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.
Print- •
-
Share
- Share this item
-
Grab the link
Copy and paste the link:
- Blog about it
- Close
- •
-
18 Comments
Follow globalgal
Comments
An article in the New York Times on rationing health care: http://www.nytimes.com/2009/07/19/mag...
July 16, 2009 at 8:28 p.m.Very interesting! Don't forget that so-called universal health care is not our only option. I think a two tier system would work better for America! And then we wouldn't have to worry about the situations discussed here!
Sandwichh - that was in a Chinese ER? I'm glad to hear that you were treated without having to pay upfront. I suppose I have generalized my experiences in several Chinese cities (and those of a few friends) to "all" of China and I shouldn't do that. I suspect that in bigger cities with more development the situation is different. Sometimes as an expat we tend to view the world around us with too many judgments & preconceptions. I try to avoid that!
Victorianbybirth - I avoid public bathrooms at all cost here! I really want to reiterate re: the hygiene situation here that this will change and improve over time. I am living in an area that is experiencing real development for the first time and many people have just not been educated. I'm lucky to have a strong immune system!
July 16, 2009 at 8:25 p.m.And that womans family is suing/did sue. Unfortunately with the abuse of ERs these days, an unfortunate situation does happen upon occasion. That particular situation wasn't an unfortunate situation as they actively did not help her, I doubt it had to do with her ability to pay.
I dislike insurance companies as much as the next guy, that is why I am totally against universal healthcare. I have seen what the third party providers have done to MCR D & if it happens, it will happen to us all.
July 16, 2009 at 3:50 p.m.globalgal,
I do okay, just the usual pains I have to deal with. And ever lacking monies to keep up with things.
I know some phrases, just don't know how to spell them. The becomings of working with them for 17 years.
Kind of like my conversational Spanish use to be when I worked with Hispanics much of the time many years ago.
I was admitted to the ER one time with out paying or being asked for $ with a kidney stone. After praying to the porcelin budda, loudly my wife said, and starting to come to tears with the pain the lady said hold on, I'll get someone.
July 16, 2009 at 1:24 p.m.I said just hit me in the rear with something for pain and put me in the corner. The ER was somewhat crowded. She probably thought I was going to have a heart attack. Was not my first or last experience with them.
Again, you are talking about a "planned" situation whereas I am talking about an urgent care situation. There is a huge difference.
In an ideal world people would plan a family, make sure all their ducks are in a row & can afford the costs involved in bringing a life into this world. Children cost 1000x more to raise than it costs to bring them into the world. They should ensure their insurance covers prenatal & delivery, most ins companies state under coverage if they do or not, if they don't openly state, one should inquire. I do not wish to pay for everyones breeding habits. I have 1 child, when people ask why only 1, I respond I couldn't afford another one.
The doctors at the womens clinic take payments over time & expect it to be paid off by the 7th month, I know as that is what I did. They are providing a very important service, they should be paid.
But my point was about people dying in hospital waiting rooms simply because they couldn't pay up front. That is not a common occurance here in the US. Why don't you dedicate 12+ years of your life to school, accrue the debt involved for the loans to go to school & then deliver all the free babies you want. Would you work at your current job for free or significantly less than what you make?
I too have recently had a grandchild who wasn't planned & my daughter was confused about insurance. Oh well, we all gotta do what we all gotta do. Does it annoy me no end that I pay a buttload in taxes & yet my child qualifies for nothing? Yes it does, but I am grateful for the little girl who has brightened up my life. Small price to pay, if you ask me.
July 16, 2009 at 12:19 a.m.I guess their antibodies are on steroids there. I don't think my immune system would handle it there at all. I know my sensibilities would be constantly offended as well. I actually threw up today after using the bathroom at the wrong time. I can just imagine how I would handle a public bathroom in China!
July 15, 2009 at 8:34 p.m.RU...if you walk into the hospital in need of immediate medical attention or in active labor, they WILL NOT TURN YOU AWAY, nor will they expect you to pay up front, or even at all. Yes, for routine scheduled visits, some doctors do require payment upfront, but not in LIFE OR DEATH situations!
It's getting dark here, guess the sun is shining there.
July 15, 2009 at 8:25 p.m.Victorianbybirth - Hep A is endemic here and very common. Most people here have probably had it as children. Heck, I'm almost 100% positive I've had it, since most cases are asymptomatic. I have had Hep B vaccines. I am not at all sure about C-Diff, but I can always try to find out. People here are very resilient, and although there is a lot of poverty and disease, the population is generally healthy. A fellow expat friend from Hungary, who somehow escaped vaccination against mumps, got sick with it last month, though.
People can sue here for negligence, and they do. But if you are too poor to pay the ER fees, there is probably no way you can afford a lawyer and all the time/effort required to sue the hospitals. But yes, there is a legal system here and lawsuits are not uncommon! (Or I should say they are becoming more common as people learn about their rights, particularly in work-related situations.)
Sandwichh - Ni hao ma? Wo hen hao, ni ne? (How are you? I'm very good, and you?) :) Thanks for asking!
RUKIDDINGME - That is an unfortunate situation and I agree it is far too common these days.
July 15, 2009 at 7:40 p.m.This leads to asking...
Ni how Mah? "spelling?"
July 15, 2009 at 11:20 a.m.As far as Chinese doctors & hospitals refusing services without payment upfront, I have to point out, here in the USA if that were to happen, lawsuits would be flying. I'm sure they don't have the option to sue in China. If our hospitals were not accredited with some agency, they would not be able to accept MCR/MCD & most insurance. Those accrediting acengies are not free, they charge a steep fee. Government regulations have made our healthcare safer than most but they also force it to be more expensive than most.
July 14, 2009 at 10:19 p.m.I can imagine c-diff & hepatitis are very common there. Thats just disgusting!
July 14, 2009 at 8:03 p.m.Victorianbybirth - as an RN, it is really difficult for me to understand the urinating/defecating in public. Babies generally do not wear diapers here, they just have a slit in their pants so that they can easily "go" wherever they are instructed or wherever their parents put them. I have seen a girl urinating in the frozen food section of the supermarket, and the parents did nothing to stop it. We often wonder why the parents don't take the children to public bathrooms or to a grassy area. It is just a lack of education. Very upsetting, though.
July 14, 2009 at 7:50 p.m.For an expat, local healthcare is incredibly cheap and depending on where you are, the quality can vary from terrible to good. My friend who received the stitches and the friend with the back pain were treated exactly as I would have expected from an American hospital. I avoid visiting doctors in Linyi, however. Instead, I travel to Beijing or Shanghai to the international hospitals and clinics that are run according to Western standards (some are even JCAHO accredited.) They are very costly, but I have a very good expat insurance plan that covers just about anything and everything. Not all are so lucky here.
Unfortunately, I have heard many horror stories here of people unable to pay for services. One woman's baby had been badly burned, but since she could not pay, the baby died in her arms without a doctor even looking at her. And very scary, a good friend of mine, a fellow expat, gave birth to her first baby in a Chinese hospital. Because she went into labor in the middle of the night, and a previous ultrasound (a week earlier) had shown the umbilical cord around the baby's neck (the baby in no distress), the doctors preformed an emergency c-section - with no anesthesia! It is the most barbaric thing I have ever heard or seen! The baby was in no distress! This is not the norm, from what I understand, but it was gross negligence in my opinion. My friend is the strongest woman I have ever met. She survived the whole ordeal without the aid of even a tylenol.
Pogofire - yes, the spitting is difficult for me to deal with, but what can you do when it is so ingrained in the society? After SARS, the government put up signs everywhere telling people not to spit, and during the Olympics people in Beijing were even fined for it. None of these measures have changed things here in the more rural areas, although I've heard that Beijing is pretty spit free these days. The worst part is the spitting is accompanied by loud, hawking noises. These people spit with gusto!
As for pricing - hospital/clinic services are incredibly cheap compared to services in the US, but people here also earn much less. A friend fell off a bike and needed stitches to his head. He paid the equivalent of approximately $20 for the ER visit, stitches, nursing care & a box of antibiotics. I know an American girl who had a baby in a Chinese hospital. She paid approximately $200 for all the pre-natal care and childbirth expenses. For "infusions" it is just a couple of dollars.
July 14, 2009 at 7:50 p.m.The urinating & defecating on public sidewalks lost me!
Doesn't sound as if it's cheaper there & at least here you will be treated regardless of ability to pay.
I was treated to a horror story last week about a routine gall bladder procedure gone awry in Mexico, poor girl almost died, had to have 2 surgeries & they charged her for both, even though the 2nd one was to fix what they screwed up in the 1st one. $4000 for the surgery, paid up front, $80 a day for a semi private room, meds & food not included. They could not even think about suing the doctor for forgetting to re-attach her large intestine, it would be cheaper for the doctor to have them killed than to settle out of court.
July 14, 2009 at 6:37 p.m.Very interesting. Their healthcare system sounds a lot like Mexico's. Everything is paid in cash, but I'm not sure if it must be paid before or if it can wait until after. I imagine pricing for medical treatments is much cheaper than here in the States??
One thing I really wish I hadn't read.........spitting all over the place....eewwww!
July 14, 2009 at 4:36 p.m.