Pages

Total Pageviews

Saturday, June 30, 2012

Order of Canada

Order of Canada, Officer




Several weeks ago I had a phone call from the office of the Governor General of Canada, informing me that I would be appointed as an officer in the Order of Canada. At first I thought someone was yanking my chain, that this was an elaborate practical joke. I emailed and phoned back to the GG's office; yes, it was true.  Nothing much happened for a while, then I began to get emails and letters, and finally a small package containing two lapel pins, the elegant little white stylized snowflake with a little gold maple leaf in the centre; and finally today, on the eve of Canada Day, the list of new appointments to the Order  of Canada is published in the newspaper.  So it's true, and I can finally believe it. I am appointed in recognition of my contributions to public health and epidemiology.  I can wear the elegant little lapel pin, and at an investiture later I will get a larger medal to wear on a ribbon around my neck on formal occasions, assuming I ever get invited to any. Naturally I am really chuffed by all this.  I just wish Wendy was here beside me to share in the glory. It isn't, and it won't ever be the same without her.




John Last, MD honoris causa Edinburgh, 2003














                           

 With my two dictionaries,
   APHA, Boston, 2006
With some of the books I've written or edited













Monday, June 25, 2012

Sri Lanka 1976 (via Bombay and other places)


Here is another post that condenses a chapter of memoirs that I wrote 20 or more years ago about an episode in my life and Wendy's.  This one has the benefit of some photo illustrations. 

In the Christmas-New Year week of 1975, I was briefed at the South East Asian Regional Office of the World Health Organization (WHO/SEARO) in New Delhi for a mission in Sri Lanka.   I was asked to examine, advise and report on the status of education in maternal, child and family health at the two medical schools in Sri Lanka, the 100 year old University of Columbo medical school and the recently established new medical school on the Peradenya campus, near Kandy. 

Structures used by ancient astronomers (astrologists?) Delhi



After my briefing, by rights I ought to have flown direct from Delhi to Columbo I had made provisional bookings to do this, before I left Ottawa. Both Air India and Air Lanka had direct, non-stop flights. But somebody in the Regional Office in Delhi made a costly blunder. My reservation had been erased from the new computerized booking system. My ticket had to be rewritten, and I had to fly Delhi - Bombay - Columbo.  Because of the way the flight schedules were arranged, I had to stop overnight, and furthermore, on New Year's Eve. To cap it all, the only hotel that had any rooms free on that night of all nights in the year, was the Taj Mahal, the most expensive luxury hotel in Bombay, if not in all of India, prices far above the normal room rate allowed to WHO consultants. When I arrived at the Taj Mahal Hotel, the clerk at the registration desk said that because they were so heavily booked, the only space they could give me was the Viceroy Suite on the top floor, which was normally rented at an astronomically high rate; but as the booking had been made for me by WHO, they would let me have it at the regular room rate. I had to promise to be out of there by 9 am on New Year's Day, as one of the local millionaires had reserved the suite for a private party starting later in the morning. I assured the reservations clerk that this would not be a problem: my flight for Columbo departed at noon, so I had to be at the airport by about 9.30-10.00 am. That New Year's Eve at the Taj Mahal Hotel was one of my rare luxurious experiences. Too bad I was on my own, and too tired and too poorly dressed (no smart dinner jacket) to enjoy it! The Taj Mahal Hotel that New Year's Eve was playing host to many of Bombay's Beautiful People – Bollywood movie stars and directors, their mistresses and lovers, captains of industry and commerce and their spouses, the rich and famous people of that great city, all sumptuously dressed, or for many women, undressed with much succulent and shapely brown skin on display. I was very hungry and had to wait over an hour for my modest table for one, discretely hidden behind potted palm trees in a corner by the servery door where no one could see my scruffy bush jacket. I ordered the hottest curry that they had, a serious mistake: my mouth was sore and numb for several days. I was still eating, and washing it down with ice-cold beer, far into the night.

Later I strolled out into a velvety warm and balmy Bombay night, to be accosted by the most revolting collection of deformed beggars I have ever encountered. They scuttled around me, silently for the most part, like nothing so much as a horde of large spiders, holding out hands, or stumps, in some cases feet. Probably most had been deliberately deformed as infants, their arms and legs broken and left to set in bizarre positions, so that they could eventually become professional beggars, arousing pity by their appearance, part of the property of some pimp who used them as other pimps use prostitutes. I had heard about these pathetic creatures before I came there, indeed I had gone outside on purpose to see them for myself. The reality was much worse than my expectations. Rohintin Mistry writes vividly about the underside of Bombay in his wonderful Dickensian novels, but wisely draws the line this side of describing the appearance of these deformed beggars. It may have been the most stomach-churning sight I have ever seen.  I retreated, walked a little longer in the private interior courtyard of the hotel, then retired to my suite, which occupied about half the top floor of the hotel, with a superb view out over the bay, a crescent of silvery waves below the Esplanade, the row of lights and handsome high-rise towers along the shore all the way to the India Gate and beyond. How sad to be all alone in this splendid setting!

Next day I got to the airport in time to ensure a window seat near the front on the left-hand side, and on a clear sunny day I flew down the coast of India, much of the time just out to sea far enough for the coast and the land immediately behind it to be clearly visible. We had already started our descent by the time we came to the southern city of Trivandrum in Kerala the home town of my friend and Ottawa colleague Rama Nair, and I had a clear view of its beaches and the rolling breakers coming off the Sea of Arabia, fishing nets hanging to dry from palm trees.

Sri Lanka in 1976 was at peace, if rumbling ominously a little. Occasionally I met people, such as an elderly Hindu holy man in Columbo, who could tell of arbitrary arrests and torture. But at both campuses of the University of Sri Lanka, Sinhalese and Tamil staff worked amicably together, most of the time in English. What is more, though we often complain about the wasteful repetition of memoranda at the University of Ottawa in both official languages, at least both have the same alphabet. In Sri Lanka, every notice, every set of handouts at the medical school, had to be in three languages each with its own alphabet: our customary alphabet for the English version, the curlicues and circles for Sinhalese, the hanging squarish script for Tamil. Some exodus of talent had already begun by 1976, but this was mainly the lure of higher incomes in the rich oil states of the Middle East, or the superior research opportunities for gifted people that led so many of these very bright Sinhalese and Tamil medical scientists and scholars to leave for Europe or America. Of course the flight of talent, and of many others, got a lot worse after the war broke out to establish a separate Tamil state a few years later. 


Rural market, Sri Lanka





Base of the ancient rock fortress, Sigurya - we climbed the ladders and paths to the top, definitely the scariest climb of our lives!


Both in the weeks that I was on my own, and in the weeks that remained after Wendy joined me, there was a great deal to see and do in Sri Lanka, as well as my official duties. In addition to many photographs in the family album, I have a plethora of vivid and colourful recollections, too many to relate fully without exhausting me and boring anybody who reads this. This account can't aspire to be anything other than some random recollections.

I started my work in Columbo, where I stayed at a small hotel frequented mainly by cut-rate German tour parties. It was odd to hear the waiters and the room maids talking in broken German no better than my own, as they took orders from the guests. There was air conditioning (very welcome, but noisy) and a small swimming pool, but I avoided it as I had ones much like it in Jogjakarta and Surabaya in Java a few years earlier - here too, as there, I noticed that many of the plump herren and their often shapely fraus or frauleins who did use it had red eyes and irritating skin rashes later. I was struck by how cheap everything was. I bought a whole pineapple one day for the local equivalent of less than a
cent, could almost have had a bath in its plentiful sweet juice; and paid about a cent to have my sandal strap sewn back on when it broke.



View of Sri Lankan countryside from summit of rock fortress of Sigurya (about 250 m above surrounding countryside)


Columbo is a large, dirty, noisy city and seaport. It had gone downhill since I had first been there, going ashore from the RMS Strathnaver that took me to England in 1951. In those days, the Galle Face Hotel on the sea front, where we young Australians en route to England had stopped briefly for a cold beer, was a proud, grand, exclusive place that had been reluctant to admit a rather rowdy and casually dressed bunch of youngsters. By early 1976, it had a musty, mouldy atmosphere, its carpets had become threadbare, its elegant furniture scuffed and decrepit, its staff demoralized. The deteriorating esplanade in front, and the lawn that had once been immaculately manicured, were strewn with litter and the tawdry stalls of street vendors. Even in late morning a few street-walkers plied their trade there, something that would never have been tolerated in the old days, I was told. Some new luxury hotels were being built, though I fancy none were then complete, at any rate in Columbo. In some ways Columbo resembled a shabbier and small-scale version of any large city in India at that time. Several of the expatriates I met, people living and working there for longer periods than I, who were familiar with both countries, remarked on the similarities, and the way India was advancing but Sri Lanka was not. The differences undoubtedly got a lot greater after the war began. Almost the only make of car was the Indian-made Morris Minor (in India the locally made version of the Morris Oxford was most popular at that time); and many of these Morris Minors were on their last legs, or wheels. When Wendy and I were on our way to catch a train to Hikkadua on the south coast to celebrate our wedding anniversary a few weeks later, the taxi that was taking us to the station lost a wheel. As we sat in the back, we looked out and saw the wheel rolling along beside us, and a moment later there was a grinding crunch as the hub scraped along the road surface. We missed the train because of this, and had to go south uncomfortably by bus.


View from our bedroom, Mrs Wickramasuria's guest house, Peradenya



Names in Sri Lanka reveal people's ethnic background, as they do in Ulster and in the former Yugoslavia. The Sinhalese, a proud, even arrogant race, handsome in a heavy-featured way, mostly have polysyllabic names ending in -aratne, -asnaika, -asuria, etc, though some have ancestors who adopted Portuguese names during the period of colonization that began very soon after Vasco da Gama serendipitously "discovered" this island that he called Serendip. So there are Soysas, Fonsecas, Fernandos. The Tamils also have polysyllabic names but they are completely different, with quite recognizably different endings: -anayeram, -sanderam, -underam and the like. The Tamils began moving into Ceylon many hundreds of years ago - it is almost possible to walk across the shallow sea from the southern tip of India in Tamil Nadu.  In British colonial times, many Indians from Tamil Nadu were imported to work as cheap labour on the tea plantations; so the numbers, especially in the northern quarter of the island, rapidly grew. The old Sinhalese culture resisted colonial dominance and successfully defended itself for several generations from its highland fastnesses. When we went by train to Kandy, sitting in the parlour car at the back with its picture windows and specially inclined seats to look back as we climbed the precipitous cliffs of the escarpment on the way to Kandy, it was easy to see how this highland region could be defended against everything except modern weapons. The Sinhalese culture has ancient origins, going back to the earliest days of Buddhism, perhaps earlier. They are very musical people whose festivals at the Poya (full) moon and at the innumerable ceremonies in the holy city of Kandy, are dominated by music (bells, pipes, flutes, drums). We met several talented musicians: "Bas" Basnaike the professor of physiology at the Peredenya campus, and Ralph de Fonseca, the professor of public health at the Columbo campus, were both brilliant pianists. I met a rather beautiful young woman at a party, who was about to leave to begin training as a concert violinist in Germany. The 5th Century frescos that have survived almost intact beneath an overhanging rock face high on the side of the fortress of Sigiriya, include several musicians (although there is more emphasis on beautiful bare-breasted damsels serving fruit to their masters).



During my visits to the Peradenya campus, I found a wonderful place to stay, first on my own and then with Wendy. This was a guest room in Mrs Wickramasuria's home, the Menaka Guest House (named for her younger daughter, Menaka, a young woman with Cushing’s syndrome). Mrs Wickramasuria's marriage had broken up. Her husband was a disgraced member of the medical profession who had gone to Australia, leaving her to survive with the remnants of her dowry, her family estate, and to eke out a living by renting rooms in her home. She was still young enough (late 30s, I would guess) to attract a lover, a member of parliament who visited her at weekends. One weekend during my stay, before Wendy arrived, I was working in my room while she and her lover were noisily enjoying themselves in the room next door. She emerged to get me my evening meal late in the afternoon, with towsled hair, her sari hastily rearranged. I was not too surprised when we got a Christmas letter at the end of that year, announcing the arrival of "Baby" - not named until some years later, because a good Buddhist  custom is to await a favourable astrological conjunction of the planets before a child is named (also, until recent times, it made sense to wait until there was a reasonable likelihood that the child would survive infancy).


Eighth Century ruins, Anarhadnapura


Carved lintel, Kandy



We shared our bedroom at Mrs Wickramasuria's guest house with a family of very quarrelsome sparrows whose nest was in the cover of the fixtures for the ceiling fan. They got quite upset if I turned the fan on. There seemed to be two cock sparrows who had fierce territorial fights, drawing blood and shedding feathers, waking us every morning an hour or so before we needed to get up. We had a superb view across the valley to the high hills and the tea plantations on the other side, where the peaks were often cloud-covered. At dusk every evening we saw a great cloud of large fruit bats gliding by from their roosts in the trees of the National Botanical Gardens to the orchards on the outskirts of Kandy on its hill at the head of the valley. 

I walked everywhere. There was a bus service to the campus but it was erratic and infrequent. It was about 3 kilometers down the hill, along the road and across a few lawns and playing fields of the Peradenya campus to the medical school where I was working. My task was to interview the staff, to discuss with them their curriculum development plans and to advise them about innovative teaching methods, better ways to use their contact time with students, integration of basic and clinical sciences, etc. (After we returned to Canada, I described this and the prima donna conduct of professors who ran their departments like potentates of medieval fiefdoms, in a little paper called "What determines quality in medical schools?"). My routine was to walk down the hill in the morning, back most days at lunch and siesta time and then back and forth again in the late afternoon, a total of about 14-15 Km a day, most of it in warm but not too hot sunshine - Kandy and Peradenya are high enough to be spared the steamy heat of the coast. Peradenya is a new campus with residences for students who come from all over the island. Sri Lanka had universal education for both boys and girls, free to the end of secondary school, and only a nominal charge for university tuition. Entry requirements were relaxed, so a very high proportion of young people went to the universities – they, of course, did not want to spend the rest of their lives working in the paddy fields. At the Peradenya campus many students lived in residences, the ‘boys’ on one side of the campus, the ‘girls’ on the other.  It was just as well.  Even with the distance that separated them the sexual tension among these youngsters was palpable  -- I could almost smell the pheramones. Their light clothing in that tropical island didn’t help. Most girls wore miniskirts rather than saris, and that didn’t help either…   Entry to medical school and to a few other faculties such as law, was more rigorously rationed, but the output of the two medical schools when I was there far exceeded the national need for doctors. This little nation was exporting at that time well over half its output of fully trained health professionals, nurses as well as doctors. And the training was good, by and large. Such a hemorrhage of trained professionals could not be long sustained, and would soon have had to be controlled by some means. It’s too bad that it had to be a brutal war which brought this about.


The little lake in Kandy



On sitting and standing: I learnt the hard way that on public transport it is mandatory to give up one's seat to Buddhist monks, no matter how young they may be. Many children enter their period of service at or even before puberty. One evening during my time at Peredenya I came back from a meeting with the Minister of Health in Columbo, tired, hot, late on a crowded bus (I had to use the bus because the trains had been stopped by a lightning strike). I had to stand, propped up really, between scores of other hot, tired, irritable people, until we reached the head of the pass to the highlands. Then gratefully I seized a seat. But a young lad in Buddhist robes came and leant over me, and everyone around me made me aware in no uncertain manner that I must stand so he (about a third or less my age and strong as an ox) could sit. We had similar experiences many times. Wendy also soon found out that her bottom was broader than those of the locals, which seem to be wedge-shaped. They had an extraordinary facility for spotting a tiny postage-stamp sized piece of seat between two sitting passengers, and insinuating themselves into this space. Thus a train seat meant for six people soon came to hold ten, perhaps more.



Standing Buddha, Sri Lanka


Sri Lanka is a truly beautiful place, a jewel of an island every bit as lovely as Java, and with no active volcanoes. It has more than Java in several ways, notably that there are large numbers of elephants. They are used as beasts of burden and in the innumerable ceremonial processions and religious festivals in Kandy. There are also a few remaining herds of wild elephants, one of which we saw one day as we were being driven to the ancient ruins of Anuradhapura. We also saw, or I did, the daily bath, complete with soap and scrubbing brush, that the elephants get if their work includes carrying Buddhist priests to the sacred Temple of the Tooth, which holds a very holy relic, a tooth from the Buddha himself. There are many water buffalo, gentle, lovable beasts, and monkeys which are often very tame. I have a nice picture of Wendy feeding a monkey which took food straight from her hand.  We were so fortunate to see it all while Sri Lanka was still at peace, and to see so much of it. Yet even then we were warned against going to the northern tip of the island, where the population is almost 100% Tamil. I think the repression of the Tamils, and their inevitable revolt against this, had already begun, but news of this was being carefully suppressed.

Wendy making friends with a distant relative, Sri Lanka, 1976







There were other problems. The worst from my point of view was the stifling bureaucracy which brought almost every activity to a standstill. The paper work involved in the simplest transactions was horrendous. Wendy experienced this too. Soon after I arrived, I lost my sunglasses, and told Wendy about this in a letter. She bought me a new pair and unwisely posted these to me from New Zealand. A day or two before we were due to leave, we got a notice to say that they were at the main Post Office for us to collect, after we had fulfilled the formalities and paid the customs duty. Wendy set off to do this early in the morning. It took her all day to move through the various queues and file the necessary documents, and at the end of the afternoon when she was approaching the head of the line, the place was closed and she was told to come back next day. She could actually see the packet she had mailed a few weeks earlier, and was so angry that she leapt over the counter, grabbed it, and stormed out in triumph. She was probably very lucky not to get arrested and roughed up: most likely the officials were so astonished by this unexpected behaviour from a mild-looking and well-behaved European that they were too slow to intercept her before she made her getaway.  Or they were too lazy. Laziness is a national affliction. Sri Lankans have never had to work very hard to plant or gather their rice crops, fruit falls from the trees, fish almost walk up from the sea into the nets. Since the earliest colonial times there has always been great eagerness to adopt the national and traditional holidays of whichever nation happened at the time to be the colonial master; and as well there are the Buddhist religious festivals to celebrate as holidays, starting with every Poya Day, or full moon. The end result was that slightly more than half of all the days I spent in Sri Lanka were holidays of one sort or another. The combination of excessive paperwork and frequent holidays offered abundant excuses for not getting anything done at all, let alone done on time.

I think we would have tired of this eventually, as we would of Sri Lankan food, despite the good cooking both at Mrs Wickramasuria's and at the hotel in Columbo, and at a few government-run resorts where we stayed, notably the one at Hikkadua where we spent our wedding anniversary that year. Sri Lankan food consists mainly of rather indifferent curries, and string hoppers: glutinous rice, squeezed through tiny holes to make thin spaghetti-like pasta, which is usually deep-fried and not very adequately spiced with condiments. On the other hand, there is fresh fruit in abundance, mangos, paw-paws, pineapples, many kinds of bananas, and a wide variety of exotic fruits I have not seen elsewhere. It is odd that this lovely place, so close to India and to the Spice Islands, should have such bland food. 

After two months there I had had just about enough. But we were not to escape easily. Our flight for Madras should have left in late afternoon. We waited at the airport before even boarding, till long after midnight, and took off for Madras about 4 am. It is less than a two-hour flight. When we came close, the captain came on the air, announcing in a sepulchral voice that he "regretted to inform us" that we could not land because of fog! Both of us, and everyone else on the plane was in despair. We turned about and went back to Columbo, waited there for an hour or so for the sun to burn off the early morning fog, then finally left, and landed safely in Madras about 16 hours late. It was a fitting way for Sri Lanka to cling to us at the end.
     
Our arrival in Madras was by no means the end of the wonderful time that Wendy and I had on that expedition. In some ways the best was yet to be. We met an Indian colleague of mine in Madras, and had a good look at that old city and its colonial British remains, a second look for me. There is a graveyard containing many graves of British officers, their wives, and children, dead at an early age of malaria, cholera or other tropical diseases (malaria was especially lethal). We flew on to Bangalore and came by car from there to Kajhuraho, the site of one of the best preserved of the temples of erotic art; then from there we went on to Agra, where we saw the full moon rise over the Taj Mahal before spending the greater part of the next day exploring this lovely shrine to the beautiful Mumtaz who died so young. And then to Delhi, where I had been several times before, but Wendy had not. We stayed at the old and somewhat seedy but very convenient Janpath Hotel, within easy walking distance of Connought Circus. Wendy found the beggars disturbing, though there were fewer than usual: the government was trying to resettle many of the permanent street people in villages and hostels far removed from the centre of New Delhi, sprucing the city up for an imminent international conference.  

Heraldic carving, Kajhuraho




Erotic statue, Kajhuraho




While I debriefed at WHO/SEARO, Wendy explored the many-layered civilizations of this great city; and we had a few days exploring it on our own, thanks to a convenient weekend. This was to be my final mission as a consultant for WHO/SEARO. To some extent I am myself responsible: my report recommended that it would make more sense, and be cost-effective, to bring visiting consultants from other countries in the region rather than from the other side of the world. But this, of course, was not my final visit to India, nor to south and east Asia. I went back en route to Singapore in 1982, to visit the All-India Institute of Hygiene and Tropical Medicine in Calcutta (described in the chapter on “A Day Trip in Bengal”). I had two visits to China, in 1981 and 1982, and two to Japan in 1991 and 1996.  And in 1997 I had another fascinating visit to Thailand, which was primarily for another WHO mission, but that one was arranged from WHO headquarters in Geneva rather than from the regional office in Delhi.  My explorations of those parts of the world have been brief and superficial, but richly rewarding. I wouldn't have missed them for anything.




Taj Mahal, Agra










Red Fort, Agra

Tuesday, June 19, 2012

How I became a Hindu


In the early 1970s, most of India's people lived, as they had for millennia and still live now, in rural villages. In those days perhaps only Calcutta, Bombay, Delhi and Madras had populations in multiples of millions; and few other cities had as many as a million. However, almost all the services were concentrated in the cities, and rural villages had little or nothing: no sewers, no electricity, no public transport - and no doctors. National planners wanted to turn this around. I was among the many experts from abroad who came to offer advice and assistance. I went to India in 1974 as one of a team of three experts on medical education and health care planning. My partners on this mission were Ted French from the University of Edinburgh and Robert Stillmann from the University of Basel and the Canton of Basel Health Services planning commission. We began our work in Delhi, where for 2 weeks we discussed strategies with our Indian and WHO/SEARO counterparts. These were the top brass in the Indian Ministries of Health, Education, Rural Development, the Indian Council for Medical Research and the Indian national medical licensing board. The WHO/SEARO staff included Haresh Chandra (a pediatrician) my friend Ray Mills, a former colleague from my Edinburgh years; and among others, a nice young man, Om Auraura, who was the executive secretary for this mission, perhaps for the whole enterprise of injecting doctors into rural health care in India. After 2 weeks in Delhi we flew to Madras, now Chennai. We had a few days in Madras, and more discussions with local staff who were testing a few plans to deal with rural shortages of health care providers, then went on by car to Pondicherry, to the Jawahal Institute of Postgraduate Medical Education and Research (JIPMER) where there was to be a national conference on rural health care with health planners, administrators and medical school teachers. There was a proposal that medical graduates must spend three months in a rural community clinic during the compulsory pre-registration year (the year they had to do after completing the medical course, before they were given a licence to practise on their own). There were some obstacles in the way of the proposal. It violated the human rights of the young graduates. There were no suitable clinics in most of the places where the doctors would be required to work; nowhere in the villages for them to live. Many women graduates (about half of the medical graduates in India) could not be expected to endure the harsh living conditions in the villages, where there were few or none of the amenities they were accustomed to. All that is another story. This is the story of my experiences on this particular visit to India, perhaps mixed a little here and there with bits and pieces of other visits to the Subcontinent.

In Delhi we stayed at the Janpath Hotel, a cheap but comfortable place a couple of blocks from Connaught Circus, the commercial centre of New Delhi. The Janpath was frequented more by Indians than expatriate Europeans. It had a musty odour due to the pervasive mildew that afflicts everything in warm parts of the world that get monsoon rains; and on top of that, an indefinable and basically attractive smell of Indian cooking. They kept a tolerable table in the restaurant, and excellent room service with early morning tea, served with a great flourish by the room-boy who held the teapot high in the air to let the tea cascade out in a long thin stream into the cup that he held about the level of his knees - a widespread Indian custom. 

New Delhi is a modern city, laid out in a pattern of concentric circles connected by broad boulevards. Parliament and government offices occupy a couple of the circles or circuses and adjoining boulevards close to the centre of the city. The World Health Organization South-East Asian  Regional Office  (WHO/SEARO) is a fine modern building architecturally similar to regional offices in Copenhagen, Alexandria, Manila, Brazzaville – the same architect designed them all. But it is on one of the outer ring roads a long way from the seat of government and the commercial and shopping hub at Connaught Circus. From the Janpath Hotel we had to take a taxi to WHO/SEARO. However, we could walk comfortably from the Janpath Hotel to interesting local restaurants near Connaught Circus, and to the shops of the government-run Cottage Industries which stocked arts and crafts from all over India, and on beyond to the fascinating alleys and sprawling bazaars and street markets of Old Delhi; and on beyond these to the heart of the Delhi of the Moghul era, the Red Fort. It was splendid having all this within easy reach, and our time in Delhi was so arranged that there were two free weekends. 

I explored this fascinating city pretty thoroughly in my abundant spare time, adding to the little knowledge I had gained from a previous visit. Two years later Wendy was with me when we stopped in Delhi for a week or so on our way back from my next WHO mission in Sri Lanka, and we explored more of it together.  Delhi has been inhabited for many thousands of years, since neolithic, perhaps since paleolithic times. Like Rome, it carries many traces of past civilizations. The earliest literate civilization of India had settlements here. It has been a focal point for sciences such as astronomy (really astrology) since before the Christian era. Among the impressive remains of former cultures are several strange-looking structures that were used by ancient astronomers, akin perhaps to the druids who constructed Stonehenge, but the structures in Delhi are far more sophisticated methods of measuring and predicting the solstices, the phases of the moon, positions of the planets, and to observe meteors and comets. Hinduism predates the birth of Christ. So there are many ancient Hindu temples and shrines, as well as others that have been built over the centuries. Buddhism too has had a strong hold since its beginnings, so there are Buddhist shrines and temples, and temples that follow Zoroastrianism, Ba'Hai, Sikhism, and  synagogues. The Moghul invasion in the 11th and 12th centuries brought with it the rise of Islam; so there are some mosques, including the Great Mosque that is one of the holiest sites of Islam. The Moghuls were eccentric Moslems: their legacy to civilization includes the exquisite pictorial art known as Indian Miniatures, meticulously detailed paintings done with a single hair rather than with a brush. What makes them eccentric is that they often feature human forms, which devout Moslems never do. We have two framed on our wall that I brought back from the bazaar in Old Delhi on my first visit in 1972, at the end of a two-month WHO mission in Indonesia.

On the second of my free weekends Om Auraura arranged an itinerary for me to see much that otherwise I would never have seen - including his own modest little home, and his wife and brand-new baby, far away in the teeming suburbs in an area where individual houses had no flush toilets, independent water supply, or electricity. They drew their piped and therefore drinkable water from a communal stand-pipe in the middle of the street. It was cold then, early January, but the local kids were playing and splashing in the water from this tap, making the most of it while it was plentiful - in the intense heat that begins in late April and continues until the monsoon breaks in August, water is too scarce for this to be possible.   

Some of the preparations for our conference at JIPMER provided other opportunities for seeing things off the beaten track that are not part of the normal tourist itinerary. The staff of the All India Institute for Medical Research, an outstanding group of internationally renowned scientists and scholars, arranged for us to visit a few rural villages relatively close to Delhi, where, among other things, there were already some medical services and family planning programs in place. In some of these villages we went into a few of the houses (just huts) and saw how the people actually lived. I can never forget the hut where we saw a little girl quietly dying in a corner of the one room in which the family lived. There was not quite enough food to go around that winter, somebody had to go without, and girls are expendable... It is a common enough scene: sons are more important and get at least some food when there isn't enough for everybody. In the quarter century since I saw that little girl dying in a village hut, the plight of females has become worse.  Ultrasound and amniocentesis have made it possible to determine the sex of the fetus early enough to facilitate selective abortion of female fetuses, and this is widely practised in both India and China. There is a deficit of as much as ten million girls and young women in India in the early 21st century as a result.  Karen Trollope Kumar and I prepared a paper on this and other inequities and injustices against women, for another WHO conference in Bangkok in 1997, and I did not endear myself to some of the male Indian delegates at that conference when I spoke out against the practice in rather undiplomatic language. 

While we were in Madras, a steamier, more humid place than Delhi even in what passes for winter in those parts, I visited the old graveyard where many British soldiers and their wives and children lie buried, having died mostly of malaria, or sometimes in large numbers from cholera. This interesting graveyard was an eloquent reminder of the dangerous times when no one knew what caused malaria. In the early 1970s, the malaria parasites responded to drugs such as chloroquin, which we were all taking, so we were safe. In Madras we also visited the first of what eventually became a very large number of holy places. This one wasn't of much account, merely an ornately carved Hindu temple, but it was a foretaste of what was to come.

On the drive south from Madras to Pondicherry, we passed by the remains of a very holy place, Mahabalipurum. This ancient temple had been built on what was then a sandy cliff overlooking the sea, perhaps a kilometer inland. But that coast is slowly being eaten away by the waves beating in from the Bay of Bengal, and by the time we saw it in 1974, all that remained were some blackened and partially submerged rocks several hundred meters out to sea. If we looked closely we could just make out the remains of the carvings that had once decorated them. So the sea has advanced over the land to a distance of well over a kilometer in that part of the world, in about 1600 years. Devout Hindus still come from all over India and beyond to worship at Mahabalipurum, to see what remains of the original temple, and to leave their offerings of flowers and fruit at a relatively new and much more modest temple that stands on the sandy shore a hundred meters or so from the breakers. Global warming and rising sea levels will very likely soon inundate that one too.

Pondicherry, in addition to being the site for JIPMER, is a very interesting place for other reasons. It was the capital of the French enclave in colonial India, and the locals include some who still speak French as a second language after Tamil, because of continuing commercial ties to modern France. More interesting than this is the ashram for which the modern city is famous. Early in the 20th century, a young local woman decided to devote her life to uniting all the world's religions. She used her family fortune to establish the ecumenical ashram that now attracts Christians, Jews, Hindus, Moslems, Buddhists - basically, when I was there, young women and men who were opting out of western industrial society and seeking a simpler way of life. In the city and bazaar, we saw many blond, bare legged Scandinavians, crew-cut or bearded Americans, Brits, Canadians, Japanese, Australians, Kiwis, Israelis, young people from all over, often easily identifiable by the national flags sewn to their back-packs. The Holy Mother, as she became, was still alive in 1974, old, frail, but still apparently vibrant and dynamic. I would like to have visited her and the ashram but we weren't able to fit this into our schedule. Strike out one holy place, but we more than made up with others, for missing that one.

Many Tamils are short, roly-poly, brown, happy-looking people. The director of JIPMER, Shiva Balasubramanyan, was no exception. He was also very bright, very able. He and his colleagues were doing interesting research on leprosy, which was common in the south of India then. They had managed to grow the lepra bacillus, a notoriously shy organism that is extremely difficult to cultivate in non-human hosts. They were using a local variety of mongoose, an armour-plated animal a bit like a South American armadillo.  Another success was demonstrating that the lepra bacillus could pass from one host to another in blood ingested by bedbugs. After learning this, we examined our bedding very closely to ensure that there were no bedbugs. 

We needn't have worried. Our accommodation in Pondicherry was spotless, a private guest house run by one of the many acolytes of the ashram - so the place was full of pamphlets and books about the Holy Mother and all her good works. Our bedding, and more important, the mosquito netting, were immaculate, intact and effective. One reflex I soon acquired there was to sweep my hand around under the rim of the toilet bowl before seating myself: the local culecine mosquitoes which carry dengue and occasionally more exotic arbovirus diseases, even more occasionally filariasis, like to roost in the cool, sheltered crevices just below the rim of the toilet bowl. This is not very far from the area where Ronald Ross discovered the anopheline mosquitoes that carry malaria - much smaller mosquitoes, like the no-see-ums of the North American prairies. We saw some of these after being shown how to look for them, and realized how meticulous Ross must have been to find them, because they are nearly invisible.

From Pondicherry we fanned out into the surrounding countryside to visit more villages where preliminary plans were being tested and where, perhaps recent medical graduates could be placed. I saw for myself that it would not be as easy as the medical bureaucrats from Delhi had hoped it would be, to find places for these young doctors, especially the women, to live. All that was to be vigorously debated when we had our conference, the climax of all these activities, the following week.

First though, there was another weekend, and a holiday that added an extra day to it. One of the local academics was a devout Hindu who invited Ted French, Robert Stillmann and me to come along with him for a brief pilgrimage to some of the holy places in southern India. We hired a car and driver, and set off south towards the tip of India, but headed inland rather than along the coast. The country there is lush, fertile, much of it low-lying and swampy, with paddy-fields and plantations of sugar cane, bananas, mangos, coconuts and other tropical fruits. It is densely settled, villages teeming with people every kilometer or so, and several large towns or small cities. In many there are holy places: temples, shrines, sacred wells. We stopped at each of these so our Indian colleague could pay his respects. About half way through the pilgrimage, we climbed a long flight of steps up a steep hill near the city of Madurai, where he threw a coconut into a deep pit with a sharp stone sticking up at the bottom, with all the force he could command. If the stone pierces the coconut, this is a particularly holy sacrifice and the one who does it is thrice blessed. Our colleague was successful and we congratulated him. More was to come. The next place was a holy well, where a rather slimy, water weed-encrusted broad stairway led down into the water. We took off our shoes and socks at his request, albeit reluctantly, and dipped a toe each in the murky water. That evidently was the final ritual on our pathway to become Hindus. He rolled his thumb in a paste of ashes and pigment, took each of us around the shoulders in turn, smeared some of the paste on our foreheads.  To our surprise, he then announced that we were Hindus.  I have a photograph to prove it, but have to say that I have never felt any different since then. However, our other Indian colleagues assured us when we got back to Pondicherry late the following evening that we were indeed from that day onward, bona fide members of the Hindu faith, would be reincarnated, upward if we were good, or lucky, or both, downward if we weren't... 

There were other experiences that made this a memorable period. During the conference the following week we had several formal dinners, formal Indian style that is. Most were vegetarian meals, occasionally fish was included. With or without meat, the meals were uniformly delicious, even possible to wash down with tasty non-alcoholic fruit drinks. This part of India is nominally ‘dry’ - not quite total prohibition, but close. Haresh Chandra, among others, found this hard to take. He liked his whisky and soda. Ted French, Robert Stillmann and I liked a beer in this steamy climate, preferably an ice-cold one. We were not always able to satisfy our thirst, certainly not at any of the formal dinners during the conference, nor at the guest house, whose devout manageress kept it strictly teetotal. It was in fact quite easy to live without a cold beer on the days when we weren't able to find a place where we could get one, because the fruit drinks were delicious and thirst-quenching, as they are also in Saudi Arabia and Kuwait, orthodox Moslem nations where alcohol is unobtainable legally. Some time during that week, we went also to the home of the local French consular representative, and there we imbibed some excellent ice-cold Alsatian beer. 

Too soon it was all over. We turned about and headed back to Madras, and on to a plane for Delhi. The debriefing was short, but a free day remained, and that was when Robert Stillmann and I took off for Agra and the Taj Mahal. We went by air-conditioned train, a very good way to get from Delhi to Agra, although it is insulated from the local populace more than I would have liked. I have been to Agra several times. I had been during my first visit to Delhi in 1972, Wendy and I went there together a couple of years later, on our way back from Sri Lanka. On this occasion with Robert Stillmann, we went also to the other famous site in that region, Fatipur Sikri; this is like Jaipur, a city of pink marble, but Fatipur Sikri is a deserted city, occupied only by beggars, pi-dogs and a few souvenir stands. I don't know, or don't recall why it was abandoned, perhaps because there is no water there. Unfortunately we got there too late in the day to see it, it was already dusk when we arrived and soon it was quite dark. And two years later, Wendy and I didn't get there at all despite our best efforts to persuade our driver to take us. Many Indians believe it is an accursed place, and are reluctant to go near it. From the glimpse I had of it, I remain tantalized, and would dearly have liked to see more of it, and in daylight.  But I was able to see a tiny bit more of India on that visit, because I stopped in Bombay, took a boat ride across the bay, visited the sacred caves south of the city, and had a brief visit to Grant Medical College, one of India’s best, where one of my new friends from the conference at JIPMER was professor of public health.

I would love to have seen a great deal more of all of India, perhaps most of all, more of the lush and beautiful south that we saw so briefly on the pilgrimage to the holy places in the weekend before our conference.  But it would take a lifetime to see all that this complex and beautiful land has to offer, and it would take many lifetimes to understand even just a little of its complicated, multilayered cultures.

Thursday, June 14, 2012

Visits to China 1981 and 1982

Several years ago I retrieved the notebooks in which I had recorded a few details about my visits to China in 1981 and 1982 and wrote a coherent account of the two visits.  This is too long and too detailed for a post on this blog, but here are some excerpts, and a couple of photos.  I'll probably add more photos later, from the large collection in one of our family albums.

In 1980 when I made up my mind to visit China, it was terra incognito  in the West, a mysterious, vaguely threatening nation of close to a billion people, cut off from us by a nearly impenetrable wall of official mutual suspicion and in some respects, overt hostility. Memories of the Communist takeover, Chinese complicity in the Korean War and in Vietnam, and more recently the excesses and atrocities of the cultural revolution were still vivid. But the barriers had begun to break down. Ping-pong diplomacy and tentative cultural and academic exchanges had begun.  In 1980, Carl Amberg, an internationally renowned scholar at Carleton University in Ottawa, husband of my colleague Anne Amberg, came back armed with names of a few possible contacts in my field. In the spirit of casting my bread upon the waters, I wrote to one of these possible contacts, the professor of public health at Shanghai First Medical University sending with my letter a copy of the big textbook of public health and preventive medicine that I had edited, which had come out to considerable acclaim a few months earlier. Armed with his friendly reply which had an open-ended invitation to visit his medical college if I came to China, I called at the Chinese Embassy.  I had several meetings and conversations with the cultural attache, who, to my surprise, was sympathetic and understanding as I explained that despite a total lack of spoken and written Chinese, I wanted to go to China  alone and unescorted.  I wanted to repeat in reverse, so to say, the experience of Chiang Yee, the “Silent Traveler” who explored and wrote about London, New York, and Paris in the 1950s, apparently without being able to speak or read the languages. In the early 1980s, soon after the “bamboo curtain” had been lifted, I was one of the first people from the West to do this. Even now three decades later, it is rather unusual for solo travelers to visit China. By the time of my second visit to China in 1982 accompanied by Wendy I had met the Chinese epidemiologist Su De-long, and my path had been smoothed considerably, bureaucratic roadblocks greatly reduced.

The adventure began with a flight on China Airlines from Hong Kong to Guangzhou (Canton), a very short hop of not more than half an hour in a small, crowded airplane resembling a DC-3 but of Russian origin.  It was not reassuring to see my fellow-passengers boarding the flight with huge, heavy carry-on duty-free goods. Television sets and stereo ghetto-blasters were popular items that would not fit on the overhead rack, and cluttered the aisles and the spaces between the seats. Somehow we managed to take off and land without mishap. At Guangzhou airport, an escort, a businesslike young woman  from the People’s Republic equivalent of the USSR’s Intourist met my flight, took me by car direct to the railway station and gave me detailed instructions about when and where to proceed to a platform to get my train several hours later. She deposited me in the “soft class” waiting room, but it was boring all by myself so I moved out after a while into the bustle and hustle of the large, main station concourse. This was like large railway stations everywhere, crowded with a mixture of bewildered or weary travelers, parties in groups with leaders who addressed them through a microphone with a portable speaker on the platform, skylarking school children, soldiers in crumpled shabby-looking army uniforms. Almost all the men and many of the women wore navy-blue Mao jackets, and only a few women, mostly young, wore brightly colored dresses.  The hubbub and constant movement were fascinating but I had to watch the time carefully, so I could move back to the “soft class” waiting room, where the tourist guide had told me a railway official would meet me half an hour before departure, to escort me to the right platform. 

I had arranged to travel alone on the train from Guangzhou to Shanghai with an intermediate stop, urged on me by the cultural attache in Ottawa, at Hangzhou, a city of about a million at that time, located in the picturesque setting of West Lake. This was a journey of about 36 hours, from mid afternoon until early the following evening.

After a two or three hour wait, one of the station attendants escorted me from the soft class waiting room to the platform where my train was getting ready.  It was a long train, perhaps 20 carriages but only one ‘soft class’ carriage with comfortable padded seats, and next to it, a dining car, which I was pleased to see because I was getting very hungry, and noticed that every one of my less fortunate fellow passengers in the hard class carriages held a large basket or package of provisions for the journey.  For a while I thought I would be the only European on the train. My fellow passengers in the soft class carriage were all Chinese, presumably government officials and some uniformed military officers. Then a few minutes before we were due to leave, I heard someone speaking German, and saw a tall, middle-aged bearded man being escorted aboard and into the next compartment to me. He spoke only a few words of English so we conversed in a weird mixture of his poor English and my equally poor German.  He was the son of former Lutheran missionaries, born in China but left when he was a child after the Communists took control. He was returning on a visit to the town where he had been born.  Soon after dawn next morning at one of our many station stops, I saw him get off the train to be met by a small group carrying a large banner in German and Chinese characters. I could read one word, “Willkommen” and wondered if there would be one like it when we reached my first destination, Hangzhou.  On that first day it got dark soon after the train entered what looked from the little I saw of if to be spectacular mountain pass up which the train labored slowly for many hours. I ate my dinner in a spotlessly clean dining saloon, a tasty meal of noodles and rice with chunks of spicy chicken which I managed to eat with chopsticks dextrously enough to satisfy pride and the attentive table waiter, followed by tinned fruit and a large pot of tea.  I was offered a bottle of beer but declined because I was very tired and feared it would be enough to knock me out. After dinner, one of my fellow passengers managed to communicate to me the fact that he was from Hong Kong, not China, and that he was an opera singer, apparently a well known, even perhaps eminent performer of classical Chinese opera. He did this using a few words of Italian, French and German that he said he had picked up performing European opera. There are too few operas in English for him ever to have had any contact with English, of which he spoke not a single word, apparently. Next day he entertained me and several other passengers with a little impromptu concert of songs from Chinese opera. That wasn’t the only musical treat on the train. Several times, beginning late on the first afternoon, hauntingly beautiful Chinese music played on stringed instruments was piped over the excellent public address system in the carriage. That was the beginning of my affection for Chinese music. 

The next day I had one of the most fascinating journeys of my life, all day long on the train as it made its way slowly across the lush paddy fields and agriculturally bountiful and beautiful countryside of south China, passing through many villages and large towns and cities. The country was very beautiful. Obviously it had been lovingly cared for during many past centuries, and virtually every square inch of it everywhere was productive. There were fat cattle and water buffaloes, goats, pigs and poultry. I saw sights that could have come straight out of mediaeval China, such as a lad herding a large flock of geese, steering them skillfully and nudging them back into line if they strayed, using a long bamboo pole to do so. It was a fine sunny day, quite warm by noon, and once I got accustomed to the routine, I joined other passengers who got off to stretch their legs on the platform when the train stopped for lengthy periods from time to time to allow another train going the other way to pass us (mostly it was a single track railroad). On several memorable occasions, our passing place was not at a station but somewhere in the heart of the country in cultivated fields or pasture on which cattle grazed. Whenever I alighted with everybody else I was immediately surrounded by a large crowd of curious locals, peasant farmers who had obviously never before seen a “round-eye” (European); and so I was able to practice my body language of smiles and gestures that had to substitute for spoken words as a way to communicate in a setting where no words existed in common between me and these obviously friendly and welcoming people. It was the same later in the cities. Whenever I walked about alone, I was approached, not accosted but addressed in a friendly manner and sometimes in what the speaker thought or hoped was English, and sometimes engaged in animated dialogues in a mixture of words and body language. It would have been impossible not to be moved by these displays of friendly curiosity.

Late in the afternoon we passed through several large cities, then soon after dark we arrived at Hangzhou, where sure enough a welcoming party equipped with a large banner was waiting to greet me. Among them was a very impressive authority on agricultural toxicology, Professor Huang Xi-men who would be my principal host and guide in the coming days. Others on the railway station platform were the dean of the medical school and two or three other dignitaries and a young woman interpreter.  For a few hours before we arrived I had been increasingly aware of the onset of an acute upper respiratory infection – hot eyes, runny nose,  rasping throat, dry cough, perhaps a fever – so I confided my concerns about this to the interpreter. She spoke for a few minutes to one of the dignitaries then left the room (by then we had reached the hotel where I was to stay) and returned a few minutes later with a cup containing a steaming infusion of tangy-tasting herbs that I was encouraged to drink, then go early to bed.  I did so, and next morning, after a good night’s sleep I awoke with all traces of the respiratory infection completely, miraculously gone. I would like to import a supply of those herbs into Canada and go into business, marketing them as a new and effective cure for the common cold!  

Next morning I began to get my first good look at a bustling Chinese city in an early phase of its transition to modernity. I was collected from my comfortable western-style hotel where I had eaten an excellent, appetizing western-style breakfast – the hotel was obviously set up to receive European tourists, although there were none to be seen during my visit. I soon saw, however, why Hangzhou was a desirable tourist stop. The car that collected me was an elderly Russian limousine with plush seats and curtained windows. I would have enjoyed sitting in the front seat with an unimpeded view but even from the rear seat all I saw fascinated me. The streets were thronged with thousands of men and women on bicycles on their way to work I suppose, as well as delivery vans, handcarts, occasional animals, but very few if any recognizably private cars.  We drove across the city without passing through an identifiable city centre ( I saw that next day) and at one stage the road skirted West Lake, a prominent scenic attraction that I saw at leisure later.  I had been invited to speak at the medical school, and soon after I was greeted at the steps of the faculty I was led into a rather spartan large lecture hall, crowded with a hundred or more young men and women and a few elderly people who were their teachers. I spoke on very basic epidemiological principles and methods, illustrating my remarks with overhead transparencies, speaking very slowly with frequent pauses so the translator could repeat what I said in Chinese.  It was surprisingly easy and rather relaxing to speak in this style, and I found it enjoyable enough so I had no hesitation about repeating the experience (though not the same talk!) at every medical school I visited on this and the next visit to China the following year.   

After my lecture and a ceremonial tea-drinking break with the medical school dean and other top people whose names and positions I have forgotten, Professor Huang became my companion and escort for the remainder of my stay in Hangzhou.  He was an impressive man, about my own age, who spoke good English (as well as Russian, the language of his graduate experience in USSR in pharmacology and agricultural toxicology). He had very good comprehension of environmental epidemiology and the principles of public health.  He and I soon established excellent rapport. He was a cultured man who read widely both in his scientific specialty and in English literature and good quality modern fiction, probably the most interesting man I ever met in China. He was investigating several of the chemicals then being used as fertilizers and as agricultural pesticides, had published papers in English as well as Chinese on the toxic effects of broad-leaf herbicides, insecticides and soil fumigating agents, and on the ecological effects on West Lake, a national beauty spot, of storm water runoff laced with pesticides and fertilizers. He eagerly read the chapters on these topics in the copy of my big public health textbook that I had brought with me to leave behind, and I hope he was able to keep that book in his departmental library after I left. Our conversations continued over the next two days and ranged widely over many aspects of environmental and public health as well as books we both had read and enjoyed. He was fond of the works of Charles Dickens and Ernest Hemingway. He and I corresponded for several years after my visit. Then he had a year as a visiting scholar in the USA and after his return to China he rose in the hierarchy, moved to Beijing, and I lost touch with him. He made sure that I had time for a good look at the beautiful West Lake, its picturesque islands decorated with some carefully tended ancient monuments; took me to a venerable Buddhist temple where I was interested to see many people praying and worshiping at the shrines in front of a huge statue of the Buddha; and also took me to his modest home so I could see how he and his wife and two teen-age children lived. I have a good photographic record of my visit to Hangzhou.  Some time during my second day he took me shopping.  I had mentioned my wish to get a few little things to take back to Canada so his driver took us into the business and commercial centre of the city, to a large department store. Immediately we entered, we were almost mobbed by a large crowd of curious shoppers, eager to get closer to us for their first sight of a European. I got some silk for Wendy to make a dress and a few trinkets. I vividly remember being surrounded by a large friendly crowd through which I had to make my way to the counter to pay for my modest purchases.  There was nothing in the least intimidating about this, all were friendly and anxious to help me, for instance by offering other items they thought might appeal to me for me to select and add to my shopping list.

Professor Huang was as reluctant to part from me as I was to leave him. It was only about a two-hour train ride to Shanghai so we agreed to postpone my departure until dusk, and therefore I saw none of the country between Hangzhou and Shanghai.  This was a local rather than a long-distance train, with a long, open carriage rather than compartments, and I was probably the only one who was not chain-smoking foul-smelling cigarettes, so I arrived in Shanghai reeking of tobacco smoke,  with red and stinging eyes irritated by the formaldehyde in the smoke. Here too a welcoming party was waiting for me on the platform, complete with a large banner carrying my name. Next day I took a photograph of the same group of senior staff in front of a blackboard emblazoned with the same or a similar message.  
My notes contain the names of the people I met in Shanghai during that visit in 1981 and in 1982 when I met many of the same people and a few others, notably Professor Su De-Long who was away when I was there in 1981.  I gave my hosts in Shanghai a copy of the written text of one of my talks, “The nature and quality of epidemiological evidence” and to my surprise they published this in the Chinese Medical Journal!  Ken Warren, president of the Rockefeller Foundation and one of his colleagues were also visiting Shanghai First Medical College during my visit, and as they were staying at the same hotel, we were able to compare notes.  We wondered how on earth the staff stayed warm in the bone-chilling cold that week. There was no heating in the medical college. It was spring time but unusually cold weather, looked as if it might even snow, with a piercing north wind that went through our clothes. Like I, Ken and his colleague only had summer weight suits and pullovers to wear under their jackets, although unlike I they at least had winter storm linings in their raincoats. Our hotel was a little better, but not much. No escorted sightseeing in Shanghai – not that there were many spectacular sights to see – but I had some free time and wandered about by myself.  I made my way from my hotel to the Bund, the old waterfront commercial district on the busy Wangpu River, and for a time got completely lost in a maze of streets on the way back to my hotel. It was there that I saw two kinds of people I had not expected to see, several beggars with bowls at their feet into which they clearly hoped and expected passers-by to drop small coins (as indeed some had); and on one street near the Bund, several heavily made up young women whose short skirts and behaviour strongly suggested that they were prostitutes. I had been told on more than one occasion that there were no beggars and no prostitutes in the People’s Republic. This was manifestly not so.  Friendly locals with a smattering of English set me on the right road back to the hotel soon after that. What I saw of this huge city was attractive, a blend of quite handsome European “Victorian colonial” architecture of buildings that had been the Chinese headquarters of European banks and other financial and trading companies before the wars of the 1930s and 1940s, with older Chinese mansions and even palaces. Looking at TV images of modern Shanghai, the commercial capital of China, I wonder how much, if any of those graceful old buildings survives. The city obviously has been completely transformed.  However, most of it, especially the central commercial and trading heart of the city, is at or near sea level, so even the half meter sea level rise of the most optimistic global warming scenario would submerge it, so the future of Shanghai could be equivocal.
In 1981 I flew home from Shanghai via Tokyo and Los Angeles. When I returned in 1982, it was towards the end of a round-the-world odyssey, that began with a flight from Mirabel Airport near Montreal, all the way to Calcutta.  From Calcutta I had gone on to Singapore via an overnight station stop in Bangkok; I was external examiner for the qualifying examinations in epidemiology and preventive medicine at the National University of Singapore and spent a couple of weeks there before going on to Hong Kong, where Wendy joined me.  We lived it up in Hong Kong, stayed at the posh Regent Hotel in a waterfront room with a superb view of Hong Kong harbour, and did much the same tourist trips that I had done on my own the previous year. We had several wonderful days there, then flew direct to Shanghai. That was the flight on which the door to the cockpit got stuck, and the cabin crew used an axe to break it open so they could get to the flight deck.  Wendy found this more alarming than I did, having had some prior experiences of Chinese improvisations to cope with unexpected mechanical breakdowns. 

This second visit to Shanghai was far better than the first for several reasons. To begin with, Wendy was with me, then as well as a slight familiarity with the country and its people there was an eminent host, Professor Su De-long to escort me in Shanghai. He was a distinguished and very gracious man, who took me into the field to see the results of the successful campaign to eliminate schistosomiasis which for centuries had killed and crippled countless thousands of children and young adults who worked in the paddy fields. The key to success was thorough understanding of the complex life cycle of the parasite and the ecosystems with which it interacted. The critical step was a concerted attack on the fresh-water snails that were the intermediate hosts, but in addition there were educational campaigns to eliminate defecating in the paddy fields, an anti-cercarial ointment to reduce the parasites’ chances of penetrating the skin, and effective medication for infected people.  The fact that domestic animals, notably water buffaloes, and water rats and feral dogs were also infected made impossible any efforts to eradicate the disease completely, but it had been virtually eliminated from humans, especially children who were the most vulnerable. I saw and photographed children who were clearly in abounding good health, a living tribute to the dedicated work of Professor Su De-long and his teams of field workers. 

Su De-long took Wendy and me to dinner, where a small crowd of nearby diners gathered around us to watch with great amusement the way she handled her chopsticks; and to a theatre, for a spectacular performance of acrobats and dancers. Even an occasional misstep did not detract from a most memorable performance, according to my notes at the time.

From Shanghai we went by train to Suzhou, reputedly the culinary capital of China in the same way as Lyon is the culinary capital of France. Our host was Dr Lee, director of Industrial Hygiene and Toxicology. The medical school is a collection of picturesque old buildings and I delivered my talk in an ancient pavilion, not a lecture hall, but the acoustics were excellent. I spoke here (by request) on the desirability of diversity rather than uniformity in educational methods. There was some local resentment among both staff and students about the centrally imposed curriculum and teaching methods, dictated by authorities in Beijing, and my talk provoked animated discussion. The  impressive fourteen-course banquet to which we were treated confirmed the city’s  reputation for gastronomic excellence. It included several fish courses, shrimps,  a local delicacy, 100-year old eggs (preserved underground for many years anyway) and the most challenging article I’ve ever had to pick up with chopsticks, slippery round translucent eggs about 1 cm in diameter, each containing an embryonic bird nearly ready to hatch. They tasted delicious, with a unique nutty flavor, but getting them to the mouth was difficult for me, impossible with chopsticks for Wendy, who had to use a spoon. There were many toasts with the local fire-water, fortified rice wine like neat vodka which we drank in tiny glasses, saying ‘Gambay’ (Mandarin for ‘Cheers’) and voicing sentiments like ‘Long live friendship between Canadian and Chinese people.’  Suzhow is famous also for canals connecting it to Shanghai and Hangzhou, for the beautiful arched bridges over the canals, and for enclosed decorative gardens. All these appear on willow pattern crockery. On our last afternoon in Suzhou we were taken to one such garden where our guide (one of the professors from the medical college) got us all lost, so we almost missed the train to our next destination, Nanjing. 


With our hosts in Nanjing




At Nanjing railway station we were met by Dr Lee from the health department and Professor Ye, an environmental health scientist from the School of Public Health at Nanjing Medical College, who was my host and later our guide when we visited the tomb of Sun Yat-sen. When we reached the School of Public Health I met about a dozen of the academic and research staff and dutifully wrote their names in the stenographer’s pad that is the basis for these recollections. After more than a quarter of a century I could not put faces to any of the names but I do remember that I was very favorably impressed by their obvious competence, enthusiasm and dedication. This is a large and flourishing medical college and school of public health, set up by Dr Sun Yat-sen on a well laid-out campus with an impressive range and depth of research in progress, but like all the medical colleges I visited it was sparsely equipped with a good but limited library. After we returned to Canada I arranged for the Chinese Embassy to send them a copy of the big public health textbook, for which in due course I received an effusive letter of thanks.  In 1998 I was visited in Ottawa by the current dean and one of his colleagues who remembered me as their first Canadian visitor since before the cultural revolution. They said they had happy memories of my visit in 1982, as did I.  I gave them copies of the latest editions of the Dictionary of Epidemiology and the big public health textbook, now only 1400 pages instead of the 2000 in the earlier edition that had been the first one I edited, and pointed out that it was printed in much smaller fonts so now it had about 1500 words to the page instead of 900 as in the earlier edition. Nanjing Medical College and its School of Public Health were impressive enough for my copious notes to consume eight pages but there’s no need to repeat all that outdated technical information here. It was in the professional reports that I wrote. We were dined and wined like visiting royalty, and treated to a fairly comprehensive tour of this handsome city on the banks of the Yangzte River (although I don’t recall seeing the massive city walls that date from around 800-1000 of our era). The city was badly damaged during the Japanese invasion and had been the scene of horrific massacres and mass rapes, so much of it is modern postwar architecture, but happily it was spared too many of the soulless concrete blocks and towers that some Chinese cities were erecting in imitation of similar buildings in USSR. We visited the tomb of Sun Yat-sen (1866-1925) the physician-statesman founder in 1912-13 of modern China, now rightly revered  only slightly less than Mao Tze-tung, especially in Nanjing where he established the modern medical college. We saw an adjoining beautiful pagoda, a Ming emperor’s tomb dating from the 14th century, and the Divine Way, an avenue of beautifully carved stone animals (elephants, camels, lions, and mythical beasts) that dates from the Ming dynasty and was created in 1350-1400. It would have been good to spend longer in Nanjing, explore it more thoroughly, but our tight timetable did not permit this. Photos and video clips of the city in 2006-7 show many spectacular changes with exciting modern architecturally and aesthetically pleasing public and commercial buildings along and just behind the waterfront on the Yangzte River. It would be good to see it again now.



Stone animal (camel?)  on the Divine Way, Nanjing, 1982














From Nanjing we went by overnight train to Beijing, sharing a four-berth sleeping compartment with two senior military officers, both of whom smoked heavily. Wendy made it emphatically clear with gestures and mime that she would be displeased if they smoked in the compartment, so they retreated to the corridor at frequent intervals. We were impressed by their politeness and their cheerfully willing compliance, and I wondered if anyone had ever stood up to them as she did. 

In Beijing we were met at the railway station by Professor He, a distinguished elderly man who had been educated at Harvard and the London School of Hygiene and Tropical Medicine in the 1930s, and by several others including Mr Wang from the Ministry of Foreign Affairs and the Chinese Academy of Medical Sciences (obviously a Communist cadre man there to watch out for any subversive hanky-panky!) Ostensibly he was our translator, but he was unnecessary for much of the time because many staff members at the medical college spoke good English.  This medical college had gone through several transitions. It had been set up with lavish financial support from the Rockefeller Foundation in 1921 and was named Peking Union Medical College.  After the Communist revolution it had become Capital Medical College. In 1967 it was closed by the cultural revolution, Mao’s most calamitous failure, then it reopened in 1979 as the Beijing First Medical College.  It has now reverted to its original name. In Beijing, the authorities had laid on a full program for me at the medical college with visits also to the  Chinese Academy of Medical Sciences, and several research institutes including the Cancer Research Institute, the group responsible for the Atlas of Cancer Mortality and a team of neurophysiologists who were studying acupuncture, seeking to discover how and why this ancient therapeutic method worked. There had recently been widely publicized demonstrations of acupuncture anesthesia, showing empirically that it was effective for major thoracic and cranial surgery as well as for treatment of arthritis and various other chronic diseases. It did not work for upper abdominal surgery but could be used for appendectomy and repair of inguinal hernia. The prevailing view was that its efficacy was due to overload of pain receptors and release of massive amounts of endorphins under the stimulus of subcutaneous acupuncture needles. I made copious notes during a pressure-packed few days in Beijing and wrote several reports and short articles for medical readers that have been published or circulated elsewhere, so in this account I will focus on the non-professional aspects of the trip.

On our first afternoon in Beijing we were both a bit fragile after a near-sleepless night in an over heated, claustrophobic sleeping car compartment. Perhaps that’s why we did some sightseeing on our first afternoon. Professor Ho’s wife, almost as old as he, but very fit, took us to the Forbidden City, which far exceeded our expectations with its displays of priceless jade, gold and jewelry.  We saw the emperor’s palace and walked on the squeaking floor – designed to squeak loudly at the lightest footfall, to warn those within that someone was approaching, perhaps with sinister intent. We walked into Tiananmen Square, bustling with people as it usually is, and also with traffic, mostly people on bicycles.  We were astonished to see the enormous loads some people were carrying on their bicycles – large pieces of furniture such as chests of drawers, for instance. Beijing was afflicted at that season (spring time) with fine dust that blows with the prevailing wind from the Gobi Desert, so people who wanted to avoid inhaling this dust covered their nose and mouth, sometimes their whole face, with a fine diaphanous silk veil. Many children had been  equipped with these by their caring mothers, and some young women, we suspected, were wearing these dust-resistant veils to make themselves look more alluring. 

Everywhere we went in China we saw groups of beautifully dressed, attractive and very healthy-looking children, ranging from pre-school toddlers to 8 to 10 year old children in the care of (we presumed) school teachers. Less often a solitary child was in the company of parents.  All these children were the products of the one-child policy, a necessary but emotionally demanding action forced on the People’s Republic of China by the relentless increase in numbers, then fast approaching a billion (about 1.2 billion by 2008, because of the demographic momentum of the younger generations that continue to enter the reproductive age groups of the population).  Wendy had several sightseeing expeditions with Professor Ho’s wife Mrs (actually Dr) Ho. At one stage Mrs Ho took her into the new underground railway where she succeeded in getting them both briefly lost.

Professor Ho took Wendy and me to a Beijing restaurant famous for Peking duck, which we duly ate, but without much enthusiasm – like all duck, it was too greasy to please our palates.  What did impress us about this place however was the astonishing variety of faces we saw there. This restaurant is very popular with visitors to Beijing from all over China. I don’t recall ever before seeing in the same room at the same time so many variations of facial bone structure, hair texture, skin color, body build, added to which were styles of clothing from the tropical south to the far north, to the outer reaches of Mongolia.  The variation in that one room full of people was greater by far than on the New York subways I had seen and written about a few years earlier. 



Wendy and John at the Great Wall








Wendy at the Great Wall of China, 1982





On a fine and sunny but cold spring day we went to the Great Wall, a couple hours’ drive away.  It was well worth it of course, justifying its reputation as one of the greatest manmade wonders of the world. We had a very good look at it, climbed up and walked along it, took many photographs, and had lunch there.  Wendy had to use a very public female toilet, where the other women were intensely curious to see if she was constructed as they were.  I wasn’t able to be with her to offer my moral support but she did quite well without me. 

We had the usual banquets in Beijing, and on our last night there I felt the need to repay the generous hospitality we had received everywhere, so rather unnecessarily and quixotically I took our hosts and their spouses to dinner. These were all late middle age or elderly people and most of them were  distinguished leaders of the profession and of academia.  All had horrific stories of their experiences during the cultural revolution when they had been uprooted from their academic roles, humiliated and abused in public, then put to hard manual labor in mines, paddy fields or, in one case, cleaning public toilets. That disastrous public policy which virtually shut down universities for over a decade accounts for the age distribution of university teachers, with large numbers of elderly and old men and women, a young generation just out of graduate training, and very few, in some fields virtually no one in middle years between these two groups. There was an urgent need to rebuild, and in Beijing we met Michelle Higginbothom, wife of the first secretary at the Canadian Embassy, who joined forces with me in Ottawa a few months later in one of several programs aimed at replenishing qualified staff in university departments as rapidly as possible.  Wendy and I were both coopted to take part in this by hosting Chinese epidemiologists during their orientation, helping them to learn English as well as epidemiology. That’s a whole other story.   
Housing: When we were in Beijing in the early 1980s there were a few high-rise apartment towers on the horizon. Now, more than 25 years later, Beijing looks as Hong Kong did then, according to pictures on TV screens. There are forests of high-rise apartment buildings everywhere one looks. In 1982, we looked down from our hotel room to a more traditional kind of dwelling. On most of the streets we could see there were quite large compounds with central courtyards, three or four stories tall, each containing multiple flats that in many cases seemed to be teeming with people. In Hanzhou in 1981, I had been in one such flat, the home of Professor Huang Xi-men. It was small but comfortable, two small bedrooms, a kitchen-dining-living room, a bathroom with a ‘squat’ toilet with a shower over it, similar to those I had seen and used in Greece and Italy in the early 1950s, and a small entrance hall with hooks to hang coats and a rack to place outdoor shoes. Access is along a balcony rather than through an indoor enclosed corridor. This multiple-unit style encourages interaction among neighbours and a communal way of life that fosters congeniality, friendships and mutual support, although of course it can lead to unpleasantness if people living at such close quarters don’t get along.  Professor Huang lived in such a flat in a compound that probably comprised 16-20 similar flats, and the compounds we could see from our Beijing hotel room looked about the same size or perhaps a little larger.
Religions: The People’s Republic of China is a secular state and we have an image of a state that is hostile to religions. The teachings of Confucius may be more like a philosophy than a religion, but I had seen obviously devout Buddhists worshiping at a well-cared-for shrine in Hanzhou, and in Beijing, Professor Ho and his wife walked us past the Protestant church that they attended. They said there had been times in earlier years of the PRC when religious faiths had been driven underground but there had never been serious attempts to eliminate them altogether and at that time the authorities seemed to be turning a blind eye to the practices of most religious believers.  

Postscript: For three years after our visit to China in 1982, about 12-15 Chinese epidemiologists in training came to Canada annually to get advanced postgraduate training. They came to Ottawa for about two months orientation and conversational English classes before scattering to centres across Canada for formal graduate studies leading to an MSc or for a few a PhD in epidemiology. 
Michelle Higginbotham coopted Wendy and me to take part in these classes.  We worked out a happy symbiotic arrangement for meals. We supplied the equipment, they went to the market to buy some of the raw materials (fish, salad, spices, etc), together we all prepared and cooked the meals, then we ate, washing the food down with liquid refreshments that I supplied. We had many happy gatherings, suitably recorded in our family photo albums.  All these men and women were very good company, and all but one of them did well in their graduate studies (the exception was a plant, we think, a communist cadre man sent to keep an eye on the others). They went back to China, but several later returned to Canada and settled here. One very bright man, Gao Ru-nie, who got a PhD, moved out of epidemiology altogether soon after returning to Calgary to open and run a successful Chinese restaurant, but so far as I know all the others stayed in the profession. We are still in touch with several, including some in China and two who returned to Canada. One of them worked for over ten years on epidemiological research in cancer in Ottawa. Besides Yue Chen in our department in Ottawa, I know or know of about half a dozen Chinese physicians who specialize in public health sciences who have settled permanently Canada, and several others who have settled in the USA and the UK. I have an impression that the brain drain from China may be considerable, but the Chinese authorities appear to be relaxed about it. They warmly welcomed Yue Chen when he returned to Shanghai for a sabbatical year recently, and Yue says that he was encouraged to move to Canada, to help establish intellectual links between China and Canada. 

The above is condensed from a longer account of my travels that is part of my memoirs. Among other deleted paragraphs is one with my impressions of the collective national mood, as observed from the facial expressions and body language of the people I saw on the streets, in shops, sight-seeing on the Great Wall, audiences at theatres.  I was struck everywhere by the cheerfulness and sense of purpose that seemed to be the prevailing mood. There seemed to be a sense of optimism, that things on all sides were rapidly improving, life was manifestly getting better all the time. People on bikes in Tienanmen Square were whistling, laughing, greeting each other happily as they wheeled their incredibly heavy loads. I suppose propaganda spread the message that sacrifice and hard work now would pay off, and it's self-evident that it has. Life is getting better for most if not all people as modern China presses ahead with its combination of unbridled capitalism and totalitarian (but not Marxist communist) governance.