Sun and Fun in Bkk and Spore

For the latter half of the Chinese New Years holiday, I traveled south to Bangkok and Singapore.  It was awesome to get away from the frigid northern Yunnan weather.  It’s not as bad as say Beijing or Hanover since the lowest lows are around to -1 or -2 centigrade, but without any central heating in the buildings, I think it’s a lot worse.

I did a little sightseeing with a friend from Kunming for two days and saw the main sights…

Grand Palace

My favorite little guardian statues at the Grand Palace

Wat Arun or the Temple of Dawn from the Chao Phraya River

Wat Pho-world's largest reclining Buddha

Ate loads of great Thai food including late night mango with sticky rice

-I played in my first international tournament, Bangkok Hat.  For those not into frisbee, a hat tournament is where players are randomly placed on a team.  I think this may be the largest hat tournament in Asia.  There were 20 teams with players from all over Asia.  My team (shown below) was Baby Pink.  Despite hating on our team color, our team really gelled and it was awesome playing with all of them.  We had players from Bangkok, Hong Kong, Singapore, Indonesia, Philippines, Vietnam, Malaysia, and Taiwan!  It was a weekend of good ultimate, thai food on the sidelines, and thai massages between games.  I don’t want to go back to the bagels and peanut butter fare we have in ultimate tourneys in the states!

Baby Pink

-After the weekend, I made a quick stop in one of my favorite place, Singapore.  Mainly it was a visit to see my grandparents and meet up with my parents.  However, it was also great to catch up with old friends and play a little beach ultimate at Sentosa. When most people think of Singapore, they most probably think shopping on Orchard, skyscrapers, and probably the gum ban.  However, as an extremely well planned garden city, there’s actually a surprising number of green spaces.   One of the highlights of Singapore was getting out of the city and going on a short gumboat ride to Pulau Ubin with my dad.  It’s was cool to see the old kampongs, mangrove swamps, and untouched nature that existed before Singapore underwent its modern, large-scale urban development.

Believe it or not, this is actually Singapore!

Mountain Biking with my Dad on Pulau Ubin

Tossing Yuseng (lo hei in cantonese) with my dad and grandma. This traditional Singaporean dish is composed of various shredded veggies with some raw fish. It is believed that the higher you toss it, the more prosperity and luck you'll have during the new year!

-On a totally different and nerdy note, this Bangkok and Spore trip was awesome because I got a chance to see cultures and places that I learned about in college.  Last fall I took a Geography course on the politics and environment in South East Asia.  It’s a coincidence that I gave had a final presentation on Bangkok’s traffic/air pollution and a final paper on Pulau Ubin in that course.  The Bangkok traffic really is as horrendous as they say (I was stuck in a cab on an off ramp for roughly an hour) and besides my dad and I, Pulau Ubin was filled with Singapore students on Outward Bound trips.  Like outdoor ed at Chadwick, Outward Bound is strongly encouraged for high school students in Singapore.  I love it when you can see the things you learn in school!

Until next time,


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Spring Festival-Year of the RABBIT

Chinese new years in China is by far the most important holiday in this country.  It’s a seven day national holiday but a lot of rural areas take 15 days to celebrate the traditional new year celebration.  Everyone makes an effort to go back to their hometown at whatever cost, which results in the world’s largest annual human migration.  If you ever want to come to China, AVOID SPRING FESTIVAL at all costs.  Transportation is a nightmare.  Train tickets are sold out way in advance, bus stations are filled with people, and the majority of shops/restaurants are closed.  During the first two or three days of the new year, most people spend it with family and it was extremely bizarre to see deserted streets in China.

Most of China Cal activities were suspended since we could not get government approvals for different projects and most patients don’t want to be away from home at this time.  I spent the first half with family in Kunming.  After going to Chengdu and meeting my uncle, he connected me with my paternal grandfather’s sister’s family.  These two siblings were close before my grandfather left China in ’49 and he visited/met her family for the first time around four years ago.  Currently, my grandfather and I are the only ones who have met them.  It’s sort of amazing to think that I couldn’t even point out Yunnan or Kunming on a map about a year ago but have reconnected with family here.  The only relatives I have in the US are my parents and a great uncle, so it was the first time that I have been able to experience a large family holiday gathering.  This is also a HUGE family (or average before China started the One Child Policy).  Since most of the family lives in either Kunming or Dali, they routinely get together for family dinner on Sundays and other family gatherings.

If I had three words to sum up Spring Festival, it would be family, food, and fireworks.  Here’s some pictures…

Here I am with five out of my six aunts and uncles during our New Years Eve dinner. My 2nd aunt lives with her family in Dali and didn't make it down to Kunming for the holidays.

Chinese New Years=LOADS OF FOOD!!

At midnight, my uncle, cousin, and I went a Buddhist temple on 西山 (West Mtn) to make some offerings to Buddhist gods.  Luckily, we drove but there were people that walked up the mountain during the middle of the night to make their new year offerings to the gods. We ended up staying on the mountain till 2:30ish.  Just in time since the police guarding the pier near Dian Chi Lake had cleared out and we could set off fireworks.

Lighting the incense in these huge cauldrons of fire

Buddha in one of the temples

Ringing the ancient bell three times for good luck in 2011

The First Day of the New Year

From New Years Eve till the third day, it’s non stop firecrackers throughout the night.  You’re supposed to set off firecrackers when you get up, before each meal, and before you go to sleep. But once it gets dark, people are setting off fireworks/firecrackers left and right.  We got up relatively early in the morning to make some 汤圆, which are glutinous rice flour shaped in a ball with walnut, sesame, and sugar filling.  It’s boiled in water and served. Then in true Chinese fashion, we started working on the next meal after finishing breakfast….

Wrapping dumplings with my first aunt

Once it got dark, I started setting off fireworks with my cousins

These fireworks were huge! In case you were wondering, hundreds of people are hurt every year during spring festival from shitty made Chinese fireworks. I tried not to think about this when I was setting these off

Other adventures around Kunming with family

Hiked 西山. Here I am with my cousin's son Bobby

The closest thing to winter sports in Yunnan...GRASS SKIING

It was actually more like rollerblading down a hill and I didn’t realize until now that my cousin didn’t get the skis in the picture. Since this is a real ‘outdoorsy’ activity in China, some people even set up tents while watching their kids ski down hill.  Oh yeah, the Chinese ski operators INSISTED that i wear the knee/elbow pads/helmet even though I insisted that I know how to ski/skate…

Feeding the seagulls at Dian Chi Lake

One of the most bizarre things I have encountered in China is Chinese people’s OBSESSION with seagulls in Kunming.  Yeah, those disgusting and annoying birds that poop on your head and eat trash at the beach.  However, Yunnan is land locked and apparently these seagulls come from Siberia and stop in Kunming for the winter.  People from Kunming flock to Dian Chi to see and watch the seagulls.  A requisite photo op for people getting married in Kunming is with the seagulls.  Really bizarre right?

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Patient Advocacy

With the arrival of Spring Festival and a little traveling in Southeast Asia, I’ve gotten a little behind with updating this blog, so here’s a couple of updates.  For most of December and January, most of my work with China Cal involved what can be best described as patient advocacy work as my co-workers and I tried to arrange procedures for all the children that needed them before Chinese New Years.  It was pretty chaotic.  At one point, I was in charge of six kids in hospitals all around Kunming; Fang Fang was with four in Chengdu, another China Cal volunteer was with a boy in Beijing while Dr. Detrano and Shan Shan were in a conference in Chongqing.  We were dispersed all over China!

Until this point, I had probably only been in Kunming for less than two weeks total.  However, I am now a pro at navigating the public transportation system to get to most hospitals around town, have more Kunming cardiologists and patients in my speed dial than friends, and am becoming more accustomed to dealing with the Chinese health care system.  In a nutshell, I spent a lot of time on the phone making sure there were available hospital beds and helping patients get to the hospital. Once the patients were in Kunming, I made the rounds to visit them every day, acted as a liaison between the doctors and Detrano, and picked up test results so China Cal also has duplicate records on file.

As expected, there have been plenty of challenges besides the obvious communication barriers.  I am quickly learning that medicine is very much a part of the service industry and there can be lots of non compliant and unhappy customers especially when you are dealing with a matter of life and death.  It’s frustrating to try to convince a patient’s family to receive free treatment for their child’s TB and to later hear that they went back to their village and wasted hundreds of RMB on traditional Chinese medicine.  Or to hear back from some of China’s best surgeons in Beijing that a child is inoperable or from a village official that a child you saw last week died from the physical exertion of walking to school. Or to realize that China Cal does not have enough funds to help children with more complex forms of CHD who we see in clinic.

It’s also infuriating to watch patients receive substandard care.  After one exhausting day going from one hospital to another, I receive a call from an emotional aunt right before I was about to go to bed.  Her niece received an open procedure to correct her Tetrology of Fallot earlier that afternoon.  This is a complex form of CHD that includes a combination of four abnormalities: VSD, narrowing of valve and artery that connect the heart with lungs, an aorta coming out between the left and right ventricle, and thickened right ventricle.  Apparently, the ICU casually slipped the family a piece of paper mentioning that the child’s heart had stopped for six minutes and was essentially crashing.  No further explanation by a doctor or nurse. Detrano and I rushed to the hospital.  When we asked where the attending and surgeon was, the nurse told us they couldn’t be disturbed since they were sleeping.  Yes, sleeping on call.  After finally calling enough people to find a conscious physician, he tried to reassure us that everything was alright.  When Detrano asked whether they had performed ultrasounds (standard in the US after such procedures) to confirm his diagnosis, he said “No, the ultrasound technician works 9-5 and went home.” Critical care based on a hunch was not very comforting. Luckily everything turned out okay this time….

When evaluating China Cal’s work, I realize that it’s a drop in a very large bucket.  We have limited funds and resources, and there are inevitably more children than we can possibly help. Taking into account the incidence of CHD and birthrates, we estimate that there are approximately 40,000 children born with CHD every year in Yunnan with roughly 13,000 to 20,000 requiring treatment.

How does China Cal measure up?

I just finished compiling my data for my follow-up study.  In short, with a small budget of less than $80,000 USD a year, we have funded 37 operations for 36 patients who were either diagnosed during China Cal screenings or referred by local village officials or physicians from 2007 to June 2010. In this cohort, there were two deaths and three had trivial, residual abnormalities. The others are doing just fine with no symptoms. I wish I could report a higher number but the roughly 40 or so patients China Cal has helped is miniscule when compared to the number of children in Yunnan with CHD.  However, just thinking about the dramatic transformation from pre and post surgery and also getting random phone calls from parents months after their child’s surgery inviting me to their village for the New Years can only leave me grinning like a fool even after the worse days.  That drop’s definitely better than nothing.

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Screening the masses in Xun Dian

Within 24 hours of arriving in Kunming from Chengdu, I was off again to Sha Dian in Xun Dian County. Sha Dian is an extremely poor farming village roughly 2.5 hours north of Kunming.  Whenever I told someone where I was going, they either tried to correct me to tell me that I was going to Zhong Dian (the Chinese name for touristy Shangri-La) or asked why the heck I was going out there.  Well, we were invited by the Xun Dian County government for what Dr. Detrano thought would just be four days of general clinic.  As usual, plans always change when you’re in the field.

After driving through the dirt, windy roads, we arrived in the village center.  Besides the couple of streets with small country stores all selling the same random assortment of things and horse drawn wagons carrying people and farming equipment, we were surrounded by acres and acres of farming land.  The main crops here are potatoes and corn.

Look at who we're sharing the road with on the way to Xun Dian! They definitely don't look old enough to drive...

Farmers working in the fields

Morning market on the main street where you can buy a range of veggies, noodles, and even stinky, moldy tofu


As expected during the first afternoon, we held a hypertension clinic in a village doctor’s clinics.  Fang Fang and I first took patient histories, blood pressures, and listened for any murmurs.  Most people came just to get their blood pressures checked.  However, anyone with blood pressure over 140 (hypertension) or complaints of chest pain would then be referred to Dr. Detrano for more in-depth examination.  That afternoon, we had a relatively light load and saw only 20-30 patients including two kids with congenital heart disease.  One had a VSD and another had a Patent Ductus Arteriosus (PDA-hole between aorta and pulmonary artery).  Both could be closed in Kunming, so we sent them home with the necessary low income/poverty forms that they needed to fill out and get a stamp approval from the local government.

Little Yuan at clinic. We diagnosed his VSD and it was percutaneously closed 4 days later.

School Screening

However, the county’s main objective for us was actually not to hold clinic but to screen the local school for heart disease.  Normally, ChinaCal does school screenings during its internship program. More interns means more manpower.  Since Dr. Detrano came down with a really bad cold and needed to rest after clinic, the school screening fell into hands of Fang Fang and me.  The county official told us that we would screen the middle school.  9 classes with 50-60 kids.  A little daunting/crazy to think that we had to screen approximately 500 kids.  This was the initial count.

Stethoscopes in hand, Fang Fang and I were off to our first class.  The county official and principal would explain to the teacher what we were doing and then the kids would line up to get their hearts listened to.  There were a couple of things that you listen to while auscultating (heart rate/regularity, heart sounds, systolic and dystolic sounds, and heart murmurs). It’s helped that I’ve been listening to abnormal hearts for the last 2 months, but I am expectedly not an expert yet.  I am sure that we may missed a couple, but I guess it’s better than nothing.

In total, Fang Fang and I ended up screening roughly 1500 children in 1.5 days.  The school officials forgot to take into account the elementary school.  No big deal, they were just about 1000 kids off in their estimate.  We worked from 7 am till 9 pm (the normal Chinese school day) with only lunch and dinner breaks!  During the last classroom, my ears hurt so much from the stethoscope that I was almost in tears.  Out of these 1500 kids, we identified around 20 with heart murmurs or other abnormalities.  We then did more detailed examinations of these kids (vitals, histories, ECGs, and ultrasounds) and identified 3 with more serious conditions that needed surgery. There was a VSD, atrial septal defect (ASD-hole between atriums), and Wolff-Parkinson-White syndrome (WPW-extra conductance between atria and ventricles). When we talked to the parents, they did not know about their kid’s condition until that day.  All three kids were 14, and it’s amazing that no one has listened to their hearts until this point in their lives!

Hard at work screening kids in one of the classrooms

A lucky boy getting ascultated

The end of that day was a mix of emotions for me.  On one hand, I felt a sense of accomplishment for identifying one of the girls that had serious heart disease.  She had a loud holosystolic murmur.  You hear a lub, then a blowing (shhh) noise, then the second heart beat.  I thought it sounded typical for a VSD, and it was pretty cool to see the confirmation on the ultrasound.  On the other hand, we had 3 crying kids.  I couldn’t imagine just going to school one day and then being told that you have a heart defect.  We tried our best to explain to the parents about their kids’ conditions and our organization, but you can’t coerce people to come to get check ups or surgery.   You just hope that they’ll call when you leave.

After two exhausting days, we loaded up all our equipment, roughly 150 lbs of potatoes (the county’s gift for us), and the two families of the children we diagnosed the day earlier and headed back to Kunming.  We could help them save on transportation and save them the hassle of getting lost in the city.

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This entry isn’t about Dartmouth night or the biggest party weekend of fall term, but about my trip to Chengdu, Sichuan (province north of Yunnan) during the 2nd week of November. It’s a homecoming since my family is originally from Sichuan! My paternal grandparents were born and raised in Chengdu and my maternal grandpa is from another city further south. One of my motivations for coming to work for China Cal was for an opportunity to visit my ancestral homeland and had always intended to visit Chengdu while in China. I was pretty excited that I had the opportunity to come to Chengdu for work though!

My co-workers (Shan Shan and Fang Fang) and I brought 4 kids and their families from Yunnan to Chengdu General Military Hospital for surgical closure of their VSDs as part of China Cal’s pediatric surgery program. We send kids to Chengdu because they have better facilities, surgeons, and partnerships with other charity organizations to lower the costs for these low income cases. It was an 18 hour train ride from Kunming to Chengdu, which wasn’t as bad as my sleeper bus experience. Probably because it was one of the few places in China were smoking was not allowed! There were only 6 hard sleeper bunks in each compartment instead of 30ish on the bus. With 18 people in our group, we took over half a car, and it was nice not have to deal with randos. The ride went pretty quickly, and I’d say that the worst part of the train was the squatting toilets on the train that didn’t always flush all the way. Pretty gross!

The kids with Dr. Detrano and Shan Shan before getting on the train to Chengdu

While at the hospital, I would describe our roles as liaisons between the hospital and the patients. We helped bring the patients to their exams, explain what doctors are saying if there’s confusion, answer any questions about their procedures, and deal with the finances of the surgeries. This experience with the patients has been my favorite so far in China. For the first time, I wasn’t the one making them cry when I took their blood pressure or ECGs, and I actually got to spend time with the patients while they waited for surgery. Since three out of the four children had increased pulmonary vascular resistance, which can significantly increase mortality if their VSDs are surgically closed, they were hooked up to IVs 24/7 with meds to try to lower their pulmonary pressure and had to just wait. It took two weeks before two of the kids got surgery last week (both are going to be discharged tomorrow). The last girl (Zhou Li Sha) is still waiting to see whether she can have surgery almost a month later. While these kids waited for surgery, I could imagine that it was pretty boring for them. They could not leave their beds and did not bring any school work since they expected to be operated on rather quickly. To help them pass the time, Fang Fang and I made some math problems for them and helped them learn some English (most kids “learn” English in school from nonfluent teachers). Zhou Li Sha was the most eager to learn. She only knew the alphabet up to G but picked up the rest in a day! We then tried to teach her pronunciations using a combo of examples and pinyin to get her to pronounce things right. I now have more respect for people teaching English to non-native speakers since it’s actually really pretty difficult. Before I left, she learned a couple of words and simple phrases. It’s funny that the text messages I receive in China are either from people at work or Zhou Li Sha telling me “Tiffany Jie Jie (older sister), you are pretty” or occasionally I get a very thrown in there. Besides spending time with the patients, I’ve also had the opportunity to go into the OR to see some open heart surgeries. Here I am in the OR!

Here's the heart or my best shot from where I was. Seeing the tiny beating heart was pretty amazing!

Dr. Ouyang, the cardiac surgeon who works with several charities and NGOs, is performing a surgical repair of the pulmonary valve in a Tibetan girl with severe pulmonary stenosis.  Here’s a random story about Dr. Ouyang.  The night before Fang Fang, Shan Shan, and I went out to dinner with all the cardiologists from the hospital.  I was starving since we only had a bowl of noodles that day from the hospital cafeteria (there’s practically nothing besides construction and small run down convenience stores nearby).  Well, I sat next to Ouyang and he told me that I HAD to try the first dish that was served since it’s a specialty.  It looked like beef in this spicy looking soup and nothing like the Sichuan food I’ve had in the past.  Well I find out after I eat my piece that it’s dog!  ugh, I was pretty horrified and made sure to ask about every dish before eating it. I’d say dog and some fried insects I had in Banna are some of the weirder foods I’ve had in China.

During the weekend, I had the opportunity to sight see and meet up with some family I have in Chengdu.  Ever since I wrote a report on my great uncle in third grade and learned about his life in Chengdu, I’ve always wanted the opportunity to visit the city and see where my grandparents grew up.  My uncle brought me to see my grandparents’ college and my grandma’s old house. I knew that my great grandfather was some kind of general in the Chinese army in the 1920s, died early, and the reason that my grandma and great uncle could flee China before the communist take over.  Turns out he was a warlord and ruling Sichuan during China’s warlord era and he organized and led the Sichuan army’s offensive against the Japanese after the Rape of Nanking.  It was pretty awesome that I got to learn a little more about my family history on this trip.

Anyways, here are a couple of pics from my trip!

Paying my respects (3 bows standing and kneeling) to my great grandfather at his tomb. It's now at the back of this picturesque park in downtown Chengdu.

Liu Xiang's photos

My cousins and I at the Leshan Giant Buddha

The Leshan Giant Buddha. It's about 223 ft and was completed in the 800s. You start at the head and descend down towards the Buddha's feet. This was taken mid descent.


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Biking Adventure

With an unexpected couple of days off since the plans to set up clinic in Nujiang fell through (didn’t get the necessary government approval), Dr. Detrano and I went on a biking trip from Dali to Lijiang.  It’s roughly 270 km (175 miles) over mountainous terrain and took 3 days.  It was my first long distance biking trip and I’m now a big fan since it’s definitely a better way to see the country. Not much else to say except so enjoy these pictures!  Isn’t Yunnan beautiful though?

Some fishing boats on the shore of Erhai Lake near Dali

During a water break, this horse drawn carriage with some Bai ladies passes by on the main highway out of Dali


Arriving and relaxing at Dali Geothermal Paradise after a flat tire, 2 hrs on a muddy, dirt highway, and 70ish km from Dali City. This complex of hot springs is HUGE and supposedly the largest in Asia. There were different shaped pools (one like a hand), some with caves, some with fish that cleanse your skin, and tons with different temperatures (40-80 degrees Celsius!). I couldn't have imagined anything better after a long day on the bike

Another one of the hot spring pools!

Typical view of farm land in Yunnan. For stretches there would be hundreds of farmers working in these rice fields

Miles and Miles of farm land in the mountains of Lijiang prefecture

Some farmers working with Yulong Xueshan (Jade Dragon Snow Mountain) in the background

Traditional Naxi houses on the way to Lijiang. The Naxi are the predominant minority group in Lijiang prefecture

Lijiang old town at night. Several small rivers run through the city like Venice.  It was nice just to wander and get lost in the little streets/alleys.

Lijiang steets during the crack of dawn. No daylight savings time here so around 7:30 am

Some old Naxi ladies knitting. The one in blue is wearing traditional Naxi clothing



My best shot of part of the first bend in the famous Yangtze River at Shigu. The river actually makes a 180 degree turn from north to south bound.



We took a day to recover in Lijiang.  I took that opportunity to go on a mini bus tour to Tiger Leaping Gorge.  Unfortunately, I didn’t have enough time to make the entire trek of the gorge, which is supposedly on of the best treks in China.  Here’s a view before our 2 km descent to Tiger Leaping Stone, where a tiger is said to have leaped to get across the gorge.

Made it to the bottom of Tiger Leaping Gorge!

That’s it for now but I finally figured out how to resize pics on my computer so there’ll probably be pictures in my future posts.

Until next time,



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A Look at Xishuanbanna

Here’s some pictures that go with my last entry.

Typical Dai Temple

People drying corn on the roads.  A pretty common site in most villages.

Ai San Er's getting an ultrasound while his family watches

After we had lunch with Ai San Er's extended family. There's a whole table that wouldn't fit in the picture! Also, the lady to the right of me is wearing traditional Bulang clothes.

The hot springs near Bulangshan about 5 minutes walk from the village. Towards the right of the river is a banana plantation.

Some Bulang houses

I am with the relieved mom and child we brought back from Bulangshan. Small, restrictive VSD and no surgery needed!

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