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Written by David A. Dayton
I spent part of last weekend helping translate for a friend who was in the emergency room of a local hospital. Probably more scary to me than being sick in China is being taken to a hospital in China. My father was a doctor in a small town (the only OBGYN in a couple of counties) so I spent probably weeks of my childhood in the lobbies and waiting rooms of hospital rooms waiting for him to deliver babies so we could get on with whatever family activity was being postponed.

(I also endured many many embarrassing comments by girls in highschool who had been to my father’s office.) Yet even in a small town hospital I never saw blood (or dirt or urine) on the walls or garbage on the floors. Nor did I ever remember complaining about how putrid the bathrooms were; because they weren’t. I never got infected with something from someone else in the hospital or from unclean instruments - I never knew of anyone else who did either.

Over my years in Asia I’ve been admitted to hospitals in Thailand, Taiwan and China for various issues. And I’ve even written about it before too. I can honestly say to you, from my experience, that you’d probably be better off self-medicating or tying a tourniquet and then running for the boarder than checking into a hospital here in China. Yes, they are really that bad. I kid you not that when I say our milk barn (where we would milk dairy cows, yes my father was a rancher too) was cleaner than any of the hospitals that I’ve seen even here in Shenzhen. At least that milk barn was hosed down and scrubbed with a brush and disinfectant soap twice a day.

Like anywhere else in the world, the best way to get an infectious disease is to be around others that are hacking, spitting, sneezing, etc. What better place to find a majority of these folks crowded up to counters or in small enclosed places than Chinese hospitals?! (That was a rhetorical question.)

So why is it worse here than anywhere else I’ve ever been (and that would include Egypt, Jordan, Lao, Cambodia and others)?  Lots of reasons:

First there are more people with more diseases in the hospitals than in most other places. Everyone and their Chinese dog is in the waiting room for anything and everything from hangnails to bird flu.

, the general level of medical education here is so low that people just don’t think to not let their sick kids come up and shake hands with the little sick foreign kids or ask to practice their hack-interrupted English with the sick white guy.

Other reasons could include hospital design, like putting the “infectious disease” units next to the parking garage entrance or the “respiratory illness” centers being located next to the emergency room waiting room, for example. I don’t particularly like the fact that I can’t have a private conversation with an MD either—There are 20-30 people in Shenzhen at this time with intimate knowledge of my urinary tract and accompanying kidney stones (I must be drinking too much melamine-laced milk).

But my favorite reasons for never ever wanting to go to Chinese hospitals are these:

Chinese hospitals are in business to make money. Sure I know, everyone is in business to make money. But the difference is that most hospitals elsewhere have at least a tacit desire to make you well at the same time they are making you poor. Here?  Nope. I really think that they believe that the longer they keep you sick the more money they make. And they work hard to this end. So it’s not surprising because the hospitals are always so packed full of customers. (Or maybe it is surprising?)

China has some of the most dangerous roads, the worst pollution, horribly contaminated food, an incredibly high rate of people who smoke, dangerous working conditions, shoddy product quality and more people than anywhere else all living in the same situation. You’d think that hospitals would be trying to get as many people in and out of the system as fast as possible. Like taxi drivers, its all about dropping that meter if you want to make money. But sadly, no. The goal here is to keep sick people in beds as long as possible.

So how do they do it?

First, they prescribe antibiotics like they were candy. Taking antibiotics too often makes them worthless. Taking them for too short a dosage period per prescription has the same affect. Chinese hospitals notoriously over prescribe antibiotics—for everything from a child’s cough to an upset stomach. And they almost never give you enough. The point is to make you either stay in the hospital and pay more bed fees or come back in a few days to buy more. Most people can’t afford to stay. So they leave. But then, a few days later, when they are feeling well, and because they have no education about medicine and probably have very little money they just never go back.

Another really cynical practice is paying MD’s on commission to prescribe more med’s to patients. This isn’t like pharmaceutical companies treating MD’s to free golf, or passing out free coffee cups or pens if they prescribe their brand of drug—MD’s in the West don’t get more free pens if they prescribe more meds. But in China, the more meds you can get the patients to buy, the higher your take home pay will be.

Fake Medicine

This is bad enough in its own right but add in the fact that much of the medicine in China is fake and you are scraping the bottom of the ethical barrel. I had multiple experiences where I’ve either been warned away from buying fake meds by hospital/clinic staff or been offered “real” medicine for a much higher price. My wife, in taking our obviously ½ foreign children to the hospital, has been asked some version of this question almost every time: “I see that your husband is a foreigner, I suppose that you want to pay extra for real medicine, right?”  At least they offer.

My friend in the hospital this last week, upon checking, out was just amazed at the size of the bill for two nights in the hospital—more than 8000RMB. So he got a Chinese friend to sort things out. After four hours and trips to multiple departments (multiple times) they figured out that since the MD had prescribed 6 days of hospitalization (for food poisoning) the hospital had billed him for all 6 days—even though he was checking out after only 2! 

The “logic” for the advanced billing?  “This is what the MD says you need. It’s your choice to follow the prescription or not (but you’re being billed regardless).”  They worked for a few more hours and got all the expenses for days 3-6 removed, but it was work and it was a hassle and the hospital was clearly not interested in helping make the process transparent or easy.

I have to add, my friend did get great attention from the staff. He was even given a bed with clean linen as soon as he asked for it. He was moved to, much to his chagrin, the front of the line for a number of different procedures (because he was white or paying more or both, he didn’t know). And the staff were quite kind, if not a bit behind the times on medical procedure.

This is the same experience that my wife and I had with the delivery of our last child here—very nice people, dirty facilities and out of date procedures. When my wife got a post-operation infection we called my father and he was appalled at the techniques and procedures we described to him. He said that they hadn’t done things like that in the US since before the 1960′s!  But the delivery cost us only a few hundred dollars in China instead of more than ten thousand dollars as another delivery cost us in the US. I guess you get what you pay for.

So what’s the point of this story? 

Entertainment value first. Warning second. China is a great opportunity. But as with every opportunity there are risks involved. Many of the risks that are faced in China are directly associated with business. Many others are not but certainly will affect your ability to be successful nonetheless.

I have clients that come to Shenzhen on their way to visit factories and invariable comment on how nice Shenzhen is and how great it must be to live here. I agree. Shenzhen is quite nice, it rates up there with large cities in poorer EU countries, according to the UN. Just remember, visiting on business for one week is one thing–Starbucks, nice restaurants, western hotels and private cars; but raising a family here, or just about anywhere in East Asia, for more than a decade is where the you pay the price for the great opportunities.

Good luck. And don’t get sick.

David A. Dayton is the CEO of Silk Road International (SRI), an U.S.-owned and managed international procurement agency based in China. Click here to visit SRI's Website.

Our valuable Editor David A. Dayton has been with us since Monday, 02 November 2009.

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