Wuhan, China

January 25, 2008

No talk of global warming here, at least not this week. Supposedly to a “sub-tropical” clime, our trip to Wuhan happens to coincide with the coldest and snowiest spell here in decades. Icicle-bedraped palm trees, an odd sight. Polished marble sidewalks and porticos—no doubt elegant in more normal times, now ice-glazed and hazardous—reduce ambulation to a wall-clinging, shuffling adventure. Three-blanket nights in bone-chilling hotel rooms. Although the outdoor temperatures aren’t that far below freezing, most of the buildings lack central heating so everyone wears their coats all the time, indoors as well as outdoors. Ah, makes a Pittsburgher feel right at home.

Now on the last leg of my four-legged, four-week journey, I am in Wuhan, China, to evaluate and cultivate prospects for collaborations on global health. I have arranged for a small delegation of Pitt environmental health experts to meet me here. With me now is Bernie Goldstein, my predecessor as Dean of the Graduate School of Pubic Health (GSPH). Before coming to Pitt, Bernie had a distinguished career in environmental health research, including a stint as the Chief Scientist at the EPA. Bernie had a flight delay en route and missed a connection, so we had to proceed without him on the first day. Robbie Ali, an assistant professor and physician with an environmental and occupational health background—who already has strong ties to Wuhan through his wife and in-laws—is here from GSPH too. Robbie speaks Mandarin very well, almost fluently. He gets around Wuhan like a native and arranged most of our local agenda. I also invited Ken Olden, former Director of the National Institute of Environmental Health Sciences, to supplement our delegation. Ken’s expert insights have been invaluable. While in Wuhan I also took the opportunity to visit some virologists who worked on SARS during the epidemic a few years ago.

With Robbie and Ken at the entrance to Wuhan University Health Sciences Campus, in front of a statue of Chairman Mao.

Wuhan is the capital of Hubei Province, situated at the confluence of the Yangtze and Hanshui rivers, about 1,000 kilometers inland. The fourth largest city in China (population of about 10 million), Wuhan is the political, economic, and cultural hub of central China. Both Wuhan and Pittsburgh are located in their respective country’s industrial “heartland” well removed from the coasts, and both cites are situated at the confluence of major rivers, features that have had strong parallel influences their respective political, industrial, and environmental histories. The cities of Wuhan and Pittsburgh already have warm relations that should facilitate new cooperative projects on health. The two cities have been “sister cities” since 1982; city and county government leaders have exchanged visits on several occasions. Furthermore, last year Wuhan University and the University of Pittsburgh—with financial support from the Chinese government—jointly formed a Confucius Institute whose purpose is to foster intercultural understanding, to facilitate the exchange of faculty and students, and to promote academic collaborations between the two Universities.

This week I travelled quite a bit within the city of Wuhan itself, and found it to be—with the exception of the heating—a fully modern international metropolis. There are few bicycles on the streets anymore—they’re jammed with cars and buses—but this in part may reflect the cold weather. The roads, utilities, and buildings are modern and Western (but the toilets are not). Wuhan is much more similar to American cities than it is to cities in developing countries. That said, the weather precluded visits to rural areas outside Wuhan on this trip. On past trips elsewhere in China I have gone to rural regions where I have visited dirt-poor and technologically backward villages. I readily appreciate the growing urban-rural wealth disparities here.

Our Chinese university counterpart hosts have been very helpful. A team from the International Affairs Office of Wuhan University served as our primary point of contact and provided us with transportation. Importantly they also provided a translator. Of the four countries I have visited on this trip, communication has been most difficult here in China, by far. Essentially no one speaks English: not the smiling functionary at the airport information kiosk, not the hotel desk clerk, not even most professors. We Americans have become spoiled by the near universality of spoken English as the basal medium of international communication. Not here. China is very large, very autonomous, and very …. Chinese. I needed a translator by my side at every meeting. And of course, every conversation takes twice as long—at least—when conducted through a translator, so our meetings here all tended to be formal, frustrating, slow, and relatively uninformative for the effort expended. Of course, I expected this; communication has been no more or less difficult than elsewhere in my prior China experiences.

Our capable translator, Geng Jia—or Christina as she permitted herself to be called—was a shy 23-year-old masters student studying English translation at Wuhan University. She did a terrific job. I committed a minor faux pas when I asked her if she had any brothers or sisters. She responded that no, she didn’t, and that no else her age had any siblings, either. She was born during the mandatory “one child only” era in China.

On our first day here we visited the Wuhan University School of Public Health, a small new school with strengths in the social and behavioral health sciences. The Dean, Zongfu Mao, was keen to develop collaborations with Pitt. Dean Mao and his predecessor Dean Bi had both spent time working at West Virginia University, with the National Institute of Occupational Safety and Health in Morgantown, and had briefly visited Pittsburgh. Later that day we met with Wuhan University Vice President Zhou Shuanbing, a civil engineer by training. He proposed that we draw up a memo of cooperation as soon as is reasonable.

Joining us for our visit to Wuhan University was the new US Consul General in Wuhan, Mrs. Wendy Lyle. She is the first CG in Wuhan and has been in residence for only two months; she points out that a new consulate is an important step up for Wuhan, and she promised to do whatever she could to facilitate our programs in Wuhan. She promptly re-organized her schedule to overlap twice more with ours after she expressed interest in visiting health institutions with us. She is an effusive and interesting character. Years ago Mrs. Lyle was the main English-speaking Voice of America broadcaster. Now, decades later, many of the English-speaking Chinese citizens we met greeted her as a celebrity and joyfully told her how she had influenced their lives. I have a renewed respect for the impact of VOA—and Mrs. Lyle.

Ken standing before the Wuhan University Library.

We spent Tuesday at the School of Public Health of the Tongji Medical College of the Huazhong University of Science and Technology. Unlike the small and young school at Wuhan University, the Tongji School of Public Health has 93 faculty with a full array of public health backgrounds and expertise and 150 graduate students. The school serves as home to the Hubei Key Laboratory of Environment and Health, the main environmental health lab serving a population of tens of millions. Joining us for the meeting at Tongji were Environmental Protection Agency officials from the national, state, and municipal levels. We had a good discussion (through translators, of course) about Chinese priorities and plans for environmental health.

Formal meeting with Senior Faculty of the Tongji School of Public Health and governmental EPA officials.

Our third day, Wednesday, was spent meeting with the leadership of the Wuhan Municipal Environmental Health Bureau. Again, we learned about priorities and plans. Two recent high-level developments in China should favor the creation of a new cooperative project on environmental health. On November 21, 2007, the Chinese government launched its first national environmental health action plan, the “National Environmental Health Action Plan for the Years 2007-2015.” This plan provides basic principles, goals, and action strategies to be implemented throughout China over the next eight years. The plan calls for establishment of surveillance networks, interagency cooperation, and collaborative international research. Local implementation plans in Wuhan are in development. In an unrelated but equally important step, on December 17 the Chinese government announced that a cluster of four cities in central China, one of them Wuhan, had been designated a national experimental zone to develop and evaluate new environmentally friendly programs. The National Development and Reform Commission has directed these cities to “as quickly as possible form systems and mechanisms beneficial to energy saving and environmental and ecological protection.” Again, local Wuhan implementation plans are now just under development. Environmental Health does seem to be a genuine priority here; they just moved into a beautiful new and well equipped 12-story building. We were shown impressive demonstrations of real time environmental ozone monitoring throughout the city.

Demonstration of the real time ozone monitoring system at the Wuhan Municipal Environmental Health Bureau.

While here we also called upon other health institutions. I already knew of, and had indirect contacts with, the excellent scientists at the Wuhan Institute of Virology (WIV) of the Chinese Academy of Sciences. Zhihong Hu, director of the institute, is the only woman director of a major Chinese agency we met. Her laboratories are modern, well equipped, and bustling with activity. I was invited to give a lecture at the Institute, which I did. On entry into the front lobby there was a large, 3-by-5-meter digital message board announcing my lecture. On this particular day in front of the message board there happened to be a group of a dozen young women, junior faculty and students, who were practicing a dance routine for performance at an upcoming festival. When I observed that it was the first time as a visiting lecturer that I had been greeted by dancing girls, Zhihong Hu burst out laughing. The WIV, under the direction of Shi Zhengli, is building the first level four BioSafety Lab (BSL-4) lab in China. Shi Zhengli, who did some excellent work on SARS, splits her time now between lab work and construction planning.

Young women faculty and students practicing a dance routine in the lobby of the Wuhan Institute of Virology

We were fortunate to fit in a visit to the ABSL-3 laboratory group at Wuhan University. They, like Joanne Flynn at Pitt, have received funding from the Gates Foundation to do tuberculosis vaccine testing. There are some excellent prospects for cooperation in infectious disease research in Wuhan, as well as environmental health research.

We also paid a call on some health institutions outside the pubic health field. The Wuhan University School of Nursing, supported by Project Hope, is headed by Dean Marcia Petrani, the only American faculty member we met at any of the institutions we visited. And we were given a tour of the magnificent new 2000 bed Wuhan Union hospital. Many of the physicians we met here had some training in America. The head of the Thoracic Surgery Unit, Professor Wang JinaJun, did his residency at Pitt over a decade ago, and expressed fond memories of Pittsburgh. As everywhere else in Wuhan, the reception we received was open and inviting. Indeed, I hope we can fulfill even some the potential collaborations that we found.

Touring the Wuhan Union Hospital Cardiac Intensive Care Unit. US Counsel General Wendy Lyle is the woman in the center. The red splotches on the gowns are not blood, they are Chinese ideographs.

Ken, Bernie, Robbie, and I all considered the prospects for collaboration here to be very good. There is an extraordinary confluence of favorable circumstances: a new Confucius Institute with Wuhan University, a new US consulate, a new National Plan, and a new Wuhan environmental enterprise zone. We discussed the possibility of creating a cooperative Environmental Health Indictors Project involving academic and local government institutions in Wuhan and Pittsburgh. Possible objectives of such a project could be to improve monitoring of environmental indicators for human health risks, to link environmental indicator monitoring data to local health outcomes data, and to develop cost-effective policies to mitigate the effects of environmental pollution on human health. The idea, just conceived, will have to gestate for a bit.

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Today is the final day of my journey, a time to wrap up and write down some of my thoughts. It will be good to be home again.