Almost all hospitals have the Japanese Encephalitis vaccine. Higher quality imported vaccines can be obtained from the Kunming CDC which is attached to Yunnan Provincial First People's Hospital or from the First Affiliated Hospital of Kunming Medical College. The international clinic may also be able to point you in the right direction if Chinese language is an obstacle.

Kunming Survival 101:

Based from observation and my training as an EMT in the U.S., I've witnessed dozens of medical emergencies here in Kunming in the last decade and there's really no easy way to approach this topic. If the community could come together and those interested take a basic first aid class people would have a better idea of when to taxi it to the hospital and how or when to wait for an ambulance. Most concussions do not require medical attention but some certainly do. Although the emergency medical staffs have gotten better they are still well below the training and protocol of professional EMTs.

In the future, here's what you should do with a head trauma situation. Try and clear people away from the injured person and if there are hostile individuals seek help to remove them from the scene. The last thing you need is to have a drunk/drugged crowd of bystanders providing unprofessional feedback and getting in the way of proper and quick situational diagnosis. If it is not possible to remove these obstacles do your best to ignore them. Furthermore, EMTs and those helping the injured often lead the risk of attack by the person who has instigated the situation or bystanders that think you are involved. That's one benefit of a medical uniform. So without it, be careful and let people know that you are trying to help.

First, establish if they are alert and oriented.

If the person is unconscious the radial or jugular pulse should be taken to establish whether or not there is a pulse present. If there is not a pulse then an ambulance should be called immediately and told the injured person is without a palpable pulse. That may get them to hurry to the site. If someone's heart is not beating CPR should be administered immediately. Since we are dealing with a head or body injury that is significant enough to stop the heart someone will need to stabilize the injured person's cervical spine (neck) to prevent unnecessarily damaging the spinal cord. Sometimes these types of injuries will cause a fracture (break) in one of the spinal bones and moving the neck around prematurely (before x-ray or other proper diagnosis) can lead to severing or injuring the spinal cord. While a bystander holds the head in place, CPR should then be given until an emergency medical technician arrives on the scene. If you are in a place with a defibrillator, AED (Automated External Defibrillators), which is a battery powered device that delivers an electric charge to the heart, then it should be used. If you haven't had training on how to use one, which only requires placing the electrodes in the proper place, moving away from the body before the electric shock is administered and pushing a button. These automated devices will read the heart's rhythm and decide if the shock is applicable. One reminder, if the injured person is in a puddle or body of water you should not use this device until everyone has cleared away from the person and the water. If you're kneeling down beside the body with water beneath you you will also be electrocuted by the AED device. One problem you will find here in Kunming with the local EMTs is that upon arrival they will not take proper precautions to avoid spinal injury. They will start by shaking the injured person and shouting to wake them up. If that doesn't work they may try and force the person to be in a sitting position and then use unsound techniques to get the person on a gurney (stretcher) and into the ambulance. Not sure how you can avoid this besides actively holding the injured person's neck and head until it is securely strapped down to the gurney.

Back to alert and oriented; try not to move the injured person until they have regained consciousness unless you are willing to take the risk of spinal/neck injury. If a pulse is present you can begin by asking the person if they can hear you. If they do not respond to auditory stimuli (sound) you can take your knuckles and rub them on the center of the sternum (midline of the chest) to provoke a response to the pain. If there's no response to pain then the person has sustained a more serious concussion. Most people injured by concussion and unconscious will wake within a few seconds to a few minutes. The length of time the person is unconscious can also determine the severity of the concussion; a Grade I concussion consists of confusion only (no loss of consciousness), Grade II includes confusion and post-traumatic amnesia (loss of memory 30 minutes to 24hrs, possible loss of consciousness for less than 1 minute); Grade III and IV involve a longer duration of loss of consciousness (1-5 minutes). Anyone who remains unconscious for minutes has sustained a more serious concussion and should go to the hospital. According to the American Academy of Neurology (AAN) permanent brain injury can occur with either a Grade II or Grade II concussion. The mechanism of injury can also tell us whether or not the injured person should go to the hospital. Just know that moving the person to the hospital before they wake or without proper training runs the risk of further neck injury. Once they are awake you can ask if they have significant pain in or around their neck. Not all neck and spinal injuries present with pain right away, and the injured are not usually conscious enough to know which pain is which. Furthermore their adrenal system as already begun the fight or flight process which can mask the pain of injured areas. Once the person wakes warm sweetened water should be given in small amounts. At this point it may be wise to try and move the person away from the crowd that has gathered around, or try and get people to back up or leave the scene. To establish the level of alertness ask the injured person these questions: if they know their name; if they know where they are; if they know the day or date. If they cannot answer one of these questions then they have most likely sustained a more serious concussion and a trip to the hospital is advised. The injured should be asked if they are experiencing nausea or if vomiting is observed these are indications of a more serious concussion. Doctors will determine the severity by physical and neurological diagnosis and/or CT scan to determine the level of brain swelling.

If the injured person has answered the questions correctly and are coherent and decide not to go to the hospital then they should be told to watch for signs of brain injury/concussion while at home; nausea, vomiting, severe headache, visual disturbance (blurred vision, double vision, sensitivity to light), lack of motor coordination (hard to move), difficulty balancing. It is important to observe whether or not these symptoms, if experienced, get better or worse over time. If any symptoms worsen go to the hospital. Otherwise, get plenty of rest at night and during the day, keep hydrated with water and electrolytes and take it easy for a few weeks to allow your body to recover.

That being said, it would be wise for restaurants and bars to do what Salvador's has done and have their staff trained in CPR, chocking and first aid. For those interested you can contact Zhang Ying (Daisy, who works in the Yunnan Provincial Traditional Chinese Medicine Hospital's Foreign Administration Department) and she can help set up a course in CPR at the hospital or provide you with information; 362-0626.

Can't wait for the good veggies!

Can't wait for the tasty veggies!

We have the responsibility as mature and educated adults to implement policies that take into consideration the quality of living on the Planet Earth for all future inhabitants. If such policies were left to the less educated, habitually lazy and apathetic layperson our children and fellow creatures would be left living among more of our generations filth. As is, the current state of PVC (Polyvinyl chloride) poison proliferation has reached astronomical levels; a great source for information about PVC poison, besafenet.com/pvc/index.htm . One of the most toxic chemicals known to science is dioxin; www.ejnet.org/dioxin/ or aka Agent Orange, www.gmasw.com/ao_info1.htm . Dioxin can be leached from PVC products during use and has been proven to cause a vast array of disease and complications with certain medical treatments. Women should read the newest research that proves exposure to PVC products causes malformation of the reproductive system in male offspring;naturepedic.com/research/phthalates.php For a complete list of PVC household products, follow this link besafenet.com/pvc/pvcproducts.htm .
Furthermore, exposure to chemicals from PVC plants that produce plastic bags, especially Phthalates
www.noharm.org/library/docs/Phthalate_Report.pdf can cause a wide variety of health problems in local populations and those "down-stream" from the inevitable toxic runoff. Current technology and research continues to provide alternatives to PVC based plastics. Plant based plastics and other biodegradable alternatives as well as washable and reusable fabric bags are some options. Follow the links below for more information about PVC and non-toxic plastic alternatives.

Useful resources for information about PVC products:
"ARE PHTHALATE CHEMICALS IN CRIB MATTRESSES CAUSING MALE HORMONAL AND FERTILITY ISSUES IN YOUR BABY BOY?", naturepedic.com/research/phthalates.php

Breathing Poison: The Toxic Costs of Industries in Calcasieu Parish, Louisiana, An article about breathing chemicals from PVC plants, www.mapcruzin.com/mossville/reportondioxin.htm

PVC: Recycling Killer, Public Health Menace, www.grrn.org/pvc/

Clean Products, PVC-free porducts, cleanproduction.org/Home.php

Toy Report, a grading system for companies that produce toys, www.greenpeace.org/usa/news/2003-toy-report-card

Blue Vinyl, a movie about toxic vinyl, www.bluevinyl.org/animation.htm

Dioxin Information: www.ejnet.org/dioxin/

Agent Orange/Dioxin: www.gmasw.com/ao_info1.htm

Alternatives To Plastic: www.mindfully.org/[...]