A gift for Lucy

The staff, as a sending off present, got Lucy a bee outfit and bunny slippers. She looked so cute in the bee suit. The staff all got pictures with her . She managed to smile rather well with each of them. Afterward she fell asleep in Kim's arms right away. We have truly enjoyed our time here and will miss all the our new friends.

Time Winding Down Here, But Still Trying New Foods

Yesterday Kim helped pass out Bibles to tourist at a local attraction. We had lunch with the team doing the Bible distribution. And yet again I got the chance to try new foods. Including one that I will never try in America..... chicken feet. I have heard through Kim that many of you enjoy my pictures of the interesting food I have tried, so here is one more.

More Answered Prayer!!

Thank you to all who have been praying for me and my family in regards to the Johns Hopkins Preventive Medicine Residency. This morning I received an email offering a position there starting July 1st of this year. Kim and I plan on accepting this offer!!!! Please continue to pray for us as we look toward taking care of details of moving, selling a house, finding a new place to live, new church family, and especially determining a new budget as the cost of living will be much higher in Baltimore and our salary will be much less. Check out my new school's website!!

Visa Extended!

So I found out today that they did extend my visa until after I leave this Saturday. Thank you for all your prayers. It is hard to believe that I am leaving in less than 1 week. It has been so good to be here. I have met so many great people and learned so much about the Chinese culture and medical issues. It will be hard to leave, but I do really miss Ella and can't wait to see her.

Enjoying Time with Family

This weekend has been mostly rainy or gray skies. But it did not stop us from enjoy spending time together and seeing some of the sites. When it rained on Saturday, we went to the Venetian. It is a Casino, convention center and shopping complex. When they finish construction it will also have a wave pool. We spent 2-3 hours there and only saw about 1/3 of the complex. If you have read Kim's blog you have realized how much of a hit Lucy is here. All the women want to hold her and at one of the local restaurants a waitress fed Lucy her first taste of white rice.

From my time in Hong Kong

Here are some of the pictures of my time in Hong Kong. It is so different than Macau. The buildings are much taller and more modern. It has less of an European influence to the architecture.

Inside the Temple dedicated to the god of war and literature, the haze is from the incense burning.

Meat anyone? It is from the local butcher.

From The Peak. The Hong Kong skyline is amazing!

Kim and Lucy are here!

Well after many hours on the plane and about 45 minutes looking for me, Kim, Lucy and I met up in the Hong Kong airport. Lucy did rather well on the plane, she slept for 6 hours straight. Kim was blessed by having three empty seats next to her (the only ones on the plane) God is Good!! Kim and I met up at the pay phones. We were both trying to call the Morgans to see if they had heard from either one of us. But before I figured out the phone number, I spotted Kim. Thankfully Kim was not too stressed. I enjoyed the time before picking up Kim by exploring Hong Kong for the day. I will put some pictures up tomorrow. Today I went down to the immigration office to apply for an extension of my tourist visa. I was only given 30 days upon arrival and hoped that by visiting Mainland China and Hong Kong they would extend this, but no such luck. I will find out on Monday if they will give me a 6 day extension. The adventures never end!! The good thing is that now they include Kim and Lucy!!

Patient Care

One of the patient care aspects that has surprised me is that I have had a fare percent of the patients I have seen want to come back and see me for their next visit and make me their doctor. For the quick follow up visits, I have actually done this for a few patients. One actually brought his friend into see me. The others I have had to say with disappointment that I am only visiting and they will have to follow up with one of the other doctors. I am also surprised with the amount of prenatal care done here. The clinic doctors do not delivery, so I assumed this would be a small part of the practice. But because there is only one hospital that does OB here, many immigrant works and westerner do most prenatal care here and then decided if they are going to go back to their home country to deliver, deliver in Hong Kong, or stay here in Macau.

PS I just got word that Kim did make it on the plane flying from Chicago to Hong Kong. I am getting ready to leave to meet her in Hong Kong!!! YEAH!

Interesting Resource

For anyone interested in getting a Chinese background to their culture and how it relates to medicine check out this site from NYU. Not only does it give cultural info, but helps teach you basic Mandarin or Cantonese, especially language needed to conduct a medical interview. I have added it to my list of interesting sites as well.

Excited to See Kim and Lucy, Just Not Yet

So Kim was supposed to leave on Tuesday, but when she got to the airport, she waited ...waited...and the plane never arrived. There were mechanical problems and she was not able to make her connection in Chicago. Instead of seeing her today, I will have to wait and she will try it again tomorrow. At least she is able to stay with my parents and see Ella for one more night. The sun is shining so bright here today, it makes it hard to go to the clinic when I was supposed to be off to pick up Kim. Well hopefully tomorrow I will see her and Lucy.

One of the components of Hope Medical is a palliative care team. Most of the work is done by social workers, some nursing and some doctors. Many participants are prior patients of Hope Medical Clinic, but some are through connections in the community. The government hospital just opened a cancer/palliative care unit. While Kennis, a social workers, was visiting one of our patients in the hospital, she met the boy below in the black baseball cap. He has a spinal tumor. He was all alone at the time, and she started talking with him. She found out that his birthday was coming , he was going to turn 19. His mother works nights and his father works days. So he does not get a chance to see them much. Kennis decided to throw him a birthday party. I was honored to be able to come along. She brought cake, and cookies. One of the residents, Eddie, came and played guitar and some of the people in Kennis's church came to help celebrate. A few of the nurses from the Hospital joined and even one of the doctors. You could tell that he really appreciated it. Please pray for him, because he was told that the radiation and chemo treatments were not controlling the cancer, and surgery will be needed. I am not sure of his faith, pray for that as well.

The one in the black baseball cap is the birthday boy, the one next to him is his roommate in the hospital, he has cancer too.
Kennis is the one with short hair on the right in the back. The other girls in the picture are his sister and her friends.

This is a picture of the church members, Eddie who played guitar for us, and Kennis, who organized the party.

Teaching Moment

One of the medical opportunities that I did not expected to have here is precepting other resident physicians. For those of you not in the medical field, a preceptor is a more senior doctor that serves as a teacher/adviser to the younger resident physicians. usually the residents will see the patient in the room, then present the patient's history and physical exam findings to the preceptor. This gives the resident physician an opportunity to ask questions and learn about possible treatment options and possible diagnoses. This is true in the United States as well as here.

Now with that background. Last week I was precepting with one of the 1st year residents. She wanted me to come look at her patient's throat. Earlier in the week another resident had diagnosed her with strep throat. She did not get better, so she returned to the clinic. I looked at the back of the throat and saw what looked like oral thrush. (yeast infection in the mouth) I was able to discuss with the resident about potential causes of oral thrush in an adult. She obtained further history and found out that the patient had been taking an inhaled steroid for her asthma. If you do not rinse your mouth out after using an inhaled steroid a person can get oral thrush. Some of the younger residents did not know this and I was able to show them the thrush and discuss the appropriate treatment. It energizes me to see others be so excited about learning, especially when I am the one teaching.

My First Hot Pot and So Far So Good

So last night a number of the single people in the clinic went out to dinner for "hot pot" in celebration of Valentine's Day. Myself and Dr. Kwan were invited along since our wives were not here with us. In case you are like me and have never experienced Hot Pot, it is when you order meats and vegetables from the menu, they come to your table raw and you cook them yourself in a boiling pot of soup in front you. The key is to make sure the meats are completely cooked as to not get diarrhea from ecoli infection. I had a great time. Unfortunately, my camera ran out of battery early in the evening, so some of the most interesting foods I ate I did not get pictures of, but these will give you the idea. I had beef, lamb, pork cut thinly as seen on the plates below. I had fish, shrimp, and lamb make into balls. I had cow stomach. I had many types of vegetables of which there is not an equivalent found in the U.S. The great thing is that it has been over 12 hours since ingesting the food and no diarrhea or stomach cramps yet!!

This was the name of the restaurant. It is a restaurant chain.

This the different types of meat, pork, beef, and lamb

The elements of fish balls, what you do is take a clump of the fish meat and plop it into the boiling soup in front of you.

You can some what see the pots in the picture, but the meat goes in your own personal Hot Pot. The Key is to make sure it is fully cooked before you eat it.Yes this is Cow Stomach. It does not have much taste, just very rubbery.

Born in the Year of the Horse

I found out that I was born in the Chinese Year of the Horse. Just for fun I looked up the characteristics of the horse on the internet. This is what I found:

Horses are hardworking people who are generally well liked and admired. As well as working hard, they play hard.

Horses are independent, and are well known for their individuality. They intuitively gravitate towards tasks to which they are well suited. This, together with their hard working nature invariably leads to success.

The horse is a strong masculine sign, and both male and female horses are fairly laid back and easy going, while at the same time being direct. Asked for an opinion, the horse will give it, and where factual matters are concerned, the horse is a good source of reliable information.

The horse is a placid person; however, if their passions are brought to the boil, the result is not easily forgotten - wild horses are hard to calm down. In the home the horse is a steady partner, although they are likely to give as much attention to their work as to their families. Horses easily fall in love, but there are many passing relationships before a long-term partner is found.

Oddly enough, this description matches me rather well.

Question about Antibiotics

In my last posting, one of my family left a question regarding the use or misuse of antibiotics here in Macau, I thought others would enjoy my response as well. This was her comment, "Question for you: There is so much in public health here about washing hands and the use (overuse) of anti-bacterial products. How does China deal with this? Do they promote the use of all these anti-bacterial products? Do they have the same resistent bugs that we face due to the use of anti-biotics?"

My response: In Macau and Hong Kong I have seen advertising on tv and on street signs that stress the importance of taking antibiotics only when a doctor prescribes them and to finish the complete course of antibiotics when they are prescribed. Here it is not necessary to have a doctor prescription to get most of the drugs from a pharmacy on the street. Only narcotics and addictive types of drugs are restricted. The problem is that some pharmacies have been known to either dilute the medication or switch the medication with a cheaper version or a substance that is not even close to the original drug. So most doctor offices have a pharmacy within the office. This provides more trust to the quality of drugs given. The mind set towards taking antibiotics is worse here than in the States. They feel that they should be better in 2-3 days from any illness after seeing the doctor. So if they do not feel better they go back to the doctor, if they feel better, they stop the medicines. As far as anti-bacterial creams/form/gels they are not really used here. Although more people wear medical masks. Some of the doctors here say this is left over from the SARS epidemic.

So far MRSA has not been seen wide spread in the community as it is becoming in the U.S. I am not in the hospital setting, so they may have hospital acquired MRSA and other resistant bacteria present.

Clinic work

Patient load in the clinic has picked up now that the main part of the Chinese New Year is over. The actual new year celebration lasts 2 weeks, but gradually the city is coming back to life and more shops are re-opening. Yesterday the clinic saw just over 100 patients. We are on track to see about this many again today. This afternoon is dedicated to lectures for the residents. A couple of the attending physicians cover the clinic during this time. I will be team teaching suture technique today. Peter Kwan, who is on faculty with Herman Memorial Family Medicine Residency in Houston, is the other facilitator. We are using pork of some kind. The residents assure me that none of it will go to waste after we are done. They plan on removing the suture and taking the pork home for dinner.

Church on Sunday

Currently, I am reading Hudson Taylor’s Spiritual Secrets. It is an amazing account of his life and work in China. It has really spurred me on to pray for the people of Asia even more. At Church on Sunday, I met a rather new believer named Jeevan. He is a security guard at one of the casinos here. He is originally from Nepal. The casino business is bringing in workers from many parts of Asia. Macau is becoming very fertile ground for the harvest. Lift up the current workers that they would be strengthened and encouraged during the next 5-10 years as more and more Asians come to Macau for work in the casinos. Just as Jeevan, may they be inspired to return to their home countries and share their new truth with their family and neighbors.

Fishing across the border

A number of the staff at Hope Medical visited the Place family in Zhuhai, just across the Macau/China border. We took the children fishing at a local pond. Zhuhai is different from Macau. The streets are much wider and it has wide sidewalks. The city is not land locked by the sea like Macau, so at the edge of the city are fishing ponds and vegetable farms. After fishing, I went to a Chinese spa and had a foot massage. For 1 hour it was 50 patakas, which is about $8 US. It was intense, okay sometimes it actually hurt, but in the end my feet were much more relaxed.

The Old Border Gate. Now it is much bigger.

Ben is a ENT resident at one of the hospitals in Macau, he is engaged to Cynthia, one of Hope's residents. No one had luck catching the fish with poles. Some of Dr. Place's children netted a number of fish.

Don't worry, I did not eat any of the fish that were caught.

Along the pond were fields of vegetables. Here is their "automatic" watering system.

New Year Dinner

I was honored to be invited to the home of Candy's parents for a tradition New Years Meal and family celebration. (Candy is Eddie's girlfriend who is one of the resident physicians at Hope) I was the first foreigner who has visited their home. They spoke some English, but most of our communication came through Eddie and Candy translating. I had a great time and was filled to the brim with good home cooked food. I learned a lot about the history and types of Chinese tea. Her family was very gracious to me. I learned a few New Year sayings in Cantonese. They appreciated my effort and I appreciated their grace in my poor pronunciation. Below are some pictures from the night.

From Left to right, me, Candy's Mother, Candy's Father, Candy, Eddie is taking the picture

Cucumber dish with mushrooms. It is very difficult to make. And very difficult to eat with chopsticks if you are only moderately practiced with them.

Spicy Pork with Celery, My favorite dish of the evening

Glutenous Rice with peanut and sesame seed filling. Served warm as the dessert. It is tradition to eat this with your family on New Years Day.

A Few Pulbic Health Topics

As many of you know, I have an interest in Public Health. So I have been mindful of the different ways that Macau informs the public on health matters. When I get back I will have share in more detail the different formats that I encountered, but here are a few pictures. The first is an example of how exercise is promoted. In most of the parks there are at least 3-4 exercise machines. The last two pictures are of a poster advertising ways to avoid getting and spreading avian bird flu. These are posted in public areas around the city.

Lion and Dragon Dance

There have been many activities to celebrate the Lunar New Year. Here are some pictures from the Lion and Dragon dance.

Happy New Year's Eve

Today is the last day of the Chinese Lunar Year. Follow this link to see some of the activities planned for the City of Macau. Click here to learn more info on the Chinese Lunar New Year. I will try to get some good pictures to share with you all as I visit the different celebrations. Currently we are finishing the year of the pig and we are entering into the year of the rat.

It may not look like it, but I am doing Medical work too

I realize that a majority of my blog has focused more on the extracurricular activities and experiences. I have been doing medical work as well, really. The clinic in general has not been as busy as I expected. Part of it is that there is enough staff to see their current patient load. The other issue is that it is bad luck to be sick near/the beginning of the new year. We did have a rather busy day on Monday, we saw just over 100 patients. On average the clinic sees roughly 60 pt's per day. The numbers for this January were up 25% from this time last year. The leadership here feels that with the continuing boom of the casino industry the patient load will only increase. Majority of the illnesses here are similar to that of the States. I have seen alot of URI, acute bronchitis, flu, and ear infections. Conditions like T.B. are much higher in our differential here, we have placed a number of ppd's. (a way to test for tuberculosis) None have come back positive yet, but I am sure we will have at least one case before I leave. About 25% of their patient population is dealing with chronic illnesses. Again, similar to the U.S., hypertension, Diabetes, and high cholesterol being the main three.

Below is a picture from one of the parks. I thought this was an interesting way of leaving your mark in the world. (graffiti that is)

Weekend Explorations

Over the weekend there were days of opposites. Saturday was very dreary and it rained all day long. It stopped briefly at night, and I did do some exploring. But when I awoke to get ready for church on Sunday, the sun was out!!! This was the first time the sun has broken through the clouds since I have been here. It not only physically warmed my body, but also emotionally warmed my spirit. After church one of the team members took a few of us to a shrine dedicated to The Sea Goddess. Once I got back to the flat I explored the Fort that was at the very top of my hill. It was used by the Portuguese to defend Macau. It was constructed in the early 1600's. The remains of St. Paul's cathedral can be seen near by as well. I have many more pictures from these adventures, but will have to share them with you in person, so I don't overwhelm this blog entry. Directly below is St. Paul Cathedral. Kim is excited to see this site, so I have saved exploring it in detail until she arrives.

This is Monte Fort. It only had to be used in defense of the City once, - against the British. And it was successful in repelling the English charge. Now is it a Museum.

This is the Goddess of the Sea, Mazu (click to learn more),

Above is a view from the statue site. It is land that was reclaimed from swamps. They are converting it into Asia's largest strip of Casinos. It will rival Las Vegas in size and stature. Below is the Chinese Temple celebrating the Goddess of the Sea.

Friday Night out with my new Chinese friends

Below are some pictures from my evening with some of my new Chinese friends. They took me to one of their favorite local restaurants. I told them to pick out their favorite dishes and I would give them a try. I said, "As long as you are willing to eat it, so am I." Along with the pictured food below they had hot wings and fried bread. These were no different than what is in the states, so I did not take any pictures of them. And no I did not get any diarrhea or stomach cramps. I had a great time experiencing the local culture. Eddie promised me that we would play some basketball before I leave. I look forward to it!

This is Eddie and his girlfriend Candy, he is a second year resident.

This is Inson, he is a fourth year resident.

This is Tim, he is a first year resident

The up close and personal look at colon noodle soup. Yes this is pig intestine. Really not bad as long as you can get past it mentally.

Oyster pizza? Well it is not quite pizza, but it is a flat bread with oysters and cheese. Not bad when is it warm, kind of rubbery when cold

1000 year egg. Cultural myth has it that the egg was originally made with horse urine. This is what my Chinese friends told me before I ate it. But since then I have investigated it on the internet and found this to be just a myth. If you are interested in Learning more about the 1000 yr egg follow the link to wikipedia