Country Driving: A Journey Through China From Farm to Factory (24 page)

“You better be back here by ten o’clock!” the nurse said. “If she comes after ten, we won’t let her in. We lock the doors at night. Those are the rules!”

I called Cao Chunmei and asked her to find a motorcycle ride down into the valley, so we could save time. But half an hour later she called back: only one neighbor had a motorbike, and tonight he was already too drunk to drive. It was dark by the time I reached the dead-end road. Cao Chunmei waited with a bag she had packed for the hospital. It contained several bottles of local spring water—most villagers believe that Sancha water is healthier than anything you can buy in the city.

“It’s a lot of trouble for you,” she said, hurrying into the car.

“It’s not a problem,” I said. “Do you have everything you need?”

“I’m fine,” she said. “Have you eaten yet?”

“I already ate,” I said. In truth I hadn’t had a meal since morning, but there was something reassuring about the polite exchange. In rural China, no matter how stressful a situation becomes, you can always count on certain conversations, and Cao Chunmei’s words made me feel calmer. Driving fast through the mountains, I watched the shadowy landmarks slip past for the fourth time since dawn: the Huaisha River valley, the Nine-Crossings River, the Black Mountain Stockade. The roofs of the Ming tombs shone ghostlike in the darkness. The expressway was empty; we made it to the hospital with half an hour to spare. Wei Jia was already fast asleep, and the boy didn’t stir when I told his parents good night.

FOR MOST OF THAT
week Wei Jia ran a fever. On the fifth day, it reached one hundred and four degrees, and his platelet count dipped beneath fifteen thousand. If it went much lower, there was a serious risk of bleeding in the brain.

Mimi and I visited daily, and every night I wrote my doctor friends in the United States. They told me that a combination of rest and good diet often stabilizes a child with ITP, but we still weren’t certain of the diagnosis. In the States, a patient in his condition would be given a blood transfusion, but the Chinese doctors hadn’t recommended it yet. And I had advised the parents that such measures should be a last resort. The blood supply in China isn’t safe; donors are in short supply and the system relies primarily on people who are paid for giving blood. At the
time of Wei Jia’s illness, experts estimated that more than one million Chinese had been infected with H.I.V. The epidemic was particularly severe in Henan Province, just south of Beijing, because of unsanitary donor practices. The big cities had problems, too—I knew a Chinese-American journalist who had recently visited one Beijing donor center and was immediately offered a fake ID so she could sell her blood. Even better-run clinics usually limited their blood analysis to antibody tests, which are cheaper and less reliable than the molecular diagnostics used in developed countries.

On the seventh day Wei Jia began to bleed from his gums. That morning the doctors gave him a bone-marrow test for leukemia, and finally they decided that he needed a transfusion. Wei Ziqi telephoned me and asked to borrow nearly a thousand dollars. In China, there is no national health insurance, and city residents usually rely on their work units for coverage. Most farmers are completely on their own, which is one reason they tend to be so careful with their savings—a rural person has to be prepared to pay cash for a medical emergency. And hospitals tend to mistreat peasants as a result. Doctors are wary of getting stuck with an unpaid bill, so they always demand money up front. It wasn’t until 2009 that the central government began to take steps toward establishing some form of universal health care, although it’s still unclear how comprehensive such coverage will be.

At the time of Wei Jia’s illness, only private insurance would cover a family in the countryside. Unlike most farmers, the Weis had purchased a policy for their son. It had been offered when he entered kindergarten, and the Weis had been smart enough to buy it; now the majority of his treatment would be covered. But the hospital wouldn’t wait for reimbursement: they demanded cash now. In such situations, families usually raise money from relatives, which might take days to organize.

Mimi was preparing to leave for a work trip to Europe, so I went alone to the hospital. Wei Jia slept fitfully; his mother told me the doctors had drugged him. Dried blood had caked around his mouth—his gums were still oozing. Accompanied by Wei Ziqi, I introduced myself to the physician on duty. Her name was Dr. Zhao, and she sat in an
office with another physician and three nurses. I asked if the transfusion was critical.

“Who is this?” she said sharply to Wei Ziqi. “Why is he here? Why is he asking questions?”

“He’s a writer,” Wei Ziqi said proudly.

“I’m a friend, as I just explained,” I said quickly. “I was the one who brought the boy to the hospital. I have some simple questions about what we should do.”

“This isn’t his affair!” Dr. Zhao said to Wei Ziqi. “You’re the parent, and you have responsibility. He has nothing to do with it.”

“I care about the child,” I said. “I’ve been trying to help them since he got sick. I just want us to make the right decision.”

“The decision has already been made!” With that, the woman turned her back on me. For a moment I stood in silence. In China, I was accustomed to people being more patient with me; in general they’re inclined to grant a sort of exaggerated respect to any foreigner who speaks the language. Usually this deference makes life easier, and like any long-term foreign resident I learned to play it to my advantage. But I had no illusions about what it really meant. At the root of that respect is insecurity: deep down, many Chinese, especially educated people, are slightly ashamed of the way their country might appear to an outsider. Dr. Zhao didn’t see me as a person who cared for a sick child; in her eyes I was simply a foreigner who distrusted her competence.

And she was clearly annoyed by Wei Ziqi’s faith in my judgment. Together we brought out the city woman’s worst instincts, from both sides of the spectrum: she responded to the peasant with arrogance and the foreigner with insecurity. I turned to the other women in the room. “Who can I talk to about this?” I said, but they ignored me. I repeated the question: silence. One of the nurses whispered a joke that I couldn’t hear; the others laughed. I felt my face turn red, and that was when my patience ended—I wasn’t going to listen to their laughter while the child suffered next door.

“It’s very simple,” I said. “I’m paying for this. Before I pay the money, I have to know why he needs the transfusion now. If you don’t talk to me, I won’t pay it.”

Dr. Zhao turned to me, her face tight with anger. “He needs immune globulin,” she said. “If he doesn’t get it, there’s a risk that he’ll have brain damage. Already he’s bleeding inside his mouth. We know what to do, and you don’t understand anything about it.”

“I’m trying to understand as much as I can,” I said. “If you speak slowly, it helps. I’m only asking questions because I care about the boy.”

“If you care, then let us give him the transfusion!”

“I’ve talked with other doctors who say that maybe a transfusion isn’t necessary,” I said. “They said that usually they would wait for the biopsy results.”

“How long will that be?” the woman said loudly. “We don’t even know. It could be a week. We can’t wait that long!”

“Why hasn’t he been tested to see if he has a virus that’s causing his fever?”

“We know that his platelet level is low! That’s our primary concern!”

“Have you done a test for hepatitis?”

“He doesn’t have hepatitis!”

“Have you tested for it? I was told that it’s a possibility.”

“There’s no need to test for it! Hepatitis isn’t a concern!”

“If you give him gamma globulin, is there a risk that the blood might carry some disease?”

“Of course there’s a risk!” Dr. Zhao spat out the words. “It could have H.I.V. or hepatitis or something else!”

“Don’t they test the blood?”

“You can’t test it completely.”

“I think you can,” I said.

“Believe me, you can’t!”

It disgusted me to hear a doctor say such nonsense, but I tried another approach: “Where does the blood come from?”

“How am I supposed to know?” The woman was shouting now, and I backed out of the room with Wei Ziqi. I told him that the blood supply was my main concern, and he nodded calmly. Using my cell phone, I called an American I knew who worked for a medical company in Beijing. She told me that her organization followed international
testing standards for blood, and she checked to see if it was possible to arrange a sale of gamma globulin. A moment later she called back.

“They can deliver it to you,” she said. “It costs three hundred and seventy-eight dollars per unit. I think that one unit should be enough for a five-year-old, if he’s not too big.”

“He’s very small,” I said.

“That should be fine,” she said. “They’ll deliver it, but you have to get the hospital there to accept it.”

Technically it’s illegal for such an organization to sell blood, but that’s how many things work in China. I took a deep breath and returned to the doctor’s room. “If I buy clean blood, can we use that?” I said.

“There’s no guaranteed clean blood in Beijing,” the doctor said.

“There is,” I said, and then I told her the name of the organization. “They have clean blood.”

“No, they don’t,” she said. “There’s no way to test for all of these things.”

“I’m certain they can test for H.I.V. and hepatitis,” I said.

“It’s impossible,” the doctor said. “There’s no test.”

“Forget about the test,” I said. “That isn’t important right now. What I want to know is, if I get blood from them and have it delivered here, will you give it to the child?”

“That’s impossible! They won’t sell you blood!”

“I’ve already talked to them,” I said. “They’ve agreed to sell it.”

“We won’t accept it,” she said. “It’s against hospital policy. What kind of question is this? Why do you even think of doing something like this? Who do you think you are?”

“You won’t tell me where your blood comes from, and you won’t tell me whether it’s safe,” I said. “So I’m trying to find a source that’s safe. This is the only reason I’m asking.”

“There’s no safe blood in Beijing,” she said. “You have no option other than using what we have. There’s a risk, but the risk is higher if he doesn’t get the gamma globulin. You need to make this decision right now!”

I was shaking with anger by the time I left the room. I called the American woman and explained the situation; she said that there was
one more thing we could do. “I know some Chinese doctors who used to work at your hospital,” she said. “I’ll ask them to check on the blood supply. They’ll know where the blood comes from, and we can see if the donor center is reliable or not. I’ll call you back.”

I waited in Wei Jia’s hospital room with the parents. Throughout the past week, they had remained perfectly calm: no tears, no panicking, no raised voices. Life in the countryside had toughened them, and it had also taught them the meaning of
Mei banfa
: Nothing can be done. During my arguments with the doctor, Wei Ziqi had stood quietly in the background. He made it clear that he deferred to my judgment; he had great faith in my unseen American medical friends, and he shared none of the insecurities of the educated Chinese. For him it was simply logical: he didn’t know anything about these issues, and he had no way of gaining information, and so he trusted the foreigner with his son’s health. My own reaction was different—I was also badly out of my element, but the seriousness of the situation made me want to control it. In truth all I could do was try to get information, hoping to make the right decision, and now it was a matter of waiting for a phone call.

Wei Jia’s hospital room was shared by two other boys. One was a twelve-year-old suffering from inflammation of the cardiac muscle, and the other was an eight-year-old with kidney problems. The room’s walls had been painted light pink and the only decoration was a Mickey Mouse clock. A clothesline hung across one wall, used by the mothers who had been living with their sons.

The eight-year-old came from Jilin Province, in the northeast, and his parents had brought him to Beijing for medical care. This was his second extended stay in the hospital, and since June the doctors had treated him with massive amounts of hormones. Over the past three months his body weight had increased by 50 percent. Everything about the child looked swollen: he had a big belly, sausage-link legs, and a face as round as a mooncake. He was constantly eating, and his mother was constantly talking about his eating. The Chinese love to talk about food and in particular there’s nothing better than talking about food and children. Over the past week the mothers had become friends—most
Chinese are naturally so social that if you throw them together they talk endlessly, even in the most stressful situation. I sat there listening, my phone in hand.

“He didn’t get fat until he started the hormones,” said the boy’s mother. “Now he eats all the time, but he won’t eat fruit.”

“Wei Jia won’t eat fruit, either,” Cao Chunmei said. She sat on the bed beside her sleeping son.

“Fruit, eggs, milk—he won’t eat anything that’s good for him,” said the kidney mother.

“Neither will Wei Jia.”

“They should give him hormones, too,” the woman said. “He’s too small.”

The twelve-year-old wore headphones and listened to a CD player. He had the gangly look of an adolescent and for the past week he had been living in this room, surrounded by the parents and their constant conversation. He had his music turned up loud. His grandmother was also there, a sixty-eight-year-old woman from the countryside of Hebei. Of all the adults, she was the most talkative, and now she offered advice to Cao Chunmei.

“The first thing you need to take care of is the boy’s health,” the old woman said. “If somebody is healthy, he can always work and earn a living. The second most important thing is education. When I was young, I had no schooling—I still can’t read! When I was a little girl, I remember one of my aunts saying to my father, ‘Why should you pay for her to be educated? She’ll just marry into another family eventually. That means you’re paying for the education of somebody else’s family. Why would you do that?’ So they didn’t send me to school. That’s why I say that education is so important.”