Tag Archives: Social Justice

“Sometimes You Have to Just Walk Away…”

There is a particular statement that I have heard on Labor & Delivery units — not just on one, but on every single unit where I’ve attended women’s births. I have heard it from nurses, I have heard it from OBs and anesthesiologists, I’ve even heard it from midwives.

What happens before the statement is made is that a woman is laboring. She is in pain, and she is doing something to express that pain: perhaps she is calling to her family members for help; perhaps she is unable to keep still in the bed, causing the fetal heart monitor to fall off. Perhaps she is saying over and over that she can’t get comfortable, or begging to be allowed up out of bed to walk, although she will not be allowed to because of her epidural. She may be asking why she is still in pain despite the fact that she had an epidural. She may be loudly vocalizing her contractions — she may be screaming as they occur. Perhaps she has been doing some combination of these things for hours.

The nurse has wandered in and out of the room and said that the woman can’t possibly be in that much pain at only 4 centimeters dilated. The anesthesiologist has been called in and swears that the epidural is in correctly and that the woman is just feeling pressure, not pain. The midwife, shame on her, has stood three feet from the woman’s bed and said that she can ask the anesthesiologist to replace the epidural catheter, if that’s what the woman would like.

Everyone clears out into the hallway, leaving the woman alone in her room. And then someone turns and says to me, the student, as if offering some great wisdom: “Sometimes you have to just walk away and then she’ll calm down.”

I am recording this here because this statement should never become normal or acceptable to me, no matter how nonchalantly it is said, no matter how reasonably intentioned the person who says it. Bear in mind that I don’t mean a situation where a woman asks for privacy to labor (privacy being something that she will never get in a hospital), but rather one in which the clinician judges that the woman would be better off by herself.

The assumption behind this statement is, first and foremost, that the woman will essentially be alone in her labor. There is no expectation that she should be continuously supported throughout labor (as has been shown over and over again in research to lead to the best outcomes), no expectation that one should do anything other than spend a few minutes at a time dealing with her.

This statement also represents the feeling that a woman asking for help in labor is, after a certain point, just a complaining, attention-seeking, pain in the ass. Her pain, discomfort, or distress isn’t real — especially if you already gave her medication. She’s just being melodramatic, and what she really needs is for you to ignore her a little bit so that she can spend some time alone in her room. Like a child. You acknowledge that the woman is having anxiety and frustration — and your reaction is to walk out.

I have recently had the realization that the people who make this statement are also fundamentally ignorant — despite being professionally involved with women giving birth, they have almost no idea how to comfort them, calm them, and make them feel cared for. It’s not exactly their fault; most clinicians have lots of patients and are taught to use very few tools to relieve suffering apart from epidural anesthesia. Nevertheless, it is galling to see that this is apparently good enough for them, and that they consider it natural not just for women to be in pain in labor, but to suffer deeply as well. (The difference between these things is a topic for another time, but sufficed to say that they do not have to go hand in hand.)

Finally, this statement begs an obvious question: If you’ve left the room entirely, returning only hours later or when she shouts loudly that she is going to push the baby out right now so you’d better get in here, how on earth would you know if you helped her to calm down?! You left her alone, you fool — you have no idea whether she is curled up in a knot of suffering, or whether she’s actually glad to be rid of your ham-fisted, anxiety-provoking presence.

I know that there are some future midwives reading this post, so my reminder to all of us is this: the next time you hear someone offer you this particular “wisdom”,  remember that a gentle hand, a low voice, and a calm, steady presence can be the difference between a happy, healthy birth and a violent, traumatic one. Go back into the room and stay with her.

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I Hate America, or, What Happens When You Dine Alone

When I first came to China in 2004, I came alone. In the small town to which I moved to teach English, I would often eat out alone, poke around the streets alone, and wander through the nearby fields and villages alone. Except I wasn’t really alone; there was usually someone tagging along just behind me, or hanging around my dinner table, or moving through the grocery store aisle by my side. They were usually under the age of 30, and often came in pairs. They wanted to ask me where I was from, try out their few words of English, see what I was buying, or just generally observe my strangeness as I went about my business. People approached me often to take my photo.

When I came back to live in China again in 2009, I came with RP – and hardly anybody approached me anymore. China changed so much in the first decade of the new millennium that I simply assumed that people had become more sophisticated in the 5 years since I had last resided there. The Olympics had happened; a flood of foreigners had come to China to do business, teach English, and study Mandarin; average people were well-acquainted with American pop culture and Western products. I figured that people were just too cool now to be interested in foreigners, or at least too cool to appear interested.

TOTALLY WRONG.

It turns out that it was simply a case of being too intimidated to come up and speak to two foreigners walking down the street or eating dinner together. China’s general public may well be more sophisticated now than they were in 2004, but as soon as I was traveling alone this fall, the interest from strangers started up again with a vengeance.

This time, however, my Chinese was much improved. Since it was slightly off-season for tourists, I was often the only foreigner in the endless string of 8-to-a-room hostels I occupied – and unless you’re feeling really tough, it’s hard to keep up the ruse that you don’t understand when your bunk mates are all talking about you two feet away.

So I would introduce myself, and that would begin the two-hour conversation about life in America, life in China as an American, superficial analyses of China’s grand economic and political strategies, and so on. Occupy Wall Street activities were just hitting the Chinese news (and were uncensored, at least initially, I’m sure because the Chinese government took pleasure in the sight of what appeared to be massive anti-capitalist protests in the world’s richest nation).

The people staying in these hostels were usually university students traveling on their school break, and I found the prevailing attitude about the OWS protests to be fascinating: that it indicated the end of the United States. I had several people ask me, in all seriousness, when Obama would be resigning.

A common sentiment expressed to me by Chinese acquaintances in all walks of life has been that the worst attribute society can have is luan: disorder, or even chaos. But because of the heavy censorship of the press, I’m not sure most Chinese people know how luan society there already is; the huge protests in Wukan, Guangdong this fall and winter were only the most explosive of an increasing number of incidents of “social unrest” happening in China every year (some 180,000 in 2010 alone, according to Tsinghua University Professor of Sociology Sun Liping). Without access to that knowledge, you can see why people would look at images like the following being blasted all over the internet, and assume that the end is nigh:

I tried to explain that these were protests about economic inequality and outrageous corporate power in the US political process, and that if the US were going to crumble it probably wouldn’t be because of these incidents, but I’m not sure they believed me.

At any rate, I found these conversations refreshing for their (relative – very relative) depth. I don’t know if it’s because I spend a lot of time hanging out in the Chinese boondocks, but the average conversation someone strikes up with me about America go no further than this (verbatim, no joke):

Shop Keeper: Oh, you’re American! America is great.

Me: Why do you say that?

Shop Keeper: America is developed. (“美国的发展好.”)

While these conversations are usually painfully uninformed, they’re always very friendly. It’s certainly pretty unusual to hear a Chinese person say that they hate America. Much more typical is having someone inform you, completely unsolicited, that they hate hate HATE the Japanese, but that they think America is just terrific. So while I was getting used to having random people approach me for a quick chat again, I was unprepared for the following scene that occurred on my last afternoon in Hangzhou.

Scene: Bird sits in an anonymous restaurant eating braised tofu with rice. Mid-bite, a Random Old Man (ROM) plops himself down in the empty seat across from her.

ROM: Hey, are you Russian?

Bird: No, I’m not Russian. I’m American.

ROM: Not Russian, huh?

Bird: Nope.

ROM: China has good relations with Russia, you know. And Germany. And France.

Bird: You don’t say.

ROM: But you’re American. (Beat)  I hate America.

Bird: Why would that be?

ROM: You guys are messing with our economy!

Bird: We’re messing with your economy? Are you aware of the fact that the Chinese government owns over a trillion dollars of US debt? And that China has protectionist policies about its own industries while flooding the US with cheap, low-quality goods – goods whose price is only so low because the Chinese government controls the value of the renminbi?!

ROM: Hey, don’t get mad.

Bird: Sure, why should I be mad? You only interrupted my lunch to tell me that you hate my country.

ROM: It’s just that I hate Obama, that black guy.

Bird: Really – and why is that?

ROM: He’s made a really bad impression on average Chinese people.

Bird: Exactly which of Obama’s policies are you against?

ROM: Why is America involved in so many wars, like the ones in Iraq and Afghanistan? Iraqis are people too, you know.

Bird: I’m sure most Americans would agree with you there. Actually, many Americans are against those wars. We have protested in the streets, but our government doesn’t listen to us. It’s important to remember that people are different from their governments – that governments make decisions without consulting their people, policies that often contradict the people’s wishes.

ROM: That’s because you Americans have too many political parties.

Bird: Actually we only really have two.

ROM: Well, that’s too many. We Chinese only have one. The Communist Party.

Bird: Yes I know that. Everyone knows that.

ROM: China’s a peaceful place, you know! We’re don’t go around starting wars with everybody!

Bird: My understanding is that China has so many internal conflicts that it doesn’t really need to wage war with anyone else.

ROM: Huh?

Bird: Forget it.

ROM: I think the Communist Party is really great. Particularly what they’re doing in places like Tibet. Tibet’s a better place now than it’s ever been before, wouldn’t you agree?

Bird: Check please!

ROM: Nah, come on – have some more rice!

Bird: CHECK PLEASE RIGHT NOW!

Fin.

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Experience Overload Part 4: Danger in the Valley, and Making it Out

Barbara and I made it out of the Valley without incident, which is certainly not always a given. Last time we made our 5am exit (I kind of love doing that – stealing away under cover of darkness!) there was a giant mudslide following a night of torrential rain, and it looked like we wouldn’t be able to leave at all.

Before going to the Valley I had never encountered a mudslide and didn’t understand what the big deal was. So it’s some mud, right? Can’t you just…go over it? No, it’s not just “some mud” – it’s like a giant flood of rocky pea soup, up to your knees, or waist, or higher. You do not just “go over it”. Earlier this year, farther up the Valley, there was a mudslide that killed 30 people when it submerged an entire village – so don’t mess around with mudslides.

Life is full of little horrors like that in the Valley. It is a deeply beautiful place, and one in which life has become easier for the Azu over the past couple decades as they have become wealthier. On this past trip, all of the fields were ripe and bursting with greenery – mostly corn and rice, but there are also little orchards of peaches and apples,  and fields of tea bushes.

The Valley in April, when the rice was just starting to come up.

But the beauty and increasing fortune of Valley life belie the many dangers of living there.

The River that cuts through the Valley is a beast – broad and muddy, swirling with rapids and hidden boulders. Every year some number of people are carried off in it and drowned, including a little boy this summer who was pulled out into the River and died, after playing alone on its shores. He had been living with his grandparents, his father having run off and his mother away in another province working as a migrant laborer. Local authorities called his mother back to the Valley, telling her that her own mother was very ill. They feared that if they told her what had actually happened she wouldn’t even be able to withstand the journey, and they were probably right; upon hearing the news that her only child was dead she seemed to lose her mind, and was closely watched in case she should try to commit suicide.

Any little incident can turn into an emergency in a place like the Valley; even those who live on the Valley floor near the main road, and who are likely better off financially, are hours away from a hospital that could deal with any remotely serious issue. This is to say nothing of the poorer people who live many hours up into the mountains, which can only be accessed by footpath. A minor injury from a fall goes untreated and becomes a lifelong limp; a small cut from a tool or animal bite becomes infected and festers, turning deadly.

One day we were in the Valley, Barbara and I were riding down the main road in a little motorized vehicle when we saw a teenage girl we know pass us on her bike. We called out a greeting to her and she smiled, disappearing over a dip in the road. Sixty seconds later I spotted her again, this time lying unconscious by the side of the road. Her arms were bloodied and she couldn’t move – fortunately this was temporary and she was only in shock, probably having had a moderate concussion (wearing a helmet, thank god).

But what if she hadn’t been wearing a helmet? What if she had broken her back instead of cutting up her arms? The hospital in the Valley doesn’t know how to treat head injuries or perform involved, emergency surgery.

We managed to get her home and she is perfectly fine now – but you see how fortunes can change in an instant in the Valley.

I don’t know when I’ll next be able to go back with Barbara; the next few months are full of plans made or half-made, and then RP and I may be going back to the US. I’m trying to savor the experience of having been there as if it will never happen again. There is no classroom that offers the education that going to a place like the Valley can, but I’m excited to return to the classroom nonetheless; these experiences show you all of the gaps in your abilities, and teach you how insufficiently educated and unprepared you are to help people in situations of real hardship.

Here’s hoping that one of these nurse-midwifery programs will take me!

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Experience Overload Part 2: Hospital Regulars

We visited the hospital several times this week, checking up on the women who were of particular concern to Barbara. Their outcomes ran the gamut:

  • The woman with the seizures and infection had been doing better, but then her infection returned and she seemed to be retaining fluid at an undiminished rate. They had transferred her to a hospital in a city four hours away.
  • The woman who had had a cesarean after her labor stopped was much improved and, by our visit yesterday, had gone home with a healthy baby.
  • The woman with uterine cancer was gone from her bed, the sheets neatly folded. I assumed she had died, but was later told by a nurse that they had sent her home to die there – nothing more they could do for her at the hospital anyway, and they needed the bed.

For the record, I think this last outcome is probably a good thing. Just as a system in which hospital births are the norm for all women leads to lots of money being spent in achieving relatively poor outcomes, I think the same may be true of a system of hospitalized death.

In death, of course, unlike birth, the outcome is eventually the same for everyone. On the other hand, hospitalized birth and death have much in common: enormous potential for trauma; unnecessary and invasive procedures being performed, often without consent being given; massive quantities of money spent on these procedures; the transformation of a private, family affair into a sterile, clinical one. I’m still formulating my thoughts about this, and, in truth, have seen a dead body but have never actually seen someone die. Still, I think that establishing a system in which the beginning of life and the end of life generally occur out of the clutches of hospitals will be one in which more people have a good birth and a good death, instead of the undignified medical disasters so common now.

One of the nursing schools that I’m applying to has a minor in Palliative and End of Life Care; perhaps I’ll be their first midwifery student to take it up!

*****

One of the days we were at the hospital, Miriam (a foreign nurse friend of Barbara’s who has lived in the Valley for years) came by for a prenatal check up and ultrasound. The hospital staff were perfectly happy to lend Barbara a spare bed to perform the prenatal check up herself. Having seen Barbara do a few prenatal check ups, I knew that she would begin by asking a series of questions about Miriam’s general health and comfort, anything unusual during the pregnancy (Miriam has a number of children already, so she is very familiar with her pregnant body), and fetal movement. She then performs a Leopold maneuver, which is the process of manually palpating the woman’s belly to determine fetal position. Miriam said it would be fine if I wanted to palpate her belly as well – and judging from how exciting I thought this was, I can already tell what a geeky midwifery student I’m going to be.

Let me tell you: feeling the position of the fetus is not as easy as it looks. You think that if you palpate a pregnant woman’s belly you’ll be able to feel something concrete in there, but Miriam is around 7.5 months pregnant, so the fetus still has plenty of fluid around it. For the first few moments I couldn’t feel anything at all – just a dense orb of fluid, like a medicine ball. But then I felt a solid, unbroken line between her belly button and left flank – the fetal spine! – and followed it down to the head above the pubic bone. Her baby has been moving around a lot, but for now it’s in the perfect position for birth.

After using a Doppler fetal monitor to listen for the heartbeat (again, not as easy as it looks to get the fetal heart beat instead of the mother’s), we went with Miriam to another hospital building to get an ultrasound. I’ve only ever seen fetal ultrasounds done in China, so my experience is limited to what they do here, but so far I can’t tell a damn thing from looking at an ultrasound screen. It occurs to me that they may intentionally do them very quickly here, avoiding prolonged views of things you might recognize like the fetal torso, because ultrasound technicians are forbidden from revealing the baby’s sex. This is because one well-documented side effect of China’s “Family Planning Policy”, as it is known here, has been an exacerbation of the population’s lopsided male-female sex ratio, and a high prevalence of sex-selective abortion.

Supposedly, ultrasound technicians can lose their jobs if anyone finds out that they revealed the baby’s sex to the parents. However, I have also heard that bribing the technicians is common, and that technicians sometimes drop hints to eager parents – saying “Congratulations!” if it’s a boy but nothing if it’s a girl, for example. At the end of Miriam’s ultrasound, she and the technician exchanged a few words:

“It doesn’t matter to us what the sex is, since we’re definitely keeping the baby.”

“It may be a boy. We’re not allowed to give you any information because of the Family Planning Policy.”

Perhaps that was a hint, or perhaps they just say that to everyone.

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Experience Overload Part 1: Training Day

I don’t think I have it in me to put up a post every day, but I really ought to. Each day in the Valley reminds me of the summer that I took intensive Spanish (bear with me on this analogy) – one day was equivalent to a week, one week to a month, one month to a semester. If I let too many days pile up without ordering it all into neat paragraphs it seems impossible to process. We’re heading out of the Valley tomorrow at 5am after almost two weeks here, so it’s time for some wrap-up. So as not to tax your patience, I’ll put this up in pieces over the next few days…

Training Day

Barbara and I started off Monday by meeting with two Azu women to prepare our training for the next day. The training was to be for some 20 Azu village women, on a topic related to maternal and infant health. We are using the American College of Nurse Midwives’ Home-based Life Saving Skills manuals, which contain very basic, picture-based instructions on how to deal with life-threatening situations that can arise during pregnancy, birth and the postpartum period. They’ve been used all over the developing world, particularly in rural areas like the Valley, and are easily adapted because the pictures and text are so simple.

(Dear visiting Singaporean medical students who were bored and translated the text into Mandarin for fun: PLEASE STOP. I know you are all bursting at the seams with your newly acquired medical educations, but endlessly crossing out the ACNM’s text and replacing it with complex instructions that women who are barely Chinese-literate will be unable to follow is counterproductive. AHEM.)

The two women we met with decided that “Bleeding During Pregnancy” would be a good topic for the training, as this is something that they’ve encountered in their villages over and over. There ensued a flurry of translation into Azu (seeing Azu being typed out on a computer is supercool), cutting and pasting and photocopying, and BAM! Azu handouts on what to do in case of bleeding during pregnancy.

The training itself went very well, and that was not at all a given. Part of the issue in running such trainings is that any Azu woman will tell you that their main characteristic is haixiu – shyness. Azu culture is highly conservative and thick with taboos around issues of health and the body. It’s not at all certain that you’ll be able to get a bunch of women together and convince them to mime such things as urination over a plastic bucket and getting a friend or family member to keep track of how much blood they’re losing.

During the training there was much discussion of Azu women being haixiu and, given that, what people might actually be willing to do in case of bleeding. They agreed that urination would be ok because they can go off alone for that, but determined that they would keep track of their own bleeding, thankyouverymuch, unless they bled so much that they passed out – in which case someone else could take over.

Fair enough.

Haixiu aside, there are other, equally fundamental issues with running such a training – for one thing, it turns out that many Azu women have no idea what their internal anatomy looks like. If I said to you, “The egg travels through the fallopian tube to the uterus”, it’s likely that a little picture would pop into your head that originally came out of a biology textbook, or Our Bodies, Ourselves. These woman are largely extrapolating visuals from their experience slaughtering livestock, which can actually be useful if they’ve been butchering pigs, but not so much if it’s just been chickens. (I will leave it to you to Google appropriately.)

They are also hungry for information, which makes keeping the trainings on track a real challenge. When presented with a highly experienced and foreign-trained nurse-midwife like Barbara, every question they’ve ever wanted to ask comes forward. What do I do in case of a breech birth?…Why do they happen?…Why does the placenta sometimes not come out? It’s too much for a two-hour training – plus, we’ve got to come with better visual aids showing HUMAN anatomy next time.

One thing that doing such trainings teaches you is that just because people are shy, it doesn’t mean they have nothing to say. This is especially important to understand in the context of hospital care in the Valley, as whenever we’ve gone to the hospital, Azu women and their families are essentially silent in front of the Chinese staff.

We started off the training by having one woman tell the story of a girl in her village who bled seriously during the 4th month of her pregnancy, and miscarried. It was as if she had cracked opened the floodgates – out came the other women’s stories, slowly at first, then faster and faster until they were literally shouting each other down with their tales of pregnancies lost and saved, labors endless and precipitous, babies born alive and dead.

I started bleeding at three months and eventually the fetus came out, the size of a plum…I started bleeding at six months and the twins were born dead – they were girls, I could tell by then…My relative bled all the way from two to seven months, but her mother-in-law prayed every day and the baby was born healthy…A woman in my village had bleeding, so we killed a chicken, stir-fried its innards and made a soup – it saved the pregnancy…A woman I know started to bleed, but she carried to term and even had the strength to pinch and bite her husband during her labor shouting, “This is your fault! You did this to me!!”

I don’t think the staff at the hospital know (or care) what a fine line they are walking with the village women, what a slim margin of error they are being given. For women who are resentful that they have to go to the hospital at all, bad outcomes that happen there are not forgiven. One woman relayed the story of what sounded like a placental abruption and/or uterine rupture – either way, there was massive hemorrhaging. The woman survived, minus her uterus, but the baby died shortly after birth. I have no idea whether or not this was the fault of anything the hospital did, but the conclusion offered by the storyteller was clear: people in her village do not like the hospital any more.

I may be justifying my own ignorance, but with topics like these it strikes me that it may be a good thing that Barbara and I don’t speak Azu. She guides the training in English, I translate English-Mandarin, and another woman translates Mandarin-Azu – which means that these village women are free to say whatever they want, knowing that by the time it gets back to me and then to Barbara, the essential facts are getting through but the nuance is long gone.

In the end, they’re not really telling their secrets to us – and that is a good thing.

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Back to the Hospital, and Shabbes in the Valley

Home

I’ve parked myself with a can of beer in front of my room’s electric fan, vainly hoping that either will do something to cut through the humidity that has settled into the Valley over the past few days. Barbara and I just came back from dinner at the house of a foreign friend who lives near by; after dinner we sat with the lights off in the living room, eating a mountain of lychees to keep cool. I complimented her on her beautiful Peruvian wall tapestries, and was then distracted by the concept of a place as inconceivably distant from the Valley as Peru – it might as well be a fairy tale. I spent the rest of the evening staring out the window of her home, overlooking the skeleton of a small, ruined power station in which villagers now grow corn in tight rows.

Tomorrow morning we meet with two local women to prepare a training for village women on life-saving skills relating to pregnancy, the postpartum period, and newborn health. One of the women only speaks the local language – let’s call it Azu – and the other speaks Azu and Mandarin. I’ll translate from Mandarin to English for Barbara, and the whole thing will be a little round-robin of translation and take three times as long as it should, but as we say in Mandarin: mei banfa.

One of the ways I know that my Mandarin skills have improved since we moved to China is that the prospect of this kind of activity only makes me a little nervous, as opposed to paralyzingly nervous in a manner that requires closed eyes and deep breathing. Now I always do pretty well in these situations, if I do say so myself. It’s tomorrow afternoon’s plan, returning to the hospital, that’s got me a little worried.

Back at the Hospital

On Friday we stopped by to see the Matron, and when she wasn’t in that day we casually made rounds, mostly to check on the woman who had had the emergency cesarean and severe infection. She seemed to have improved somewhat from the day before, but as we stood by her bedside I looked at the woman lying in the bed next to her – and then I looked again.

I recognized the face peeking out from underneath heavy blankets, her eyes just showing beneath her “new mother’s” head scarf. When we had visited the day before, she had just arrived at the hospital in labor, with her water already broken. She didn’t seem to be in heavy labor yet, and when Barbara examined her she noted that the baby was posterior, its head wasn’t engaged in the pelvis, and there was very little amniotic fluid remaining. A posterior baby (“sunnyside up”) is often more painful to deliver, but will usually come out on its own with a little maneuvering. One whose head isn’t sufficiently engaged in the pelvis might not come out at all, necessitating a c-section.

There are ways to encourage the baby to move down, but the hospital doesn’t favor any of them. They don’t like the women to move around in general, and particularly not after the water has broken because they fear cord prolapse (that the cord will slip out before the baby, which can be fatal as it cuts off the baby’s oxygen supply). This is not a well-founded fear when there is very little amniotic fluid, so Barbara encouraged this woman to walk the hospital corridor and to stay well hydrated.

The whole thing was hopeless. Let me explain the issues.

The Problems of Hospital Birth for Azu Women

1) This woman had been hooked up to an IV of oxytocin, to make her contractions stronger – this IV bag hangs from a runner attached to the ceiling. It is not mobile. So if she wants to walk the halls (which the staff do not want her to do anyway), they have to unhook the IV from the ceiling and someone in her family has to trail around behind her, holding the bag over their head. This gets tiring, so they do it for 5 minutes, drop their arm, and then the staff tell her to get back in bed.

2) The woman was thirsty, but refused to drink water. She refused to drink not because she’s a fool, but because the maternity ward has no bathroom – so if she wants to use a bathroom she has to go at least downstairs to another ward, or to an outhouse outside the hospital, which is not all that appealing when you’re in labor. The maternity ward does encourage women to use bedpans, but they had run out of bedpans by the time this particular woman arrived. Even if they had given her one, the women don’t tend to use them because they are in open wards, with no curtains separating the beds, so they would have to use them in front of other women’s husbands and relatives. Not gonna happen if they can help it – so they drink as little as possible.

3) By the time this woman arrived, her water had already been broken for two days. She had waited so long to come in for numerous reasons, including: a) Azu women tend to minimize their pregnancies and labors as long as possible. There are taboos surrounding pregnancy and birth that mean such things are rarely spoken of; b) Many Azu women, including this one, live a tremendous distance from the two-street town center where the hospital is located – they don’t want to walk hours and hours down a mountain if they’re not sure whether or not they’re really in labor; and c) Azu women don’t really like the hospital. The care is free, and they’re even given a cash incentive to show up and give birth there, but they still often prefer to stay in their villages. The local government has made that a moot point by recently passing a law requiring them to come to the hospital, but many are still unhappy about it; they have a hard time communicating with the Chinese staff, many of whom don’t speak Azu at all. They feel looked down upon and condescended to by these more affluent “city folk”, who look different, speak differently, dress differently.

4) And then there are all of the larger reasons that any Azu woman here is disadvantaged giving birth; their diets tend to consist of only a few vitamin-poor staple foods at any given time (potatoes, cabbage, hominy). They generally receive no prenatal care, meaning that any problems tend to become emergencies, usually at the time of birth.

This particular woman finally received a cesarean several hours before we arrived at the hospital. In light of the other woman with the severe infection, seizures and emergency cesarean, the hospital staff had gotten too nervous to wait any longer – her labor had stopped, they told me.

And now here she was, under blankets, her baby in some distant part of the hospital. She was mumbling, delirious with pain, unable to open her eyes. I knelt down beside her and squeezed her hand – what else is there to do? – and tears began to stream from her eyes, forming a little reservoir where they reached her nose. She squeezed my hand back and began to sob and shake – I worried that I was making it worse.

I noticed a young man and an old couple nervously hovering against one wall of the room and asked if they were her family – yes, they said. Because the hospital has no chairs or stools for anyone to sit on, they didn’t know where to be. I managed to scrounge a stool from a closet so that her husband could sit next to her, so that at least she would know he was there. When I walked past the room later on, I saw him spooning soup into her mouth.

We’ll see if she’s doing any better tomorrow.

Shabbes in the Valley

I did not grow up an observant Jew, but I’ve been experimenting with a few things lately, trying them on to see how they fit. Last month I decided to start lighting candles on Friday nights, for Shabbes – I cover my head, I light the handles, I wave the flames toward me and cover my eyes, I say the prayers. When I’m done feeling like I’m playing dress up, the whole thing feels pretty good. The first prayer I should say, of course, is  to Adonai, Eloheinu, creator of the fruits of the internet – because seriously, I wouldn’t know how to do any of this stuff otherwise.

Shabbes is always supposed to be a welcome event in the week, but after Friday at the hospital it seemed particularly necessary to light the candles, to go through the steps, to create a break with what had happened before.

I hadn’t brought anything to the Valley with which to cover my head, so I went out and bought the first head scarf I could find, which is one traditionally worn by older Azu women. Barbara was suitably impressed, so she took this photo of me (in which I realize that the shirt-scarf combination is sort of a horrifying optical illusion of plaid – apologies).


On Saturday night, I lit an improvised Havdalah candle for the first time in my life, accompanied not by wine but by Coke Zero, which, unlike wine, is available all over the Valley. I liked Havdalah – maybe this coming week I’ll even spring for some fruit juice.

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Kunming Fake Apple Stores Shut Down

The local authorities have reported their findings from the investigation they conducted into the fake Apple stores in Kunming, and a couple pieces of information have made it into the news.

The first is that they found five fake Apple stores in Kunming, not just three. I’m actually only surprised that it’s so few – the three that RP and I found were just the ones we happened to come across while walking home from dinner.

The second piece of information is that two of the five stores have been shut down – not for intellectual property rights violations, but because they didn’t have business licenses, the bare minimum necessary for a commercial retail operation.

What this means, of course, is that three of the five stores (coincidentally, the three that I put photos of on this blog) were issued valid business licenses by authorities who were, to give them serious benefit of the doubt, asleep at the wheel – and those stores continue to operate.

What this also means, I assume, is that by putting up that blog post, my husband and I are indirectly responsible for some number of people losing their jobs as employees of those stores. How do we feel about that? Terrible.

I want to explain again: when we photographed those stores and put up that blog post, it’s not because we found it shocking someone had ripped off Apple in China. I’ve been coming to China for almost eight years, and RP has been coming here for 10 years – we’re well aware of the prevalence of shanzhai goods and stores in this country. Even the street that the main fake Apple store is on has what we assume are numerous other ripoff stores – it has two shoddy Nike stores alone, and this is supposed to be the main upscale shopping street in the city.

We photographed these stores because they were such detailed and complete ripoffs that they almost rose to the level of artistry, if you look at them in the right frame of mind. And I put it on my blog because I thought that a few people outside my normal readership of, say, six people, might find it amusing too.

We’re not shills for Apple – we’re just appreciators of absurdity. And the idea that people might lose their jobs over a blog post seemed ridiculous. We hadn’t foreseen the fact that this story would sit perfectly at the intersection of Americans’ Applemania and Sinophobia and, as one article I read put it, “blow up the internet”.

This is not to say that I have no feelings about violations of IPR in China. I hold the prevailing Western opinion that a total disregard for IPR seriously hampers innovation. Given the extent to which IPR is ignored in a city like Kunming – and, I imagine, numerous other similar Chinese cities that you’ve never heard of, each containing millions of people – if I were a Chinese businesswoman, I would open a fake Apple store tomorrow. What’s the point of coming up with your own business idea if you can just lift an existing one wholesale that you know will be successful and won’t be shut down by the authorities?

I think it is a fair criticism that social injustice is being propagated by a system in which the workers who actually produce Apple’s products in China are unable to afford to purchase them. (Not that the Chinese people complaining on this blog about the price of Apple products are factory workers – let’s get real. You’re not labor activists, you just want Apple products as much as anyone, anywhere.) Indeed, an Apple product in China is likely to be more expensive than purchasing one in the US, or even Hong Kong. The reason for that, however, is because the Chinese government slaps a massive import tax on these and other such products, making it even less likely that people will be willing to buy the real thing and support enforcing IPR laws.

Shutting down these couple Apple stores in Kunming doesn’t represent a move to enforce IPR laws in China – they were shut down in a little show-trial move on the basis of having been so shady as to not even have business licenses. But if such stores were to be shut down en masse on that basis, despite the loss of retail jobs, I admit that I would support it. I think that supporting such a move represents the hope that China could be a thrilling country of innovators on a scale that the world has never before seen – and it certainly represents a blow to the insulting insinuation that shanzhai crap is China’s major cultural contribution to the planet.

If France can enforce smoking bans in bars, China can enforce IPR laws. Agreed?

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