Sunday, November 21, 2010


I recently took a trip to a rural area of Henan province for work.  I have to admit being too shy with my camera, but the Chinese business trip (出差) is an experience worth describing in itself, and the little I can say about Henan ( 河南) is worth noting.

I've been researching the health of Chinese elderly, particularly centenarians.  The county I visited in Henan province has a particularly high concentration of centenarians.  They also had some unexpected results on routine blood tests, so we went to pay a site visit to meet some study participants and to see the lab where the blood tests were processed.

We took a train from Beijing (北京) to the capital of Henan, Zhengzhou(郑州).   Passing some curious sites along the way.

Like one might imagine in a country as large and diverse as China, there are many regional stereotypes and prejudices.  One Chinese friend in Beijing told me in Chinese, perhaps with a certain sense of irony, “中国人不喜欢河南人,” "Chinese people don't like Henanese people."  I was told they have a reputation for dishonesty and thievery.  I am assuming that the reputation is not entirely fair.  Henan is one of the poorest provinces, though its distance from the coastal cities of wealth is not nearly as great as Western China.

While Henan was the birthplace of the first literate Chinese imperial dynasty, its more recent history is notorious enough to resonate with these prejudices.

Henan AIDS Villages
As described in Cohen's 2004 article in Science, businessmen in the 1990s set up commercial blood "donation" centers in rural areas, taking advantage of the peasants' poverty to purchase blood and blood products on the cheap.  However, Chinese are culturally not very comfortable losing blood, so the centers offered to return the blood cells to the donors to prevent anemia (and allow them to donate more often).  With the support and encouragement of local government, villagers donated blood that was then pooled with other plasma and the red blood cells returned to the donor.  As a result of the mix of plasma and blood and re-use of tubing and other equipment, an estimated 55,000 plasma donors were infected with HIV.  Other viruses such as Hepatitis C were also rampant.  This came at a time well before China was prepared to acknowledge, let alone treat HIV among its population.

The most famous Henanese physician, gynecologist Gao Yaojie, built her international reputation calling attention to the unsanitary commercial plasma purchasing business and the numerous "AIDS villages" in their wake.  Now, as a 84 year-old dissident living in Harlem, she estimates the total number of AIDS cases in China (including those who have already passed away) at 10 million, well above the official figure of 740,000 HIV positive Chinese that is commonly circulated in the medical literature.

When i arrived in Zhengzhou I was talking to an American who had married a local woman, and they had been living together in Henan for years.  Before parting ways, the Henanese woman warned me to be careful around the train station for the immingrants from Xinjiang, where the famous Uighers are from, who are notorious pickpockets.  I guess everyone has their own prejudices.

In Zhengzhou I was picked up by a representative from the Henan state CDC and his driver in a new black Buick, which is much more of a luxury brand in China than in America.  The drive out to the county study site took hours on the new expressway.  The road was relatively empty except for truckers, and speed limits appeared to only be enforced by geographically fixed speed cameras, as described by Peter Hesler in Country Driving.   Needless to say we flew over past the trucks, the driver slowing periodically for the hundred or so meters around the predictable speed traps.

Upon arrival in the county seat, it was dark.  We, of course hadn't eaten dinner, and the real ritual of the Chinese business travel was about to begin.  The roll of the Chinese host is very important culturally, and this tradition seems exceptionally important when welcoming professional visitors.  Our elaborate dinner with motorized lazy Susan was punctuated with the almost competitive ritual drinking and choreographed toasts to guests and hosts that would make the glasses of wine at the Jewish seder seem like grape juice.  We drank first glass of the anise flavored erguotou liquor (二锅头) before the first dish had arrived.  I had been warned to respond to the question of "Can you drink" with "我不会" ( "I don't know how"), so they went easy on me.  One of the health officials from Zhengzhou was more firm in his refusal to drink, leaving 3 or 4 ounces of liquor untouched in front of him while he repeatedly toasted our hosts graciously with water.  After dinner my colleague came to my room where I was working a little to tell me that he was drunker than he had ever been before and needed to stay up to drink some water and talk a little bit.

Health of the Chinese Centenarians
Our work in Henan started the next day with a presentation from my colleague updating the local CDC officials on our progress in the study that they had collected data for.  I was struck by the juxtaposition of the Hammer, sickle and AIDS ribbon, but perhaps that combination of iconography is becoming more common.

We also visited their laboratory to test the equipment related to some funny results in the data.  They also had a special HIV lab, though I did not take a picture, for the many HIV + patients who were plasma donors.

We also met some of the local elderly featured in much of the local CDC's recent work.  One woman said, when asked loudly and closely, that she was 109 years-old.  Her neighbor, tightly gripping a bird in his left hand, described her family history, relative good health and strong appetite,
and a couple in their late 80s.

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