A Grieving Mom in Shanghai Learns Her Son May Not Have Pancreatic Cancer After All: Misuse of the CA-19-9 Antigen Test

A few days ago a grieving mom in Shanghai, a good friend of ours, shared some tragic news with me: her teenage son had pancreatic cancer, one of the worst cancers. Her son was likely to die soon, if the doctor was correct. Only about 20% of pancreatic cancer patients live past 5 years. She was almost overcome with grief and had been crying for a couple of days. But even though she had gone to an expensive hospital that caters to foreign clients, she wasn’t sure she should trust the doctor. The mother called me to see if I knew where she could turn for help. She didn’t know that one of my sons happens to be a doctor treating cancer at a leading US clinic.

I received a photo of the lab report for the boy and sent it to my son. The physical results reported that a scan of internal organs showed no unusual problems indicative of cancer. There were no other symptoms, just a slightly elevated CA-19-9 antigen level, 45 instead of a desired maximum of 37.

My son was greatly disappointed that the doctor would create such needless panic by telling the mom that her son probably had pancreatic cancer. My son explained that the CA-19-9 test is not supposed to be used for diagnosing cancer on its own. Absent other symptoms of cancer, it’s predictive power for cancer is less than 1%, he said, and when he learned that the son was just a teenager, he said it’s even less likely to be pancreatic cancer because that disease is almost unheard of in young people. The mother’s grief was turned to relief.

I later found scientific publications confirming what my son had said. For example, see K. Umashankar et al., “The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: An evidence based appraisal,” Journal of Gastrointestinal Oncology, 2012 Jun; 3(2): 105–119; doi: 10.3978/j.issn.2078-6891.2011.021:

CA 19-9 serum levels have a sensitivity and specificity of 79-81% and 82-90% respectively for the diagnosis of pancreatic cancer in symptomatic patients; but are not useful as a screening marker because of low positive predictive value (0.5-0.9%).

Other articles indicate that diabetics, such as this young man, can have inflated CA-19-9 values (this applies at least for Type 2 diabetes–I’m not sure if CA-19-9 artifacts from Type 1 diabetes has been investigated ), one of many possible alternative causes of elevated CA-19-9 values. Alternative causes for the elevated test result do not appear to have been  considered by the doctor who terrified a mom by declaring that it was probably pancreatic cancer. Again, the test can be useful in tracking the progress of treatment of a known cancer, but should not be used to diagnose cancer in the absence of other evidence, as in this case.




Keep this in mind when you have your physical in China. Don’t panic if a doctor reports that you might have pancreatic cancer based on a blood test result alone. Get a second opinion and understand why that value may be high, but don’t panic. Physical testing here can often include too many unnecessary tests in search of phantom problems that may be listed in your report by people who aren’t necessarily qualified to make such proclamations.

The family still needs to be cautious and follow up on the possible causes of the inflated test result, but it was only slightly elevated unlike the much higher scores that I’ve seen reported in patients who actually do have pancreatic cancer.

I am so grateful that my son was able to help bring peace to a mother who had been crying for a couple of days over the “fake news” she received from a generally good hospital. I suggest that here or anywhere else you should be open to the possibility that some doctors don’t know what they are talking about. And of course, that can apply to what I’ve said here. Do your homework, ask questions, and be cautious about what others declare.

 

By | 2018-06-20T16:52:56+00:00 June 17th, 2018|Categories: China, Consumers, Education, Health, Safety, Surviving|Tags: , |0 Comments

Xiaogang, Anhui: Can You Hear the Roar of Prosperity from China’s Quiet Revolution?





One of the most touching and courageous moments in China’s recent history is depicted in the painting shown here of a secret meeting of farmers in a tiny village that few people have ever seen or heard of. It was the beginning of a quiet revolution, what one might call China’s Second Revolution, whose roar continues to inspire and strengthen this land. These farmers are gathered in a hut in a dark side room free of windows to keep the meeting hidden from spies. As the mostly illiterate farmers touched the red ink pad to sign an illegal contract with their fingerprints, they were putting more than ink onto paper: they were putting their lives on the line. That moment in 1978 marks the birth of a revolution that has changed the world and blessed hundreds of millions in this land. It’s a story rich in basic lessons that the West may need to relearn in order to survive.

Xiaogang Signing

The village is called Xiaogang (pronounced like “Shau Gong”). It’s a tiny dot on the map in Anhui Province about an hour away from the major city of Bengbu, a city most Westerners have never heard of because, of course, it only has the population of Chicago. But Xiaogang Village is really small, I’d guess around a thousand people or less, and that’s counting the outsiders who work here to staff their gargantuan tourist buildings that commemorate the economic revolution that began here. After learning about the dramatic but not frequently shared story, I finally made a pilgrimage in 2017 to what is now a sacred spot.

The story basically is that the village of Xiaogang had been suffering from the effects of the Great Leap Forward and then the Cultural Revolution, along with some bad weather, perhaps. The old system of that day left people with relatively little incentive to work hard and produce more. They were starving. Whether they worked hard all day or just slept, they would still get inadequate food and risk starvation. Why bother? But they suspected there was a better way. Led by a brave man, the farmers met and agreed to implement a bold new (but actually very ancient) system. The contract they signed agreed to give a portion to the government and then they would get to keep the surplus for themselves. In the article “Xiaogang, Anhui,” Wikipedia describes the Xiaogang miracle this way:

During the Great Leap Forward, Fengyang County, along with much of the rest of the country, experienced a period of famine. A quarter of the county’s population, 90,000 people, died of starvation. In Xiaogang village alone, 67 villagers died of starvation out of a population of 120 between 1958 and 1960.

In December 1978, eighteen of the local farmers, led by Yan (NPR’s name is a typo, there is no YEN in Chinese romanization) Jingchang,[2] met in the largest house in the village. They agreed to break the law at the time by signing a secret agreement to divide the land, local People’s Commune, into family plots. Each plot was to be worked by an individual family who would turn over some of what they grew to the government and the collective whilst at the same time agreeing that they could keep the surplus for themselves. The villagers also agreed that should one of them be caught and sentenced to death that the other villagers would raise their children until they were eighteen years old.[2][3] At the time, the villagers were worried that another famine might strike the village after a particularly bad harvest and more people might die of hunger.

After this secret reform, Xiaogang village produced a harvest that was larger than the previous five years combined.[2] Per capita income in the village increase from 22 yuan to 400 yuan with grain output increasing to 90,000 kg in 1979.[3] This attracted significant attention from surrounding villages and before long the government in Beijing had found out. The villagers were fortunate in that at the time China had just changed leadership after Mao Zedong had died. The new leadership under Deng Xiaoping was looking for ways to reform China’s economy and the discovery of Xiaogang’s innovation was held up as a model to other villages across the country. This led to the abandonment of collectivised farming across China and a large increase in agricultural production. The secret signing of the contract in Xiaogang is widely regarded as the beginning of the period of rapid economic growth and industrialisation that mainland China has experienced in the thirty years since.

This is dramatic stuff, and it’s been recognized by the Chinese government as a key moment in China’s history. Wonderfully, Deng Xiaoping embraced the Xiaogang miracle, which was vital inspiration for the economic reforms he introduced. The timing was just right, and as a result, when local police came knocking on the door of the main farmer behind the conspiracy, it was not to take him to his death as he expected, but to ask for help in expanding their illegal system across many more farms in China. He came away from the police station as hero, not as a criminal, and China awoke to a revolution that continues to roar. Some of you will call that capitalism and an abandonment of Chinese socialism, but over here I think it’s more officially viewed as an important modification in socialism, part of the unique Chinese approach, that overcomes empty “bubble talk” and lack of commitment to work that many faced. However you want to package it, it was a huge step for China. I have seen the burden of poverty in this country and yearn for China’s economic success, and applaud the brave farmers who started the revolution and the policy makers who recognized and learned from their wisdom. What a revolution it has been.

I hope you’ll consider a trek to Xiaogang someday. (I might even join you if you give me advance notice.)

Getting there wasn’t too difficult from Shanghai. It required two or so hours in a high-speed train, often reaching 300 km/hr, to reach Bengbu, and then about an hour in a taxi to reach the village. The town is pretty much just one side road on the main highway. But it has a big arch as you enter, and then a giant tourist center, and then you find that the tourist center is not about the historical event that should make this town famous, but about its current geography, agriculture, climate, etc. Not what IO came for, but nice to have, I suppose.

Only after inquiring did we learn that the place celebrating the key historical event is on an even bigger building about one kilometer down the only side road off the main highway the the town seems to have.

When my wife and I with two other Western friends finally arrived at the primary building about the Xiaogang miracle, I was amazed at how large it was. And what a thrill to finally be there! But where were all the crowds? The place was obviously built with the expectation of big tour groups, but it seemed rather vacant on the Saturday when we showed up. Never mind, I was so excited to finally be here.

As we entered and paid a small fee, it was about 11:50 AM, and the staff informed us that it would be lunch in 10 minutes and we would have to leave until lunch was over at 1:30 PM. Since we had a 3 PM train to Nanjing for additional plans and would need to leave by 2 PM, waiting until 1:30 would be a huge set back. I politely pleaded our case: “We are foreigners who have traveled a long way to see this vitally important site in Chinese history. We have looked forward to this for so long and now are here on a tight schedule. We have to go to Nanjing this afternoon and would not be able to see all the museum if we wait until 1:30. We won’t cause any trouble and don’t need any help. Can we please just stay and look around during your lunch? Please?” No, sorry, we are closed at noon. Come back at 1:30. We didn’t get anywhere with diplomacy, so we rushed in and started looking and shooting photos. A friend suggested we just stay and keep looking. But soon a staff member came to escort us out and right at 12:00 the lights went out. China has made huge progress in customer service attitudes during my six years here, but sometimes there is still room for progress. Tourist sites that close in the middle of a Saturday for lunch (or naps) represent an opportunity for progress, IMHO.

The memorial had some frank information though it was very tactfully presented and balanced with reminders of the positive impact of officials over the years that greatly cheered and motivated the workers.  But repeatedly we can see hints about the excesses of the Cultural Revolution. The scene below from the museum is of a landowner being harassed for having taken the “capitalist road.” Those scenes could be very tragic.

During our 10 minute spree through the building, we realized it was just a museum and didn’t look like it housed the site where the economic revolution began. On our way out, though, we asked some more questions. “Oh, you want to see the old hut? It’s just down the street, about 200 meters, and it’s open during lunch.” Ah hah! Glad we didn’t spend all our time in the museum to miss the most important site. There was the hut where it all began, and the side room with the table where the contract was signed. We sat there and put our fingers to the pad and thought of the brave farmers, tired of watching loved ones die of starvation, risking their lives for the right to keep a reasonable chunk of what they produce. Economics 101, but forgotten by too many in our world.

The result of the conspiracy was a sudden boom in prosperity. About a 600% increase! It went viral and lifted one of the poorest parts of China. Farmers rose out of poverty and could afford luxuries like a television, a ceiling fan, and a sewing machine.

The leader of China today, Xi Jinping, paid tribute to Xiaogong with a 2016 visit. Of that moment in history and of those brave farmers, he said this:

“The daring feet that we did at the risk of our lives in those days has become a thunder arousing China’s reform, and a symbol of China’s reform.” 

Whatever you think about the politics of China and the revolution that gave us the nation of China, I think all of us Westerners can embrace and learn from this second revolution of China that has lifted so many of its people and brought so much opportunity and hope. At this time of thanksgiving, the courage of those who brought about the Xiaogang miracle is one of the things that I am grateful for. And how grateful I am that I could visit that site and meet some of the locals of Xiaogang. Sadly, I was the first foreigner they had seen there for months, one worker told me. Wish more of you would come by and experience the spirit of this place.

Finally! Now I Have 4G on My iPhone 6+ Thanks to China Unicom (Goodbye, China Telecom!)

Two days ago the most amazing thing happened. I needed to buy a new SIM card for my Apple iPhone 6+, and when I went looking for a local China Mobile (中国移动) store, I saw a competing China Unicom (中国联通) store closer to my office and decided to give it a try for convenience. When I put the China Unicom SIM card in my iPhone, I was shocked and delighted to see that after all these years of suffering, I finally had 4G service. Wow! That means fast access to the Internet and, for example, all the valuable functions WeChat provides (taxi hailing, payments, bus schedules, social media, even video calls). Life just got better.



One of my few frustrations in China has been the slow data services on my iPhone. When I need to use the Internet and don’t have local WiFi, I’ve been limited to 2G. Folks at the Apple store here explained that my US iPhone was designed for a different cellular network not compatible with China’s network, so there was no hope of 4G service like everyone else seems to have. But they were wrong. The real problem, as explained by a knowledgeable Taiwanese colleague, was that the provider of my former SIM card, China Mobile, operates over a portion of the cellular spectrum that is incompatible with my iPhone. China Unicom, on the other hand, operates over a different portion of the spectrum, making their network more compatible with US phones. The China Unicom employee smiled as she explained what was apparently well known to her: their service gives me 4G, but China Mobile’s service can’t. Wish I had known this a couple years ago! Even after a supposed updated SIM card was installed in my iPhone courtesy of my employer, the service remained 2G.

Why am I changing SIM cards at all? My employer is giving me a new company phone, a Samsung model with high security features (VMWare to track employees and make it harder to steal trade secrets, supposedly) that has 4G, and are giving me a new SIM card with that phone while requiring me to return the old SIM card I have been using in my iPhone. Changing phones is a bit traumatic, but discovering accidentally that I could easily upgrade to 4G just by switching to China Unicom helps make the change more welcome. Thank you, China Unicom!

Credit Cards in China: Don’t Rely on Them, and Use Virtual Credit Card Numbers for Security

Many visitors to China are surprised to see that credit cards are not widely accepted. High-end hotels will accept them, certainly, but they might not be accepted at many Chinese hotels. Many restaurants are not able to take Western credit cards. Train tickets, taxis, and numerous other services will refuse them. Simply put, cash is king in China. You really need to have a healthy amount of cash for daily survival. Have a stack of 100 RMB bills and some smaller bills and a few coins.

The first time I used a credit card in China was at a Best Western hotel in Shenzhen, near the Hong Kong border. Within 15 minutes after using the card, a spurious charge was made against that number by someone trying to purchase something in California. Our credit card company called to report the problem and our card had to be inactivated. Big hassle. Not everyone has that problem, but in Asia there are many places where credit card numbers will be swiped. They are easier to swipe than the highly secure ATM cards that are commonly used and accepted in China, cards that require a 6-digit password.

For secure use of a credit card here or anywhere else, a great service offered by some providers is a virtual credit card number. Bank of America, Discover, and Citibank offer this service. With a virtual credit card service such as Bank of America’s ShopSafe system, you can request a one-time or limited time use credit card number with a set maximum amount that can be charged against it. You don’t have to worry about the virtual credit card number being stolen. For example, I just logged into my credit card’s service and requested a virtual credit card number. I specified the amount that could be charged ($30), the date the card would expire (2 months from now), and then received a new card number, CCV code, and expiration date with my name and linked to my credit card. I used this to pay for an annual service that I don’t want to be automatically renewed with a provider who may not have the highest security. I made the payment and don’t have to worry about them charging me over and over or about hackers stealing my card number. It’s worthless now that I’ve made my payment.

Virtual credit card numbers can help you add security to your travels and your online life. You will need online access to your account to create them. You can obtain a variety of numbers for different parts of your trip. It’s a terrific advance in credit card security.

By | 2018-04-25T05:57:43+00:00 April 25th, 2018|Categories: Business, China, Consumers, Finances, Products, Restaurants, Shopping, Surviving, Travel tips|Tags: |Comments Off on Credit Cards in China: Don’t Rely on Them, and Use Virtual Credit Card Numbers for Security

Expats in China, Be Sure to File Your Tax Report (WeChat Can Help)

The Shanghai City government has sent out notices to employers reminding them to have foreigners who make over 120,000 RMB per year to file a tax report with the government. It’s due March 31. Foreigners typically need the help of HR or someone else to do this. Not a simple process if you haven’t done it before. In Shanghai, you can use the “fabu” site on WeChat (search for and follow 上海发布, which can show up just by searching for “fabu” I think). Enter that site, click on the second icon on the lower left corner (市政大厅), and then you click on the red and white icon at the bottom of the screen in the center (个税查询), which deals with individual taxes. From there, you’ll need to enter your ID, name, create a password, and enter other information including a recent tax payment level. When done, it will give you access to your past tax payments. Please see HR or a competent Chinese friend for the details.

I’m not sure what problems arise if you don’t file this report, but China is a place where you don’t want to ignore laws, especially those that affect how the nation’s detailed computer records view you. This one feeds right into those records, so don’t skip it.

 

 

By | 2018-03-28T16:43:21+00:00 March 28th, 2018|Categories: China, Finances, Shanghai, Society, Surviving|Tags: , , |Comments Off on Expats in China, Be Sure to File Your Tax Report (WeChat Can Help)

Jimmer, the “Lonely Master,” Might Be Doing Better and Doing More in China than the Deseret News Thinks

In the state of Utah, Salt Lake City’s Deseret News recently carried a touching but slightly downbeat article about China’s most popular basketball player, Jimmer Fredette, the impressive star who once stunned American crowds while playing for Brigham Young University. The article is “Lonely Master: From March Madness to Shanghai, the Unlikely Journey of Jimmer Fredette” by Jesse Hyde, published March 12, 2018. It has a lot of positive things to say about Jimmer and his accomplishments in China, but the general tone of the article is that Jimmer has missed out on his US dreams and thus has settled for something painfully inferior by coming to China, a grim and gritty place. I think there’s another perspective that ought to be considered.

Yes, the CBA is a far weaker competitive field than the NBA, and yes, it is disappointing that his NBA career did not give him the opportunities and satisfaction he sought. But don’t shed too many tears for Jimmer: things might not be as grim as the article implies.

The negative picture painted of China is quite disappointing. It’s a beautiful, exciting place where Jimmer is visible and influential to millions of people in ways that would not be possible in Europe or the US. I have met Jimmer and chatted a few times but don’t know him well nor can I speak for him. But what he is doing here is remarkable and has touched many people. His goodness, his honesty, his humility, and his high standards have also helped him touch people beyond what his athletic skills alone could do. For someone who possibly may have a sense of a mission higher than personal temporal success alone, coming to China brings many opportunities to achieve greater good, while also benefiting from a shorter season and excellent pay. Win/win from my perspective. His presence in China is part of something big, at least in the minds of many of his BYU-related fans here.

One of those fans, a Communist Party official, requested a chance to meet Jimmer last year. I was honored to be part of the little gathering where introductions were made. Jimmer with his characteristic class and humility brought gifts for the Chinese men who had come — framed photos of him as keepsakes. They were thrilled. Before Jimmer showed up, one man in the small group, a business leader in charge of the large complex where we rent some beautiful space to hold LDS services, chattered excitedly about Jimmer and quoted statistics from Jimmer’s games when he was at BYU and in China. Kid in a candy shop when Jimmer arrived. The official had gifts also, a terrific album of Chinese postage stamps. It was a beautiful souvenir for each of the foreigners at this event, which I’m proudly holding in the photo below.

With typical Jimmer class, Jimmer noticed a couple of keenly interested staff members from the little cafe where we met and invited them to get their photos taken also. It was a big day for all of us.

The Deseret News article makes numerous references to the pollution of China and Jimmer’s depressing situation here. The lead paragraph suggests he can’t see much of the skyline in Shanghai due to pollution (yes, we have pollution and some days visibility is noticeably reduced, but we have a lot of beautiful days too and air quality is improving). His apartment is “empty, lonely, a place he just crashes, so devoid of personal effects….” Regarding some reminders of his wife and daughter in his apartment: “Sometimes he needs those reminders. Like when he’s in Shanxi, a gritty industrial city where the gray dust blows from the cement factories and the grime is so thick he could scribble his name on the windows of parked cars.” And when he’s in Shanghai, in spite of the wealth and good food here, “even here, the air carries a slight whiff of chemicals you can almost taste. It’s hard not to want to be somewhere else.”

At this point in reading the article, I wondered if the staff of the Deseret News have ever been in Salt Lake City during the winter months, when the winter inversion traps air in the Salt Lake Valley and leads to painfully high levels of particles, nitrogen oxide, and other pollutants? Of if they have ever been near operations of the massive copper mine that scars the Valley? Or drove through Utah County in the days when the Geneva Steel works were cranking out massive whiffs of chemicals into the air? Or if they have lived near a paper mill in the United States? Shanghai air can get smoggy and is typically worse than most places in the US, but apart from an occasional painter using oil-based paint or a vehicle burning too much oil, as in almost any city, noticeable “whiffs of chemicals” are something I generally don’t experience here, unless those chemicals include the cinnamon aromas coming from Shanghai’s amazing Cinnaswirl bakery with world-class cinnamon rolls, or from the intoxicating smells of any of the hundreds of different cuisines available in Shanghai. OK, we do have stinky tofu, which does have a noticeable smell from its unusual natural chemistry — maybe that’s what the writer encountered here. But you can just take a few steps and be free of that.

China has pollution, certainly. There are spots that are gritty or grimy, just as in America. But it’s also one of the most beautiful and exciting places to live, especially Shanghai. For me personally, my respiratory health during my nearly seven years in Shanghai has been much better than it was in the US, where I would often get bronchitis or other issues in winter. Here it’s been great and I’ve almost never had to miss work due to illness. One or two days for an injury, but my health has been terrific. Part of that is from the food, which is high in fresh produce and generally quite healthy.

Come give China a chance. It’s one of the nicest places in the world, in my opinion. Anyplace is grim when you are away from family, but with such a short playing season, we hope that Jimmer can continue to thrive here and increasingly experience the beauty and wonders of China while here.

As a reminder of the surprising beauty and sometimes even miraculous nature of life in Shanghai, here are images of one of Shanghai’s secrets: its impressive angels rising from the ground to watch over this city. May Jimmer continue to be among them.

Finally, here’s a couple views of one of Jimmer’s favorite Shanghai spots.

Shanghai Disney Castle

The Shanghai Disney Castle

 

Cinderella’s Castle.

 

 

By | 2018-03-17T07:24:37+00:00 March 16th, 2018|Categories: Business, Career, China, Food, Health, Photography, Relationships, Religion, Restaurants, Safety, Shanghai, Society, Surviving|Comments Off on Jimmer, the “Lonely Master,” Might Be Doing Better and Doing More in China than the Deseret News Thinks

Long Distance Bus Tickets Be Ordered on Ctrip.com (Chinese Language Site Only)

A friend staying with us today needed to buy a bus ticket for tomorrow to get back to Rugao, a town near Nantong. He wanted to go to a bus station to buy the ticket, but that would have used up a big part of his day. Instead I figured there must be a way to do that online. I asked a Chinese friend and was informed that Ctrip (携程) is a good way to do that. I tried my Ctrip app (now just Trip, tied to Trip.com), but this English only app does not show bus information. I lauched Ctrip.com on my iPhone and changed the language setting to Chinese, and still had nothing about buses. I went to my computer and opened Ctrip.com in English, and still had nothing. But when I used the Chinese language version of the website, the bus information was plainly available as the menu item “汽车票” (vehicle tickets), which takes you to http://bus.ctrip.com/.

Ctrip Menu showing Long Distance Bus Ticket Options

Ctrip Menu for Chinese Language on Laptop

You then enter the departure site, destination, and date (Chinese characters are needed for the locations), click on the orange button, and you’ll see a list of bus trips available for your date.

Over on the right, the orange buttons take you to a payment page. You’ll need to enter your full name as on your passport, passport number (select 护照 = passport), and enter the same information in the second area for the person who will pick up the ticket (typically you), along with the phone number (手机). If the ticket is for someone without a phone, enter the phone of someone who can be in touch with the person to verify the ticket. I entered my phone for this traveler without a Chinese phone number (but he has WeChat) and will let you know if this fails tomorrow. Fingers crossed.

Then click on the big orange button below to pay using WeChat. You’ll get a 2D code you can scan to bring up WeChat payment. Pay for the ticket and the person can then pick it up at the bus station. Make sure you give them the images of the ticket info, receipt, etc.

In my case, I sent him screenshots of the payment confirmation, then clicked on ticket information to get the ticket sales number (取票好) and order number (取票订单号) in another screen shot. If all goes well, my friend will be on a bus tomorrow to Rugao. If not, it’s a long walk. I’ll let you know.

If you know of other ways to order long-distance bus tickets online, let me know. This seemed pretty easy and the fee was low (3 RMB for a 73 RMB ticket).

By | 2018-03-16T20:00:41+00:00 March 16th, 2018|Categories: China, Products, Shanghai, Surviving, Travel tips|Tags: , , |Comments Off on Long Distance Bus Tickets Be Ordered on Ctrip.com (Chinese Language Site Only)

Your Shanghai Apartment and Construction Noise

One of the surprises many foreigners have after moving to Shanghai is how noisy things can be when a big construction project starts. That quiet vacant lot across the street o your building may turn into a volcano of noise that slowly rises one story after another, or the once silent or vacant apartment next to you may become a source of constant pounding and drilling as the owners remodel it over a period of weeks.

Before you select a place, it’s good to look around and see if adjacent lots or buildings look like construction will soon take place. The worse situation is an old vacant building that will be demolished prior to rebuilding. Demolition in China is not a sudden event. It involves endless hours of a giant mechanical woodpecker pounding at stray blocks of cement to break them into tiny chunks. This is one of the most annoying sounds. Much better is the constant grinding sound that occurs when foundations are being dug or poured, for it sort of becomes like white noise that you can sleep through.

Fortunately, Shanghai has strict laws on noise requiring crews to become silent at night, I think by 11 PM, and to stay quiet until about 6:30 AM, giving you a chance to sleep. But these laws apply to ordinary companies and private owners, not to government projects like building a subway. We have a subway site under construction next to our house. Loud grinding and clanking noises will keep going until about midnight and then they are at it again at 3 or 4 in the morning. Pretty much noise all day long. How does one cope?

Make sure you have an apartment where your sleeping quarters will be away from the most likely construction site. That makes a huge difference. Also, consider adding some noise shields over your window at night, like foam board to completely cover the window. Or consider buying a white noise generator to mask the street noise. Ear plugs might also help.

But the real key is knowing what you are in for, as much as you can, before you select your apartment. Then prepare appropriately. Good luck!

By | 2018-03-12T16:30:21+00:00 March 12th, 2018|Categories: Health, Housing, Shanghai, Society, Surviving|Tags: , , |Comments Off on Your Shanghai Apartment and Construction Noise

Philippine Airlines: Prepare for Pre-Flight Turbulence

philippine-airlinesTravel in Asia normally works well and there are some great airlines here, but there can be some painful challenges with some. One of our most frustrating experiences has been dealing with Philippines Airlines.

Perhaps the most frustrating experience we’ve had in booking flights in Asia has been with Philippines Airlines, trying to schedule a flight from Shanghai to Dumaguete via Manila. Working with the various uncoordinated offices and archaic systems at Philippines Airlines, in our experience, feels like working with a bureaucracy out of the Dark Ages. We’ve been on the phone for hours trying to resolve a simple issue that is still unresolved as I write.

Basically, we have tickets we booked months ago through Travelocity.com for a flight that begins with China Eastern from Shanghai to Manila with a 4-hour layover, followed by a flight on Philippine Airlines to Dumaguete. But China Eastern made a schedule change — as they often do! — which reduced the layover to 2 hours and 50 minutes. Unfortunately, the suggested minimum time for a transfer in Manila (apparently a chaotic airport) is 3 hours, and we are now 10 minutes under that. My wife has made that connection before in just 1 hour, so 2 hours and 50 minutes should work, but Philippines Airlines is refusing to issue the ticket that we have paid for until we change to a later flight. But that change that might require sitting for 8 hours or longer in Manila and missing our first day of planned activities. We’d rather take the risk with the current schedule.

Philippine Airlines has given us and our Travelocity agents conflicting information and hasn’t properly responded to requests for help. They have bizarre internal rules that don’t allow even Travelocity to contact the right people directly and require email contact only for dealing with schedule changes like ours, greatly complicating things.

After much effort, the people in their main office in their help center told us that we need to get special approval by contacting some mysterious office in San Francisco. As I write, it is 2:30 AM in Shanghai and we have been trying since 1:00 AM to reach the San Francisco office right as they opened at 9:00 AM California time, but the number that the airlines gave us to call never answers, and a similar US number listed for their San Francisco office also does not answer. We called the US 800 number and have been getting different answers depending on how we ask the question, but in the end it appears that we still need to call the mystery office in San Francisco but are also waiting on hold for various offices inside P.A. to “coordinate” something or other. Ugh. Next time, we’ll strive to avoid Philippines Airlines.

At the moment, we are being told that we need to get Travelocity to send the same email that the airlines already has received, but to a new address that will reach the mystery office in San Francisco. And no, absolutely no, the customer service office we reached through the US number for Philippine Airlines simply cannot forward that email to San Francisco or call San Francisco. They lack the advanced resources needed for such a thing.

Update, 3:37 AM: We finally reached the San Francisco office and learned that they could help us, maybe, to get on a later flight that day, but they would need to contact the Philippines office to do that — the same office that on multiple calls has required us to go through San Francisco — and also learned that this would take two or three days (pushing us dangerously close to our departing flight next week) because they cannot just check things and do things on their computer and cannot just call the Philippines office but can only communicate internally with them via email, and since the Philippines office in question is closed on the weekends, we won’t find out if there are even seats for us until Monday at the earliest. Bizarre.

Wish us luck. We are getting a little airsick from all the pre-flight turbulence. Hope things go more smoothly once–or rather if–we get on the plane.

One of the biggest challenges in general with flights in Asia (and the US) is that when you book them months in advance, there will frequently be significant changes like the cancellation of a flight and a new flight that may leave hours earlier or later than you want, causing lots of headaches late in the game. And lost sleep.

By | 2018-02-09T12:43:25+00:00 February 9th, 2018|Categories: China, Surviving, Travel tips|Tags: , , , |Comments Off on Philippine Airlines: Prepare for Pre-Flight Turbulence

VPN in China: Why I Recommend ExpressVPN

ExpressVPN is something I use daily in China, but I’ve found it’s a useful privacy tool anywhere. For China, it allows me to connect to foreign websites like Facebook that are normally blocked. It creates an encrypted connection between your computer and a variety of servers around the world (you can choose where), and then makes all your Internet traffic appear to come from that local server. By doing this, you data is always encrypted and your privacy is enhanced. Essential for China, valuable everywhere else. Annual subscription is required. Well worth it.

With one subscription, you can have a computer and iPhone protected at the same time.

I never do online banking or other sensitive tasks unless ExpressVPN is on, reducing the risk of someone intercepting my traffic and snooping.

Internet access is a cat and mouse game in some parts of the world, but ExpressVPN is regularly updated and seems to stay ahead. Tech support has been excellent. There have been times of frustration, but they’ve got me through the problems.

On the iPhone, there are two ways to access ExpressVPN. One is via the app, which works well. The other is via configurations in your settings area, which used to be the fastest and easiest way to connect, but with recent changes in either the iPhone software or ExpressVPN or China, I’m not sure which, that option often doesn’t work for me. But I can always get on through the app.

Other VPN tools are out there. However, among foreigners here in China, there seems to be a pretty strong recognition that the gold standard really is ExpressVPN. Others I know have encountered many frustrations with other tools, especially free ones. Let me know what your experience has been if you’re a user of VPN of any kind.

By | 2018-01-15T16:36:19+00:00 January 15th, 2018|Categories: China, Internet, Shopping, Society, Surviving|Tags: |Comments Off on VPN in China: Why I Recommend ExpressVPN

Surviving Your Bike Ride in China

Riding a bike is one of the best ways to get around big cities in China. I have my own large Giant bike purchased new for 800 RMB, and I love it. Fast and smooth, but just one gear. That’s fine for Shanghai. Many people ride rental bikes now like Mobikes or the yellow Ofo bike that I sometimes ride (the Mobikes are just too small for me, while the Ofo brand often allows the seat to be raised high enough to make it possible for a tall guy to ride, though not comfortably). I ride my bike most days when going to work in the Hongqiao area of Shanghai. It’s often faster than a taxi and much faster than a bus. You can join the pack of crazy motorcyclists who are not impeded by traffic jams, cutting in and out of obstacles while carefully observing all relevant laws — well, most of the laws of physics, I mean.

Bike riding is fast and convenient, but there are serious dangers. Not as dangerous as a motorcycle, where the higher speed means higher risk, but that higher risk includes collisions with you on your bike, and the results can be nasty. A friend of mine just badly crushed his hand in an accident with a motorcycle while riding his bike. He will need delicate surgery. Another friend was riding across a bridge when she hit a rock and fell from her bike, badly shattering her forearm. Painful surgery and months of recovery were required, but after a year has regained nearly all of her motion. But trust me, you don’t want an accident. Understanding the dangers is critical.

One of the biggest dangers comes from motorcylces and especially their nearly silent electric version, the ebike or electric bike. They can be zooming toward you from behind and you won’t hear them coming. They can be coming in from an angle from the back or side and you won’t hear them coming, unless you listen carefully. More important than listening is looking: you need to frequently make quick glances over your shoulders, especially over your left shoulder where faster approaching vehicles are likely to be coming, but also sometimes over your right shoulder.

Vision Trumps Everything

Peripheral vision is crucial. Frequent glances over your shoulders are vital. Understand that a vehicle may suddenly approach you from any side and any angle. A motorcycle or bike may dart out from an alley or from between parked cars on the side of the road. As you approach an intersection or driveway, someone may suddenly move into your path and it will usually seem that they never even looked your way before entering traffic. It’s amazing that some of them are still alive, but natural selection can be a slow and overly random process. I certainly have not seen any evidence that natural selection has been weeding out insane motorists and cyclists over the years in China. Evolution might work well for some species, but it seems rather inactive for species on the road. Never mind, just focus on not being the one who gets weeded out.

The key is being totally alert and aware of what’s happening in front of you, at your sides, and behind you. Listen carefully for horns, bells, rattling sounds, motors, snorts, cellphone conversations, or other indications of an approaching ghost rider. Watch for signs of motion between stationary cars. Anticipate taxi doors suddenly opening, usually on the right side. Note the protruding nose of a dog getting ready to make a dash for it. Anticipate the craziness of intersections where people may cross your path from all directions. Total alertness and attention is your key to survival.

Here’s the shocking news: for enhanced safety, I’ve given up wearing my helmet. Yes, terrible of me, right? But the statistics globally don’t show that bikers who wear helmets fare better than those who don’t, and in my Shanghai experience, I’ve realized that anything that hinders my peripheral vision or my ability to quickly look over my shoulders increases my risk. Avoiding collisions and falls is the first priority, much better than falling with a touch of added protection. Helmets limit my vision and slow me down when making rapid backward glances. Sayonora.

Alertness is also needed for coping with obstacles on the road. Manhole covers may be moved and the dangerous hole not well marked. Potholes may be large. Bricks or other objects can be in your path. With the rise of rental bikes clogging sidewalks, you will sometimes find a rental bike has been abandoned on the side of the road that partially blocks a bicycle lane. Dangerous! Be  good citizen and move it out of the way, but do this by stopping gradually and with clear signaling of intent. No sudden moves!

Speaking of rental bikes, they add a lot of danger to the scene. Not just because they might be barriers, but because they have brought many new cyclists onto the roads who don’t know much about cycling and safety. And they are slow. They go at about 30-50% of my speed, in part because the wheels are small, and as a result they are constant barriers in front of me I need to weave around. But their riders often don’t ride very well, weaving back and forth as they go. So annoying. Increases the risk for everyone. Be cautious and carefully plan how you can avoid them and get past them as soon as possible. Further, bike renters will often step out onto the road with their bike without even looking at incoming traffic. So clueless. Anticipate their stupidity and be cautious when you see someone standing by a rental bike, possibly getting ready to create a pile-up on his or her first ride.

To Be Safe, Be Predictable

From my experience, a key safety tip is that you need to be predictable. Sudden turns, veering to a side, or a sudden stop can result in disaster. In China, car drivers and motorcyclists constantly forecast where others are going and then plan their sudden weaving in and out or other crazy maneuvers based on forecasting the routes of nearby vehicles. They expect you to just keep going and will time their move based on the forecast. But if you suddenly stop or turn without warning, you may end up where they are about to end up. Bang. Ugly. Notice this when you are in a taxi. Drivers are very aggressive and it all kind of works as long as people are somewhat predictable.

Hand signals aren’t common but are a good idea, especially for left turns against traffic. They aren’t going to stop for you in most cases to let you turn, but the signal lets others know what you are doing so they won’t crash into you.

When you stop, try to do it gradually. Recently I was riding along, thinking I was alone, and saw a person who was on the ground right after an accident between a bike and a motorcycle. I stopped quickly to help and then heard someone right behind me yell as he slammed the brakes of his electric motorcycle to avoid me. I was nearly taken down by that mistake. Be predictable. No sudden moves!

I hope this doesn’t deter you from riding a bike. There are dangers, but if you are alert and cautious, you can manage the risks and enjoy getting around town much faster than going on foot or with public transportation. But do realize that there are risks. Walking and public transportation have much lower risks, so weigh them as alternatives. Very few people have ever needed major surgery after a ride on the subway.

 

By | 2018-01-07T19:24:24+00:00 January 7th, 2018|Categories: China, Crazy, Health, Safety, Shanghai, Society, Surviving, Travel tips|Tags: , , , , , , , , , |Comments Off on Surviving Your Bike Ride in China

The 144-Hour Transit Visa to China: Risky If You Are Staying With Friends or Anywhere Besides a Hotel

The complexities and costs of obtaining a tourist visa to China can be avoided sometimes by taking advantage of the transit visa program that is available in some major cities like Shanghai, Beijing, and Guangzhou and several others. Shanghai offers a 144-hour transit visa, which is great for a brief stay here. Some places may offer 72-hour transit visa or 24-hour transit visas. These visas don’t cost anything as far as I know and are easy to get. You have to show that you have a departing international flight scheduled within the allocated time from your arrival, and you need to stay in the designated area. The Shanghai-Zhejiang-Jiangsu 144-hour visa allows you to travel throughout Shanghai and its neighboring provinces, Zhejiang and Jiangsu while here. Getting the transit visa is easy, at least at the Pudong Airport in Shanghai, where there is a special line at the far left of the customs area called “Transit 144/24” for the 144-hour and 24-hour visas. It’s a great program — but there are some rules that can create trouble if you aren’t prepared.

The biggest problem might be if you are planning on staying with friends or an AirBNB rather than a normal hotel. An important part of the transit visa process is ensuring that you and your place of residence are registered with the police. The work to do this is usually handled by hotel staff who make copies of your passport information and process things with the police.

What if are aren’t staying at a hotel? Relatives of mine who just arrived here yesterday informed me of the process. When you register for the visa, the helpful staff will say no problem and explain that you just need to go to a police station within 24 hours. They will give you a card that also tells you to do this, as shown below:

Instructions on the 144-hour China Transit Visa Card

So in the evening after our friends arrived early on a Friday morning, we walked a few hundred yards to our local police station. Strangely, I felt that I should bring along information to renew my own residence registration with the police in since the one I did recently might need updating after finalizing my recent visa renewal. As a result, I brought the contract for our apartment.

Our Local Hongqiao Road Police Station

To my surprise, when we entered the police station and explained what our friends needed, the woman in charge asked for our contract. Whew! Felt so relieved. Here it is. Then she looked at the address. “Oh, you live in Minhang District. This is Changning District. You are at the wrong station.” We explained that the authorities at the airport and the card simply tell us to go “a local police station,” and this is the local one closest to us. She laughed and said, “No, you need to go to Minhang.” Of course.

Minhang has many police stations, but in our own registration efforts, we learned there is only one that we can use for our address. So the card should explain that. The one we have to go to is quite far away and took over 20 minutes by cab to reach. Time was running out because we knew the key office at the police station would close by 8 pm.

When we got there, the woman explained that we needed our contract — check! — and also a license from the management of our apartment building showing that we were properly authorized to live there. Wow, a second surprise document required. Amazingly, as were packing up to go on this journey, I had grabbed that also. Check!

Or maybe not. The officer explained that the license was for my wife and I, but I also needed to get the same form for our guests. Huh? This would require them to have a contract of some kind, as far as I know, and would require a great deal of time and effort, and might not be possible at all. She shook her head and insisted, but in the end with a gentle smile and a soft request for help, she shook off the hidden rules somehow and gave us a break, but said next time we should get the license. No idea how to do that, honestly, but guess we’ll have to try.

In Chine, there are rules that can be hard to predict and sometimes vary from place to place or person to person. This officer was kind and gave us a break. Others might not have been so gracious. But in any case, if you are coming to China on a transit visa, stay at a hotel and make life simple.

If you are inviting guests to stay with you in China who may come on a transit visa, work with your local police station ahead of time to know just what documents will be needed and make sure you can get them.

 

By | 2017-12-08T17:58:13+00:00 December 8th, 2017|Categories: China, Housing, Shanghai, Society, Surviving, Travel tips|Tags: , , |Comments Off on The 144-Hour Transit Visa to China: Risky If You Are Staying With Friends or Anywhere Besides a Hotel