Construction forest, Qingdao, China

Licun cityscape, Qingdao, China
A nearly-completely forest of apartment buildings as seen through the grimy windows of our gym, which is going out of business. Qingdao’s cityscape, especially in the north (Licun) and east (Laoshan), is dominated by massive construction projects.

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:


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”

  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.

Chinese church grannies stick it to local authorities, occupy church building to save it from gov’t bulldozers [UPDATE]

[UPDATE: After supposedly striking a deal to save the church building, gov’t seals off access and tears it down. Scroll to bottom for more photos and quotes.]

* * * * *

Here’s my soapbox: People need to update their understanding of Christian persecution in China. And a recent Chinese-officials-try-to-bulldoze-a-church incident that’s hit international news is a fine opportunity to illustrate what I’m on about here. Like it or not, the relationship between Chinese authorities and Chinese Christians is… not super-simple.

Does the Chinese gov’t persecute Christians?
First of all, it’s Chinese governments — plural — as in local, provincial, and national levels that are often at odds with one another, and never mind that levels of tolerance and policy implementation vary greatly from region to region. “The Chinese gov’t” is a complicated collection of departments that vary hierarchically and geographically, and each one has latitude re: its attitude and posture toward Christians within its territory. If some Chinese Christians are in trouble, we need to ask who’s giving it to them; “the Chinese gov’t” isn’t specific enough to be a useful answer. A given instance of Christians-in-trouble usually has little if anything to do with Beijing.

Second, this is a bad question, because if you’re talking about the whole country, the answer is:

  • “Sometimes, but not usually.”
  • “All the time, at least somewhere.”
  • “Systematically marginalized? Yes. Actively persecuted? Not so much.”

Chinese authorities leave most Chinese Christians alone most of the time (within a status quo of effective, systematic social marginalization). So a more useful question is, “What factors are most likely to provoke trouble from the authorities?” There’s a list.

But let’s get to the sensational persecution story. This one’s actually kind of fun. Christians brazenly defy lower levels of gov’t while appealing to higher levels of gov’t. From The Telegraph:

Christians form human shield around church in ‘China’s Jerusalem’ after demolition threat
Christians have flocked to defend a church in eastern China after Communist Party officials claimed it was an “illegal construction” and announced plans to demolish it

…specifically, by painting “demolish” and “illegal construction” on the outside of the building. I suspect that got church-goers’ attention:

If you see these kinds of (sensationalized) headlines and (understandably) get the impression that Beijing is literally plowing churches into the ground across the country, look at the details in more than one report. In this case, one province let churches get out of hand, so they’re reducing the number of extra-high, extra-conspicuous steeples and have picked a couple buildings for demolition. Here’re some hand-picked excerpts:

the Sanjiang church is part of the Three-Self Patriotic Movement, China’s officially sanctioned and government-controlled Protestant church, making this week’s stand-off highly unusual.

A woman who introduced herself as a representative of the local government rejected claims the Communist Party was persecuting local Christians.

“They can believe. This is free. We can’t control them,” said the woman, who gave her name as Zhang Biyao.

Ms Zhang said the church had been illegally built and was structurally unsound. The government wanted to protect “people’s safety,” she claimed.

Sanjiang’s congregation was unconvinced.

Parishioners believe their church was targeted after Xia Baolong, the provincial Party chief, visited the region and was unimpressed by the prominence of a church built to house thousands of worshippers.

“His behaviour is illegal. He has abused his power. The construction of the church is not against the law,” said Wang Jianfeng, a 47-year-old man from a nearby congregation who was among hundreds of people gathered on the steps outside on Friday in a show of force.

Wen Xiaowu, another visitor, said he believed China’s president would be “displeased” with his Communist colleagues in Zhejiang.

“Xi Jinping has said society should be harmonious. He is very open-minded about disciples of the Christian church.”

So:
— Local officials allow the government-controlled Three-Self Patriotic Church (or at least a legally-registered church; reports conflict) to build a big flashy church building.

— The provincial head comes into town and doesn’t like it. The unwritten rule is that Christianity must keep a low profile, and Christians in this province have been pushing that line for a while. In fact there’s a province-wide campaign to tone down the visibility of churches, mostly by making some (not all) churches take down extra-conspicuous steeples. See other articles here and here. This problem arose in the first place because churches across the province were given so much relative leeway that their buildings became too numerous and conspicuous for the comfort of provincial Party officials. In more tightly restricted provinces, churches aren’t allowed to become this conspicuous.

— So the local officials, who care first and foremost about their careers (which depend mostly on kissing up to their superiors) announce that the church building is illegal and, for the sake of “the People’s safety”, the “unsound” building must be destroyed, even though they’d previously designated the building a “model project”.

— So rank and file Christians publicly defy the local and provincial authorities, by [1] staging a sensational protest, [2] singling out the provincial Party head by name for blame, [3] appealing to higher levels of the Chinese gov’t (in this case the Chairman himself) [4] via domestic and international news media. (Using news media to apply pressure to the gov’t is common, though also dangerous.)

–> In other words, these Chinese Christians are appealing to the Chinese gov’t (President Xi Jinping) to protect their legal rights against persecutors from the Chinese gov’t (Zhejiang province Party head Xia Baolong and the local officials carrying out his orders).

If they get to keep their church building, will headlines read, “Chinese central authorities defend Christian church”? I suspect not.

Read the whole thing; while it may be short on solid info, it’s full of colourful anecdotes:

Sanjiang’s resistance has been organised with almost military precision. A makeshift kitchen behind the altar provides rice, pork and fried liver with leeks for those occupying the church while women hand out bottles of water and satsumas at the entrance.

By day, Christians from around the province crowd the church’s steps, with undercover security agents mingling among them, snapping photos and eavesdropping. By night, hundreds of worshippers take it in turns to keep watch, grabbing a few hours of sleep on cramped wooden pews between shifts.

Yang Zhumei, 74, said she had pleaded with officials to leave her church alone.

“I held their hands and said, “Comrades, don’t take down our cross. I can give you my head instead.”

The Christians have seen to it that the local and provincial authorities now have an embarrassing mess on their hands that will look much worse to their superiors than an overly-conspicuous church building would have. But even if the Christians win this round and keep their building, they’ll still be left with a ticked-off provincial Party head whose security forces know who every single one of those protestors is. For these Christians, things might not be easy until he retires or gets promoted.

It’s also worth comparing this to another recent local-government-hassles-legal-church-over-property incident.

Update: Demolition

(Images and quotes from this Telegraph article and @tomphillipsin.)

Near the root of this conflict are provincial and local gov’t concerns that Christianity in Wenzhou is growing out of control:

Provincial authorities deny they are waging an orchestrated campaign against Christian places of worship. However, Feng Zhili, the head of Zhejiang’s ethnic and religious affairs committee, complained earlier this year that Christianity’s spread had been “too excessive and too haphazard”.

See where this church sat along the highway:

And so they got the occupiers out and neutralized, sealed off access, and brought in the excavators:

After mounting their high-profile occupation in early April, many protesters withdrew from Sanjiang church after its leaders appeared to have negotiated a compromise with the government.

However, that deal appears to have broken down in recent days with reports that some church leaders and worshippers had been harassed and detained by security agents and officials.

“All the roads are blocked, you can’t get close to the church,” said a local Protestant leader, who asked not to be named for fear of reprisals from the government.

Photographs sent to The Telegraph and posted on social media sites showed at least four excavators that appeared to be ripping down large sections of the church’s exterior.

Other images showed black police vans, military trucks and security agents standing on the main road outside.

Church members told The Telegraph authorities had attempted to silence the congregation and said they believed their communications were being monitored. “My phone is not safe,” said one.

Asked to comment on Monday’s demolition, a propaganda official from Zhejiang’s Communist Party Committee said, “I don’t know” before the line went dead.

(Full article here.)

There are still appeals to Beijing, even from the head of China’s gov’t-controlled seminary:

In an unusual step, Chen Yilu, the head of the Nanjing Union Theological Seminary, spoke out against the provincial government’s “crude and hard-line” handling of the Sanjiang church crisis.

In a strongly-worded commentary that has been circulating online, Mr Chen said the incident would damage the Communist Party’s image as well as harming “social stability”. He called on Beijing to “intervene as soon as possible to avoid further deterioration”.

But, as they say, “The mountains are high and the emperor is far away” (皇帝).


More from this particular soapbox:

The art of palm-greasing

A closer look at how things ‘work’ in one particular Chinese county. From the Sydney Morning Herald: “It’s not just carnal pleasures that are up for sale, but investment projects, procurement contracts and almost every key position in the bureaucracy.”