Salgınla mücadelede maske zorunlu olmalı mı?

medikritik Cu, 03/04/2020 - 10:44

Dünya Sağlık Örgütü'nün (DSÖ) ‘sadece özel vakalarda kullanılsın’ uyarısına rağmen salgının önüne geçemeyen pek çok ülke zorunlu maske kullanımını tartışmaya başladı.

COVID-19 ya da yaygın bilinen adıyla Coronavirüs salgınına karşı mücadelede maske, en çok tartışılan konulardan biri oldu. Bir yanda Asya’nın doğusundaki ülkelerde sokağa çıkarken evcil hayvanına bile maske takanlar diğer yanda İtalya’da maske taktığı için protesto edilen meclis üyesi. En başta şunu vurgulamak gerekir ki hem Dünya Sağlık Örgütü (DSÖ) hem de başta Çin Halk Cumhuriyeti olmak üzere virüsle başarılı mücadele etmiş-etmekte olan ülkelerin sağlık komitelerinin uzmanları, virüse karşı mücadelede maskenin tek başına yeterli olmadığını özellikle vurguluyorlar. Tek başına yeterli değil, fakat etkisiz de değil!

Doğu Asya ülkelerinde maske yıllardır
yaygın bir şekilde kullanılmaktadır. Maskeyi kış aylarında
özellikle artış gösteren hava kirliliğinden ya da hastalıklardan
korunmak için kullananlar çoğunlukta olsa da bazıları “maske
modası”na uyarak yaz aylarında bile bunu sürdürmektedir.
Dünyanın geri kalanında ise maske takmanın yaygın olduğunu
söylemek pek mümkün değil. Peki Coronavirüs salgınına karşı
maske kullanımı hakkında Çin Ulusal Halk Sağlık komitesi, Dünya
Sağlık Örgütü ve diğer ülkelerden uzmanlar neler düşünüyor?

DÜNYA SAĞLIK ÖRGÜTÜ NE DİYOR?

Dünya Sağlık Örgütü resmi
sitesinde “maske kullanımı Coronavirüse karşı tek başına
etkili değil, maske kullanımını el yıkama gibi hijyenik
önlemlerle ve diğer önlemlerle desteklemelisiniz” vurgusu
yaparken maskenin sadece spesifik vakalarda kullanılması önerisini
yapıyor. DSÖ maske kullanımı için yaptığı açıklamada ayrıca
şunları vurguluyor:

  • Sağlıklıysanız, sadece 2019-nCoV enfeksiyonu şüphesi olan bir kişiye bakıyorsanız maske kullanın.
  • Öksürüyorsanız veya hapşırıyorsanız maske takın.
  • Maskeler yalnızca alkol bazlı el ovma veya sabun ve su ile sık sık el temizliği ile birlikte kullanıldığında etkilidir.
  • Bir maske takarsanız, nasıl kullanılacağını bilmeli ve uygun şekilde imha etmelisiniz.
  • Aynı açıklamada nasıl maske kullanılacağı ile ilgili de şu öneriler yapılmakta:
  • Bir maskeyi takmadan önce, elleri alkol bazlı el ovma veya sabun ve su ile temizleyin.
  • Ağız ve burnu maske ile kapatın ve yüzünüzle maske arasında boşluk olmadığından emin olun.
  • Maskeyi kullanırken maskeye dokunmaktan kaçının; eğer dokunmak zorunda kalırsanız, ellerinizi alkol bazlı el ovma veya sabun ve su ile temizledikten sonra bu işlemi yerine getirin.
  • Maskeyi nemli olduğu anda yenisiyle değiştirin ve tek kullanımlık maskeleri tekrar kullanmayın.
  • Maskeyi çıkarmak için: Arkadan çıkarın (maskenin önüne dokunmayın); derhal kapalı bir çöp kutusuna atın; elleri alkol bazlı el ovma veya sabun ve su ile temizleyin.1

SESSİZ VAKALAR VE ÇİN ÖRNEĞİ 

Çin Halk Cumhuriyeti’nin salgına
karşı mücadele stratejisinde Dünya Sağlık Örgütü ile ayrı
düştüğü konulardan biri de maske kullanımı üzerine oldu
(diğeri Wuhan’ın karantinaya alınması idi). DSÖ’nün
“maskenin virüsten koruduğuna dair kanıtlanmış hiçbir çalışma
yok, maske kullanmak ek risk getirebilir” vurgusunu temel alarak
maske kullanım stratejisi belirlediğini söyleyebiliriz. Çin ile
DSÖ arasındaki uzlaşmazlık da tam burada başlıyor. Çünkü ne
Çin’de ne de Kore veya Japonya’da bu söylem üzerinden bir
strateji oluşturulmadı. Tam tersine Çin’de Salgınla Mücadele
Komisyonu başkanı Prof. Zhong Nanshan salgının en başından
itibaren halkın dışarıya maske takarak çıkmasını öğüt
verdi.

Çin Komünist Partisi yetkilileri de
bu öneriyi ciddiye alarak bir nevi zorunluluğa çevirdi. Öyle ki
virüsün kontrol altına alınmasına ve Çinli yetkililerin “salgın
bitti” açıklamalarına rağmen şu anda Çin’de sokağa
maskesiz çıksanız bile metroya binemez, marketten içeri adım
atamaz veya herhangi bir restorana giremezsiniz. Hatta şu an Çin’de
birçok işyerinde çalışanlar gün boyu maske takmaktadır.
DSÖ’nün “hasta veya sadece semptom gösteren kişiler maske
takmalı” önerisi Çin’de “herkes dışarı çıktığında ya
da toplu yerlere gittiğinde mutlaka maske takmalı” olarak
uygulandı. Çünkü “sessiz taşıyıcı” olarak nitelendirilen,
semptomlar belli olmasa da virüsün kuluçka süresinden dolayı
virüs taşıyıcısı olan kişilerin maske kullanmadığında başka
biri veya birilerini enfekte edebildiğine dair kanıtlar gittikçe
artmakta. Çinli yetkililerin açıklamalarına göre Çin’de
görülen vakaların üçte birinin hiçbir hastalık belirtisi
göstermediği tahmin edilmektedir.2 Yine Japonya Yokohama
Limanı’nda karantinaya alınan yolcu gemisinde 600’den fazla
pozitif vakada, hastaların yaklaşık yarısında hiçbir semptom
belirtisinin olmadığı raporlandı!3

Özetleyecek olursak Çin’de maske
kullanımını şu sebeplerle özendirildi: Virüsün damlacıklar
tarafından yayıldığı ve kontamine yüzeylerle temas ettiği
belirlendi, salgının yayılım hızının oldukça yüksek olduğu
tespit edildi ve yukarıda da belirtildiği gibi “sessiz vaka”
olarak adlandırılan durumun yani bir süre sonra kimin enfekte
olduğu belirsiz bir durumun ortaya çıkmasından dolayı maske
kullanımı özellikle özendirildi. Ana haber spikerleri
maskeleriyle haberleri sundu. Çin Devlet Başkanı Şi Jinping
salgın boyunca maske ile poz vererek kullanımı özendirdi ve bazı
eyaletlerde maske takmayanlar için kanunen engellemeler getirildi.

SARS SALGINI ETKİSİ

Maskeye bakışta, Batılı toplumlar
ile Doğu Asya arasındaki bir diğer fark ise SARS salgını. SARS
salgınının anıları Doğu Asya’da özellikle Çin’de hala
taze ve bu da maske kullanım oranını özellikle artırmış
olabilir. Ayrıca konunun bir de davranışsal yönü var. Hong Kong
Bilim ve Teknoloji Üniversitesi’nde davranışsal ekonomist Prof.
Donald Low, maske takmanın önemi ile ilgili şu şekilde katkı
yapıyor: “Dışarı çıkmadan önce her gün bir maske takmak,
üniforma giymek gibi bir ritüeldir ve ritüel davranışta,
üniformanın ne anlama geldiğini yaşamak zorunda olduğunuzda
hissedersiniz, bu da sizi yüzünüze dokunmamak gibi daha hijyenik
davranışlara yönlendirir. Yine maske takmak kalabalık yerlerden
kaçınmak ve sosyal mesafe oluşturmak için itici bir rol oynar.”4

DİĞER ÜLKELERİN YAKLAŞIM

Çin Halk Cumhuriyeti, Kore, Japonya,
Tayland gibi Doğu Asya ülkelerinde yaygın ve bazılarında zorunlu
olarak maske kullanımı olduğuna değindik. Burada maske
kullanımında tek istisna ise Güneydoğu Asya ülkesi Singapur
oldu. Singapur hükümeti, maskeye en çok sağlık çalışanlarının
ihtiyacı olduğunu ve DSÖ’nün açıklamalarını da baz alarak
maske kullanımında oluşabilecek risklerden dolayı vatandaşlarını
maske kullanmamaya çağırdı. 

Avrupa’da ise Avusturya, Çek
Cumhuriyeti (resmi kısa adıyla Çekya) ve Slovenya, kısa bir süre
önce bazı kamusal alanlara girmek için maske kullanımını
zorunlu kıldı.5 Çekya Sağlık Bakanlığı yayınladığı
bir video ile vatandaşlarını (herkes için maske anlamına gelen
#Mask4ALL sloganı ile) maske takmaya davet etti. (Çekya Sağlık
Bakanlığı destekli maske takma çağrısına şuradan
erişebilirsiniz: https://www.youtube.com/watch?v=HhNo_IOPOtU).
Çekya’da 2 Mart 2020 tarihli Coronavirüs vaka sayısı 3 bin 589
ve salgından dolayı 38 Çek vatandaşı ise hayatını kaybetti.
Avrupa’da Coronavirüse karşı en az vaka sayısına sahip olan
birkaç ülkeden biri olmasını Çekya yetkilileri “diğer
ülkelerden farklı olarak yaptığımız şey maske kullanımını
zorunlu hale getirmek” olarak açıklıyor.

Avusturya Şansölyesi Sebastian Kurz
ve Sağlık Bakanı Rudolf Anschober da yaptıkları açıklamada
Avusturya genelinde bakkal ve süpermarketlere giren kişilerin
cerrahi maske takmaları gerekeceğini, maskelerin ise ülkedeki her
bakkalda ücretsiz olarak bulunabileceğini belirtti.6 Viyana
Tıp Üniversitesi İnfluenza Bölüm Başkanı Monika
Redlberger-Fritz de alınan kararı onaylayarak “maske kullanımı
yanındaki kişiyi korumanın önemli bir yoludur” açıklaması
yaptı.

Almanya’nın doğusundaki Jena şehri
yönetimi de birkaç gün içinde süpermarketlerde ve toplu taşıma
araçlarında maske takmanın zorunlu olacağını duyurdu.7

TÜRKİYE’DE NEDEN TEŞVİK EDİLMİYOR

Türkiye’de uzmanlar şimdiye kadar
“açık alanda maske kullanımı gereksiz, maske kullanılacaksa
kapalı alanda ve enfekte olan hastalalar kullanılmalı”
söylemlerini ifade etti. Hatta yer yer maske takmanın zararlı
olduğunu iddia edenler de oldu. Hem Bilim Kurulu üyelerinin hem de
diğer uzmanların Türkiye’de maske kullanımını teşvik
etmemesinin en önemli nedeni sanırım Dünya Sağlık Örgütü’nün
tavsiyeleri ve maskenin etkin bir şekilde virüsten koruduğuna dair
kanıtlanmış bir özelliğinin olmaması. 

Maskenin, salgında başarı sağlayan
ülkelerde kullanılması ve bu ülkelerde maske kullanımına sosyal
izolasyon, enfekte olan kişinin belirlenmesi ve diğer hijyen
önlemleri kadar önem verilmesi ABD’de de maske kullanımına
yönelik bakışı değiştiriyor gibi görünüyor. Bir süre önce
maske kullanımının bilimsel olmadığını ve bunun dünya günlük
maske üretiminin neredeyse yüzde 80’ini yapan Çin’in pazarlama
planı olduğunu söyleyen söylemler yavaş yavaş değişmeye
başladı.

ÇELİŞKİLİ AÇIKLAMALAR

Sağlık çalışanları için maske
takmak zorunlu ama vatandaşların maske kullanılması gereksiz
bulunuyorsa bu insanların gözünde bir çelişki oluşturuyor.
Elbette sağlık çalışanları göz bebeğimiz, ama eğer maskeler
virüsten korunmak için etkinse ve bu yönüyle sağlık
çalışanlarının kullanması gerekiyorsa pekâlâ zorunlu olarak
dışarı çıkmak, fabrikada veya hizmet sektöründe çalışmak
zorunda kalanlar için de bu durum geçerli olabilir.

Bir diğer çelişki de maske konusunda
teşvik edici olmayan Dünya Sağlık Örgütü üyelerinin her hafta
yaptığı haftalık bilgilendirme brifinginde maske takmaları.8

Kendi sitesinde sadece “semptom
gösterenler veya enfekte kişiye bakmakla yükümlüler”in maske
takmasını salık veren DSÖ’nün basın toplantılarını maske
takarak yapması insanların gözünde maske kullanımını
özendirerek yapılan resmi açıklamalara ters bir durum
oluşturmaktadır.

TUTUMLAR DEĞİŞİYOR

Science Dergisi’nin, Çin Hastalık
Kontrol ve Önleme Merkezi genel müdürü George Gao ile yaptığı
bir mülakatta Gao, Coronavirüse karşı maske takmamayı büyük
bir hata olarak nitelendiriyor.8

Virüsün insandan insana “solunum
damlacıklarından” geçtiğini söyleyen Gao, bunu önlemenin tek
yolunun da maske takmak olduğunu ifade ediyor. 

Görünen o ki önümüzdeki süreçte maske kullanımına bakış büyük ölçüde değişecek, başta Çin olmak üzere salgına karşı başarıyla mücadele veren ülkelerde maske kullanımı zorunluluğu ve özendirilmesi üzerine diğer ülkeler maske üretimi, edinimi ve kullanılması gibi konularda radikal önlemler alacak gibi duruyor.

ORÇUN GÖKTÜRK/BEİJİNG ULUSLARARASI İŞLETME VE EKONOMİ ÜNİVERSİTESİ MASTER ÖĞRENCİSİ / AYDINLIK

DİPNOTLAR:

  1. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-…
  2. https://www.scmp.com/news/china/society/article/3076323/third-coronavir…
  3. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.1…
  4. https://www.bbc.com/news/world-52015486
  5. https://www.npr.org/sections/coronavirus-live-updates/2020/04/01/825180…
  6. https://www.independent.co.uk/news/world/europe/austria-coronavirus-fac…
  7. https://www.reuters.com/article/us-health-coronavirus-germany-masks/ger…
  8. https://twitter.com/whowpro/status/1231930911978995717
  9. https://bilimveutopya.com.tr/koronaviruse-karsi-maske-takmamak-buyuk-bi… 

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ремонт бытовой… (doğrulanmamış) Cu, 18/10/2024 - 13:48

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Ремонт духовых… (doğrulanmamış) Pa, 20/10/2024 - 15:22

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DanielSpola (doğrulanmamış) Sa, 29/10/2024 - 16:23

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Per, 31/10/2024 - 22:58

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Pa, 03/11/2024 - 07:18

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Pt, 04/11/2024 - 18:19

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Çar, 06/11/2024 - 19:01

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Cu, 08/11/2024 - 17:38

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Pa, 10/11/2024 - 15:00

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Sa, 12/11/2024 - 12:33

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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