Day 8: Visit with a Chinese Dietitian and Night Market Food

Day 8 started off as the day from hell.  It was my first day getting some work done in China and when I went to open a powerpoint file I was working on, my entire Office Suite crashed.  I have no idea what happened.  It worked fine in Japan, but when I opened it in China, all I got were errors and no way to update.  Add in limited access anyway because I was in China and I was really at a loss.  Panic mode kicked in, but I will say the tech support lady at Kaplan that I chatted with was extremely helpful and suggested I try Kingsoft, a knock off version of Microsoft.  Needless to say, this worked extremely well, although I have no idea if I ended up with viruses along the way (because it isn't my normal computer and it currently isn't in use, so I really don't know, and yes I know I need to check on that).  

After my crisis was resolved, I quickly got ready to head all the way across Beijing to the 304 Hospital.  No, I wasn't sick or injured.  Actually, this is a military hospital and I as headed there to meet up with a recent graduate from a nutrition program in the US who now works back in her home country, China.

I took the subway there, which was actually a much nicer experience than I had anticipated.  Chinese tourists tend to be very pushy and don't know how to line up properly.  It is frustrating to say the least, but as it turns out, in more of a normal or 'home' setting, they don't behave as badly as you would expect, or as some tourists give the appearance of (speaking from my own experience traveling and being in places with Chinese tourists in places outside of China) and the subway was not as dirty or run down as I had expected.  This was a pleasant surprise given my already crappy morning.  No one pushed to get on or off, people were aware of people around them, and people pretty much kept to themselves.  This was definitely a good thing because I had a 40 minute or so subway ride.

Anyway, backing up to my walk to the subway station.  I got to pass by the same Cathedral (I looked it up online, it is a cathedral) we saw lit up the night before.  Even though it was a Monday morning there was a bride outside having pictures taken.  You can see a large crowd of people just in front of the door.
Also on my way I passed by these gates that signaled the start of a food street.  I believe this is the one that is called Wangfujing Snack Street.
Since this is primarily a busy spot at night only a few vendors were open and others were getting set up.  But that didn't stop me from taking a peek.
These candied fruit sticks are a very popular treat.  This is called Tanghulu.  I didn't try any, not just because it was early in the day, but some of the fruits would have had skins and I was trying as much as possible to be cautious given the water situation and concern with food safety.
But they definitely looked tasty!
My next stop was the hospital.  It was easy to find, which was also a good thing because I was still a little stressed from my morning.  When I arrived at the gate I was met by the "dietitian" (in China she is now considered a doctor and practices nutrition, which was something I remember from my first trip and thought was interesting but didn't fully understand at the time, more on this later- they don't have the same RD credential in China).  She was with her boss, an active duty military member that served as the clinical nutrition manager.  She seemed very nice, but of course I didn't really get to speak to her directly because she does not speak Chinese.  The dietary staff joined us for lunch and the kitchen prepared a huge meal for us to enjoy in the VIP dining area of the hospital.  This was above and beyond what I was expecting and quite honestly was really awesome.  Of course they thought it was funny I wanted to take pictures of everything, but they understood and would stop the spinning lazy susan to let me have a chance to take a picture.

This dish was probably my favorite.  I don't usually like celery so I was surprised that I liked this so much.  I think because it was cooked it was different. I just don't like the raw, stringy stuff.  This was tofu skin (yuba) with celery and carrots.  It was so good!
These are tomatoes with sugar.
Some broccoli with garlic, I think.  Since I wasn't expecting all of this I didn't actually tell them I don't eat meat until we were in the dining room.  In just a few minutes they had all of these wonderful vegetable dishes pouring out of the kitchen.
I believe this was duck.  Beijing is very well known for it's duck dish, Peking duck.
Here is some tofu in sauce.  Also very delicious.
This was one of the best treats.  Yogurt is a big thing in Beijing.  I know, I had no idea either, even though I read it before we went, it still didn't click until I saw it sold just about everywhere.  This yogurt was homemade by one of the dietary staff members (or maybe she was a kitchen employee).  It was amazing!  Like seriously amazing.  If I could make yogurt that tasted like that at home I would do it all the time and eat this every day.
They gave me some honey to drizzle on top.  Yum!
More vegetables!  I was so glad to have all of these vegetable options.
I think this was another meat dish.
I am pretty sure this was meat-free but it looked weird so I am not sure I was brave enough to taste this.  Let's just say I don't remember eating it.
This was the kung pao chicken.
This came out served over a flame to keep it cooking.  This was vegetables with octopus.
This is a bread, fried, a little like naan.
These were steamed buns with red bean paste inside.  Yum!  And that was it for me delicious meal.
Her boss was curious about what I do in my job and how I practice nutrition so I described some about the WIC program and what kind of counseling I provide.  I genuinely felt welcomed into their facility and despite the language barrier I think they were happy to have me there and interested in learning about what they do.  

Next the "dietitian" took me to see what some of the rooms looked like and to visit an ICU.  One of the reasons why I planned this visit was because 9 years ago when I went to China it was part of a continuing education program that last 3 weeks.  We toured hospitals and some Traditional Chinese Medicine (TCM) hospitals and pharmacies, along with a nursing home, and some kitchen visits in restaurants and hospitals.  It was very cool.  But I was curious to see what had changed in 9 years.  I found that many things were similar, but the one change was that nutrition care had advanced.  It was definitely progressing, but there were still areas that could be improved.  Mostly from an educational standpoint and educating the public in general about healthy diets, primarily less rice (where diabetes is concerned especially) and less sodium in foods.  

I picked her brain for a couple of hours and I learned a lot.  But the one thing that was good to hear was the explanation about her being a doctor.  I remember last time we asked about RDs to the nutrition person at a hospital.  We were told they were a doctor.  We were told doctors provide nutrition.  I believe this person was also a pharmacist and they were in charge of tube feedings.  But they were a doctor.  I didn't really understand this at the time (and honestly I don't know if I fully understand it now, but I think I have a better understanding).  Basically, once you finish the prerequisites you take an exam, like a credentialing exam, and when you have passed, you become a doctor.  A full doctor, like a medical practitioner, except you practice in nutrition.  You are fully considered a doctor.  The girl I was with was able to submit her school information from back in the US and then (I think she said she had to) take the exam and now she is considered a doctor and practices nutrition.  Interestingly, she did not do an internship and in the US she could not take the exam to become an RD because of this, but I definitely feel that her US training in nutrition science makes her qualified in China even without an internship.  It seems like she has learned a lot on the job.  At her facility only her boss and her would be the equivalent of a dietitian.  The others would be more like diet techs.  It seems like most of the focus is for nutrition support.  There is little else with medical nutrition therapy or the use (and education) of therapeutic diets.

One thing that was interesting was that regular hospital rooms had 4 beds and private rooms or VIP rooms were 2 beds.  That's double what we have in the US.  The ICU was also very different.  At my last facility each ICU bed was in a private room and fully enclosed.  Here the patients were all together in one open room.  No one in the ICU I visited was on a ventilator, so that was also different from the ICU setting I was used to.  I saw one patient on TPN.  It was hanging in a glass bottle.  I have seen that before for the lipid in a TPN but not for the entire TPN and seeing glass in an ICU was something I hadn't seen in a long time.  I think most IVs are using the bags, but of course I haven't worked in the clinical setting in 5 years now (wow, 5 years ago as of June 12th was my last day of clinical before moving overseas).

I didn't see anyone with a tube feeding running, but I was able to see this bag of a formula powder that can be provided for use as a tube feeding.  It can also be drank and I believe for this patient it was being orally consumed.  It was considered a complete meal and had all the food groups mixed up (it reminded me of the tube feeding product in the US known as Compleat).  The family of the patient brought this in for the patient.
I have no idea what anything is, but I thought it was cool that I got to look at the nutrition information for the formula.  Yeah, I know, I am a nerd!  This is what I did on my summer vacation!
After my tour of some of the facilities we went back to her office and I asked a ton of questions about her time in the US studying nutrition, places she visited in the US, how nutrition practice works in China, and how she types her notes.  She showed me her computer documentation system but of course it was in Chinese so I couldn't read anything anyway.  They don't do the PES statements and ADIME notes like we have in the US, but since she studied these she knows how to model her notes this way.  It seemed like the documentation and charting was a lot less involved than what we have in the US, but it seemed like she was doing a good job including things in a similar manner.

After about an hour or so we headed to a department seminar that some ICU doctors were attending with the nutrition staff.  They were having a guest that was way cooler than me.  A Chinese nutrition researcher that just finished a year at Harvard was presenting a discussion on the role of the RD in patient care and how early nutrition interventions lead to better outcomes for patients.  Some slides were in English so I was able to read those.  She described to the doctors the nutrition care process, calculating energy needs, the PES statement, and the role of the RD (as an American RD would practice).  It was fun because I got to be an example of an American RD and although I didn't understand what they were saying, the researcher talked about RDs and then pointed to me.  I guess I was there on the right day to serve as a real life example.  The presentation also discussed the role of using oral nutrition supplements to complement the diet in boosting calorie intake and reducing length of stay.  The girl I was visiting at the hospital served as my translator and from the information  or pictures on the slides, I could follow along.

Overall this was an amazing experience and I am so glad I was able to plan this day at the military hospital with a US trained nutrition professional working in China.

After my visit I went back to the hotel and met back up with Ryan.  He had been out all day visiting business with his class trip.  Our first stop that evening was to the night market with all of the crazy food stalls.  This is less traditional Beijing food and more of a display or weird, wacky, and downright gross street foods.

Here you can see the long street lined with food vendors.  Thankfully they were open to people taking photos without buying things.  Some vendors get mad, and that is understandable, but as someone who is curious and thinks things look but but doesn't eat meat it is nice to have people who let you freely take pictures.
Couldn't even tell you what this is if I tried to guess.
Giant shrimp on a skewer.
A variety of things on sticks.
Even stranger things on sticks.  Octopus, shrimp, and what looks like some kind of tiny lobster.
Crabs!  I was tempted but really had no idea how to go about eating this while walking down the street.
Yeah, that's some weird stuff.  I think the far left may be a bat...or a rat?!?!
These are traditional Beijing treats.  This is a meat filled bun and I believe this is pork.
These were definitely the cutest thing for sale on this street.
Eggs on a stick...this was definitely a new "sticked" item for me.  I have seen a lot of things put on a stick, but this was really interesting.
My guess is that these are desserts.
Nice looking fruit skewers.  The fruit that is dark red-purple in the front is a Chinese fruit known as a bayberry or yumberry.  I didn't try any because I wasn't sure how to eat them and I was worried about the safety of it (supposed to avoid fruits with skins- unless washed in bottled water).  If I see these in Taiwan later this summer I think I will give them a try.
Scorpion on a stick anyone?
How about starfish on a stick?  I wasn't there, but someone in our group tried one and said it was terrible.  The consistency was not good, as you would imagine.
I came very close to trying this out.  I am pretty sure this was just grilled tofu.
I love these!  I really should have tried them.  These are Korean rice noodles.  I suppose this could be the Chinese version, but I have only had them in Korea and when I asked the guy selling these if they were Korean rice noodles he said yes.
More strange things on sticks.  This time we have some snails.
After walking around a little more we went to a nearby mall and tried out Lime Thai Restaurant.  It seemed to be a popular choice because a few others from our group were already enjoying dinner inside by the time we arrived.
Ryan started off with the papaya salad.  The last time I had this was in Bangkok and spicier than anything I have ever had before, so I passed on trying his out.
It may have been a Thai restaurant but we still ordered the Chinese beer.
For dinner I had prawns and vermicelli, which was very good.
Ryan had the pineapple fried rice, which is one of my favorite dishes.
Dessert was back at Moon Papa because, well, we love frozen yogurt!  This time I tried banana with cookies.  Yum!
On our way back to the hotel we passed by the bustling cathedral and noticed a few funny sights.  One was an old man out in pajamas (like full on silk pjs that were undeniably pajamas) and slippers and a Chow Chow groomed like a lion (with no noticeable owner and not on a leash).  But it was extremely adorable so I took a few pictures.
You can see all the people in the background dancing.  It looked like so much fun.
So cute!
Here is the man in pjs with the dog.
That wraps up another fun filled day in Beijing.

QUESTIONS:  Have you ever taken an education vacation/tour?  Have you ever arranged a visit with someone that has the same profession as you?  What is the strangest street food you have ever eaten? What is the craziest grooming style you have ever seen on a dog or cat?

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