You have all probably heard of (or perhaps experienced) that most dreaded of holiday souvenirs - Montezuma's Revenge. We have our own variation here in China, which I have variously named Mao's Revenge, China Rot Gut and the Middle Gurgle (since China is known as the Middle Kingdom...). The digestive system is capable of some pretty amazing feats, chief among them the ability to adapt to foods and environments while traveling or living abroad. This adaptation process varies from gut to gut. While I am no steel gut hero, I rarely get sick anymore, so this weekend when I was overwhelmed by a particularly nasty bug, I felt like a China newbie.

So, getting sick in China. What's that like? If it is intestinal upset, be sure you have quick and easy access to a Western-style toilet. Public toilets in China, including most restaurants and shopping centers, are of the squatter variety. These are fairly common throughout Asia and although a little uncomfortable for us Westerners, it is easy enough to figure out how to use them. But not when you are sick. There is nothing worse than maintaining balance and aim while perched like a pretzel over a ceramic hole of unknown depth and cleanliness. Thinking of visiting China? (Or anywhere you travel, for that matter.) Bring along a box or bottle of Pepto-Bismol. It is a life-saver.

As for respiratory issues, you can be sure the polluted air and exotic flora will do a number on you... or not, as some people seem more resilient in this area than others. I do notice that I suffer from colds/allergies more often here than I did back in the West, but knock on wood I have yet to suffer from any real case of the flu. (You watch - H1N1 will strike the moment I hit Publish!)

The truth is that sanitary conditions here are just not the same as they are in Victoria and that opens the door for easier spread of some dubious little critters, like SARS. Please understand that I am not saying that all viral/bacterial disease begins and ends in China! I am simply stating that due to the developmental nature of many of its cities, conditions are ripe for the spread of disease. In Linyi, it is not uncommon to see babies, children and the occasional adult urinating and defecating on the sidewalks, for example. Hawking secretions from deep inside the lungs and spitting them wherever you happen to be standing or sitting is also normal and acceptable (on your office or home floor, on the train, in the supermarket - all reasonable places). Dodging spit slicks on my daily walks is probably my least favorite thing about life in China. But this city is developing. A few years ago it was deeply immersed in the third world.

The one thing I do experience over and over is "helpful" advice from just about everyone on how I should deal with the cold or allergy attack (or whatever happens to be ailing me). And the advice is always the same: drink hot water and wear more clothes. Take these antibiotic! Oh, and also, why not go to the hospital for an infusion? Ummmm... unnecessary visit to building full of hacking, coughing people, and their sputum, to receive a needle poke and infusion of unknown, although probably benign normal saline or sugar water? Or possibly an ineffective antibiotic? For a cold? No Thanks! I usually just remind the helpful advice giver that a) I am 33 years old and have survived relatively well without hot water and additional clothing and b) as a registered nurse, the hospital really is the last place I want to be when I'm sick. No really, the last place!

And now a word about everyone's favorite hot-button topic - healthcare! How do the Chinese pay for their healthcare? Cold, hard cash. Chinese emergency rooms are kind of like those gas stations that require you to pay before pumping. A doctor will do a quick evaluation, not for triage purposes really, but to produce a bill, which must be paid before healing can commence. And I mean this quite literally. If you roll into triage with blood spurting out your neck, no one will touch you until you have paid for service. If a doctor does treat without pay, he/she will then be responsible for paying the bill him/herself.

I once accompanied a friend to the ER when he hurt his back. He needed a special scan, but since he couldn't walk, he required a stretcher for the ride over to the radiology building. No problem. I paid a 100RMB deposit for use of the stretcher and wheeled him myself to the scan, since they didn't actually have any staff to do that sort of thing. Later, another friend walked back to radiology to retrieve the scan results for the doctor. Hospital inpatients will also need family members to feed them, clean them, turn them, help them walk and, of course, pay their daily fees.

The concept of family doctor doesn't seem to exist here. Instead, when ill, people visit a neighborhood clinic or go direct to the emergency room. During Mao times, so-called Barefoot Doctors fanned out across the country to care for the largely rural population, but since that time, medicine has reverted to hospital and clinic focused-care in urban areas. The Barefoot Doctors were farmers and villagers who received basic health training in order to improve hygiene, treat common illnesses and provide preventive health care. Although I am not a fan of most of Mao's policies, I admire this initiative and believe that China could use a hygiene and healthcare revolution.

There are government health insurance plans in China, but I really do not understand how they work. How does one qualify? Perhaps through employment by a state-owned enterprise, or perhaps through military service? I am not sure. Insurance coverage seems to be tied to your birth city (or registered home, which is usually the birth city), however, so to receive treatment and have it paid for, you would need to travel to wherever you are from, not always easy here for working people who live on limited incomes. Private health insurance exists as well, but again, I have no idea how it works. I have heard rumblings more and more about a complete overhaul of the Chinese healthcare system coming up in the next few years, and I think it is time.

In the meantime, I keep a supply of 100RMB bills in my wallet and the phone number to an air ambulance service out of Beijing on speed-dial.