Hygiene

I spent the past week in Henan province, one of the regions where there is a high-prevalence of HIV infection due to the blood selling schemes in the 1990s. The town I stayed in is pretty rural and is surrounded by villages and farms. This is what most of China is like – not big modern cities like Beijing and Shanghai, but rural towns and villages. As a result, some of the modern comforts and even habits you are used to is not available here (although to be honest, sometimes people’s habits not much better in Beijing!).

For example, despite the speed and progress of development in China, good hygiene is still a serious problem. The constant hacking and spitting of phlegm, the bathrooms that smell perfumed with urine, the lack of soap and toilet paper in many of the bathrooms has given me a renewed appreciation for Purell (Kelly – I should have brought the big bottle like you said!). People just hack loudly and spit freely even in public – they don’t even try to be discreet about it. Cab drivers hack and spit out the window, people walking on the streets just hack and spit on the street. People even spit indoors. Besides the fact that it transmits germs, it is just truly gross.

And even after being in China for more than two month, I still approach every public bathroom experience (including at airports, restaurants and hospitals) with great trepidation. Although many bathrooms have western style toilets, many of them still only have squat toilets. Although they are technically more sanitary, I dislike using them. You’d think that if people grew up using squat toilets, they’d have figured out how to use it without peeing all over the place. Not the case though. But even the squat toilets can be considered a luxury in some places where the “bathroom” is pretty much just a gutter. In addition, you can never forget to bring toilet paper with you. It seems like such a basic necessity, but it is just not provided in many places.

If you visit Beijing, you will notice that there are many public bathrooms on the streets. Although there are many renovated hutong courtyard houses with all the modern amenities, most of the old hutong buildings (the ones they are knocking down left and right to make way for modernization) still do not have bathrooms. Thus, people still rely on these public bathrooms. They are to be avoided except in the most desperate of situations. And the B.O. here is simply atrocious. Deodorant has clearly not made it to this country. I try to avoid hot, crowded places (like the subway which is not air-conditioned). Enough said.

Kelly is convinced that living in China for a year will shorten my life by five. I originally told her not to be silly, but I’m beginning to concur. I think I have inhaled more second hand smoke this month than my entire life prior to moving to China. People are allowed to smoke everywhere. 50% of Chinese doctors smoke (and one of them told me that there have been studies that prove that people who smoke and those who don’t have the same life expectancy…). The tobacco industry is government-owned so there is absolutely no incentive for the government to encourage people not to smoke – it is just too lucrative for them. People smoke in front of children with lung infections, pneumonia and TB. Some doctors even smoke during patient consultations. It is just crazy. They pretty much consider it an inalienable right.

On top of that, the pollution in Beijing is really out-of-control. I really don’t see how the Chinese government will be able to clean up the air by the Olympics next year. On bad days, it feels like you are walking through a cloud forest. It appears foggy all the time and even buildings just a short distance away is barely visible through the haze. They claimed to have had over 250 blue-sky days last year. Not sure who makes the determination that the sky is blue in Beijing, but I can assure you there’s no way they can have that many. I’ve only witnessed a handful. Oh, and I mentioned that I’ve already been to China’s most polluted city – Linfen. It’s apparently also the world’s 2nd most polluted city. Some city in Azerbaijan beat out Linfen to earn the ignominious honor of world’s most polluted city. As a result of the combination, I seem to have developed a cough that won’t go away.

Many of the kids I’ve seen suffer from infections as a result of their depressed immune systems. However, most of the adults did not really understand the importance of hygiene. When a kid dropped some M&Ms that I had given him on the ground, his grandmother tried to pick it up off the ground and put it in the kid’s mouth (granted M&Ms are a luxury to them, one that many of the kids were enjoying for the first time, but eek!!!). In addition, I have seem so many little hands (and big hands!) caked with dirt during my site visits that I started to lecture the parents on the importance of cleanliness – on how even simple things like washing your hands more often can make a difference and prevent the transmission of germs and diseases. I also try to emphasize to smokers that they should NOT smoke in the presence of children. Maybe that is my contribution to public health in China, since I can’t actually treat patients.