By Jonathan M. Metzl, Special to The Kansas City Star

FENGXIAN MEDICAL OBSERVATION FACILITY, June 27 | This morning, Chinese medical observation officers woke me from a deep sleep. I opened my eyes to three figures, draped from head to toe in infection control gowns, goggles, gloves, shoe covers and face masks, who surrounded my bed in a remote room in a run-down motel in rural China.

“Temperature” said the first officer through his mask before placing a thermometer under my arm. “Food OK, yes?” asked the second.

After my temperature read as normal, the third officer handed me a small bouquet of flowers to celebrate the start of my fifth day in H1N1/swine flu quarantine. The hazmat trio left after five minutes, and I was left to ponder yet another day in isolation.

It was not supposed to be this way. Six days ago, I flew from Detroit to Shanghai to lecture at an esteemed Chinese medical school. As a physician, I knew of China’s aggressive public health response to the H1N1 virus. Thus I was not wholly surprised when a team of masked public health officials met our flight and took temperatures from every arriving passenger.

The display seemed excessive and somewhat nonsensical (“Have you had contact with pigs?” each passenger was asked), but we were quickly set free. I passed through customs and cabbed to my downtown hotel.

On my second night in Shanghai, I returned from dinner to find two white-coated medical officers waiting in the lobby. “Dr. Metzl, yes? You come with us.” Apparently, a passenger three rows in front and five seats across from me on the flight tested positive for H1N1. I had 30 minutes to pack my belongings. When I returned with my bags, I found the entire lobby cleared. The hotel staff stood in the corner wearing masks.

“This is preposterous” I complained. “I have no symptoms whatsoever.” My protests were quickly drowned out by the siren of the ambulance that sped to the front of the hotel. The back door opened to reveal three fellow American passengers from the Detroit flight. Someone threw my suitcases in, I climbed in, and we drove two hours in darkness and fear. I later learned that 10 ambulances worked through the night to pick up persons from our flight.

By 3 a.m. we arrived at a motel complex in the countryside. Imagine a Motel 6 in the middle of a field, abandoned for a year before being lightly sanitized and heavily security updated. Window screens failed to cover the windows, letting mosquitoes in.

Rugs frayed; wallpaper peeled from the walls. But each room boasted a new door alarm that sounded upon opening, and the latest in high-tech metal containment fences surrounded the complex.

More ambulances arrived carrying American passengers from the flight — by night’s end more than 50. Infection control officers hurried us through the abandoned lobby, up an elevator, to a floor that was to be our home for the next seven days. Each of us was assigned to a single room. Before shutting the door, an officer handed each of us a letter. “Ladies and Gentlemen, I hope you have had a good trip to China,” it read without a hint of irony.

“In order to combat H1N1 you will stay at the Fengxian Medical Observation and execution institution for these special days. Stay at your observation room, no come out of your room. This temporary separation is for your family and friends’ happiness and health. You will find quality services here. Have a nice time at this special moment.”

We now sit in a rural motel in a field beside a chicken farm, awaiting the passage of seven days. A physician, an engineer, a pharmacist, a photographer and her two children, three businessmen, a banker, and many others. According to the U.S. Consulate, the Chinese government quarantined more than 400 Americans, and countless Chinese and other nationals, over the past weeks. More ambulances arrive daily, and the number of held people grows with each arriving flight.

In this, but one of the quarantine sites, our isolation is not as complete as advertised. We pass the days in the doorways to our rooms, talking across the empty corridors and comforting one another about the heat, the mice, the missed opportunities, and especially the isolation. Shrink-wrapped observers visit us twice a day, morning and night, always with thermometers and sometimes with flowers. Not one of us is sick, save being exceedingly homesick. We continually query the rationale for keeping us here. But the observers tell us nothing.
As we sit, we strive to understand the situation. Certainly, pandemics are serious matters, all the more so in countries already traumatized by SARS and avian flu.

Moreover, governments have the right, indeed the absolute responsibility, to protect their citizens from communicable disease.

Much of our confinement appears to fly in the face of what might be considered established notions of international public health. We seem more likely to get sick from our current living conditions than from any illness we may have contracted before our arrival. Most other countries, and even now Hong Kong, have moved away from quarantine as a means of combating H1N1. Worse still, we are at times stigmatized and treated with suspicion—businessmen tell of Chinese colleagues who cancel business contracts after learning about the quarantine, and my hotel mysteriously tripled the room rate should I wish to return.

Why, then, are we here? Some of us think that the quarantine policy was an overreaction on the part of authorities (I have advised colleagues not to travel to China until the policy is changed). Others argue, jokingly, that it’s a ruse to revive the Chinese motel industry. Others contend that we are pawns in a grand act of political theater. Still others wonder whether central authorities here reflexively define illnesses that appear to come from the outside as threats to the fabric of Chinese society. We all feel that, in the bigger picture, whatever public health benefits China might gain from its H1N1 policy risks being offset by the negative feelings and publicity.

Sadly, many of us will leave this fascinating country without seeing anything beyond these four walls. In the meantime we, unintended casualties of a public health struggle between protecting people and controlling them, await the next temperature check, and for the pandemic, and the anxiety, to pass.

Jonathan Metzl was released from quarantine Monday night.

Jonathan M. Metzl is a Kansas City native and attended the University of Missouri- Kansas City Medical School. He is associate professor of psychiatry and women’s studies and director of the Program in Culture, Health and Medicine at the University of Michigan in Ann Arbor.