Misadventures at a Chinese Hospital in Qingdao

Our About page says we’re “trying to live into and love — and some days just survive — China.” That last bit is just supposed to be some tongue-in-cheek hyperbole, but it recently became a little too literal.

For reasons that no doubt expose my questionable judgment, I tried to use the nearby local Chinese hospital in our un-redeveloped patch of an older outlying district of a wannabe 2nd-tier Chinese city, rather than the big downtown hospital that sometimes has Western-trained doctors in a clinic specially targeted to foreigners. I mean, how complicated could it be to get treatment for a persistent cough? What could go wrong, you know? As it turns out… a few things.

* * * * *

Why Not Choose a Local Chinese Hospital?
Of course we’ve seen the headlines and heard the stories about Chinese hospital corruption and low standards. But we’ve had two tolerable experiences at this particular hospital before: once when our two-year-old had bad pneumonia she got prescribed oral antibiotics and breathing machine meds (when we resisted hospitalization), and recently when the same kid had diarrhea she got prescribed ‘normal’ diarrhea medicine plus Chinese herbal belly button plugs (just for kicks).

I figured it’d be more convenient (wrong) and less expensive (also wrong) to visit a Chinese doctor I could walk to and pay 6元 to see rather than visit a maybe-Western-trained sort-of English-speaking Chinese doctor who costs 100元 to see plus 70元 in taxi money round-trip. And just the fact that I knew I could navigate a Chinese hospital visit on my own kind of made me want to give it a shot.

* * * * *

How to Get From the Front Doors to a Filled Prescription… in 11 Easy Steps (at least)
The Number “4” People’s Hospital is pretty average; you can find better and you can find worse (it wasn’t actually the Number “4”; I’m obscuring that detail to protect the possibly-guilty and because “4” means “die” in Chinese).

The process…

  1. from walking in the door and taking a number (<5min)
  2. to paying, getting a card, and registering to see a doctor (15min)
  3. to seeing a doctor (15min)
  4. to paying for tests (15min)
  5. to getting tests done (45min)
  6. to picking up the test results (30min for blood; 4hrs for CT printout — but the doctor has them almost instantly via the hospital’s computer network)
  7. to seeing the doctor again for a diagnosis and prescription (15min if you spend time arguing like me)
  8. to getting the skin test done to check for allergies to the prescribed meds (20min)
  9. to paying for those meds (15min)
  10. to receiving your meds (5min)
  11. to getting your IV drip prepared and inserted into your circulatory system (IV drips are a national pastime in China) (15min)

…can appear daunting at first. Each one of the points above represents a trip to a different window and/or office and/or machine, and most of them involve standing in crowded noisy lines of other sick people. (The times above are what it took for me the other day.)

Honestly, Number “4” People’s was decently navigable; at any point in the process you can ask a nurse at the booth by the main entrance and she’ll tell you what to do. To get your test results you insert your hospital card into an ATM-like machine (your name displays on a screen when they’re ready to print), but the doctor had my results on her computer before I’d made it back to her office from the testing room.

But you should probably bring a Chinese friend if:

  • You’re too sick to stand for a while in the crowded heat and yell through glass windows and run around a bit;
  • You don’t have at bare-minimum solid HSK4-level Chinese (this might not be enough). Aside from the all the medical vocabulary, it’s just noisy and hard to hear clearly.

* * * * *

How Not to Handle Your Average Local Chinese Doctor
I’d walked in at 9:30am and ping-ponged through Steps 1-6 by 11:10. Now I’m back in the doctor’s office (Step 7)… and this is when things start to go bad.

I’m not saying ‘bad’ because there’s no privacy with the door wide open and other people in the room, one of whom will eventually chime in on my consultation — that’s normal and expected. I’m saying ‘bad’ because she looks at my CT scan and says: “You need to be admitted for 7-10 days and take IV antibiotics.”

“Can’t I just take antibiotics pills? I’ve never needed an IV before. Usually we just take pills for this.”

“You’re pneumonia is too serious for pills. You need to be admitted. Look here…” She shows me her screen:
CT_scan_pneumonia
“…That’s your heart. That black part is your lungs. It’s supposed to be all black. See all this? This here that looks like meat? That’s the pneumonia.”

This is not what I want to hear. As if I know how to judge the seriousness of a CT scan. And sure, I know the Chinese doctor stereotypes — over-treat everything (especially with IVs and unnecessary hospitalization and surgery) just to make extra sure, and never mind a financial incentive to over-prescribe — but I mean, come on. Really?

There’s no way I’m being admitted; we leave for North America in just over two weeks, we have a newborn and two young kids at home, and I have work to do. So I’m still aiming for pills while trying not to be too rude: “I can’t be admitted; that’s impossible. Can we really not use pills in this situation?”

“I really don’t want to give you oral antibiotics,” she says while flipping through my CT images, “Not for pneumonia that’s this serious.”

I haven’t given up yet, “Well, what’s the difference between me taking pills or an IV? Is it just that pills will take longer? Because I don’t mind! I can take pills for weeks if I need to!”

“Your pneumonia is really too serious. You’ve got to be on an IV…” She will not budge. After some more back and forth — during which I wish now that I’d just flat-out refused and forced her to give me pills — I agree to come sit in the hospital’s Infusion Hall twice a day for four hours at a time for three days, after which she’ll maybe consider giving me pills depending on my progress. We also go back and forth about whether I can just do the IVs in our neighbourhood’s clinic, but she refuses. I have to come into their hospital twice a day for four hours at a time.

It’s insane; I can’t believe I’m agreeing to it but my only other option is hospitalization, and by this point I’m feeling pretty sick.

infusion_convoI want to walk out and catch a cab straight to the foreigner clinic at Qingdao Municipal or even to super-expensive Family United — anywhere a doctor will prescribe oral antibiotics. But here’s the catch: it’s the beginning of the Dragon Boat Festival national long weekend. Jessica’s already called both those other hospitals and neither has an American-trained doctor available. At Family United I’d have to go to Emergency, so with tests we’re talking 10,000元 (their nurse’s estimate!) and I’d still be seeing a locally trained Chinese doctor!

* * * * *

From the Infusion Hall to the ER… in under 10min
So that’s why I show up again at 3:30 to collect my CT printout and go on a drip for the first time in my life (though we did sell plenty of our plasma in college; I’ve got lots of experience sitting in a chair for hours with a needle in my arm).

It takes more time to get from Step 8 to Step 11 than I’d anticipated (plus I wasted about 15min standing in line at the wrong time). I send Jessica this photo at 4:28. The drip’s been in for about a minute:
POd_inthe_infusionhall
I’ve got my laptop so I can do some work, and my Chinese reading’s loaded on my phone. Neither has enough battery to last the full four hours, even used consecutively. I’ve forgotten my book. So far I’ve been polite to everyone and kept my face pleasant, but I’m in a foul mood. I can’t believe I’m going along with this. I’m about to start in on my Chinese reading when…

…huh. does my stomach feel weird? i don’t think so… maybe i’m imagining it? or does it? it’s hard to tell… … wait, no, it does feel a little weird, maybe i’m hungry… … wait, are my fingers tingling? the heck…? my fingers are tingling… … oh man i need to rest my head somewhere…

“Hey, nurse! Please come here.”

“What?”

“I feel uncomfortable.”

“Oh! Haha. I don’t know. Hold on… Hey! Older Sister! Come here!” I see her wave down a nurse who looks slightly older than this rookie, who’s in the middle of a funny conversation with a coworker. They all get off work in about 20 minutes.

…am i sweating? i’m sweating… why am i sweating…

“What’s the problem?”

“I feel really uncomfortable,” I’m slumped forward in the chair, I wonder if I’m slurring.

“Here eat this.” She shoves a piece of candy in my mouth. I crunch it down as fast as I can. One of them pushes me back up into a sitting position.

…candy? the heck… oh man this is not getting better… i’m sweating buckets… i must be dripping on the floor… i’m dripping… ohhh black stars… white stars… am i gonna barf? …if i barf where should i barf? …not on my clothes… clear a space on the floor here…

Suddenly there are doctors — two, I think. They’re talking to the nurses. One looks straight at me and says, “What’s your name?”

“My name is Lu Tianlang.” …fuzzy black stars on the edges of my vision… and blinding bright whiteness like the washed-out parts of a photo…

His face is right in front of me, “Have you eaten? Did you have lunch?”

“At three in the afternoon I had three zongzi.”

He turns to the others, “It’s definitely not low blood sugar.”

…slumped… sweat… tingling… i can’t see clearly… a face, question…

“What is your name?” All I can see is his face and collar; all around and behind him are the bright white shining stars. I try to focus on his face.

“My name is Lu Tianlang.” …pretty sure i slurred that one…

An old man wheels a gurney up, they help me climb on — I’m oddly aware of the fact that I remember to grab my phone first — someone puts the laptop between my shins, they’re wheeling me down the hall. I think I hear them say the word in reference to whatever IV solution they used to swap out my medicine (guessing it’s this). I can feel the stars and tingling start to recede, and I tell them I’m starting to feel better. The doctors seem happy; they try out some English on me.

Chinese_ER_convoIn the neighbouring building’s ER they take blood pressure and do an EKG. I watch the doctor read the printout. He smiles, gives me a thumbs up, says I’m fine and leaves. I flag down a nurse who says I can go as soon as my drip bag is done in about 45 minutes. I’d better think of something to tell Jessica…

* * * * *

Outside the main entrance I thankfully get a cab immediately. The driver’s 60 years old. We chat. I mention what’s just happened. He takes a sideways look back in the direction of Number “4” People’s and mutters, “That place is no good. They don’t know what they’re doing in there. I don’t go there. They don’t know what they’re doing…” Then he lectures me about the importance of being healthy.

I’m feeling crappy and slightly scared. I have no medicine and tomorrow I’ll have to try another hospital. But I’ve got all kinds of warm feelings for this taxi shifu. It’s like ‘China’ decided to throw me a bone after all, even on a Bad China Day.

* * * * *

Salvation
1:30pm the next day is the soonest I can get to see a foreign-trained doctor — a “Dr. Qi” who works at the Municipal Hospital’s International Clinic. I imagine the consultation being mostly in Chinese, like the previous two times I’d seen doctors at that clinic.

But then he walks in and starts speaking *American.*

What?! …JACKPOT!!! MY NIGHTMARE IS OVER AND I’M GETTING PILLS!!! I COULD KISS THIS GUY RIGHT NOW! (Except for, you know, the pneumonia.) I wonder if the shock showed on my face.

I suspect he gets this reaction a lot. Another China long-termer in Qingdao told me later,

“I cried the first time I went in to see Dr. Chee. I couldn’t believe I was doing it in English and I just lost it right there in his office!”

I can understand that!

Turns out his name’s not even Qi (Mainland Chinese spelling for the surname ) like I’d assumed from hearing it spoken; it’s Chee (for ), as in his family probably originally immigrated from Hong Kong or somewhere (mine originally came from the Ukraine and Switzerland — hey, small world!).

This doctor visit is a full-on miracle of modern medical science. He’s better than a lot of doctors I’ve seen in North America, and I’m not just saying that because he prescribed me oral antibiotics that are literally 5x cheaper than the IV meds I’d bought the day before. If you are a sick English-speaking foreigner in Qingdao, Dr. Chee at the Qingdao Municipal Hospital’s International Clinic is your man!

* * * * *

One Final Awkward
But there’s one last task to do on the way home: get that nearly 600元 worth of IV antibiotics refunded. This requires authorization from the doctor who prescribed them. So I’m going to walk into her office at Number “4” People’s with some other hospital’s blood test gauze taped to my arm and a bag of pills that she wouldn’t give me but some other doctor obviously has, and ask her to refund two huge bags of stuff she insisted I buy even though I’d said I didn’t want to, and even though submitting to her treatment had landed me in the ER. Awkward.

I walk straight up to her office just after 4pm without taking a number (she gets off at 5). I’m polite and smiley; she’s chatty, if a bit flustered and rushed. She’s assumed I’m there to return the drugs and immediately gets after it. I can’t describe the process because she personally does all the running around between floors and departments and windows for me — I just follow her and stand off to the side.

We talk all about what happened 24 hours before, and she keeps saying, “It’s really strange!” over and over. She doesn’t verbally apologize, and we don’t even come close to broaching the subject of, “So what do I do now?” Apparently it’s an unspoken understanding that I’ve found another doctor, or at least that I won’t continue with her. She’s super accommodating, and at 4:30 hands me my partial refund, says a hurried goodbye and rushes into the elevator with someone.

Was it an unspoken apology? Was she afraid I’d make trouble? Collusion between the pharmaceutical and medical industries is rampant in China, and her prescription cost 5x more than what the American doctor at a more prestigious downtown hospital prescribed. Was she afraid of being accused of something? I can’t know, but it’s all possible.

And no joke: they refunded me 444.64元 (of 581): “Die, die, die, unimpededly die.” That’s gotta be the most inauspicious Chinese hospital receipt ever.

* * * * *

That evening I thanked her on Weixin for helping me return the drugs; I just wanted to say goodbye and close things out. She replied with a written apology and a 100元 hongbao:
doctor_apology_hongbao

Not at all, I still feel apologetic. It was Bangda [a particular drug], and you did a skin test, so I thought it over, not excluding being too nervous or low blood sugar. But no, how about you first take oral antibiotics and see. I’m really embarrassed, I hope you’ll understand! Here’s a hongbao to express my apology!

I asked several different Chinese friends how to respond to that: Should I take the hongbao? Not take the hongbao? What should I say? I replied with what one of them told me to say, and tried to return a portion of the hongbao like another suggested (she didn’t take it):

It didn’t cause a health problem, so it’s fine, medical science isn’t perfect, anyone can make mistakes, let’s just consider it my contribution to the accumulating experience of medical science.

How often does that happen in China? A doctor giving a patient a hongbao? It’s usually the other way around. Here’s the anti-bribery sign from the front desk at the international clinic in the downtown hospital:

no_hongbao_please
HONEST MEDICAL TREATMENT, REFUSE TO ACCEPT HONGBAO
诚信医疗 拒收红包
Now that I think of it, I didn’t see any of these signs at Number “4” People’s. Maybe that should have been a clue! (Here’s another one from a previous medical adventure in Huangdao.)

Diagnosing & Prescribing for Pneumonia
Qingdao Number “4” People’s Hospital:

  • Consult: 6元
  • Meds + IV fees: 597元 (and pressure to accept hospitalization!)

Qingdao Municipal Hospital’s International Clinic:

  • Consult: 100元
  • Meds: 118元

I want to assume the best and give benefit of doubt, but a part of me still wonders how to interpret that 100元 hongbao apology.

If China confuses adult foreigners, what about their kids?

Jessica and our oldest had this conversation this morning:

L: “Mommy, do you remember when you were talking about how Daddy was born in the horse’s ears?”
Jessica: “What? Can you say that again?”
L: “The horse’s ears…Daddy was born there. And you said that I went to the hospital and was born in the cow’s ears.”
Jessica: “Are you telling silly stories again, L?”
L: “Mommy, no! You said it!!! I was born in the ear of the cow!!!”
Jessica (pieces finally colliding together): “Oh! L, I said you were born in the YEAR of the cow. And Daddy was born in the YEAR of the sheep. And Mommy was born in the YEAR of the horse. And K was born in the YEAR of the dragon.”
L: “Are you sure I wasn’t born in the cow’s ear?”

And then a few minutes later from L: “Are there really dragons?”

For more stuff along these lines, try these topics:

How to do cross-cultural transitions right: Build a “RAFT”

Moving cross-culturally is a lot of things, but one thing it isn’t is easy. You leave behind siblings, nephews and nieces, parents and grandparents, and friends, plus places and things infused with memories and meaning, like the house where you grew up and park where you proposed.

We did that once, the first time we moved to Asia. After three years we returned to Canada to have our first child, and then we did it again. After another two years in China we returned to Canada a second time for the birth of our second child. And now we’re back in China for the third time.

The return trips to China after each birth were harder than the first time we left. Taking your children away from their grandparents, uncles and aunts and cousins, Sunday school friends (never mind all the grass and trees and oceans and lakes and air) hurts.

You realize more what you’re doing when you’re also doing it to your kid.

There’re others you leave behind, too: coworkers, people you don’t like, people you have a grudge against. And there’s the nasty bonus surprise: returning to your culture of origin (like our friend Rob) after a long time away is often harder than leaving your original home ever was in the first place. Not only are you leaving behind so many friends and places and memories, but “home” has changed since you left, and so have you, and it won’t feel the same. Much of the familiarity you’re expectantly anticipating never materializes. But this post isn’t about entry or re-entry; it’s about leaving.

Regardless of which direction you’re going, the experience of leaving so much behind is huge whether you take the time to acknowledge it or not. And how you leave it can have a big impact on you personal development, on the kind of people you and your lover and your kids are becoming. This experience impacts all of you, and some ways of intentionally navigating the experience are healthier than others.

We received some great advice about how to do cross-cultural transitions before our most recent move back to China, advice we tried out a little bit in the months before we left, and we think it’s worth sharing. I wish we’d put more of it into practice than we did. It’s called “building a R.A.F.T.” and comes from chapter 13 of Third Culture Kids by David C. Pollock and Ruth E. Van Reken (pages 200-204 in our 2001 edition). Below is my summary/paraphrase/riff of what they wrote.

Building a R.A.F.T.

You’ll see quickly that this process takes some forethought and planning ahead; put it off ’til the last two weeks and you’ll likely not have enough opportunities. You’ll also notice that it’s something for every family member to do, not just the adults.

Reconciliation
Closure matters. Festering bitterness matters. Making peace matters. Emotional baggage matters. Guilt and regrets matter. Forgiving and being forgiven matter, and that’s what reconciliation is all about. Reconciliation means growing up. It means attempting to communicate hurts and forgiveness, and initiate apologies.

A cross-cultural move presents a tempting cop-out: to run away and ignore strained or broken relationships. But refusing to resolve interpersonal conflicts sabotages healthy closure, and this lack of reconciliation sabotages the rest of your “RAFT” — the rest of your transition and entry/re-entry experience. You can’t really move away from these kinds of difficulties anyway; you’ll carry the emotional baggage of unresolved problems with you. Bitterness is unhealthy, unresolved relational issues can interfere with new relationships, and if/when you eventually move back, those problems will still be there, and they’ll be even harder to resolve.

A cross-cultural move also provides a great excuse, if you need one, for attempting to make peace: “Hey, I’m leaving for China for who knows how long, and I don’t want to leave a mess between us…” or however you need to do it.

You can’t always achieve reconciliation, of course, because it takes two willing parties. But you can always attempt it, and at least own up to the part of the relationship you’re responsible for. In our recent personal experience we found that the attempt is worth it whether the other side engages or not.

Affirmation
Think through your list of friends, coworkers, supervisors, neighbours, classmates. Do more than just say goodbye. Affirm people; let them know you respect and appreciate them, acknowledge that they matter. This is good for them and for you: it strengthens your relationships into the future and makes you more aware of what you’ve gained from living in the place you’re leaving. Pollock and Van Reken illustrate with some examples:

  • Make time to tell coworkers that you enjoyed working with them.
  • Tell friends how their friendship has been important, and maybe leave them some sort of memento.
  • Send a note and small gift to neighbours, mentioning positive things about your interactions with them.
  • Reassure those close to you of your love for them and that you don’t leave them lightly. Order flowers for the day after you leave.

Affirmation helps with closure by acknowledging the blessings you have in the form of relationships, and mourning their passing.

Farewells
Making farewells to people, places, and possessions helps avoid deep regrets later. Schedule ahead so that you won’t end up missing anyone or anywhere or any thing that was in any way significant, and make a real ‘official’ farewell to each. It’s a time to acknowledge all the positive things and feelings, and acknowledge that it’s sad to leave each person and thing behind.

People – this is crucial, even more so for children, who will need guidance. You want to say and do something, make some sort of gesture like baking cookies or writing a note, that acknowledges the importance of that person to you, expresses thanks, and lets them know they will be missed.

Some sort of “rite of passage” ritual often accompanies major life transitions like graduation or retirement parties. Taking the time to do something similar in spirit creates a significant memory acknowledging the importance of a person or place, and helps face and process the fact that you’re leaving them.

Places – Visit emotionally significant sites to reminisce and say goodbye. Everything from the tree you loved climbing to the park where you got engaged. Some people plant a tree, or hide some little treasure that they could dig up later if they ever return. The point is to openly acknowledge the time as a true goodbye, admitting that the stage of life these places represent will soon be in the past.

Possessions – You have to leave a lot of stuff behind in international moves. Certainly, adults and kids have to learn about letting go, and we all have too much stuff anyway, but everyone should talk over what to take and what to leave behind. It’s also important to deliberately choose and take what become “sacred objects”, a slowly growing collection of physical objects that connect the different places and stages of your life. When important objects must be left behind, try giving them as gifts to a friend and taking photographs. Jessica and I have a Christmas tree ornament (or something we use as one) from most of the significant places in our life together. Every year we can remember.

In addition to all her teachers and ‘aunties’ and ‘uncles’, we had our three-year-old say good-bye to her classrooms, playground, the lake where she swam all summer, places we visited regularly, her bedrooms, toys she was leaving behind, parks we often walked in, and a bunch of other stuff. And we took pictures of it all. This gave us plenty of opportunity to verbalize what was happening then and later after we’d returned to China. It helped all of us put words to the experience and mourn all that we were losing in a healthy way.

Think Destination
During the goodbye process, start shifting gears mentally, reorienting your thinking to the near future: you’re arrival and adjustment in a new place. Think realistically: identify positives and negatives and differences about your destination. List problems you’ll likely encounter. Make a list of your coping resources, both external (finances, support people you can lean on) and internal (your ability and methods of dealing with the stress of change).

Thinking ahead and identifying these things helps make the transition much less rockier than it could be. Forming realistic expectations helps avoid disappointment (from too high expectations) and makes sure you don’t miss out on available resources (due to too low expectations). You aren’t mentally and emotionally leaving so much behind in order to go nowhere; every step away from what you’re leaving can be a step toward what you’re gaining.

Related stuff:

So you want to make a difference in China?

Good luck. ;)

Here are four quotes from three different centuries. The first three come from Jonathan Spence‘s To Change China: Western Advisers in China 1620-1960 (1969).

Jonathan Spence on education in 19th century China:

It was particularly hard for a foreigner to enter the educational sector. To the Chinese, education was the key to social harmony and political stability: from the Confucian Classics, hallowed by a tradition reaching back over two thousand years, the young learned obedience, morality, and the norms of acceptable behaviour. On the basis of their study of the Classics, they participated in ascending levels of examinations for the civil service. Success in these examinations opened up prospects for a career in government, the major source of wealth and power. To introduce new subjects — such as Western philosophy, languages, or natural science — was to threaten the basis of the Chinese state. Innovation, accordingly, was vigorously resisted. [Spence, 129]

John Fryer, missionary/educator/translator employed by the Qing dynasty, on learning Chinese:

It was all a question of time and tenacity: “Most foreigners who come to China have the notion that in a year they will master the language. They get a teacher, and pound away vigorously for a week or perhaps a month and then give up in disgust.” Accordingly, they made ludicrous mistakes which negated all their endeavors. He told his cousin of hearing a missionary in Shanghai trying to tell his Chinese audience that “Jesus is here also”; the missionary, muddling his tones and aspirates, succeeded only in assuring the puzzled listeners that “Jesus is inside shaving his head.” “If I could have my way, not a single missionary should say one word in public till he had lived with the people and studied the local dialect of his mission station at least five years, and passed an examination. Just imagine the ridicule which such people bring to Christianity.” [Spence, 145]

Mikhail Borodin, “Stalin’s man in China,” on his failure:

I came to China to fight for an idea. The dream of accomplishing world revolution by freeing the people of the East brought me here. But China itself, with its age-old history, its countless millions, its vast social problems, its infinite capacities, astounded and overwhelmed me, and my thoughts of world revolution and the fight for freedom, in China became an end in itself, and no longer a means to an end. My task was to grasp the situation, to start the great wheel moving, and as time has passed it has carried me along with it. I myself have become only a cog in the great machine. [Spence, 202]

BBC commentator Martin Jacques on understanding China (quoted by Dr. Brent Fulton of ChinaSource.org):

Last year Martin Jacques, a BBC commentator, put it well when he said, “The great task facing the West over the next century will be to make sense of China – not in our terms but in theirs. We have to understand China as it is and as it has been, not project our own history, culture, institutions and values onto it. It will always fail that test. In truth such a mentality tells us more about our own arrogance and lack of curiosity than anything about China.”

(And of course we have lots more quotes and reviews of China Books and DVDs.)

“A pile of loose sand” and civic consciousness in China

Read Ian Johnson’s Wild Grass: Three Portraits of Change in Modern China (2004). Plenty of important insights to be gained from this book, particularly since “evil cults” have been in the news again and Johnson does a great job illustrating why and how certain groups can be so brutally persecuted. A related insight that I find interesting is the challenge of developing “civic consciousness” among ordinary Chinese.

“A pile of loose sand” and the lack of Chinese civic consciousness
In the early 20th century, Dr. Sun Yat-sen famously referred to the Chinese as “a pile of loose sand” and apparently saw nationalism as the solution:

For the most part the four hundred million Chinese can be spoken of as completely Han Chinese with common customs and habits. We are completely of one race. But in the world today, what position do we occupy? Compared to the other peoples of the world we have the greatest population and our civilization is four thousand years old; we should therefore be advancing in rank with the nations of Europe and America. But the Chinese people have only family and clan solidarity; they do not have a hundred million people gathering together in China, in reality they are just a pile of loose sand.

That was almost a century ago. Today, China suffers from nationalism overload, yet the same lack of civic consciousness still plagues domestic China. Consider these comments from award-winning journalist Ian Johnson describing late-90’s China:

A friend of mine liked to argue . . . [that] the crackdown showed that Chinese actually didn’t care much about each other or the discrepancy in what they saw and what the [authorities] did. There was no solidarity with the persecuted, unless they were family members or personal friends. It was like the traffic accidents that one sees in big Chinese cities — crowds gather only to stare; almost no one stops to help. No wonder [the authorities] could hold on to power so easily, he said. It doesn’t have to divide and conquer its enemies; they are divided of their own accord. I had to agree with him, because I rarely encountered a person who got really angry about the way [the authorities] treated [the persecuted] adherents. While some far-thinking people saw the campaign as unjustified and cruel, most simply shrugged and wondered why people bothered to stand up for something they believed in. Concerned with their daily struggles, they couldn’t understand why [the persecuted] believers insisted on exercising publicly. “Why not just exercise in the living room?” was the most common response I got when I asked about the repression… [pp. 288-289].

For more about the specific persecuted group referred to above and a similar group, see these links:

Cross-cultural living and the desire to be intimately known

Guest post! Cindy is one of the very few 100% fully bi-cultural people I’ve ever known. She originally wrote this in Facebook, and after reading it I asked to repost it here. I think it connects powerfully with everyone, especially those of us who live far from home, and most especially with Third-Culture Kids who aren’t really sure where ‘home’ is.

Let’s get to know each other

by Cindy
I had a conversation with my girlfriend about the hypothetical situation of whether we should remarry if our husbands died. I know my married girlfriends have had this conversation too, don’t deny it people. Her response was how hard it would be to have to get to know another person as intimately all over again.

Truly one of the greatest gifts in relationships is to be understood by another person. And trusting you will be accepted and loved in spite of the intimate knowledge. However, the process from acquaintance to intimacy takes time. It takes time to tell stories, to react to circumstances in life, to laugh and cry together, to argue and disagree, and then to make up. These experiences build layers of trust and loyalty and compose the patches of material that make up friendship. Through time we weave our lives together and enter together into the depth of relationship that allow us to be known by one another. And we are created to long for that depth. To be deeply known.

The trouble is, then we move. We pick up and move to another town. Or in my case, across the freakin’ ocean. I grew up in a small school where my friends were like my brothers and sisters. We were that small and that close. At graduation we scattered literally all over the world. Our new communities didn’t know our collective history and we had to start over from scratch with the storytelling and the laughing and crying and all that relationship building stuff. Then we’d move again. And start all over again. It’s no wonder people who are forced to move around a lot, like military families, have intimacy issues. It’s simply too exhausting.

Each time we enter a new community, that new place shapes us, molding us into someone different. When I left Wheaton, I was starting to question some of the conservative elements of my beliefs. Fuller helped introduce a broader spectrum of theology and how to incorporate doubt and criticism into a vibrant faith. In a sense, there was a Morrison Cindy, a Wheaton Cindy, a Fuller Cindy, a China Cindy, and a back-to-Taiwan Cindy. As time went on, the world changed and so did I. In the moving river of life, people who stepped in along the way journeyed with me downstream without the knowledge of who I was before I became who I am. Like a diamond, we can only reflect light off of one surface at a time even though we are made out of many facets.

The potential for misunderstanding is alarming. In our limited perspective, it’s too easy to make judgments regarding a person’s comments without a fuller understanding of their background. Wheaton Cindy would be appalled at some of the theological slants of back-to-Taiwan Cindy, and Chinese Cindy cannot hardly stand American Cindy most of the time. The complexities of our biological, cultural, mental, and spiritual identities is what fuels the psycho-therapy economy. And yet there exists inside of me the desire to be wholly known. The impossibility of somebody understanding the nuances of every past experience, every hat I wear, every idea and action and word I exhibit, doesn’t stop me from trying.

So I tell stories. I share my reaction when stuff happens. I laugh and cry. I argue and disagree. And I make up. Then I listen, not only to stories but to the stories behind the stories. I try not to jump to conclusions about people because I don’t know where they’ve been upstream. I look for the other faces of the diamond that make up each person I encounter because seeing only one side is not satisfying. I lean deep into the relationships around me to know and be known. It’s what I was created for.

I’m Cindy. It’s nice to meet you. Let’s get to know each other, shall we?

Lying, “Lying” and Mainland China [Updated 2x]

“Lying” isn’t just a cross-cultural communication pot-hole between Chinese and Euro-Americans, it’s a crater. Conflicting communication styles result in Westerners sometimes thinking their Chinese counterparts are lying even when they actually have no intention of deceiving anyone. The Americans get the (long-standing) impression that the Chinese are devious and deceptive, while the Chinese, who weren’t intending to deceive anyone and were merely being polite and gracious, are annoyed to no end at the simplistic and judgmental Americans.

But there’s another side to Mainland Chinese society, where ethics are simply a non-factor in decision making. Mainland Chinese lie and deceive reflexively in many aspects of their daily lives and relationships; it’s routine, accepted, expected and generally considered unavoidable. If you’re straight, honest and genuine, people will think you’re simple, naive and stupid. Corruption is endemic in every layer of society, and it is common for it to taint thesis papers, resumes and job applications, personal ads, and communication between spouses, parents and children, employees and employers, clients and suppliers, etc.

This is the China revealed Factory Girls: the post-Communist, unapologetically amoral, full-on materialistic free-for-all China. It’s a social world where everyone seems to automatically, reflexively lie all the time about everything to everyone else, including parents, boyfriends, coworkers, bosses, clients, employees and potential spouses. This is deliberate deception, not mere non-literal communication. Here’s one of many examples:

Married men who pretended not to be were the number-one dating hazard of Dongguan… In a place where people lied reflexively for work, deception naturally seeped into personal relationships. Lying was often the pragmatic choice because it got you what you wanted. Eventually your lies might catch up with you, but few people thought that far ahead.

Chunming had her own rules for such affairs. No one should get hurt, and neither side should make demands. “Of course, I’d like to find the right person and get married,” she told me. “But since I haven’t, it’s fine to be with someone you don’t love. You can still enjoy your time together. You can still rest your head on his shoulder when you’re tired and feel a sense of security.” [p.350]

So Mainland China presents outsiders with a cross-cultural communication double-whammy: a relatively high reliance on nonverbal, “high-context” communication, and generations of people raised in a corruption-saturated society in which deception is routine. You can find both aspects of Chinese “lying” in the posts below:

  • Caging a Monster (by Murong Xuecun)
    “In my country, there is a strange system that rewards liars, and with the passage of time, people have become accustomed to lying. People lie as naturally as they breathe, to the point that lying has become a virtue.
    […]
    “In this system, people only care about short-term profits. In this system, not following the rules is the rule, and unscrupulous means are the only means in government and business so only the dirtiest players emerge victorious. In this system, everyone is a criminal so no one needs to repent.”
  • Chinese “Lies That Bind” (Frog in a Well)
    “because they live in closer and longer lived groups, Chinese are more focused on the social consequences of a statement than its literal truth. […] these differences cut two ways. To be “free” or “independent” can also be “irresponsible,” “lonely,” or “selfish.” What Chinese call “harmony” can be “conformity” or “repression.” American “straight talk” can be childish, reckless, or self-righteous, and Chinese “sweet talk” can cover up realities until they fester.”
  • Do the Chinese Lie? That Depends… (The Lingua Franca)
    “In short, for most Chinese people, lying is not really lying. What we in the West would consider to be a bald-faced lie, a person in greater China might think of as a courtesy, a convenience, or a smart tactic, none of which are immoral. In fact, lying to achieve some business or social aim, and getting away with it, is considered to be a sign of intelligence and social skill among many Chinese.”
  • Dumb Americans (Seeing Red in China)
    To many Chinese, Americans don’t have xin-yan (心眼, meaning, literally, eyes of the mind; or figuratively, calculating, wily), they trust what you say, and they believe you are doing what you say you are doing. For that, they are dumb.

    …to speak your mind straightforwardly, to defend your position forcefully, and to uphold what you believe without compromise, are all signs of childishness. A lot of Americans, alas, fill that bill.

  • Chinese people like it when you “lie” to them? (China Hope Live)
    “Interpersonal communication ‘with Chinese characteristics’: A little understanding goes a long way when feelings get hurt by Chinese/Expat miscommunication”
  • To “lie” or not to “lie” (China Hope Live)
    “If you stop to think about it, there a tons of common situations in English where we use words to mean what they don’t actually literally say, but to us it’s “obvious” in those situations what the intended meaning really is. Our delivery, the context, and our non-verbals all speak quite loudly and quite clearly, so clearly that we would never think of such instances as “lies.” Sarcasm is only one kind of example.”
  • Free Advice – for you and your Chinese friends (China Hope Live)
    “If you’re a Westerner with Chinese friends, or a Chinese person with Western friends, you probably ought to read this. It’s from the end of Communicating Effectively with the Chinese, which is co-authored by a Chinese and a Western scholar and easily the single best-all-around book I’ve read on the subject so far. They should force-feed it to all China-bound Westerners, in my opinion.”