Why McDonalds?

When we travel you can usually count on us hitting up a McDonalds or Starbucks where ever we are. Why is that, when at home in the states those are not places we hardly ever eat at? A couple reasons: 1) it's food from home and 2) it's pretty darn consistent.

Sure, we can get a pizza most places we go but you never really know what you are going to get (clams and corn on the "meat lovers"? Yeah, that happened). If you are looking to order favorite foods from home it is best to have your expectations set low; it often comes out at best with something not quite right, and at worst just all wrong. But at McDonalds that quarter pounder and French fries is about the same where ever you go (except of course at places that don't serve beef, then you've got interesting new things to try like the McVeggie. It's also fun to see the local additions - taro pies in Taiwan for example). I can order my Starbucks drink, in English no less, anywhere and I know exactly what I'm getting. So while it's not necessarily what we'd consider good food, or the food we miss the most, it is familiar and there is something comforting in that.

Soup du jour

In Taiwan after I had Tegan everyone kept bringing me soup. Soup with different herbs, proteins, vegetables - each with some quality that was good for new moms. Now in Nepal I also get a daily dose of soup; soup at every meal is the advise. Not that I'm complaining, I love soup and it's so cold right now it's nice to fill up on warm food.

 

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Pediatricians in KTM

Health care is a much bigger concern for us now than it had been the first time we took jobs internationally.  We raved about Taiwan's health care, and while I wouldn't rave about Nepal's, we have found what we need to stay healthy, and in particular keeping Tegan healthy.  We've had Tegan (now 16 months old) in for a few trips to the doctor in Kathmandu now, including a well-check, routine childhood immunizations, an emergency visit after a fall and a "she seems sick and we're new parents so we'll take her just to make sure" visit.  Jeremiah and I have also been for regular vaccinations.  As I mentioned in my dentist post, CIWEC is the clinic in town that we and many other expats go to.  We've gone with appointments and without and have always been seen very quickly.  Right now there are two doctors that we've preferred, Dr. Will and a woman expat who I have forgotten her name.  Both were wonderful with Tegan, though both are GPs I believe.  For her well-check we saw the pediatrician Dr. Kishore who was also friendly and gave us good information to think about for vaccinations.  The clinic is clean and everyone takes the utmost care with keeping things sterile.  Overall we've been quite happy with it all.

Celebrating Chinese New Year

After celebrating Chinese New Year for the last 3 years, we wanted to do something for the occasion even though it's not celebrated here (though Tibetan New Year is I guess, next year we'll look into that).  

We started our day at Namo Buddha with mountains and "xīn nián kuài lè" (happy new year). Not a bad place to start your day!

When we got back home we did some stuff around the house that reminded us of Taiwan.  We had our New Years posters up, including the one from the year of the rabbit when Tegan was born.  We looked at some books we have in Chinese (this one is from Mo Willem's series Elephant and Piggy) and the book I made Tegan about being born and living in Taiwan.  We listened to a children's New Year song on YouTube and finally ended the day with a red envelope (I had to make out of Nepali paper because I forgot to bring them from the states with me, but the red fish paper was fitting I thought).

It all wasn't quite the same, and we missed amazing meals we've had with friends in the past (and I'm afraid to admit I in particular have been missing the cheesey 7-11 New Year characters and gimmicks - Hello Kitty anyone??) but we had a wonderful day none-the-less.

Happy year of the snake everyone!

Here and There

Wedding cars:

Taiwan - red ribbon, bows and fireworks

Nepal - intricate floral designs

National Adoption Month {Guest post!}

Before November is through, I wanted to recognize National Adoption Month.  When I was young, my mom worked for an international adoption agency for the China department.  Since then, hearing stories of families working so hard to adopt babies who so desperately needed a home, I have had great respect for families who come together through adoption.  A number of our good friends have adopted children internationally as expats and I asked one of them to write about their experience.  Krista and her husband Frank have 2 beautiful girls; they have been blogging about all the great activities and ways they are honoring National Adoption Month over here.  Enjoy!

My husband and I are international educators living in Taiwan. When asked to write this guest post from a former coworker and current amazing friend, I was beyond honored. November is a special month in the McGowan household; it’s a time when we honor adoption, our two beautiful girls, and the amazing natural families who made our dream come true. Adoption for us wasn’t out of necessity, it was a choice we made, my husband and I--together. This choice came with it’s ups and downs, as all choices do.

Our story is perhaps a bit different from many adoption stories in that we wanted a private adoption in a foreign country. Navigating through the legal hurdles and obstacles was mind numbing. We finally discovered all we had to do was get a baby, then deal with the legal stuff later. Easy right? Well, that’s where things became difficult. I’ve written about some of the bumps and bruises we experienced along with way on our blog Taichung Teachers.

Adopting in a foreign country is not for the faint of heart. We were 100% dependent on local friends, translators and hope that everything was going smoothly. We spent thousands of dollars translating documents into Chinese and then Chinese documents into English. As court dates drew nearer, we were met with list after list of new documents needed by the Taiwanese courts. These documents were not always accessible. For instance in Taiwan, all nationals are registered to a household and our adoptive girls needed to be registered as well. The problem was, we aren’t Taiwanese nationals and therefore could not have anyone registered to us. The solution by the Taiwanese officials, “just have a friend register the girls under them.” The courts also required we show them our US household registration-which of course we don’t have because there are no household registration cards in the US. This idea was completely foreign to the courts and caused us quite a bit of stress as initially, they were unwilling to bend.

All of these things were problematic, but would have been accepted more positively had all our friends who have adopted gone through the same process. The problem is, every single case required different paperwork. It was as if the judge pulled out of a hat which paper she needed on any given day.

In honor of National Adoption Awareness Month, we thought we would finalize our adoptions at home in the good ole U-S-A. We found a lawyer to deal with the re-adoption end and then the search was on to find a lawyer to help us with the citizenship end of things. This is where we hit a wall. Being expats with no desire to head home any time soon, we fall into a grey area. If we wait two years, no problem. If we want it done immediately, major problem. We have to start from scratch with a US home visit and go forward from there.

Adopting abroad has been difficult at times, but worth the struggle. Adopting has been the single best thing I have ever done in my life. However, I’ve found there are little to no resources available for our type of situation (one that I am planning on rectifying as soon as possible). Adopting abroad has expanded my world view beyond what I expected was possible. I now see immigration differently and have been frustrated with my government’s lack of acknowledgement of my children.

With that said, I have found that the greater adoption community is beyond supportive and our friends have stood by us throughout the whole process. At the end of all this struggle, we have been blessed with two darling little girls. Due to the way we did our adoptions, we walked out of the hospital with our girls being 1 day old and 2 days old. This probably wouldn’t have happened for us back home.

We have a rainbow family and one we are incredibly proud of and honored that we were chosen to raise these little monkeys. I don’t refer to myself as an adoptive mother, or my children as adopted children-we are a family built on love. Every night my husband and I read the girls a story, tuck them into beds and kiss them goodnight-just like every other family. Every morning we are greeted with peels of laughter and monster hugs. Whatever difficulties we have experienced become quickly melted away when our little girls look at us and give us big ole cheesy grins. At the end of the day, we are parents, they are our children and we are a family.

Where the heart is

We've been parents for a whole year now - it's been a year of awesomeness.  Most of that year has been spent living abroad, in 2 countries no less.  As we navigate expat living, we are making a conscious effort to make sure we have strong roots in family, traditions, and an idea about what "home" means.  Yes, our daughter is only one, and yes, she won't remember this early stuff, but we are setting the tone for what living overseas looks like for our family.

How are we doing this?  It's definitely a work in progress but here's what we've got so far:

1.  Spend time in the Portland area, what we consider our "home" - when we talk about home, we want Tegan to have connections there.  It may not be what she considers home, but she'll know what we're talking about.

Oregon zoo

2. Have consistent traditions - it's easy to have events and celebrations be different each year when you are abroad, we're making an effort to set things in place that can be the same each year.

Birthdays, St. Patrick's Day, Sunday morning breakfast - all important traditions

3.  Have relationships with extended family - we skype a lot with family, and we're creating a book this Christmas break with everyone's picture in it so while we are in Nepal Tegan can look through it.  I also like the idea of reading night time books over skype as well as recording people reading books aloud to play when we can't skype.

Skyping with her uncle

4.  Have things in our home that are the same no matter where we go - pictures, decorations, special books and toys

5.  Story-telling - we want Tegan to know about the places she's lived, where we are from, who has been a part of her life.  We have books from the countries, pictures, our blog - all to record memories of her life experience and we will tell her stories of the parts of her life she doesn't remember.

6.  Read about and discuss with other families Third Culture Kid issues - I deal with this a lot in my job as a school counselor but of course things are always different when it's your own family.

These things will inevitably be adapted and change as Tegan grows up, but isn't that really what living abroad is all about?  Learning.  Being flexible.  Change.  But within that constant state of flux, we want everyone in our family to feel grounded, both in tangible and intangible ways.

If other families have recommendations about how they do this we would love to hear them!

One of my biggest fears

The dentist.  Just thinking about it makes my heart race.  I know I'm not alone here, you all are cringing now too, right?

In America we did a pretty good job of going in and getting cleanings.  When we moved to Taiwan the dental care just wasn't the same so we put it off a good while.  Right before leaving we both had a cleaning and I needed a few fillings.  Great.  So, I sat down to have it done.  Everything was going just peachy (which in retrospect I should have been suspicious of) when all of a sudden every nerve in my mouth radiated out in fire and I was ready to jump out of the chair and cling to the ceiling.  She had drilled with no novocaine.  "Just 5 more seconds" she said as every muscle in my body is tight and hands gripped the seat.  2nd longest 5 seconds of my life.  (The 1st longest?  "Just push 5 more seconds" about 6 months prior as Tegan was being born).  As soon as her hands were out of my mouth I, politely, informed her that in America we don't drill without anesthetic.

None of it was good.  Except the price I guess, it was quite cheap, though considering the next paragraph and its $300 price tag I negate this positive point.

Fast forward to a week ago.  I was eating lunch and realized the corner of a back molar was missing.  Same area as the filling I'd gotten in Taiwan.  I asked around, got the name of a dentist (Dr. Pollard at CIWEC) and made an appointment.  I dreaded going.  A dentist I didn't know, in Kathmandu no less, and a bit ol' chunk of my tooth gone.  Long appointment short, he was empathetic to my Taiwan story and gave me plenty of anesthetic to get through the work, fixed the bad filling job, and made some recommendations for future work.  He even made small talk and had nice little stories to keep me entertained and calm.

While not all of it was good, it was as good as it could be.

I'm giving myself a little reprieve before I think about the next steps in dental work.   I think I've deserved it.  In the meantime, my toothbrush is my new best friend!

Leave the stroller at home

Travel and strollers just don't always go together very well.  Many of the places we've visited/lived have had uneven roads, non-existant sidewalks and crowded areas that made stroller usage impractical, if not impossible (ramps and elevators no where in sight!).  They are also often just another thing you have to cart around, send through x-ray security and maneuver when your hands are full.  So, much of our travel thus far has involved babywearing (our baby, Tegan, is just about to turn 1 and we've lived and/or traveled in Taiwan, Thailand, Nepal, and the states with her).

When Tegan was little we used the baby bjorn a lot while out and about.  She fit in it well, it was cooler than the moby wrap and easier to take on and off (we alternate carrying her depending on the situation).  She hated slings and I used the moby a lot at home and around our town but found it bulky and time consuming for traveling. 

As she got bigger, we've moved to the Ergo because it's better for baby's hips (they sit rather than hang) and I personally find it more confortable.  Tegan didn't like this carrier until she was big enough to really sit in it, but they do have newborn inserts and our good friends used their Ergos practically from day one with much success.  Sometimes she sits in front, sometimes on the back and occasionally when she's more antsy I put her on my hip.

In countries where everyone wants to touch and hold your baby, a carrier is a great way to hold off over eager admirers and help keep baby feeling safe.

We've recently added another carrier, for our longer hiking, the Osprey frame backpack.  So far only Jeremiah has carried her in this one as it's a bit heavier.

I highly recommend babywearing, for anytime really, but especially as an alternative to strollers when traveling.  I like having a variety, and Jeremiah and I each have different preferences, so the more the merrier in this house (I just bought a sling to try out with Tegan on my hip and I'm pretty sure she is going to love it).

Some tips:
-Practice at home first.  Walk around, put it on and take it off, put the child in and take them out, do some chores, bend down, get stuff out of your pockets, etc.  You'll get the hang of it and see what works for you.
-If you don't love it at first try again, or try a different style carrier.  Everyone has a preference.
-If you go with a wrap style, you can pre-wrap it so you are ready to go when it's time to put your child in.
-Some airports will make you take the child out of the carrier when going through security, others won't.
-Many airlines will make you take baby out for take off and landing as it is safer to have them in a car seat or in your lap if you have a lap-seat ticket.

Any other babywearers out there have advice?

Top 10 Taiwan posts

According to google analytics, these are our top posts about Taiwan over the last 3 years:

Rainbow Village
Leofoo Village Theme Park
Simply adorable (oh my how she has grown since this picture!)
Guava
Sun Moon Lake
Guo Nian
House of Unique Stink (I can still taste it...)
Having a baby in Taiwan
Modern Toilet
Musings (this one was fun for me to re-read since it was from the very beginning)

Things I will miss

As we have spent our final days in Taiwan saying goodbyes, packing up and finalizing all sorts of odds and ends, I find myself sadly thinking "this is the last time I will ___ in Taiwan".  Here is a list of the things I will miss about living in Taiwan:

• Taiwanese breakfast - dan bing especially
• The people at the restaurants/shops we frequent - they know us, they know our orders, they greet us with great big smiles.  Sure I can order my tea in broken chinese (yībēi lǜchá bàn táng) but when I see our tea guy I just say "one" and he knows what I want, or if I say "two" he knows I want my order and Jeremiah's (oolong, not green, tea).  And I have no doubt if we went down there right now, Allen at Thai Yun would feel safe betting $100 that we would order the Yunan style tofu.
• Tea: green and bubble tea - zhēnzhū nǎichá
• Geckos living in my office
• Mango, dragon fruit, guava, passion fruit
• Lo bao gao
• Taiwanese people in general - we've been continually amazed at the generosity and helpfulness of complete strangers.  
• Cheap and easy health care
• Day and night markets - the food, the fashion, the bargains
• Scooters - we've been without our scooter for about a month now and Jeremiah especially has missed it.  Pre-Tegan the scooter was the fastest and easiest way to get places, and to park!
• And of course all our friends we have made during the last 3 years - we will miss them most of all.

With such a long list there is really only one thing to do - come back and visit!

Preparations under way

We're catching up on our vaccinations and health records for our move to Nepal - last weekend we proved we don't have TB after a skin test and chest x-ray.  We also had blood tests and got our teeth cleaned.

We've sold our car and furniture and have started packing up the few belongings we will keep.  In less than 2 weeks we will be on the plane heading back to the US for the summer; it is bittersweet - we are both very excited about going home and then to start our new jobs, but sad to be leaving our home for the last 3 years.

Taipei Lantern Festival - Year of the Dragon

Two years ago we went to the Taipei Lantern Festival and had a great time.  We decided to go again this year after hearing that the lanterns were to be especially impressive.  Well, apparently everyone else in Taiwan got that memo because, boy, was it crowded.  We spent so much time fighting to get through the masses of people that it was hard to enjoy the lanterns at all times.  There were some awesome displays though, and it was definitely an experience.

Temple close-ups

incense

intricate paint

jiaobei, or moon, blocks

Tea eggs

A pot of tea eggs brewing away at 7-11.  Wikipedia says this about tea eggs in Taiwan:

"In Taiwan, tea eggs are a fixture of convenience stores. Through 7-Eleven chains alone, an average of 40 million tea eggs are sold per year.

Also some people would say that the tea eggs' flavor is very addictive. It tends to linger in one's mouth because of the star anise used in the preparation. This spice has also commonly been used in teas from other countries, where they also report a similar addictive quality. Tea eggs can be made with or without cracks, but will still have the same flavor, but a different appearance. The most traditional way to prepare them is simply to make cracks in the shells after they are finished hard boiling, but before one soaks or boils them in the brine made out of tea, sugar, soy sauce, star anise, and cinnamon. All of these ingredients can be modified depending on a person's preference. Soaking the eggs for longer will result in more flavor."

We haven't tried them yet, but will soon!

Happy Year of the Dragon

Saying goodbye to the rabbit and hello to the dragon.  We celebrated yesterday with friends with lots of food - bbq for lunch and all sorts of traditional foods for dinner!

Cheeto fail

Seaweed flavored cheetos.  We bought them.  Ate a couple.  Decided they were gross.  In a moment of desperation ate a few more and confirmed they were gross.

Voting day

People lined up down the street from our apartment to vote in Taiwan's presidential election.

Having a baby in Taiwan

In the last year we've learned a lot about having a baby in Taiwan, heck, we've learned a lot about having a baby in general!  We went the doctor/hospital route, so I don't know anything about other forms of prenatal care and birthing.  I'll outline what we learned... if anyone has questions feel free to contact me.

Medical
When we decided to have a baby here we didn't know where to go at first.  A representative from Kuang Tien had come to our school and explained their international program for foreigners - translators and specialized services offered.  Translators in particular caught our attention - if we were going to have a baby we wanted to make sure the doctor and we were communicating clearly (not always the case when you go to the doctor here, though most do speak medical english).  The hospital was a bit of a drive away from us, so we decided to try it and see if it was worth the drive - it was.  There are, however, lots of hospitals and clinics available.

I called the international phone number at Kuang Tien and asked for an appointment with an obgyn.  The man who answered the phone didn't know what an obgyn was: maybe not the best translator, but once I told him the point - we wanted a baby - he figured it out.  I told them the times I could come in and he recommended a doctor for me who had clinic hours at the times I could come in - turns out he picked a great doctor for us, Dr. Su Chi Feng (we'll always be grateful for that choice).

Once I was pregnant we went in for doctor visits on the same schedule as one would go in the states.  I got an ultrasound every visit so we got to see our baby a lot.  At first we had a translator that went with us to each visit but our doctor's english was great so we didn't need the translator.  Almost all visits and treatments were covered under the national health insurance NHI.  We paid about $3US a visit, and out of pocket for a few extra optional tests (maybe $30US? - not much).  I wrote more about a typical prenatal doctor visit in my last post.

We flew back to the states around 20 weeks and back to Taiwan around 28 weeks - we got a letter from the doctor in english and chinese saying I was safe to fly during that time but had no problems with the airlines.  We also got copies of medical records to take back with me in case something happened while I was home.

When it came time to have the baby we requested private rooms.  At our hospital women labor in a common room with curtains and then are moved into a delivery room.  We preferred our own room - we paid extra for this and are glad we did.  We also paid extra for a big private recovery room and again were happy with this choice.

I had asked our doctor earlier who would deliver our baby if he wasn't available - he laughed and said it was his job so our course it would be him, and it was.  I'm not sure if this is always the case or if we were a special circumstance.

It was important that though labor, delivery and recovery we advocated for what we wanted and how we wanted things to go.  We noticed people got stuck on doing things a certain way simply because that's how its been done before and some of what we expected was different from what the nurses and doctors were used to - anything from bigger medical decisions to simple baby care - and we had to request for things to go a certain way (I'm sure everyone breathed a sigh of relief when we were finally discharged :).

Typical hospital stays after birth are 3 days or 5 for c-section.  We had our baby room in with us and nurses and doctors were always coming and going.  Often when only 1 nurse was required 2 or 3 would come so they could pool their english knowledge.  Doctors would come and translate forms for us, and once even a young ENT resident came to translate for us.  There was a place for Jeremiah to sleep and he only went to work the last 2 days (much to the nurses dismay - who would take care of me???  um.... them!).  Breastfeeding was supported and encouraged.

Insurance
We have National Health Insurance - NHI.  It covered almost all my prenatal visits, though when I went over the standard amount of covered visits our cost was still only about $9US each visit.  Health insurance for the baby is covered under mom the first 2 months (this is the same for Taiwanese moms/babies too).  However, foreigner babies have to be in Taiwan for 4 months before they can get NHI.  This leaves a gap of at least 2 months (we're having a hard time determining if it is 4 months from birth or 4 months from the time they get their ARC). We looked into private insurance to cover the few months in case something went wrong but this proved difficult.  We will pay out of pocket for health care until NHI kicks in for her.  The out of pocket cost of the birth for us was under $100US and we had the added expense of the private rooms we requested, though this still was so cheap compared to home.

Clothes/Supplies/Stuff
I bought maternity clothes from home.  Sizes and styles here didn't really suit me.  I also bought my prenatal vitamins from home though I did see them available at our local pharmacy (not sure of the quality or what is in them though) and a friend bought some at costco here.

As it got closer I packed my hospital bag with recommendations from folks in the states.  Some supplies needed were not provided by the hospital but we could purchase there so we did that.

We bought a Chicco carseat at SOGO.  We mostly see moms here holding their babies in the car (I was told a law is changing this) and a few people laughed at us when they saw we had it in the car early in case I went into labor.  We bought most of her clothes from the states - baby clothes here can be expensive or just not what we are used to.  We also brought basic medicines from home as well as cloth diapers.  There are many baby stores in Taichung that are well stocked with just about everything you could want - some familiar brands and many Taiwanese brands.  Our nursery is furnished from Ikea.

Legal
Soon after birth we went to AIT for her passport, SSN and consular birth certificate - their website is very helpful in figuring out all you need and though you can't call to ask questions they are very quick in responding to emails.  what the website doesn't say is you may have to prove that you lived in the states for a period of time (even if both parents are US citizens) and I was told college transcripts is the easiest way to do that, though they didn't actually ask to see ours when we went.  Passport came in the mail in a few weeks, SSN a few weeks after that.  Our employer applied for her ARC (we were told this must be done within 30 days of birth).  The hardest thing about all of this was getting a suitable passport photo of a newborn - we took about 100 pictures to get one of her that met standards.

Other miscellaneous cultural things
-I think our baby will never be dressed warm enough for the moms and grandmas we meet.
-I was asked many times who would take care of my baby after she was born - typically the month after birth is a time for the mom to recover and she has help taking care of the baby, sometimes even staying at a special clinic.  It appeased some when I told them my mom would come visit for awhile.
-No one ever came up to me and touched my belly as often happens in the states but many people were curious and had questions
-Warm water is always better than cold (as is the case also when you are sick) though I stuck to my ice water and cold drinks
-Special foods are given to mom to help her recover from birth - soup is key.
-People laughed when they saw all the baby furniture we had and our nursery set up.
-We get a lot of advice from people when we go out with the baby

I admit I was nervous at first about having a baby abroad but as soon as I met my doctor and got some information I felt very comfortable and we are so happy with the way everything turned out.

*Edit: we also found this forum helpful: Parent Pages

Prenatal care in Taiwan - visiting the doctor

Since I have gotten many questions about what our health care is like I thought I'd share a typical prenatal appointment experience.  I also posted this awhile ago on our other blog. 

We have been going to Kuang Tien Hospital and work with the international department who provides assistance to foreigners - a huge plus for us!  For this particular visit, I emailed the international coordinator and asked her to make an appointment for me, I received an email back the next day telling me I was #9 for August 2nd and could show up any time after 9:30am. We got to the office a little after 9:30 and the nurse checked me in - weight, blood pressure, etc. She then took my file, baby book that tracks my development and health card to the doctor and we went in a few minutes later.

In the doctor's office I had an ultrasound (I have one every visit). He measured Baby O's head size, femur bone and abdomen to help determine due date (still around October 22nd). He measured the heart rate (normal) and checked for any problems (none). Finally, we discussed that she is breech and what that may mean down the road. For now, however, she has plenty of room to turn around.

After the ultrasound we went to the computer where he noted information in my file. He explained the blood test that I was to get next and sent us on our way with a nurse to get my blood test, and for Jeremiah to get his blood type determined since we didn't know it.

The nurse took us to the blood drawing area and we took a number. After about 10 people it was our turn and the nurse translated for us when needed. The nurse took us back to the obstetrics waiting area while they processed Jeremiah's blood type. 30 minutes later they called us in and told us I would need to get a shot today and one after I give birth. The nurse walked us to the pharmacy to pick up the injection (she waited in line for me to get it) and then took us to the injection room. We took a number and waited our turn. This was the craziest part of the day - I was called into a good sized room that was filled with people. One man was sitting in a chair getting bandages on what looked like road burn on his back and arms. There were 5 beds with people in them getting various treatments - a young boy getting an IV, someone getting a burn bandaged, an old man getting blood and a few others. Everyone out in the open. I was showed to a bed and while everyone else was out in the open getting more intense procedures than I was, the nurse closed the curtain around us, then gave me the shot in my arm and we were sent on our way home.

We paid about $3US and it included everything. The interactions with the doctor were all in english and the nurse who took us around translated for us when the other nurses didn't speak english. A productive and satisfactory visit.  We have found that with the right doctor, who understands there are some cultural differences in medical practices between America and Taiwan, and is flexible around those differences, everything can go very smoothly.  We are very fortunate to have such doctors.