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..

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.

NEW THING OF THE DAY

Sitting in natural spring water at 46 degrees

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. 

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: http://prezi.com/fq0fv-d0bfcf/?utm_campaign=share&utm_medium=copy&rc=ex0share

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 http://prezi.com/c2mszczmtnas/?utm_campaign=share&utm_medium=copy&rc=ex0share)  - 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)

Trepidation in Taiwan

Risk of the Day

Earthquake.

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.