Anti-bribery signage at our hospital in Huangdao, China

Health is one of the biggest worldview disconnects between Chinese and Western cultures. Another is ethics. Putting it simplistically: To us, their stark pragmatism sounds amoral and selfish. To them, our abstract principles sound naive and heartless. It’s mutually appalling, and mutual understanding is nigh impossible. (Parenting has gotta be in the top 5.)

We’re halfway through a week in the hospital, and I thought this anti-“hongbao” signage was interesting. “Hongbao” (红包) is an ingrained aspect of Chinese culture where the patient’s family slips extra money to the surgeon in a “red envelope” to encourage better treatment. It’s illegal in Chinese countries, but that doesn’t stop it.

Front and center on the nurses’ station:

hongbaosign Anti bribery signage at our hospital in Huangdao, China
Honest medical treatment; Refuse to accept hongbao
诚信医疗拒收红包

Despite this, the translator assigned to us (she’s helpful, but her English is harder for us to understand than the doctor’s Chinese) says, “Sometimes, it still happens.”

Apparently there are a lot more ways than hongbao for doctors to earn extra ethically-suspect income. This poster is at the entrance to our floor:

To Strengthen Medical Treatment Clean Behaviour Customs, Construct “The Nine Forbiddens”
加强医疗卫生行风建设“九不准”

    hongbaoposter Anti bribery signage at our hospital in Huangdao, China
  1. It’s forbidden for health care personnel personal income to be connected to medication or medical examination income.
    不准将医疗卫生人员个人收入与药品和医学检查收入挂钩
  2. It’s forbidden to take a commission.
    不准开单提成
  3. It’s forbidden to receive payment against the rules.
    不准违规收费
  4. It’s forbidden to illegally accept social welfare subsidies.
    不准违规接受社会捐赠资助
  5. It’s forbidden to participate in marketing activities or distribute medical advertising against the rules.
    不准参与推销活动和违规发布医疗广告
  6. It’s forbidden to fill prescriptions for business purposes.
    不准为商业目的统方
  7. It’s forbidden to use illegally and selfishly procured medical products.
    不准违规自私采购使用医药产品
  8. It’s forbidden to accept kickbacks.
    不准收受回扣
  9. It’s forbidden to accept patient “hongbao”.
    不准收受患者“红包”

I don’t think hongbao is good despite what the authors linked below argue. But simplistically dismissing it as a bribe without first understanding it isn’t that helpful either. Looking more closely at the reasons and dynamics of this old practice also provides a helpful window into Chinese culture and common ethics. Here’s a bit from an American hongbao apologist:
From China, With Pragmatism

It is very common for a Chinese family to give hongbao to a surgeon who is about to perform a procedure on a family member. Everyone knows to do this, and everyone does it to the extent that they are able. The Americans in our group thought this practice was unethical bribery, because it sought to bias the doctor in one’s favor. The Chinese people at the table replied, “Of course it biases the doctor. That’s why we do it.” Not only were they mystified by the censure, but the Chinese were prompted to ask if the Americans had any children — for every parent surely uses any means necessary to protect loved ones.

When one embassy officer (working his best “hearts-and-minds diplomacy”) suggested that the Chinese switch the giving of hongbao to after the successful operation, rather than before, the Chinese were struck dumb with astonishment. Of course, you have to give the hongbao beforehand because it motivates the doctor. The gift tells the doctor: (a) to take special care with our child (b) we respect your surgical skills/education and “give face” accordingly (c) we are devoted to our child, will hold you responsible and have the means to do so. The fact that not everyone can afford to influence their doctor with hongbao is not grounds for withholding it, since we’re trying to protect my child here and now. The parent, according to the Chinese, should never weigh the child’s well-being against something so arcane as an abstract principle.

And here’s another piece that spreads the blame around:
Bribery serves as life-support for Chinese hospitals

Bribery is the lubricant that helps keep China’s public hospitals running, and the health system would struggle to function without illegal payments to poorly paid doctors and administrators, say medical practitioners and industry experts.
[...]
A doctor fresh out of medical school in Beijing earns about 3,000 yuan ($490) a month including bonuses — roughly the same as a taxi driver. A doctor with 10 years experience makes around 10,000 yuan a month, according to Peter Chen, chief executive of privately run Oasis International Hospital in Beijing.

“Without the grey income, doctors would not have the incentive to practice,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations in New York.

Dealing with the problem is not so easy:
Should Doctors Be Rewarded for Refusing Bribes?

hongbao is adding to the financial pressure most patients are already under, at a time when medical and health cost is very high. The public has long expressed their dissatisfaction with this accepted practice. The government has already taken a number of measures to save the deteriorating patient-doctor relationship resulting from hongbao by announcing that doctors who take bribes will be struck off the doctor roll. In some parts of China, it is announced that those who report this practice to the government can receive a reward worth thousands of yuan, while the doctors concerned will be dismissed. However, despite these kinds of measures, it seems the hongbao tradition is entrenched and likely to die a very slow death in China.

Here’s a little larger, current context for the hongbao practice:
Under the Knife — Why Chinese patients are turning against their doctors

Violence against doctors in China has become a familiar occurrence. In September, 2011, a calligrapher in Beijing, dissatisfied with his throat-cancer treatment, stabbed a doctor seventeen times. In May, 2012, a woman attacked a young nurse in Nanjing with a knife because of complications from an operation performed sixteen years earlier. In a two-week period this February, angry patients paralyzed a nurse in Nanjing, cut the throat of a doctor in Hebei, and beat a Heilongjiang doctor to death with a lead pipe. A survey by the China Hospital Management Association found that violence against medical personnel rose an average of twenty-three per cent each year between 2002 and 2012. By then, Chinese hospitals were reporting an average of twenty-seven attacks a year, per hospital.

So it begins…

Monday was the first day of a new Chinese preschool school year.

soitbegins So it begins... mamaaaaaa So it begins...

And that pretty much sums it up. But I’ll share some special highlights below anyway.

First day of the school year means the opening ceremony. The school yard is ringed with parents (mostly grandparents) peering between the iron bars. We have to make a good impression.

As a 6’4″ foreign male at a preschool with an all-Chinese-female admin & teaching staff…
fittingin So it begins...
…I totally fit in.

This is where we teachers all pledged to do something, but I’m not sure what: andiswearbythemoonandthestarsinthesky So it begins...
Chinese sound systems are for noise, to make an event sound like a Big Deal, not for clearly amplifying sound so large numbers of people can understand what’s being said. Plus at the time I was thinking: Oh hey, so this is what Chinese do instead of placing one hand over your heart and raising the other palm-out…

The kids had to turn around and bow to the teachers:bowdownpunymortals So it begins...
But only about 1/4 of them got the memo.

The Expensive English-speaking White Guy and the Obligatory English Song:whitemencantjump So it begins...
(I want it noted in my annual review that my feet actually left the ground.)

“Foreign teachers” (外教) are the bottom of the Anglo-American expat barrel, I suspect even below 4th-rate amateur Russian models and, at this preschool, hovering somewhere in the vicinity of the only other males on staff: the cook, driver, and gate guards. And I’m pretty sure I don’t outrank the cook.

More Chinese preschool stuff:

Things That Are Awesome (Fushan, Qingdao edition 青岛浮山)

Things That Are Awesome (in sharply descending degrees of awesomeness):

#2. The views on top of Qingdao’s Fushan mountain (浮山).

FushanviewQingdaoshibei Things That Are Awesome (Fushan, Qingdao edition 青岛浮山)

#3. Those portable personal fanny-pack radios popular in Mainland China.

#4. Those portable personal fanny-pack radios popular in Mainland China on top of Qingdao’s Fushan mountain.

#5. Those portable personal fanny-pack radios popular in Mainland China on top of Qingdao’s Fushan mountain playing We Are The World:

Aaaaand…. #1! Those portable personal fanny-pack radios popular in Mainland China on top of Qingdao’s Fushan mountain playing When a Man Loves a Woman when you’ve hiked up there to celebrate your 12th anniversary.

Snogging pics in

3…

2…

1…

Fushansnogging01 Things That Are Awesome (Fushan, Qingdao edition 青岛浮山)
Fushansnogging02 Things That Are Awesome (Fushan, Qingdao edition 青岛浮山)
fushansnogging03 Things That Are Awesome (Fushan, Qingdao edition 青岛浮山)
fushansnogging04 Things That Are Awesome (Fushan, Qingdao edition 青岛浮山)

When little foreign kids go to a Chinese beach…

…this happens. It doesn’t always happen exactly the same way, but what happened this past weekend is pretty typical:


(Language students! Listen for these key words:
洋娃娃可爱眼睛漂亮美女姐姐玩儿。)

I know we’re not the only foreigners in China that regularly attract this kind of attention from total strangers. How do you handle it?

In North America, if some stranger started taking pictures of little kids at the beach or wherever I would automatically interfere and probably call the police. Because that behaviour is outside our norms; chances are too high the person is a creep.

oooyangwawa When little foreign kids go to a Chinese beach...
Our two-year-old, with… I don’t know who.

But what about in China, when photographing, talking to, and even trying to pick up a stranger’s kid isn’t considered odd? I don’t mean that Mainlanders are always running around posing with each other’s toddlers; other Chinese toddlers aren’t exotic to them. And I don’t mean that China doesn’t have its fair share of perverts. I mean that this behaviour isn’t seen as violating anyone’s privacy or personal space. When it does happen, the idea that the person’s a pedophile doesn’t even enter people’s minds. 99% of the time, they really are just being friendly and curious in a socially acceptable way. (They don’t perceive an ever-present pedophile threat like North Americans do; their society just hasn’t caught up to ours, apparently…)

pantslessbro When little foreign kids go to a Chinese beach...
“Wa! The foreign doll is so cute!” “Wa! The Chinese boy has no pants!”

It is stupid to respond coldly or meanly to a Chinese person because they don’t behave according to North American norms. Actually, that’s being an ethnocentric jerk. You’ve got to understand what their behaviour means within their social context, because that’s where you are. If you’re going to treat people like they’re doing something wrong when they genuinely don’t think they’re doing anything wrong, then you’d better be able to articulate a really good reason (or have a good reason why you have to treat them that way regardless — but “It’s so annoying!” is not a good reason).

usualsuspects When little foreign kids go to a Chinese beach...
A typical crowd for our family, from two weekends ago. Compare to the next photo below.

But feeling annoyed is totally understandable and natural. And not all friendly and curious attention is the same, because Mainland China is not a monolithic society:

  • The more cosmopolitan Chinese are more likely to ask you before taking pictures of your kids. Bonus points for them!
  • Typical 2nd-tier city urbanites with leisure time on a Saturday behave like in the above video: form a crowd, take photos, try to hold hands, touch your kid’s face, pick up or otherwise pose with your kid — like the kid’s part-human, part-tourist attraction. If often starts with some mom or grandma trying to get their kid to make friendly and pose with your kid. Collecting photos is a thing here. These are the majority in our experience in Qingdao and Tianjin. I understand getting annoyed with this, and I understand looking for ways to counter it, but I can’t see how it’s right to respond to them like they’re doing something wrong.
  • Peasants (people from the countryside or inland cities) either hang way back, seemingly intimidated, or do like the urbanites but louder, coarser, more blunt. Like yelling at your kid from a few feet away so they’ll turn for a picture, as if they’re a zoo animal: “Hey! Look at me! Look over here! Hey!”
  • The worst (in our experience) are those who don’t attempt to communicate with you or your kid and won’t acknowledge you even if you address them in Chinese. One day I was playing with our youngest in the waves, and a middle-aged countryside woman runs over, grabs our youngest while yelling to her friend to come take a picture, oblivious to our daughter’s efforts to get away — as if she’d just caught a big fish! — and to me yelling at her. I grabbed my daughter back while giving the woman an earful, but she never looked me in the face. This kind of thing almost never happens.

The problem is that for the most part they aren’t doing anything wrong, but to us foreigners it feels wrong, like we have a right to be annoyed or offended or alarmed (and in our own countries we would). So our default tendency is to respond negatively because to us their behaviour is inappropriate. And some days you just want to relax at the beach without having to deal with it! Some days, you feel like doing this:

moatfull When little foreign kids go to a Chinese beach...
I have mixed feelings about the moat; it just seems so… anti-social:
“Take a hint, people!”

Bad China Days and fits of anti-social sandcastle-building aside, here’s what we aim for:

  1. Kids’ physical safety does not get compromised. We are there, fully alert, creep radar running on Chinese and Western dual frequencies, ready to wield those shovels if necessary. And call me ethnocentric or whatever, but you are not sticking your finger in my kid’s mouth (yes I have batted fingers away.)
  2. If our kids indicate (verbally or non-verbally), or we suspect, that they don’t want the attention, then we fend people off immediately/preemptively. You can still do this politely and with finesse, though sometimes in the moment I’m more blunt than I should be. And this only applies to “special” attention; we expect our kids to be nominally decent to people (respond to normal greetings, say thank-you, etc).
  3. Plan ahead. If you’ve got an option where unwanted attention is less likely, then take it. When we go to the beach, we always aim for the least crowded areas.

Or you can send subtle, anti-social messages by doing things like making a moat around your picnic blanket:

moateffective When little foreign kids go to a Chinese beach...
It works! See? (Though it’s not 100% effective — such subtlety is lost on most domestic tourists and āyís over 45.)

Maybe that sounds kind of stringent. But in practice it translates into our kids getting a lot more interaction than the average foreigner family, I suspect.

Basically, we protect our kids, but (try to) remember that most of these “overly-friendly” (by paranoid North American standards) Chinese strangers aren’t doing anything wrong. They aren’t breaking their social rules, and if you respond to them like they’re being inappropriate, your response simply won’t communicate. And you’ll come off like a jerk. Which is understandable, since expecting local Chinese to behave like Euro-Americans is just dumb.

Some related stuff:

P.S. - Though sometimes I have to admit, I do wonder…

igoticeland1 When little foreign kids go to a Chinese beach...

P.P.S. – Not actually recommending the sandcastle “spite fence”, though I’m definitely tempted to use it again. :)

Being Obnoxious With Monks

Actually, it was a nun, and I was arguing with her handlers. It was an irate customer who was yelling directly at the nun. (It looked like the customer got some money back in the end, but I couldn’t tell for sure — she’s in the orange jacket, near the centre of the photo.)

suanmingnun01 1024x613 Being Obnoxious With Monks

A Buddhist fortune-teller eyes my camera in a Qingdao market.

Usually my conversations with Buddhists and Daoists are mostly me asking questions. I try to nail down what they actually think, and get a sense of how their beliefs and practices function in their lives. Because I want to understand them; I want to understand the worldviews we encounter on their own terms. (The “high” Buddhism and Daoism we studied in school seems to have precious little to do with the Buddhism and Daoism we regularly encounter at street level in China.) Since there are lots of little god shops around, when I have a few extra minutes I stop in to chat. It’s never been confrontational. Until the other day.

My almost 5-year-old daughter and I have just finished lunch in the market. We’re going to buy trees to plant in the public grass/dirt area outside our first-floor apartment’s windows. I have a bag of tomato and húlu (葫芦) seedlings in one hand and my daughter’s hand in the other.

There’s a crowd around something on the sidewalk. Actually most of the street and sidewalk is basically one big crowd, but Something is Happening up ahead. I peer down into the circle of heads (6’4″ lǎowài can do this in China) to discover a Buddhist nun doing what’s called 算命, where they tell your fortune and then, for a fee, perform rituals to help you avoid the bad things headed your way. (Apparently, so my friends tell me, you pay even more if your future predictions are good.)

suanmingnun02 764x1024 Being Obnoxious With Monks

Reading futures, selling fortune

Judging by the surrounding interest, this seems like a minor Big Deal, so I pull out my phone and start taking pictures.
suanmingnun04 Being Obnoxious With Monks

Claiming a patch of sidewalk.

Wish I’d taken video; it’d be fun to have this exchange recorded:

“No! No! You can’t take pictures!”

(A handler comes toward me waving her hands.)

“Why not?”

(I wish I’d kept taking pictures.)

“You can’t take pictures of this. It’s bad for your ___.”

(Wish I could remember the exact term she used, but the idea is that me taking pictures of this nun in action would negatively affect my life/fate/etc.)

“No problem! I don’t believe in this superstition.”

(I’m feeling a little ornery. I don’t know why. Maybe being born on the Protestant side of the Reformation means I have a low tolerance for people selling indulgences. Or maybe (yes, actually) it’s because my hands are full, I’m with my daughter, and I’m in increasing need of a public restroom. At least I didn’t use the Mao Era term “feudal superstition” 封建迷信。)

“You can’t take pictures! This is a problem of belief.”

“Right, I don’t believe this. But what are you afraid of? This is a public–“

“We don’t have the same belief. In your country you all–“

(This is common point of worldview disconnect. In China, many people consider your heritage a perfectly valid reason for believing something; in the West, it’s usually the opposite — telling someone they only believe something because of their heritage is a way of saying that person has no good reasons to believe what they claim. Because — speaking very generally — when a North American says they “believe in X”, they usually mean they “think X is true”, but a Chinese using the same phrase isn’t necessarily making a truth claim. Personal convictions about the true nature of Life, the Universe and Everything (and ‘staying true to yourself’) just aren’t as high a value in China, compared with, say, getting along and getting by. And when personal convictions do matter to a Chinese, it can come off as really selfish. Anyway, it sometimes rubs my fur the wrong way when people assume that I think what I think for (what I think is) no good reason.)

“This has nothing to do with my country. Why can’t I take pictures? What are you afraid of?”

(I’m in a hurry, I suspect this whole thing is a scam, and I’m curious what objections they’ll raise since they couldn’t make me fear for my fate. But now the argument that’s been simultaneously happening on the opposite side of the crowd erupts into yelling and accusations of cheating people out of their money. The crowd starts thinning out, maybe feeling a little awkward between me/my camera on one side and the irate customer on the other. If you look closely at the above photos, to the the fortune-teller’s right you’ll see three handlers wearing hats facing away — they’re dealing with the angry woman, whose face can be seen in all the three crowd shots.)

suanmingnun03 764x1024 Being Obnoxious With Monks

Now you know! Cold weather = dog season

One of the fun things about China is fresh fruit in season. That means good fruit and it gives a fun rhythm to the year. And due to traditional Chinese ideas about health, fruit is not the only thing that has a season:

20130925 030DOG1 Now you know! Cold weather = dog season
上市 “Dog meat is on the market!”

Our innocently unapologetic corner of Qingdao is so endearing. Why wouldn’t you put up a big “DOG MEAT” sign right outside your restaurant? This is about a 10-minute walk from our place. We regularly eat their 老醋花生 and 肉末云豆。 Have not tried their dog yet. This is one of several (as in, over ten) places within walking distance to get dog meat. That’s just how we roll in Licun ().

Dog meat is hard to find in the summer because dog meat, like donkey and mutton, makes you 上火 — it ups your internal “fire”. I’m not even going to attempt to explain what that means, but your fire being too low or too high (usually too high) is a bad thing, and results in acne and colds and stuff. But in the winter it’s cold, so your “fire” can stand a little reinforcement. Or something. I guess.

20131001 198DOG2 Now you know! Cold weather = dog season

For more about eating dogs:

For more about Chinese healthiness:

Chairman Mao the good luck god

Walked out to the street market at the entrance to our neighbourhood to get some bǐng before dinner yesterday. The late afternoon sun was sparkling brightly off the superstitious dashboard ornaments of the cars that clog our complex. First a Guānyīn,

IMG 6526guanyin Chairman Mao the good luck god

then a prayer wheel,

IMG 6527prayerwheel Chairman Mao the good luck god

and then a…

IMG 6531maobust Chairman Mao the good luck god

…Chairman Mao.

Mao as a part of Chinese folk beliefs isn’t anything new, of course. But I thought it was funny the way it just fell across my path today. For more about Mao’s current status in China’s popular spiritual imagination: