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   <title>Postcard from Southeast Asia</title>
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   <id>tag:blogs.phillynews.com,2007:/inquirer/postcardfromsoutheastasia/62</id>
   <updated>2007-08-30T14:48:30Z</updated>
   
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<entry>
   <title></title>
   <link rel="alternate" type="text/html" href="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/2007/08/_lunch_in_hanoi_on.html" />
   <id>tag:blogs.phillynews.com,2007:/inquirer/postcardfromsoutheastasia//62.3056</id>
   
   <published>2007-08-30T14:47:37Z</published>
   <updated>2007-08-30T14:48:30Z</updated>
   
   <summary> Lunch in Hanoi on Wednesday. Journalist Son Phan, who is from Vietnam, shows us how to cook fresh herbs with sauteed fish. The fish was brought to the table in a pan atop a nifty traditional cooker....</summary>
   <author>
      <name>Frank Kummer</name>
      
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      <![CDATA[<img alt="139-3935_redux_IMG.jpg" src="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/139-3935_redux_IMG.jpg" width="400" height="300" />
 Lunch in Hanoi on Wednesday. Journalist Son Phan, who is from Vietnam, shows us how to cook fresh herbs with sauteed fish. The fish was brought to the table in a pan atop a nifty traditional cooker. 
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<entry>
   <title>No stop signs </title>
   <link rel="alternate" type="text/html" href="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/2007/08/no_stop_signs.html" />
   <id>tag:blogs.phillynews.com,2007:/inquirer/postcardfromsoutheastasia//62.3053</id>
   
   <published>2007-08-30T11:02:13Z</published>
   <updated>2007-08-30T13:55:26Z</updated>
   
   <summary>There appear to be no stop signs or stop lights in Hanoi, so the only thing that makes the hordes of honking motorbikes slow down is the prospect of a collision. The only thing that makes them stop is a...</summary>
   <author>
      <name>Frank Kummer</name>
      
   </author>
   
   
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      There appear to be no stop signs or stop lights in Hanoi, so the only thing that makes the hordes of honking motorbikes slow down is the prospect of a collision.

The only thing that makes them stop is a collision.

This makes crossing the street fairly difficult, at least the first time you do it.

But it&apos;s also one of the many things that makes this developing city, a place with such painful American memories, exciting, fascinating and terrifying.

      
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<entry>
   <title></title>
   <link rel="alternate" type="text/html" href="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/2007/08/_a_view_of_hong.html" />
   <id>tag:blogs.phillynews.com,2007:/inquirer/postcardfromsoutheastasia//62.3040</id>
   
   <published>2007-08-29T18:03:47Z</published>
   <updated>2007-08-29T18:04:35Z</updated>
   
   <summary> A view of Hong Kong harbor from the Princess Margaret Hospital....</summary>
   <author>
      <name>Frank Kummer</name>
      
   </author>
   
   
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      <![CDATA[<img alt="138-3883_IMG.JPG" src="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/138-3883_IMG.JPG" width="400" height="300" />
A view of Hong Kong harbor from the Princess Margaret Hospital.

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<entry>
   <title> Poultry &apos;wet&apos; markets sparkle</title>
   <link rel="alternate" type="text/html" href="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/2007/08/poultry_wet_markets_sparkle.html" />
   <id>tag:blogs.phillynews.com,2007:/inquirer/postcardfromsoutheastasia//62.3033</id>
   
   <published>2007-08-29T16:18:38Z</published>
   <updated>2007-08-29T17:26:06Z</updated>
   
   <summary> About the only wet part of the Hong Kong “wet” market, it turned out, was the freshly hosed-down textured tile floor. Even the third floor, where the poultry vendors were located, was conspicuously free of bird droppings or other...</summary>
   <author>
      <name>Frank Kummer</name>
      
   </author>
   
   
   <content type="html" xml:lang="en-us" xml:base="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/">
       About the only wet part of the Hong Kong  “wet” market, it turned out, was the freshly hosed-down textured tile floor. Even the third floor, where the poultry vendors were located, was conspicuously free of bird droppings or other icky stuff. Sure, there was bird poop in a tray under the bottoms of their cages, and the cages were stacked five or six high.

 But leave it to Hong Kong, the market seemed as hygienic as such a place can possibly be, right down to the dispenser of bacterial hand gel near the exit.

Senior Health Inspector Sin Chiu-hong, in a clean, white-shirted uniform, told me that every 25 days, the poultry vendors have a compulsory “rest” day. They cull (read: kill) all their birds, shut down, and the whole floor is cleaned and disinfected. They have to do this – even though their chickens are vaccinated against avian flu – or risk losing their vendor license. 

In addition, inspectors walk around every day the market is open, checking for sick birds. 

“If the chicken is sick, the crown turns purple and its nose runs, and it hides in a corner of the cage,” Sin explained.
      No wonder. That bird would be toast. Its, ahem, fluids and solids would be sampled, then it would be killed and laid to rest in a big green tight-lidded trash can. If its infection turned out to be H5N1 avian flu, all the birds from that market, healthy or not, would be toast. And if, even worse, the H5N1 infection showed up in a sick bird at another of Hong Kong’s 100 wet markets, then all the chickens in Hong Kong would be toast.

The last time a sick bird was found to be infected with the dreaded H5N1 avian flu was in 2003. 

But with all these precautions, Hong Kong’s fresh chicken biz has lost its pluck. About half of the 800 vendors who operated in 2001 have voluntarily sold their licenses back to the government, Sin said. In the market we visited, three out of six stalls were vacant. 

The woman I watched slaughter three birds operates her stall with her elderly mother. She laughed when asked (through an interpreter, of course) whether her own kids would carry on the family business. 

“Oh, no,” she said. “They don’t want to. And I don’t want them to.” 

Other floors of the market were no more exotic or chaotic than Philly’s Reading Terminal. The tangy aroma of cilantro hit me as I walked by tables piled high with veggies and fruits. To my surprise, the fish vendors’ floor had NO detectable smell. 

Why do infectious disease experts get so freaked out about live animal markets? Because that’s one place where flu viruses can jump from a duck to a chicken to, yikes, a human, maybe with a pig in-between. Actually, viruses don’t “jump” from one species to another; they shuffle their genetic material in ways that make them mightier than the immune system. But I’m way too sleepy to get into that right now. 

We journalists got up punishingly early today, Wed., and flew here to Hanoi. Saiful Islam (master’s in public health; reporter with the English service of Bangladesh’s national news agency) almost missed the bus to the airport. He has a little problem with punctuality.

“That was close. That was really close,” chided Susan Kreifels, our East-West Center program coordinator, raconteur extraordinaire and mother hen.

Here in Hanoi, we’ll see a wet market later this week. The Vietnamese version will not be so neat and nice, says native Son Phan, a reporter at the Saigon Marketing Weekly. 

   </content>
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<entry>
   <title>&quot;Wet&quot; market</title>
   <link rel="alternate" type="text/html" href="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/2007/08/wet_market.html" />
   <id>tag:blogs.phillynews.com,2007:/inquirer/postcardfromsoutheastasia//62.3013</id>
   
   <published>2007-08-28T16:47:51Z</published>
   <updated>2007-08-28T16:50:49Z</updated>
   
   <summary>On Tuesday morning, the vendor pulled three squawking, flapping chickens from a cage, tied each one&apos;s feet, and took them into the back of her stall at one of Hong Kong&apos;s &quot;wet&quot; markets. I watched as she deftly pulled back...</summary>
   <author>
      <name>Lloylita Prout</name>
      <uri>http://www.philly.com/mld/inquirer/</uri>
   </author>
   
   
   <content type="html" xml:lang="en-us" xml:base="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/">
      On Tuesday morning, the vendor pulled three squawking, flapping chickens from a cage, tied each one&apos;s feet, and took them into the back of her stall at one of Hong Kong&apos;s &quot;wet&quot; markets.

I watched as she deftly pulled back each bird&apos;s head, slid a cleaver across its neck, drained its blood into a coffee-can size hole in a giant metal drum, and plunked the twitching creature into the hole. The third bird uttered a strangely human-sounding cry as the blade sliced its neck.

Next, the vendor plunged all three fowl into a barrel of scalding water and used a stick to stir them like a witch&apos;s brew.

Finally, she put them in the de-feathering machine. They rumbled around while their soggy feathers extruded from a slot near the bottom of the device.

Naked, flacid and grey, the slaughtered chickens were ready for the customer.

In this day and age, I can&apos;t understand why many people in Southeast Asia prefer this so-called &quot;fresh&quot; chicken over boneless, skinless, packaged, refrigerated breasts at the grocery store.

But even though I found this slaughter unappetizing, not to mention brutal, it was not an infection control nightmare. Nor was the market the kind of launching pad for deadly pandemic flu that I had expected to see. At least, the Hong Kong market wasn&apos;t.

Tomorrow, I&apos;ll explain why.   


      
   </content>
</entry>
<entry>
   <title>Impression of Hong Kong</title>
   <link rel="alternate" type="text/html" href="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/2007/08/inquirer_medical_reporter_mari.html" />
   <id>tag:blogs.phillynews.com,2007:/inquirer/postcardfromsoutheastasia//62.3011</id>
   
   <published>2007-08-28T12:56:45Z</published>
   <updated>2007-08-30T17:30:34Z</updated>
   
   <summary>My first jet-lagged impression of Hong Kong on Saturday night (Friday morning Philly time) was that for a place that’s been civilized since about 200 BC, it is surreally new. We’re talking an endless vista of skyscrapers, most with utilitarian...</summary>
   <author>
      <name>Lloylita Prout</name>
      <uri>http://www.philly.com/mld/inquirer/</uri>
   </author>
   
   
   <content type="html" xml:lang="en-us" xml:base="http://blogs.phillynews.com/inquirer/postcardfromsoutheastasia/">
      My first jet-lagged impression of Hong Kong on Saturday night (Friday morning Philly time) was that for a place that’s been civilized since about 200 BC, it is surreally new. We’re talking an endless vista of skyscrapers, most with utilitarian post-modern design, giving the city a soul-less Blade Runner aesthetic. It’s no coincidence that Hong Kong was an inspiration for the dystopia depicted in that neo-noir cult movie. Of course, Blade Runner came out in 1982. Since then, almost everything in this former British colony has been ripped down and replaced with newer, taller, more high-tech structures. I’m barely exaggerating. The driver who picked me up at the vast, airy airport said it – and the reclaimed land it sits on -- is 10 years old. Likewise the 5.8-mile bridge and tunnels that connect it to the network of islands and peninsulas that make up greater Hong Kong. (The driver also pointed out a &quot;really old&quot; brick building from the early 1900s.)

The thing is, Hong Kong feels more like Utopia than Dystopia. Murder and armed robbery are rare. There are no taxes because the city government has so much money. (The reason, as it was explained to me, is that the government owns all the land and collects staggering sums from developers, who in turn charge staggering sums for a 600-square-foot apartment.) 

Even though 7 million people are packed into the human equivalent of beehives, the individuals I’ve encountered have been unfailingly polite and friendly. Women and men alike have held doors open for me. On the crowded subway, a teenager offered me his seat.  (Maybe the 18-hour flight has made me look particularly haggard? Maybe they can tell it&apos;s my first time in Asia?)  Most surprising and best of all as far as I’m concerned, smoking is banned in indoor public places.


      <![CDATA[But I digress. I’m here with fellow journalists from places including Minneapolis, Seattle, Vietnam, Bangladesh, China and Indonesia because Hong Kong is likely to be ground zero in any explosion of a novel infection that could kill billions of people – or be quickly snuffed. As a hub for global commerce and a gateway to mainland China, Hong Kong is uniquely situated to get hit. This is where SARS (severe acute respiratory syndrome)  – the pneumonia-like illness that apparently originated in China -- was first identified in 2003. It went on to affect more than 3,000 people worldwide and kill more than 150 of them. Hong Kong is also where, in 1997, a ferocious new bird influenza first “jumped” to humans, sickening 18 people, of whom six died.

Hong Kong snuffed that bird flu, called H5N1, by killing 1.5 million chickens and by temporarily shutting down the filthy, bloody open-air markets where poultry and other live animals are slaughtered on the spot for shoppers. (Tomorrow, our East-West Center leaders will take us to one of these “wet” markets, so-called because the ground is slimy with animal waste and blood.)

In the past few years, H5N1 has come roaring back among poultry in Asia and beyond. Only rarely does this endlessly-mutating microbe infect humans, but when it does, it is highly lethal – and it gets another chance to mutate in a way that would enable it to infect  humans with ruthless efficiency. Maybe even as efficiently as the 1918 flu pandemic that killed at least 20 million people worldwide.

While American media pay only periodic attention to H5N1’s scary potential, it's the kind of threat that keeps Hong Kong authorities awake at night. SARS was their wake-up call, and no one wants to be caught cat-napping when a pandemic strikes – as experts believe it eventually will.

Today, Monday (Sunday in Philly), we journos got to see two big changes wrought by SARS.

The first change was the creation, in a mere two years, of the $125 million Centre for Health Protection -- Hong Kong’s version of the U.S. Centers for Disease Control and Prevention. Not coincidentally, Dr. Thomas Tsang, the new controller of CHP, worked for several years at the CDC.

One component of CHP is an “emergency response centre” that looks only slightly less  high-tech than a NASA mission control room. But instead of monitoring a space shuttle, uniformed workers track reports of illness outbreaks in Hong Kong’s healthcare system. Twice a day, the information is sifted and synthesized into a “sitrep” – a situation report.

Most of this data is numbingly mundane, so to keep an edge, the emergency center runs drills, like last month’s “Exercise Cypress.” This involved the pretend landing of a plane carrying two people infected with H5N1 bird flu. They were hypothetically admitted to Princess Margaret Hospital, where they set off a Level 3 response and were put in the new isolation wing to avoid infecting anyone else. Officials in the patients’ imaginary country were immediately notified, as was the Hong Kong airport, the World Health Organization, etc.

The isolation wing is the other big post-SARS change. It is part of a gleaming, state-of-the-art Infectious Disease Centre (there’s that annoying British spelling again) at Princess Margaret Hospital, where SARS demonstrated the strengths – and weaknesses – of Hong Kong’s infection control system. The hospital was overwhelmed by 585 real SARS patients and twice that many suspected cases. Ten percent of the hospital’s staff contracted SAR$, including the head of the intensive care unit; fortunately, these selfless workers survived, unlike 10 percent of the other SARS patients.

Four hospital officials gave us a tour of the new, barely-used facility, with its 8 floors of negative air pressure wards, airtight doors and windows, and bio-safety lab. Each of the  108 isolations rooms is separated from the corridor by a special anteroom about the size of a walk-in closet. The anteroom doors are programmed to open and close sequentially by sensing the presence of, say, a nurse – thus eliminating germy door knobs and preventing contaminated air droplets from escaping into the hallway. Unfortunately, this safety feature was problematic with our group of 15. 

“Move closer. More. More,” directed senior hospital administrator Olivia Ma, trying to get us all sufficiently crowded together in the anteroom so one door could close and the other one open.

Editor’s note: The <a href="http://www.eastwestcenter.org">program</a> Marie is traveling with is sponsored by the Honolulu-based East-West Center, founded by Congress in 1960 to promote research and education about issues of common concern to the U.S. and the Asia Pacific region. Nine other health journalists from the U.S. and Asia are participating in the health journalism program. Their first stop was Hong Kong.

 

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