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? 

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.

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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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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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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In a pharmacy in Jingu, a city south of Kunming, James discovers an interesting item in the supplement aisle: sheep placenta extracts. The instructions read that this is particularly good for maintaining the health of senior patients.

This seams rather weird to us, and kind of gross.

In the US, walking down a supplement aisle at a Whole Foods store, there are the herbs against colds and other ailments (focus on what it is) and there are the supplements organized by their main ingredient, a vitamin or mineral (focus on what's in it). The only animal extracts, I seem to recall now, are cod-liver oil, but don't these go by the title of Omega-3 et al?

In the end, Chinese eat all parts of most animals and perceive Westerners as wasteful not making use of all organs and throwing away the intestines. So, in the end sheep placenta supplement only points out what Western supplements are missing out on. Or is it that we just don't know where our zinc and potassium is coming from?

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Browsing Chinese pharmacies, there is always a section of dried exotic animals such as sea horses, snakes, bats and penises of various animals such as seals, antelopes and tigers. The pharmacist explains that one places these animal parts together with other herbs and roots in alcohol and then drinks the infusion to improve and enhance one's health. But this is not for everybody, “just for men, to enhance their health” - meaning 'male potency' in Chinese.

I wonder whether this is more a thing of the older generation, as I haven't seen these infusions at any of my Chinese friends' homes. Or is this kept in the bedroom like I'd imagine Viagra would be in the West? Do men buy these for themselves or is this the perfect gift to be received from one's wife? Or even mistress as it is very common for Chinese men to have a mistress? Or, is this something that is only gifted between male friends?

Given the relatively high price for some of these aphrodisiacs and the elaborate packaging options available, my guess is that it's mainly for gifting.

The pharmacist does't quite understand what I am getting at. Will have to find out more about this.

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First time I heard of a cultural panacea was in London during grad school, when one of my Greek friends told me that her family didn't have health insurance because her mother treated everything with olives: olive soap and olive oil. When her sister contracted an STD and the olive soap treatment didn't work, they consulted a biochemist uncle who 'prescribed' something beyond olives. Her mother's deeply ingrained belief in the healing power of olives struck me. What olives is to my Greek friend's mother, green tea is to the Chinese but maybe in a less orthodox way: green tea toothpaste, green tea extracts in shampoo and cosmetics, green tea everywhere in home remedies.

In Kunming, a girl in her early twenties who goes by the English name Nora shows me how she treats her pierced ears when they get irritated. After enjoying a cup of green tea, she selects two stems of tea leaves and dries them. Once they are dry and have hardened, she places them inside her pierced earlobes. “The green tea extracts from the leaves soothes the irritated skin. It also keeps the piercing from closing up, that's convenient.” These tea-leaf-stem earrings can be worn for months, “they are natural and healthy,” she explains.

This makes me wonder about other cultural panaceas: in Indochina it seems to be tiger balm, but when I lived in the UK, I remember paracetamol being the cure-it-all. My British friends seem to treat everything with it – from a hangover to the common cold. Paracetamol is incredibly cheap and readily available at drug stores such as Boots. When will an OTC (over the counter) drug take the place of tiger balm, green tea or olives?

Where hot showers are still a luxury in China, a hot foot bath in the evening brings relief after a hard day of work. In the villages, we've taken foot baths and felt the wonders. Somehow your body feels clean and relaxed, and you forget that you are actually still quite sweaty and dirty from the day's hike.
“Soaking my feet makes my whole body feel good,” tells us Mr Zhen who introduced us to a local hot spring just outside of Yuanjiang – an Eldorado of Chinese notions of wellness: soak your feet while eating snacks that have been cooked in the hot spring. The water temperature is just under the boiling point. Multiple seating areas have been molded out of concrete allowing the water to be mixed to the right temperature. While sitting on chairs with foods piled on the table, you can soak your feet up to mid-calf high. When the water temperature gets too cool, you can just drag over a pipe that adds water right from the source.
In a couple of months this place will have turned into a construction site. Plans are to develop a resort.

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After a day-long bus ride, we were excited to find a hotel with a massage place right next door. We checked in and as it was already dark went straight for a massage to bring relief to our aching backs. The two ladies working there laughed at our request for massages and told us that the massage tables in their space were for children only – for eye massages. As they were closing up for the day, we decided to take a closer look the next day.

At the entrance, parents are reminded of their duty to care for their only child's wellbeing. In large Chinese characters it says: “Parents with observing eyes have a child with good vision.” Since 1980, the one-child-policy has been reinforced in urban areas and has led to the phenomenon of each child getting the attention of six adults, that is two parents and four grandparents. This change in society together with the economic changes in China has had an effect to such an extent that the generation born after 1980 even has their own name “Ba Ling Hou”, directly translated “after eighty”. Now, since one's offspring is limited to only one child, parents, naturally want the best for their child – the best education, the best environment, the best foods, and the best treatments.

From the two ladies who run this children's nearsightedness prevention center, we learned that the treatment for nearsightedness only works when it's started right away after the child is diagnosed with nearsightedness or the first symptoms are observed by the parents. The treatment is a mixture of Traditional Chinese Medicine, massage and eye exercises. It takes six weeks, during which the child comes to the center twice a day for massages, applying the medicinal eye mask together with a special facial massage appliance and doing the eye exercises instructed with a red balloon on a stick. Sometimes the treatment also involves dietary requirements. The package deal costs RMB 1000 ($152), a substantial amount for a family in a tier 4 city in China.

The two pediatric nearsightedness specialists ventured into this business after they got laid off from their work at the local sugarcane factory. Not wanting to sit around idle, they came across the organization Black Eyes, took the training course, and set up their own franchise business in their home town. Despite the new healthcare system in China which provides reimbursements for medical care and the fact that their center does not qualify for such reimbursements, business is still going well.

During our visit, multiple children came on their own or were dropped off by their parents. Some kids brought their friends along. They got a free diagnosis and casually joined in doing the eye exercises. There was a carefree and optimistic atmosphere, making the place feel more like a playground than a medical center.

Nearsightedness in China is very common. I remember very well that during my four-year degree of Chinese, most of my German classmates and I got worse eyesight due to constant deciphering of the tiny Chinese characters in our dictionaries and the poor newspaper prints. Later, when I taught at a Chinese middle school, I was surprised to see that one of the two compulsory exercise sessions each day was dedicated to massaging the acupressure points around the eyes. These kids told us that this practice continues and that these visits to the center were in addition to the half hour of eye exercises that they do at school.

Chinese kids have very busy schedules, running from piano lessons to dancing classes, and from their Chinese chess clubs to doing the vast amount of homework that often keep them up until midnight. I am unsure of how effective this combination treatment is in terms of stopping their eyesight getting worse, but it is giving the parents the feeling that they are doing something for their kids while the kids get a chance to get relaxing massages and time to socialize with their friends in a non-competitive environment.

Other interesting facts:
From Wikipedia: "The prevalence of myopia in high school in China is 77.3%, and in college is more than 80%."

From Science Daily: "In fact, a study released in the fall by the National Eye Institute (NEI) found that office-based treatment for patients with a common eye muscle coordination disorder, along with at-home reinforcement, is more effective than home-based programs in isolation."

From a skeptical site: "Remember: no type of eye exercise can improve a refractive error or cure any ailment within the eyeball" 

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