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The newspaper of The Johns Hopkins University July 10, 2006 | Vol. 35 No. 39
Thinking Out Loud

William R. Brody

By William R. Brody

East Meets West

I am writing this column from the inner city of Beijing, living in a "hutong" — one of the traditional houses that used to line the small streets and narrow alleyways of Beijing — and studying Mandarin. OK, it's a crazy idea. Now that we have that behind us, we can talk about more important things.

Living in a hutong could be considered roughing it. Fortunately, we are renting one that has been upgraded to include indoor plumbing (whew!), a couple of air-conditioning units on the wall, a washing machine and a microwave oven. By U.S. standards, this is roughing it. But next door, literally, are the very basic units, so we are living in the midst of the Chinese lifestyle that is rapidly disappearing. Sadly, the government is daily demolishing hutong villages to make way for large boulevards and skyscrapers housing multinational corporations and others featuring luxury condominiums rivaling those in New York or London.

We are experiencing directly the benefits of the hutong lifestyle, which is very simple, with all the necessities of life located within a few steps of our door. There are many restaurants, with dinner perhaps running as little as a couple of dollars, and we have had some wonderful meals for three or four people, with beer, costing less than $10! After the shock of living in small and pretty basic quarters, we find the life interestingly refreshing — wonderful small shops selling very fresh fruits and vegetables (the Beijing watermelons are a delicious treat you would be hard-pressed to match in the U.S.), barbershops, massage parlors (legitimate ones, I think, though I haven't yet sampled their services), laundry, tailor, shoe repair and, most important for us, a bicycle repairman.

Wendy Brody in the couple's Beijing 'hutong.'

Not too far down the main street outside our hutong are the expensive places. I bet the food in the restaurants is no better, but $10 won't get you much past a simple appetizer. And the big Western hotels and shopping centers feature the most expensive food and goods anywhere. The contrasts between the ultra-rich, the rising middle class and the poor here are tremendous. When hutongs are torn down, the peasants are moved wholesale to suburban high-rises — divorced from the character, and convenience, of the hutong, albeit with indoor flushing toilets most likely. And with many tens of millions of migrant workers heading to the cities on the East Coast looking for work, China has an internal "immigrant" problem rivaling that of California or Texas.

One of the first words you learn in Mandarin is dong-xi, pronounced dong-she, which means "something," so you can say to your teacher, "I would like to eat something." Also useful in a restaurant, although it is unlikely anyone will understand you because getting the words right isn't enough — the tone of the words is critical, and that is hard for us lao-wai (foreigners) to get right without months of practice.

Anyway, after working on dong xi, my wife, Wendy, made an interesting observation. The two characters for dong xi are the same ones that mean "east-west." And while one can speculate how east-west also came to mean "something," one thing is clear — nowhere is the clash between East and West more evident than in the city of Beijing. Traditional Chinese culture is facing the yin and yang between Chinese herbal medicine and Western medicine, Chinese cuisine vs. Kentucky Fried Chicken, Pizza Hut, McDonald's and Starbucks. (I looked it up: There are 50 Starbucks shops in Beijing, and probably many more KFC, Pizza Huts and McDonald's. Ikea just opened its largest store outside of Scandanavia in Beijing.)

The contrast between rich and poor is striking. Since my first trip here in 1994, when the only cars were government vehicles of an aging vintage, today the parking lots are filled with Audis, BMWs, large VWs, Buicks and other luxury vehicles. And supposedly somewhere between 1,000 and 4,000 cars are being added to the Beijing roads every month!

Pollution and traffic in Beijing are also world-class. There are Western-style suburbs going up faster than one can ever imagine, adding to the traffic gridlock and pollution. We are commuting by bicycle, so we are immersed in the traffic jams and literally taste and smell the horrific pollution. We often get to our destination faster than a car would go. Smoking is so common among the Chinese that we can assume that lung cancer will be of epidemic proportions, if not already so. We are commuting about 40 minutes each way to/from our Mandarin classes, so I can vouch for the traffic as well as the pollution. Some days you literally cannot see the tops of skyscrapers 20 yards away through the blurred skies. And there are mammoth construction projects going on to prepare for the 2008 Olympics, as well as to meet the demands of the rising middle class for better housing and higher-class shops and services.

The language school we are attending, ironically, is the Taipei Language Institute. It features one-on-one tutorial instruction and is considered one of the best in China, even though its headquarters are in Taipei. A large cadre of students attend, many Americans but also Koreans, Japanese and Europeans, all ages and from all walks of life, though most are in their 20s looking to make a career around the emergence of China. We met a Korean woman who is a current SAIS student, spending the summer here studying Chinese between her first and second years. The instructors are nearly all young Chinese women in their 20s and early 30s. An American colleague who has lived and studied in Beijing says he has never met a Chinese language instructor over the age of 35, and he wonders what becomes of them.

The bicycle repairman, Mr. Yang, is our best friend and life support system. He said his family was quite prominent, with several of the older generation being professors; but after the communist regime took over, his family wasn't allowed to attend school, so he ended up fixing bicycles and renting out a few that he owns. He is quite proud that he had put his son through school (you must pay to send your children to the public primary and secondary schools) and that he is now a dentist. With a great smile, he showed us his beautifully perfect set of false teeth that his son had made for him.

Mr. Yang operates on bicycles right on the sidewalk and is found at his station seven days a week, 12 hours a day. He is as good a diagnostician as the best Hopkins internist and as manually adept as a top professor of surgery. And he is generally busy most of the time we visit him. Nearly each day we need some adjustment to our bikes (air in the tires, brake adjustments, etc.). The bicycles are old but quite comfortable and ridable, and we learned that the older bikes are generally more durable, and also less likely to be stolen. We often get thunderstorms in the evening, and the rain falling on the bikes quickly changes to rust, freezing up something — hence the need to see Mr. Yang for an urgent clinic visit.

The commute is quite hectic and the driving more challenging than in Boston or New York City. Here there are bike lanes on most streets, but the bike traffic may be two-way; cars and buses not infrequently use the bike lanes; and, of course, there are lots of pedestrians. You learn not to make eye contact with cars; if you do, you lose all available rights of way open to you. We are exhausted by the end of the day from our commuting, but it is a great way to explore the city.

The emerging middle class is starved for things Western, while the culture remains profoundly Eastern. Gucci and Rolex, Starbucks and KFC, golf, World Cup soccer and Formula One. How all this will end up is anyone's guess. But I want to close with one observation, not of my own making.

An economist named Roemer many years ago made the observation that certain entities generate their own "demand." Roemer pointed out that the more hospital beds there are per capita, the higher is the utilization of hospital services. Ditto for doctors. The Dartmouth Atlas of Health Care points out that communities with twice the number of cardiologists per 100,000 population will have much higher utilization of patient visits, procedures, etc. Although I haven't seen a study, my guess is that Roemer's law holds for lawyers as well.

Roads, too. When a road is built — generally if the economy is robust — developers will buy up land now made accessible and construct houses or factories that require people to commute longer distances, hence filling up the new roads. And since new roads allow the addition of more automobiles, one can never get ahead of the power curve. Beijing today, compared to my first trip in 1994, amply illustrates how the large supply of four-lane boulevards and wide ring roads has generated a "demand" for more and more cars. When your family lived in the hutong, there was no need for any transportation, save perhaps a bicycle or small motor-driven vehicle to haul cargo for your vegetable market.

Another important point to consider about China: While right now it has a relatively young population, that population is quickly aging, and by 2030, because of the country's one-child policy, it will have the same inverted age distribution that Western Europe, the United States and Japan will have. How China will pay for medical services is an issue right now but is likely to emerge more importantly in the future.

While the demand for high-quality Western medical services is growing and could present some important opportunities for Johns Hopkins, one should not overlook the fact that it will be a focus on public health that is likely to make the most dramatic improvements in the health of the country over the next few decades.

The only books I am reading these days are Chinese language instruction books (written, mercifully, in English), so, somewhat apologetically, I have none of my usual summer reading recommendations.

For now, have a good summer, and zai jian. Till we meet again.


William R. Brody is president of The Johns Hopkins University.


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