China & Mongolia
2008, May 3, 2008
People to
People Mission Beijing & Mongolia
April 18-28 2008
April 18, 2008, Sunny Strong
On this day, across the USA, People to People delegates were
journeying to Beijing to participate in an information and cultural exchange
with other Blood Banking and Transfusion Medicine professionals. Packing
everything from taro chips for digestion to extra chips in our cameras, we
hurried to finish our hometown obligations, leave our generalized impressions
of China behind, and ready to increase our understanding through interactions
and observations.
Our Los Angeles flight left and we were off! Well, upon
check-in we were told:
1. The good news was that we wouldn’t actually encounter a
typhoon.
2. The bad news was the headwinds would necessitate
refueling in Seoul.
Because of the long two- hour refueling in the plane in
Seoul, we missed our Hong Kong transfer to Beijing. It’s tough being diplomatic
when one is EXHAUSTED. But there we were, nine strangers on a mission, stranded
together at the HK airport. This was our icebreaker game. “Hi, I’m Sunny. I’m
sleepy, too. How will we get to Beijing?” One delegate offered to buy coffee
for another. One delegate watched luggage while another inquired about a new
flight. In an effort to seek assistance, the delegate leader steadfastly dialed
several prefix/phone number combinations, handing the phone to George, our
Cantonese/Mandarin/Chinese speaking delegate, to ease the communications. We
alternated between joining a veritable mosh pit throng and lining up like crows
on a telephone wire sitting on the airport carpet, our backs against a pillar.
Where would we sleep that night? How to convince Dragon Air
of its responsibility to put us on a flight that day? What about our meetings
with the medical school and university staff?
Mike, Pat, and George (aka Dr. Wang) begged at the Cathay Pacific desk.
How pleased we were to hear that an airline representative would be right over
to help us! We waited a very long time. Then there was hope that we had a
flight out of HK. Each of us had a bit of information, but we were willing to
trust and act as a team. OK, we were also desperate! One person spotted the red
uniform of the promised airline attendant. Hearts soared!!! Then, she was gone
like a flash, running away from us. What?
We learned our gate number just at the moment we were to be
boarding. Running delegates following a blur of red uniform- quite a sight. We
made it on the flight with no time to spare. The same cannot be said of our
luggage.
China
April 20-24, 2008
Our delegation is diverse in age and background and
nationality= cool!
Because I am the only non-medical type, I have our fabulous
guide, Wendy, to myself. (Wendy is her English name, assumed to aid the
foreigners she guides). She previously taught English at the university.
We checked into our elegant hotel, dined then crashed. Our
luggage arrived the next day for most of us. Others had to wait another day!
We received a cultural briefing, learning that China is in
the shape of a rooster, has 1.3 billion people and is the 3rd largest country
in the world. Everyday, 1,000 car licenses are issued in Beijing, a city with a
3,000 year old history.
The Forbidden City and Tian’an men Square
This historic, huge plaza gave me chilly bumps! We were
flying back from Bangkok in 1989 when passengers from around the world gathered
to get the details of the student protest. We saw the building where Mao is
entombed and the monument to those who died in the civil war. It is vast and
formal and serious. Just as our civil war battlegrounds evoke memories of
heartbreak and violence this center of Chinese government speaks volumes. A Chinese professor from ASU wrote an
article cautioning Americans to learn more of China’s history. He likened our
fixation with Tian’an men Square to all visitors to the US focusing on the
tragedy of Watergate or Kent State.
The same professor reminds us that 2008 communist government
is not like that of the Cultural Revolution nor of Stalin’s time. Their present
government is working hard to increase the comfort and quality of life of all
Chinese, including those in Tibet. Our Chinese guides describe their system as
‘nationalism’. It is truly hard to walk
in another’s shoes and avoid stereotypes! Our guide, Wendy, emphasized that it
is her FIRST choice to share an apartment with her extended family, to
participate in the new China and be part of that progress. She said, “You may
not like our history”, but it is ours. The same ASU professor reminds us that
this is a history of being conquered and of building walls, not of taking over
other nations.
Mao’s famous portrait surveys the square. The city was called
‘forbidden’ because commoners were not allowed to enter. The Imperial Garden
combines lush greenery, winding tree trunks, and dusty pale roses. It is
lovely.
Drum Tower & Hutongs
I climbed a dark, drafty, steep stone stairway high up in a
13th c. tower housing 25 large drums about the size of a wine cask. At the half
hour, volunteer drummers in bright uniforms ceremoniously drum out the time for
all to hear. They continue a tradition begun centuries ago when the gates of
the Beijing city walls were opened at 7am and closed at 5pm. The drummers’
strokes form a pattern while they make their booming sound. Very dramatic.
Afterwards, we walked outside around the tower roof, taking in the city view.
On one side, we looked down into the courtyards of the old Hutong
neighborhoods. The word ‘Hutong’ means a narrow lane between two courtyards.
On another side we saw modern Beijing with a mind-boggling
array of exciting, new buildings. One has a sense of this being one ‘happening’
place!
We rode a rickshaw along a pretty tree-lined boulevard
lining a canal, down narrow streets into the gray (the color of the common
workers) one-story homes of the Hutong. The guide led me the private home of a
retired chemical factory worker and her husband who is an automobile repairman.
Normally, people retire at 55 or 60, but she was granted early retirement due
to the nature of her work. As most Chinese, they have one child, now a French
major at the university. Their home belongs to his workplace. The land it
stands upon, like all land, belongs to the government.
This Hutong had three rooms: kitchen, living room, and
bedroom. The toilet (not plumbed) was outside. From this small kitchen, she
produced homemade dumplings, a pork and celery dish and rice and tea. We sat on
little stools at a folding table. I imagine this gives them more floor space in
their small home. Bright posters and a china doll decorate the bedroom. Books
lined one wall. Our hosts invited us to watch television while she prepared our
lunch. I brought them some simple gifts as a thank you.
Summer Palace
Oh, the Empress Cixi knew how to indulge herself! She picked
a beautiful site by the lake for her summer retreat. In fact, she lived there
more months of the year than in the Forbidden City. Her symbol is the phoenix.
The emperor’s is the dragon. These are depicted in statues, carvings,
gargoyles, etc. The Chinese believe they are descendents of the dragon. The
main road through Beijing is called “The Dragon’s Pulse”.
We strolled the well kempt grounds shaded by a lovely carved
walkway. Light gray rocks, sculpted by the rains, decorate and border the
hiking paths. April is a fine month to visit this part of the world. It is hot,
humid and crowded in summer.
Temple of Heaven & Park
South Park is a senior paradise. Want to dance, meet
friends, play cards, sing, and play in a pickup band or mini opera? Want to do
Tai Chi or Yoga surrounded by flowers and green? Volunteers, who are experts,
teach others. The atmosphere is happy; many smiles and much lively chatter.
These seniors look hardy and engaged in life. It reminded me of a conversation
I had on a plane a few years ago. The Chinese seatmate lamented the fact his
father did not want to stay in Seattle because he missed the peer gatherings of
his Chinese neighborhood.
We continued to the Temple of Heaven where the Emperor made
sacrifices to the Jade God. He would petition for a good harvest. Goats were
sacrificed in ornate brass cauldrons. Fruits were put on golden plates as
offerings. These buildings have been recently restored. The vivid blues, reds,
and yellows gleam in the sunlight. Gorgeous.
The Olympics
We only had time to drive past some venues. Wow! Beijing is
an architectural showcase for world-class designers. My personal favorite is
the National Stadium nicknamed The Bird Nest. It is formidable, whimsical, and
beautiful. The Kowhais building looms over the area like a giant robot or
dinosaur. The Aquatic Center is whimsical blue. It will be fascinating to watch
the August Olympics.
Thousands of trees have been planted along the roads to
beatify Beijing. Some of these in very humble areas.
The Great Wall of Juyongguan Pass
What a wonderful day. I did not realize the real hike is up
the many uneven, steep stone stairs to the great wall. I am grateful it was
neither too hot not too cold, as exertion was the order of the day. The wall is
no longer contiguous. We hiked a less crowed section rebuilt by the first
emperor of the Ming Dynasty to protect against Mongolian raids.
The beautiful green hills and mist plus ancient huts and
towers reward us as we climb and climb determined to reach to top. Spring
flowers dot the trees.
Foot Massage Parlor!
In China, a whole-body massage does not include the feet.
This is left to the foot massage specialists.
Imagine entering a gold and black marble foyer, greeted by
lithe lovely hostesses, escorted down a long corridor to a 4-person suite and
to your lounge chair. Boy, girl, boy girl. Our therapists greet us, and then
invite us to trust them by putting our feet into a dark, black barrel of
unknown liquid. Herbs? Eel oil? We soak.
They begin with a shoulder and neck massage. When some of us
are swooning with pleasure, they attack our feet. For the next HOUR they
massage our feet- every little bone and nook; the young man who is assigned to
me smiles and works non-stop for 1.5 hours. Dad’s massage therapist does the
same. I imagine he is enjoying it as much as I. Afterwards, he begs to differ.
In fact, 70% of the session hurt a bit, he said. In my case, only 5 % made me
wince, usually when too much pressure was applied to the front of my calves. I
imagined I’d be bruised from this? Instead, I believe the massage relaxed
muscles tensed during our hike to the Great Wall. We were not sore the next
day. I’m ready for my next foot massage!
Mongolia April 25-27
Our second travel glitch occurred on the day we were to
leave Beijing at 8am. In fact, we left at 8pm. Ugh! They bussed us to an
airport hotel for meals and a rest. It was tough to forget we were seeing
airport walls instead of either Beijing or Ulaanbaatar! After our pity party,
we arrived, exhausted, in Mongolia. It was decidedly worth the trip.
This vast, beige land is so exotic. The casual style and
pace were a contrast to the industry of Beijing. The Russian influence in
architecture and food added to the sense we had traveled more than two hours
from China.
I admire the harmonious relationship of Mongolians with
Nature. It feels like they use what they need, and then save the rest for
others. However, the mining, one of their main resources, has polluted the
fresh water lakes. This is especially dire in a country with lower than normal
rainfall in recent years. The Gobi desert is moving north.
We visited Buddhist temples and monasteries. Some newly
restored, others destroyed by Russia and left as ruins. The bright silk scarves
of Blue, yellow, white and red wave in the breeze. This breeze becomes a
whispery hum in the canyons of this mountainous land.
Having lunch and a visit in a GER (we say yurt) was an adventure: Yak milk
tea, homemade soup and dumplings, fried bread and brittle hard cheese served by
our host, the father of a daughter attending university and a son who
accompanied me on my horseback ride. He sang a plaintive folksong as we rode
away from the ger into the sparse, silent landscape. If you see the movie “Cave
of the Yellow Dog” you have met this family! In the midst of this nomadic life,
comes a cell phone ring. In fact, I was startled to hear my own phone as I slid
down some loose rock after visiting a Buddhist shrine. Many TV antennas on gers
we passed. This Mongolian family had one ger for cooking and one for sleeping
etc. The outhouse was a few feet away.
Again, I had a private tour and driver, as I was the only
non-medical delegate in our group. We stopped to admire camels, goats, sheep,
yaks, and an eagle along the roads. The roads can be very rough, deep potholes,
sharp rocks, and much dust.
Our last evening in Ulaanbaatar, we were delighted to hear a
Mongolian orchestra including the famous two-string fiddle with horsehead
carved on top. There was a high-pitched chanteuse, a petite contortionist, and
an incredibly beautiful dancer. All wore traditional silk costumes. What a
treat! When asked whether I’d seen Mongolian art, I answered that the everyday
dress qualifies. Leather designs appliquéd on white leather boots, other
symbols embroidered or appliquéd on jackets, saddles and belts. They are a
handsome people, reminiscent of our Inuits.
In summary, I would recommend People to People
(headquartered in Spokane). We did visit with locals, our guides were
knowledgeable, and history was emphasized to give us a context for
understanding. How fortunate we are.
Ambassador
Programs
Blood Banking and Transfusion Medicine Delegation to China
and Mongolia, April 18-28, 2008
Delegation Leader: D.
Michael Strong, PhD
Introduction
This delegation included 12 professionals, all members of
AABB, one guest and one national guide, Meng Liangliang (Bruce). There were
also local guides for China, Bao Xiaolan (Wendy) and Mongolia, Mr Ayangaa
(Augi). Delegates included: physicians, managers, teachers, laboratorians, a
public relations specialist, a donor recruiter, a stem cell specialist, and
Industry representatives including regulatory and marketing specialists. They
represented a broad range of expertise in transfusion medicine and blood
banking, tissue banking and cellular therapies.
The objectives of the visits to hospitals, blood centers and
treatment centers was to:
Gain an
understanding of the practice of transfusion medicine in each country
Gain insight into the practice of
blood and tissue banking in each country, including donor selection and safety
Explore the
status of cellular therapies
Discuss and examine the practice of
treatment of bleeding disorders
Exchange information on managing
adverse errors and accidents in transfusion medicine as well as managing
threats to blood safety
In addition to the professional meetings and exchange of
information, an important aspect of the trip was the sharing of cultural
information and experiencing the important historic sights of the two
countries. Our guides did an excellent job of informing us as to history, daily
life and attitudes of the people in our host countries. All were impressed with
the experience, including the rigors of travel.
Journal
April 18-20, 2008,
On this day, across the USA, People to People delegates were
journeying to Beijing to participate in an information and cultural exchange
with other Blood Banking and Transfusion Medicine professionals. Packing
everything from taro chips for digestion to extra chips in our cameras, we
hurried to finish our hometown obligations, leave our generalized impressions
of China behind, and be ready to increase our understanding through interactions
and observations.
Our Los Angeles flight left and we were off! Well, upon
check-in we were told:
- The
good news was that we wouldn’t actually encounter a typhoon.
- The
bad news was the headwinds would necessitate refueling in Seoul.
Because of the long two- hour re-fueling in Seoul, we missed
our Hong Kong transfer to Beijing. It’s tough being diplomatic when one is
EXHAUSTED. But there we were, nine strangers on a mission, stranded together at
the HK airport. This was our icebreaker game. “Hi, I’m Sunny. I’m sleepy, too.
How will we get to Beijing?” One delegate offered to buy coffee for another.
One delegate watched luggage while another inquired about a new flight. In an
effort to seek assistance, the delegate leader steadfastly dialed several
prefix/phone number combinations, handing the phone to George, our
Cantonese/Mandarin/Chinese speaking delegate, to ease the communications. We
alternated between joining a veritable mosh pit throng and lining up like crows
on a telephone wire sitting on the airport carpet, our backs against a pillar.
Where would we sleep that night? How to convince Dragon Air
of its responsibility to put us on a flight that day? What about our meetings
with the medical school and university staff?
Mike, Pat, and George (aka Dr. Wang) begged at the Cathay Pacific desk.
How pleased we were to hear that an airline representative would be right over
to help us! We waited a very long time. Then there was hope that we had a
flight out of HK. Each of us had a bit of information, but we were willing to
trust and act as a team. OK, we were also desperate! One person spotted the red
uniform of the promised airline attendant. Hearts soared!!! Then, she was gone
like a flash, running away from us. What?
We learned our gate number just at the moment we were to be
boarding. Running delegates following a blur of red uniform- quite a sight.
Across the airport, down the escalator, onto a train, up an escalator, across
the airport; all on the run; we made it on the flight with no time to spare.
The same cannot be said of our luggage.
Recorded by Mrs. Sunny Strong, Children’s Librarian, Edmonds, WA
April 21, 2008
Beijing, China
Meng Liangliang (Bruce) and Dr. Michael Strong briefed the
delegation at the Swissotel in Beijing.
Bruce introduces Bao Xiaolan (Wendy), our local guide. This was the
first time all of the delegates were together, as three had arrived one day
earlier. This initial gathering gave us much useful information, from
understanding cultural differences to the importance of personal promptness for
the good of the whole. He stressed the five-minute principle and that tardiness
was highly frowned upon. Bruce showed us China’s map, flag, and 23 provinces,
summarized its long history, and explained the importance of saving face. We
learned losing face and giving face referred to; the former loses respect and
the latter is to ask for help. He advised us to be sensitive to the different
viewpoints regarding the Chinese government’s interactions with Taiwan and
Tibet. Public places like the airports and public squares are inappropriate for
discussion of our political opinions. He introduced us to the “whatever is good
for China” slogan to facilitate our understanding of national unity in China.
If there were 13 delegates there were at least 13 cameras, and Bruce advised us
to ask to take pictures when in China and professional meetings. Photographing
patients is prohibited. Bruce reviewed currency exchanges and what monies are
acceptable in China and Mongolia. Business card exchanges are important. We
should show respect in professional meetings by honoring the protocol. There
will be a brief introduction about the facility followed by a presentation by
Michael Strong. We were urged to learn to use chopsticks. Bargaining is
expected in some shops and stalls. Our national guides are good resources in
this regard.
We were told that China is a very safe country. As in any
tourist area, there may be pickpockets, so be vigilant. Bruce then briefed us
on Mongolia, its history, people, customs and geography. We are restricted to
40 pounds check in plus carry on. No liquids are allowed in carry on luggage.
Dr. Strong started with introductions and asked for
volunteers to keep journal notes on each day of the trip. He briefly reviewed
the professional meetings in regard to who would be making presentations and
things that must be done such as thank you notes, gift presentations,
evaluations, and CME forms. Dr. Strong reminded us we have an opportunity to
meet and converse with our Chinese counterparts in various meetings. We brought
our gifts for our Chinese and Mongolian counterparts, and distributed them in
tote bags for ease of delivery. Gifts consisted of AABB and other professional
materials plus cultural items from various parts of the country.
Dr. Strong prepared and distributed thank you notes for our
hosts that everybody signed.
Recorded by Ms.
Virginia Hughes, Acting Director/Asst. Professor, Auburn University,
Prattville, AL
Cultural Program
Monday, April 21,
2008
Briefing and
overview on China
The briefing on
Chinese culture included the history of one of the oldest cultures in
historical times. Beijing, the capital,
is the political and cultural center of the country. The Chinese Society of Blood Banking
Transfusion (CSBT) and the Beijing Red Cross Blood Banking Center are
headquartered in Beijing. This city of 15 million is home to important
hospitals. Beijing is more than 850 years old in a country with a 3000-year-old
history.
The cultural program
for Monday included a walking tour of Tian’anman Square and the Forbidden City.
Tian’anman Square is located in the center of Beijing and has a special
significance for the Chinese people. For
the local people it is a place to relax and a place for special holiday
celebrations.
The Forbidden City
was the imperial palace during the Ming and Qing dynasties.
It houses numerous rare treasures and is
divided into several courts where the emperor exercised his supreme power over
the nation and where he lived with his royal family.
The evening event, a
theatrical performance of the history of Kung Fu, tells the story of a young
boy who faces challenges in learning how to become a monk. This performance told the story through the
pageantry of dance acrobatics and martial arts.
During this first
day of cultural immersion, The People to People Delegation got a very good
sense of the culture and pride of a country that is unified in thought and
processes, many of which serve to rally support for blood donations. We discovered a sense of national pride,
especially with the upcoming international Olympics.
Recorded by Pat
Paulauski, Director of Public Relations, Florida’s Blood Centers, Orlando, FL
*********************************************************************
April 22, 2008
Blood Banking and Transfusion Medicine
Professional Delegation
Beijing
We arrived at the Beijing Red Cross and met delegates from
the Chinese Society of Blood Transfusion. The following Chinese counterparts
were introduced: Zhu Qingsheng – President, The Chinese Society of Blood
Transfusion
Prof. Ni Daoming – Vice President & Secretary General;
Prof Di Daoming, Vice Secretary of the Society; Liu Jiang, Beijing Red Cross;
Ren Fu-Rong, Director of Blood Transfusion Safety Research Laboratory.
The American delegates were introduced in turn by Dr.
Strong. He offered thanks to the Chinese counterparts for their hospitality and
recognized this gathering as a great opportunity to discuss transfusion
practices between the US and China.
President Qingsheng welcomed us warmly on behalf of Chinese
Society of Blood Transfusion. It had been three years since the last delegation
had visited China. He acknowledged us as experts in transfusion medicine and
the US as the most developed country and most advanced in the practice of
medicine. He stated that China was still a developing country and there was
much room for improvement in the area of transfusion medicine and looked
forward to exchanges of ideas and experiences from the US delegation. There has
been an increase in donor criteria and requirements and China has implemented
intense oversight of donor selection over the past ten years. He wished us a
successful trip and great friendship from the Chinese people.
Prof Daoming, Vice President & Secretary-General of The
Chinese Society of Blood Transfusion, presented historical perspectives of the
Society and future goals. The Society was founded in 1988. Its primary goal is
to incrementally improve transfusion medicine in China. There are approximately
400 institutional members and 20,000 individual members. There are six
committees and an expert panel for offering advice on technology and blood
establishments in China. The Society was responsible for writing the first national
guidelines for transfusion and has one blood center in each of 23 provinces
throughout China. In 2001, the Chinese government invested 200 million dollars
in blood services that were used for new equipment, facility renovations, and
quality improvement. Four years ago twenty percent of blood came from paid
donors, today over ninety-five percent come from volunteer donors and community
initiatives. Blood establishments have good rapport with medical organizations
in the US. In April 2006, CSBT participated in a conference with AABB; they
have benefited from symposiums and workshops sponsored by AABB. The CSBT also
has a good working relationship with Johns Hopkins and NIH. In June of 2008,
they will host the ISBT conference. Prof Daoming hoped that the relationship
between China and US will continue to promote continued improvement in blood
safety.
Liu Jian, from the BRCBC, gave a brief history of the
Beijing Red Cross. The functions of the BRCBC are blood collection and supply,
research, and training of staff. The BRCBC supplies blood to 150 hospitals in
Beijing. It was founded in 1957 and its main facility is 8000 square meters. It
has a fixed value of 1.5 hundred million dollars and houses 422 staff within 11
administrative departments and 9 centers. The BRCBC has trained over 5000
employees to date. We toured all laboratories in the BRCBC including apheresis,
whole blood donation, donor testing and component preparation, and the HLA lab.
In 2007, 300,000 units were collected which was an increase
of ten percent from 2006. Standards from AABB are implemented and processes are
reviewed every six months. There were 30,000 therapeutic units collected. There
are 20 bloodmobiles in Beijing, which visit about 15 sites per day, including
university campuses. In October 2008, two more collection sites will be
utilized. There are ongoing clinical studies with Roche and Johns Hopkins.
Blood safety strategies from WHO (World Health Organization) are also
implemented. There are over 1000 Rh negative units stored frozen. During the
Olympics, there will be an inventory of over 200 fresh RBC units. The BRCBC
follows ISO quality systems and all blood will be screened using NAT, in
addition to the current test menu. All testing used must have been approved by
SFDA. The blood screening laboratory participates in both external and
international quality control. Many research studies have been published in
international journals. The HLA laboratory performs all related testing in
China, which currently totals over 65,000 samples. There are over 15,000 donors
registered in the BRCBC.
Overall impression – the Chinese delegation was very
interested in our insight and very professional and proud of the efforts they
have made toward the improved safety of the China blood supply. Most impressive
was the apheresis donor room with about 100 students waiting to donate and
watching the NBA playoff games on TV. There were about 50 apheresis chairs all
filled with donors. When asked about why they were donating, the answer was to
help their society.
Recorded by Karen Long,
VP of Regulatory Affairs, Roche Diagnostics,
Pleasanton, CA
*********************************************************************
April 22, 2008
Peking University
Institute of Hematology (PUIH)
We were given a
presentation by Professor Huang Xiaojun at the PUIH, which is comprised of 6
wards, 10 laboratories, 29 departments with 118 nurses, 35 physicians, 1
academician, and 7 professors. Cellular Therapy and the Cord blood bank are
collaborative. In 1999 there were 1000 outpatients, in 2003 there were 6000+.
The PUIH performs allo and syngeneic bone marrow transplants, human progenitor
cell, and cord blood transplants; there were 217 in 2007 and 1452 performed to
date. The cord blood bank has stored
over 8000 units for public use, up to 2007. They are regulatory members of
ASICORD and expressed interest in attaining AABB accreditation for recognition
and improvement in quality. There are 23 beds in the BMT unit. One particular
area of interest is the video monitor of patients, which could be viewed by
family members outside of unit itself and allowed two way video conferencing.
The Hematology Laboratory has a FACSCalibur and FACSort. The cytogenetics lab
runs 300 samples per day and includes PCR capability for DNA analysis.
Recorded by Dr Leonor
Fernando, Director of Apheresis, University of California, Davis Medical
Center, Sacramento, CA
Cultural Program
Drum Tower & Hutongs
We climbed a dark, drafty, steep stone stairway high up to
the area housing 25 large drums about the size of a wine cask in Oporto. At the
half hour, drummers in bright uniforms ceremoniously drum out the time for all
to hear. They continue a tradition begun centuries ago when the gates of the
Beijing city walls were opened at 7am and closed at 5pm. The drummers’ strokes
form a pattern while they make their booming sound, very dramatic. Afterwards,
we walked around the tower roof, taking in the city view. On one side, we
looked down into the courtyards of the old Hutong neighborhoods. On another
side we saw modern Beijing.
We rode a rickshaw along a pretty tree-lined boulevard
lining a canal, down narrow streets into the gray one-story homes of the
Hutong. The guide led me into the private home of a retired chemical factory
worker and her husband who is an automobile repairman. Normally, people retire
at 55 or 60, but she was granted early retirement due to the nature of her
work. As most Chinese, they have one child, a French major at the university.
Their home belongs to his workplace. The land it stands upon, like all land,
belongs to the government.
This Hutong had three rooms: kitchen, living room, and
bedroom. The toilet (not plumbed) was outside. From this small kitchen, she
produced homemade dumplings, a pork and celery dish and rice and tea. We sat on
little stools at a folding table. I imagine this gives them more floor space in
their small home. Bright posters and a china doll decorate the bedroom. Books
lined one wall. Our hosts invited us to watch television while she prepared our
lunch. I brought them some simple gifts as a thank you.
Concurrent Guest Program recorded by Sunny Strong
April 23, 2008
Visit to Traditional
Chinese Medicine Hospital
Traditional Chinese Medicine
Met with Dr. Nan Jihong (Nancy) at the Guang’anmen Hospital
(GAH) – the official hospital of the Olympic games. Nancy oversees students that are studying from abroad. She explained
that prior to her current position she worked in experimental animal research. Over
800 doctors and nurses work in 28 clinical departments combining traditional
Chinese medicine with Western Medicine. Founded in 1955 with the China Academy of TCM, GAH has trained over 1,000
physicians in Traditional Chinese Medicine (TCM). Practices within TCM are
Tuina (Massage), acupuncture, herbal medicines and QiGong (TaiChi is one
component of QiGong). However they
practice integrated medicine in addition to more modern/Western medicine. They
are leaders in patient care, education, and research.
TCM is a very important part of Chinese culture and the body follows nature and improves
life. For instance, Nancy pointed out that you don’t see Chinese wearing
T-Shirts in the spring. Instead the body follows the season. In spring
everything is opening up (pores) and you need to protect these openings from
invasion. So Chinese wear several layers, even sweaters. In the autumn, pores
close and this is the time that Chinese wear T-shirts when the pores are closed
and not available for nasty invasion. This is changing with the younger people.
China is considering teaching TCM in grade school.
Currently there are
colleges for training in the practice of TCM, prior to these; the practice was
passed down through families. Patient Care is based on 2 diagnoses given to the
patients, a Western diagnosis (i.e. Cancer), and a TCM diagnosis (i.e. “blood
stasis”)
Care is then
integrated, with surgery first if needed (can be done at this facility or a
Western facility), or if a body is strong enough they can remain at the
facility and receive chemotherapy/ radiotherapy.
Transfusions are
given at the institution if needed. Nancy confirmed that during surgeries there
is both homologous and autologous component transfusions, and the capabilities
of utilizing cell salvage is available
There are 3,000 outpatient visits daily and 80% utilize only
TCM. The hospital has 600 beds.
Diagnosis is made by
4 methods:
- Observation:
Holistic, spirit, body shape, face (complexion), hair, nail, skin, tongue
(movement, position, size, color, coating [color, thickness]).
- Hearing/smelling:
voice, breathing, smell of breath
- Asking:
history – about 10 questions based on Observation and Hearing/smelling
Pulse
taking – takes a lot of practice combined with clinical diagnosis. Different
doctors can have different interpretation.
This leads to Syndrome
differentiation/method of treatment. The
patient is responsible for purchasing “medical notes”, in which documentation
is made, and the patient keeps this record with him.
GAH is recognized as
a National Center for diabetes, cancer, and anal and intestinal disorders. GAH
has created an herbal hemorrhoid injection that is a 1- time fix with dosage
and injection sites important. Each
department utilizes its own herbal treatments (i.e. the respiratory department
has developed an herbal paste that is applied to the acupoints of the back to
prevent asthma attacks). Treatment is in the summer for winter asthma
and the paste is on the back for 6 hours, removed, and patient comes back in 10
days. Total number of treatments is 3.
They have over 30 years experience with this treatment and on a single
day can have 7,000 patients lined up for it.
There are no
pediatric inpatient beds; however they will follow those with chronic diseases
as outpatients. Treatments used must go through clinical trials (human – animal
– human) prior to SFDA approval; then it is considered “licensed therapy”
The GAH visit was finished by watching patients receive a
massage for neck problems, acupuncture for stroke and incontinence, and
watching the CTM pharmacy fill the daily prescriptions of herbal medicines for
patients.
For lunch we went to a Friendship store which is a
government run store for Chinese goods with “good prices, no bargain”. Or was
that “no bargaining”. The rest of the afternoon was spent climbing the Great
Wall (once some of us found the alternative wall through very secret stairs and
passageways). Mike and Sunny were apparently first to the top on the more
widely traveled portion of Wall, though Pat showed us all how to conquer both
parts in a single afternoon. We all would have enjoyed a foot massage at the
end of the walk but settled for spicy Chinese food before we got 4 -5 hours
sleep.
Recorded by Dale DeCan, Intl Marketing Manager, Roche Molecular
Systems, Pleasanton, CA, and Dr. Kathleen Nicol, Director, Nationwide Children’s
Hospital, Sunbury, OH
Cultural Program
Summer Palace
Oh, the Empress Cixi knew how to indulge herself! She picked
a beautiful site by the lake for her summer retreat. In fact, she lived there
more months of the year than in the Forbidden City. Her symbol is the phoenix.
The emperor’s is the dragon. These are depicted in statues, carvings,
gargoyles, etc. The Chinese believe they are descendents of the dragon. The
main road through Beijing is called “The Dragon’s Pulse”.
We strolled the well kempt grounds shaded by a lovely carved
walkway. Light gray rocks, sculpted by the rains, decorate and border the
hiking paths.
Temple of Heaven & Park
South Park is a senior paradise. Want to dance, meet
friends, play cards, sing, and play in a pickup band? Want to do Tai Chi or
Yoga surrounded by flowers and green? Volunteers, who are experts, teach
others. The atmosphere is happy, with many smiles and lively chatter. These
seniors look hardy and engaged in life. It reminded me of a conversation I had
on a plane a few years ago. The Chinese seatmate lamented the fact his father
did not want to stay in Seattle because he missed these peer gatherings of his
Chinese neighborhood.
We continued to the Temple of Heaven where the Emperor made
sacrifices to the Jade God. He would petition for a good harvest. Goats were
sacrificed and produce proffered. These buildings have been recently restored.
The vivid blues, reds, and yellows gleam in the sunlight. Gorgeous.
Concurrent Guest Program
recorded by Sunny Strong
April 24, 2008
Trip to Ulaanbaatar, Mongolia
Travel from Beijing, China to Ulaanbaatar, Mongolia
After getting up very early and making our way to the
airport, through customs, checking our bags, getting some coffee from a
Starbucks clone coffee shop called SPR coffee, we settled in at the gate with
the confidence that this trip would be less eventful than the trip from LA to
Beijing. We immediately noticed that the flight was running 12 hours late.
After we scrambled through our phrase-books for a list of
profanities in Chinese and Mongolian (with English words thrown in for
clarity), Bruce herded us off to a bus that takes us and everyone else on the
plane to a nearby hotel for the day. It specializes in airline employees and
had a Chinese buffet for lunch that reminded us of buffets in the US
unfortunately.
On the plus side, there was free internet at the hotel so we
had a lot of time to catch up on our email. I also had an interesting
conversation with a nice student on the bus, a Mongolian Mormon on break from
BYU who spoke perfect English that he learned on his mission- in Idaho. He told
me that travel to Mongolia was nearly always delayed this time of year due to
high winds and dust storms. He’d already been on the road for 4 days trying to
get home from New York.
We finally got off the ground at about 10 pm. 14 hours
behind schedule. The two and a half hour flight was uneventful. However, the
contrast between Beijing Capital International Airport and Chinggis Khaan
International Airport was remarkable. The new terminal 3 in Beijing was an
enormous architectural wonder, newly opened in February and designed to handle
the millions who are coming to Beijing this summer for the Olympics. On the
other end of the flight, the small, Soviet-era building in Mongolia was clean
and functional but no more than that. They didn’t have gate numbers on the
tickets there, because there was only one gate. It proved to be indicative of
the contrasts between our two host cities. Four bags were missing when we
arrived in Mongolia. It was that kind of day.
Recorded by John
Reagan, Manager, Puget Sound Blood Center, Mountlake Terrace, WA
***********************************************************************
April 25, 2008
The Blood Center of the Ministry of Health
Center and Hematology Department of Health Services
University of Mongolia, Ulaanbataar, Mongolia
The morning started with a welcome and introductions. The
facility has a 50-year history and this day was considered an historic event
being the first time they had been visited by an American delegation. They
asked for cooperation and sharing of information for the ultimate purpose of
blood safety.
Mongolia is divided into 21 provinces with 46,000 to 122,000
population. Each province is further divided into smaller areas called soums.
There are 340 soums with a population of 3000 in each. Fifty percent reside in
Ulaanbaatar. The first blood transfusion station was set up in 1956. In 1963 a
government decree made it official. In 2007 it was reorganized into the
National Blood Transfusion Center by the MOH. There are 26 blood centers in
Mongolia all headed by MOH. In 1994 voluntary donations began.
Ulaankhu Davaadori, Director of Mongolian National Blood
Center gave us a warm welcome and stated this was the first time such a large
group of professionals have visited their center. He proceeded to review the
history and demographics of the center.
There are 4 centers with populations 46,000 to 122,000.
The capital of Mongolia, Ulaanbaatar, comprises 50% of
population. In 1938 transfusion started with war wounded, 1956 first
transfusion station, 1963 first official transfusion station established by
decree and 1994 Mongolia went to all volunteer donors. In 2007 a decision of
MOH established a national blood center. There are 26 blood banks in Mongolia
Different units of the National Blood Center include: donor
collection, production of components, Lab, QA, QC management.
First Time Donors
Whole Country Ulaanbaatar
Countryside
New donors
55% 61.2% 39.6%
Red cells
22% 26% 56%
Plasma 5% 6% 2%
Directed donation
5% 6.5% 2.2%
Per 1000 population 7 15 3.5
Collections
In blood center
58% 41% 93%
Outside of center
42% 59% 75%
Donor Gender
Males 40%
Females 60%
48% of donors are students, 17% military and 17% state
employees
TEST Method
ABO group
slide
Rh
slide
Syphilis
RPR
Anti-HIV
Elisa
HBsAg Elisa
Bilirubin
kleggann-groff
ALT
Raitman-frenkel
TP
Goriyaev net
RBC
Goriyaev net
Platelet
Goriyaev net
Hgb
spec
Mongolian blood
type distribution
A
20-23%
B
32%
O
33-40%
AB
7.9%
Rh neg
0.6%
There were only 5-6 cases of complications due to
incompatible blood, as stated; 3 were due to plasma products and 2 from RBC
transfusions. Reactions or complications are not reported due to the
non-reporting system.
340 soums use whole blood because there is no equipment for
blood separation. Local donor blood banks are making only whole blood and
separated components are not available.
Whole Blood
Soums
100%
Other cities
20
Ulaanbaatar
1
Provision of Blood
Components
Ulaanbaatar other cities Soums
WB
100% 80% 60%
pRBCs
60% 30% 0
FFP
50%
2% 0
Cryo
30%
0 0
Plt Conc. 20% 0 0
Albumin
30%
0 0
Kell positive population = 0.9%
In 2003 the Department of Quality Management was
established. In 2007 the first reference lab opened. Prior to 1994, Donors used
to be paid but are now classified as non-remunerated. 7 of 1000 persons are
donors.
International knowledge of transfusion is high but in
Mongolia it is lacking. Financial resources are limited for outside training of
MDs. There is limited outside international cooperation. There is no emergency
blood supply.
The Goals of the Blood Center are Government resolution of
problems, work to strengthen lab and make quality blood products, train MDs in
proper use of blood products, establish reference lab and be on track with
international standards.
The following questions were asked:
1. How
can we cooperate with US to solve problems and set priorities?
2. Training
of international staff?
3. Joint
training and research initiatives?
4. Propose
to conduct joint projects and solve joint problems.
The majority of attendees were MD’s. Medical Education
consists of 4 yrs medical school and 2 year residency in clinical lab.
Donors less than 25 yrs of age are healthier and have less
hepatitis B incidence
Hepatitis B is a problem in Mongolia.
Age range for donors is 18 to 50 yrs
0.2% of donors are directed from relatives
Donors in
Ulaanbaatar
New 55%
Repeat 22%
Directed 5%
In the afternoon Dr. Kathleen Nicol gave a lecture on
pediatric/neonate transfusion and Dr. Leonor Ferdinand discussed the Circular
of Information for blood transfusion.
Recorded by Edith Whiting,
Victorville Community Hospital and Ardele Hanson, Medical Technologist Magic
Valley Regional Medical Center, Twin Falls, ID
Cultural Program
Having lunch and a visit in a
GER (we say Yurt) was an adventure: Yak
milk tea, homemade soup and dumplings, fried bread and brittle hard cheese
served by our host, the father of a daughter attending university and a son who
accompanied me on my horseback ride. He sang a plaintive folksong as we rode
away from the Ger into the sparse, silent landscape. If you see the movie “Cave
of the Yellow Dog”, you have met this family! In the midst of this nomadic
life, comes a cell phone ring. In fact, I was startled to hear my own phone as
I slid down some loose rock after visiting a Buddhist shrine. Many TV antennas
on Gers we passed. This Mongolian family had one Ger for cooking and one for
sleeping etc. The outhouse was a few feet away.
Again, I had a private tour and
driver, as I was the only non-medical delegate in our group. We stopped to
admire camels, goats, sheep, yaks, and an eagle along the roads. The roads can
be very rough, deep potholes, sharp rocks, and much dust.
Our last evening in Ulaanbaatar,
we were delighted to hear a Mongolian orchestra including the famous two-string
fiddle with horsehead carved on top. There was a high-pitched chanteuse, a
petite contortionist, and an incredibly beautiful dancer. All wore traditional
silk costumes. What a treat! When asked whether I’d seen Mongolian art, I
answered that the everyday dress qualifies. Leather designs appliquéd on white
leather boots, other symbols embroidered or appliquéd on jackets, saddles and
belts. They are a
handsome people, reminiscent of
the Inuits in the United States.
In summary, I would recommend
People to People (headquartered in Spokane). We did visit with locals, our
guides were knowledgeable, and history was emphasized to give us a context for
understanding. How fortunate we are.
Concurrent Guest Visit
recorded by Sunny Strong
April 26, 2008
Mongolia Cultural Day
This morning we enjoyed some cultural sights, beginning with
the Manzshir Monastery. On our way going there we heard a brief history of
Mongolia, which has a population of about 3 million people. Over 1.5 million
live in Ulaanbaatar and the remaining are distributed around the rural area. On
our way to the park was a stop to participate in a Mongolian custom. When a
warrior goes to war a stone signifies his return. Like in any war, some stones
remain indicating perhaps death of a warrior. Arrival at the Manzshir monastery
was not what I expected but we climbed to where a ruin stood. There were some
pictures attesting to the existence of this monastery. Visited a museum. Had
lunch at a Seoul restaurant buffet style. We then went to the Gandan Monastery
wherein some very persistent children selling seeds to feed the pigeons met us.
We visited the main temple where a picture of the Dahli Lama as a young man is
shown with Avalokitesvara looking over all the people. We went around the
prayer wheels praying for a safe return to Beijing the following day. We
stopped by the monument of Chinggis Khaan before returning to our hotel. We had
a farewell dinner in a banquet room with a European theme and were treated to
folklore music Mongolian style, including the two hair Horsehead Fiddle and
Bass, a contortionist performer, a singer and a dancer.
Recorded by Maria
Olszewski, Medical Technologist, Children’s Memorial Hospital
Chicago, IL
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