Babu. Everywhere we go in Tanzania, we hear of Babu.

“Have you heard, he healed a person with AIDS! And a blind child could see again. I saw it myself. The cup, the kikombe. He hands out the kikombe with a herbal tea from a local plant. The plant it comes from, when it is not boiled, might be poisonous. No, it is a poisonous plant, it's a magical plant. God has chosen Babu to heal us. Africans to cure Africans. Did you hear, our local politicians have gone to see Babu. Oh, and Nelson Mandela went by helicopter - he jumped the line. 30,000 people are being treated each day. Even nurses and some doctors have gone.”

“They did some tests in Kenya: not effective. What should I think now? They will do more research. Babu can't be wrong. All these people he healed, they cannot be wrong.”

“The plant grows all over the Serengeti. The soil conditions aren't everywhere the same. It's only powerful where Babu is. Oh, and it's not effective unless Babu has said his payer over the brewed tea. He gets up early every morning, he hardly sleeps. He does this because god has told him.”

By the time we get to Arusha, the closest town to Loliondo on the Tanzanian side, yet still a days bus ride away, our heads are spinning with stories. Everyone has heard of Babu, some have been to see him, many more have heard and told stories. Everyone has an opinion. In June 2011, more than 3 million people have pilgrimaged to Loliondo, to receive the cup, the kikombe from Babu. Babu just means old man, in a respectful way. Babu is a priest. Loliondo is far away, the roads are poorly developed. A faster way to get there leads through Kenya.

Last year, Babu had claimed that the kikombe would heal HIV/AIDS but very few people came to seek the treatment. Was it because of social stigma? The situation changed dramatically, when Babu claimed that his treatment worked for the following six chronic condition: cancer, diabetes, HIV/AIDS, gastrointestinal, respiratory and cardiovascular illnesses. People started coming from all over Tanzania and even from abroad – whether they were sick or not.

Exaud, a local tour guide offering safaris and hiking tours, decided to be of service to the sick. He made his car available and drove six people to Babu. “Folks in my car were sick but nobody admitted they were HIV positive. Everybody went because of something else. I am sure some had AIDS. But I didn't want to know either, we had a long journey together.”

They waited three days before it was their turn. In the meantime, the conditions for the kikombe awaiters turned rougher by the hour: the village wasn't prepared for such an influx of visitors and there was a lack of food and clean drinking water, shelter, and sanitary facilities. In some cases, people even died of dehydration, before they reached their turn of the kikombe. Also, managing such a crowd demanded volunteers. Exaud was one of them, dishing out kikombe to the sick. Whenever people rushed and pushed, Babu would call them back to their senses, reminding them that if they didn't behave, he'd stop handing out the kikombe all together – that worked.

“One day, a blind boy drank the kikombe and was able to see again. I saw it with my own eyes! You don't believe me … it's true. Ask around.” Exaud tells us.

Miracles like these were much told of, fueling the anticipation and hopeful atmosphere in the crowd.

In the meantime, the effect of Babu's kikombe on Arusha's healthcare system is noticeable.

Dr Chamba in Arusha offers us his perspective on the story. As Babu's kikombe became well-known, the hospital wards around Arusha and Moshi cleared out. Patients left, being taken to Babu by their relatives for a more promising and much more comprehensible treatment. Dr Chamba saw HIV patients coming back from Babu who were still ill. For them is was surprising and even devastating to find out they were still testing positive. Some just declared the test as invalid, going for another test, and another one. Just to find out eventually that they hadn't been cured.

One of Dr Chamba's diabetes patient felt so confident in Babu's ability and treatment that he threw his diabetes medicine out of the car window on the drive back from Loliondo. A few days later, the relatives brought him to Dr Chamba's office. The patient was in a coma.

Babu's kikombe has from mobilized crowds of people for a pilgrimage of hope. The stories of Loliondo have brought feelings of pride and empowerment to Tanzanians, who usually find themselves on the receiving end of development aid and health care. Yet, the kikombe doesn't cure everyone and has even caused much harm for some. What I find most intriguing about this story, is the fact that everything around the kikombe and Babu is so different from medical healthcare experiences. And hardly any of the medical healthcare offerings are met with as much enthusiasm as the kikombe.

So, what can health care learn from Loliondo?

Here is an attempt of extracting the aspects that make the kikombe so powerful. 

# 1 It's a single dose.

A one-off treatment fuels the perception of a silver bullet.

# 2 It's a familiar dosage form.

A cup filled with a herbal brew is something people can relate to. It's simple and it's something everyone has seen before. Maybe because of its simplicity it becomes a powerful carrier for the spiritual aspect.

# 3 It's a local African ingredient.

Why it might work: From Tanzania for Tanzanians, from Africa for Africans. This notion might be experienced as empowering as it brings a solution from within rather from outside.

# 4 It is administered by a spiritual leader.

Church plays an enormous role in local people's lives. The fact that the spiritual leader understands more than the congregation is accepted and also demanded. Babu starts each day with a prayer and places high emphasis on the fact that god has given healing power to this plant and chosen him to facilitate. The language he uses is familiar to people and they know this way of reasoning from their churches. Hearing scientific explanations from healthcare professionals, on the other hand, often seems foreign and alienating to them.

# 5 It's taken amongst a crowd of exhilarated people in a non-medical setting.

The journey and atmosphere while waiting for the treatment is filled with compassion and a feeling of belonging – of being human. People aren't divided up into their conditions, some even take the kikombe as prophylaxis (not recommended but frequently heard of) and others take it more than once (also, not recommended by Babu). The social connections at the site happen naturally, being human and suffering from one ailment or another in Loliondo brings people together. And seeking the kikombe treatment doesn't stigmatize, on the contrary, it is uniting people. Do people even feel as patients here? Also, the crowd is hopeful and full of anticipation to the treatment rather than in most medical settings where patients in the waiting room are quiet, lonely in their worries and thoughts, the lucky ones accompanied by a relative or a friend.

# 6 It only costs as much as a local bus fare

The treatment cost is low. 500 TSH (33 US cents) for a single dose. A single dose it's all that's needed which makes the costs seem predictable. If one ignores the hidden costs of getting to Loliondo and back, and the medical costs for when the treatment turns out to not have helped at all.

# 7 It's a long journey to get to the treatment

Now I'd be really curious to see how some of these aspects could get worked into an experiment for delivering health care. What effect might a collaboration between health clinics and local spiritual leaders have when both are aligned?

What can we learn from Loliondo for designing healthcare services in the developing world? For designing healthcare services in the developed world?

Pictures of Babu and Loliondo with comments from Tanzanians here.

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When we were in Germany in June, I saw this offer that so brilliantly addresses the concerns of the aging population in Germany.

In Germany, the 60+ seniors make up a large percentage of the wealthy population. Many companies want them as their customers but don't necessarily understand their needs, and hardly address their concerns.

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Tchibo got it right:

 German seniors want to travel and see the world but tend to have health problems. So they are afraid of getting sick or needing emergency care while traveling abroad.

So Tchibo offers travel tours with a doctor and nurse accompanying the group.

Photo curtesy of Joho345.

Some background on Tchibo:

Tchibo is an interesting business story in Germany. This family owned enterprise started off after World War II selling roasted coffee beans via mail order. Then they opened stores and cafes selling ready brewed coffee and pastries. Later, they leaped into retail offering home appliances, clothes, and other goods but still sticking to their small cafe-size stores. This unique model made it possible: “every week a new world” (in German "Jede Woche eine neue Welt"). Every week they sell different things to make sure that the offering stays fresh and seasonally appropriate. For example, when summer comes around, one week the theme is picnic and the products range from silverware, napkins and table cloths, even garden furniture to blankets and bocce. The next week, the theme could be camping, or something entirely different. After expanding into goods, Tchibo entered the services space, selling mobile phone credit, insurances and now also travel packages.

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March, 2011:

We are on the plane leaving Asia for Europe. The past three months have been an incredible experience rich in stories and anecdotes, pictures of artifacts and personal health experiences. While there are still so many stories to be written down and shared with you, here are a couple of themes that have bubbled up and sit at a higher level. It's probably not quite accurate to lump China and Indochina together, as there are major differences between each country and region, but given the similarities, I'll attempt it anyways.

1) Maintain the health balance through daily action
One thing that strikes me as major difference between Asian and Western notions of health, is the perception of the default state of health. Growing up in Germany and the UK, I get the sense that being healthy is perceived as normal. If you become ill, something is wrong with you. In China, and it also seems to be the case in Vietnam and Thailand, health is a matter of balance. Everyone seems to be taking something for one ailment or the other. While it is normal to constantly do something for one's health by eating the right foods and taking natural medicine, I wonder how people perceive sickness.

A while ago, I came across an academic paper published by a medical anthropologist that examined how people felt about the common cold versus the flu in Europe. There seems to be an intriguing difference: while people felt that coming down with a cold was their fault, for example they hadn't dried their hair properly after a shower (a Celtic belief) or didn't wear a scarf in cold weather (also a Celtic belief), the flu was perceived as something beyond their control.

Do people feel guilty when they get out of balance, i.e. sick, because they haven't done the right things to prevent it?

2) Fine-tune well-being
Western medicine is known and admired for it is fast acting and solves a big problem quickly. It excels at fixing life threatening emergencies. However, its strength isn't to create sustained well-being . Traditional Chinese Medicine (TCM), herbs and other remedies take longer but enhance one's well-being as they bring the body back into a balanced state. In China, severe and chronic conditions, such as diabetes or hypertension, are not only treated with Western medicine, but also with TCM. In Vietnam and Thailand, it seems that people also complement their treatments with additional herbal medicine from pharmacies that cater both, Western and herbal medicines.

3) Strengthen cultural health identity by practicing local health rituals
Strong presence of Western development organizations seem to push local practices of healing to the periphery, it seems. Cambodia and Laos, the two least developed countries in the region, seemed to have the highest numbers of development organizations, and a correlation with lowest number of herbal pharmacy shops visible and accessible from the street. Are there any development organizations that includes local health practices?

So, when people are poor and cannot afford western medicine, they perceive their local health practices as poor man's solution. It's cheaper and more accessible than western medicine. Health organizations often lump local practices together with superstitions and so practices get pushed to the periphery. Until they are stopped being practiced, maybe.

On the flip side, as people become more well-off, when is Western medicine THE cure versus A cure? What difference does it make for people in their journeys from sickness to wellbeing when local health practices are included by the western medicine healthcare provider vs sought out by themselves? In China, it seems that cultural health practices bring a cultural pride and identity to people. What happens, when people loose this notion of cultural health-self?

Story:
Southern Medicine - Vietnam's medical identity?

4) Including the spiritual world for a complete health stakeholder map
Accidents, disease or disability are commonly linked to people's superstitions and beliefs in ghosts and spirits of the ancestors. While in the West, scientific explanations are sought, it seems that the Asian approach looks into both worlds: the spiritual and the scientific. It's easy to claim that the more educated and developed people are, the more they focus on the scientific explanations. The stories that I've come across suggest something else: both worlds exist in parallel – just to play safe? Or, are there important socio-cultural needs that aren't addressed by the rational scientific approach? The spiritual aspects deal both with the emotions of the individual as well as the family and larger community.

Stories:
Laos - Angry spirit causes accident
Vietnam - Ancestor's spirits top doctor's orders

5) ...?

This is by no means a complete list, and I am curious to hear from you. What patterns have you observed? What is missing? 

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At a bookstore in Phnom Penh, we find out some interesting Cambodian cultural titbits: avoid closing business deals on Wednesdays as it brings bad luck; when a cat gives birth people dry and keep the cat placenta in their house for good luck; and it's common for Cambodians to seek the help of a shaman when they are unwell. The latter of course interests me the most. These shamans are called kru in Khmer, derived from the Sanskrit word for teacher 'guru'. The guide book continues “... don't be disturbed if the kru spits on and rubs saliva over your face.” Sounds like an intriguing story for WellAroundTheWorld, so we set out on our mission to find a kru.

In Siem Reap we hire a tuk-tuk driver for multiple days to visit Angkor Wat, Banteay Srei and the other breathtaking sites of the ancient Khmer empire. As we get to know our driver Mr L, we stir the conversation towards health and eventually ask him whether he knows a kru. He is surprised about this request but agrees to take us to one.

A little bit of background: Mr L is 32 years old and a farmer. He is married and has four daughters. His wife takes care of the farm and he contributes to the family income operating a tuk-tuk mostly for tourists. He's been a tuk-tuk driver for seven years and local English classes have helped him to become fluent for his day-to-day business. His fashionable glasses and fluent English let him appear more educated and worldly than he actually is. Mr L took his first pill at age 18. He's only had one experience with needles, that was one year ago when he was given infusions for malaria.

Mr L tells us about the options for treating a health problem for local Cambodians: “When you have money, you go to the hospital. When you don't have money, you go and see a kru. Children are different, we can take them to the local Children's hospital. That is free of charge, but a farmer like me can only afford the kru.”

As we are sitting in the tuk-tuk full of anticipation, James and I envision dark alley ways, a place tucked away from the hustle and bustle of the touristy streets of Siem Reap, pots full of herbal medicine boiling over wood fires, strange smells, and a chanting kru performing the spitting ritual.

When Mr L pulls off to the curbside, we stand in front of what looks like a normal pharmacy. Maybe it's got a second room inside where the 'magic' takes place?

Nothing.

It's a normal pharmacy selling Western medicine. The most exotic thing we find is chicken essence soup cubes. What's has happened? Did he misunderstand our request?

Mr L tells us: “This kru is really good. I explain to him what I have and he gives me medicine. Last time I came here I had an upset stomach. I got a tablet and felt better within a couple of days. He is number one kru. I used to go to a different one, but he wasn't any good. This kru is the best.

To Mr L, there is no difference between a pharmacist trained in western medicine and a kru who administers herbal medicines and other rituals. To him, a kru is simply someone who gives you advice and helps you get better. Kind of makes sense, but we can't help being disappointed that we missed out on the kru experience that we had imagined.

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As Peace Corps Volunteer, James taught Maths and basic computer skills at Mzumbe secondary school. In his final year, he set up computer labs across the region.

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When we visited in June, 2011, we heard the following story from one of the teachers:

One night in the rainy season, some students claim to have seen a creature with a bushy tail pass through the school campus. In the Kiuluguru language, this is called a zombwe. After the sighting, the students noticed a rash appearing on their bodies, especially on their faces and necks, and connected this with the sighting of the zombwe.

They called the disease Mzumbeitis Zombwesis, until their teachers heard about it and laughed at the students: “These are just normal insect bites! The students study late in the night and insects swarm around their desk lights.While the students are studying hard, all heads down, they get bitten by insects! That's the real cause for Mzumbeitis Zombwesis.”

Superstitious beliefs even among the top students are common and teachers feel that it's their responsibility to clarify the scientific causes.

The traces on the skin of the fabulous creature zombwe makes the better story, though.

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In his last year as Peace Corps volunteer, James had set up computer labs across multiple schools in the Morogoro regions. One of the schools is run by missionaries: fathers from Kerala, India. We spent some time with the fathers at their retreat outside of Dar, where seven brothers from Zambia, Uganda, Mozambique and Kenya come together for an intensive year of praying as part of their preparation for priesthood. In the spirit of self-sufficiency, they keep cows and ducks, have fruit orchards and a vegetable garden.

Father John* shows us around and we get to admire the curry leave tree and all sorts of other trees which produce leaves and fruits that are used in South Indian cooking. The green fruit hanging from the tree is custard apple, and the yellow round one in the hand is a passion fruit.

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Behind the house, we notice some flowers that are left out in the sun to dry.

These are hibiscus flowers and when dried are added to shampoo to die gray hair black. I was surprised to see such indulgence in vanity at a missionary retreat. Father John and the others giggle about Father Paul* and his habit, but don't seem to interfere and leave him his grooming treatment. He hand picks the flowers and leaves them to sun dry.

It seems that pampering themselves is one of the things the fathers don't abstain from. Staying in their dorms, we are given a towel and soap, and are surprised of their choice: Ayu soap, exclusive fragrance soap, with natural lotus oil. “with a special conditioner made for delicate skin keeps your skin soft and moisturized.”

What can be unpacked about this choice of soaps?

One possible explanation might be the following: since they've all decided to live a celibate life, their grooming of course isn't for courtship. But there seems to be a strong connection between maintaining one's appearance as well as displaying cleanliness and spiritual purity. Another aspect: while these vegetarian-raised South Indian fathers have given up many things in their lives for joining the seminary, they seem to have gained something else:eating meat and carving out the luxury to groom themselves.

Or maybe, Ayu is just the cheapest soap out there - the fathers are good at managing a tight budget.

*names as always changed to protect people's privacy

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Years ago, a guy friend told me about an additional use scenario for tampons in the Norwegian military: when female soldiers crawl through the mud and wade through mirky waters, they can catch vaginal infections. So, they use tampons for protection.

This was the first time I had heard of the usage of a tampon to prevent things from going in, instead of protecting things from coming out and causing much embarrassing blood stains.

What a great opportunity space to rethink the tampon to not only offer 'leakage protection' but also preventing contamination. Apart from claiming greater comfort and supposedly easier insertion, nothing much has happened in this industry for a while - until I came across these products at my favorite drugstore dm* in Germany in June, 2011.

Extra protection
This kind of tampon is specially designed for women to enable them to go swimming and do exercise in water during their periods.

Health enhancer
This brand pushes the boundaries even further: their tampons not only protect but even promote vaginal health. The brand understands that women who frequently experience vaginal thrush infections are more cautious to use tampons. So they repositioned their brand as vaginal health enhancers. Treated with pro-biotic 'goodness' they claim to add good bacteria to fight off thrush infections caused by bad bacteria. This way, it allows them to tap into the market of non-tampon using women offering them the comfort of using tampons and at the same time fighting off future thrush infections. Does it really work, though?

Bonus: they are made of fibers that have not been bleached and are all natural - reassuring every worry of their customers.

*dm is a drugstore chain in Germany and Austria, currently expanding into Eastern Europe. Beyond great products, dm is known for their employee-friendly management and their sustainability programs. Their founder Goetz Werner bases his approaches on Rudolph Steiner's Anthroposophy. More on his business approaches and focus on the human being here.

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This story is about Carol*, a grad student in California.

When I first met her, she told me she had a much younger sister, ten years younger to be exact. It's not the most usual but also not the most unusual. The story got fascinating, when Carol started telling me about her annual bills for medical freezing services that ran up to USD 2,000. This all might not make much sense right now, but let me start from the beginning.

Carol's father is an orthopedic surgeon, specializing on hip and knee surgeries and in his free time he collaborates with university students from Germany inventing medical devices. Carol's mother is a teacher.

After Carol was born, her parents wanted to have another child – but for some reason it didn't quite work. Years of hormone treatments followed and they finally were successful with in vitro.

In vitro fertilisation is a process where they take eggs and fertilize them in a test tube, hence the name. The scientists then look at how many eggs have been successfully inseminated and plant those back into the uterus.

Now, I'm sure you've heard of the octuplets and sextuplets in this world. Many of these have so many siblings because as Carol explains “No scientific decision is being made, like my dad did, but all eggs are put back into the uterus.”

In Carol's case, her father – the scientist – decided that they'd only put two out of the four successfully inseminated and healthily developing eggs into her mom's uterus. The remaining ones, they stuck into the freezer – a professional, medical freezer of course. At this point, Carol explains that “other couples get into ethical and religious arguments where they feel like are they are killing their children or playing God by selecting one egg over the other. My dad was just my dad, the scientist, and there was no issue with freezing the other ones.”

As the pregnancy develops, her mother experiences a miscarriage and only one child is born – exactly as the parents had hoped for.

Carol learns all this as a ten year-old, being the daughter of a scientist it doesn't strike her as very unusual.

The years go by, and as Carol and her sister grow up there is mentioning of the fertilized eggs that are still in the freezer. Her mother starts wondering what to do with them and being her philanthropic self, she entertains thoughts of giving them to couples who can't have children. The moment she voices her plans to her husband - Carol's father – he objects. He doesn't want his genetic material to end up with a family he doesn't know and have no connections with. He'd rather donate them to science. To this proposal, Carol's mom can't agree to. “Why should she let science do cruel experiments with my siblings?” Carol remarks. And so, the eggs stay in the freezer and Carol's parents keep paying the freezer bills.

So, how does Carol end up with the freezer bills?

Carol goes off to college and on one of her trips home, finds her parents putting together their will. Sitting down with to finalize the process, their lawyer asks them the following question: “Besides real estate, bank accounts, life insurance and other assets, are there any unusual assets?”

Her parents and Carol look at each other: “Uhm, the eggs in the freezer!”

Her parents can't agree on what to do, so a spontaneous decision is made: they sign them over to their daughter.

Here is Carol, 22 years old, a grad school student, having inherited her siblings-to-be who sit in a medical freezer because her parents can't agree what to do with them.

Maybe realizing the awkwardness, Carol's dad adds a new spin to this. In case his daughter doesn't meet Mr. Right in her fertile years, or in case she might have troubles getting pregnant, she could always give birth to what genetically are her sibling. Sounds all great to a scientist …

Here is Carol's take on her father's offer: “How am I going to convince my future husband to have children that technically are my siblings, and then give birth to them?”

In the end, her parents continue paying for the freezer bills and not much has changed. But Carol has come to the conclusion that she has helped her parents with the conundrum, and reassures herself that “the eggs are probably freezer burned by now, so that's that.”

Special thanks to Carol for sharing your family story with WellAroundTheWorld!

*as always, names are changed to protect patient privacy. 

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One day in April during our world trip, we had brunch at my friend and former colleague's house in Vienna. Since James and I aren't coffee drinkers, Ina asked us the typical tea drinker question: “What kind of tea would you like?”

Her selection was broad and included quite a few herbal teas, with labels such as Erkältungstee (tea mixture against colds) and Bronchialtee (tea mixture against bronchitis). The latter caught my attention as it was a mixture that was especially prepared for Ina with a handwritten label of all the different kinds of herbs.

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Ina Biechl* relies on herbal teas for non-serious ailments. This tea has been especially prepared for her according to directions from her family doctor. He ordered the pharmacist to mix this blend when Ina had a nasty cough that wouldn't go away. According to her, it helped much better than some of the stronger treatments she'd used in the past. In her words, “why go against fragile illnesses with forceful bombs?” (“Warum mit starken Bomben auf zarte Krankheiten losgehen?”).

European pharmacies and drug stores offer a wide selection of herbal teas. While browsing through pharmacies in Munich, Frankfurt, Vienna, Budapest, Belgrade and Sofia, herbal teas occupy quite a large section of the retail space.

Pharmacy in Vienna, Austria:

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Drugstore in Budapest, Hungary:

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The teas fall under four categories:

1 – What the tea is made of: for example, camomile tea consists of dried camomile flowers.
The cross-section of herbs is coming close to an undergraduate course in botany.

2 – What the tea aims to cure: such as Acid Reflux tea, Rheumatoid Arthritis tea, flue tea.

3 – Which organ, bodily function or body part the tea supports: such as nerve tea, kidney tea, stomach and intestine tea.
NB: most continental European consumers are ok with bodily functions being called out by their names.

4 – the desired outcome of the tea: sleep tea, relaxation tea, invigorating tea .

Ina's mental model of 'fragile' illnesses caught my attention and made me think about mental models for the non-serious ailments in different cultures. It struck me how people in continental Europe view these teas as natural support for the non-serious, the usual and the seasonal ailments that occur regularly. Having grown up in Germany, I view colds as important to my wellbeing. It's natural to get colds and have the body fight through it. It's like an 'update' for my immune system, kind of like running antivirus software on a computer. It takes time and that's ok.

Here in the US on the other hand, where some people don't even have sick days it seems like that having a cold is having a weakness that needs to be fixed immediately. With this background, it makes more sense why there are maximum strength and extra strong doses of potent cold medicines readily available over the counter without having to talk with a pharmacist.

How many days per year do you allow yourself to be knocked out by a cold?
What's your mental model of why you get colds when you get them? 
Why does it seem to be important to some people to have help from natural remidies in their healing process?

**After I explained US patient privacy policies to Ina and how I wouldn't include her name or any information that would reveal her identity, she pushed back vehemently. She insisted to have her full name with any quotes I use from our interview. Thanks, Ina Biechl!

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Wynter is from America and lives in Istanbul with her Kurdish boyfriend Akin to research religions in Turkey. For interviewing an Islamic leader of a Muslim community, Akin introduced her to the local imam of his hometown in east Turkey. Before Wynter headed to the mosque, Akin urges her to listen to him for some very important advice. At this point, she's expecting to hear the usual about covering her hair etc but this time it was something new. Akin said, “Whatever happens, just don't fart!”

The passing of gas is perceived as pollutant of spiritual clean spaces, hence disrespectful. This has nothing to do with physical cleanliness, in the same way as the ritual washings are not required to be thorough washings. That's what the hamam, the Turkish bathhouse, is for.

Here is another story:

When Akin was a student in the US, together with a group of fellow students, he would take a bus to a mosque for Friday prayers. Before the group would get on the bus, everyone would carry out the ritual washings of feet, hands and face. One time, a guy had been out the night before drinking beer, which caused a havoc on the bus. Interestingly enough, his fellow moslems weren't outraged about the consumption of alcohol at all since most of them liked to drink. That wasn't the problem. What caused everyone's anger at him were the consequences: his beer farts. Him passing gas on the bus defiled everyone else's spiritual cleanliness, so they all had to do the ritual washings again.

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Ümran* is in her mid forties and has three daughters and one son. Her husband has a rafting company and moved the family to the riverside for business proximity. They live in a large house by the beautiful Köprülü Canyon. Her husband's business is going extremely well, especially since he started hiring cheap labor from Kyrgyzstan as rafting guides. They have the right cultural background (they are Turks) and language skills (they speak Russian). With the majority of the rafting tourists being from Russia, this makes the perfect combination.

However, his family is very lonely. In a culture where there are no female public spaces (the tea house is a men's place) it's perceived as inappropriate for a woman to go out of the house unless she has a reason. Until recently, Ümran's reason had been her only friend who had lived one mile away from her house. The perfect walking distance to see a friend, she finds. But her friend moved to Antalya and since then Ümran has hardly been leaving the house. “There is nothing for me to do, nobody I can go and see, so I just sit here and watch TV, drinking one sweet tea after the other. Now I am fat and my doctor tells me to lose weight, but how?” She shows me her latest blood works and points to the encircled high cholesterol among other clinical and sub-clinical test results.

For now, her daughters are still in school and free to move around, at least during the day. “The evenings are lonely, too.” says Ümran when her daughter leaves the sitting room. Shortly, she comes back serving us another round of sweet tea.

* Name has been changed for patient's privacy.

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Hassan* (65) is a retired policeman who lives in a mountain village during the summer and in the close-by city during the winter. He and his wife Sevim*, a retired nurse, have a fruit garden, keep bees, raise chickens and have countless cats rummaging around their garden, trying to sneak into the house or wherever tasty food is being prepared. Hassan's favorite cat is a black and white beauty called Bekintash according to the Istanbul soccer team he is rooting for. Hassan's life consists mostly of driving in his pick-up truck to nearby towns delivering and picking up goods, and to work in his garden with the fruit trees or the beehive boxes.

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From an outside perspective, he doesn't have much stress. But he protests and tells everyone how his relationship is causins him stress. Also, the people's interactions in the small mountain village seem to make his life complicated. His wife is constantly complaining (in mock or for real) – mostly about how he is ruining his health in front of her eyes. Hassan smokes one cigarette after the other, but ironically that's not his wife's concern – despite her nursing background. It's the sugar he puts in his tea that makes her cringe.

Turkey's national drink is black tea served in tiny tulip-shaped glasses with a large scoop of sugar. And it's what's causing his wife's worries. As a Turkish woman, she is the one in their household serving him the tea and if he demands sugar in it, cultural norms force her to oblige. With her teeth clenched and a pointy remark, she hands him over his tea, the large sugar crystals very visible at the bottom of the glass. Hassan laments that he's being denied what every Turk has the right to enjoy and the bickering continues. Later, he sits outside with the local imam** smoking a cigarette in one hand, and a chain of beads in his other hand. He flicks the chain through the air as his fingers run from one bead to the next in a rhythm. “Doing this relaxes me. I have so much stress. With these beads – what do you call them in English? - I can finally calm down again.”

*  Names have been changed for patients' privacy.
** The imam is an Islamic leader of a mosque and the Muslim community.

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We had just crossed the boarder from Cambodia into Thailand and where looking for local transport, when we saw this man and his unique usage of his ear as a coin purse. I've seen women across Asia stashing away bank notes in their bras and underwear, but mostly for safekeeping. This gentleman was probably going for convenience - having his bus-fare ready whenever needed.

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Warning: this blog post contains disturbing images.

Walking to a restaurant in Hanoi, we pass by a display that is rather disturbing: close-ups of injuries, people with bloody limbs or missing limbs. We are quite confused and disturbed seeing these awful images, especially right before lunch. Later, we find out that this is an emergency hospital for accident casualties. In order to raise awareness of the results of risk-taking in traffic, they display these images. Traffic in Hanoi is fast paced and there seem to be no rules at first sight. Cars and motorbikes come from multiple directions. As pedestrians, we are at the bottom of the food chain and quickly learn different techniques to cross the street:
(1) Wait until someone else crosses the street and follow in their 'shadow'. A group of other pedestrians with the same goal makes it even easier as critical mass allows you like a school of fish to look bigger and even the fiercest drivers slow down.
(2) Move slowly into the traffic and walk across at a steady speed so the traffic can flow around you without halt.
(3) Hop into a cab and let them do the U-turn. This had crossed our minds but we refrained from doing it – intrepid travelers' honor.

From a pedestrian perspective, Hanoi's traffic is intimidating and the scare tactics seem to be not needed. However, a French expat tells us that traffic becomes a very different game the moment you sit on your motorbike and weave between cars, pedestrians and street peddlers.

My guess is that displaying bloody images as scare tactics don't work very well, though. It's often not the fear of our own lives that make us change our unhealthy behaviors, but the fear of negative social impact. “Others will think badly of me if I do X' seems to be a more powerful formula. People in Russia started using deodorant when they feared social exclusion, as folks with smelly armpits failed to get jobs they were qualified for. And, Listerine mouthwash became successful as halitosis was invented as a condition that would interfere with one's dating success. More on Wikipedia: Listerine's new ads featured forlorn young women and men, eager for marriage but turned off by their mate's rotten breath. "Can I be happy with him in spite of that?"

So what could this hospital do to make irresponsible driving and traffic accidents socially unacceptable? Stories of families who ended up spending all family savings to restore their loved one's health, sacrificing family business opportunities (key Vietnamese value) and educational opportunities for the children (another key Vietnamese value). It'd be interesting to prototype a couple of stories that touch upon key cultural values and allow people to engage deeply instead of showing bloody images that make you want to look away and not think about the possibility of an accident at all.

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In many Asian countries, people rarely touch each other. One of my Japanese friends told me that her parents don't hug her. The last time they probably did was when she was a toddler, couldn't walk and was picked up by them. Since then, she's only had little physical contact with them. This typical East Asian behavior is changing as young couples in the cities hold hands and even make out in public. In China, a remnant of the uncomfortable feeling people associate with touching can be found in medicinal massage clinics. A small cotton sheet is placed over the patient's fully dressed body and the massage therapist's touch is confined to the covered area. The only times the therapists touch bare skin is at the end of a full body massage when they massage the face, as well as during a foot massage. For this reason, a massage therapist explained to us in Yunnan, foot massages are more expensive. At his clinic, he charged twice as much compared to a full body massage.

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On Cat Ba island, Vietnam, we observe a barber cleaning his client's ears on the street. The headlamp adds a sense of drama to the situation. How deep will he stick his little metal tools into his customer's ears? In the West, the following phrase is commonly cited: “Don't stick anything into your ears that's smaller than your elbow.” But in Asia, getting one's ears cleaned is part of a hygiene ritual. I've heard people in China claiming that it is important to have one's ears cleaned regularly otherwise they clog up. A barber offering the service told me that his clients find it quite pleasurable, like a massage.

Vietnamese barbers seem to also offer other services such as nose hair trimming and chiropractic neck adjustments. Watch out what you are getting into!

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As Vietnam is becoming wealthier and processed food is more available, these weight-loss products are best sellers at herbalists' stores.

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In China, riding on busses with chain smokers and in polluted cities, our mouth masks have become our best friends.

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In Vietnam, the mouth mask is part of the motorbike outfit together with the helmet and gloves during chilly weather.

It also protects you from 'cold winds' entering through the mouth and nose which are commonly believed to be causing sickness. In China, it's utilized to protect others from one's own sickness.

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But there is more to the mouth mask than health. Mouth masks are also utilized in the quest for white skin. What a tan is in the West, white skin is in Asia. And probably even a little more desired, as white skin speaks of higher social class, especially for women. So for this social engineering purpose, women of lower social standing do everything to protect their skin from the sun. 

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For those of dark pigmentation, there are a range of products to whiten your skin (Pakse, Laos). Alas, it's impossible to find a skin moisturizer that doesn't offer to whiten your skin. And just to be on the safe side, this Nivea deodorant also does the job under your armpits (Bangkok, Thailand).

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In Danang, Vietnam, we saw motorbike helmets that had a little opening at the back and wondered whether there was a little clip-on of some sort. It all became obvious when we see a woman on her motorbike zooming passed us: her helmet fit perfectly around her hair bun.

How many times have I had to redo my hair bun to fit with my bicycle helmet? As European I must admit that the thought of not wearing a helmet once in a while crosses my mind - even in the California where biking helmets are a social norm. When I lived in Munich, my vanity many times jeopardized my safety. The Danang helmets elegantly solve this issue, making it so much easier to comply with safety regulations. I wonder about the impact this considerate design has made?

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The pictures below were quite tricky to capture as we were in a taxi rushing to the bus terminal. It took me a dozen attempts or more to get these shots. Fortunately, hairdo helmets are popular in Danang.

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When Chinese travel, their souvenirs include the usual knickknacks as well as local produce such as fruit, honey, meats and also natural medicinal products. Unfortunately, the US and many other countries disagree with such practices and many Chinese travelers have to give up their often pricy purchases. Next time you are at an international airport and a flight from China arrives, watch how the customs activities increase and the dogs sniff around to detect any last bits and pieces of produce.

In Vietnam and Laos, it also seems to be a common practice to purchase medicinal souvenirs. Shops selling local natural remedies are right next to the touristy souvenir stores. In Sapa, Vietnam, close to the Chinese boarder, many natural medicinal products are sold as imports from China. Our Vietnamese friend Yen tells us how her brother bought some of these maggots soaked in alcohol and is crazy about this medicine. Whenever he feels under the weather, it's his first choice to get better.

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This one below are herbs crushed to make a powder for medicinal baths. The Red Dzao tribe use these herbal baths to stay healthy and energetic in the mountains. More on their herbal baths here.

In Laos at a famous waterfall sightseeing spot, local natural medicinal products are sold next to souvenirs: dried roots, dried frogs on sticks and palm sugar wrapped in bamboo fibre.

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