My Chinese Health Care Experience

Each year, the employees of the University get a free health check.  This is performed at a small hospital/clinic on the Medical School campus.  It takes all morning and is very extensive.  Oh and it is completely free!  So last year I decided to take advantage of this to experience Chinese Healthcare for myself.

This exam would cost a lot in the US as it includes many – usually separate – tests and procedures.  The blood draw included testing  for lipids, cbc, several hepatitis B antibodies, and a CA125 test for women (used to detect ovarian cancer)  and PSA test for men.  Other tests include, an EKG, Chest X-ray,  Eye exam, glaucoma test, pap smear, blood pressure, and an ultrasound exam for thyroid, breast, abdominal aortic aneurysm, and ovaries.

First you sign up online for your appointment.  There is a two week period and each morning approximately 300 people are seen.  When you arrive, you check in and enter a large room with benches and examination room doors off all sides.  China still uses doctors and nurses for all healthcare so technicians are not part of the healthcare scene.  The physicians are both male and female but nursing is still pretty much an all-female profession.

Another thing I should point out is that China doesn't have HIPPA laws and your information is shared with anyone near enough to see or hear your results.  Although,  the written report was given in a sealed envelope.  Privacy also has a different meaning in China.  The number of people in the country and the number of people served by the clinic is a single day doesn't allow for the kind of privacy you have while seeing a doctor in the US.

First we had our blood drawn,  I was given two q-tips to hold on the puncture afterwards to stop the bleeding.  This didn't work very well for me and I bled for quite a while and got a nice big bruise on my arm. 

When we went to the ultrasound room, there was a queue on the bench outside the door.  Inside the door there were 5 chairs along with the nurse at a computer and a bed with a drawn curtain.  The patient was on the bed with the doctor, as he examined the patient and looked at the ultrasound screen, he called out the findings to the nurse who then typed them into the report.  So the 5 people in the chairs, the person waiting their turn behind the curtain and the patient on the bed all hear the details.  No one but the doctor and next patient can see behind the curtain.  Since all patients for this were female, the ladies seemed okay with this.   The doctor spent about 10 minutes with each patient. Far less time than would be allotted in the US for an ultra sound exam of anyone one of these areas.  I have heard Western doctors here say, ‘The Chinese doctors won’t miss anything big’.    The doctor picked up the inflammation in my thyroid and the cysts in my breasts.

The EKG (ECG) was performed by a very old machine and a dated technique.  I had clamps on all 4 limbs and then the machine had suction cups instead of leads.  I have been told by US doctors that this is completely acceptable.   The doctor looked at the strip (graph) right there and noted my inverted T-wave.  This usually means you have had a heart attack.  I always have to explain that I haven’t had a heart attack it is an infantile anomaly.  Hard to do when you don’t speak much Chinese.

For the Pap smear, there was more privacy, but not much time. Patients were told to take one leg out of their pants and panties and hop up on the table.  It was all over in about a minute.   I told my Gynecologist this story.  He roared with laughter and said he should try that kind of assemble line medicine. 

Several other things I noticed.  The blood pressure was taken by the small modern automated machines.  These are very popular in the US but not considered the most accurate.  I was surprised a troop of nurses didn't take the blood pressure.  I also noticed that almost everyone there had a systolic pressure close to 140.  That is the cut off for high blood pressure in the US.   This is interesting because the population here is chronically dehydrated and they eat a very high salt diet.  Not sodium chloride but mono sodium glutamate. 

I refused to be weighted because I didn't want “the whole world” to know how much I weighed.  Again no privacy.   This caused a stir of course.  And my Chinese colleague got to explain this to the nurse. (I'm just that crazy laowai.)   Because my friend had to help me with the language I had even less privacy than the other patients.  I had to adopt sort of an “out of body” mind set to keep from being mortified with embarrassment.   This year, when the health checkup came, I politely refused saying I have to do it all in the summer in the US.  

As you can see there are some pluses and minuses to this system.  The CA 125 blood test for ovarian cancer is expensive, about $175 in the US.   It is NOT used nearly enough in the US, yet here every women received the blood test and for free.  In the US, ovarian and uterine cancer are STILL not detected early which puts women at greater risk.   Personally, I am glad to see independent testing labs springing up in the US where a patient can get his own blood workup. 

Ultrasound of Thyroid with inflammatory areas
highlighted.

I have been on Thyroid medication for more than a decade. Yet,  I have never had a Thyroid ultrasound.  I asked my doctor in the US.  “Do you just assume that all women with low thyroid hormones have Hasimoto’s Disease.”  (That is the name of the inflammatory thyroid disease.)  She said no and sent me for an ultrasound.  While it doesn't change my treatment, it is important to know that you have a chronic inflammatory disorder because it can lead to other inflammatory problems. 

One the minus side, the speed at which these tests are performed means that they are not very thorough.  A small breast cancer could easily be missed.   Many of the exam rooms did not have paper on the table and there was no cleaning between patients.  This is typical for China.  Yes the doctors do where gloves for say a Pap test, or rectal exam but may not for a less invasive test.   I have always thought that because of the sloppy cleanup between patients, it would be very easy to spread disease here.  I have had other expats tell me the same thing in x-ray and MRI rooms, no cleanup.   More people in the population wear masks here.  That is good if a sick person is trying not to spread their germs to others.  If you wear a mask to keep from getting sick then you also have to make sure that you don’t touch an infected surface or person. Thus it is less effective. 

 Smoking is still very popular here so while a chest x-ray every year may seem excessive,  it is necessary.   Hepatitis B – the viral kind – is also very prevalent here.  There are 400 million people in the world with Hep B.  One-third of them live in China.  There are vaccination programs now to protect kids, although the rate of vaccination is not yet high enough to really control the disease.  It is common for a mother to pass the disease before birth.  There is a lot of discrimination against Hep B carriers.  They can be turned away from schools and jobs.  There are laws to prevent this kind of discrimination but it still exists.  I am unaware of any programs to vaccinate adults.  I sure the vaccine is available here but I don’t think there is the education or the motivation to make this a priority in China.

I think the employees at the University are grateful that their employer provides this service for them.  I know that other large companies also do this but it certainly isn't universal.  Of course, the University Employees are also going to be more educated and seek out healthcare when they have a problem.   However, the scope of learning here is very narrow; you can’t assume that education in one field connotes education about health or the body.  China is still very much in the era of “the doctor knows all” and questions are not asked.

China has a large population of people who are self-employed or employed on a more temporary basis and thus would not have access to health care or health insurance.  Health insurance here is relatively new. It is generally just catastrophic care (with a lot of exclusions) and for those with stable employment. The employer is required to pay 80%.  The Chinese Government’s goal is to have 85% of the people covered within the next few years.  That is not realistic at all.  But then numbers can be manipulated to say anything.

All in All, An interesting experience but not one I'm willing to repeat.

Healthcare In China

Hello Friends and Family,

This will be the first of a series of posts about China and my observations about the healthcare system here.  There is a general rule followed by Expats that you don’t criticize your host country.  But at this point, I want to share my observations and research in the hope that we will all get past the sound-bite opinions and packaged perceptions.

First I need to correct the American way of thinking.  Communism and Socialism are not the same thing.  China doesn't have socialized medicine nor do they give more than a superficial bow to a government backed retirement system.   

China has always called it Communism with Chinese Characteristics.  This is a favorite phrase here.  In summary, it means that communism didn't change many of the basic tenements of Chinese Culture.  Meaning: the family takes care of the elders and it is the family as a collective who must take care of the sick or the infirm. 

When the decision was made in 1970 to institute the one child policy, government officials seem to have forgotten to consider how this would affect the family’s ability to care for the sick and elderly.  I have to say that after seeing the overpopulation here.  I have a better understanding of why the policy was considered necessary.  In 1970, at the time the policy was enacted, each women had an average of 5.3 children. In addition, China experienced serious famine and starvation for several decades. There was no way to feed all the people. Every day, I see the after effects of childhood starvation in the small stature and soft bones of the elderly. 

Saying I understand why they did it, doesn’t mean I agree with the forced abortions or ridiculously old fashioned approaches to birth control and sex education.  I’ll have a whole lot more to say on that in the future.

So let me give you some examples of how the healthcare system works here.  In theory, anyone can see a doctor for 1 yuan.  (16 cents).  The idea of clinics is new here so primarily you will go to the hospital and are seen in the department covering your problem: Cardiology,  orthopedics etc.  You will need to register with the hospital and have a hospital ID card first.  You will pay for your visit in advance and if an IV or medication is required you will stand in the cashier line a second time before it is administered.  The doctors have 5 year bachelor degrees here, meaning they don’t have the education of American doctors and they are dealing with a very uneducated population.  There is nowhere near enough medical facilities and you will register and wait hours to see the doctor.  Waiting areas are packed, with the windows wide open, no heat or air conditioning provided.   In order to make up for the low cost of seeing a doctor, you will most likely get an IV drip.  I know this sounds like massive over kill until you understand more.   The lowest price for an IV drip is 125 yuan.  There are short, 30 minute drips and long, 2 hour drips. There are different names for these in Chinese.  If you need antibiotics for an infection this is how you will get it.  If you walked in with hives, you would get a cortisone IV.  

The clinical pharmacy field here is not well developed. There are many pharmacies but it is unlikely that it will be staffed by anyone besides a clerk.  Those who do get a bachelor degree in pharmacy are likely to work at the hospital.  In addition,  the pharmacist may only deal with traditional Chinese medicine (TMC) compounding, mixing herb etc.  In which case, the pharmacist would be filling a prescription from a TMC doctor.  I have never heard of a person leaving the doctor with a prescription for western medicine.  If you actually go home with medication you will get it at the hospital.  

TCM Pharmacy

Another reason for the IVs and hospital provided medication is that amount of fake and poor quality medication here.  There is a lot of medication here that was meant for animals in other countries.  Also the doctors can’t be sure that someone will take a 10 day supply of medication on schedule. Thus it is quite common for someone to be told that they will need to return every day for 3 or 5 days for an IV.

Western Medicine Pharmacy, I appreciate getting
Amoxicillin without a prescription

Soon after arriving here, I read an article in the English language daily about a nurse that went to Singapore to work.  She was severely reprimanded for giving a patient his medication early.  She learned how important this is and stated that in China you get the medication whenever it is convenient for the nurse.  This kind of comment gives you a general idea of the training here.

Nurses learning to Smile.  2013

A hospital stay is a family affair here.  They will be an important part of the patient’s care.  Although there are a few VIP wards that may be different, generally China still has beds in wards. Each ward room has one bathroom.  No shower.  A 6 or 8 bed room is typical.  That one bathroom will also be used by the family members helping the patient.  Again the windows will be open as fresh air is considered very important to alleviate germs.   Since many of the cities here have terrible air pollution,  the air is NOT fresh!!  Hospitals don’t provide food and so the families will be feeding the patient.  Outside the hospital, street vendors will set up daily to sell food to the families of patients. Families coming from outside the city will spend the entire time in the hospital. It is unusual for them to get a hotel room because that is considered too expensive.  The family will be paying for the entire operation and stay. 

It is also common to have a hospitalization here where your bed will be left in the hall. If the wards are taken and you must be hospitalized then your bed will be left in the hall, possible for a week or more.  Again the family will be there to assist you.  You can get a pretty good idea of the desperate need for more hospitals and facilities

China could easily be ground zero for a massive viral/bacterial outbreak.  While masks are frequently worn (for the wrong reasons) gloves are still not mandatory.  That is to say gloves are usually worn but it isn’t 100%.  There is unlikely to be any clean up between patients on say an exam table and paper on the table is optional.  I have friends who have been in MRI rooms with blood on the walls. The training for the technicians is minimal so they just don’t understand why any cleanup is necessary.  A cleaner will often use the same bucket of dirty water for the entire day while mopping. 

Our company, as well as many other international companies, doesn't allow us to have medical care here.  There are two western clinics staffed with doctors from the US and Europe.  If we need care beyond their capabilities, we will be flown to Bangkok or Singapore. 

As we all know in the US, the Chinese government has plenty of money.  So why isn't healthcare a priority?  Why aren't new hospitals and better training a priority?   Healthcare barely gets mentioned at the federal level.   The ugly truth – if your country is terrible over populated would you want people to live longer?

Working in China

Very sorry for not posting more often.  I'm working at Sichuan University in the Physiology Department.  It was a very slow process to get hired but more than 6 months after I interviewed, I actually started working.  I found the contract negotiations in China very peculiar. You sign the contract and then they make a little change, and then another little change and then another little change until you are just so fed up you put your foot down!  So I didn't take the research and teaching position that the Department really wanted me to take, instead I'm just teaching and that is enough.  Another curious fact about Chinese Universities, the contracts withhold 10-25% of your salary for a year end bonus. Apparently this is okay with everyone and your bonus will depend on how your department is doing. I tried to fight that one, but in the end gave up. I did receive a bonus at the end of the year so I guess that is good.  Its a good mechanism for making you live on less than you make.

Limin Yue, Hannah Zhou, and Yvonne Tang,  Dr. Yue is the Department Director,  Hannah and Yvonne are my colleagues.  Both have been so helpful in navigating the University Administration and talking to the employees who only speak Chinese

Our Department had an outing in December.  In classic Chinese Tradition we went to a big lunch and then walked around a Wildlife Area for several hours.  It was cold but that never stops anyone here.  I think I have on 4 layers of clothes.

The Fall Semester was overwhelming.  I had to prepare 6 hours of lecture a week for the Medical Physiology Class that I gave to the Foreign Medical Students.  I had 105 students from India, Sri Lanka, Malaysia, Indonesia and a few other Asia countries.  It was an interesting mix of students.  The students from India are in China because they didn't get into a school in their own country. Some students will point blank tell you that this is what their parents want for them. Apparently if a girl gets a medical degree it lowers the dowry her parents have to pay. (It brings prestige to the boy's family.)  On the other hand, the students from Malaysia are very bright and probably don't have many medical schools in their own country.

I take very seriously my role as an educator of future doctors. I realize these are undergraduates and will not be practicing in the US, but seriously some just don't have the smarts to be doctors.  After studying the digestive system, I had students trace the digest of a cookie from the time it entered your mouth until it was absorbed into the blood stream.  One boy wrote that it would go down the esophagus and into the gizzard where it would be ground up.  SINCE WHEN ARE WE ALL CHICKENS.  Giant Eye Roll.

I'm sorry to say that I failed 24 students. My department supported me and told me that sometimes they have failed 30% of the class.  In China, if you fail a final, you can take a retest at the first of the next semester so there is still a possibility that some will pass.  I should hear about this next week.  Other than this one piece of grace, in China there is no retaking a class, there is no going part time, and there is no taking longer than 4 years to graduate.  The first weekend classes for masters degrees have just been introduced.

The Spring Semester starts at the end of February, after the Chinese New Year Holiday.  This semester I am teaching graduate students in all the biomedical sciences.  I made up the class to imitate a class that American graduate students take.   Its called Graduate Student Workshop and I am teaching them to write abstracts in English,  create posters for presentations and meetings, and to give a presentation in English.

I was anticipating about 20 students.  It isn't required and I figured it would be mostly my own department. I was told that 30-50 graduate students had been told about the class.  Well, on Friday morning at 8:30 am I had over 80 people in my class.  I didn't have enough homework handouts, go figure.  I think a lot of it was just "let's go see the foreign teacher."  I think I am the only foreign teacher on the Medical School Campus although there are a few on the main campus.

My campus is very old and beautiful.  It is used by many retired people who came walk around the campus in the afternoon. This man painted the yellow autumn leaves.  I wanted to buy the picture but didn't have enough Chinese to ask.

The Campus that I teach on is old.  It was called Western China School of Medicine and started in 1910. It was founded by 5 missionary groups from the UK, US, and Canada.  In 2000, Sichuan University "absorbed the medical school." So now we are the Huaxi Campus,  The Campus is in central Chengdu across the street from Huaxi Hospital where are students do their clinical work.

This picture of Yvonne and I, is in front of building where I teach.  It is such a beautiful building on the outside. Unfortunately the inside is pretty old too. No heat, no air conditioning - except for a few fans.  Some of the wooden windows don't close.  The classrooms have been updated with computers and projectors.  Some days in December it was really chilly!

Visiting Thailand

Jintian: January 8, 2013

Hi Everyone,

I'm playing catch up so let me tell you about our trip to Thailand at the beginning of December.  Bangkok is about a 3 hour plan ride away.  There is one nonstop daily on Thai Air and that is a very nice airline to fly - one that still feeds you!

First we went to Phuket (Poo-ket) which is an island on the southwest coast, on the Andaman Sea.  Duane insists on calling it the Indian Ocean but you don't hear people call the Gulf of Mexico - the Atlantic, so I prefer to be more specific.  Anyway the water is so beautiful and Duane really needed the break.  He was just exhausted from working so hard. We stayed at the Renaissance Resort which was away from the very touristy areas and that was perfect. 

Next we went to Bangkok and stayed with a Chevron friend who used to work in New Orleans.  It was so helpful to have someone who really knew the area.  We rode the elevated train to the big weekend market call the Chatuchak Market.  Wow that was cool.  Sooooo much shopping.  Duane would have been happy to sit with a beer on a bench but he was a trooper. I ended up buying a large bag purse to carry all my finds. We also visited the palace grounds which is very cool.  I can't help but think of the King and I while I was in Thailand as the story is very loosely based on a true story.  We also went to Wat Pho.  Wat means Temple. The temple name is much longer but everyone calls it Wat Pho.  This temple has one of the largest reclining Buddhas and it was really impressive.  Wat Pho is also famous for its Massage School.  A Thai massage is all about stretching and range of motion.  Duane and I indulged in a 30 minute foot massage and a 1 hour body massage.  During a Thai massage you wear very loose fitting pants with a dropped crotch and a t-shirt.  The Thai people are very modest and they are moving your arms and legs all around so this isn't like a western massage where you lay quietly under a sheet. 

 

The Palace grounds (above), the reclining Budda at Wat Pho (below)

We also spent one day out of the city visiting the site of the "Bridge on the River Kwai" and the Tiger Temple.  During WWII the Japanese used POWs to build a railway from Burma into Thailand called the Death Railway because of the thousands who lost their lives.  The Town of Kanchanaburi (Catch-a-nop-oly)   north of Bangkok is where  Khwae Noi and Khwae Yai rivers converge into the Mae Klong river (now called Mae Nam Kwae in Thai)  where the original wooden bridge was built.  The bridge there now is steel and was built after the war.  Two Allied cemeteries honor the POWs.  The graves were originally in small plots all along the railway. Now they are interned in the two cemeteries.  Each grave has a plaque identifying the person, their military unit and a quote from their family.  It was a very moving experience.

 

The bridge, the cemetery, and a modified truck used to carry 

supplies as the railroad was built during WWII.

The Tiger Temple (Wat Pha Luangta Bua Yannasampanno Forest Monastery) is about 45 minute drive from Kanchanaburi. The story goes that years ago, the Monks were asked to take care of several tiger cubs who were orphaned when their mother fell to poachers.  Now the Temple which is very remote, has 112 tigers and other animals.  Some of the tigers are used to people - which is not the same as being tame - and some have been rescued and will never be near people.  There are also several bears, a lot of water buffalo and deer on the property.  The ages of the tigers when you visit, determines what opportunities are available for interaction.  We hit the jackpot and came away with a once in a life time experience. The good instruction of our hosts, Tim and Jam in Bangkok, meant we knew when to arrive and the right questions to ask.  We signed up for the Exercise the Teenagers program and the Feed the Babies program.  If I had known what I was info on the exercise program I probably wouldn't have signed up but then I would have miss a really thrilling experience.  We washed the tigers, we fed them boiled chicken, and then we got into a big "cement pond" for the exercise session which lasted about 30 minutes.  As you can see from the photos below, the idea was to wave around the bags and noise makers on sticks to get the 6 tigers to jump in the air.  I used to do this with my cat,Pretzel, when she was younger - on a much smaller scale. As you can also see, these are big animals!  The volunteers where there to push the tigers away when they got too close but they were frolicking all around us and on top of each other so they were close enough to touch.  I felt something on my foot, kicked it away, and then realized I had just kicked a tiger's tail. By the end, we were soaking wet!

Next we went to the feed the baby program.  They had 6 tiger cubs from three litters, ranging in age from 5 to 10 weeks.  They were already significantly bigger than house cats. Their paws were so big! They were really clumsy looking, and oh so cute. Even Duane had a big smile on his face. We stayed with the babies for 45 minutes.  Both programs had volunteers to take pictures of you while you interacted with the tigers so we have wonderful pictures.

Thailand is an interesting mix of Asian and western.  They drive on the "British" side of the road and they have many western style shopping centers.  On the other side there are still many people who speak little or no English even though it is taught in school as a second language. Thai's also have their own alphabet which is nothing like ours, or the Chinese. Fortunately all signage is in English and Thai so that helps greatly. Thai people are warm, friendly, and very proud of their King and culture.  It is also a very Buddhist country which translates into a laid back, peaceful attitude, and less drivers honking their horns (than in China.)  I can't want to visit again.

Holidays in China

Jintian:   January 7, 2013


Hi Everyone,
Well, the holidays have ended so its about time that I filled you in on what we have been doing. We had 14 for Christmas Day with Kenny's friends from the International dorm as well as a few others.  I made each person a Santa sack since I couldn't buy socks.  I filled the bags with special candies from America and little cheeses like Babybel (cheese is expensive here).  When we went to Thailand at the first of December I bought souvenirs to use as stocking stuffers so everyone got cell phone charms, silk scarfs and magnets. 

Our family tradition is home made soup on Christmas day and the big dinner on Christmas Eve.  I always make Clam Chowder.  Alas, no clams, so this year I made a veggie soup with beef and a creamy potato soup with ham.  We did have hot rolls.  I have carried on with Grandma Taylor's tradition and make hot rolls for most important occasions.  

We played a card game of Spoons - with chop sticks after the meal.

Christmas in a non Christian country is an odd experience. First it isn't a holiday. Duane's company take it off by most don't. Many people worked a regular day.  This was good when I realized that I didn't have enough bowls for everyone and Duane walked over to the store to buy more.  Its not a holiday from school, in fact the semester ends in January,  Kenny is taking finals this week.  The teachers who have the foreign students usually excuse them for Christmas day but the Chinese students go to school.  China loves to decorate though so there are plenty of fake Christmas trees around.  Our building put a big one in the lobby and on Christmas day we had a very skinny Santa handing out candies.   The stores all have a few decorations and window displays. Some window displays use an orange-red which to the "trained eye" doesn't say Christmas at all.  There is no mention of Jesus in this and the young people just think its another day to get a present.  Most Chinese families don't actually give presents but the young people are pushing the idea. (of course).  On the other side, New Years is a three day holiday Jan 1-3.  However, as is China tradition for several other holidays,  you get to work Saturday and Sunday after to make up the days off. 

All in all, it was a nice Christmas Day, and I was happy to have a crowd.

Jintian (today)  November 8, 2012

I have been in Chengdu almost 3 months.  Wow it seems both very long and very short.  We just received our sea shipment now everything we packed from home is here. As you can imagine what you think you will need and what you do need are not always the same.  We are in a very large city so if you hunt long enough you can usually find what you need.  In this city of 14 million there is no yellow pages.  In fact most shops are small, and family owned so there are no websites.  And of course if there were they'd be in Chinese.  This means you get things done by word of mouth.  When you need a key made for example, either you recall seeing a shop in your travels or you ask everyone you know if they know a key maker.   Everything you do is the same.  So you may go half way across the city for a service in very bad traffic.

The Chevron Spouses (that is males and females) have a wonderful network and have been so helpful in getting settled.  They provide starter kits of dishes and kitchen ware while you are waiting on your shipments and have pages of information on cleaners, hair salons etc.  There is also a Chengdu International Women's Club here that functions much like a newcomers club.  There are families living here with a number of multinational companies Chevron, Shell Oil, Volvo, Boeing as well as the US Consulate is here. Plus all the University's hire English speaking natives as teachers and there are a lot of people here with various NGO's and religious groups.  There are several international school corporations here, Quality Schools International, and Leman are here, I think they are both from Europe. All tolled there are about 8-9,000 westerners in town.  But you really don't see them often.  And it is still common to run into Chinese who have never seen a westerner. (Laowei, foreigner).

Duane and I went to a Murder Mystery Dinner set in the 1920's. Duane was a gangster, cal you tell.  I was a reporter.  This was a fundraiser for Hopeful Hearts, an organization that pays for heart operations for children. Healthcare is not free here.

There are many many funny attempts at English on signs,  I need to start taking pictures.  At the same time, I am always so grateful that they have made the effort as the communication issues are really frustrating.  If I were in a country using the traditional roman alphabet, I would type the words into google translator and get a close idea of what was intended.  Here I cant do that.  So my appliances, my tv remote, the heating and air conditioning, everything - has symbols I cant understand.   When I go to the grocery, I search for those few items that have more than chinese on the label.  I feel very triumphant when I find the things I need.  In fact that has kind of been my attitude towards most of the challenges.  That I will figure out a way to make it work.    I couldn't find teriyaki sauce so I found a recipe, hunted down the ingredients and made my own. I cant find sour cream so Im making my own.

 A nasty food experiment.

 When a baby is a month old, the family throws a Full Moon Party. Duane's coworker invited us to the party for his new daughter and her cousin.  Duane was a happy man holding two little girls.  She cried when I held her. Ha!

Well this seems plenty long so, I'll sign off.  Love and Hugs, to all.