Why I Love Baseball

We returned this week from our annual baseball park tour. 3 of the last 4 summers, Gabe, my dad, and I have gone to 3 or 4 baseball parks over several days. Our intent is to visit them all. There is really only 1 rule - the park only counts if all three of us have been to it together. So, for example, I have been to Anaheim, Boston, Miami, Tampa Bay - but not with both Gabe and my dad, so they're on the list. We've done 10 so far and next summer it looks like we might head to Boston (for Fenway's 100th anniversary) and both New York's.

It is a great tradition that, when I tell people, always elicits some reaction. Usually a "How cool!"

In front of the Kirby Puckett statue at Target Field, Minneapolis

It also works for us because we all love baseball. My father grew up in Cleveland and has been an Indians fan since day 1, but has never, with his own eyes, seen a championship from them. He seems to live and die by them daily. Often he'll call during a game and say something like, "They're up by a run and putting the closer in - I can't watch. Every time I do, they lose." As if his watching (or not watching) has an impact on the game. But often, he is right. My favorite, and most frustrating, memory of this was during the 1997 World Series. It was Game 7 and the Indians were 3 outs from their first World Series title in almost 50 years. They handed the ball to their closer, Jose Mesa (who my dad hated - with good reason), with a one run lead in the 9th. My dad called and said, "I am turning off the TV. Don't call me." He gave up the tying run that inning and they lost in the 11th. Gabe is a pretty serious baseball player and has an appreciation for the history, and strategy, of the game. And I have always loved baseball (despite being raised an Indians fan...) and have been coaching for the past 6 years or so.

So, as we made our way through the new Target Field in Minneapolis, Royals Stadium in Kansas City and Busch Stadium in St. Louis I took my time to look around. Baseball parks themselves are fantastic, magical places. Both in time and out of it. Look around any modern ballpark and you'll see flat screen TV's, Ben & Jerry's ice cream, and scoreboards showing highlights from that day. Modernity at its finest. But baseball, as a game, stands out of time. Not much has changed in the last 100 years. Batting helmets. The use of middle relievers. Non-wool uniforms. Unlike basketball, it hasn't added an extra run for REALLY long home runs. It doesn't change offensive and defensive schema almost every year, like football. It is what it has always been  - a game about throwing, catching, and hitting the ball. That is why it is, really, the only major sport that you can compare era to era. Argue with a friend over who the greatest running back is (Jim Brown) and you'll get a bunch of answers, most of which will be followed by "But if he had trained/played against players from this era..." Same goes for basketball. The game has changed so much - no one has a true center anymore - that you can't match people up next to each other who are more than 10 years apart! And baseball parks themselves are testaments to the game and history. All of the new parks - they're old school. I love that this is a sport that is working so hard to hold onto its past - not forget it and move on to the next best thing. Amenities are new and upgraded, but it's (usually) done tastefully and honoring the past.

Plus, the game literally exists outside of time. No other major sport does this. Golf and tennis do, but those are "man vs. self" sports. And, for me, the problem with "man vs. self" sports is that you REALLY have to care about and know the individuals for it to be truly compelling. And there aren't any truly compelling players out there - Tiger was a spectacle, not a compelling individual. In fact, he was one of the most bland and boring individuals. So the game exists without a clock. Which I love. You go to the game to be at the game and if it goes into extra's - great!

In front of the George Brett statue at Royals Stadium, Kansas City (with Uncle Jordan)

For me, half of the experience is just being at the game. Sitting. Yelling. Arguing or discussing a play. Beer is an integral part of the experience. You're there for 2.5-3.5 hours talking with friends/family on a warm summer afternoon or night. Enjoy yourself. Sit back. Watch the crowd. Watch the sun go down over the stadium.

I, personally, keep score at every game we go to. In part this is a way to stay focused, but it also appeals to me because of the intricate strategy involved in baseball. I know a lot of people find the game to be too boring, too slow - to them I say "You don't know or understand baseball at all." The strategy involved in baseball far surpasses any other sport. The double shift, the drawn in outfield, the pitch out, the pick off, the drag bunt - there are a million little things that happen during every game, offensively and defensively, that are calculated risks and attempts. It is fascinating to see small ball played by a team who lacks power, and the way it can infuriate and win out over a long ball team. And to see a 3 hitter or a 1 hitter - WOW. That's not boring, that is an artist at the top of his game giving a virtuoso performance. It is a thing of beauty. It is flirting with perfection. And it can't be done in football, basketball, or hockey.

Every sport is a game of inches, but I believe that baseball is the one where it matters most. The difference between a long pop fly and a home run is, literally, less than an inch on the bat. Many times, the difference between a walk and a strikeout is mere inches. A well timed jump and grab is amazing and replay worthy - a few inches off and you shake your head in shame and remorse. Incredible plays by a shortstop or 3rd baseman are often just "that close" from being a hit through the gap. In basketball an inch or two can mean a missed shot, but it could always bounce in or be rebounded for a put back. In football, an inch or two doesn't always matter so much - the ball is large and hands are big. In hockey - well, I have no idea. And it is this "flirting with perfection" that I love too. Every game, before it starts, has that ability to be "the one" - the perfect game, the no-hitter. To say you were there for one of those exceedingly rare and special events that are still talked about years later. And it all comes down to inches or less, dozens of times in any one game.

Baseball is the sport that most mirrors life. The season is extended and has many ups and downs - 162 games allows for a lot to happen. Teams start out strong and fade (see: Cleveland Indians, 2011), others start out poorly and right the ship (see: Boston Red Sox, 2011), others go through more of an up and down process, seeming to get better, then slipping, before fading out or recovering. But the length allows the growing, learning, and bonding process to happen. Football, at 18 games, is a sport where fortunes are made and sealed in any 3 or 4 week period. Lose 4 and you're done. For the season. In basketball, there's too much of a known quantity before the season starts. It's almost a foregone conclusion most years who will end up in the playoffs. The regular season is a (not so) entertaining diversion before we get there. Baseball always has surprises - the small market team that beats up on the big market (bully) one and goes far. The team that spent $100 million but can't buy a win. Aside from being an extended journey, it most mirrors life because it isn't easy. The best players in the world are unsuccessful 2/3 of the time (at batting). An average player is unsuccessful 3/4 of the time. No pitcher has ever been perfect over a season - everyone takes their lumps and loses multiple times - often badly no matter how great they are. And the dependance on the others on your team is instrumental. There is a moment, in every game, where every single individual has an opportunity to shine or fail and the fate of the entire game and team rests on one persons shoulders for that one moment - but the game is still a team game. In basketball those moments happen far more often, so become unspectacular. And in football, so much of what happens you never notice (line play) and is a protracted war versus a shining moment. Baseball, like life, is hard to master, dependent on others at times, but has enough individuality to be seen through so many different people's lenses.

In the end, I love baseball because of its history, honesty, artistry, timelessness, and because it is a shared experience. I have memories of baseball - from my youth as a fan, from my adult life as a parent, as a coach, and as a fan - that are special and shared. I share baseball with my son every summer - it is a right of passage and a symbol for us and for me - of time passing, of a shared experience, of hard work and growth - and I am lucky enough to share it every summer with my father and my son together. It is the glue that brings us together to spend time together - usually just the three of us - and is a shared love we have. So, for no other reason than that, I would love the game. But I think there are so many more reasons and so much more to love about it than that.

In front of the Stan Musial statue at Busch Stadium, St. Louis

Why 'The Help' and 'Rise of the Planet of the Apes' Are the Same Movie

I saw this weekend what I believe to be the 2 best movies of the summer - The Help and Rise of the Planet of the Apes. And they are remarkably similar despite one being historical fiction and one being science fiction.

To start with, both movies have a "true story" feel to them. The Help is presented as a biography of black housekeepers in the South and RoPA is presented as a historical accounting of a science experiment.

And both are human stories - evoking fear, hope, laughter, sadness, and pride. The stakes start out as very personal and individual for both, quickly evolve to encompass those around them and closest to them, and ultimately society at large. New relationships and worlds are opened to both Skeeter (The Help) and Will (RoPA) and by the end, neither are entirely what they were when they started.

Both are, essentially, stories about what pain and loss can drive us to. In The Help it is the loss of a maternal figure (Skeeter's housekeeper Constantine) who raised her and who was driven off by her family. While Skeeter does not know this at first, it motivates and propels her on her already burgeoning path to make sure the people around her are treated humanely. In RoPA it is the impending, and ultimate actual, loss of a father (Will's father Charles) to Alzheimer's that push Will to search for a cure. In creating a cure, he comes to understand that the other primates inhabiting our world with us are as aware, feeling, and capable of emotion as humans and deserve to be treated as such.

In the end, both portend a new world order. The Help takes place in the midst of the civil rights movement and documents (literally) the uncivilized treatment of blacks. By the end it is clear that American society will never be the same. And 50 years later that is still true - even if the hope of that movement has not yet been fully realized. RoPA takes place at the dawn of a new age for mankind - it's end as newly intelligent primates rise to the top of the food chain in a world destroyed by our own greed and failures to protect ourselves. It is a cautionary tale about power and the role it plays in corrupting those with it.

Both take a look at society, shine a harsh light on the unsavory underbelly (racism and animal cruelty), and show how they can be a cancer from the inside. Jarred Diamond has written some fascinating books about how and why societies fall and virtually all do so from the inside. Each movie looks at a potential cause of this society's collapse.

One final thought - the original Planet of the Apes movies from the 1960's were a tale of racism - which is clearly what The Help is about. All good science fiction is a means of exploring the world around us and talking about societal issues that are too sensitive to come out and discuss openly (Star Trek was groundbreaking in its time for so many reasons - but more on that another time...) I find is telling that the message behind that franchise has shifted significantly in 2011 to be about animal cruelty and the will of medtech companies to push for higher profits at the expense of consumer safety. Racism is not longer an ugly secret - it is an open one.

Two wonderfully done films that raise many questions about the world we live in, and the way we raise our "children" to think about themselves and those around us. See them both and enjoy them. But never forget that the best storytellers teach us something about ourselves.

Final Thoughts

It is hard to believe that almost 2 weeks has gone by. My first night in China feels like it was both so long ago and just a moment gone. I have done an incredible circuit of the most populous country on Earth – northwest, southwest, southeast, and northeast. I have experienced 4 distinct parts of an ancient and huge culture, been exposed to dozens more, met scores of people, and seen amazing things. I am trying to make sense of what I have seen – out it into some type of order, find a meaning.

To be sure, there are a lot of positives and things to learn. The history and culture I have seen and experienced are amazing. To think that I stood in and saw things that are up to 7,000 years old is incredible. And the Chinese history is so much more rich and diverse than I ever imagined – as only a 7,000 year old tradition of a people that spans a quarter of a continent can be. And I have met so many kind and generous people. Doctors, nurses, and hospital staff who work hard each day to ensure that children will have a better life. Businesspeople and philanthropists working for a better society than can successfully meet its own challenges. Everyday citizens who just want to share what their life is like. I have made many new acquaintances and a few friends that I hope I will stay in touch with.

Something is happening in China. It has likely been building for a very long time. It feels like there is an awakening, a growing and pushing of boundaries, a rustling under the surface. The government keeps a tight control over many of the things of daily life – the cost of bread and oil, access to information (the internet, television), education. It probably does this both because it has to and because it keeps it in control – all systems and organizations work to keep themselves in existence, it is the rare one that puts itself out of existence.

He phrase “sleeping tiger” has been used to describe China and I get it now. There is a raw power in being able to harness 1.3 billion people and what they can do. They are a mighty engine to create cheap products, a massive market to sell to, and awesome and terrible war machine, and an incredible populace that could change any social ill. One part of me thinks my children should start learning Chinese – now (sorry Gabe and Zoe) because once this sleeping populace awakes, can there be any question they will lead the way into the next century?

The challenge, of course, is that they are not free to make up their minds, to explore any field of study or pursuit of expression. There is a tight control over license plates, access to college, and certain jobs. While the “American Way” is not perfect – by any stretch of the imagination – it does not require such a large use of resources just to keep the population in places. And it encourages creativity and new directions from any who want, also providing the rewards to those people in the same magnitude. The limits on people are, to a very large degree, imposed by themselves and both their ability and desire. The social contract in America is clear – you can go as far as like with the knowledge, perseverance, ingenuity, and willpower at your disposal. The government is there both to protect the physical well being of the populace and integrity of the boarders and interests of its people. (Excuse my oversimplification and incompleteness…) In China, neither side of that equation is true. There are limits to what most people are allowed to achieve, or even attempt, and the direction and will of the government are even murkier.

What is the social contract then? What is the role and purpose of government in people’s lives and what do people owe their government? Without a clear answer to this there is, as I have seen, a lack of direction (people with pointless jobs or jobs with no purpose), a mistrust of authority and systems (fear of hospitals), and a general malaise that can permeate all things.

The government is run by The Party. That inside group that makes all of the decisions. Several times I heard people talk of times when the TV went out. CNN has been allowed for a time now, but there are moments, where a story critical of the Chinese government or policies, is aired. And across China, CNN goes out. There is someone, literally, sitting there with their finger over a button that will block the signal. And parts of the internet are restricted (as I found out firsthand). These are just small examples of how The Party controls things. But it goes far deeper. There is a population control policy in place. Families in the city may have 1 child, in the country 2. Many people skirt or ignore this rule. But if you want to move up – if you want an important promotion, you’d better follow the rule. And if you get your promotion or job and then break the rule? Your job will be gone.

The Party is an organism that grows under, and through, everything around it. There are Party representatives in every industry, and in every town. No real work or advancement can get done without their, sometimes tacit, approval. While large and infiltrating every corner, they no longer take on the menacing quality of former generations. They seem to rule by suggestion and permission (given and withheld) and, make no doubt, set the direction and policy of an entire nation.

And that system has worked well in an agrarian based, class society of the 20th century. But the world has moved on and the ability to control information and access is far harder. Where are they leading the people to now? Can a single party with ultimate control continue to be a viable model? Can the party control a country this large with as many competing, and splintering, demands? Can it evolve and become a new form of communism?

Many times in my trip I told my companions I felt like there were many similarities with what I was seeing and the Israel I first visited in the 1980’s. It felt like a country with one foot in the old, and one foot in the new. There were pockets of modernity right up against grainy, old world buildings and smells. There was a mixing of cultures and history that expressed themselves in creative and bizarre ways. Hey were both jarring and creative. The architecture in some places shares some similarities, and I suppose this comes from a common communist-socialist background and a utilitarian need when dealing with large numbers of people moving quickly to cities. The stocky shape and indefinable character of buildings built out of need rather than esthetics. There is a melding of cultures that the two countries share as well, taking the shape of a variety of smells, foods, music, and a cacophony of different skin tones.

In the end, what stands with me most is that there is an immigration going on within China, It is an immigration from countryside to city. While normally this would be a migration, there is such a complete change in the social fabric, mores, and daily functioning between the two, they feel like completely different worlds. There is a generation chasm – not just a gap - that is being created in this country. It is a world of fathers and mothers that is agrarian and simple, growing up in caves and making your own food, and a world of the children which is cars, the internet and coffee shops. I do not know where it is leading to, but it was fascinating to take a step into it for a while. I know that it will stay with me for a long time and that, wherever it leads, it will have an impact on my life and all of yours.

Quick Hits & My Blog Plans

There are a number of thoughts and ideas I’ve had that either didn’t get fleshed out enough for a blog post or I just didn’t have time to address. I’ll do them below.

My intention is to do a final wrap up blog tomorrow, before we leave, and then upload the pictures to all of the blogs when I get home (I stopped trying to upload them after a while, but in many cases they make the story or add to it considerably.) If you’ve read for any reason or any amount over the last 2 weeks you’ll want to come back next week and check out the pictures! I may also upload all of my pictures and post a link to them – I’ll only use the pictures in the blogs that relate directly to them.

Warm Water
The Chinese do not drink, or serve, cold water. This is a tea culture and they are used to warm drinks at breakfast, lunch, dinner, and snacks. Water is, at worst, served slightly warmer than room temperature, and at best steaming hot. Even if you do not want tea at a meal, you will get a glass of steaming hot water. Several people commented on our Western desire for cold water – something one of our hosts (a nurse!) said was bad for our stomachs and digestion. She would NEVER drink cold water – especially not in the summer. While strange for us, like everything else in this country, it is a cultural touchstone which speaks to the way they live their lives and their thousand of year old history and tradition.

The Bathroom Experience
Going to the bathroom in China is always an adventure. First, the sinks are generally outside the bathrooms, no big deal. But rarely is there any soap – even in the hospitals we have been in (!!) That’s on the way out, what about the way in? Before entering a stall, you had better check to make sure it’s not a squat toilet. The majority of toilets in public, and I imagine all in the countryside, are a porcelain hole that you squat over. (Sorry, couldn’t get a picture that wasn’t utterly disgusting…) Oh, and don’t forget to bring your own napkins or paper. It won’t be found in the bathrooms in public (airport, etc.) Finally, there’s the signage. My favorite was a green placard over a toilet in the airport that had a cartoon panda on it holding up his thumb with the caption “Aim carefully!” A common problem in general is the literal translation done by many companies when trying to add English. Chinese is a character driven language, so individual “letters” can stand for an entire thought. That’s how you end up with the following sign Estelle saw on the door of a handicap woman’s toilet – “Deformed Man Ending Place.” The mind boggles. One can only wonder.

The Traveling Experience
Flying in China is still like the old days in the States. While not a luxury, it is treated as special. Meals are served on every flight. They come by to serve you or refill dinks 3 times (on a 90 minute flight) or more.

The landing process is something passengers, apparently, don’t have time for. Every time, the plan lands and, before we have even achieved a complete 4-point landing, people are unbuckling, standing up, getting down luggage, and stepping into the aisles. And god help you if you get in their way in the aisle.

I have been in 5 airports now. I have one bag – a large one – I am traveling across the country with. It cannot be brought on, so I have checked it each time. The majority of the airports we have been in have not been large at all. It takes less than 5 minutes to get from your gate to the baggage claim. And most often are bags are on the conveyer belt within moment. The efficiency is amazing, and something we only wish for in the States.

A Job for Everyone!
China is a big country. It has an immense population (1.3 billion, and currently the largest in the world, although its population control policies will lead to India taking over that position in the next 10-20 years.) And things are tightly controlled by the government. We saw 1 homeless person during our entire journey (although we were told by many of our hosts that this issue is a fairly new and quickly growing problem.) Apparently there is a job for everyone.

You see evidence of this all over – the person whose sole job is to empty the trash cans – 20 times a day in a nearly empty building. The woman whose job it is to push the buttons on the elevator for you. The overstaffing is everywhere – if there were less than 8 stewardesses on a flight or 6 waitresses in a small restaurant, it was an anomaly. And at nice restaurants it was almost obscene – people to bring the food, people to place it on the table, people to simply refill cups, the person whose job it was to stir the dishes so they didn’t gel up… It got to feel overwhelming and almost oppressive. Were they there to watch us? Maybe we UNDERstaff in the West.

Probably not, or at least that’s what I decide after we had dinner one night with a particularly worldly host of ours. When asked what their spouse did and, with some regret and embarrassment, they told us that their spouse worked for the state run company. It was a nice job – but they only worked 2 hours a day. At least, they went in for 2 hours a day. Even then there isn’t much, or anything, for them to do. Yet their spouse doesn’t feel right not going in at all. Our host was embarrassed knowing that their spouse was being paid – by the state – to do nothing. Unfortunately, we were told, this is quite common and that a “good boss” allows this, especially since they have a baby at home. Our host was apologetic about this common practice because they had a lot of experience in the West and worked at a particularly busy job.

With so many people, and a desire to make sure they aren’t living on the streets, the option the country has taken is to employ nearly everyone, even if they don’t have anything to do.

Is Hotpot Kosher? AND When Old Meets New - A Tale of Rural Internet Access

Last night we went to a hotpot restaurant. Hotpot is a local custom and involves a large table with a huge vat of boiling broth in the middle. There is an inner bowl and an outer bowl. The inner bowl is just broth. The outer bowl is broth mixed with spices and, especially, Szechuan peppers. This is the Szechuan province, after all, and it is known for and proud of its spicy food.

In hotpot you order a bunch of different meats and vegetables and, in courses, either dump them into the broths to let them cook or hold thin pieces of meat in the boiling broth to cook it between your chopsticks. Sometimes you reach (with chopsticks or a ladle) into the pot and – surprise! – something from a former course comes out. Little bits and pieces of some of everything mix together and cook up so that, by the end, the broth is an amalgam of everything thrown into it during the course of the night.

For me, this was a big hurdle. The first course was some type of whole bottom feeding fish and leeches. I passed. But the damage was done. Anything else that went into the mix was going to be infused with what just went in. Could I push aside the fact that my upcoming beef would be boiling in whatever came before it? Now, mind you, our hosts were keeping quite tame. Andreas (my colleague, and a far more extensive world traveler than I) went a few years ago and they had monkey brain in the hotpot. There was nothing like that tonight. Pork went in soon after, as well as pork dumplings, beef (2 kinds), mutton, sweet pork balls, cauliflower, tofu (2 kinds as well). It was spicy, and very good (at least the things I ate…) and I did a marvelous job of pushing aside the fact that all of my tofu and beef was marinating in pork and leech juice…

Eating, in China, is a different experience.

First off, there are no real main courses. There are hot and cold dishes. They are brought out continuously and, in general, you order 3-4 cold and 5-6 hot dishes in a meal, plus some type of noodles or rice. The preparation for a single dish can be extensive – so 8-10 is unwieldy in a home. But you get to try several different options at any one sitting. It is a much more participatory arrangement. I just ate from my chopsticks, but I stick them into the bowl or plate to grab more. So does everyone else. Can you imagine how THAT would go over in America? If I stuck my fork into the salad, ate off it, then stuck it back in? In China, this is the norm. You share, you serve each other, there’s no “this plate of food is mine” – it’s a collective, shared experience. There is something very nice about it.

Second, when you eat together in a group, you eat in private rooms. I’ve been told, by some of our hosts, that it’s in part because Chinese people are very loud and noisy and this facilitates conversation with your own group better. The Chinese also take meals very seriously, and want to make sure you are enjoying yourself. At most meals our hosts are walking around, making sure our glass (of beer or otherwise…) is always full. And since toasts are a big part of meals, there is a lot of refilling to do. There is also a lot of truth in the fact that deals, in China, get done over food. You don’t want others hearing your business. You also don’t want others to know if you’re meeting with the government, or if you do, what you’re discussing. Private rooms help facilitate that.

Finally, there are the toasts themselves. Business gets done over meals. And what seals deals, and shows the depth of your relationship, are toasts. They are expected and they are plentiful. Your host makes the first toast – to your partnership, long history, new friends – and everyone drinks up. Then, toasts get made in roughly the order of the importance of the people in the room. Those slightly below make toasts to those above them – their wisdom, health, help in career advancement. And you drink up. There are some rules (at least, I have been told…) – if a woman toasts a man, he has to drink up. If someone says “Gambe” – which means “bottom’s up” – you have to finish your glass. They drink a lot and take it as an affront if you don’t drink deeply (or so I’ve been told – I tried my best not to offend my hosts at any time during the drinking…). Only an “I’m driving” (drunk driving carries a 15 day stay in a jail like facility) or “my doctor says I shouldn’t” works to get you out of the expectation, woman or man.

As to the question I posed at the beginning? The answer is, clearly, a resounding “No”.
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We went out to a county hospital today to see a demonstration of their telemedicine project. In China there are 3 levels of healthcare hospitals and clinics: township (clinics), county (small hospitals – a county hospital might serve 3 townships with 200,000 – 500,000 people overseen), and city (large hospitals). You enter where you are – if you live in the countryside, you have to go to your township clinic. If they can’t treat or identify the issue, they refer you to the county hospital, etc.

In Szechuan there is a highly developed medical record system which is tied in to a telemedicine project. Doctors can speak to each other to consult or teach up and down the continuum. X-rays, MRI’s, and records are shared instantaneously through the same system. It is quite impressive. We have been looking for something similar to test the ability to connect our partners around the world so that they can remain in touch and a greater level of training and consultation can take place.

What has amazed me throughout this trip has been the clash of old and new, modernity and tradition. We were in the Chinese countryside – an hour from the city – and the hospital and city were rudimentary, by any Western standard, but we were using the peak of medical telemedicine technology. The room we were in had no air conditioning, the paint was peeling, there were 4 walls and a desk – but the level of care and treatment, and the knowledge by the medical staff, was extremely high.

There are no easy answers, things are not black and white in China. Just when you think you have it figured out or pinned down, you are surprised. It may be, that from an outsiders perspective, things are like that in the States as well and this is just a cultural issue. But I don’t think so. I think this is part of the culture clash – the explosion of modernity – that is happening here. The government decided internet access is a high priority, so everyone gets internet access – countryside, farming villages.

Tomorrow we leave for Beijing for the night and then fly home early Friday morning!

Tradition! (It’s Not Just for European Milkmen Who Play the Violin…) AND My First Cardiac Surgery

I was in the OR to view my first ever cardiac surgery. (Come to think of it, my first ever surgery viewing, period.) Wow. What an incredible experience.

There is a very intense and complicated dance that goes on. Cardiac surgeons, perfusionists, anesthesiologists, nurses… And everyone is constantly preparing for the worst, and hoping for the best. The activity, clearly, centers on the patient. But the activity around them is immense. Scrub nurses are constantly cleaning or preparing instruments, should the surgeon need something. An additional nurse is getting supplies and refilling them. Perfusionists are monitoring and administering the heart-lung bypass machine, which the patient comes off of and goes back on at different times in the surgery. Anesthesiologists keep the patient sedated and ensure they are doing well.

Surgery did not go as well as hoped for today. Which is extremely sad to me. I met this patient last night – a 17 year old boy – bright, articulate (more than passable English), hopeful. His parents were sweet and appreciative. They were not destitute and looked like a lower middle class family – well dressed, well spoken. Only a portion of what they hoped for occurred. He will require another surgery to get to the portion they could not. It is late for this child to be having this surgery, which adds a complication.

I gained a great deal of understanding, and appreciation, for the work done by the surgical teams. And I have a much greater understanding of how the ICU team takes care of the patient and is really the lifeline for them. Surgery (generally) takes a few hours and is critical, but the post operative care is essential if they are to survive. My understanding is that pediatric cardiology requires more teamwork and multidisciplinary work than most other specialties. Without exception, the people I have met – from the Toronto team we brought and the local team – are caring, hard working, down to earth individuals who care deeply, and respectfully, for their patients.

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In China there is a deep seated cultural reverence and deference to the more experienced members of society. This cultural more goes back many thousands of years, probably in part because if you managed to live into your 60’s, you must have done something right.

The implications of this and the ways it expresses itself is interesting. On a simple level, when walking down a street, people move to the side for the elderly. Slightly deeper, this is still an apprentice society – you learn your trade at the feet of a more experienced elder. Whether that trade is woodworking or medicine, society is structured in ways that require patience and waiting. While I have not yet been able to figure out the medical training system here (and neither have my colleagues), it is very different from the United States. You get a “medical degree” and then work for several years with more experienced doctors before passing a large examination and then studying to become “a doctor”. Along the way, it seems, you get “sponsored” by an existing physician who oversees your training and development.

And in China, you never just enter a room for a meal and take a seat. There is, for every dining experience, and order and hierarchy to the seating. The most senior person sits in the center of the table, facing the door, with the next most senior (or important or an honored guest) person on their left, and the next most senior (or important or an honored guest) on their left, and so on. Where you are asked (or told) to sit is a clear message to others in the room. And someone joining the party in the middle of a meal can result in a significant reshuffling.

This reverence and honor of elders is extremely deep seated. While it can be confused with a deference to authority, it seems to me that that is actually secondary due to the nature of life – older tends to be senior. You don’t question your elders, you wait for them to unfold their plans or share their thoughts in their own time. And because you did this for them, you expect the next generation to do the same for you.

I do not know how modernity will impact this age old tradition. There is something calming and assuring about knowing your place and the expectations of you. The reverence feels like it comes from a place of love and respect, not some expectation that is forced on society. And it is deeper than “It has always been done this way…” With the change to city life and the fast paced nature and get ahead mentality that often associates itself with it, I am unsure how, or if, this cultural and historical norm will be affected. I am not sure it will last. It may be like Tevye - a lonely milkman pushing back against the ever growing crush of modernity. But certainly something will be lost from the world.

Goodbye Lanzhou, Hello Chengdu

(I apologize for the second post in a day - the post before this one was supposed to go up yesterday, but through a combination of internet issues and my own stupidity, I lot it and had to reconstruct it...)

We woke up this morning and had a tour of Lanzhou planned before we left for the airport to fly to Chengdu. We were met by Fiona once again, who took us to the Gansu Province Museum. On the way there we passed the largest mosque in the city and around the area were a lot of Muslim men and women. Women covered their heads, but not their faces. We had seen a scattering of Muslims throughout the city during our day - they fit in, interacted with everyone else, and were accepted. This is an example of Lanzhou's long history of minorities.

Gansu (which is where Lanzhou is located) has an almost 8,000 year history. It sits on the Yellow River - the "Mother of China" - and vied with the Tigris & Euphrates for the start of civilization. We were supposed to have an English guide, but something happened, so the Assistant Director of the Museum, and Head Curator, came down to give us the tour. I should say here, this is nothing out of the ordinary in China. Everywhere we have gone everyone is so willing to drop everything and help us - it doesn't matter who they are or what they are doing. Needless to say, the tour was fantastic.

Gansu was the home of the Silk Road and there was an extensive exhibit of its history and artifacts (but very little to no silk...) We saw the famous bronze "Flying Horse" - the modern symbol of Chinese tourism. (I promise, once I get home, I will add pictures. Some of them are just outstanding and breathtaking...) We saw pottery, bronze, jade, and porcelain - some of it almost 7,000 years old!! We then saw an exhibit on the minority antiquities, with an emphasis on Buddhist art and statues. They were phenomenal.

The local dish is Beef Noodles and Fiona took us to a beef noodle shop where they showed you how the 4 different kind of noodles were made and made them in front of you. (Round, flat, wide, and triangular.) We then went to the Waterwheel Park. As recently as 1952 Lanzhou had 250+ waterwheels on the river. The park itself was beautiful - with antique waterwheels and a long, tree lined path along the banks of the Yellow River. There were families out playing badminton and taking pictures. We saw a bride and groom - many couples come to this park to take pictures. There was a traditional style Chinese bridge and an amphitheater where the Chinese Opera does summer concerts.

Then, it was off to the airport, with Dr. Tang joining us. He will be staying in Chengdu for a week to observe and learn with his colleagues in what, we hope, will be the start of a wonderful relationship between the two hospitals. It was a quick trip - 1.5 hours - from Lanzhou to Chengdu, which is located in the Szechuan province and is known for its spicy food.

We landed and immediately you could feel the difference in the cities. Chengdu is calm, stable, not in a hurry. The traffic was manageable - almost sane. There were not flashing neon lights all over. Event the architecture was more subdued. It is a modern looking city, but not flashy and vying for your attention every second, it seems to be calm, confident - aware of itself and saying, "Here's who we are. We hope you like it. If not, that's okay." And in the few hours we've been here, the people are the same. Shanghai seems like and exciting and wonderful place to visit. Changchun was trying so hard to prove it belonged. Lanzhou was a bustling, lived in city trying to stave off windstorms and poverty. Chengdu is a place you could live.

At least, that's my impression after 5 hours...

Lanzhou, The True Heart of the Country AND Driving As A Contact Sport

Friday night we flew into Lanzhou. As we approached the city by air I looked out the window and, for as far as the eye could see, were the mountain steppes that are part of the region. It looked like someone had taken the worlds largest bed sheet and crumpled it up/ There were undulating crevices and peaks going towards the distance and all were a dull brown color.

We landed and were met by Dr. Tang ad our driver. Driving into Lanzhou was different than driving into Shanghai or Changchun. It was a long drive (almost an hour) through the steppe hills - a backdrop of low mountains that went on for as far as the eye could see, all of which had been terraced to have ruler straight lines of trees planted all up the hillside. Lanzhou is an arid area that, through deforestation, has taken on an almost desert-like appearance outside of town. Someone in the government decided that a major reforestation project was due. How they will water, literally, millions of trees in an arid semi-desert - I haven't a clue.

Once we landed and got into town it was dark - but we were taken directly to a restaurant where we were joined by one of our translators - Fiona - who has worked with Children's HeartLink visiting teams for over 4 years. She is a nurse and quite fluent in English, thanks to her love of American sitcoms and "Lie to Me - on Fox!" Lanzhou has always been home to many ethnic minorities, from Buddhists in the early ages to a quite sizable Muslim population now. That meant fantastic lamb and beef and no need for me to worry about pork or shellfish! Honestly, this first meal was one of the best I have had. While not the spicy Szechuan food, it had a lot of flavor and was spicy. We had several types of lamb, which were all fantastic.

The next morning we went to the hospital and got to meet Dr. Tang's colleagues - Dr. Bin, Dr. Song, and others, as well as the former chair of the department, Dr. Gau, and the VP of the hospital, and long time supporter, Dr. Yu. The hospital in Lanzhou is connected to a university, so it is a teaching hospital. And they take a lot of pride in this. They are warm, caring, earnest people. I would say they are simple, but hat sounds condescending. It is not. They are aware of what their mission and job is and they work diligently and hard to accomplish it with all of their considerable thought, talent, and spirit. They were, to a person, open, inviting, and genuine.

The city itself was an interesting change from Changchun. Less Soviet looking (but some small influences) and more "traditional Chinese" - with lots and lots of people all over and immense traffic. But it is clearly a city modernizing as well. We went to the mall the next day and it reminded me of the Water Tower in Chicago.

I've mentioned before that driving in China is an adventure. Lanes and lines mean little. People compete with cars and don't back down. Drivers veer from lane to lane, like a weaver at a loom. Crossing a double yellow line and playing chicken with oncoming traffic is common - especially if the car in front of you is slow and you want to make that next turn...

Part of the issue with driving in China is the population explosion an subsequent massive building. None of the cities were designed for cars to begin with, so in a sudden growth mode most places just did more of what they had before. Plus, in a city like Lanzhou (3 million people0 there are 300-500 new drivers A DAY.

Then there is the driving itself. In order to get a license in China you have to take over 50 hours of instruction. Or be willing to pay a premium to just get your license. If you can afford it, you do that latter. The former isn't so great to begin with, apparently. Nearly every 20 or 30 year old we have met - doctors, nurses, translators - do not drive themselves. Some are practicing for their license, most are not. Chinese who move to the States for a time get their American driver's license, but refuse to drive in China. But you better get it while you can, because in China if you are over 70 it is illegal to drive.

And then there's the issue of learning. Very few parents have ever driven, so are unable to help teach their children the rules of the road. It is a significant cultural and generational gap.

The best way, I have found, to be a passenger in China, is to close your eyes. Which, sadly, seems to be the way a lot of people drive here...

Individualization in China OR How to Stand Out In A Country of Billions OR Why I Could Never Buy Shoes Here

Today was a relatively simple day, visiting our partner site here - the Jilin Heart Hospital. Jilin is under construction, and has been for some time, due to the weather, a scarcity of skilled workers in the area able to do the construction work, and other reasons. They are building what will ultimately be (according to Estelle) one of the most advanced cardiac care centers in the developing world. We spent a lot of time touring the facility and meeting with their staff to discuss the transition plan to the new facility.

Jilin Heart Hospital - Under Construction

So, with minimal running around and several trips back and forth through a busy city center, I had time to reflect on some of the things I've seen, heard, and experienced on the trip so far.

China is big. Land wise, yes, but in terms of population it is huge also. 1.3 billion people. That's a B at the beginning. The population of the United States is roughly 310 million. So China has at least 4 times as many people in it. And, as I've mentioned before, there has been a boom in city living. While traditionally an agricultural country, in the last 20 years the population has reversed so that now 2/3 of the country is living in urban environments and 1/3 are living in the country. That means there is a greater population of Chinese living in the countryside than there are people in the entire United States. But it also means that a population almost 3 times the size of the entire United States is now living in cities. And most of those people are new to the cities. This explains the explosion of huge cities, the building boom, the massive expansion of cars (and inhumanely bad driving habits of their drivers...)

And there are no suburbs. Everyone lives in the city in apartments. Cities continue to grow and grow. So apartment buildings don't go up - apartment villages do. Several - sometimes a dozen - identical buildings made to house people - shiny and new - appear virtually overnight, every night. There is never just one of anything and they are never simple or bland. They are temples to modernity with glass and height and sleekness. And over every finished skyscraper stands a construction crane.

So how does one stand out - show individualization - when everything being built - apartment buildings, cars - are mass produced and the same? One way is to be a six foot tall non-Asian with a shaved head and size 12 shoes. Twice now I've been reminded how rare this is. When at the SCMC they wanted to take us back to see their operating theater. We had to put covers over our shoes. But the plastic covers wouldn't fit my shoes. They couldn't find any that would. Their world isn't made for size 12's. And at every hotel they provide complimentary slippers for you to walk around your room in - a historic cultural custom. After arriving in Changchun I decided to treat myself - relax, put on some slippers. If only I could get my feet into them. I don't fit the mold of the average size Asian apparently...

So, if you're not me, how do yo stand out and individualize? One way is through what you own. Chinese love luxury goods. They buy them up as fast as they'll come out. And they come out fast, so that people have to buy the latest. Some are simply horrifying, but as long as their the newest and the most expensive, they'll be bought. They may have the same apartment as the person next to them, but, by god, theirs will be decorated nicer (???) or newer. Fashion, also, plays a unique role, as do hair styles (and colors) and ring tones. Everyone is trying to have the newest, flashiest of each. So, of course, the bar keeps being pushed further and further. Walking down a Shanghai street is like a day at preschool when the toddlers are allowed to dress themselves. An explosion of color, pattern, and style begging for attention and there just because they can.

I guess, when you're competing for individuality against 1.3 billion other people, you do what you can to stand out. As Li, our friend from Medtronic traveling with us in Changchun, said to Estelle and I this morning - every problem [or issue] in China is overwhelming and miniscule. Take any one problem a person may have and multiply it by 1.3 billion and it is overwhelming. But take any societal issue or challenge and divide it by 1.3 billion and it is infinitesimally small. It is all about perspective here and nothing in China stays the same for long, no answer is absolute, and no one knows what is coming next.

Except for me. I know on this trip I won't be able to buy a pair of shoes that fits me here.

Final Day - And Thoughts - On Shanghai and First Impressions of Changchun

When we woke up this morning something was different in the city. There were people. And cars. And noise. And smells. Shanghai was back - the real Shanghai, not the Shanghai we had been seeing for the past 48 hours. The holiday was over and the city was returning to itself - it's rhythm and pulse had returned.

We went to SCMC once again, but to the heart institute to meet with Drs. Xu, Lu, and Du. These 3 generous, kind, and talented individuals are all cardiac surgeons a the Children's Heart Center. The Children's Heart Center at SCMC is the most advanced and well respected in the country. It is an impressive, modern facility that helps to train many of the doctors and nurses across all of Western China. They have a proud history of creating their own pumps and instruments in the time before China was opened to the West and hold nearly all of the pediatric cardiology firsts. They are so proud - and have so much to be proud of - that they have a museum dedicated to their history and accomplishments in their building. Below is a picture of Estelle with the Drs. in their museum.

The are quite wordly, too. Dr. Lu trained in Boston and DC. Dr. Xu has traveled and spoken in the US several times. hey have all gone to Israel for training. All 3 spoke wonderful English (far better than my Mandarin...) And when I let them know I could not eat pork or shellfish, they didn't hesitate a second before letting the chef know and my ending up with a special meal.

Shanghai is the gleaming new China and I loved it. But it is a crowded, growing city. 3 things illustrated that well:

• First, as you walk through the obnoxiously crowded streets you notice that people stick together. 2 men, 2 women, a couple (whether or not they are a "couple") stay very close, hold hands, link arms. Personal space is non existent and people cling to the familiar.
• Second, Dr. Xu told us a story. The hospital is in a very crowded and new part of Shanghai - Pudong Province. It is busy, crowded, filled with skyscrapers, and very shiny. 10 years ago they built the new heart clinic. At that time the hospital was surrounded by farmland. It was inconceivable to me! We were in the middle of a bustling metropolitan - not the edge or outskirts, but smack in the middle!
• Finally, on our way out of the hospital Dr. Xu told us that he had visited Washington, D.C. several times over the last 20 years and didn't like it. Why? Because every time he went it was exactly the same. This is perspective and familiar in a nutshell - the Chinese are living in a world where everything is changing all the time. So much so that a "normal" American city and experience is boring.

From there it was off to the airport, a 2.5 flight to Changchun, a 45 minute drive to the hotel, assorted adventures and mix ups, a hotel room swap, and blogging. Fortunately, a friend of Children HeartLink's in China who works for Medtronic - Li - has joined us to help translate. As he said, Changchun is "underdeveloped" which is a euphemism for behind the times. Mind you, this is a city of 3 million people. But all I could think as we drove through it was that it reminded me of Ukraine. In many ways, this is old China - communist China - where buildings all have a certain, similar look. People have a certain, closed, mindset. We couldn't use a credit card because we didn't know our pin (and credit cards don't have pins...), the taxi ride cost us 5rmb (less than a dollar), we couldn't find anyone who spoke English so had to call our host at his home to order dinner. (BTW - the local beer is the lightest and least flavorful I have found yet...)

EDIT: Okay, looking back at my comments now, and having spent a day or two with the residents, while there are a LOT of similarities to Ukraine and there is a communist feel to the city, the people, at least the ones we interacted with at length, are warm, kind, intelligent, working to make a better life for themselves and others, and seriously consider the issues impacting their work, their profession, their country, and the world.

The Other Side of Shanghai

Today was a very interesting day. We went into it not know what to expect. We had 1 meeting set, and it was possible it could take all day. It did.

Through an acquaintance at work we were introduced to a gentleman who helps run a VC firm that works to bring medical technology to China. His VC firm also wants to make sure they are doing something to help those in need, both in China and around the world. He (Bruce) was a very serious and passionate individual who spent 5 years in the US for graduate school and work, before returning to China. Our morning was spent talking with him about his firm and how they wanted to help us find a way, through new and changing Chinese regulations, to earn charitable dollars from Chinese individuals to be spent in China.

Philanthropy in China is new. First, it is exceedingly difficult to form a public charity for a host of reasons. The largest charity in the country is the social service sector of the government - the agency that provides social security, etc. Second there hasn't been enough personal wealth spread over enough people to make charity a viable option for almost anyone. Third, there has been no culture of giving, which is no small thing at all. All of that is changing and the government is both recognized it and may be on the verge of encouraging it. We, as an organization, are a nice fit because we have a long history (41 years) and have numerous contacts and partners within China. This means we are established, reputable, and can be funded to continue to do our Chinese work.

After a great lunch on a fantastic day - 60+ degrees and sunny - we returned to the office to meet with someone Bruce met through business contacts.  This woman, Jane, spent over 10 years in the US for undergraduate and graduate school in business. She was very strong in hr convictions, boisterous, and spent a significant portion of hr college years playing endless hours of World of Warcraft, living in a MMPG virtual world. Her software company has designed a 3D game engine and is beginning to create games, but they really are looking to create a virtual world where players can spend and use virtual money to actually help charities. She has a very cosmopolitan view and perspective and sees this as not only a first step for China, but the future of charity and commerce.

To be honest, wrapping our heads around the way people playing in a virtual environment could (or would) help a charity was difficult, but fascinating. Given Jane's passion and proclivity to speak at length that took several hours. But then she let us know that this enterprise was actually her attempt at creating an entirely new type of monetary and banking system. One not constrained by a government or the forces of supply and demand. And she was already actually doing it. Already the debit cards associated with the game, where people earned and spent virtual dollars, are being accepted and used in the real Chinese world - to pay electric bills, buy coffee, etc. The implications are amazing - she was creating her own "money" in a virtual environment and, somehow, it is translating into the real world. Her focus is squarely on the philanthropic side of the endeavor - her philosophy is based on Jet Li's One Foundation. His idea is that if each Chinese person gave 1 yuan to charity each year, there would be over $1 billion to spend. A little from each person, in China, translates to a lot. Jane sees a similar way of raising large amounts of money. People buy avatar items all the time virtually and pay for them. One company in China last year, who sold virtual hairdos for avatars, made $1 billion. For pixels of color for imaginary people in a game environment. This works in China because virtual worlds and games are big, people are more than willing to pay for these types of items all the time, and the numbers support it - 640 million people with internet access and almost 200 million who play online games. The possibilities are staggering. Even if we earn 10 cents from a purchase, the numbers work in our favor to be able to potentially raise extremely large sums of money, but only a little from each person.

Jane suggested we leave the office and go get coffee next door at the Shangri-La hotel. We got into her personal car and her driver took us over to the 5 star hotel that simply reeked (literally - when we walked in the smell was overpowering) of old world China. Women dressed in traditional garb serving and opening doors. Yao Ming's wedding reception was held here. We sat in the lobby and she ordered Pu-erh tea for us. Known as the King of Teas, there have been times where these leaves have been used as currency in the country. And for a long time only the Emperor and his family were permitted to drink it. The tea comes from a very small region of the Southern part of the country and some of the trees it comes from are 1,000 years old. It is expensive and gains value and esteem over time. 60 year old tea can be $1,000 for a cup. We drank 10 year old tea. And the service of it, as is the case in China, was elaborate and beautiful.

Over tea we learned that Jane, after graduate school at Harvard, worked for the Chinese government in NY buying US treasuries on behalf of China (as she says, they essentially "own" us now...), before working with George Soros and Jim Rogers after the Quantum Fund and making an immense amount of money. She then started, and sold, several companies on her own. She was exceedingly wealthy and looking for a way to give back- and to allow others to help society as well. She sees personal philanthropy as a way individuals can help, and China as the country and people to lead the world into the next phase of social philanthropy through the use of online virtual communities. Fascinating stuff, to be sure, but extremely heady and, at this point, theoretical. Where this goes can only be guessed at right now.

Tomorrow we are off to Changchun. I have no idea what kind of internet access I will have there, but will post more as soon as I can!

A Look at Shanghai and Who Needs Facebook??

Day 1 in Shanghai is in the books. We started with a wonderful meeting at Shanghai Children's Hospital with Lily Hsu from project HOPE. Project HOPE has been working at the children's hospital for a long time and Lily has been with them for 11 years, starting as a nurse educator in one of their programs and now an administrator for their Shanghai initiatives. They do work with a lot of different areas within the Children's Hospital, but see a need for more pediatric cardiology care and work within the entire country for our work. Lily has a great sense of what is happening all over China and it was a wonderful meeting with another nonprofit working to help children. Here is Shanghai Children's Medical Center (SCMC) and a picture of Lily:

The rest of the day was free and we spent it exploring the city a little. Shanghai is a city of some contrasts, but it is really very modern and "cosmopolitan". There is no question about its modernity - it is clean, gleaming, there are new buses and cars all over. Lots of young people - all dressed in the latest fashions. But every once in a while the "old" China pops up. A man riding a bike with 3 trees sticking up from a carriage on the back, or the following gentleman:

Do you see that he is sweeping the street with a REAL STRAW BROOM? Of course, the craziest thing was that he swept the street across from where we had our breakfast, then turned into a corner of the building behind him and took a leak. On a public street. In the middle of the morning. As a city employee.

The Worlds Fair was held here in 2010. Shanghai is quite proud of this, and there are still signs all over the city proclaiming "Shanghai - home of the 201 World's Fair!" The new subway system is testament to the kind of money China poured in to help make the city gleam for millions of foreign visitors. No doubt it will all be falling apart in a few years.

Today was a holiday (not really - tomorow is the legal holiday, today is just an extra weekend day for the country - go figure) so there were lots of people out, especially at the park. So we took the subway to People's Park in the middle of the city to walk around and see what was going on. When we entered, there were dozens and dozens of people lined up along the edges of all of the walkways - mostly men - with long pieces of paper in front of them with a lot of writing and each one had a hone number at the bottom. Confusing - I was wondering what this had to do with the holiday - were they selling a service, such as grave cleaning, something important and personal in China. Maybe they were grave cleaners and visitors - you know, for the busy person who didn't have time to visit their ancestors but wanted them to know they were loved and missed. Rent-a-family.

No. This park is where single Chinese men and women go and, on the weekends, try to make a "match". They sit out, yelling at every member of the opposite sex who goes by, and try to engage them to find a spouse. No need for Facebook (oh, that's right, they don't have access to it...) or speed dating, it's a dating park.

We then walked to the Shanghai Museum - a beautiful, huge art and artifacts museum that showcases China's cultural heritage, from jade, to calligraphy, to paintings, to furniture, to ceramics like porcelain, to clothing and ritual items - just beautiful items, and some were almost 3,000 years old. It was an incredible building, and below is it and the most amazing mask we saw that was about 2,000 years old.

We then walked a pedestrian mallway that was teeming with people. Of course, being foreigners and tall, every salesperson approached us to sell "purses and watches".

This led to the Bund - when Shanghai was opened to foreigners (it was one of the first, and few, international ports opened to foreigners in the early 1900's) there were French, British, and American quarters established, which were settled by each and the laws enacted within each were their own, not the Chinese. The British and Americans combined theirs but the French, being French, refused to cooperate. So distinctly non Asian areas grew up in Shanghai, with architecture to match. it is quite striking in an Asian city to see some suddenly French colonial building, but that is what the Bund is, along the river. I liked this picture because it seemed to show what Shanghai, and the Bund, are all about - East meets West, old meets new -

Along the Western side of the river is Shanghai's most recognizable landmark - the Shanghai Pearl. It is a tall, gleaming television  tower built 15-20 years ago.

I'll leave you with a few random impressions:
- The beer generally sucks. It's very light. Nothing dark or with any real flavor. This is a problem for me, but after 1 day I'm figuring out how to get over it...
- There is a nationwide problem of spitting in the streets. So much so that before the World's Fair and Olympics they paid people to walk around and scold people who spit or cursed. But, so far, I haven't seen one person spit or blow their nose in the street. Progress!!
- It's the little things that make you realize you're in a foreign country. Fire extinguishers. Every building has a few. But they keep them sitting on the ground in the corners of rooms - bathrooms in the restaurant, corners of the museum. Not a big thing, but just strange when you're used to seeing them on a wall or in a case in the wall.

I've Landed In China! (And Am Now Behind the "Great Wall"...)

I'm here! Fight was great - easy. Never had 14.5 hours go by so quickly. One bad James L. Brooks movie and another viewing of Harry Potter 7.

The biggest issue is The Great Wall. China doesn't allow Facebook or blogs. But Skype works, and through my mom's search I've found a workaround. I hope it sticks. There is a ton on the internet about this issue and how they randomly cut acces etc.


So - a few first impressions: lane striping and turn signals are optional (kind of like Boston), but horns are not. They are essential, apparently. Bikes aren't quite as common s I thought they'd be, but they don't seem to care about traffic laws very much.

Today is a holiday - Grave Sweeping Day (think memorial Day), so we'll see what happens. Most of our appointments cancelled for today because of it, but we do have 1 at the Shanghai Children's Hospital. Then the afternoon is ours - and we're hoping things are open. There is an art museum close by.

I'll post some pictures later!

Where the Hell Am I Going? (And Why Am I Going There??)

I've gotten quite a few questions about who I work for, why I'm going to China, what I'm going to do when I get there, and where I will be.

All excellent questions. I wish I knew the answers.


Who Do You Work For And What Do They Do?
I work for a 41 year old nonprofit - Children's HeartLink - which works to treat children with congenital heart defects (CHD's) in developing countries.

You should know that CHD's are the most common type of birth defect in the world and each year approximately 1 in every 120 children is born with one. In the United States and other developed countries CHD's are identified early - sometimes in utero and usually within moments of the child being born. Here, they are then whisked away and fixed within minutes of being born. There are certainly a group of children who have to have surgery a little later in life, but in the United States a child with CHD can and does live a full, normal life. Not so in developing countries.

• First, the condition is most often undetected. The child may have breathing problems, may turn blue at times, or may faint. There are a wide array of symptoms and for doctors who do not have experience or knowledge with CHD's, they can be confusing and hard to pin down.
• Second, the specialized doctors and health care teams trained to identify and treat CHD's do not exist in nearly large enough numbers. In the United States there are more than 2,500 pediatric cardiologists who treat CHD's. In India, which has a population almost 4 times the size of the United States, there are estimated to be 35-40 pediatric cardiologists.
• Third, the coverage of treatment doe snot exist in most developing countries. While a relatively cheap surgery (not counting staff time, the cost is, on average, about $3,000), the lack of specialists with knowledge and lengthy recovery time make it an expensive condition to treat. (I should say that the universal coverage of CHD's in the United States is coming under fire in the new health care legislation and there is some question as to whether all instances will be covered moving forward...)

We do our work by teaming up with the best pediatric cardiology programs in the United State, Canada, Great Britain, and Singapore  and creating long term relationships between them and pediatric cardiology programs in the developing world. We choose our sites around the world carefully - they have to have an existing program, do a high number of charity cases, be committed to development and growth, etc. We link up a volunteer institution with significant experience with a partner site and work with them to move them along the continuum of development. In some cases this means they are looking to be able to do more surgeries, thereby significantly increasing the number of children treated, and in others it means expanding their skill set to take on more complex surgeries, thus helping some of the more severe cases. In all cases, we are working with our partner sites over a 5-7 year period to develop their skill set and move them towards becoming a regional center of care and training so that they can, ultimately, turn and help their colleagues within their own country in the detection and treatment of CHD's.

The ultimate goal of Children’s HeartLink is to empower local medical professionals to prevent and treat pediatric heart disease in their own populations so that every child can receive the care he or she needs.

What Are You Doing In China?

I will be visiting our 4 partner sites in China with our VP of International programs, Estelle Brouwer. At one (Jilin Heart Hospital in Changchun) there will be a full medical team visiting and I will get to see what they do to help our partner sites. I'll also get to see surgeries - little heart surgeries - first hand. At the other sites (Chengdu, Lanzhou, and Shanghai) we will meet with hospital administrators to share our developing model and talk about our relationship. We'll also be meeting with some other nonprofits that do work in China similar to ours and also meeting some potential funders.

Where Will You Be?

The short answer - all over the Central and Eastern part. I didn't realize it until the other day, but we're flying all over China. Which says a lot. China is the most populous and fourth largest country in the world. Yet the entire thing operates under 1 time zone. Crazy.

I will be in Shanghai (East coast), Changchun (NE), Chengdu (South central), and Lanzhou (central).