Monthly Archives: Mar 2018

Wall to Ourselves

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Wall to Ourselves

Sara and I have been fortunate to learn, time and time again, that if you do some serious planning and take the extra time, you can always get away from the crowds and find yourself in truly breathtaking situations (and you can read about them here, here, and here). But in China, a country where the crowds themselves are breathtaking, we weren’t sure if that feeling of solo exploration would be possible.

Spoiler alert: it is. But I’d be lying if I said we never doubted ourselves.

Being 6,000 miles long, there are many points from which to access the Great Wall, each with different amenities: some are fully infrastructured, with restaurants and shops on the wall itself, while one section features a toboggan slide (which is something that I would totally do on a return visit!), but also, of course, major crowds. However, far along the eastern end of the wall, where the Chaohe River flows in from what was once Mongol territory, is a little town called Gubeikou (‘old north gate’). It has a very weird internet presence in that many travel sites mention it, but few offer any concrete details about how to get there or what to expect. The two stretches of wall on either side of the river are called ‘Crouching Tiger’ and, you guessed it, ‘Hidden Dragon’ (okay, technically it’s actually ‘Coiled Dragon’, but why else would a dragon be coiling unless it was hiding??). All of these seemed like good enough reasons to give it a try.

Finding our way to the bus through Beijing’s massive Dongzhimen station was technically uneventful, though it felt like an adventure because it was our first time being completely on our own in China, having to memorize the characters for our destination and then search for them on literally thousands of buses. One perk of being in the most populous country in the world is that the buses leave every 10 minutes, but even then we found ourselves sardined in the far back between our backpacks and the collection of shiny new kitchen appliances that someone had bought in the big city and was taking back home with them.

After three hours we arrived at the city of Miyun, at which point Sara used some very impressive bartering to get us a spot on a van that was going to Gubeikou. The van was filled with Chinese tourists, and knowing that Gubeikou was not a large place, we figured we were all going to the same hostel.

Forty minutes later, however, the driver pulled over, shouted ‘Gubeikou!’ and we found ourselves on the side of an empty highway, alone with our backpacks. To our right, there was a town that did vaguely resemble a photo I’d seen (a decorated arch, an ornate stone building, and beautiful winding canal), but that photo had clearly been taken before some kind of zombie apocalypse that had evidently occured since. The ornate stone building now had padlocks on the doors and boards over the windows, and the canal was literally clogged with logs and branches. Worst of all, there was not a Great Wall in sight.

I got the sinking feeling one gets when one finds themselves in a Chinese ghost town without internet or a vehicle and it’s getting dark and there isn’t even an unlocked building where one might spend a chilly, disappointed night. We wandered up the cobblestone road, only to find more of the same, when suddenly a single taxi came trundling out of the shadows. We stood shamelessly in the middle of the road, hellbent on getting into it and going ANYWHERE.

The driver (who already had a passenger, but seemed pretty chill) didn’t seem to recognize anything on the map we showed him, but kindly let us in and drove us a couple minutes out of the ghost town to what seemed like a sleepy but inhabited town and stopped outside of a building that said, in English, ‘Teachers residence’. Very appropriate, but no luck at actually finding someone inside willing to take us in for the night.

It was pitch black by now, and we had lost all sense of direction as the cab meandered through an uphill labyrinth. We stopped by some sort of field, and suddenly the driver was talking to an older gentleman who had come running from the void. From their facial expressions (which we are apparently terrible at reading), we thought that they were both equally confused. Suddenly, however, the driver let us out and the other man led us to a low building, opened the gigantic square iron door (classic China!), and welcomed us to our hostel.

The man turned out to be the hostel-owner’s father, whom she referred to in text messages as Master Ho, which of course only added to his mystique. As a gesture of good will, he made sure to procure several chives from the darkness outside for us to add to our instant noodles. He and Sara had a long conversation that was completely unintelligible to either of them, but she thinks it may have been about my height.

I woke up the next morning still hesitant about where we’d ended up. But when I set out to find some eggs for breakfast, breathing in the relatively smog-free air, my doubts were immediately assuaged.

The spine of the Crouching TIger…

At this point, we had to choose which section of the wall we were going to attempt. ‘Coiled Dragon’ was lower, gentler, and marked on a detailed GPS map. ‘Crouching Tiger’, meanwhile, was steep, winding, and accompanied by the following instructions: cross the bridge and look for some steps on the right.

We deliberated for a moment…then set off towards the bridge. I’ll let the pictures speak for themselves.

That’s tiny me at the bottom of the roller coaster.

The scrubby landscape sloping up the steep flank of the Crouching Tiger’s spine makes it easy to imagine (or actually see, if it’s the year 1200) Mongol hordes invading from the north.

The Trans-Siberian Railway trundling under our feet, straight from Moscow.

We had hoped to get away from the crowds…we never dreamed we’d manage to get away from all of humanity entirely. I alternated between feeling so incredibly connected to history and feeling like a kid on the world’s biggest play structure. Even though the modern Mongolian border was hundreds of miles away, the sense of being on the very frontier of something ancient was palpable. Awe is usually a momentary state, but this lasted the entire six hours we were on that wall.

 

Now and then the path veered away from the wall, into fields of pink blossoms and unearthly white rock.

The view from below

The view from above

Gubeikou, you had us worried for a moment, but you were truly unforgettable.

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The Ol’ Spring-Break-in-Beijing Classic!

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The Ol’ Spring-Break-in-Beijing Classic!

Whaa?? Where am I? Oh, hello!

(*dusts himself off and looks around to get his bearings*)

Returning to this blog feels (I can only assume) like falling through a hole in space-time, like Lucy discovering Narnia, or Jack Skellington finding himself in Christmastown. But maybe this Twilight Zone-esque bewilderment is an appropriate metaphor for a Western traveller whose first foray into Asia was a week-long sortie into one of its busiest, most ancient metropolises (metropoli?).

Though going to China for a single week seems preposterous, the planetary alignment in this case (Sara having an actual Spring Break due to a clerical error the previous year / that Spring Break coinciding with mine / both the aforementioned Spring Breaks coinciding with the end of her medical exchange in China) was too good to pass up. We decided that the best way to immerse ourselves in this wildly different world was to spend the entire week in the bustling city of Beijing.

 

The sprawling 3,000-year-old Imperial palace, ominously known as the Forbidden City, is practically synonymous with Beijing. Standing in its first plaza, vast and paved enough to put an IKEA parking lot to shame, one gets the impression that the sole intent of this place was to intimidate visitors, to suggest the size of the army that could be assembled in such a gathering place. And then, after crossing that infinite expanse of concrete, one passes through the extravagant arch on the other side and enters…ANOTHER INFINITE EXPANSE OF CONCRETE! AND ANOTHER! These plazas repeat themselves almost to the point of absurdity, with decadent names such as Hall of Eternal Happiness and the Hall of Infinite Prosperity, finally culminating in the Imperial Garden, a refreshing Eden of exotic trees that feels like the organic nerve centre of this massive geometric body. The effect is staggering.

Breathing the fresh air of the Imperial Garden.

 

Sara making herself at home in the Hall of Literary Brilliance.

 

The next day we took the metro (which, incidentally, is a great crash course in Mandarin characters, since all the stops are just some combination of the words for north, east, south, west, gate, bridge, lake, and river) to the Temple of Heaven Park: equally majestic, but with the intimidation factor replaced by lush tranquility. Here we saw the mellow side of the otherwise frenetic Beijing lifestyle: people dancing, elderly folks doing gravity-defying tae chi, and parents playing with their kids.

 

I insisted we take a fairly lengthy metro detour to see one of my favourite architectural wonders (/anomalies): the CCTV Headquarters, aka THE PANTS!

If you are ever in Beijing, you absolutely must visit the Wangfujing Snack Street. Yes, it’s touristy, but it’s also delicious and completely unique. Where else can you find live scorpion kebabs, heaps of tentacles, or whatever donkey wallow is?

Our final major destination was the Yongzhe Lama Temple, Beijing’s largest Buddhist establishment. If the Forbidden City was formidable and the Temple of Heaven tranquil, then the Lama Temple was, in a word, reverent. A ubiquitous blanket of fragrant smoke keeps each individual alone with their thoughts, free to explore the sacred maze. I was fascinated by the worshippers, recognizing the looks on their faces but not the bells, flags, wheels, and statues that held such meaning for them.  Being an outsider in a place so intimate made me think of the old parable of the blind men who each touch a different part of an elephant and thus think they are touching something different entirely. What I was witnessing was indeed a very new and different part of the same proverbial elephant than I’d grown up with.

 

Lastly, I would be remiss if I didn’t mention Beijing’s hottest travel destination, and although you won’t find him in Lonely Planet, I’m sure he wouldn’t mind being referred to as such. My friend and fellow teacher, Travis, played the role of perfect host throughout this trip, letting us stay in his apartment, keeping me up til 3:00am on the night of my arrival to break me of any potential jetlag (watching him play hockey in a freezing cold arena for two hours helped, as did the copious amounts of beer and jianbing at the local expat bar afterwards!), helping us with everything from buying a metro pass to asking for less slippery chopsticks in restaurants (the wooden ones make it a LOT easier, okay!!), inviting us to hang out at the Canadian embassy after a ball-hockey game to partake in the finest hoser beverages in all of China, driving us to and from the airport, and finding the best spots for Peking duck (thanks Han!), hotpot, and malatong. T-Rav, I can’t believe we ACTUALLY got to take you up on your invitations to see you in your natural habitat. Xiexie for a fantastic time!

Sara and Travis greet me at the airport with a sign taped to a hockey stick using a band-aid.

 

A first and unforgettable experience of Peking duck.

 

A toast to Canada’s finest spirits, hockey team, and expats!

Shant-outings*

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*Thanks to Joshua for the oh-so-punny title

As mentioned previously, Shantou is tucked into the coastline of the South China Sea, making it the perfect jumping off point for day trips to the numerous surrounding islands. On our first weekend in China, myself and the other Canadian exchange students took the ferry for 1 yuan (~20 cents) across the Shantou Harbour and landed on the idyllic shores of Queshi island. We were greeted by a woman expertly dissecting pineapples with a machete and neatly skewering the slices onto long skewers. An entire pineapple for 7¥ ($1.5) seemed a reasonable price to pay for a snack as we walked along the island’s meandering paths.

View of Queshi from the Shantou side of the sea

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Our goal was the pagoda we had seen every morning we walked along our side of the harbour. On our way up the mountain, we explored a series of naturally formed granite caverns with such enchanting names as “Rainbow Lying Cave,” “Happy Fate Cave,” “God’s Shoe,” “The Platform for Watching Sight of Flame Mount,” and “Three-Tier Cave Toilet” (on second thought, maybe that last one was 2 separate stops…)

View of Shantou from the Queshi side of the sea! 

Terrifyingly steep steps into the caves!

Lovely lunchtime stop
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Giant Buddha (only after an entire photo sesh with G.B. did we realise we had been sitting in front of a sign that read, in Chinese, that pictures cost 2¥ each… and consequently a terrifying encounter with the giant security guard ensued)

After eating lunch in the pagoda at the mountain peak and paying our respects to giant Buddha back down on the ground, we headed back to the ferry. Before we had even landed back on mainland, we were already receiving WeChats from our host students, inviting us out for an evening of quintessential Chinese cultural fun: KTV.

KTV (aka karaoke) is more than just a past time in China… it’s practically an art form. Whole streets are lined with massive KTV buildings, each hosting a multitude of private rooms where groups can order food & drinks and custom-create a karaoke setlist of K-Pop and the newest Swifty singles. At KTV, the most stoic and shy of students suddenly comes into their own and discovers their latent pop stardom, belting out sexy ballads with no restraint or reserve whatsoever!

Post-KTV, we were up bright and early to board the bus taking us to a village about 2 hours from Shantou. Interestingly enough for a self-declared Communist country, healthcare is not publicly funded in China, and therefore many citizens cannot afford basic medications or even a simple doctor’s visit. Thanks to Guangdong-born Hong Kong billionaire philanthropist, the Li Ka-Shing foundation has instituted numerous charitable works to address health inequities across the country, including the one we were participating in that morning – Medical Aid for the Poor (MAP). Once a month, MAP physicians set up free clinics in villages near Shantou, providing free medications, blood pressure readings, and specialist consults. They also provide home visits for any rural citizens unable to transport themselves to the clinic.

My lunch at MAP won the honour of being the most interesting food I have ever eaten to date: I was so proud of myself initially for trying what I was convinced was liver, since I had never had that before. But when I checked in with my Chinese friend, she blithely corrected me: “Oh no, those are blood clots. Maybe pig? Probably dog.”

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Home visits & tour of the village temple

Since we were spending so much time in “small town” China (remember that Shantou’s population is a mere 5 million), we thought we should grab the chance to see big city China at its most iconic: Hong Kong.

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For being so close to Shantou, it was a headache and a half to actually make our way to HKSAR. A chartered car, a bullet train, a subway, a walk through two sets of customs, and another subway later, we were finally in our Hong Kong home for the weekend – an itty bitty hostel room on the 14th floor. The rule was that some part of each person had to be touching their bunk at all times, otherwise there was not enough space for us all in the room!

Hong Kong had some noteworthy features: milk tea, pork floss toast, the mind-blowing bus ride up to Victoria Peak (call me small town, but I have never seen buildings rising up higher than the surrounding mountains!!), and the hilarious experience of finding our way up to the “Highest Bar in the World” and negotiating with the hostesses and fellow patrons for rented pants so our male compatriots could actually enter the bar (because apparently, while shorts are incredibly offensive and inappropriate, ankle-skimming polyester gems passed around to 3 different gentleman in 1 hour are far, far more acceptable). However, in general, I do not feel the need to go back to HKSAR. I feel so privileged to have spent the majority of my time in “small town” China that actually felt unique, and not simply like a crowded version of any forgettable kitschy American town.

Buildings, buildings everywhere…

The day after arriving back in Shantou from HKSAR, we were again packed into a bus, this time to trek several hours to Nan’ao island, where we spent a lazy day hiking up to yet more pagodas, watching our bus driver carve roast chicken with his bare hands, and getting yelled at by locals for daring to swim in the ocean (apparently, that’s just not done).

All in all, our Shant”outings” made an already memorable exchange even more extraordinary. And after three weeks of this, I still had a week of true holidays left…
(To be continued!)

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Barefoot to White Coat

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Having returned from my three months of out-of-province electives, I settled back into the swing of things at home… at least for the next two months 😉 I was at home just long enough to do some CaRMS interviews for my upcoming residency specialty training, complete my final undergraduate OSCE (a lengthy clinical exam with actors pretending to be patients suffering from a variety of weird and wonderful ailments), and spend an incredible month working with the Program of Assertive Community Treatment (aka PACT), a service provided at home to individuals with severe and persistent mental illness, helping them stay out of hospital and maintain their independence in the community.

March 1 was Match Day, the day where medical students all across the country are informed which specialty program they have been accepted into; or in other words, the day we find out what type of medicine we will be practicing for the rest of our careers. I was beyond thrilled to match to my first choice of Family Medicine – Northern-Remote stream, a specialized Family Med program designed to address inequities in access and quality of healthcare for Canadians living in rural and remote areas, particularly those of Indigenous descent. While every Family Med program across Canada offers excellent medical training, I was drawn to the Northern-Remote stream for its unique decolonizing vision and immense scope of practice. And now, as of July 1, I will be a member of its team!!

“Plan B” theme party on Match Day Eve – Joshua and I showed up as WWOOFers, to nobody’s surprise!

Match Day!!

Even after some epic Match Day celebrations, the adventures were not over! Two days after the Match, I boarded a plane along with three other med students, and two days after that, we landed in Shantou, China, a “small town” of only 5 million people in the Guangdong province, nestled on the coast of the South China Sea.

Our apartment complex and view from my window

Seven minute walk from my apartment to the harbour!

The four of us had the immense privilege of being chosen to participate in an international medical exchange with one of our sister universities. Every day for three weeks, we toured two different hospital wards, ranging from Neonatology to Hepatobiliary to Orthopedic surgery. An English-speaking physician was assigned to us on each ward and would accompany us on bedside rounds of their patients.

The brain tumour research hospital… appropriately shaped.

Shantou “Hospital #1”

Bedside rounds & teaching


There were a number of striking differences in the Shantou hospital wards compared to our Canadian wards, but the most notable by far was the organization of care. In North America, family physicians (known in the past as “GPs”) are the first stop for the vast majority of patients. Sore throats, earaches, slipped discs, period problems, prostate problems, depression, pregnancy… most health concerns can be treated directly by a family doc, but if need be, the patient is then referred to the appropriate specialist for more unusual and complicated health conditions.

This type of healthcare organization, aka with a “primary care” focus, is rare in China, and the vast majority of individuals in China bypass primary care physicians and attempt to access specialists directly for all healthcare concerns. In other words, if you have a headache, you try to see a neurologist. A cough and sore throat? You hope to somehow snag an appointment with a respirologist. Partly this is due to cost: with China’s three-tiered system, individuals are required to pay for most services out of pocket, so patients do not want to risk having to pay a family physician and subsequently pay another fee to a specialist. Furthermore, there is a strong historical component that has cultivated a sense of mistrust towards the idea of primary care.

Several decades ago, the concept of “primary care” referred to farmers in rural areas who received a mere 3 months of training by urban medical professionals, in an attempt to address healthcare access issues for the enormous rural Chinese population (which represented 80% of the total Chinese population during the 1970s and 1980s). While these “barefoot doctors,” as they came to be known, provided some relief to the healthcare crisis, their training and medical expertise was understandably unequal to that provided in tertiary care centres staffed by fully trained physicians. The barefoot doctor system eventually collapsed under economic policies introduced during the Cultural Revolution.

Family Medicine was only introduced as an official specialty in Chinese medical schools in 1999. In 2009, new health reforms were put in place in response to rising public frustrations over difficulties in accessing professional medical care, as well as the steep prices associated with healthcare. The Chinese government instituted a goal of training 300 000 family physicians by 2020; even this impressive number, however, would still only provide 0.2 family doctors for every 1000 citizens (in comparison, consider that there are 1.17 family docs per 1000 Canadians – ~6x more than in China – and that is still woefully inadequate!!)

Some may think that China’s approach to healthcare is actually more effective; after all, cutting out the middle step of a family physician should likely result in faster and better service, right? On the contrary. Since 2009, primary care use in China has decreased, while visits to hospitals and specialist services have increased significantly. And sadly, death from all causes, money spent on healthcare, and inequity between rural and urban health measures have also increased in China. Multiple studies have shown that regular primary care improves health outcomes and reduces time spent in hospital. But unfortunately, in China, people with multiple different health concerns tend to use specialist and hospitalist care over regularly seeing a family physician. Moreover, people with lower incomes tend to have poorer access to primary care services, and therefore are at a higher risk for poorer health outcomes in general.

The partnership between our university and Shantou has been an exciting adjunct in addressing the primary care gap in China. While in Shantou, Canadian Family Medicine faculty and residents were very involved in giving lectures to and leading discussion groups with Shantou medical students and residents.

It was fascinating to discuss both the differences in clinical approaches between China and Canada, but also realize just how many similarities existed between our sites. As one preceptor stated, “We are all just trying to provide the best care possible to our patients.”