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Written by Barrie Noland
Antibiotics and painkillers are widely available "over the counter" in pharmacies throughout China, and pills are likely to be much cheaper than an IV. The second reason is that there is a belief among Chinese medical staff that drugs administered directly into the bloodstream work faster than drugs that must be processed through that time consuming middleman, the human stomach. My headmaster cannot translate my diagnosis. "You have a bad cold!" she says.

I have a fever of 101.4 F and a general ill will towards all humans. I stand in a room with six other people to receive my shot in the rump. In a country where public baths are a fact of life, there is little privacy. I tell my headmaster: "I want her to wear gloves. Gloves." I mime.

My headmaster looks at me like I’m growing another head. She explains, and the nurses squint.

"No gloves, no injection." I say/mime.

When you're getting ready to take your pants down in front of your boss and five Chinese nurses, you can get pretty demanding. The nurses have no gloves. I give a bottle of hand sanitizer to the nurse, who smears it disgustedly on her hands and immediately goes to the sink to wash it off. I all but physically restrain her.

I get my shot and the nurse washes her hands. The same nurse then gives me my IV. Not wanting to go through the same thing again, I cover my own hands and arms with sanitizer. I mentally assemble a kit of things for me and other expatriates in need of a hospital visit:

  • Rubber gloves.
  • Hand sanitizer or alcohol swabs.
  • My electronic translator.
  • The Chinese word for “Penicillin,” (Qingmeisu), which I am allergic to.

Over the next three days I recover beautifully. If you plan to get sick while in China, be prepared to have many of your notions of medical treatment transformed. Finding a doctor you approve of in China can be tricky. Most facilities offer a progressive blend of Western methods with Chinese traditional medicines. But these methods are usually hardly in keeping with Western expectations. To the expat, the scarceness of spotless hospitals, adequate lighting and a standard of sterility are upsetting if one is unprepared. I was unprepared.

After suffering through “The Traveler’s Complaint” (diarrhea), the next thing to hit me within my first months in China was a respiratory infection. The city of Changchun lies close to the Gobi desert and dust storms are common.

The city itself is highly industrial. Enough careless exposure to this dry, dusty climate can aggravate asthma and trigger other breathing problems. If you forgot a dust mask or party the nights away in smoky clubs, you can find yourself in the interesting position of needing a doctor.

Here’s how it happens:

One day in March I am stricken with the Northeastern China Super Flu (real name unknown). I wake from a dream of fighting through quicksand (Harrison Ford was also there) to find that I am lying in sheets soaked from the sweat of a fever that broke several times in the night. My headmaster feels my golf-ball sized hail of a lymph node and says, "Don't worry. After class, I will show you to the hospital."

Near death and not of sound mind, I teach my class with vegetative lifelessness. I yearn for the hospital. My headmaster tells me the hospital we are at is the “biggest and best in the province.” I think it should be burned. And then the ashes should be burned.

There is trash in the hallways we must walk around and over. Handprints on the walls.The hospital dentist feels my throat and speaks to my headmaster, negotiating the cheapest way to get me back to work as soon as possible.

Most Chinese health staff, if they put on gloves at all, often put on one pair of gloves in the morning and take them off when it’s time to go home. The dentist at the chair closest to me peers into the mouth of the little wincing girl whose tooth he is drilling. His tools are on a dingy cloth spotted in brown blood. He is wearing gloves, and they are dirty as though he's been opening doors and changing tires in them.
On a table behind me, there is a large vacuum bottle of Sodium Pentothal.

Sodium Pentothal.

That mystery-novel buzzword that everyone knows means "truth serum?" That stuff dentists haven't used since the 1970s because people claimed it caused resurgences of memories of past lives? Yes.

At least there’s something for the pain, I think. Then I notice that in the top of the bottle, stuck in through the vacuum seal, is a dripping hypodermic. The reason the hypodermic is almost full and stuck jauntily into this jar is because this hypodermic is used for everyone and is stuck back into the jar so the dentist can know where to find it next time.

According to a 2001 Center for Disease Control report provided by the United States Embassy in Beijing, it was common practice then in China for health care professionals to wash and reuse needles. It is still common practice. The explanation for this is that there is still inadequate education about methods of disease transmission in many parts of China, and simply that it saves money.

I am taken to get my blood drawn by a nurse wearing no gloves. I kick a McDonald's cup out of the way and submit. In the lab, a tech swabs the pipet of the blood chromatograph with a used alcohol swab which he tosses back onto the table it came from. Then he impales my blood tube on the sanitized pipet.

Over 99% of the Chinese population has RH+ blood. But unless you want to lug supplies of your own blood around China (good luck explaining yourself to customs) you’re pretty much going to have to chance that you won’t need a transfusion. I just knock the positive sign off my type when asked for it and hope for the best. If you’re AB- or a type similarly rare, remember bags of blood are not permitted as carryon aboard reputable airlines, and it’s a felony for most people to mail them.

At another, cheaper hospital, I am prescribed a shot and three IVs. The most common method of administering drugs in China is the intravenous drip. There are two reasons for this. First, it is far more expensive for the patient. If you are a teacher, your school should pay for your health insurance. Otherwise, the money comes out of your pocket. The expatriate’s recourse is to ask the staff to write down the name of the drug you need, and to take that name to a pharmacy.

China has one of the fastest growing AIDS populations in the world. The practice of reusing needles and other disposable medical materials in China is commonplace. Although not the norm everywhere, forgoing gloves and washing IV and blood collection needles in soapy (or not soapy) water and reusing them is widespread enough to warrant extreme care. Since it is rarely possible to provide your own needles, the solution is to demand only brand-new or at least fresh-out-of-the-plastic needles and bring your own supplies. The plastic does not guarantee that the material has never been used; it means that the material has been sterilized in a medical stove. This is just as sterile as a brand new needle.

My experience with Chinese health care, while harrowing, is not necessarily the experience every expatriate will have. A friend recently recommended a dentist to me. Her experience was sterile and she was provided with her own set of personal dental utensils for her next visit. She got the name of this dentist from a Chinese friend who vouched for the dentist’s appeal to Westerners. This is the ideal situation, and you can find it by making your needs clear.

While it may be embarrassing to presume to tell nurses how to do their jobs, it is your health that is at stake. If you feel that the care you are about to receive does not meet an acceptable standard of cleanliness or professionalism, you should feel no guilt in requesting a level that is acceptable to you. It’s their country, but your body.

For more information on health procedures for expatriates, as well as information on the progress of health care in China visit the World Health Organization’s country profile for China.

Our valuable Editor Barrie Noland has been with us since Monday, 03 May 2010.
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0 #3 expat209 2010-05-21 21:42
Very insightful and helpful article, thank you!
0 #2 Joao 2010-05-04 19:18
excellente report. thanks barrie noland for sharing your insight. I experienced the same as you. as a expat from portugal/europe union coming to china for work, it was terrible experience...all the dirt...Santo! many hospital remind me of markets rather than "hospital". people smoking...spitting..Jesús! i don't want to judge...i was helped well, and say thank you to doctors, but i am also careful too and keep eye what they do when they treat me. by the way, i very had good experience with dentists in china! even with small ones located on the street.
0 #1 Peter 2010-05-03 21:25
I have tried to avoid going to the doctors here, in the way of putting something off aslong as possible with hope it goes away. I remember when I had travellers sickness last year, and went and got my poop tested, the doctor who read the results of the test, was smoking a cigeratte in the office. With the tests showing nothing, his recomedation was to stop drinking beer and start drinking rice wine (baijiu).. haha

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