Chapter 3 - The Case of Mistaken Identity

Back in the U.S., Jeff was used to getting asked questions like “Where are you from?” or “What are you?” And when he would answer that he was from Chicago and that he was pretty sure that he was a human-being, in the back of his mind, he knew they were referring to his ethnicity. Sometimes a little offensive, sometimes just inquisitive, these types of questions were actually fairly common. He just didn’t expect to get asked this so often from his Chinese co-workers at the CDC. People here were a little more straightforward and some might consider blunt with their questions, but this was something he prepared himself for… as best as he could.

For the first half of his 12-week internship, Jeff would be in the Institute of HIV/AIDS/STI Control and Prevention. His main interpreters were Dr. Cheng and Dr. Liu. Dr. Liu was actually supposed to go to UM in the summer as one of the Chinese exchange scholars, but for one reason or another, his VISA was postponed. The two of them introduced Jeff to a new program at the TJCDC in which they were targeting high-risk groups, specifically MSM (men who have sex with men) and what they refer to as MB’s or Money Boys. In 2007, there were 156 cases of HIV/AIDS found in Tianjin. Although the prevalence of HIV/AIDS is fairly low in the city as a whole, the government along with the help of the Bill and Melinda Gates Foundation, have funded this project (all throughout China) to focus on this previously ignored group.

Diving head-first into his new job, Jeff spent the first week learning about the “Four Frees and One Care” policy that China had started at the end of 2003 to help fight the stigma and discrimination around HIV/AIDS infected individuals. This policy would allow for free antiretroviral drugs, free voluntary testing and counseling (VCT), free prevention of mother-to-child transmission, free schooling for children orphaned because of AIDS, and government assistance to those living with HIV/AIDS. In 2005, Tianjin was the first city to provide free testing to everyone, and Jeff was able to witness part of this procedure the first day of work. In the afternoon, Dr. Cheng translated some of the surveys for him and they sat in on an interview being given to an MSM college student. Somewhat uncomfortably standing in the corner of the small room, Jeff listened in on the survey and watched the young man give a blood sample. They then proceeded to urge Jeff to “Go ahead, ask him a question, he speaks a little English!” Not sure what to say, he asked the student if he had any prior sexual education in the past, which the man replied “No.” After another awkward minute of silence, Jeff headed back to the office.

While he was learning a lot about how China was currently dealing with HIV/AIDS, many of his Chinese co-workers were more interested in practicing their English and talking about life in the U.S. One afternoon, they called him into their department and sat him down. Slowly, one by one, the other people in the HIV/AIDS department began to rise out of their cubicles and unintentionally surround him. They explained that they also liked to take breaks to talk about things other than work and proceeded to bombard him with questions. One of the questions that caught him off guard was, “Are you Asian?” Dr. Cheng began to explain that Jeff looked like he came from the Xinjiang Province, an area in Western China with ethnic minorities. It was a part of the country near Tibet known for people who had ‘mixed’ with many of the European nations. Jeff politely smiled and hoped that it was a compliment rather than an insult. He explained that his family was originally from the Philippines but that he was born in America, more specifically Chicago. This elicited some nods of understanding, along with a barrage of even more questions. Jeff was glad though, because it changed the topic of their previous conversation in which he had spent 20 minutes explaining that Americans are not exactly like the characters in the movie American Pie – which he surprisingly found is a favorite movie for many Chinese.

A few weeks later, Kellie joined Jeff in the Institute of HIV/AIDS/STIs. They took a tour of the STI laboratory, and for one reason or another, they thought it would be a great idea to show the Americans what a crab looked like under the microscope. However, they failed to mention what they were going to show them until after they looked at the slide, so Jeff and Kellie were a little surprised to say the least. The rest of the week thankfully didn’t include any more crabs, but it did include a trip on the high- speed train to the local CDC in the Tanggu District. But it wouldn’t be complete unless Jeff was asked about his background at least one more time before the weekend. On the elevator ride home Friday night, Kellie and Jeff bumped into one of Kellie’s co-workers from a previous department. Kellie introduced Jeff to the woman, who said hello and immediately asked him, “What is your blood?” Although taken aback a little, Jeff did have to give the woman credit, and mentally awarded her the blue ribbon for the most creative way to ask if he was Chinese. Bravo indeed!

At end of her two weeks in the department, Kellie and Jeff were scheduled to deliver some presentations on the afternoon of May 30th. Kellie was asked to talk about HIV/AIDS in the US, and Jeff was asked to discuss the educational system in the US as well as the MPH program at UM. They were told not to worry about the presentations, and that it would just be a small gathering of people… that is until an office-wide announcement was made the day before, and the two students found themselves walking into a crowded conference room complete with the Vice Director of the CDC in attendance. Don’t be nervous, they said! It’s just our department, they said! It was a good thing they had over-prepared their presentations just in case. Once Jeff and Kellie were finally done presenting, it was time for the all-important question and answer portion… which would soon be followed by the swimsuit, evening gown, and talent competitions. One man in the very back of the room raised his hand, “Excuse me, I have a question for the young man who did his presentation on the educational system.” Sitting at the edge of his seat, Jeff anxiously awaited what he believed to be a very serious question from this man who spoke very good English. “Yes?” Jeff replied. “I think…” the man hesitated… “I think that you look Asian to me.” While not exactly the direction he thought the conversation would turn, and not even sure if his statement was technically a question, Jeff proceeded to re-tell his “back-story” yet again, knowing that this wouldn’t be the last time he would have to say it.

You Think You Know, But You Have No Idea: The True Story of Kellie with the Institute of Health Education

It is hard to believe that we have been here for three weeks already. Our time in China is going by very quickly. My summer internship at the TJCDC is structured a bit differently than Keith and Jeff’s. I will be rotating through several departments throughout the summer. This will give me a great overview of different public health issues facing China and the methods used to address them.

Due to the trouble with our visas, we arrived in China a week later than planned. This shortened my time with the first department I was scheduled to visit, Institute of Health Education, to only three days. But these three days were packed full of activities and visits around the area. We traveled to Jixian County, which is about an hour and half drive from the TJCDC. There were activities planned for two days, so because of the distance, we spent the night at a local hotel. It is a rural area with beautiful rolling hills which are lush green at this time of year. We passed many freshly planted tree fields and small enclaves of houses and farms. While in Jixian County, we visited the County CDC and met with officials working there. Next, they took us to a high school to do some interviews with students and teachers. We wanted to find out what health issues they thought were important. We also did interviews with students and teachers at a primary school a couple miles away. Everyone received an incentive for participating – a cool pencil case. Although I couldn’t communicate with anyone directly, my interpreter translated every word for me and relayed my questions. I had a fabulous interpreter from the Health Ed department, Wang Gang (pronounce Wong Gong). After the interviews, we toured a local village health clinic. Then after a long day of work, we had a fabulous meal at a restaurant that specializes in sea food. The food was fantastic, even though I didn’t know what I was eating most of the time.

For the next day in Jixian County, we had several activities planned. Along one of the main roads in the area, there is a large market. Vendors are packed inside a large open area and even along the road itself. It was bustling with activity and people shopping for food and odds and ends. If you needed or wanted something, I’m sure you could find it here. We sent up several tables and displays promoting AIDS awareness and other health issues. As people passed by, we handed them health information brochures on eating healthy, avoiding stomach pain and diarrhea, and hand-foot-and-mouth disease. There have been recent outbreaks of this latter disease, so people were especially interested in this information. I received many quizzical looks while I helped distribute the brochures. People were very kind and smiled and waved back at me. (This was my only way of communicating with the people.) Some small children said ‘bye, bye’ and ‘hello’ as well; we all had a lot of fun with the kids.

After a couple of hours, we moved our supplies to a smaller market area set in the middle of a thinned tree grove. We set up our supplies for a game involving health questions and prizes for answering the questions correctly. This was a lot of fun. Here’s how it worked: a person would take an index card from the signs hanging on string stretched between a couple of trees and then take the card with their answer in mind to the table where the TJCDC workers were. Once at the front of the line, the person would give their answer in hopeful anticipation of receiving their prize. Most often people were right, but sometimes they didn’t have the answer. They could come back and try again and also answer as many questions as they wanted. Some people really made a killing on the prizes. We gave away small bags of iodized salt, which helps prevent Iodine Deficiency Disorders, and a measuring spoon and bars of soap. Again, even though I couldn’t communicate with anyone, I handed out the prizes. I think this was the most fun part anyway. It was great to see people’s faces light up when they got the right answer and smile as I gave them their prize. And they loved the prizes. After another excellent lunch of Chinese pizza,we headed back to Tianjin. I took full advantage of the car ride home and dosed nearly the entire way back.

My last day with the Institute of Health Education proved to be just as busy as the first two. First, we went to the Hexi District CDC. This is the same district where my apartment is located. This CDC is completely smoke-free complete with no smoking signs strategically placed throughout the entire building. This may sound a bit strange, but many buildings, including some hospitals and even CDCs, are not smoke free. You can often detect a slight smoky odor when you walk into a building. So the Hexi District CDC is really making progress on tobacco control and prevention. Next we went to a women’s and children’s hospital to speak with some doctors on how they provide health information to their patients. One very interesting and unique way they do this is by hand writing messages on what we would call dry-ease boards. These messages are very elaborate and involve detailed pictures of Disney and other cartoon characters. They really get your attention and are an excellent way to draw people in so the messages are not ignored. For lunch, we had Peking duck at a great restaurant. Peking duck is famous in northern China, especially Beijing. Basically, you dip the roasted duck in a brown sauce and put it in a thin flour tortilla along with cucumber strips and a few sprouts. Very delicious. On my trip to China in February, I also had Peking duck. So I’m getting very good at wrapping the tortilla so the goods don’t fall out. :)

After lunch, we went to one of the prestigious high school in Tianjin, Xin Hua High School. This high school has existed for over 90 years and is one of the best in the city and the area. Many of the graduates go onto famous universities as well, including Peking University in Beijing and Nan Kai University in Tianjin. Due to the pressure and competition, the school has established excellent mental health services, including group and one-on-one counseling, activities for students to relax and have fun and various ways to distress. There are about 3,000 students at the high school, ages 13 to 18, and 4 doctors provide the necessary care. In the opinion of one doctor I spoke with, poor eye sight and being overweight are the major health issues facing the students, along with the pressure of succeeding in school. It was great to speak with the doctors and I was honored to meet the Head Master as well. He presented me with an amazing gift, a commemorative gold plate marking the 90th anniversary of the school. I have a special place for it on my desk at the CDC.

This pretty much concludes my three days at the Institute of Health Education. It was an extremely busy three days. All of the activities we did were planned especially for me. It is very humbling and I greatly appreciate all of their hard work and preparations. I hope this gives you a small glimpse into the work they put into planning for my arrival. It is unfortunate that my time with them was so short. I know they planned many other activities that because of our delayed arrival had to be cancelled. After the Health Ed. department, I worked in the HIV/AIDS and STD Control and Prevention Department; the same department that Jeff is in, for two weeks. So now I am working with the TB Control Department for one week and after this week I will be in the Chronic Disease Department.