observe 500,000 vaccinations and teach 500,000 students in the time span of a few months. So, we have to depend on the local people here – the CDC workers and the teachers – to help us carry out this project and trust that it is getting done. People must be willing to help themselves in order to be helped. In any case, it is better that we are standing back as observers, working behind-the-scenes to organize the project and checking up on its progress every now and then to make sure things are going as planned. By handing over the brunt of the work to the locals, they are given the opportunity to help themselves and the ownership of making Qinghai the first province in China to vaccinate all of its children. More importantly, if funds suddenly run out at the Asian Liver Center, the Chinese will still have the knowledge to carry out this project and achieve similar results in other provinces. In fact, providing free vaccinations and making them readily accessible to all is important, but in some ways, education is even more powerful. Sure, getting three shots will protect you for life, but if you don't know what Hepatitis B is, then you will still fear the disease and discriminate against those who are infected. Without education, you will not encourage your friends and family to get vaccinated, and you will not know the options available to chronic carriers for delaying the onset of liver cancer and prolonging their lives. Hence, the slogan we came up with for our project: "Get vaccinated. Know more. Protect yourself for life."
Goat #2: Distribute the pre-education surveys. The purpose of pre-education surveys is to measure the level of Hepatitis B knowledge among the students before they are educated, as a baseline for comparison with data from post-education surveys. The idea is to get data like: "Before the Qinghai Vaccination and Education Project, only 10% of the students were vaccinated and only 30% knew what Hepatitis B is. Now, 100% of students in Qinghai are vaccinated and 90% know what it is, 85% know how it is transmitted and how it is not transmitted, and 92% do not fear the disease." Data like this will make Yan and I very proud. Otherwise, we will get fired. Just kidding. Still, pre-education surveys are crucial for showing just how much impact this project has had on Qinghai's health. Our goal was to hand out 6,500 surveys to 10% of the schools in Haidong to serve as a baseline for our study. (Haidong's student population is about 50% of the total student population in the five districts we're vaccinating this year.) Unfortunately, when we got back the surveys, the majority of the answers were clearly fabricated. Either one person, with the same pen (sometimes even with the same pen that was running out of ink), went through a stack of 50 and marked off the correct answers, or just marked off random answers (sometimes not even checking one answer, but rather the space in between two answers). Or a class of students all got correct answers, which most likely means that one kid, or teacher, knew the right answers and the rest just copied them down. In the end, we still graded 6,000+ surveys to prove to the Xining CDC that, indeed, they are useless. Most of the districts received a score of at least 95% correct on most of the answers. Ideally, these results would be exactly what we want – everyone already knows about Hepatitis B, so our work is done without even having started it! Realistically, having asked students in person about Hepatitis B (and usually receiving blank stares) and knowing that a "good" score would near 80 or 85%, we knew that we couldn't use the surveys. What a waste.
Despite all the trouble this has caused, Yan and I have learned a lot from this failure. First, our job is not to vaccinate nor is it to educate, as explained earlier. These jobs are for the local people to accomplish. Instead, our job is to organize, observe, and assess. Regarding the latter of the three tasks, it is absolutely crucial that we obtain accurate data. This means that we will have to personally go to each school, go to each classroom, hand out the pre- and post-education surveys, watch the students answer the surveys without outside help, collect the surveys and compile the data. Thankfully, after having dusted off the statistics sitting in the back of our brains (and receiving a lot of outside help and advice), we discovered that we actually don't have to get 10% of the students to take the survey (which would have meant going to about 150 schools). Instead, we only need about 400 responses to get data that is accurate with 95% confidence and a 5% margin of error (i.e., only 4 to 5 schools). The key to getting data that is representative of all five districts, though, is random sampling. This will be tough, but everything else in our project has eventually worked out, and I have faith that this will, too.
Goal #3: Help film the documentary.The Asian Liver Center has hired two filmmakers to make a documentary of this project. I mentioned this in an earlier post, but to recap, one filmmaker is British and the other is American, and both have previously worked on other documentaries for the Asian Liver Center (one is on youtube – search for "another life hepatitis b"). Anyway, Yan and I were tasked with a simple job: notify the Xining and Haidong CDC that they will be coming to film a documentary. Again, this was tough. In fact, making this documentary a possibility has been the most incredible feat Yan and I have accomplished thus far.
First, nobody in China really knew what was going on with this documentary, much less that plans existed to make a documentary. And, of course, it's difficult to make a documentary of any kind in China with all the censorship. The censorship multiplies when you want to film vaccinations, interview people in villages and rural areas (God forbid they say anything bad about the government or mention that they are not receiving equal access to healthcare services), and interviewing government officials (God forbid we have on tape officials saying incorrect things about Hepatitis B). Even more, everything works very, very hierarchically in China. To get any one task done, it must be approved by the people at the top and relayed down the chain of command. Tasks will not get done if you just go directly to the people you need to work with to get it done. In China, efficiency must be abandoned and headaches must be suffered. This means that to get this documentary approved, we have to talk to the people at the Foundation in Beijing, have them call the Xining CDC, who then has to call the Haidong CDC, who then has to call the county CDC, who then has to talk to the doctor at the local health center and the principal at the school. And that's not enough. Someone from the Xining CDC has to accompany us at all times to make sure that the local CDC workers will listen to us, and someone from the local CDC will also have to accompany us to make sure that the rural people will recognize us. (Actually, it's more likely a step to keep us foreigners in line and make sure that we're not snooping around and causing trouble.) To top it all, as I said before, timing things here is impossible – the filmmakers were arriving during a week that there was going to be no vaccinations…so what were they going to film??
Of course, Yan and I are incredible and everything worked out impressively in the end. We fought to film at a school, and not just any school, but the perfect rural school with documentary-worthy scenery. We fought to follow the lives of 4 children, go into their homes, interview their families and film a typical day in the life of a rural person. We translated from English to Chinese and Chinese to English (and sometimes even requiring a third translator to translate from the Qinghai dialect to Mandarin Chinese and back). We were the middle-(wo)men between the filmmakers and the CDC workers and between the filmmakers and the interviewees. And, we scheduled for the filmmakers to come back in time to shoot the second round of vaccinations and the teachers getting educated about HBV by the CDC workers. Yan and I should get a gold star.
Since Yan did most of the translating, my job was to be the Sound Engineer, though at times I was promoted to the positions of Associate and Executive Director. Actually, it was an amazing experience to learn about the process of filming and making a documentary. Obviously, we went through the painstaking trouble of working through the logistics of this documentary. But the best part is that we were always behind the camera when the kids were playing in the playground and learning in the classroom, when the parents were talking about their lives and how this project has affected their lives, when the CDC officials were talking about Hepatitis B as a public health problem in Qinghai and how this project is helping to resolve this problem. And it was great to watch two professionals working in the field – to observe how they plan what to shoot, who to shoot, and how to shoot it, and try to understand why their decisions will most assuredly look great on film.
Anyway, this post is getting incredibly long, but YES, I have been working!! Kind of. I feel like I have to convince myself sometimes that I am employed now. As always, pictures to accompany this post are available at http://www.flickr.com/photos/12460644@N0 3/.
I'm currently sitting on my momentarily gnat and fruit fly free bed in Le Du (a xian or small county within Haidong, a district within Qinghai), and wondering where I should even begin this post, as so much has happened since the bai jiu fest back in Xining. To save you the pain of reading verbatim my daily diary entries, I'll divide this update between two posts regarding my personal and project-related experiences. PS – Sorry about having to switch to inboxjournal.com; it has a lot of mistakes (e.g., words are going to be unintentionally bunched together or split apart), but at least it's accessible in China.
Yan and I have grown to love Xining, the capital city of Qinghai. It's almost like Beijing, but maybe about 10 years behind in development. When I first got here, all I saw was the potholes in the sidewalks, the trucks chugging by with a three-foot high pile of lamb carcasses, the mothers holding their toddlers over any crevice in the ground to let them pee or poo through the large slit in their pants.
However, after having spent a couple of weeks here, we've gotten to know the city so well that we often miss our hotel home in Xining whenever we have to travel outside of the capital. Our hotel has nice showers and a great restaurant, which takes care of two of my biggest worries about going to China. I haven't been forced to go even a day without showering and I've been getting more than enough daily intake of vegetables (both of which I thought I'd be lacking for at least a week and even up to a month while in Qinghai). Everyone at the hotel recognizes us as the two girls from America, and a few are always incredibly nice to us. One waitress at the restaurant (who is always dressed in a neon pink and green Tibetan outfit) is very patient with me whenever I try to practice my Chinese with her. Since she knows we prefer vegetables instead of meat, she has suggested some pretty tasty dishes, one of them being you mai cai which we have ordered almost every night. When we asked her if there are any fun things to do around the city, she suggested going to Nan Shan (South Mountain, literally). By chance, a few days after we asked was 9/9, the city's holiday to climb the mountain. We were extremely excited to hear this news, expecting to do a pretty rough hike, see some great scenery, and be surrounded by locals celebrating. When we get there on 9/9, dressed in our hiking boots and armed with bottles of water, it's slightly drizzling, there are about 10 other people around, the cement paths are cleanly kept, and the bushes and grass are deliberately landscaped. There is even a mini-Shanghai and a very cute bridge that make for very boring pictures (to be loaded onto Flickr).
Another great story is about one of the young girls that work at the front desk. One night, as we were heading up to our room, she asks for our help to study for an English exam she was going to take the next day. We gladly help her out and wish her luck. The next night, my stomach's not feeing so well and Yan goes downstairs to get me a cup of chamomile tea. She comes back to the room empty-handed but with a great, big smile on her face. She tells me that the same girl we helped the night before told her that chamomile tea is not the right cup of tea – instead, I'm supposed to drink this special tea boiled with lots of ginger and some brown sugar. Since we clearly don't have the means to make this tea in our hotel room, the girl calls her mom immediately, tells her to start cooking some, runs home to get it, and brings it straight to our room! I don't know whether it was the tea or the fast-acting karma, but my stomach was feeling much better by the next day.
Anyway, yes, Yan and I do venture out of the hotel at times. Just around the corner are three dumpling houses – we've tried all three and have chosen our favorite. They make their dumplings right in front of you on order and it's run by an incredibly welcoming woman who even let us help her make some jiao zi our first time eating there! A little bit farther down is the best open-air market in the world – we know it now like the back of our hand. The boy who sells li (apple pears) recognizes us, probably as his most frequent customers, and always excitedly asks, "So, how many do you want this time?"
My favorite pastime is walking from our hotel to Wang Fu Jing (a huge department store, but can also be used to describe the general shopping center of Xining; one also exists in Beijing). The directions are easy: go straight down one street from A to B. It's great exercise: we can easily ride Bus #25 at a cost of a whopping 1RMB, but Yan and I almost always opt to walk. We only do this on occasion since it takes about an hour and a half each way, if we don't stop along the way (we've estimated that it's about a 6-mile round trip adventure). The best part though is that we pretty much cover the entire city's boundaries. Starting from the hotel, the streets are a bit more rural and there aren't as many people. We pass by a lot of construction that usually forces us to walk on the roads where bicyclists, motorcyclists, cars, buses, and other pedestrians are constant hazards. There is a Muslim shopping center about a block long, always filled with men wearing white hats and women wearing brilliantly colored headscarves buying more white hats and more brilliantly colored headscarves. As we approach Wang Fu Jing, stores selling purses, jewelry, sporting goods and American brand names begin to line the streets, sidewalks become more crowded, and people are dressed more hip. There is a small bakery that has specialized in making small, delicious muffins. This is the highlight of the trip for me. I always wait for fresh ones to come straight out of the oven. Not much long after the muffins, we'll see KFC#1, at which point we're only about 5 minutes away from KFC#2 and Wang Fu Jing. Destination arrived.
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