A tale of two hospitals

It's been an interesting ride these past few days as I get to know my sweet daughter, and in my free time I've been thinking about the ways my care at Tuen Mun Hospital was better, worse, or the same as when I delivered my son in the US.  It's hard, actually, to say which experience was better overall.

Doctors:

US:  in the US I had one doctor, Dr. Keith. he respected all my wishes and whenever there was a conflict between me and the evil nurses, he always had my back.  He made all the right choices, medically speaking, and helped me safely deliver my son.

HK:  During the time I was at TMH, a team of five doctors consulted with each other and me about my "case".  One doctor should have her license removed and be banned from medical practice. The other four ranged from very good to phenomenal.  Once I realized many of my problems came from the one, I asked her to remove herself from my case and I never saw her again, which greatly improved my quality of care and peace of mind.

Nurses:

US: I disliked every single one of the nurses at CHOMP.  They were rude, mean, aggressive, and sometimes downright nasty to me.  No one was anything like your image of the nurturing and kind nurse.

HK: (there are three sections: ante natal, delivery, and post natal, and there are specific nurses assigned to each section) Some nurses in the post natal ward clearly didn't like me and there was some racism going on.  Other nurses were simply too overworked to be anything but as efficient as possible, meaning they were abrupt, but not purposely trying to be rude.  Some of the nurses, though, were simply wonderful.  All the nurses in the delivery ward  were amazing.  I loved loved loved them all.

In both the US and HK, I found some staff to be on some kind of power trip, but this was a bigger issue for me in HK because my cesarean made me far more helpless and in need of care than my regular delivery in the US.  For example, there was one nurse in particular who really enjoyed the power she had to deny my repeated requests to go to the bathroom.  After a day and a half of begging to be able to relieve myself, either by bedpan or in the toilet, I finally got so angry at her and her inhumane refusal to allow me to meet a basic human need of elimination, I tore off my IV and my leg massager, pushed my bed away from the wall and threw myself off the bed to get to the restroom.   Naturally, this caused quite a stir.

 After relieving myself and the adrenaline of my temper tantrum wore off, I realized I was in considerable pain in multiple places and bleeding rather badly.  However, I proved I was no longer immobile and the catheter, massager, and IV were taken away so i could get up and down myself the rest of the time.

Service and mother care:

In the US, after delivery, my son was bottle fed despite my request not to do so because I was breast feeding.  I was pretty much left to my own devices after delivery, and advised to get up and walk a bit as soon as I cold.  Nurses used a fist to punch deeply into my abdomen to "massage" my uterus back into shape.   my son was wheeled into my room to visit me a few times, and I was wheeled into his room to visit him, but I mostly didn't see much of him until the day I was discharged.

HK:  In HK, I was connected to a machine that massaged my legs for two days while I wore special leggings to prevent swelling and deep vein thrombosis. No one in the US cared about that, and I remember my legs and feet doubled in size right after birth and was quite uncomfortable.  However, this time, I only had swelling in my feet, and that was until I pushed the leggings down to my toes..then I had no swelling at all. The uterus massage the nurses taught me in Hk was considerably a kinder gentler version of the gut mashing I got in the US, and was far more tolerable, while ultimately performing the same job of helping the uterus to shrink back to normal.  The nurses tried their best, given extreme circumstances (at night, for example, there is only one nurse to care for over 150 mothers and babies, plus a few other staff), to meet everyone's needs.

Despite the far better ratio of nurse to patient care in the US (1:1 or 1:2), I felt I was generally treated better by most of the staff in HK, with a few exceptions of some people on a total power trip who shouldn't be in the business of caring for others.  I also generally felt my wishes were mostly met better in HK.  I had asked to BF my daughter right after birth, and they honored that as soon as I was patched up.  I asked not to bottle feed while she was away from me, and they also honored that.

Baby care:  here the US probably does better, although to be honest, i really didn't get a chance to witness how the babies were cared for by the nurses, but it couldn't possibly have been worse than at TMH.  I felt so sorry for those babies.  Because the nurse to patient care ratios were so incredibly high, babies were often left to cry until they were screaming in hysterics, and they spent most of the night screaming in hysterics day after day.  Meanwhile, their little brains are being hardwired that their cries don't matter and no one is caring for them no matter how they try to call for help.  This "let them cry it out" method of care just breaks my heart.   I felt very upset and I didn't want my daughter's earliest experiences of care to be that way; so I found ways of "beating the system" so that I was either occupied "breast feeding" or not in the room when it was time for the babies to be returned to the nursery, knowing the staff was far too busy to track me down, or pick her up later.

Food:  Equally crappy.  In the US, you get to choose what kind of crap you eat from a menu of items whereas in HK, you get what you get.  I guess having a choice makes the US hospital better, but only by a hair.

Amenities:

Here the US really outshines HK.  I labored in a room all to myself, which had a couch for my husband to  sleep and relax on when not attending to me. He was allowed to be with me the entire time.  I had my own bathroom which also had a tub and shower in it, which was kept immaculately clean.  I could have the lights off, on , or dimmed as I liked.  There was a baby bed for the baby (which I never used because Kai was in NICU while we were in the hospital).  There was a big screen TV, DVD, and music player to watch videos or play music during labor.  All materials (diapers, towels, chux pads, baby hats etc) were provided to me.  This was not a fancy hospital; this is rather standard in the US.  Anyone and everyone is allowed to visit any time.

in HK, I was expected to provide  everything for myself and my baby.  There are two public toilets, kept as clean as possible when shared by 100 bleeding women.  My room had only 8 women in it, but one of the rooms had about 40 beds.  Despite having about 70 beds, there were also cots put in random places anywhere they could fit, as there were far more women delivering than the hospital had capacity for.  Many postnatal patients were also put in the antenatal room to help with overflow, so the antenatal room also had cots, and additionally many women there who were low priority had to spend their time on chairs instead of beds.  There was one TV which had no sound which played Chinese soap operas.  My husband was not allowed to attend the labor or delivery, despite the fact we specifically filled out a request form for this purpose and was approved months earlier.

Cost:

US: every pre-natal visit to the doctor was 100.  Blood testing was 300.  the shots I had to take for being Rh negative was about 200 I think.  the total hospital bill for me and Kai for three days stay was over 60,000 USD.  Fortunately, the state of CA picked up the bill as I was still a student at the time and didn't have a job or insurance so I qualified for the SCHIP program/WIC etc.  But if I had even had a part time job, I would have had to pay it all.  It would have completely bankrupted me.  And we had a relatively normal run of the mill birth.  All post-natal visits were also about 100.

HK:  every pre-natal visit to the doctor was free.  Blood testing was free. the shots for being Rh negative cost 150 HKD (about 20 USD) the total hospital bill for Kiara and I for 5 days stay was 650 HKD (not quite 100 USD).  We paid the bill in cash and walked out debt-free.  all post-natal visits have been free so far.  I did have to pay 17 HKD (about 2.50 USD) to get my stitches removed.


If I had unlimited money and resources, I would have wanted a very different birth experience, that's for sure.  But given how cheap the health care is in HK, I think the quality of care is rather good.  And either way, I ended up with two beautiful babies, so that's what really matters in the end.

update: Buck up, and get a grip

Last night I went to a private doctor about an hour away to get another opinion on the health of my baby.  I explained to her the the heart beat had been fabulous for 37 weeks and I couldn't understand why it was such a problem now and wasn't there a possibility the problem was with equipment/over anxiety/medical profession need to cut people up driving this issue more than a genuine medical issue? 

I explained I REALLY HATE the thought of getting a c-section, hate it more than words can express, and am willing to undergo whatever procedure necessary to prove we are both strong and healthy enough to have a natural unaugmented birth. 

the doctor looked at me and said, "I'm going to be totally honest with you.  you are obese.  Cesareans are extremely dangerous for obese women for a variety of reasons, much more dangerous for both baby and mother than a natural birth.  Trust me, NO doctor in Hong Kong wants to perform a C-section on someone like you.  You are very high risk for this procedure, and so especially NO doctor in the PUBLIC hospitals want to be the ones to perform your cesarean..it will be longer, harder, riskier, and they won't get paid more for it.  If a group of four doctors in  a PUBLIC hospital are recommending you to get one, they are doing so despite knowing how hard it's going to be for them to perform one." 

I couldn't help myself, and started to cry a bit.  it was so not what I wanted to hear.  But I knew I needed to hear it. On the one hand, it did make me feel better that the doctors weren't being knife-happy cowboys licking their chops at the thought of getting to cut me open.  they were advising me to let them do something they didn't want to do any more than i wanted them to do it. 

On the other hand, i hadn't considered the thought that my cesarean would be any more dangerous than any one else's, but it makes sense.  having to slice through a layer of fat makes it easier to make a mistake and cut too deeply or cut the wrong thing, it makes the sewing up process harder and longer and more at risk of infection.  i will require more anesthesia, which brings a host of it's own complications.  i was scaring myself silly imagining all the things that could go wrong and I started to feel so sorry for myself i couldn't hold back the waterworks. 

then she asked me to hop up on the bed/table thingy and we can at least have a look.  As i suspected, her equipment was significantly more sophisticated then what they had at Tuen Mun public Hosp and I was even allowed to see the baby for myself (somthing the public hosp couldn't be bothered with showing me, despite requests to see for myself)  and i even got pics, something TMH doesn't give out to patients. 

After some time, she told me they were right; the quality and amount of the fluid in the sac was poor and the heartbeat irregular and combined, that indicated a serious enough problem to warrant a cesarean, rather than risk the baby having a cardiac arrest in the middle of labor.  Again, NOT what I wanted to hear. 

She also advised me to schedule one in advance, rather than wait for an emergency cesarean, because in an emergency, I'll be stuck with whomever is on duty at the time, versus a scheduled procedure where they will probably try to find a doctor with a good long record of successful high risk cesareans to take me, to reduce the personal risk to me ( and to the hospital). 


I left feeling awful, worried, and so sorry for myself.  But also more at peace with the procedure, that it really truly is in the best interest of the baby.  My son taught me long ago that it's not about me anyway.  it hasn't been about me for 6 years, and it's not about me now.  I need to buck up, suck it up, and get a grip. 

I need to make a plan and figure out what it will all mean after the procedure is done.  breastfeeding will be significantly harder because we will be separated while I'm being sewed up, and they will be performing diagnostics to see if the heart problem is self-correctable or will need further medical intervention.  She will probably be given a bottle by the nurses at some point.  i know where this road leads.  To combat it, I'm going to have to work very hard, even though it's harder to hold a baby when recovering from a cesarean, harder to get around, harder to do everything the first few weeks.  I need to prepare myself for that, literally, and mentally.

I have another diagnostic appointment at TMH on Monday.  if they tell me I need a c-section, I will accept this advice and do what I have to do.

Finally, the private doctor was able to determine something no one at the public hospital could tell me:  the baby's gender.  So I finally know, just literally days before she is born, that she is, indeed, a girl. 

health in HK part...i don't even know anymore!

Last night I was in the hospital for six hours while four doctors deliberated over whether or not they should slice me open right then and there or if they could wait a week before slicing me open.  meanwhile, i was asking if there was any way I could avoid being sliced open at all. 

You see, I have always sincerely believed women are made to safely carry, birth, and feed human babies, whereas they are NOT made to safely be sliced open, ever.  the more i learn about cesareans, the more I realize how dangerous a surgery it is, and how grave a decision to have one is. 

The thing is, people think about it as being more like rhinoplasty.  Rhinoplasty is a fantastic reconstructive tool when you get into an accident or something goes horribly wrong in fetal development, but most often it is completely medically unnecessary, brings with a host of potential complications, and the person who gets it is often worse off for having had it done.  Who things Michael Jackson's nose jobs did him any favors? 

But the majority of people don't consider these complications and side effects and go into these surgeries as if they were about to get a tooth pulled.  "Hmm....Tuesday sounds nice, I'll get it done before the in-laws come to town and then we'll all have a party!" 

Doctors, too, are far too complacent about cesareans.  basically i think nurses and doctors are knife-happy cowboys who believe cutting people open is the answer to most problems, but somehow they are far more blase (I wish i could make French accents) about C-sections than other operations.  And yet, the 6-8 week recovery period, and the variety of potential complications that are more common than in a regular birth, are certainly nothing to sneeze at.

And yet, when truly medically necessary, operations are life savers.  So i was trying to determine if my baby's irregular heartbeat, which had been regular and strong and perfect for the past 37 weeks, was truly a medical emergency or if it was a temporary glitch in the heart-brain communications department and would sort itself out on it's own.   We listened for hours, and watched on the ultrasound, and switched machines several times to make sure it wasn't a glitch in the machinery, but truly, the heart, so perfect until now, just couldn't get it's act together. 

of course, i wanted to know why a perfect heart would suddenly be a problematic one, and they didn't know.  I asked if it could self correct, and they said it's possible, but they didn't know.  I asked how many babies with irregular heartbeats survive normal deliveries and they didn't know.  What they DID know is that sometimes babies with irregular heartbeats DIDN'T survive normal deliveries.  Why is it doctors never know when you ask them how normal something is, but always know when you ask them how abnormal something is?  Why all this bias for the abnormal? 

Google wasn't any more helpful.  i found lots of literature about how babies with irregular heartbeats are delivered by cesarean, but i couldn't find a thing about whether this was necessary, how often it self-corrected and made c-sections unnecessary, or how many women delivered happy healthy babies naturally anyway.  I want to do what's best, but it's hard to know what's best when you are only given one side  of the argument. 

the other issue is that there is almost no amniotic fluid in the sac, just like with Kai.  i was disappointed to hear this, because my experience with Kai and his dehydration taught me to really go wild on the liquids, and I've been drinking crazy amounts of water/fluids  for all nine months,  and was told last night the amount of water I drank had no influence on the fluid levels of the amniotic sac; it all depended on the health and general condition of the baby.  it was the combination of the poor amniotic sac condition and the irregular heartbeat that concerned the doctors.

I do have to say, I feel better that four doctors and three nurses consulted together and watched me for hours before concluding a C would be best.  And they laid out the options: 
1.  have a c section/induction right there and now and let them have at the baby. 
2.  Wait a week and see if it self corrects, then have a C section, or an induction ( i also am opposed to inductions, because I had this done before and I know what utter crap that turns into)
3.  Wait two weeks, but if it does not self correct, i will not even have natural delivery as an option.
4. let the body progress naturally, natural onset and delivery in 2-4 weeks time, but if the heart has not self-corrected, the likelihood is high that the baby would not survive the stress. 

But even so, I would have liked at least one of the doctors to have been older than I.  Someone who had delivered 1,000 babies and had seen everything and knew what the real range of normal looked like.  Just because something isn't textbook perfect doesn't mean it's abnormal, or dangerously different.  I'm going to try between now and next week to find someone with a little more experience assess the situation and tell me honestly what is necessary and what is not.  And find my peace with whatever I need to do.

What is the world coming to?

In China, if you hit a person with your car and kill him or her, you pay a fine.  This fine is apparently far cheaper than the cost of ongoing care you must provide if you simply injure the person, so it is economically far better to kill a person you've hurt rather than try to rescue them.

This is why, says a Chinese driver, he ran over a toddler TWICE...to make sure she would be good and dead in case he got caught and had to pay her parents for killing her.  

Oh but this is just the beginning of the story.

In China it is a fact of life that you are always being watched.  Of course, CCTV caught the act, but the video continues to roll.....to reveal no fewer than 18 people looked at the half dead whimpering bleeding child and kept right on walking.  After 7 minutes of passers by casually walking by, the child is hit by a second truck who probably honestly didn't know the crumpled mess in the road was human.  It was after that time that a bag lady pulled the limp body out of the gutter.  And then the mother comes on the scene, screaming for her baby.  

There are so many elements to this story that seriously upset me.  How come it took the mother at least 8 minutes to arrive on the scene?  Where the hell was she?  Why was this toddler crossing a busy street alone?  Why did at least 18 people (on the camera) pass her by, looking right at her, without at least pulling her out of the road...or calling the police or an ambulance for that matter?  Why did the first driver hit her, stop, and then run her over a second time with his back wheels to make sure she was good and dead, preferring to consider his wallet over the life of a young child?  

China news reports say she is alive in critical condition.  Outside news agencies have proclaimed her brain dead and not likely to survive.  It's amazing she is not already toe tagged, and a tribute to the incredible resilience of babies... but even so, it's hard to imagine her little body ever fully recovering.  

As a parent (and a pregnant one at that), I have so many emotions...anger, mostly, but also fear for the safety of my family.  What if something happened to my husband while he was wandering the streets with my baby and no one helped him or my child (who of course couldn't help much himself and would be in danger as well without an adult watching him)?  And a deep deep sadness and feeling of despair for humanity in general. 

Because in all honesty, I can't say for certain this would never happen in the US, or anywhere else, that this is purely a Chinese problem.  I remember my Freshman year in college in Social Psych class learning about the Bystander Effect whereby the more people witness a horrific event, the less likely anyone will actually help a victim, as everyone simply waits for someone else to do something.  With 7 billion people in the world, that's alot of witnesses doing nothing at all.  But then, in philosophy class, I was told humans created a social contract to live together in order to protect themselves, seeking safety in numbers.  Are we as a human race safer alone or as part of a community?  

Many psychologists claim that one of the reasons mental disorders are on the rise is because we have become too isolated, even as we are more connected by the internet.  Yet the more we live with each other, the less likely we are to connect with each other.  Humans are full of paradoxes and nonsensical behavior.  I fear this incident, horrific as it is, is probably well known only because the Chinese Big Brother always has his eye on the masses, and so these events are recorded for others to watch and feel horrified.  I earnestly believe there are millions of people who died because their murderers would rather deal with a dead body than an injured one.  Who died in front of others who simply couldn't be bothered to step in and save them.  

Go ask Shanda Sharer, Kitty Genovese, any German over 70 years old.... the list goes on and on.

The Horror.  The Horror.

* Update: Oct 21, 2011: Little Yue Yuem, 2 years old, has passed away.  Shame on China.  I hope you do a lot of soul searching and honor her memory by treating someone else with more compassion. 

I love the renegade doctor!

Last week i had yet another appointment at TM hospital.  I see a different doctor every time.  this one i really liked, although he probably isn't popular at the hospital. 

When i went in to the room to see him, he did his prodding as per usual, checking the heartbeat, and then we got to business.

"According to the schedule, you need a glucose tolerance test.  how about next week?"

"But, doctor, i did that test already.  I'm fine."

"however, it is policy that we test you regularly for hypertension and diabetes because you are overweight"

" there is no family history of hypertension in my family, or diabetes.  i never had those problems with my first child. the urine samples are always perfect.  the glucose test makes me very ill.  And my blood pressure has been consistently under 120/80 this whole time. "

"that's true.  there is no medical reason to do these tests, so if you don't want them, that's OK."

Wow, a Chinese doctor that chose to listen to reason rather than follow protocol blindly! Hallelujah!  then he said:

"Your next appointment is in two weeks"

"In America, I only ever had appointments once a month.  Why do i have to come here so frequently?  this has been a very normal pregnancy and i hate having to take so much time off work."

"Well, there is absolutely no medical reason to have you come in so frequently. it's just hospital policy.  if you would rather wait 4 weeks until the next time, that's fine."

Woot!  Nothing but net! 

"But since you are Rh(-), you DO need to come in and get a shot of Rogain in a few weeks.  how's Monday the 31st of October?"

"Well, actually, Mondays are my most busy days at work, whereas Tuesdays I have much more free time.  it would be less troublesome to my school if i came in on Tuesday"

"OK, Tuesday it is then."

In all my time here in HK, I have never ever met a single person willing to actually decide something based on logic and reason, and here I was having a rational negotiation and won 3 out of 3!  this may seem like nothing, but every time i tried to make a request to skip a test or do a test on a different day, I have received nothing but grief, over and over, and never have i been allowed to choose when and how things get done.  Such is public hospital care here. 

i was so astounded by my good luck i forgot to ask him for a sick note to give to the office staff!  i was simply floating on cloud 9 i was so happy to find someone who would listen and respond to my needs...

if i thought he was going to deliver my child, i would be far less stressed over the whole delivery thing.  I know he lets people decide things based on rational discussions and reason, and personal preference, not on just what the rules are (which he agrees are arbitrary and not even medically based)......and that's just the person i want to work with.  If he told me I needed a medical intervention, i would be more willing to trust it's because it's necessary and not just because it's policy.   Too bad you can't request your doctor in public hospitals here.

But boy I bet he's not liked at the hospital.  He's probably considered a troublemaker for being able to think for himself and allowing patients autonomy.   he'll probably be fired by the time I go into labor.

  It's funny how the very same qualities some cultures admire are the ones other cultures despise.....

Not quite human

My friends and I have been cackling over some Internet research I've been up to.  There are some wacky people on the Internet.  But the research is so interesting, I feel the need to share.

In the US, I discovered when i was pregnant with #1 that my blood was Rh(-).  Since my husband is Rh(+), this required, for the health of my baby, me getting a couple of shots in my butt of Rogaine (yes, it is truly called Rogaine) to keep my body's immune system from killing the "virus" it mistakenly thinks  an Rh(+) fetus is.  In the US, this was not considered a big deal, and was a 15 minute procedure.  However, in HK, this is considered a huge deal and is an 8 hour procedure.  having a bit more time on my hands than I have had in the past 6 years, I decided to finally research what being Rh(-) is all about. 

First, a little science...and then the comedy.  Humans have known for over 100 years that there are different types of blood, A, B, AB, and O.  this is quite common knowledge.  then about 50 years ago, it was discovered  blood has a special protein in the red blood cells called Rh.  it was mistakenly believed the protein came from the Rhesus monkey, and was named Rhesus factor, but after this was disproved, it was shortened to Rh. 

In Africa, Asia, and among native tribes with zero mixing of Europeans, the population is 99% Rh+.  Being negative is kind of a genetic mistake, like Downs Syndrome or Albinoism, that certainly happens, but rarely. However, Among Western Europeans,  some populations are as high as 35% negative.  In the Americas, where everyone mixed with everyone, it averages out to be about 10% of the general population, albeit still slightly higher for whites than other races.    While it can be said to be a genetic aberration among some populations, there is clearly something going on beyond chance for so many European descendants to be negative, or absent this human protein. 

Many believe this means Rh- folks are not quite human.  Ok, let the crazies out of their pen, give them a computer, and let the fun begin!

One theory is that negatives are descendants of those who mixed with aliens (you knew this was coming, right?).  As aliens mixed, their blood, which didn't have the human protein, caused problems because alien or part alien females recognize their human fetus is not in the same species and systematically kill it.  This might be true for me. I've always felt a little *different* and I've always enjoyed Star Trek, as did my mother, who was also probably negative. 

Another is that humans are part reptile.  Because, obviously, reptiles don't have this protein. 

Another is that Angels mixed with humans, invoking biblical references i never heard of before and don't quite understand. 

Another is that Neanderthals, who resided in Western Europe at the time of an early modern man  migration from Africa to Europe, didn't go extinct at all, but when they mixed their negative blood with positive Man blood, sooo many babies were not born as a result their population dwindled and eventually disappeared.  Being negative is a sign of being at least partly neanderthal, or other humanoid subspecies that was thought to have gone extinct along with the rise of modern man.  there is actually some science to back this one up; a recent discovery of a half breed skeleton which is partly modern human and partly Neanderthal several weeks ago actually seems to show some proof there was a time of mixing between humanoid species.  And it would explain why concepts that some so easily for most people, like addition subtraction and spelling, are so darn difficult for me.

Another is that negative blood is more "pure", in that these modern humans broke out of Africa before the Africans developed the protein, and that Africans, aboriginal people, and Asians (who left Africa in later waves) are actually mutated versions of humans resulting from mixing with monkeys (based on the mistaken original idea of Rh coming from the Rhesus monkey, even though that was long ago debunked).  Oh wouldn't Hitler have liked to have known about that!

Another angle is that being negative was a survival strategy for Europeans during times of plague and disease.  Rh(-) folks seem to have a scientifically proven  resistance to certain lethal bacteria like trichinosis, found in raw animal meat and feces.  this theory stretches the idea that perhaps the genetic mistake of being negative turned out to be a Darwinian winner in the face of several European plagues that wiped out most of the Western European population, and possibly at one point most Western Europeans alive were negative; the Super Humans who could walk amongst the dead and dying unharmed.   However, since a negative woman can't bear more than one or two positive babies before her immune system goes on the attack, eventually the number of Super Humans decreased to today's numbers. 


My husband, being Rh+ is clearly human.  My status is not so clear.  Apparently I'm not quite human.  Thus, the flurry and concern over my human baby's well being at Tuen Mun Hospital.  I guess this is just what one has to put up with when one marries outside of one's species. 

Or it could all just be a genetic mutation, like other genetic mutations, that can get exacerbated when too much inbreeding occurs.  But that's not nearly as fun to write about. 

What's your theory?

Health in Hong Kong

So far, these entries have been about me, because I've been the only one who needed care in HK!  But today's episode is about my five year old.

This Saturday my son fell on an escalator and the teeth of the steps ripped a nasty gash in my son's bare legs (it's still very hot and humid here). Busted open and bleeding profusely, I debated whether the leg needed stitches or not.  Since there was a clinic right next door, I decided to go and see what the clinic doctor said. 

In HK, there are two ways to get health care.  a private doctor charges about 300 dollars (and up), and typically the wait time to see him or her is between 20 minutes to an hour, depending on the number of people in "line" before you.  Alternatively, you can go to the hospital, where the charge is $100 for care, but you can expect to wait several hours to be seen.  In my local hospital, the triage room is the same room as the regular patients.  So the patients who are a little sick and waiting are sitting right next to the dying on gurneys (who are also waiting).  This may explain why Tuen Mun Hospital  is described as "the war zone," as typically the dead and dying are at least separated by a curtain or something from the rest.   

I remembered once I had a head injury and I thought I needed stitches.  After waiting at Beth Israel Hospital for 3 hours, I was finally seen and told I certainly could have benefited from stitches, but you have to get it done within an hour or your risk of infection outweighs the benefits of stitches.  So I opted for the private doctor, where I hoped I would be seen early enough to get the stitches, if necessary. 

I brought my son to the doctor and registered him.  a man got up from his spot on the couch to let my boy sit down and rest his leg.  the manager of the mall found us and collected my details and gave me her details so I could claim the cost of the doctor with the mall's insurance company.  While i was talking outside with the manager, Kai was half passed out and nearly falling off the couch.  Another man moved from his seat to sit next to my boy to prop him up and hold him back from the edge so he didn't fall while I was outside.  Everyone told the nurse they wanted Kai to be seen before them, so we got ushered in after only about 10 minutes. 

the doctor cleaned up the wound.  it ran the entire length of his shin.  Most of it was a surface scratch, but we were concerned about a couple spots where it was quite deep.  Finally, the doctor decided stitches were not necessary, cleaned the wound some more, and bandaged it up.  he asked us to check the bandages in two days and if it was infected, to return for more assistance. 

Two days later, the wound still looks simply awful.  I think he should have gotten stitches after all.  I don't know why the doctor didn't stitch him up.  It's going to be one hell of a scar. 

Tomorrow, joy of joys, i get the spend the ENTIRE day at TMH, because they are worried my Rh(-) immune system is attacking my Rh(+) baby.  I will be seen as an inpatient.  I hope that means I get a bed so I can at least relax with a book for the 10 hours they expect it will take to do everything.   

It finally clicked.

My husband's been pushing me for years to identify something I'm passionate about and publish something about it. 

 I like to write, I like to research, I like to present (what teacher doesn't like an audience?)  but I never felt strongly enough about anything to make the effort.  Like most of my colleagues, I was surprised when I started attending conferences how easy it was to do a presentation....we all say " gee, I could do that!" but my problem was not that I thought I couldn't, but I didn't care enough to want to. 

Especially the past 4 or 5 years, I have been feeling particularly passionless about just about everything in the TESOL field, and lately I have been wondering if I'm in the right field at all.  I like what i do, but i thought I had lost my passion for it..I don't LOVE it, and if you don't love what you do for 10 hours a day, you really should get out, especially when your work is with other humans who depend on you for something. 

But I realized this morning, I HAVE had a sincere passion all this time and just never really connected the dots.  Not only do I have a passion, but it's a passion about something that as far as i know, is a HUGE gap in the entire field of education.  And I really don't know how it's possible that I could have been saying I had no passion for years and years when I did, all along. 

As an undergrad studying Early Childhood and primary school education, I realized teacher education courses spend no time, or almost no time, specifically talking about the unique needs and considerations of ESL children.  My activities with my native English speaking students didn't go over so well with my ESL kids, and i didn't know how to fix that. 

 While obtaining my MA in TESOL, and in talking with others who got MAs at other universities, or certificates at any one of the dozens of TESOL certificate courses available worldwide, I realized TESOL education classes, generally, spend a great deal of time on adult second language acquisition and adult motivation and adult-centered themes and issues, but unless you are taking a specific class on teaching children, very little or no mention is made of the unique needs and considerations of teaching young EFL/ESL learners.  Most people get general teacher education or general TESOL certifications, so the majority of educators have no idea what to do with young ESL learners. 

the problem is that general ECE courses are very good at explaining how and why children are different from adults, citing child psychologists and researchers like Erikson, Piaget, Bronfenbrenner, and how their brains are fundamentally different and the best practices for them.  However, they do not deal with second language or dual language acquisition issues. because it's assumed little kids just "pick everything up easily and naturally' so there is nothing special to consider about them, which is totally untrue! 

On the other hand, TESOL education courses assume the majority of its graduates are going to go into adult education, higher education, or at least secondary school. They are very good at explaining how the brain processes language, but overlook the fact that the adolescent and adult brains are fundamentally wired differently from the young child's brain.  However, because research has conclusively proved that the earlier the better in terms of SLA, parents and governments are increasingly expecting their kids to start English education in ever earlier grades, and in many cases, from Kindergarten or even infancy!  there is a huge market for teachers willing and able to teach young children, so many TESOL grads end up working with very young children. 

After a period of trial and error, many figure out what seems to work, but I have seen some shockingly developmentally inappropriate educational practices conducted by even long term veterans.

This bothered me so much in Japan, I conducted no fewer than 8 or 9 workshops on the topic.  it bothers me so much in Hong Kong, I don't even want to be a part of the massacre of the young mind.  There is a systemic problem, starting with the very top people in government, that absolutely no one truly knows or seems to care what is appropriate or even possible for pre-operational and concrete operational thinkers.  it's like even 4 year olds are expected to be able to learn like 14 year olds.  Since HK seems to score at the very top of international standardized tests, no one seems to have a problem with it; whereas i was warmly welcomed to give workshops on the topic in Japan (who recognizes they have a problem in their educational system), no one is in the least interested in my soap box efforts in HK. 

it's shocking, considering the number of general education teachers who end up teaching ESL children, and considering the number of TESOL certificate grads who end up working in primary schools and kindergartens around the world, that more attention is not paid to this very important area.  it seems there are a lot of myths about teaching children that are so pervasive, no one even thinks there is a problem. 

Myth 1: teaching children is easy
Myth 2: children are chock full of motivation and enthusiasm all the time
Myth 3: children are sponges and absorb everything (that's almost true, but they forget just as quickly as they learn for a variety of biological reasons, and there are variety of factors that influence just what, if anything, they absorb at all)
Myth 4: children only need exposure to acquire language ( this is based on baby brain research and is true for pronunciation, but not other features of language acquisition)
Myth 5: you can teach children to read English the same way you teach them to read their native language OR
Myth 6:  it's a bad idea to teach reading and writing to children; oral fluency is the only important part. 
Myth 7: techniques that work with one age group can still be effective with another age group
Myth 8: Homework is an effective tool for revision for pre-adolescents and young children.


There are other common fallacies, mainly corollaries and associations with the above myths, but these attitudes result in teacher education courses severely lacking in direct instruction on how to work with young children in the ESL/EFL context,  I think this is a shame because there are some genuine benefits to starting language education early, as long as the language education is done appropriately.  Thus, many parents and community leaders are introducing their kids to ESL/EFL study at earlier and earlier ages, using teachers who are learning how to teach youngsters by trial and error, without any real understanding of both childhood cognitive development and second language development. 

I've actually been rather passionately discussing these issues for years without realizing it was something i was passionate about.  How did that pass me by for so long? 
But it finally clicked. 

I'm so glad to learn I wasn't as dispassionate about TESOL as I had been thinking I was.  I was stuck in this mindset I needed to be excited about an adult-oriented topic.  But i am positive i can and should pull the things i learned in early childhood education classes and TESOL classes and find ways to help teachers of young ESL children, a large and growing segment of the TESOL field.

Biskey, the Dream Teacher

Biskey, the Dream Teacher

Today I took my son to KFC.  I like chicken, but only the breast, and usually in HK when I order, I never get breast, despite repeated requests for it.  Today, as usual, when I tried to order, the woman insisted she was giving me breast, when I knew it was thigh, and sure enough, when I sat down, it was thigh, which I dislike. 

Disappointed, I tried to find a way to deal with my disappointment in a positive way.  Rather than blame the worker for not understanding me, I said, “Kai, this is my problem.  I only like breast meat, but I have never learned how to express this in Cantonese.  I can’t be upset because I need to learn how to explain myself better in their language.  But I wish I were eating breast right now.”   

Kai surprised me with an entirely different point of view.  “You know Mommy, the important thing is that you have food to eat.  It doesn’t matter if it is thigh or breast; at least you have something to eat and enjoy.  That’s what’s important in life. 

"It’s like when I wanted to play in the park when we went to “put-put” golf.  I really wanted to play there more, but we had to go someplace else.  At first, I was disappointed because I wanted to enjoy it more, but then I realized that the place we were going might be just as fun, so I decided to look forward to the new place rather than feel sad about leaving.” 

“And you were absolutely right, weren’t you, Kai?  We went to my friend’s house and you made a good friend and played with him all night and really loved it there!” 

“Yeah, so I learned it’s better to think about what the good points are instead of feeling bad about the sad points.” 

Now, I am a bit of a pessimist, and any effort I make to look on the bright side of things is usually a concerted effort on my part.  I have been trying though to be more positive in my thinking.  I had thought it was a positive thing to say the problem was mine because I need to communicate better, but Kai one-upped me with his belief that I should be grateful for having any food at all.  Just as he surprised me the day at the park, when he decided that he wasn’t going to feel sad about leaving, because the next place might be just as fun.  I was pretty blown away by that mature comment that day as well.  

He really surprises me with his wisdom sometimes, far beyond his years. 

So I asked him, “Who taught you to have such a wonderful attitude?”  (thinking he would say Daddy or somebody, but his answer completely surprised me.)

“I learned it in my dreams.”

“In….your….dreams?  And who teaches you?”

“I don’t remember her whole name; it’s pretty long.  But it’s like Biskey.  She lived in Japan.  And then moved to South Africa, but she didn’t like South Africa much, because she was always being chased and she was tired of running, so she went back to Japan and now she’s in Hong Kong.  She teaches kids, and babies, how to do things, like taste and smell and enjoy.  She made a class and I’m in her class.  I talk to her a lot, in my dreams. She knows English too.   I learned those ideas from her. 

She looks like a big tree.  At first, I thought she was a tree, but she isn’t.  She’s a girl.  And she is always teaching me things.  She has been teaching for a long time.  She taught you, Mommy, when you were two years old.  She taught you how to love.”

Kai looks at me with shining eyes, and rocks back and forth in his chair as he eats his chicken, grinning ear to ear. 

I don’t know what to make of this story.  Part of me really wants to believe there is a Biskey in the world, teaching children how to love and think positively.  It was a pretty elaborate story to come up with off the top of one’s head.  If it was just a story, I’m pretty impressed by the elaborate story scheme and character development.  If it’s true…..there are certainly stranger things in this world.  

Who would Biskey be?  A dead relative?   Many people in my family, including myself, have a gift of communicating with the dead in our dreams.  Has this gift been passed on to my son? 

Could it be an Angel?  Most religions have angelic figures in their mythology, and there is no reason to not believe that there are probably life forms on Earth living in a different plane of existence, which we have called gods and angles, for lack of a better name.  It’s cool to think there is an angel that instructs kids in their dreams how to live a positive life.

Anyway, thank you Biskey, whomever or whatever you are,  for teaching my son such wise and wonderful concepts.  Hopefully, through him, I can learn these lessons too. 

Or re-learn them, apparently.  

Death and taxes

There is a famous saying that there is nothing certain except death and taxes.  This year, I've managed to avoid both until now, but my overseas 6 month extension on US taxes is nearly over, so I had to sit down and bite the bullet this weekend.  Know how long it took me to do my damn taxes this year?  8 hours.  8 HOURS!  That's a whole freaking work day!  I had to file for both CA and Fed, of course, and there is a grand total of 25 (25! I wish they had caps for numbers!) pages of forms now sitting on my table.

in addition to those pages I had to print to send in, there were literally hundreds of pages of explanations how to do the forms, opened up in different tabs on my computer because I had to bounce between forms.  The 1040 alone was 179 pages long!  Then there were tabs of tables.  The calculations were long and tedious.   For example, this is what you have to do if you have a child:

If you have a child, you can get a credit for child care expenses.  I paid 6K on child care expenses.  I can take up to 3K in a credit.  But then, you have to multiply that 3K maximum by .20, .21, .23, .25, up to a maximum of .35 depending on how much you earn.  Then you have to list the smaller of your salary, your spouse's salary, or the credit, and that is what you can take as a tax break there are 3 pages of forms and worksheets necessary to calculate all this.   Then you can take a child/dependent credit.  There is a whole 4 pages of worksheets you have to do to get this credit.  After this credit is worked out, you can take an ADDITIONAL child credit.

This is calculated by
1. start with 1,00
2 enter amount from line 51
3enter amount from line 32
4 subtract 3,000 from line 4a and multiply THAT by .15
5. enter the smaller of line 3 or 6, put on line 13, then put that on line 65
(this is the easiest of the calculations with the fewest number of steps, so the only one I can be bothered to write down). 

Everything is like that.  there was a worksheet for every line, and every line, and my tax form has 77 lines ( some with a's and b's).  No wonder people do this as a full time job.  One return can take an entire working day to do!

Basically, the government's tax tables charge the people about 12% of their income per year.  But this is over and above the 10% they take out every paycheck for medicare, social security, and CASDI. THe state also gets its cut, from each check AND end of the year. 


I asked my husband why in Japan I never did taxes.  He said it's because the city office (who knows EVERYTHING about you in a very big brother way) already knows all your particulars, so they calculate it for you and take it from your salary and you never even see it.  Most companies know this, so they pay a little extra to employees so the salary they quote you (say, 4 million yen a  year) actually IS the salary you bring home, because you were paid more and that extra was taken out before you saw it.

Imagine, getting paid what you were actually quoted.  I once had a teacher at my school that was shocked at how small her paycheck was and thought I had made some mistake.  I calculated her salary with her, and she said "Wait, you quoted me a salary BEFORE taxes?"  In the US, honey, that's what we do.  We tell you you are going to earn 20.00 an hour, but in reality, you will only be bringing home about 16 of that, and then at the end of the year, you will get taxed on 12% of that, even though you live in the #2 most expensive area in the US, and 16.00 is minimum wage there. 

In Hong Kong, I received a short questionnaire two months ago.  It just asked me who my dependents were, how much I made, if I own property, and about 10 other questions.  It took me about 10 minutes to read over and fill out.  I mailed it back to the government and I will be getting a bill someday.  It's basically 16% of your income, less credit breaks for dependents, but they sort it all out for you and just send a bill.  If you are curious, you can use an online calculator that has all the formulas loaded on it, enter your details, and it tells you what bill you can expect to receive, in case you want to prepare in advance.

Since it's so straightforward and transparent, people usually know what they are in for and put money away every month in special bank accounts especially designed to hold tax money, which pays interest, so at the end of the year, they get a small bump due to the interest.  NO 25 pages of forms.  No tedious calculations. No entering this line on that line and reading 500 pages of explanations how to do the forms.  A short questionnaire, an online calculator, and a bill.  Much less scary big brother than Japan and much less gut-wrenching than the US.   I hate hate hate doing US taxes.

It's all a bunch of crap, too, because most of it is designed to help people find a way to pay less than they "owe"; if you are willing to take the time (or pay someone to take the time), there are all sorts of loopholes and special worksheets to help you not have to pay your fair share.

For example, this year, I got a credit for moving out of the country AND I got a credit for my overseas living expenses; not just the cost of rent, mind you, but all utility bills can be included too. For HK residents, this is a whopping $114,000 credit ( more than people living in Tokyo). I'm happy to take it since it's there for me, but I feel weaselly, because what the hell?  I never got a credit for living expenses while living in the US, but why do overseas Americans get such tax breaks?  Oh, because the diplomats and military folks live overseas.  Can't make THEM pay taxes.  Why can't Americans get a credit for living expenses if they actually live and work in the US?  Why do Californians and New Yorkers get taxed the same as those living in Arkansas with 1/2 the cost of living?   It all total crap designed to help special interests.  I may be benefiting from them this year, but it still pisses me off as a tax paying American that people who don't even live and work in the US get these special considerations, while the people who do live in the US don't get them. It should make you all mad too.  The US is just crazy, crazy, and it's never going to end until the corruption is rooted out, and that won't happen as long as we allow lobbying to be legal.

That's my rant of the day.  Hope it makes you mad too.  As I've said about so many other things, it doesn't have to be that way. 

Health in HK: Part 3

Today I went to the hospital for yet another check up.  I had two tests today.

The Glucose Tolerance test is a bit of pure hell.  After fasting for 10 hours, you have to drink a cup of syrupy sweet water, and then wait two hours and get your blood checked to see how your body tolerates consuming nothing but sugar for 12 hours.  I can tell you, I don't tolerate it at all.  In fact, both times I've been pregnant, I've had a particularly hard time eating anything sweet, and generally avoided fruits and sweets the entire time (even carrots and sometimes tomatoes proved too sweet for me with Kai, although veggies don't seem to bother me much this time).  Even a few grapes can make me terribly ill.  So imagine how I felt having nothing in my stomach for 12 hours except this horrid sugar water!  Ugh. 

After hanging out in the hosp for three hours, feeling terribly ill, the lunch trays went by and that really set off my MS alarm.  Desperate, I begged the nurses to either discharge me (the blood had been taken and all I was waiting for was my discharge papers, which apparently needed another hour to process for no good reason) or let me wait for my discharge papers in another room that didn't make me wretch.  They refused to do either, so I left. 

I had a few hours between appointments, so I ate lunch, went home, and took a nap and groggily schlepped myself back to the hosp. for my 4:00 appointment.  As you may recall from former Antenatal visits I've blogged about, this usually takes about 3 hours, only 10 minutes of which I am actually receiving care.  I was prepared to be there until 7:00 or so. 

Joy of joys!  I started the process at 4:00 and was finished, waiting for the elevator, and texting my hubby that I was done at 4:21!  20 minutes, start to finish, and that included taking time to pee in a cup and everything (I didn't bother to collect my own pee at home since I was at the hospital all day).  AND they even gave me my discharge papers from the other section that I hadn't waited for in the morning AND had set up another appointment (actually two, two weeks apart). 

Considering how awful I still felt from the glucose test, I was entirely grateful for this expedient service.  I wish it were like this every visit. 

And I'm Back!

I just returned to Hong Kong from nearly a month in Japan.  I spent most of that time happily visiting friends and family; and although it's never good to compare countries, because there are so many factors making it more like comparing apples to oranges, I compared to HK all the same. 

HK is by far a cheaper place to live.  It was hard to justify buying anything because we knew we could get the same thing for a fraction of the price in HK.  The only thing about HK more pricey than Japan (at least where we live) is housing.  for example, we live in a very cramped apartment for about 1,000 USD per month.  By HK standards, this is extremely cheap (most places start at around 2K per month USD, for smaller space than what we have) and actually quite spacious.  Most Hk people fit 10 people in the space we three share.    However, my friends in Japan rent an entire house for about that price.  HK has officially beaten Tokyo for the dubious honor of most expensive housing in the world. 

The salary paid to teachers in HK is also far superior to the salary paid to Japanese teachers in equivalent areas.  Considering how cheap everything is in HK compared to Japan (except housing), and the lower tax rate, that means teachers in HK enjoy more money in their pocket than in Japan.  If money is your thing, HK is a good place to be. 

And that's about it for the pro-HK side.  EVERYTHING ELSE is better in Japan.  You name it, any subject, any concern, any issue, is done better in Japan than HK. Even the sensitive topic of treatment of foreigners, when looked at holistically, Japan noses ahead, by pure virtue that their obnoxious attitudes are a result of thousands of years of global isolation and not because of any intentional malice and contempt. 

(To be fair, I think HK people's malice and contempt partly comes from British colonialism and many expats deserve such contempt, as they act in ways that make me disgusted and ashamed of being part of this expat group.  On the other hand, their nefarious and vile treatment of non white expats (south east asians in particular)  is beyond defence.) 

Even my morning sickness was better in Japan.  i was sick about 2-3 times for about 45 minutes each time the whole month I was in Japan.  However, I have been sick all day every day while in Hong Kong.  the day I arrived back to Hong Kong, I went to a local mall to eat dinner because we had no food in our apartment, and puked all the way there and have been sick pretty much all day every day the whole three days I've been back. 

Is it psychological? Why would i be sick only in HK?  Am I showing my rejection of HK through a physical rejection of food?   Yet my son and husband also feel worse having returned, due to the increased heat, humidity, bad smalls everywhere, and pollution.  Being pregnant, I'm just more sensitive to the poor environment than they are. HK is no place to grow a strong healthy baby. I grant there may be a case for calling my MS psychosomatic, but I think it is actually a very real attempt by my body to try to warn me about the poisons in the air, food, and water and how it is affecting my baby. 

Apples and oranges.  Compare and despair (a Stuart Smalley no-no).   Yet, weighing the pros of Hk and Japan as honestly as I can (being a third party expat in both), I believe Japan is far superior in every way that is important to me. 

But oh how i wish I wish I wish Japan paid it's teachers as well as HK. 

And so you may be wondering how the good ol US of A stands in this match up?  it's hard to be objective of your native country, where your standards of norms and expectations are derived. I'm not even sure it's possible to make an honest evaluation of your native country.  Certainly,there are things about the US that are EASIER for me to navigate and comprehend, but easier does not mean superior.  Probably, head to head in the areas I care about (education, health care, society, child welfare, equality) japan does do better than the US, or at least not any worse.  There are probably other areas I don't care so much about that the US does better; but in these difficult economic, political, and socially unjust times, there are hardly any bright spots worth boasting of for Americans, whose constitutional rights are being violated, with their consent, on a daily basis. 

Like a child of a dysfunctional parent, i love my mother country and would willingly and instantly forgive her if she made any real effort to change her ways. But i also see her for exactly what she is and am not interested in calling her home as long as she continues to act in ways that makes me ashamed to bring my friends and family over.

So while in Japan, Mabo and I made a critical decision: we will move, permanently, to Japan after I complete my obligations in Hong Kong. At least permanently for the foreseeable future.  The question is: can this globetrotter ever permanently live anywhere?  I don't even know if it's possible for me.....

Care in HK Part deux

Well, an update to my adventures navigating the system in HK is long overdue, since I have had two visits to the hospital since I last wrote. 

the first visit was to the local maternity clinic. There, I spent the entire morning....over 3 hours.... mostly waiting while mothers and babies swarmed around me in a knowingly way, like ants in their anthill.   I waited in a line to see the receptionist, whereby she gave me a cone shaped cup to pee in, as i had inconsiderately not bothered to collect my own pee to bring to the clinic.  Imagine having to pull your pants up and get things zipped and buttoned while holding a cup of pee you can't put down because it has no flat bottom.

then i waited an hour to get my blood pressure checked, weighed, told i was fat (who knew?)  and told my pee was fine.

then i waited another hour to meet the nurse who gave me a few sheets of paper, answered a question, and took 6 viles of blood.

then an hour later i got to see the doctor, who poked my tummy a bit, took a listen to the heartbeat, and told me I would have to go to the hospital, right away, as in right now.  Because I was RH negative, and they couldn't handle special cases like me. 

then i waited 20 minutes to get my discharge papers in order, and was given a brown packet of paperwork to give to the hospital, which the clerk stressed i must to that very day.  so i went to the local hospital.

I waited 20 minutes at the elevator, just to get a ride to the Ambulatory care floor, as there were about 100 people in front of me waiting to use one of the four elevators in operation.  Once i got there, i waited an hour in line to see the receptionist, one of four receptionists who all seemed to be working very hard to process everyone as quickly as possible.  the receptionist processed my paperwork and told me when my appointment would be, two weeks later. 

"Two weeks?  but i was told i needed to get here today!" 
" well, if you hadn't come here today, it would have been more than two weeks. it was good you came as soon as you did.  you need more blood testing, an a glucose test to make sure you are not diabetic."
" I was told my pee was fine!"
"but you are obese, so you might be diabetic.  You need a glucose test."
Geeze. 

Instead of waiting in line to go down the elevator, i thought i would be smart and take the stairs.  however, two flights down, i realized the stairs didn't go outside and i was in a restricted area.  back up the stairs and back waiting for the elevator.  I hope I'm never in a fire in that place. 

A whole day lost.  By the time I was done waiting in line, my work day was done and i just went straight home.  I remember when i was pregnant with Kai, the doctor and nurse did everything these doctors and nurses did, in about 15 minutes.  The one time i had to wait was when the doctor was late because he was delivering an early morning baby. 

Two weeks later, I arrive at the hospital.  I wait in line for the elevator, and register myself with the receptionist, and take a seat.  This time, I bring my very own jar of pee.

the rules for pee are very strict.  you must use the second pee of the day, not the first.  you must not eat between the first and second pee of the day. You must wash yourself thoroughly before you pee and catch it mid stream, not at the beginning or the end.   the container must be very clean and with a sealed top, obviously.  it was very hard waiting to pee a second time and not being able to eat, as I tend to puke uncontrollably on an empty stomach.  But I did all this because I wanted to give them the very best non diabetic sample i could. 

 At the hospital, the nurse takes it, dips it, and then throws the stick away.  "Wait, I did all that and you don't even want the pee?"
"You're urine is fine.  Go throw that away."

I throw away my hard earned effort and wait.  I wait for three hours.  When i see the doctor, he pokes my tummy, says the uterus is exactly the size it should be, the pee is exactly as it should be, the heart is beating exactly as it should be, and I need to schedule an appointment to take a glucose test.

"Wait, i came here to do the glucose test today."
"We don't have time to perform the test.  we need to make preparations."
"All i do is drink sugar water, right?  How much time does it take to prepare sugar water?  i can get a coke downstairs."
"We need to consult the chemist and he is very busy today and can't possibly do the test.  no i will schedule you a blood test For July 23rd and you can go to the maternity ward to schedule the glucose test for another day."
"Doctor, i work.  i have a job.  i can't be taking a hundred days off because you can't be bothered to do two simple tests on the same day.  I came here today to do the glucose test and the blood test and I can't waste time running around like this for the next nine months."
"Well, we can try to schedule the next blood tests and glucose tests on the same day next time, if you like. "
"How many blood tests do you need to take?  I've already done two!" (In America, I had my blood drawn once and several tests were done, and never had another test after that).
"we will be monitoring your blood every time you come here from now on."

Oh brother. 

When leaving, i noticed the schedule for the two tests: 9:00 am for the glucose and 3:00 PM for the blood test.  Shit.  So I'm literally going to spend my entire day there next time.  What fun.  he couldn't possible have scheduled the two tests closer together?  Am I supposed to be grateful because it's on the same day, at opposite ends of the day? 

Total cost for both hospital visits: $0.00.  Not one penny.  Can't there be some happy medium where you get the service of doctors clinics in the US without the price tag? 

Oh yeah, Japan.  you have to pay 30-50 dollars, but you never wait long and things are efficient. I appreciated medical services in japan before, but I really appreciate them now.  really, Hong Kong, universal health care does not have to be this crappy.

Father's day, once again

I used to really dislike Father's Day.  In fact, for the better part of the past 15 years, FD has passed right by me and I didn't even know it until July rolled around and I was vaguely aware I missed it along the way. 

This is because for the better part of the past 15 years, i haven't had a TV and missed all the adverts.  or the adverts were in a language I didn't understand.

As a kid, I used to dread Father's Day, because the teachers at school would make me write a card or some crappy thing addressed to my father.  Even before he died, I used to say he was dead so I wouldn't have to do it.    It's not that I'm angry or bitter or anything like that.  Not that I ever wished him dead or had a grudge against him personally. 

I hated Father's Day because i was supposed to think of something to write (for a graded assignment) that sung the praises of someone I barely knew, and the few memories I had were not exactly appropriate to put on a greeting card. 

Would Hallmark have had a card that said:
"Happy Father's Day, Dad!  I'll never forget when I was five how you stole all the money and food in the house and left me alone for a weekend while you went on a drug/drinking binge!  I watched so many Woody Woodpecker cartoons...it was awesome Dad!  You're the best!" 

or how about, "Happy Father's Day!  you were so right about many things, like how I was going to become fat, so i needed to go on a diet.  You were so helpful when you tried to hyponitize me to sleep for days on end so you didn't have to feed me so I could loose weight!  it was a great idea, Dad!  Your parenting skills are second to none!"

Again, totally not bitter.  I could have been bitter, I suppose.  i just never wasted much time thinking about him, and when i did think of him, it was more like " I wonder if he's dead yet?"  Not because I wanted him dead, I assure you, but i was one of those kids very aware that people died, and being a kid, thought basically anyone older than a teenager was graveyard material. 

No, he was who he was and I didn't dislike him at all until I had my own child and really understood the weight of being a parent, and the actual gravity of the crap he pulled.  

But this year, because of Facebook, I realized (OK, a day late) that it's Father's Day again. 

So for those of you who have or are fathers, Happy Father's Day!  May you always be worthy of your child's love and admiration. 

Who is this child?

My son says things that make me wonder who he is.   

Today, I was fixing breakfast, and Kai looked at me and said, "Mommy, are you frustrated?"  I said, in surprise,"No, I don't feel frustrated.  Why?"
"Because you look frustrated.  Tell me all about your dreams last night."  Jung, anyone? 

Later on, after watching "Green Eggs and Ham" on the computer Kai said, "If I were Sam, I'd let him be.  He doesn't care.  He just keeps pushing him to try the eggs.  It's so mean." 

The other day, Kai and Mabo were playing badminton, one of their favorite pastimes. Recently, Mabo bought him a child-sized racquet with a Winnie the Pooh motif, and it is a much prized possession.  Well, he was upset at Mabo and hit him repeatedly with the badminton racquet. Mabo told him that he didn't deserve a racquet since he used it as a weapon, and Kai should give it away to some other child who can follow the rules and use it appropriately.  After considering that for a while, Kai said, " You know Daddy, you're right.  I don't deserve this. We should give it away.  Where's the wrapping paper?"  Since when does a 5 year old conclude he should give his prized toys away to more deserving children? 

One of my favorites was a few months ago, when he looked at me and said, apropos of nothing (that I could tell) " You know Mommy, love IS what it's all about!"

A few weekends ago, I was having a really rough time with my morning sickness and was lounging in bed, the only place in my whole apartment that doesn't smell awful from my neighbor's cooking. Kai walked up to me and stroked my face and said, " You just stay there and sleep  make a strong healthy baby.  I'll go play by myself for a little while." And he did....for two hours!   

He says these kinds of thing so often I sometimes forget he's five.  It's like he is channeling an adult's mind sometimes. And then he laughs at fart jokes, or whines about eating his veggies, and I remember, oh yeah,  he's five. But most of the time I am just blown away by the things he comes out with and I wonder, "Who is this child?" 

A hard day: homesickness, and a rant.

Today was a bit hard.  Of course, I was nauseous the whole day, but in addition I was feeling really quite homesick, which was a new concept for me.  Then, the short time I forayed out into the world,  every Chinese person I met yelled at me, so I slunk home and spent most of the day in bed. 

That's it in a nutshell.  The rest of this is me whining, so you can stop reading here. 

In the past 16 years, I have lived in 11 different cities (not including "couch surfing" for various lengths of time with friends and family) and each time I have left, I have never looked back.  I may reminisce about good times, but I never felt bad about leaving the old place or felt the current place I was in was better or worse, just different.  In short, never once did I feel homesick.  In fact, I never really considered myself having a real "home" to feel sick about.  I certainly didn't miss the crappy trailer I grew up in with out electricity, water in the winter, that my mother kept saying she was going to "blow up" she hated it so much herself.  And I never really felt terribly attached to any other place I lived.  I enjoyed myself when I was there, made friends, but easily detached. 

So perhaps I'm just getting old.  Perhaps this a stage in culture shock I just skipped the last 10 times. Perhaps my hormones are getting the better of me. Or perhaps I hate Hong Kong just that much. But today, for the first time ever, I thought about the place I lived before I came here and couldn't stop crying. I was totally homesick for a place I only lived 2 years.

Let's compare:

In Fairfax, I lived in a two story apartment complex with about 30 or so other families. Our apartments all faced an inner courtyard that had a pool, grass, community toys for the kids to play with, and a track kids could race around in.   I knew every single person there.  And almost everyone liked children, loved Kai, and gave him toys, clothes, snacks, candies on a regular basis.  Often I would have no idea where my child was, so I'd stand on the grass in the middle and call out "KAI!" and someone or other wuld stick out their head and say "He's in here!"  And I'd go over and have a chat and thank them for their hospitality and  encourage Kai to play outside where I could at least hear him and have a vague idea where he was.  Our apartment also had a community area where people who no longer wanted their books, music, toys, candles, dishes, etc would drop them off and others would take them to use.  Large furniture often moved from apartment to apartment and enjoyed long lives. Everyone thought Kai's fashion choices (green tutu, sparkle purse, white communion dress) was fabulous and unique and no one questioned my parenting for allowing him to wear such ensembles. Local restaurants had community toy areas for the kids to play, and the local playground had sand and trees and a small creek, and lots of community trucks and bikes and things for kids to play with, in addition to the normal play structures.  There was one ice cream shop, all organic, with a poster "How to make a community" on it, and a wall of photos of all the people in town eating their ice creams.  They had massage fairs, crystal fairs, wine fairs, organic farmer's markets, coffee houses that were locally owned and operated and had open mic nights, music clubs, pubs, and even a vegan (no meat, no eggs, no milk no nothing) restaurant smack dab next to the greasiest meatiest hamburger and hot dog joint in town.   Everyone and everything was OK.  It was like the 60"s never went away.  people wore their hair long, were often barefoot, wore non chlorine, non dye, handmade garments that flowed like a cloud around them.  Halloween was a community affair, preceded by the costume parade (there were always parades, it seemed).  Easter too.  They had one and only one church, and I visited there once just to see what it was about, and basically their message was "We don't know what we believe if we believe in anything".  It was kind of Agnostic, which I found a rather interesting concept for a church.  Surrounding this village was rolling hills with hundreds of trails and MT. Tamalpais, and a 20 minute drive through the hills brought you to to the great Pacific Ocean.  A 40 minute drive brought you to San Francisco. The sky was clean and  blue, you could see millions of stars at night, nature hugged and nourished us. Everywhere there were redwood forests, rolling waves of grassy hills, and sparkling blue ocean. Everything was clean and the temperature never got colder than a morning frost, and was usually warm but not boiling.

Except for the fact it was damned expensive like the rest of California and you needed a car because public transportation was non existent, it was perfect.  I even knew that before I left.  But I just couldn't live there on  the salaries Mabo and I were trying to live off of.  Rent, child care, car payments, and school loan repayments, all the very lowest I could find, ate up 90% of our income, and we had about 200 a month for food, clothes, gas for the car, etc.  I suppose 200 could get you somewhere in Maine, but in CA, you can spend that in an hour.

The only way out of debt was to leave my heavenly Fairfax. 

Now, in Hong Kong, after months of living frugally, we have paid off all our debts back in the US, except for the school loans, ad even have leftover every month to take Kai to go on dolphin tours, and see "Live dinosaur" shows, and do all sorts of cool fun things we couldn't afford in the US.  We finally were financially in a position to consider having another child.  We never have to worry if we have enough money to buy groceries, or whatever we want.  But at what price? 

In Hong Kong, everything is dirty and spoiled.  The air is poisonous, the paint is leaded, the walls have asbestos, the furniture formaldehyde, the ocean is clogged with trash, the foot paths in the hills are "Paved" with broken bits of china and other trash, there is trash everywhere, the food makes you sick, the ocean is unswimmable, and the tiny bits of grass that exist are corralled off and guarded, literally.  The other day we saw a whole ten stars and got so excited because usually the pollution prevents you from seeing any at all. 

The worst part for me is the yelling.  Chinese people are paid to yell at everyone all the time.  Today, for example, we went to the pool.  There are no fewer than 20 rules posted.  We followed every damn rule, and still got in trouble.  Kai brought a toy, and that was not allowed.  I put sunscreen on us, and that is not allowed.  Imagine, no sunscreen allowed!  Shit! So I put on my T shirt to prevent hospitalization from being burned, and no T shits allowed!  A leaf from a tree planted around the pool fell down into the pool.  Kai started to play with it.  Yep, no playing with leaves allowed either.  Fuck me!  Kai was in the kiddie pool that is like three inches deep and was jumping around...no jumping!   I was just giving every life guard the look of death, I just couldn't believe it.  But I COULD believe it, because this is life in Hong Kong.  Everything is NO.  Every playground, every beach, every place had signs the size of billboards to accommodate all the rules what you can't do. And still, there are tons of rules not written down that Chinese people just make up to get a chance to yell at kids.

  And hundreds, maybe thousands, of people are employed to enforce these rules. And they don't just say "Hey, don't do that."  Most of the time, they yell and yell and yell and just don't stop. I have a teacher I work with that yells in the kids' faces, with a microphone, and they are crying and hysterical and she still yells and yells and carrys on for 20 minutes.  This is very Hong Kong style and I hate HATE HATE it, especially when it's my kid.

Now most people tell me my son is pretty well behaved.  I watch him carefully and make sure he never does anything obnoxious and when he gets borderline obnoxious, I nip it in the bud instantly.  Non Chinese people praise my son on his manners.  Chinese people invent things to yell at him for.  It is horrible. 

So I earn enough money to pay my bills and have left over to start saving up for the next move.  The sooner I can afford to get out of Hong Kong, the better.  Sadly, I do not think I will ever be able to afford to live in Fairfax again.  The problems of cost of living vs teacher salaries is never going to balance in Fairfax's favor.

I don't know if I will ever find a place that felt like home as much as Fairfax did.  But if I do, and I can live there sustainably, I will never move again. 

Chinese medicine

I have a friend who is married to a Chinese medicine doctor.  He graciously agreed to meet me yesterday, on a holiday, to see if there was anything he could do to help me.  Without going into gory details, lets just say my digestive tract muscles are proving they are just as adept at moving food and drink in the other direction as well.  Like the rest of the muscles in my body, they are not used to that much activity, so everything from my throat to my diaphram to the rib cage muscles are now very sore, which is starting to affect my quality of life. 

I had this problem with #1, and took Zolaft, but it rendered me incapable of comprehending speech, and i refused to take it after the first two times.  As a student, I could afford to wallow in misery all day in my bed (as long as i did the required reading and writing), but now as a working adult, I gotta be on my toes.  Since western meds make me feel stupid, I decided to take a crack at Chinese medicine. 

So far, my one and only experience with Chinese medicine was over the winter, when Mabo and I drank several gallons of medical tea they sell on the streets to chase away the flu bugs.  It tasked absolutely horrid and i gaged profusely the first time I chugged a cuppa down, but damn it worked.  I never had to take a sick day off of work all winter (for a cold; I got food poisining several times, but that's another story). 

So when my friend and her husband met with me, they warned me that Chinese medicine tastes different from western medicine and stressed that I may not entirely like it.  yeah, I figured.  After checking my pulse and other points on my body, he wrote a "prescription" and walked me to what he considered to be a reputable medicine shop.

Let me take a minute to explain Chinese medicine shops.  These shops are literally everywhere.  In them, large glass jars of various dried out objects are stored on shelves.  There are also dozens of little drawers where smaller dried out objects dwell.  In addition to various dried out roots, bulbs, and herbs, these places also carry dried out gekkos, lizards, turtle shells, starfish, sponges, and even sea horses (small, medium, and large) as well as a variety of earth and sea based creatures I don't even recognize. Mabo has recognized a couple items which are on Japan's endangerd species list.   The Chinese use literally everything on earth for various medicinal purposes. There is nothing they won't put into their bodies.  As my friend said yesterday, the Chinese will never die of starvation.  They will most certainly poison themselves to death, but never ever will they starve.  

If you have ever watched the Japanese cartoon "Spirited Away" you will understand exactly what i am talking about.  (if you haven't, please do; its a great movie!) Watching the "pharmacists" prepare my potion was just like watching Kumoji prepare baths.  While various herbs, spices, (and god i dont want to know what) were being prepared,  the doctor explained to me how to prepare the brew at home.  because he didn't know if i would be able to stomach the medicine, he prepared only two days worth of medicine for me.  if it works and I don't mind the taste, he will prescribe more later. 

That night, after two and a half hours, the potion was finally ready, prepared as he required: all the ingrdients were to boil in 5 cups of water until I had only 1 cup.  then after straining the medicine, i was to boil another cup and a half down to one cup and mix the two.  The two cups at the end were to be evenly split and drunk, one cup at a time, in the morning and at night. 

I had my first cup this morning.  it was not nearly as bad as i had anticipated, and if I liked the taste of anise, I might have actually liked it.  And it may be a coincidence, but I haven't had the urge to move my food in the wrong direction yet.  the real test will be 3:00 this afternoon, as my most difficult time is 3-8 pm. 

Oh, and he also showed me a trick:  If you rest three fingers on your wrist, there is a point three fingers down on your tendon that, if you push it, will reduce nausea.  yesterday, when I was gagging and wretching and looking for a public restroom, he pushed that point, deeply, and I went from "critical danger" to "generally nauseated but not critical", which was really an improvement for me. 

He told me if I visit his father (a medicine man for many years) in a couple of months, he will be able to tell if it's a boy or a girl just by looking at my wrists!  I'm super curious about this procedure, so I want to go! 

News and a new segment: Getting Care in HK

Easter passed, uneventfully, and now my school kids are gearing up for the home stretch.  There are about 30 more instructional days, not including days for test prep and tests, a couple weeks of work after the kids leave, and then I get to take some much needed time off!  Hooray!

We have decided to go to Japan for the hols to reconnect with family and to bump Kai's language skill before he enters first grade at the Japanese International School this year.  It's the best school in Hong Kong, dirt cheap (comparatively), the only non-Chinese school in HK not filled to capacity, and the only requirement is that Kai be proficient in Japanese.  Needless to say, we are very anxious that he get accepted, as he wouldn't be able to go to any other school, as the local Canto schools won't take him and the English language schools are already filled for next year, and are impossibly expensive anyway.   I have 17 messages in my inbox all telling me to look elsewhere. 

As excited as I am to go to Japan this summer, I don't expect I'll be much fun.  When I was pregnant with Kai, I had morning sickness all day every day for 9 months.  The severity, length, and symptoms lead my doctor to diagnose me with Hyperemesis Gravidarum and gave me Zolaft, which made me feel just awful and unable to comprehend language.  As I was still a student in grad school, it was a major problem that I couldn't comprehend language, so I stopped taking the medicine.  


It's possible my morning sickness is the normal kind this time around.  It's possible by July all this pregnancy bulimia will be a distant memory, but I recently learned that people who develop HG are more likely than others to react the same way in subsequent pregnancies.  This leads people to speculate that HG might be an immune reaction to the "foreign agent" in the body.  This makes sense since I am a negative blood type and Kai was a positive blood type and there is a very good chance this sucker is positive too, since Mabo is Japanese and they almost never have negative type babies.  Anyway, typical home remedies are apparently not helpful for those with HG, and Zolaft-ish products are the only known way to manage the illness.  However, as a language teacher, I can't be on meds that render me unable to comprehend language! 


So if it's HG again (and let's pray its not, because it's no fun), I won't be anything but miserable the whole time in Japan.  But at least that's different from being miserable in Hong Kong.  My poor family and friends will just have to deal!  


Kai is very interested in this pregnancy and we have spent some time looking at pics of fetal development on the internet as I progress to see how the baby is coming along.  While on line, we came across several medical web sites  indicating women with morning sickness are less likely to have miscarriages than women without any sickness, statistically.  So Kai is OK with mommy puking everywhere because that means I'm "making a good baby," in his words.  




And now for a new segment of the blog: Getting Care in Hong Kong


Now that I'm pregnant, I've entered the  strange world of maternity care in Hong Kong.  


I went to a maternity clinic several weeks ago in April because my gyne doesnt do deliveries and besides maternity care is free for HK residents if you use the free clinics and hospitals. It was rather scary.  You certainly get what you pay for in Hong Kong. 

Additionally, my area is very close to China, so alot of Chinese come over the border just to get maternity care; even if it's not free, it a lot better than in China.   I'm sure clinics in other areas are much better, but where I live its insane.  Hundreds of mothers and babies milling around, flowing in and out of rooms or sitting in chairs (if you can find one unoccupied) and DMV-style number counters and window counter people barking out what to do through speakers. 

I saw a room with 15 little baby weighers and 15 little counter tops, just like my doctors office in Monterey, but instead of one per room, 15.  I didn't know where to go, which line to get into, so I just walked up to a window that had no line and told the lady I didn't know what to do.  She asked me to wait, and 45 minutes later, she announced she had made an appointment for me at the local hospital  in May and had made an appointment for me for the clinic in June.   That was it.  I could go home.  But first, she pointed out to me the requirements for things I had to bring with me at my next appointment; among them, a sample of pee.  Yep, I get to collect my own pee at home, put it in a bottle, and carry it with me all the way to the clinic in the hot June sun.  They don't collect on site.  Now that's different.  No one weighed me, took any samples, offered advice, I didn't even see anyone. I asked if I could change the dates since they conflicted with work, but no.  I dont get to choose when I come in.  I come in when they damn well say I come in.  Now there's service for ya!  But, it's free!  If all goes well, I may spend less than 50 dollars US for the entire natal care and delivery.  That's compared to 100 USD every time I went to the doctor and 65K for Kai's delivery, not including testing fees, so a total of about 70K USD. 70,000 and 50 are mind-bogglingly different in terms of cost to have a child.  I'm glad I'm not having this one in the US.