The Misconception about "Made in China"

Having left China 5 years ago after I graduated from medical school, I still find that I carry a few of those Chinese "sensibilities"with me. You can't really expect to live somewhere for 6 long years and not be changed by it. Now that I'm back home, I've noted a great proliferation of Chinese people in Kenya, considerably outnumbering most other non-black foreigners. In fact, I've seen situations arise where whole grocery store signs and even billboard posters are written in Chinese characters (hanzi). This latter item is a cause of great concern, especially since it signifies that the Kenyan government has, as usual, retreated to its laissez-faire approach to dealing with important issues. But, I digress, that's a matter for another time and place.

I was in the city shopping for some pants recently. Being the "old-school" fellow that I am, a  fervent fan of Dockers, and someone who despises the ultra-tight chinos that seem to be all the rage these days, I was basically shopping for Dockers, or whichever good khakis I could find. I remember the experience, particularly because of this one seller at a shop in Moi Avenue. From our interaction, I learnt that,

1. Dockers are no longer the in-thing, and thus they no longer stock them
2. His khaki pants were of such high quality that he was willing to charge the premium price of sh. 6000 (roughly $60) for the pants.
3. These were not Chinese-quality pants

Lord knows I didn't end up buying the pants at that store. Sure, I was downtown, but the ambiance of the store and the pants themselves didn't exactly seem to reflect sh. 6000 worth of value. If I was being generous, I wouldn't have parted with more than half that amount. However, the lasting impression from that conversation was that "Chinese-quality" jibe, which, in light of all my experiences, is certainly undeserved.


China for me was a hodgepodge of experiences, especially in the beginning. I remember going to the country with the mindset that things would be cheap and affordable; the agent who'd helped me get into school had assured me that I could really just rock up and pretty much just buy everything I needed when I got to my destination in China. Of course, someone had forgotten to inform him that Wenzhou is a very peculiar city; infinitesimally small, by Chinese standards, but renowned throughout China for its entrepreneurs. One other thing about Wenzhou was that things were quite expensive. I remember my friend once discussing how she went out shopping with her mother in the city, and they were shocked at how expensive things were. So much for the notion of "Made in China being cheap!"


Another fascinating aspect of shopping in Wenzhou was that you were expected to bargain for prices. Personally, I like a concrete price; don't want to feel like I need to have this relationship with a seller where I'd have to haggle over prices. If I haggle too much, then I feel like I've cheated someone out of their money; if I don't bargain enough, I end up "getting taken to the cleaners," and having my wallet suffer. Before becoming conversant in (Mandarin) Chinese, this would play out with the aid of a mere calculator; then later the phrases "Tai gui le!" (extremely expensive),  "Pianyi yi dian(r)" (make it cheaper) and "Da zhe" (Bargain) would be used often; and beyond even that, you'd end up having full fleshed out conversations with your seller.


Despite China being the world's factory (an image that they're currently working to change), it was also an issue getting things that you wanted. As usual, people stock things according to market demand. Therefore, getting the styles, sizes, colours that you wanted really depended on the sensibilities of the general populace. So, in the beginning, most of Wenzhou's fashion seemed like this tight-fitting K-Pop and Chinese celeb attire that I had never (and never will) come to embrace. Of course, after coming to understand the language, and thanks to word-of-mouth from fellow foreigners, I learnt where I could get different stuff within the city and without (Yiwu), and even where I could get things specially tailored. Moral of the story,

"If you know where to look for it, you will find it!" 

Some of my friends were certainly adventurous and had business ventures at home that they stocked from China. Once you understood the language, you weren't merely confined to the middlemen in cities like Guangzhou (an African favourite); you could actually travel to far-flung areas where you could personally liaise with factory owners and get the goods prepared as per your exact specifications. (Imagine my surprise at being able to have Kitenges - an East/West/Central African staple of fabric - tailor made at a Chinese factory in the middle of nowhere). In addition, China is all about volume. Sure, you only wanted a few hundred 'whatevers' for your store, and they'd give it to you at a good price; however, if you upped the volume to 500 or even a couple of 1000s, there'd be a drastic drop in the item price. Take home message,

"Don't be afraid to buy in bulk...a massive amount of bulk!"

One last fascinating aspect of China is that there is varying quality of goods. Initially, my friends and I came up with a scale for the range of qualities that existed: (in ascending order)

1. For African countries and other less-developed areas
2. For the domestic Chinese market
3. For export to the United States and prominent European countries

So, there were chances that you could end up with say US-export bound goods, but you would pay for them at a premium. Reflecting back on my early shopping experiences at Wenzhou, I remember this one time when I walked into a Li-Ning store looking to buy some sneakers. A friend of mine (Dr. Michael) had intimated that Li-Ning was probably one of the best Chinese brands, and I decided to check it out for myself. I remember asking if the price could be lowered on a certain pair of sneakers, and the seller's response was simply,

"No, that won't be possible. However, you can walk on over to those stores over there and you'll be able to get shoes at the price that you want."

Finally, a concrete price! Someone so confident about the quality of his goods that he'd only sell them at one price! It was like a breath of fresh air.

Thus I had to rework some of the notions I had developed while living in China. There were in fact even premium products made specifically for the Chinese population, and Li-Ning became one of my go-to brands. Dealing with sellers clarified things further. For instance, you could be trying to buy a specific wrench/spanner; you'd find that the seller has 3 similar looking items, but differently priced; upon inquiry, he'd be very honest and let you know that the spanners are of varying quality: the 1st would probably only be good for a year; the 2nd he could guarantee for roughly 3 years, and on the 3rd he could give you a lifelong warranty.

Therefore, the weakest link is the actual buyer. People decide to buy the cheapest item on the shelf, and then charge a premium for it as if it was made of gold. Imagine my shock on coming back to Kenya, and finding goods - purchased in Guangzhou at one-third the price they would go for in Wenzhou - being sold at 3 times the going Wenzhou-rate in Kenya! People are busy making excessive profit margins, but they're undercutting the quality at every turn.

I've already stated how disappointed I am that Chinese would pull off this kind of tactic with regards to quality, but as long as there's a sucker around to buy this kind of stuff, who are they "to look a gift horse in the mouth?" The responsibility really lies with our sellers/distributors and government regulatory bodies to make sure that only the best things are being brought into the country; they need to be looking out for us all, and getting us the best in terms of deals and quality.

China has another task altogether. It's understandable that we all have to start from somewhere. People nowadays might not remember the time when "Made in Japan" was considered inferior in all aspects  (Akio Morita's book about SONY - aptly titled "Made in Japan" -  was an eye-opener). I also remember the time when Korea's LG used to be known as "Goldstar" (and I wasn't rocking with anything Goldstar-affiliated). Everyone has to go through the phase where they copy what's hip-and-new, but then they eventually have to innovate and progress; make their own mark in the world. Eventually, China will get there, but it would help if they shelved these half-baked poorly made Chinese products, and sought to make "Made in China" a singularly premium product. I think the world would be better off for it.

All in all, there's a lot going on in all the variability concerning "Made in China" products; but in my honest opinion, the biggest problem is the local/domestic sellers who are being underhanded. Until they understand that "Cheap is really Expensive", not much is going to improve. 

God Bless.

Ant-Man and the Wasp "Spoiler-Free" Review

Seems that it's no longer a rarity for me to wind up all alone in theaters anymore. In just my last two recent outings - The Incredibles 2 and this time around - I've been the only soul in the theater...and I love it! Thank God (again) for the early morning showings

Time to get back into things Team Marvel after the devastation witnessed in Avengers: Infinity War. This takes place about 2 years after the events of Captain America: Civil War, and just prior to the events of Infinity War. This catches up on the events of one of the wild cards from Civil War (Hawkeye still somewhere in the ether) and the story lets us explore the dynamic of Scott Lang's life after the fallout. He's under house arrest, has a better relationship with his family (even with his Ex's current husband) and he and his crew of delinquents (Luiz, Dave and Kurt) have set up a security firm. The only thing that's not working out for him is that Hank Pym and his daughter Hope have basically abandoned him since his little dalliance with Cap. He's basically going through the motions so he can get done with his house arrest stint and revert to living a normal life. That all changes when he somehow ends up quantum-entangled with Janet Van Dyne, the previous incarnation of the Wasp and also a Pym; so this movie sets out to unlock the secrets of the quantum realm in order to free her. Since Hank and Hope have had to go off-grid, not only do they have the FBI on their backs, but their black market dealings have invited a two-faced seedy character (Sonny Burch) into their lives. As if that wasn't enough, they have the ethereal "Ghost" hot on their trail for the keys to the quantum realm, which might be her only way of finding a solution to her condition.

I really enjoyed this movie for much the same reason that people are giving it so much grief. First off, the stakes are not as high in this movie, which is fine; this wasn't meant to be another movie in the tune of Infinity War. It is so diametrically different from the first Ant-Man that they can barely be compared: the first movie was a wonderful heist film mixed in with some industrial espionage in the same right as the first Iron Man; the sequel keeps matters close to the chest and seeks to close the Janet Van Dyne arc that it started in the first movie by having us explore more profoundly the concept of the quantum realm (which comic book/cartoon fans would recognize because Hank Pym has used it to house criminals).

Another complaint about this movie is that Marvel has yet again given us a movie with a weak villain. Well, to truly expound on that, this movie has no real villains. (to-may-to, to-mah-to!). In my opinion, the movie doesn't suffer one bit from this turn of events. Sonny Burch (Walton Goggins) is a villain in a portrayal similar to Iron Man's "Justin Hammer"; to him, this is all about business and he's just trying to land the biggest score. Ghost (Hannah John-Kamen) is a most unfortunate character who's merely out for her own survival; her problem is that "the end essentially justifies the means" in her mind. Considering how rough her childhood was, you can't exactly blame her for not truly developing a sense of empathy. The collision of all these competing interests still provides enough conflict to elegantly propel the story forward. (I would argue that Captain America: Civil War also played around with the villain in the same way. The only true villain they had was "Crossbones", and after his speedy exit we get "Baron Zemo" whose machinations only revolved around him setting up conflict within the heroes' ranks).

The characters from the last outing are all present here and mostly share the wonderful chemistry set up in the first Ant-Man. Thanks to the fallout from Civil War, Scott Lang's relationship with Hank Pym and Hope gets set back to zero, with even more disdain than he faced last time around. Hope sheds her business suit and has more screen time as her alter ego, and she gets to more intensely utilize the combat skills that she previously took out only on Scott. Thankfully, they also got rid of her horrific haircut from the first movie and allowed her to loosen up a bit more. Among the newcomers, Hannah John-Kamen nicely captures the other-worldliness of the antagonist; Laurence Fishburne's turn as Bill Foster was also a pleasure to behold - part nemesis to Hank Pym and part father figure, his stake in the film was relatable. Randall Park plays a pretty by-the-numbers FBI agent Jimmy Woo; though, I instantly recognized him as the patient from House MD who tried to circumcise himself with a pair of box-cutters, but I digress.

As usual, the visual effects are a feast for the senses. The alternate shrinking-growth melds really well with the fighting and looks just as believable as it did first time around. Ghost's phasing ability is so gloriously rendered that it would be considered a cool superpower, if it wasn't for the fact that it causes her a great level of pain. This movie also did its bit of scientific research and you will be impressed by how well they are able to represent the cuddly yet deadly tardigrades.

This movie is a great addition to the MCU and something lighter for you to get into after Infinity War. It is not mere filler: it is a more down to earth family-oriented movie. Enjoy it for what it is, Grade A in my books.

The Things That Medical School Won''t Teach You (9): The Ick Factor

I was just thinking about one recent night while I was on duty at the Casualty Department. As (bad) luck would have it, I ended up with the kind of patient that the nurses swore that I attracted to the department: someone with Per Vaginal (PV) Bleeding. Unfortunately, we didn't have ultrasound services operating at night, so we either had to send such cases out to a place where they could get urgent ultrasonography done, or tough it out with the little that we had at hand (good ol' back-to-basics medicine).

On this one occasion, I remember the patient being really embarrassed; it wasn't because of the invasive procedure that I was performing (which is the usual suspect); rather, she was embarrassed because she felt she was tasking me with dealing with this particular unsavoury medical malady. I just calmed the patient down, and let her know that this was basically what I had trained for, and she had no reason to feel ashamed. (I didn't mention that I'm also paid to do this kind of stuff, but money isn't exactly the thing I'd highlight as a saving grace).

This whole incident made me think about exactly what I've been through to get to where I currently am. As if on cue, the first memory that popped in my head was an incident from my internship - the surgical rotation to be exact. 

My rotation consisted of 4 sections (Male Ward, Female Ward, Theater, Casualty) which the 4 interns of the surgical department rotated among weekly. This just happened to be my first week on the Casualty rotation; so, it's Sunday morning - 8 AM-ish - and the Casualty Department is pretty nice and quiet...until it isn't anymore! They rush a patient in who's had a traumatic amputation of his right forearm. There's a tourniquet in place, but still, it's one of the more macabre things that you could witness in a day. Story goes that the gentleman set about using his chaff cutter early in the morning (before even 6 am), and while he was at it his right long sleeve got pulled into the machine, and his forearm followed thereafter. Thus, here he is before us, missing more than half of his forearm.

Dastardly as things might seem, you only get a few seconds of pause before instinct kicks in: get IV access, get vitals, draw blood for tests including blood grouping and cross-matching, shred clothing, run fluids to get his pressure up, get the patient warm and covered, call up theater to have it prepped for an emergency and then call up the Consultant Surgeon so that he can get down to the hospital pronto. Some of the steps actually overlap and are not so easily delineated in practice. So we finally get the man into theater to basically finish off what the chaff cutter started. (Unfortunately, the limb was too mangled and we were missing the other half which the chaff cutter must've  made literal mince meat of).  We deal with the veins and arteries, then we take care of any visible nerve endings, cut them as far back as we can; next we prune the bone fragments, remove the traumatized flesh and shape things up so that we can have a nice stump. All this is important because we want to improve his chances of being able to be fitted for a prosthesis later on, if the opportunity avails itself.

When surgery's over, he gets wheeled out into recovery, and we can all take a collective breath; and then, in one of those very weird medical occasions, we end up with a light moment. The anaesthetist had used Ketamine to anaesthetize the patient, (clinicians recognize Ketamine as "truth serum") so when he wakes up he's basically bawling about not being able to pay for the weddings of his unmarried son and daughter; he goes into detail about the whole thing (most of which goes over my head because he's speaking in Kisii), but the theater staff translate some of it for me in the midst of their chuckling. As always, my Consultant could be trusted to deliver a scathing remark, and even this time he didn't disappoint, "Why didn't he just leave that task for his workers to perform? This was just pure greed!"

By the time I met him in the ward, the Ketamine-induced reverie had ended, and he was stable. It might have seemed very heartless of us, but after the shock of the experience, I'd rather settle for a wailing patient than a dead one. On the plus side, we'd guaranteed that he'd live another day, such that he'd be able to thank his lucky stars, or alternatively be able to mourn for a lost limb.

I remember running into him at the hospital a couple of months later when he was coming to the hospital for physiotherapy, and he was in a jovial mood. I also ended up treating him for some nerve issues later on. It's always a strange experience when a patient who's had a limb amputated tells you they can feel their digits - in this case "Fingers" - itching or even hurting (the marvels of the human body). All in all, it was good to be able to glean a positive outcome out of such a bad situation.

Against the backdrop of such an experience, it should be clear that any medical professional before you (of sound training) is an amalgamation of many unique formative experiences, some of them quite terrible indeed. However, it is this very training which helps mould "book smarts" into actual experience, instinct and second nature. Many a time, I'm quick to remind interns that they haven't really had a true internship experience until they have intimately interacted with all manner of substances that a patient's body can produce. If your personal effects have not come into contact with Saliva, Blood, Faeces, Mucus, Urine, Pus, Meconium, Sweat, Vomit in any of their variations, then you've had a pretty sheltered internship. 

The more I think about it, medical practice sounds a lot like Motherhood. I doubt any mother would deny that they've had to weather all the aforementioned substances in taking care of their families; in our case, the only difference is that many a time we are doing this stuff while taking care of complete strangers, which might make it harder.  

The medical practice involves getting accustomed to a cornucopia of sights and sounds (even smells!). I'm reminded of my stint at Messiah College when I took an elective Anatomy class, which had somewhat of a tricky time slot; my only choice at getting a meal was either to eat right before the class, or grab a meal after it ended at about 5pm; the first time I had that class, I might have skipped the instructor's reminder to change gloves often because the smell of cadaver-infused formaldehyde seemed to leach into the gloves and become one with my skin. I vividly remember that I grabbed a burger as my late lunch that day, and it took sheer willpower to finish it as I battled my sense of smell to get through with the deed. Wouldn't have taken much imagination to have me reckon that I was sinking my teeth into some good ol' cadaver-du-jour. Fast forward a week or so later, and we'd all gotten so used to dissecting the cadaver, I'm pretty sure we could've had a meal in the classroom (if the situation had called for it).

My instructor - Sheri Boyce - told us that it wasn't unusual for some people to end up forgoing some specific meals after spending some time in the class. There was just something about the consistency of  roast beef or spaghetti that strikingly resembled some of what they were dissecting in the cadaver, so they could never bring themselves to sample those foods again. (Glad to say, I had no such problems, even in light of the "hamburger experience").

However, nothing reminds you about how much you've changed, until you interact with "normal" people. I don't quite remember how it happened, but one day a group of art students popped in to sketch the cadavers. Apparently they had the sentiment that sketching the human body in its most raw form was the pinnacle of an artist's experience. I guess they weren't prepared for what that raw form would look like once you'd peeled off some of the layers. All I can remember is that they came in with their sketch pads raised and started to watch us work, but for such an animated crew (some of whom I had interacted with) they were unusually quiet. Next time I peeked over, their sketch pads were down by their sides, and they were just staring, their faces a few shades paler. Suffice it to say, my attention was more fixed on the cadaver, with all the sharp instruments and sharp shards of bone posing quite the imminent risk, so I never really quite noticed when the artists disappeared, but when my attention shifted to them later, they were all gone. Takes a really strong constitution and some getting used to to handle some of this stuff!

I don't think it's a mere coincidence that one of the words I've used most often today is experience; that really is what makes all the difference. First time experiences need not be so pleasant with regards to half of this stuff because it really is a steep learning curve. I'm reminded of

1. a few medical school colleagues who would go faint at the thought of having their blood drawn or at the sight of blood; (always astounded me how afraid some medical staff are of needles!)
2. that one time I had a nursing student hold a child as I was attempting to perform a lumbar puncture (spinal tap). Must've been something about the novelty of the experience and him bending down to hold the child (maybe dehydration), because a minute or so afterwards, he felt light headed and I had him go sit down on a nearby bench where he promptly passed out.
3. drawing blood from a patient in the casualty department, and having his relative (who was standing by for moral support) suddenly collapse in a heap onto the casualty floor. Oh the joy of having one emergency suddenly turn into two!
4. the smell of singed flesh when first encountering the diathermy. Nothing quite prepares you for the sensation of burnt/roasted human flesh when someone uses the diathermy to cauterize tissues or to cause clotting.
5. dealing with any sort of perforated gut contents. You'd think the patient was sick enough when you reviewed them in the wards, but when you get them on the operating table and open them up, the most nefarious of smells will assault your senses. It's like literally being immersed in a septic tank. We always joked that the operating room was done for the day after such a procedure. Would need thorough cleaning and the grace of God before another procedure could happen in there again.
6. standing in during a delivery, and guiding the mother on when to push during her contractions; this one time though, the mother, being uncooperative, grabs my arm instead of her knee, promptly painting my coat sleeve with meconium. (Sadly, civilians seldom believe me when I tell them that child delivery is not the "sanitized process" they believe it to be, especially with regards to the mother's psyche)  

Fortunately, medical training is a marathon, and not a sprint. Ideally, a good superior will not hold initial uncertainty and inexperience against you, but will use it as a teaching point to enable you to gain the confidence you need to become a skilled clinician. (Perhaps it might even allow them to reminisce on how they were when they started out); and it is always an opportunity to derive a much needed laugh at the comedy that arises.

"We learn to do something by doing it. There is no other way." – John Holt

As usual, people should revel in the fact that "their medical friends" are all a little insane; but then again, someone would have to be slightly unhinged to do what we do on a daily basis. May your little bit of insanity bring stability and healing to this precious world.

God Bless