We had a very constructive consultation with Dr Lianlian Wang, a gastroenterologist with a clinic at the International Hong Kong Medical Centre. It was different to yesterday's consultation in that she asked a few pertinent and answerable questions, listened to and apparently believed the answers, made comprehensive notes and gave Freda a thorough physical examination. She concluded that she had no concerns about Freda's abdomen or organs down that way and ordered a few blood tests. The gluten intolerance test, which she agreed was worth investigating, will take a week. Meantime the quicker tests have ruled out any bacteria infection and her blood cell count is normal. Great news. We're still not much further on than we were in Simao, except that we've been able to talk to someone about Freda's health in English and feel happy that all likely avenues are being explored. What's more, she didn't come up with any suggestions that we hadn't yet considered. The burning question now is what we do for a week. Should we snuggle up in our hotel room, work and study in the VSO Programme Office or head off on a train journey round the North. A month or two later and it would be perfect timing for the Harbin ice festival. Enjoyable as it would be to see the giant ice sculptures in real life, let's hope we get some answers before then.

It's not a great photo but it's the best 'evidence' we could get that we were within a stone's throw distance of the the American President. As we emerged from the Metro to return to our hotel we noticed that both sides of the main road (6 lanes wide) were closed to traffic. There have been police, guards and 'volunteers' patrolling this section of town since we arrived but uniforms had quadrupled for this evening. A few minutes later the first car in the entourage [see photo for some representative vehicles!] passed, followed by about thirty others, either black or white, with the Presidential limo near the front flying a Chinese and an American flag. The latter was on the right. Is that symbolic? For a moment we panicked he was heading for our  Seven-Eleven store, preventing us from picking up a Chinese takeaway. Fortunately he was opting for a Sizzler steak. Why not good old Beijing baozi (steamed dumplings)? Either Hu Jintao is looking for an excuse to go Western or Mr Obama also has a gluten intolerance.

We have both good and bad news, depending on where you live. The good news is that the local Simao doctors are pretty good at dealing with basic gastric problems. If you're worried about having some nasty intestinal bacteria or tropical disease, best to visit Simao's ren min yi yuan (People's Hospital). The bad news is that we had to travel several thousand miles to discover this. Fortunately for us VSO medical insurers paid for the 400 RMB consultation fee. The good news? The Bayley & Jackson paediatrician (who shall remain anonymous, thanks to the face mask) knows of a gastroenterologist who has a clinic at the even-more-expensive Hong Kong International Hospital. We have a 9 o'clock appointment, which means joining the tens of thousands of commuters on the Beijing Metro.

The consultation was interesting. I guess my last encounter with B&J left me slightly sceptical of their general professionalism. Given that it was 18 months ago, however, I was hoping things had changed. Only slightly. Although I was reasonably happy that this was a doctor (the last person I saw was a private practitioner who was forced to squeeze into a white coat for appearances) we spent an hour going in circles. I presented all of Freda's symptoms and tried to avoid mentioning any of our own specific ideas/concerns. Who am I to say? As it happens, given the fabulous advice and support we have had from VSO London Medical Unit and another UK doctor, it seems I was better equiped to guide the consultation than I thought. In fact, after 45 minutes I ended up whipping out an email with the information on the basic tests for coeliac, basically a gluten intolerance. I'll give you some snippets...


[after 20 minutes of describing the symptoms and Freda's medical history]
Doctor: Over the last 3 months, while Freda has had diarrhoea, has she ever had a fever?
Lesley: No, never.
Doctor: Really? Are you sure? No fever?
Lesley: Really, it's always the first thing we check. No fever.
Doctor: That's strange.

Doctor: Has Freda been innoculated against TB? It's not done in many European countries but in China we give it to babies.
Lesley: Yes, she was innoculated in 2005, just before coming to China. I believe we refer to the vaccine as BCG.
Doctor: Freda, I need to see your arm. Can you take your top off. [Inspecting the arms] I can't see a scar here. Are you sure she's had it?
Lesley: Yes, in 2005. Her sister's vaccination site took several weeks to heal and she has a big scar but Freda had no local reaction, it healed quickly and left virtually no scar.
Doctor: Mmmm. Where did she have it? Is that the scar? I can't see a scar. So, did she have it?
Lesley: Do these symptoms really fit TB? Apart from the diarrhoea, tiredness and mood swings, she's been well. I didn't realise TB presented itself like this [i.e. no fever, no bloody phlegm, no cough (since the Spring).
Doctor: Well, if a child has diarrhoea for this long, we have to consider some special diseases....

[After 45 minutes, more perplexed]
Doctor: Well, Freda's weight is normal. She should weight about 26 kilos by this age and she weighs 28, which is unusual for someone who has had diarrhoea for so long. So, what is the diarrhoea like?
Lesley: Water
Doctor: Really? Like water? And does it have anything special in it?
Lesley: Apparently undigested food. Fairly typical, acute, diarrhoea.
Doctor: And how often does she go in a day, 2 or 3 times?
Lesley: About 5 to 6 times?
Doctor: Really? Freda, how often do you go a day?
Freda: Well, about 5 or 6 times, it depends. Sometimes more.
Doctor: And it's diarrhoea?

[And so we went on, round and round in circles. I was beginning to doubt my own sanity, judgement and memory.]

Lesley: Freda's symptoms have been much worse the last 3-4 months but she has had similar symptoms for years, now that we think about it. Each time she's been unwell, however, we've been able to find other reasonable explanations so we never made any connection.
Doctor: So, when did it start?
Lesley: Well, if what I said is true, I can't remember. She could have been like this for years but we thought it was 'normal'.
Doctor: So, before you came to China, how often did she go to the toilet (No 2) a day?
Lesley: I can't remember, that was four and a half years ago. Had I realised at the time it was significant I would have counted, but I didn't. All I am sure of is that there are certain patterns....
Doctor: So you can't say how many times she went to the toilet before you came to China.

[55 minutes into the consulation]
Lesley:....and that things are worse now. We've had to take her to the hospital twice this term  for a saline drip...
Doctor: Oh yes, because you were worried.
Lesley: No, primarily because we couldn't rehydrate her orally, she was losing too much liquid.
Doctor: Really, so you needed a drip?
Lesley: Yes, she was dehydrated.
Doctor: Oh, I see. So she really did have diarrhoea?

Lesley: Can you test for gluten intolerance here?
Doctor: Yes, we can run several food allergy tests, like beef, fish, eggs and so on.
Lesley: What about for gluten - I believe the test is for specific enzymes [showed email]. Could you please check.
Doctor: [after calling the lab] No, we can't do that. I think you'd better see a doctor in the UK.

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You think that was long-winded? That's not half of it. Sorry to off-load. I need to rant to someone. I must finish by saying, however, that I am EXCEPTIONALLY grateful to VSO for bringing us to Beijing to find a doctor. If I'm a little frustrated it's as much as wanting a reasonable service for VSO (given that they are paying) than for ourselves. I shall remain optimistic, however,  about tomorrow's consultation. The other good news is that whatever is wrong with Freda, she's thriving on her gluten and dairy-free diet. Regular as clockwork, perhaps for the first time in her life. Yes, really.....

Receptionist: Hello. We have a small children's play room. Would you like to see it?

Freda: Hey, mum! Does she mean a playroom for small children, or a small room for children to play, hee hee hee?

Receptionist: It's this way....

Freda and Lesley follow in excited anticipation.

Freda: Ha ha! I guess both are right.

There's always fresh fruit nearby in Simao. These days we just need to step outside the back gate of the College to find this lady selling bananas and oranges from her tricycle. We were even forced to sample some before buying. It's the orange season but since our friendly orange farmer went to live in Shenzhen with his daughter we don't know anyone with an orange grove. We visited him for four years but were shocked last November when we discovered his small farmhouse overgrown and the orange grove taken over by weeds.

We're still in T-shirts and sandals these days, yet had to splash out on some fur-lined boots for Freda. The reason? I'm taking her to Beijing to see a paediatrician, following yet another week off school with the same old symptoms - diarrhoea, tiredness, mood swings. It's been 3 months now and we're beginning to feel very stressed at being unable to solve the health mystery. We seemed to have exhausted the local health service and VSO London are expressing concern. I'm glad. We need help now. 

One thing I'd like to look into is whether she has some kind of food allergy. She was very sick a few nights ago, following a couscous meal. Another coincidence is that this term has been particularly bad and the main difference in our lifestyle has been the oven. How ironic if all those lovely pizzas, cakes, loaves of bread, flans, etc could have led to her physical demise. When a friend brought up gluten intolerance as a possibility so many other things came to mind - how Freda is always ill when we go on holiday. Going on holiday always involves passing through Kunming, where we have a sudden increase in wheat products - bread, buns, pizza. We only used to have a loaf of bread about once a month, which was about how often Freda used to be ill. We always put it down to poor hygiene. The cause of the last 3 months of ill health may not be a food allergy, but we're going to look into it, among other things. We leave on Sunday with all our winter woollens.

I hadn't realised how expressive katydids were until Ali got up close to this little chap with his macro setting - easy to miss on our cactus plant, sitting outside the kitchen window. It's the season for bright green insects and there are lots of praying mantis about too. It takes nerves to get up close to them though.

Nerves are a little bit tense at the moment as various pressures mount: Freda seems to be unwell again, Edie has developed a cold and my work is piling up, as usual. Uncertainty about what is wrong with Freda is hard to deal with over a long period of time. She was much better last week and managed the new morning school routine. We've emailed the VSO medical unit in London, as well as a few other medics, and we await advice and suggestions.

As to the old work chestnut. Well, I know I could lower my expectations on that front, and simply do less, but that's easier said than done when there are so many people asking for help in one way or another. Nevertheless, I am trying to stick to  a reasonable working day - get to the office by 8, have an hour or so for lunch then work on until 5 or 6, assuming I'm not in charge of home school that day. I'm also prioritising. The result is that this week is being devoted to completing a TLT training report, enter the TLT feedback and evaluation into a database and finalise a digital PIE Resource Package for distrition to anyone who wants it. That's not bad given that I've been asked to teach two model lessons at Simao No. 6 Middle School and run an English singing activity with Edie's class. I have put on hold the job-hunting, 20+ replies to middle school penpals, TLT follow-up preparation and trips, article writing and College workshop planning, never mind all  the things I'd love to do but haven't even started - bookmaking classes, this term's orienteering programme, cooking club etc etc. Hobbies? I'll consider those again on Saturday. The good news is that by the evenings I'm too tired to do anything but flop on the bed with a book (on bad days it's the couch, with a DVD) and have opted to start more seriously studying Chinese again. Oh, does that count as rest??

Freda's been unwell again. It's been about three months now of good days and bad days, increasing to good days and bad weeks, with various symptoms that come and go. We're in a process of exploration, to try to find out what the root cause is. Following a recent lab test we know it's unlikely to be some kind of nasty bacteria in her gut. The symptoms seem to be too severe to be a result of tiredness alone although that's clearly now a factor. We've narrowed it down to either a virus (Lesley's dad was recently diagnosed with something after presenting with exactly the same symptoms) or some kind of digestive problem (though that would be unusual at her age) or, perhaps the most worrying or upsetting of all, school-induced stress. It could of course be a combination of all three. Thus, we're trying to tackle it from all angles. For months Lesley has been increasing her communication with the school to try to influence the way they deal with certain things - like their over zealous desire to put grades on everything the kids do, from bouncing a basketball to writing maths formulas. Since Freda and Edie entered the education system here Lesley has been tirelessly monitoring, evaluation and supporting or challenging everthing what goes on. Bare in mind that she spends her days facing students and teachers who have suffered a great deal in the said system, a fate she doesn't want to fall upon Freda and Edie. So far we have been pleased and the kids have thrived. Edie is still thriving and seems to thoroughly enjoying Grade 1. She has the advantage of being fluent in Chinese, which Freda wasn't when she started. Now it's time to take stock, again.

This has been a hard term, this week being the crux. Lesley has been negotiating her way through the school hierarchies to build relationships and find a way to communicate these needs in a non-threatening and constructive way. In a school system that virtually never invites communication with/from parents, this is a bit step to take. Nevertheless, the school have been very supportive so far. So much so they have agreed to have a meeting tomorrow afternoon with us, the Director of Studies, Freda's form teacher and her Maths teacher. Let's hope they want Freda to carry on attending the school as much as we want her to have a positive environment in which to learn. With that shared goal I hope we can get to the root of the matter. Of course, it might still 'just' be a virus....

I really hope you can't answer that question, as we all went ahead and had our H1N1 vaccinations this morning. Edie and Freda were picked up from school early for the pleasure. The CDC (Centre for Disease Control) came in their white van with box loads of the vaccine for teachers and students who had ordered it yesterday. Some colleagues refused, but more on the grounds of needle phobia than any concerns about the vaccine. Apparently the flu crisis point is anticipated to be Spring Festival - no surprise given that millions of Chinese take to the transport networks at that time. By then it will be too late to be vaccinated, so we thought we'd play it safe. Why not? Freda's been very run-down lately and we're all prone to coughs and colds at the best of time. What's more, I can't afford any time off work! Some teachers are even concerned about the increased risk early next month as the 1,000+ grade 3 students return from their teaching practice-cum-extended-holiday. They were due back next week but the new campus, where everyone should be moving to in the coming months, isn't complete. Even if they do make it back in 3 weeks, as anticipated, my guess is they'll be living on a muddy building site.

Other news - This morning Lesley had a heart-to-heart with No 1 Primary School's Director of Studies, Mrs Zhou, concerning Freda's increasing unhappiness in her Chinese lessons. More on that tomorrow....