Hiking Tiger Leaping Gorge: Day 2

When we realized that waiting for it to clear up might take several days, we headed back out onto the trail in the fog. An hour later the clouds began to dissipate, and we enjoyed a few hours of relatively flat trail.

Eventually, you’ll encounter another bit of uphill. RP and I got ourself all prepped for another vertical shlep, but it turned out to be exceedingly short. We sat on a flat rock at the top of the brief climb and took out our lunch, looking out over the Gorge and feeling very pleased with ourselves. This was short-lived, as we suddenly heard a crowd of voices coming up the path. When the group appeared it was clear that they were not actually hiking the High Road, but had driven the Low Road that runs along the bottom of the gorge near the river. (There are a few short paths up from the road where tour groups can come up for the views.)

This particular group, as it turned out, was a Korean Christian youth group. We knew this because they were clearly being corralled by a man with a pastor-ly air, who, after speaking some soothing words to his young charges, lead them in what could only have been religious song followed by increasingly boisterous and feverish praise of the Almighty. This picture really does not do it justice.

Now, I don’t mind if you want to hike Tiger Leaping Gorge and pray – it’s a place that encourages you to be introspective and in awe; a natural place for prayer. But 15 people depositing themselves two feet away from a couple of peaceful picnickers and proceeding to fill the gorge with shouting is just rude. Rude!

After passive aggressively giving this youth group evil looks for a couple minutes, I decided we should just move on.

The trail descends steeply before softening to a gentle downward slope. Enjoy the views – try not to spend too much time staring at the path.

Eventually you’ll see a sign for Tina’s Guesthouse – you’ll be almost to the junction with main road at this point. Wipe a tear from your eye that the gorge is behind you!

Across from the end of the trail is a guesthouse advertising bus services back to Qiaotou, where you can catch another bus back to Lijiang. But don’t do it! Keep going! Perhaps another 20 minutes down the road is Sean’s Guesthouse, where you can stay the night before heading out again for Daju.

(Note: Sean’s Guesthouse seems to be engaged in a cutthroat battle for customers with Woody’s Guesthouse, played out in messages painted on rocks along the path – Sean’s Guesthouse This Way! — WOODY’S GUESTHOUSE ALSO THIS WAY BUT CLOSER THAN SEAN’S!!!1@#!, etc. I’m sure Woody’s is nice as well, but I recommend Sean’s for the tremendous stone deck from which you can admire the last of Tiger Leaping Gorge as the day comes to an end. And dry your socks.)

If you get lucky, as we did, the night will be clear. In most Chinese cities, including Kunming, almost no stars can be seen due to the atrocious haze and air pollution. But night in the Gorge is pristine – that night at Sean’s, it seemed as if the whole universe had descended to wrap us in its magnificence. I think that the power of a truly dark sky is that human beings spend almost all of their time focused on space that is no more than 50 feet above our heads – often much less. When the sky is truly dark and clear, the earth retreats into nothingness and you realize that essentially all known space and matter is not around you, but above you. It takes your breath away.

If you’re not already a member of the International Dark-Sky Association, you should be.

Hiking Tiger Leaping Gorge: Day 1

There aren’t very many hikes in China that are both impressive and easily accessible, not because China doesn’t have beautiful hiking terrain, but because hiking isn’t a particularly popular pastime here.

The exception to this is Tiger Leaping Gorge, a hike along the ridge line of a stunningly beautiful, 2,000-meter deep gorge with views that include lush greenery, snow-capped mountains, and white water rapids so dangerous that you’re not actually allowed to raft them.

Plus, if you’re in decent shape it’s not even that hard – and you’ll likely find yourself encountering only a few other people as you follow along the trail.

If you’re anywhere near Yunnan, you should hike Tiger Leaping Gorge – I can’t believe it took me so long to get there, and I’m so grateful that I made it before leaving the province. Now that I’ve convinced you to do it, my additional advice is to allot three days for the whole trip; the Gorge can be hiked in a very leisurely two days, with one night spent at one of the couple of guest houses located along the the trail. This two days will get you from the trail head in Qiaotou to the trail junction with the main road at the end of the Gorge (near where Sean’s Guesthouse is located) – but you will miss the truly stunning scenery from there to Daju, which is utterly unlike the Gorge itself. It is 100% worth it to take an extra day for this.

I’m about to describe the route, but in case it’s helpful here is a photo of a little map that someone handed us along the trail. I know it’s crumpled and hand-drawn, but it can help you visualize what’s ahead of you on the trail.

Click map to view larger image.

A word on the weather: we hiked the Gorge in Yunnan’s rainy season with no problem. It hadn’t been pouring in the few days leading up to our trip, and we called ahead to check with Sean on the condition of the trail just to be sure (0887-8202223), but it was nothing to worry about.

Without further ado, here is an instructional guide for hiking Tiger Leaping Gorge, from Qiaotou to Daju. I’ll post Days 2 and 3 of the hike in the next few days.

Start by getting yourself to Lijiang. There is a very nice overnight train from Kunming that gets you into Lijiang around 8am. I recommend not choosing the top bunks if you go with a hard sleeper, because it’s a little…cramped.

If you hustle, and get lucky, you can make it to the Lijiang Bus Station in time to catch the 8:30am bus to Qiaotou. I believe it’s the #18 public bus that goes from the Lijiang Train Station to a couple blocks away from the bus station, but we had to scramble to make it, and if you’ll probably want to get a cab just to be safe.

The bus to Qiaotou took us around 3 hours, but I believe this was because of construction that forced us to take a smaller, bumpier road. Either way, we arrived in Qiaotou with enough time to eat lunch before setting off on the trail. In Qiaotou you’ll need to pay the the fee for hiking the trail, which is 50 RMB (25 RMB for students with a Chinese university ID).

From the Qiaotou bus stop, you need to walk perhaps 10 minutes farther along the road to the trail head. You should see the following sign (“Tiger Leaping gorge hiking high way thus into”):

After following this sign you’ll pretty immediately run into a confusing mess of dirt paths – the one you want, all the way along the trail, is the so-called “High Road” (高路). There are periodic blue and yellow signs, along with seemingly Rasta-themed arrows painted on rocks in red, yellow and green, to show you the way along the trail.

The views start getting good straight away.

The first day is the toughest, because that’s where you gain almost all of the elevation. You gain it first to get up to the ridge line, and then at the notorious “28 Bends” – literally, a set of 28 little switchbacks to get you to the highest point of the trail. Apparently some people even start from the other end of the trail, ending at Qiaotou, just to avoid the 28 bends – but they’re seriously not that bad. Don’t be a wimp.

You’ll know you’re getting to the 28 Bends because the view gets more dramatic…

…and weed starts to grow by the side of the trail! Local people will tell you very earnestly that they smoke it because it helps them sleep.

Anyway. The Bends.

You’ve gained all the elevation now, and you may notice the weather change. For us, it got chillier and we walked right into a drifting rainstorm. Take pictures even if this happens to you, because the view is still awesome, even with rain.

We were hoping the rain would let up so we hid out in a little cove in the side of the mountain waiting for it to clear – but it never did. Given that the rain was making the trail a little slippery, and that it was getting to be dinner time since we hadn’t started the trail until noon, we decided to call it quits and stay in the Tea Horse Guesthouse (茶马客栈). If you get an earlier start, it’s completely possible to make it to the Halfway Inn (中途客栈), which is 60-90 minutes farther along the trail.

The Tea Horse Guesthouse was a very decent place to stay the night – and it goes without saying that it was well situated…

One word of advice while you’re hiking the Gorge: if the weather is clear, even for an hour, take lots of pictures. When we checked into our room, the view from our window looked like this:

And when we woke up the next morning, it looked like this:

Total white-out.

This Day, Again

For the past few years I’ve been seeing the 10th anniversary of 9/11 coming, wondering what it would be like when it arrived. Now here it is – and doesn’t it feel terrible?

Anything that happened less than 10 years ago can seem recent, but when you hit a decade you have to admit that, somewhere in there, a new era has dawned. In the past, I’ve referred to 9/11 as the most significant single event to happen in my lifetime, and I still believe that. But it has been eclipsed by all of the terrible events that have come since, in its name, with it as an excuse. The declaration of an ideological war that has created more enemies in the Muslim world that the West ever had previously, the massive and ongoing loss of lives. The implosion of the American financial system, the Great Recession.

It does feel as though we’ve been hiding out over here in China as the West eviscerates itself – there has been a certain blissful distance in this, and some guilt as well. I never know how to mark the more ordinary anniversaries of 9/11, let alone the passage of 10 years. RP and I talked about that day again; where we were; what it has meant for New York and New Yorkers; what has happened since for New Yorkers, the country, each of us personally. I don’t feel a decade older.

How do you mark the day?

*****

Despite all of this, you will be glad to hear that the bad spirit following us around seems to have departed. Thanks to all of you for your excellent suggestions on how to get rid of it! Now that it has gone, what’s left is the sense of being done with Kunming – so done. Beyond done. Let’s-get-on-a-plane-tomorrow done.

As an illustration: if you follow the Chinese human interest news, you may have read that China is becoming more culturally liberal, with such hallmarks of alternative youth culture as multi-day music festivals springing up around the country. RP and I have always been curious about what these music festivals might be like, wondering if these were the places where real Chinese youth culture and coolness could be seen – and, as luck would have it, the first such giant music festival in Kunming was held over the past couple days. Today we went to the last of it, all prepared to have a good time, and particularly prepared to see Cui Jian, the headlining act and most famous rock musician in Chinese history.

Well…Cui Jian was pretty good. The rest of it was sort of disastrous.

It was actually a great venue, a beautiful night, and a hilarious crowd for people-watching (old ladies bopping around – check. Wannabe Kunming hipsters – check. A healthy sampling of goofy Kunming foreigners attempting to dance with the cops – double check.)

But China just doesn’t know how to do this kind of thing. The music was mostly terrible (because no self-respecting Chinese band stays in Kunming for very long). The whole festival venue was submerged in corporate advertising of a kind I have never seen before: giant screens showing ads on a loop for Mercedes-Benz and Budweiser while the bands played in front of them, occasionally cutting off the bands’ sounds systems so that the ads could play with sound for a few minutes. The crowds stood there, mesmerized, watching the screens.

When Cui Jian finally came on at people cheered and hollered – he’s a big deal. It’s kind of like seeing Bruce Springsteen play, if America hadn’t produced another rock star since.

But the overwhelming feeling that came over me was that it’s time to go. Kunming and I are done with each other. I’m like that random guy still hanging out on the college campus a couple years after graduation – not cool.

Fortunately, my ticket is purchased – I’m on a plane to Beijing on Wednesday afternoon, to begin almost two weeks of a very happy tour guiding opportunity: my mom is coming to visit! She’s playing ambassador for my family, an emissary from Manhattan, here to check up on China and what on earth I’ve been up to for the past couple years. I’m totally thrilled.

And after that – the open road, as it were. Taiwan, Xinjiang. The great beyond.

Don’t you worry (weren’t you worried?!) – I’ll be keeping you all regularly updated with tales and photos. First up (tomorrow) pictures from our awesome trip to Tiger Leaping Gorge and Shaxi. Stay tuned.

The Volcanoes of Tengchong

After the stresses of the Valley, I met up with RP for a few days in the town of Heshun, a snarl of tiny streets, a few restaurants and glut of largely empty guesthouses outside the small city of Tengchong, Yunnan.

Tengchong and Heshun are not really places that foreigners go unless they live here – they’re sort of third tier destinations, after you’ve hit up the classics of Dali/Lijiang, Xishuangbanna/Ruili, and even maybe Deqin/Zhongdian. Still, the county of Tengchong is a place of minor fame in Yunnan, largely for its history – it has been settled for over 2,000 years, longer than almost any part of this region, and was the site of well-known battles between the Japanese and the Chinese (aided by the Americans) during World War II. It is also increasingly well known for tourism due to its unique geography: Tengchong is ringed by inactive volcanoes and dotted with natural hot springs.

In our house, Tengchong is famous for marking the eastern terminus of the Ledo Road (also known as the Stillwell Road), an epic route that wends its way through Burma, ending in Ledo (Assam), India. This road was used as a supply route by the Allies to the Chinese during WWII – and if RP and I were rulers of the world, this route would be open and walkable today. It has been restored from Tengchong to Myitkyina in Burma, but no further, and we hear that the China-Burma border guards do not favor random Americans crossing it on foot.

Ledo Road and the Burma Road, 1944-1945

We weren’t really prepared for a major Himalayan hike anyway on this particular trip, so instead we spent a day taking in the volcanoes, soaked ourselves in the sulfur-tinged hot springs, and went for walks in the surrounding area.

In the evenings we sat on the balcony of our little guesthouse in Heshun, watching the volcanoes turn dark and the lights come on over the Ledo Road, that wide path of stone and cement disappearing though a break in the Gaoligong Mountains to the west, and on towards Burma.

Lately, we’ve been attempting these little getaways from the stresses of regular life in Kunming more and more frequently, bit by bit breaking our ties with this city that we will soon be leaving for good. We’ve had waves of friends over the past couple years here, and the majority of the most recent wave have left. It seems as though all of our possessions are limping along, worn out or broken. There’s a sense now that we’ve perhaps overstayed our welcome in Kunming – or rather, our interest. The work that brought me to China is done, and the work that brought RP to China almost so. A few days ago we happened to turn down a street that we haven’t walked in 18 months or so, and were shocked by how long ago that felt, by what shiny new foreigners we were here then.

When we occasionally run into another foreigner who we have known since the beginning of our time here, there’s a sense of mutual weariness and minor embarrassment. Oh, you’re still here? Yeah, we’re still here too.

More than that, there seems to be some sort of bad spirit that’s taken up residence in our lives, a poisonous malaise that follows us around, bringing unexplained tensions and bad moods. We manage to create oases within the murkiness – it was our first wedding anniversary on Sunday and we had such a sweet and relaxing day in a valley outside of Kunming – but deep stresses linger just below the surface of our mundane activities.

I’m seeking input. Anyone know any good rituals for banishing bad spirits?

The good news is that we’re headed out in half an hour on the overnight train to Lijiang, where we’ll set off to hike Tiger Leaping Gorge and then spend a few days in nearby-ish Shaxi. It might rain on us the whole time, but I’m hoping the mountain air will clear my head. I’ll report back with photos next week!

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!

Experience Overload Part 3: Miracles and Meltdowns

Miriam (Barbara’s foreign nurse friend) runs a free clinic out of her home one day a week, so Barbara and I were able to go a couple times when we were in the Valley. The clinic is a pure act of charity; Miriam’s resources to treat the many people who sit on her front porch each week are limited, and people are often seeking help for complex illnesses and injuries. Sometimes frustration runs high because people are clearly looking for a miracle cure – but in order to know why this is reasonable, you have to understand the mysterious circumstances under which healthcare is sometimes provided here.

As in many places in China, tuberculosis is endemic to the Valley. Cases here are often allowed to progress to a stage rarely seen elsewhere; permanent lung damage, disabilities from TB that has spread to and destroyed skeletal joints, and deaths are not uncommon. The government, however, does provide a certain amount of TB medication for free if you test positive, and Miriam is often able to arrange for a patient to receive this treatment. That can, indeed, seem miraculous – one day you have a cough and a fever, the next day you’re diagnosed with TB, and then this foreign lady makes sure that you get free medication and home visits so that you’re not going to die! From that perspective, why shouldn’t people turn up expecting to be cured of all manner of diseases?

Clinic days are long; the first patients have shown up by 8:30am, and we often weren’t finished until 5pm. At a desk job, that’s just a regular day – but when you’re seeing an endless stream of patients who often cannot be helped, you want to go home and go to bed without dinner at 6 o’clock.

What complicates matters is that many of the patients we saw had actually already been seen by a physician in one place or another – the Valley hospital or a village clinic – and simply did not like or did not understand the answers they received.

Some of these patients face deeply serious problems: one young mother brought her 2-month old baby girl to the clinic for intractable chest congestion. I have never seen a baby that looked like this before – she cried endlessly in a way that seemed to choke her every five minutes. She was clearly unable to breathe properly, and turned blue several times. At the Valley hospital the mother had been told that the baby did not have pneumonia, and they didn’t know what to do for her.

Fearing that perhaps the baby had cystic fibrosis, which would be tantamount to a quick death sentence in a place like the Valley, Barbara and Miriam advised the mother to take the baby immediately to the city hospital four hours away for further tests. Unfortunately, the young mother was living alone with the baby at home for the next few days, with her husband off working and in possession of all of the money. There was a discussion of scraping together enough money to lend her so that she could get to the city, but someone who spoke Azu and Mandarin would have to accompany her, since she did not speak Mandarin and the city hospital staff do not speak Azu. No such person could be found on such short notice.

Then there are other patients who have been told what to do to fix their health problems and are simply being stubborn about it. One amazingly wizened Azu woman presented herself on Miriam’s front porch complaining of eye troubles, eventually revealing that she had been diagnosed at the hospital with cataracts in both eyes. The woman was a serious character: at 75 years old, she stood perhaps two and half feet tall, a consequence of her dwarfism. She was dressed as if she had been plucked from her village and drafted into the Cultural Revolution-era military; she wore the traditional Azu women’s patterned skirt and embroidered vest, strung from neck to knees in beads and large shells, and had paired them with a camouflage green Mao hat and combat boots of the kind favored by the People’s Liberation Army.

Despite the fact that she had been correctly diagnosed, and that her problem was fixable with a very simple surgery that would be provided for free by a hospital right down the road, she refused to go, claiming that the doctors there would kill her. She quickly announced that she would only have her eyes operated on by a foreigner, and demanded to be sent to Kunming for said mythical foreigner to schedule her surgery.

We explained to her, in the nicest possible terms, that she was being a huge pain in the ass, and that if she wanted her sight back she should go get her free surgery down the road, where they were not going to kill her.

“You people aren’t helping me!” she companied, adding, “Plus my knees and hips are sore.”

Lady, you are a 75-year old with dwarfism who has done manual labor in the fields her whole life. My joints would hurt too.

*****

One of the strangest problems we’ve encountered at the clinic is infertility. Barbara and I were meant to be focusing on any OB/GYN patients, and apart from a few women with minor infections, they all seemed to be having trouble getting pregnant.

Infertility can be difficult to cure even if you have lots of money and all of the latest technology available to you. So what do you do when women show up at a free clinic halfway up a mountain side, with no lab technology, no samples of or understanding of any medications they’ve previously been given, and tell you that they can’t seem to get pregnant?

These are not 40-year old women who put off having children because they were busy with their careers or because they couldn’t find a suitable mate. Azu girls often start marrying by age 16, and everyone seems to be married by age 20. Marriage and childbearing and extremely culturally important, and therefore nearly universal. So again: what do you say to a 26-year old in seemingly good health, who had one still birth when she was 8 months pregnant seven years ago, who has been trying to get pregnant ever since, but who doesn’t quite understand the mechanics of how pregnancy actually happens?

Pesticide use on crops in the Valley is ubiquitous, and women often apply it with their bare hands – perhaps that’s the problem? Perhaps it’s their husbands who are infertile, having contracted sexually transmitted infections? Perhaps this incidence of infertility is no higher than normal in a population of this size, but because it’s so embarrassing for Azu women to discuss it they will only come to this free clinic, making it seem like we’re seeing unreasonably large numbers of infertile women? Who knows.

We drew lots of pictures, and explained in simple terms about the ovum traveling down the fallopian tube. We went over the possible causes of infertility, and even tried to explain how to monitor your temperature and other symptoms daily to determine whether or not ovulation is occurring. Even as I was explaining these things, I could see how hopeless the situation probably was for most of these women. They seemed to understand what we were saying, but were quiet; perhaps they knew how hopeless it was as well.

If we could help everyone who came to the clinic, the days would simply have been exhausting. But because we couldn’t help many of them, the days were not only physically tiring but full of anguish. Azu people are often happy to explain their health problems in front of other Azu, presumably because they are used to the very public nature of village life – so when one 36-year old woman approached me speaking so quietly that she was almost inaudible, I knew her problem must be very serious. Barbara and I took her into an inside room, where she presented us with a CT scan of her uterus. I don’t have any training in reading CT films, but even I could see that her uterus had some sort of mass in it, and what looked like only one fallopian tube. She said she had been trying to get pregnant for six years, and then dissolved into sobbing. She lifted her shirt to show the thick, dark scars lacing her abdomen from previous gynecological surgeries.

It was certainly not my place to give this woman a possibly faulty reading of her CT films, nor to pretend to understand how much pressure she must be receiving from her family to have a child at age 36. What was clear was that no one had ever sat with her for half an hour and allowed her to say how scared and upset she was about her infertility. We gave her advice as best we could, and she cried, “It’s hopeless, isn’t it? Isn’t it hopeless?”

It’s at times like these that I find myself wishing away the next few years, so that I can be done with my nurse-midwifery training and actually help a woman like this. Did we do anything to help any of these women in the Valley? Did we offer them hope, simply with our presence, that we then dashed by being unable to fix their problems?

How do you know when you’ve done a good enough job?

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.

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.

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.

A New York Jew in China: A Year of Yiddish Videos

Over the past year, RP and I have made a series of 12 videos about various aspects of life in and around China, and I present them to you below, beginning with the final episode. They are in Yiddish, with English subtitles.

Yiddish?! you ask? Yes, Yiddish.

Some of you may not know that Yiddish is still spoken by anyone – some of you may think it is only spoken by ultra-Orthodox Jews. Many of you know some Yiddish words that have embedded themselves in English – shlep, nosh, oy! – but most of you have probably never actually heard Yiddish spoken.

For the curious: yes, Yiddish lives. An approximately 1,000-year old language, it is written in the Hebrew alphabet and is related to German. It is not a dialect, a jargon, or jabber, but is related to German much in the way that Dutch, Afrikaans and English are. It is a rich and beautiful language with influences from Hebrew and numerous western European and Slavic languages. Up until recently the lingua franca of Ashkenazi Jewry across the globe, the vernacular language of millions, the Holocaust and powerful forces of assimilation have driven it into decline. But Yiddish lives, still – and is even experiencing a modest revival among non-Orthodox Jews, according to some sources.

Why make videos in Yiddish instead of English, or even Hebrew? And why make them about life in Asia?

To take the second question first: why not? Yiddish is a living language spoken by well over a million people, and living languages should be used to document, describe and relate any and all experiences of their speakers. Yiddish enters its second millennium of life in the 21st century, bolstered by a dazzling history of literature, poetry, song and theater. It continues as a vernacular language in this century; Yiddish is emailed, texted, Skyped and Tweeted. Some people even make Yiddish videos and put them up on YouTube.

As for the first question – well, of course the author Isaac Bashevis Singer would have said it best. It may well be apocryphal, but he is reputed to have said of Yiddish:

It is the richest language in the world. Take such words as “a poor man”. You can say of a poor man, a pauper, a beggar, a mendicant, a panhandler…

But in Yiddish you can say: A poor shlemiel, a begging shlimazl, a pauper with dimples, a shnorer multiplied by eight, a shleper by the grace of God, an alms collector with a mission, a delegate from the Holy Land, dressed in seven coats of poverty, a crumb catcher, a bone-picker, a plate licker, a daily observance of the Yom Kippur fast and more and more.

There are some who call Yiddish a dead language, but so was Hebrew called for 2,000 years. Yiddish was the tongue of martyrs and saints, of dreamers and kabbalists. It contains treasures that have not yet been revealed to the eyes of the world. I say, therefore, to my children: Come back to me. Learn me, and my sister’s Hebrew and Aramaic. Learn my and your history. Treasures are stored up for you, saved form a thousand fires, preserved through a thousand exiles, hidden and carried forth from enemies and tyrants. Yes, you will find many treasures but the greatest of all is yourself. You will find in me your inner being, your identity, your very soul.

Without further ado, here is one year of A New York Jew in China, A New Yorker Yid in Khine, אַ ניו־יאָרקער ייִד אין כינע . Hats off to my husband RP for his perseverance in driving this project forward, despite my endless kvetching.

Episode 12 – Birobidzhan: A Yiddishland in the Far East

From the Jewish Autonomous Oblast on the Russia-China border.

Episode 11 – Living a Jewish Life in China

Increasing numbers of expat Jews in China leading Jewish lives.

Episode 10 – Passover in Kaifeng

In the small community of Kaifeng Jews, in Henan province.

Episode 9 – Chinese Medicine

In which RP gets stuck with acupuncture needles.

Episode 8 – Growing Old in China

Playing mahjong, smoking pipes, dancing in the public squares.

Episode 7 – The Jews of Malaysia and Singapore

A little-known history of Jews in Southeast Asia.

Episode 6 – What Do Chinese People Think of Jews?

They think we’re really, really smart.

Episode 5 – On the Roof of the World

Reportage from the Himalayas.

Episode 4 – Jewish Shanghai Lost and Found

Revisiting the sites and history of the Jews of Shanghai.

Episode 3 – The Real Chinese Food

Who doesn’t like a little mooshoo pork?

Episode 2 – Disappearing Languages

What it takes to document a small, endangered language on the edge of the Himalayas.

Episode 1 – New Cities

The new cities of China, springing up around us.