Anna Lembke, Assistant Professor of Psychiatry and Behavioral Sciences at the Stanford University Medical Center, visited SCPKU for two weeks as a faculty fellow in July 2014.  Below are the highlights of a conversation Professor Lembke had with SCPKU in which she shares more details about her research and how SCPKU helped to advance her work in China.

Q: Describe your research and its connection to China

My research focuses on improving the lives of those with addictive disorders. I am especially interested in the intersection between health care systems and culture, and how this intersection impacts addiction treatment. I became interested in studying drug use disorders in China for a number of reasons. First, I spent a year after college living in China (1989-1990) teaching English as part of the Yale China Program. I have followed events in China with keen interest ever since. Second, the total number of drug users in China may be as high as 7 million, with China predicted to have the most heroin users of any country in the world within 5 years. I was curious to find out how China is addressing its burgeoning drug problem, and didn’t just want the “party line.” I wanted to learn about how people addicted to drugs in China are seeking and getting help.

Q: What got you interested in the study of addiction?

When I first began practicing psychiatry, I was not interested in treating addiction. But over time, I came to realize that if I didn’t treat my patients’ drug and alcohol problems, their other mental health issues were unlikely to improve. I also realized that in targeting and treating addiction, I could help patients transform their lives for the better, as well as the lives of those who love them.

Q: Why did you decide to apply for an SCPKU Faculty Fellowship?

SCPKU gave me the financial and logistical support to pursue a research project in China, an opportunity that would not have been possible without their help.

Q: How valuable was SCPKU's team in supporting your fellowship at SCPKU?

The team here at Stanford was helpful with drafting the initial proposal, creating the budget, which was especially challenging, due to my lack of familiarity with what things cost in China, and making contact with the SCPKU staff in Beijing. The team in Beijing was helpful in setting up temporary housing and meals in Beijing, as well as providing maps, information on how to take the subway, and logistical support getting back to the airport.

Q: What were your fellowship objectives and were they met? 

My fellowship objective was to interview treatment-seeking heroin users in China to learn more about the state of addiction treatment in China. My research assistant, Dr. Niushen Zhang, and I planned to publish our findings in a peer-reviewed journal.

We learned that individuals in China addicted to drugs experience intense social stigma. They are reluctant to utilize government-sponsored treatment, because of fear of loss of anonymity and the ensuing social and economic consequences that follow when they are publicly identified as “addicts,” not to mention the potential loss of their personal freedom. (Addicted persons in China are sent against their will to forced detention centers, or “rehabilitation through labor camps.”) As a result, drug addicted persons in China are deeply mistrusting of government-sponsored treatment, and willing to sacrifice large sums of their own money for anonymous, confidential treatment.

Dr. Niushen Zhang and I recently published our findings in Addiction Science and Clinical Practice, 2015, “A qualitative study of treatment-seeking heroin users in contemporary China.” (To access the article online go to http://www.ascpjournal.org/content/10/1/23)

Q: Describe some highlights of your stay in China/SCPKU. 

The highlight for me was hearing the life stories of heroin-addicted patients at New Hospital in Beijing, and attending an Alcoholics Anonymous meeting, conducted entirely in Chinese. The AA members we met told us their participation in this grass-roots 12-step movement literally saved their lives. I also met many wonderful doctors and nurses working with addicted patients in China. Finally, Dr. Zhang and I became good friends. We had hardly known each other before venturing off to do research in China.

Q: List at least THREE words or thoughts that come to mind which best describe your experience at SCPKU. 

Compassion, endurance, overcoming adversity
 

Q: Any future plans in China? 

I’m thinking about taking a group of Stanford residents and/or medical students to China for a total immersion 3-week course to learn about addiction in China.  But not right away.

The leader of U.S. Pacific Command, Adm. Harry B. Harris, Jr., addressed U.S. nautical movements in the South China Sea while also calling for sustained military cooperation between China and the United States in a speech at Stanford Center at Peking University (SCPKU) on Tuesday.

Led by Ambassador Karl Eikenberry, a group of Stanford faculty and scholars from the Walter H. Shorenstein Asia-Pacific Research Center (APARC) listened to the speech from Stanford via an interactive, live videoconference at the Graduate School of Business. The speech was followed by a question and answer session, co-facilitated by Stanford professor Jean Oi in Beijing.

The admiral’s visit to SCPKU was part of a larger trip to China, which included discussions between senior Chinese and American military officials.

News media covered Admiral Harris’ remarks delivered at the SCPKU, which co-sponsored the event with Shorenstein APARC's U.S.-Asia Security Initiative. Articles appeared in the New York Times and Wall Street Journal (subscription may be required to view), among other publications.

In a recent interview with Voice of America, David Straub, associate director of the Korea Program at the Shorenstein Asia-Pacific Research Center, said that "Washington and Seoul will press China and Russia harder to use their influence to bring North Korea to genuine denuclearization talks."

The full article is available by clicking here.

Alexandra Harney quotes REAP research in a feature on the recent boom in vocational education in rural China. To read the original article, click here.

In China's countryside, tracts of forests are being replaced with concrete as a new type of factory is being built: the education factory. Motivated by a push to redirect China's economy toward a more innovative, high-tech future—and hopefully dodge the "middle-income trap"—the government is investing in vocational school parks designed to educate hundreds of thousands of students. 

China's vocational schools focus on workplace skills, rather than theory and academic subjects. However, in twenty years these students may be left behind, possessing skills that are no longer applicable in China's changing economy. Furthermore, many vocational schools fail to provide human capital enhancing experiences, instead shipping their students off to work as interns in factories that are often irrelevant to their majors and in some cases violate Chinese labor laws. 

Harney writes, ""You can build as much as you want, but unless you get good teachers, good curriculum and a system that assesses and rewards high performing schools with more resources, it's just going to be a waste of money," says Scott Rozelle, co-director of the Rural Education Action Program at Stanford University and the author of many papers on vocational education in China.

"There is no question China needs to raise skill levels. Wayne Zhang, who runs a home decor products factory in northeastern China, says that finding skilled workers - in order to increase capacity or make more complex products - is increasingly hard. Of the 100 such staff he set out to hire last year, he has only been able to find 60.

"As of 2010, just 24 percent of China's workforce had attended at least some upper secondary school, compared with an OECD average of 74 percent, according to a study published by the Freeman Spogli Institute for International Studies at Stanford University in February."

In response to this problem, REAP launched Assessing and Credentialing Vocational High Schools, a project aimed at establishing an evaluation system to hold vocational schools accountable to education standards and provide incentives to improve. Preliminary results show that the system is leading to improved student learning and school satisfaction. Read more about this project here.

Matt Sheehan
China Correspondent, The WorldPost
October 12th, 2015

Simply giving nearsighted children glasses can dramatically boost their school performance. Convincing teachers and parents is harder.

This article is the second in a What’s Working series that looks at innovative policy solutions pioneered by the Rural Education Action Program. REAP brings together researchers from Stanford University and China to devise new ways to improve rural education and alleviate poverty. You can read the first article in the series here.  

QIN'AN COUNTY, China -- Wei Wentai can barely be heard over the crescendo of cackles coming from the hallway. Fourth graders everywhere cane be boisterousness, but today the presence of two foreigners, an exotic breed in the rugged hills of western China, has driven these kids into a frenzy.

You could try to reason with the children: tell them they need to quiet down because Dr. Wei is here to train their teachers in how to perform vision tests. Those tests will give some kids free glasses so they can see the blackboard, dramatically improving their grades and chances of graduating high school.

But yeah, that’d be about as effective here in rural Gansu, in China's northwest, as it would be in Alabama, and it takes the lunch bell to drag the mob away from the classroom window. 

With relative peace restored, Wei continues to tutor the 12 village schoolteachers in the basics of eyesight and education. Having grown up nearby, he knows what superstitions to dispel (“No, glasses do not make your eyes worse”) and what points to drive home (“Yes, glasses dramatically improve grades for nearsighted students”). Despite receiving his medical training in Shanghai, Wei returned home after graduating and always speaks in the local dialect when training the teachers to perform this basic eye exam and write referrals.

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It’s a simple presentation tailored to this county, but one predicated on years of trust building and scientific trials by researchers on both sides of the Pacific Ocean.

Driving the project, called Seeing is Learning, are researchers from Stanford University’s Rural Education Action Plan (REAP) and Shaanxi Normal University’s Center for Experimental Economics in Education (CEEE). These groups operate in an emerging field of development economics that prizes rigorous experimentation over theory. Concrete interventions, randomized controlled trials and impact analysis are what drive their research and policy recommendations. Randomized controlled trials compare a randomly assigned group of participants receiving a particular treatment being studied with one not receiving the treatments. These trials are often called the gold standard of scientific research. 

REAP and CEEE have spent almost five years accruing the political capital and research results that they hope will overcome one of the biggest obstacles standing between rural Chinese kids and a high school diploma: most of them can’t even see the writing on the blackboard. 

Like many of their peers around East Asia, rural Chinese children suffer high rates of myopia. Around 57 percent are nearsighted by middle school, according to one REAP study. Unlike schoolchildren in Singapore or in China’s cities, most kids growing up in the Chinese countryside are ignorant of and isolated from vision care. 

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In hundreds of visits to rural Chinese classrooms, REAP program director Matt Boswell has rarely seen a bespectacled face. A patchy and inadequate rural medical system, the high cost of glasses and cultural preferences for eye exercises over glasses (what one researcher calls “voodoo health”) mean that most children growing up in townships and villages never take a vision test. 

“There is no eye care at the township level in China,” said Boswell. “Period.”

That void has a huge impact on education. In a study published in the British Medical Journal, REAP and Chinese researchers showed that giving myopic kids free glasses improved their math test scores by about as much as reducing class sizes. Those improvements came despite the fact that only 41 percent of students who were prescribed glasses actually wore them regularly. According to Boswell, when results were limited to the students who actually wore the glasses they were given, the impact proved enormous: it roughly halved the achievement gap between these rural students and their urban peers in just nine months.

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Improvements of that size represent some of the juiciest low-hanging fruit in Chinese education. Sixty percent of children in the countryside will drop out before high school, many due to failed grades and entrance exams. These tens of millions of dropouts threaten to throw a wrench in the Chinese government's plan to transition to a service- and innovation-based economy.

But when dealing with China’s bureaucracies, having a simple solution to a vexing problem isn’t enough to start harvesting that low-hanging fruit. The real art and science of the project came in aligning bureaucratic interests to get it off the ground.

“Every issue has its own little ecosystem,” Boswell said. 

For Seeing is Learning, that ecosystem involved education officials committed to the eye exercise regime, schools that closely guard access to their students, families who are deeply suspicious of the effect of eyeglasses and hospitals that saw no reason to screen rural kids.

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To break the impasse, the researchers had to first get local education bureaucrats on board. Randomized controlled trials proved the effectiveness of glasses and debunked the myth of eye exercises. They caught the eye of a powerful official in the nearby city of Tianshui, whose backing opened the doors to local schools. With REAP’s pledge to subsidize glasses, the hospitals suddenly saw large new markets materialize.

As a kicker, one trial found that when teachers were offered an iPad if their students were wearing glasses during random inspections, usage rates jumped from 9 to 80 percent.

“Hospitals love it because they get in the schools. Principals love it because of the impact on scores,” said Boswell. “We love it because the kids are learning.”

Turning that newfound excitement into a working program required the creation of two “Model Vision Counties” in which nurses and doctors like Wei Wentai receive accelerated optometry training.  In order to expand that reach from the county seat down to the village,  REAP ran another trial to see if teachers could conduct accurate eye exams after just a half-day training (answer: yes). So the newly trained doctors now rotate through the village schools, training teachers who then refer students to the hospital vision centers for proper prescriptions.

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Now the researchers are looking to scale up the program to six counties and at the same time turn the vision centers into sustainable social enterprises. Using their privileged access to schools, the vision centers can sell glasses to urban children with the resources to pay. Those profits then subsidize the first pair of glasses for rural kids, and repay REAP's initial loan, which REAP can then reinvest in creating further Model Vision Counties.

It’s a new model for REAP and one that prompts many new research questions. Can the vision centers earn enough revenue to both subsidize glasses and keep the hospitals happy? Will teachers enforce wearing eyeglasses if given a simple mandate rather than an iPad? Will the impact of the first pair of glasses convince rural parents to purchase the second pair?

Those questions will be investigated and answered when the project scales up. But as this van winds its way back down from the village to the county hospital, Wei Wentai reflects on the work they’ve done.

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A child takes an eye exam administered by REAP and CEEE.