Friday, 8 November 2013

Talking in Taiwan (2) School of Nursing, Yang Ming University, Taipei

Risk of the Day
‘The most power one ever’ hit land in the Philippines at 0500 this morning, reported on CNN just after breakfast. Some steady wind speeds of 200kph and over 1000mm of rain in places. And we’re not that far north of the Philippines here, and it was getting a bit blustery yesterday.
Classification:     NAG (natural and act of God)
Control:                Not much (1/4) – but be aware of the weather forecast before you expose yourself
Likelihood:          1 (almost always mid-summer)
Impact:                 3
Score:                   4

Second leg of the High Speed Train – the fifty minutes had disappeared before I got the chance to even half-finish writing my talk for the School of Nursing, due at 1330. And – in Taiwanese hospitality fashion that I’m now getting too used to – Lue’s ophthalmologist sister had invited us to lunch. Ten minutes back at the hotel afterwards to hastily scramble together the rest of the talk, as a Prezi.

Arrived at the talk just in time, to an audience of about 50 – mostly young student nurses. A bit of a technical glitch (almost exactly the same as last Saturday) when they couldn’t get my laptop to connect to the ceiling projector, so had a bit of jokey banter with the audience which seem to relax everybody – or at least it did me, and probably not the frantic technicians who were on their third projector by this time. I couldn’t really do without it as most of the talk was a photo slide show about different aspects of greencare. But it sparked into life and I was off – for about an hour. After the talk we had a good half hour for questions, and what good questions they were too: from ‘how do I start it on my ward?’ to ‘what is the inspiration that people need to get engaged in it?’ to ‘if it is aesthetic, how can you show that?’.

Off to the northern end of the metro to see sunset over Fishermans Wharf from Lovers Bridge in Tansui, and the planes streaking across the purple sky reminding me where I would be in just over 12 hours. Ever willing to pack in a few more activities, we then went to see Lue’s brother in the ophthalmology practice which he shares with his sister – but he was overcrowded with patients, so it was just a quick ‘hello’. Interesting to see how a medical clinic looks though (busy!).

Anxiety then started to rise as my nostrils twitched and Lue led me to sit down in a fast-food joint, opposite but about 10cm away from an attractive young Taiwanese woman who was tucking into a large bowl of rice noodles. It was almost embarrassing to have to watch her expertise with the chopsticks from 10cm away, but I think I picked up a couple of useful tips about how to hold them together, and how to shovel considerable volumes in without dropping it all over the place.

The anxiety was turning to panic as we waited and watched – then it arrived: the challenge was on. Having failed to master the art of enjoying stinky tofu the first time round, I was to be allowed a chance to redeem myself. Lue made it sound even more attractive by explaining that it was in a spicy dish with large intestines. I also found a large vermillion jelloid mass in my bowl, which I thought might be liver – but I was informed was clotted pig’s blood. So – unable to bear the shame and humiliation of a second failure – I dug the sponge-like slabs of stinky tofu from the bottom of the bowl, thought of England and demolished them. By the third or fourth I was almost wondering if I was getting to like them, but I don’t think I’ll be doing an experiment to find out for sure any time soon! Sadly, I was too full by then to manage the intestines and pigs blood – and simply basked in the triumph of my gastronomic achievement.

From there back by metro to the ‘must see’ Shilin night market – dazzlingly bright, noisy and smelly (guess what of!). The food hall downstairs was utterly bonkers – how could so many people be packed into a vast brightly-lit underground hangar with raw food bits of everything imaginable and more besides, mountains of freshly cooked food stacked up in every direction you could look, stalls, cafes, cooks, and swarms of people seemingly all mixed in together ? But so it was; we had a modest bowl of soup and single dumpling.

I have already mentioned a few branches of Lue’s extensive family, and as we were walking off the metro, we met two more of them, who were duly introduced to me. And – just to top the lot for warm and generous gestures to a stranger like me – they insisted I took packet of special spiced pork to have as my supper when I got back to the hotel. Food they had bought for themselves and their families, they gave away to a poor starving wretch like me!

And so, with hospitality overload and gratitude fatigue, and not quite having captured in this blog what Taiwan is really like, to bed. What an extraordinary week, and what amazingly generous and kind people.

New Thing of the Day

The frenzy of the food floor at the night market – and the question to which I need to give serious thought: why are Taiwanese people so thin?

Thursday, 7 November 2013

Tourist in Taiwan (2) Sun Moon Lake

Risk of the Day
Venomous snakes and giant poisonous bees.
Despite cycling and walking a fair amount today, no snakes spotted – but a gigantic bee jumped out of a bush and started chasing me on the path, going within centimetres of my face. Close one, Lue said – every so often the papers report deaths from them. One sting = hospital; two = emergency steroids; three = ITU.
Classification:     NAG (natural and act of God)
Control:                Almost full (3/4) – don’t be stupid and keep your eyes open, bees a bit trickier
Likelihood:          1
Impact:                 4
Score:                   4

Another of those hang-around-and-see-things-as-you-like days today – with Sun Moon Lake and two spectacular temples on the itinerary.
Unexpectedly included a cycle trek alongside the lake where cars can’t go (third best cycle lane in the world, it is said!); an almost vertical climb 600m climb to a pagoda which was shut for post-earthquake maintenance; all things Taoist and the most ostentatious (and, dare I say, vulgar) Buddhist temple in Taiwan; finished off with dinner - a light but spectacularly flavoursome five-courser at a vegetarian restaurant.

New Thing of the Day
The thought that humble little bumble bees can mutate into murdererous flying death balls the size of a small bird.

Wednesday, 6 November 2013

Travelling across Taiwan – from Yuli to Puli

Risk of the Day
Being driven around the crowded highways and back streets of Kaoshung by a man who is continually cracking business deals by text, emails and mobile phone.
Classification:     NTD (Nutty Taiwanese Drivers)
Control:                little (2/5) How can you argue with somebody in the middle of a big deal?
Likelihood:          2
Impact:                 3
Score:                   6

Taiwan looks like a simple teardrop-shaped island on the map, about as long from one end to the other as it is from London to Newcastle, and from side to side about as far as Manchester to Birmingham. But in fact is a bit more like a doughnut – where you can’t get across the hole, because that’s where the impassable central mountains are (impassable, that is, except for some very slow and treacherous mountain passes). So, with Yuli half way down the rural and thin eastern coastal strip, and Puli right in the middle of the island, west of the central mountains, the distance from Yuli to Puli is just under 50 miles as the crow flies. But, because of the doughnut effect, we took all day travelling about 280 miles between them to do it – in an enormous loop around the south of the island.

And, to make matters more interesting still, we used almost every conceivable mode of transport we could – except a helicopter, which would have got us there in half an hour and not been half as interesting. So we walked out for our usual breakfast, got a taxi to the local station and then the ordinary train – four hours from Yuli to Kaoshung (the country’s second city). Then the deal-cracking friend drove us around Kaoshung, including lunch on the harbourside with a Ferrari and Lotus parked outside – now I’m not a car buff, but I know that they are seriously rich men’s (almost certainly) toys. Inequality is more important than GDP as Wilkinson and Pickett have taught us, and as Lue was explaining in its Taiwanese context to me last night. Anyway, so it must have been a good quality restaurant – and indeed we were not to be disappointed once inside: fish, fish, and fish and then a bit more fish. Then unknown fish organs (which looked a  bit like kidney flesh). With a little bit of rice noodle and vegetable on the side. And we saw them all wriggling and crawling when we arrived and chose them  – so as fresh as could be (except the organ bits didn’t wobble or quiver – obviously).

Then we took a ferry boat across the harbour to visit the old British consulate, and had tea – colonial style - with a commanding view over the ocean and harbour entrance. Two friendly nations, both with an obsession about tea – but, despite the elegant Staffordshire bone china,  I’m afraid the English Tea was like nothing I have ever or ever will drink in the UK. Very pleasant, just a quite different drink. But then I very much doubt that London Taiwanese tea – like Oolong - can be made to taste anything like it does over here.
Tea at the old British Consulate in Kaohshung
As dusk approached and the dealing activity increased, the friend drove us through the rush hour to the terminus of the High Speed Rail line. More like an airport than a train terminus, we booked onto the 1830: I had a quick phonecall to a Singapore colleague-to-be while waiting, as it’s much easier to phone without an eight hour time shift. And I got a very easy deal of my turn to buy dinner – Lue thought it would be best if we buy two made-up plates of food to eat on the train. Extremely inexpensive, may I say – and I couldn’t even buy drinks, because they come free on the train.

The train was extraordinarily fast, smooth, quiet and comfortable – and wide. The indicator at the end of the carriage read that we were doing 292kph, about 185mph. Exactly 42 minutes to zip up from the far south to the middle of the west coast – hardly time to get to the noodles and nuts at the bottom of the dinner plate. So four hours to go half way down the east coast, and less than three quarters of an hour to go half way up the west coast – which means it must be a pretty wonky shaped doughnut to flog the analogy to death…

Then the bus to Huli – a bustling brightly lit city of about 100,000 with what seems like an endless succession of roundabouts: the Milton Keynes of the Far East? Finally to Lue’s home village, a few minute taxi drive into the mountains from Huli. Journey’s end, for today at least.

New Thing of the day:
Travelling on a train which feels more like a (super luxury) plane, and barely having time to finish a plate of food in 120 miles.

Tuesday, 5 November 2013

Tofu from Taiwan

Risk of the Day
Sleepy driver.
Classification:     NTD (Nutty Taiwanese Drivers)
Control:                Moderate (2/4) – shout at him if he’s dropping off!
Likelihood:          2
Impact:                 4
Score:                   8

Another day, another few and varied meals ahead.

We started with a short walk to a breakfast cafe and had an egg and noodle pancake-type thing wrapped round a slightly sweet load-bearing element. Easy! Uncharacteristically, I was rather relieved to find it was not involving octopus, garlic, chili or any really strange new tastes, textures or smells.

Then to visit various centres of the hospital group, after paying a courtesy visit to the superintendent and deputy superintendent: both psychiatrists. My over-riding impression was of sense of space, and apparent belongingness, even in wards of over 100 patients. Yu-Li, being a rural area with much space, takes more than 80% of its patients from outside Heulein county. But I was left feeling that we have lost something in the UK by selling off large rural estates, as well as spacious urban ones, to property developers - and rehousing many of our most frail and vulnerable citizens in 'fit-for-purpose' pressure-cooker hospitals and therapeutically vacuous community residences.

But there is always greencare - and I was shown round the hospital farm, which has 34 hectares of arable land, and where suitable patients find work, and cycle to and fro from the hospital. The main production is of rice - they have paddy fields as far as the eye can see, and all the machines to turn it into 25kg sacks ready for the kitchen. In fact, it does just about suffice for the 2500 patients in the hospital group. They did have pigs until the price of pork fell too much, a few years ago. I was confident and enthusiastic with them that it could all be turned into a thriving greencare therapeutic community!
Greencare - Taiwan style? [Hospital in the distance, paddy fields in the background]

Then over the coastal mountain range for a rather special lunch: a seafood restaurant on the Pacific Ocean in the sunshine. Phoned Ben in California (trying to wave was not successful), -16h, and Nicky at home, -8h: felt like we were truly spanning the globe! Then a great drive south along the pacific highway to a visitor centre, and back across the mountains.

Just a small dinner with some work colleagues, he had said. Well, two tables each of 15 people from the hospital was not small in my book*. The seating had to be carefully arranged to maximise the Chi - me next to the superintendent, who was next to the deputy superintendent, with Lue my host on my right, all on the psychiatrists' table (including the friendly resident who was laughing the whole time); the others were adjacent. Then there was the food: lobster, chicken, lamb, tofu, prawns, crab, pork, more strange chicken legs, ostrich, duck, special rice and then birthday cake. With toasts throughout, to and from everybody - collectively and individually. Maybe a bit like group analysis' maxim of 'in the group, of the group and by the group'!

Then the big one - thankfully not in the restaurant where I would have to do it in front of the assembled multitude - STINKY TOFU. Bought home in a double-layered plastic bag (which still had me quivering) presumably to prevent undue atmospheric pollution (I reckon horse poo, though Wikipedia says ripe cheese and decaying flesh), Lue decanted onto a plate for me. But I had a 1cm piece and knew that I was not going to be able to see it through. "Oh well, at least you can tell Nicky the the food was horrible so she doesn't get jealous of your trip", said Lue, quite helpfully.

* Banquet number 6 (I think!)

New Thing of the day
It has to be stinky tofu
This is the first thing yet 

that has truly defeated me..

Monday, 4 November 2013

Tourist in Taiwan (1) Taroko Gorge

Risk of the Day
Falling rocks.
Classification:     NAG (natural and act of God)
Control:                Almost none (1/4), but could wear a helmet
Likelihood:          0.5
Impact:                 5
Score:                   2.5

Time to wind down a bit today: Lue is at work, so he has asked a driver friend to take me to see Taroko National Park. Utterly spectacular, not easily describable in words, so I won't try.
Safety helmet? Moi?
Afterwards, the Hot Spring Experience. Again, beyond words so no comment.

Sitting in natural spring water at 46 degrees

Sunday, 3 November 2013

A train in Taiwan

Risk of the Day
Getting out of the car on the offside in Taipei.
Traffic does not give priority to pedestrian lights and a young female surgeon was recently killed because of it.
Classification:     NTD (nutty Taiwanese drivers)
Control:                Nil (3/4) get out on the other side, stupid!
Likelihood:          3
Impact:                 3
Score:                   9

Luxury hotel breakfast - oh dear, another three-full-meal-day. I tell Lue that I will have to eat small portions, and eat slowly as we are being too well-fed. He replies that after today, normality will return - but I'm not sure I believe him, given the level of generosity and eagerness to be hospitable I have found so far.

So after a bit of a lie-in, off to an elegant restaurant situated on an inelegant street corner under a motorway flyover. This is a meeting of the society of group psychotherapists - including Lue and Min's mentor Dr Chang, the 93-year-old founder of psychotherapy in Taiwan, and about ten others. An altogether more congenial and less hierarchical affair than last night's conference dinner*
The Taiwanese Group Psychotherapy Society
Next to the main railway station in Taiwan. The city does not have several main stations - but just one for the metro system, all the provincial lines, and the high speed trains. As the size and bustle of it all amply showed - the lower level included a vast area of shops, restaurants and activity - and the bottom level (where the metro is) was more than double the size of that. I'm not sure what level we waited for our train before we went down for it, but it is a thoroughly bewildering place that I would be rather worried about negotiating on my own, without a local guide.

The train was advertised as two minutes late, and was one  minute late - for the two hour fifteen minute journey along the northeast coast to Hualien, where Lue and his family live. Although grey and rainy, the scenery was spectacular once the train cleared Taipei: wooded mist-covered mountains to our right and the Pacific Ocean to the left. Next stop in that direction, California.

As soon as we arrived at the hotel, it was time to go for meal number three - with Lue and his family. A very congenial affair, memories of the UK and Oxford (his wife and two now teenage daughters daughters spent 3 months there with us in the Thames Valley), and gifts for all**

So, after writing this, happily to bed - stomach well full. But slowly with small portions...

* fourth banquet
** fifth banquet or celebration meal

New Thing of the day
Getting the train from an East Asian capital, 
Taipei station handles over half a million passengers per day and is unimaginably busy. Make Paddington seem like a tranquil country halt. 

Saturday, 2 November 2013

Talking in Taiwan (1) Taiwanese Society of Psychiatry

Risk of the Day Being electrocuted by the electric toilet
On arriving back at my hotel room, after only a moderate amount of fine red wine, I was disturbed to find the toilet glowing ghostly blue in the dark. On further exploration, it had numerous other electrical, plumbing and extremely personal features that were all controlled by a remote close by. However, I escaped unharmed.
Classification:     UE (unnatural end)
Control:                Full (4/4) turn it off!
Likelihood:          1
Impact:                 2
Score:                   2

Woke with that 'uh-oh - something's happening today' feeling, and finished polishing up the talk (after some more helpful comments from Lue about what his colleagues would and wouldn't like to hear). Here's the version that I presented, plus refs and links:

We arrived at the conference venue - the military medical academy - in a blaze of bonhomie and lavishly-illuminated drug company stands.
Guess who's paying for this party!
The Prezi confused the technicians team, but we agreed it would be fine if shown from my own laptop, in the vast, plush, crimson auditorium. In fact it wasn't fine: the technicians took about five minutes to get me up and running, during which time my kindly and gracious introducer, Dr Ta-Jen Chang, extemporised about something in Chinese, and after the previous speaker had over-run by about 20 minutes. Keep Calm, and all that...

One of the uniformed conference assistants pinned a fragrant orchid arrangement to my top pocket and off I went. The talk went pretty much as planned, and I'm told it was fine. I nearly walked off the stage before they could do the ceremonial presentation - the level of corporate care and detail was extraordinary - plaques and gifts duly received and photographed, I could relax. Several people approached me later in the afternoon to thank and congratulate me - felt very warm and thankful to them all.

Some interesting conversations with people, one theme of which I need to think about and explore: "it would not work for us to have TCs in Taiwan. It would not work". And it seems to be both economic and structural: psychotherapy is too expensive to be included in the national health insurance scheme, and it is seen as separate to psychiatry (although most psychotherapists here are psychiatrists, they do it in their own time, with private patients).

If we can make the model work in Bangalore and Low and Middle Income Countries, Bouganville with Natural Nurturers, and possibly even Kabul - as part of the 'Enhanced Self-Help Groups' programme (see  - why ever not in Taiwan? Is it the hegemony of westernised practice? Or just a manifestation of the enormous gap between 'expert help' and 'self-help'? Or a widespread lack of understanding about the principles of empowerment, personal agency, and groups taking responsibility for themselves? Only questions for now, but I will try to come back to this one.

Back to hotel and short rest before the formal conference dinner. And how formal it was! Lue rather ruefully pointed out to me, as we walked into the banqueting suite, that he would have to sit at the other end of the room because I was the special guest and had to sit with the important people, and he was not: it is very hierarchical. Not very TC, I said, as we parted company.

I ended up sitting between a hyperdynamic Chinese researcher (vast cluster RCTs on adolescent interventions in schools for BPD), and a laconic journal editor (who was very amused at the 'horse-trading' going on all around as preparation for tomorrow's elections to the governing committee of the Taiwanese Society of Psychiatry). My over-riding thought was that these people were all fiercely competitive, working in a globalised academic 'game', and very familiar with the trappings of hierarchical  formalities, manners and rituals. Although I expect this is true in all fields, I started to wonder whether its prominence here - in international psychiatric development - might be related to my earlier question, about empowerment. This system by which the experts maintain their power and status - may be the same system that keeps a substantial gap between 'expert' and 'self-help' treatment...

New Thing of the day
Wearing a bouquet of flowers on my lapel (involuntarily)

Friday, 1 November 2013

Trepidation in Taiwan

Risk of the Day
Just missed a 4.3, a couple of hours before I landed. Hope to catch another one before I go - NO YOU DON'T they tell me. They are absolutely terrifying even if you experience them like us - one or two a month on average. Anyway, no risk mitigation possible as they're utterly unpredictable and they have done all they can to make buildings structurally safe; they even moved Lue's children's school because they discovered it was exactly on the fault line between the Eurasian and Philippines tectonic plates.
Classification:     NAG (natural and act of God)
Control:                Nil (0/4)
Likelihood:          3 (in a week)
Impact:                 0-5
Score:                   0-15

Lue's cousin thought it was no good being sympathetic to foreigners with jet lag. The only answer was wake him up, get him out and keep him busy - and so they did, followed by what felt like attempted murder to keep me awake.

So off from our hotel to her house, close by in suburban Taipei at about 10am. Breakfast as soon as we got there: bread with squishy white stuff inside from 'the best bakery in Taipei'. Quite delicious, but I have no idea what it was - and that is a refrain I have repeated many times since. Then a fried egg and soy sauce. Good. Looking quizzically at a dumpy looking chair in the corner of the room, I was offered a go in it. My feet immersed in menacing cloth pouches, they turned it on and the thing burst into life - and fought with me for a good ten minutes before declaring victory over me. A quick conversation then - possibly only partly understood - set me up for a painful evening.

Back in the car (Mercedes "it's safer") and through the streets to jump out here and there to see interesting ancient shops, or a Tao temple, or other sights. And to the 101 building - and quite unexpectedly, not to the observation deck - but to the fabulous classic Taiwanese restaurant for a five (or was it six?) course lunch*. All exquisitely prepared and presented, and utterly unknown to me. I could have been eating mashed conkers and crispy bat for all I knew - and quite possible was! But delicious and I'm sure nutritious...

Then to the National Palace Museum - with a fascinating commentary from Lue about the immense collection there, the immense antiquity of Chinese culture, and the utterly immense number of Chinese visitors who now come there from 'Mainland China', as they call it. Then explanations of the complex and unsettled relationships between Taiwan (RoC), mainland China (PRC) and Japan. But, despite the hoards of Chinese visitors following their pushy tour guides to get between us and the exhibits, we did manage to get close to the very very famous jade lettuce.

The taxi just about got us to the restaurant in time - for a hastily-arranged family party for Lue's mother, to which I was generously invited**. Hastily arranged by Lue's hyperdynamic cousin, with ages one to eighty seven all sat round a large table with another variety of unknown delights spinning under our gaze. And cups and cups of tea, of course.

That might have been enough for a first day's anti-jet lag programme, but it was not to be. My indiscreet comments about the effect of the massage chair earlier in the day came back to pursue me: the masseuse neighbour was ready and waiting for me. First, half an hour on the feet - almost unbearable agony. I had no idea that it was possible to make feet hurt so much - but in an odd way that feels good for you. Then the neck and back - completely unbearable agony, but I felt it must be very weak, and shameful, to admit it: therefore suffered in stiff British silence. The theory of the last bit - I think - was to suck out all the bad Chi from my spine; the practice was (first) to put six egg-cup sized vacuum suckers onto my upper back and to try and suck all the contents of my chest into them. Like the strange French contraption for delivering reluctant babies - the Ventouse - except six of them, for no reason of getting through a tight spot, to a sentient adult. Then to beat the underlying muscles to a pulp with such strength and determination, that I feared it must be a displacement defence mechanism - about something deep and dark in the Taiwanese soul!

And so to the hotel, and rewriting my talk for tomorrow. Rewritten for two reasons: (1) Lue told me what the Taiwanese psychiatrists would and would not like to hear and (2) my Prezi desktop programme, which I had used on the talk on the flight over, had crashed and lost all my work. Still feeling like London time (late afternoon) so not sleepy, so all done. Ho hum.

* Fist celebration meal
** Second celebration meal / banquet

New thing of the day
Massages so rough they hurt ("in a good way", I felt obliged to report) given by both machines and real people.