“Ummm….you want her to do what, where?!” “On an A4 piece of paper, no less?!”
The doctor’s office, Xi’an circa 2015.
Ask any expat in Xi’an, what their worst fear is, living in China….and usually at the top of the list (next to pollution) is: getting sick!
Or even worse, your kids getting sick.
I’m not gonna lie, healthcare in China, well, second-tier China at least, is not as we know it.
The inevitable language barrier only adding to what can range from a rather amusing experience (you can read all about a couple of such trips to the local doctor we had here, including our visa medical) to a downright terrifying one!
Rewind this time 12 months ago and my ‘Small Person’ got sick with gastro. A bug that literally debilitated her for about five days…and then of course went through most of the family including our visitors (an expat’s second worst nightmare)!
With no sign of improvement it was time to get our three year old to a local doctor, which in China usually means the hospital. With me down and out, wavering in and out of any coherent ability to function, the hotelier had the unenviable task of dragging her out of bed and taking her to the one and only English speaking doctor in the city.
On cue she was asked to give a number two sample. All relatively straightforward, I guess…except for the small fact that she hadn’t eaten for days, so this was about as likely to happen as a China winter with no pollution! Alas, this small but pertinent issue aside….she was encouraged to produce it there and then, IN the doctor’s room, ON the doctor’s floor, ON a piece of A4 paper (actually, make that half a piece of A4).
What I would give to see the look on the hotelier’s face! 😉
Thankfully that and the time we had to take Small Person with croup in to the hospital to use their nebuliser (we’ve since invested in our own to save on the trauma) means our hospital experiences have been limited.
For other expats, it seems lessons have been learned. A recent Facebook status by a fellow expat says it all: “My boy fell and split his head open, we opted to try and fix it ourselves to avoid the trauma of a Chinese hospital.”
Expats who live here for any length of time become masters at diagnosing and treating themselves with a host of medical supplies they’ve stocked up on from back home. I’ve even heard the story of one woman who’s been here for eight years and literally lanced and sterilised her child’s infected toe, herself! The trauma of this far less than the ordeal of visiting a local hospital.
Another friend went to the doctor about a small gastro problem (unfortunately more common than us Wai Guo ren (foreigners) would like) and was promptly admitted to hospital, indefinitely. In what could be the worst situation to be sans toilet paper, his bathroom was devoid of all manner of toilet accessories! (BYO?).
And to top if off, his only option for dinner, extremely spicy, pickled food. Not so soothing for the Du zi (tummy). Needless to say, he checked himself out, pronto!
A girlfriend’s little girl contracted pneumonia, which here in China means a daily trip in to the hospital to be treated with intravenous antibiotics. Oral antibiotics aren’t given out and there is only one type of broad spectrum antibiotic used for all of the potentially different strains. After three days of sitting in a chair lined up with a bunch of other sick children, her little hand taped to cardboard and the IV inserted, they insisted she be admitted to hospital. (FYI children under the age of two have the IV drip administered in their forehead! Not the most comfortable or comforting sight!)
My friend had the good fortune of being in a private hospital, which of course, like anywhere in the world is more often than not a step up from the public hospital.
Even better at 600RMB a night, it was the VIP room. Still, no food was supplied….and it was BYO towels, soap….and Dettol.
While you might be expecting hygiene in a hospital (of all places) to be up to scratch…let’s just say, here, in China, it’s not exactly an environment awash with disinfectant.
My friend was partially relieved to see a mop present, but that relief was short-lived when she realised it was used (usually minus cleaning supplies) about as regularly as the sheets were changed….weekly!
Another friend has regular medication she needs to go into hospital, to get, weekly (because they won’t administer any more than a week’s dose). There is one dosage administered for ALL patients regardless of the patient’s individual requirements. (Is it just me, or does this have disaster written all over it?!)
And I’m guessing it’s not a good sign when the doctor asks you ‘which’ medication you think you might need?!
“Wait, what I have the flu and you want to give me an injection?” In China one such medical thought process is that an injection is far more beneficial because it enters the bloodstream quicker than oral antibiotics.
In all reality, if someone is seriously ill, most expats won’t hesitate to fly themselves or their children out to a major city like Hong Kong for treatment.
Thankfully there is a medical helpline called International SOS, whom most foreign companies are affiliated with. You can call up and speak English to professional doctors and send x-rays and test results to them to garner a second opinion, anytime you need to. They’ll also arrange for you to fly out. (Note: make sure you have international health insurance because without it, anything like this costs a small fortune and local health plans generally won’t cover evacuation or repatriation coverage)!!
For anyone, it’s a frightening thought to be stuck in a foreign hospital, let alone one where you don’t speak the language and don’t understand the process…. health insurance is an expat’s best friend the world over, here in China, it’s a necessity – especially with international medical insurers offering direct settlement at expat-friendly hospitals like United Family Hospital and Parkway Hospital in first tier cities like Shanghai and Beijing. Handy to know, if you don’t want to fly out in a non-emergency event.
Despite these glaring anomalies that exist between the Eastern and Western medical worlds, healthcare in China has come a long way.
The Chinese government recently declared the pursuit of “Healthy China 2020,” a program to provide universal healthcare access and treatment for all of China by the year 2020. As of now 95 per cent of Chinese have some form of health cover but as encouraging as that is, bringing a population of 1.3 billion people out of the third world and into the 21st Century is not without it’s challenges.
While it means more locals than ever before now have access to major healthcare centres and hospitals – these centres are still playing catch up — the number of properly trained doctors and nurses are struggling to keep pace with demand for care.
In China, it’s unusual to get a formal appointment, mostly its about lining up and that can mean standing in an overcrowded room for hours on end to register yourself and then pre-pay your account.
Often, no matter how sick you might be, if there is no signature or no money, treatment is put on hold! Note: A) This is potentially a little tricky if you can’t read the forms and B) a little dangerous if it’s a life and death situation.
Medical professors coming to Xi’an have declared the city 30 years behind in modern medical techniques.
Unfortunately being a doctor in China is not all it’s cracked up to be. It’s not considered as prestigious a role as it is in the Western world and GPs are chronically underpaid.
While the government caps the prices of common medicines, other prescriptions come with kickbacks for the doctor leading to overprescription of expensive drugs, imaging tests and unnecessary and lengthy hospital stays. (Have gastro, don’t expect a quick exit!!)
For many Chinese families, an emergency medical procedure means going into debt. There is still a widespread perception that to get top quality care you need to show doctors Guan xi (relationship) or hong bao — red envelopes stuffed with cash.
A Chinese friend who had her baby in Xi’an a few years ago, had to do just this to make sure she could have her baby in what was deemed one of the city’s better hospitals.
Hospitals in China are categorized through a system of numbers and letters, with the highest quality hospitals in the country being allocated the number 3 and the letter A. A 3B hospital will be slightly lower quality and 3C even lower still.
Husband’s are still generally not allowed into the delivery room for the baby’s birth….and the protocol is often on the patients to fend for themselves. My friend’s delivery was by no means straightforward and happened quickly.
She had to hoist herself from the waiting bed to the delivery bed with no help whatsoever (mid labour)! (In China, most doctors won’t lift you for fear of being held liable, if something goes wrong.) The same happened when the hotelier was visiting a sick colleague in hospital (with a head injury, I might add) and he had to be lifted from one bed to another. His parents and my husband had the honours.
During the delivery of my friend’s baby, the nurse refused to do a much-needed episiotomy unless she signed the papers, right then and there, during the height of labour!! No pen? What! Just reach for that handbag above your head! While you’re at it, be ready to write down the time, weight and date of birth yourself! (What do you think this is, a hospital!!??!)
Perhaps as an expat, the best option is to stick with TCM – Traditional Chinese Medicine! Most hospitals also have a TCM section where you can have a consultation and purchase your remedies there and then.
It is after all, considered China’s national treasure.
Proven over thousands of years, how can you go wrong?
As they say….when in Rome…..
This is China!
Psst.. a new expat and (after i’ve scared the c–p out of you) need to look at health insurance plans?….This might help.
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Hi Nicole,
I can’t say that your experiences reflect those we have had in Guangzhou. We have used the public system here several times (despite having international health insurance), and have found the doctors to be very professional. The attention to hygiene at the one hospital was remarkable compared to that overseas.
I can relate to the no food comments, but hell, who wants hospital food anyway! Everyone seems to be very happy getting delivery from great local restaurants.
Our experiences were not quite up to western standards, but not far below and for a tiny fraction of the cost.
I find it amazing that the government can provide such fantastic services in Guangzhou given such an enormous population.
Hi Wai, thanks for your comments. I’m really pleased you had such a good experience in Guangzhou. I’m definitely seeing a common thread among so many readers. It really seems like there is quite a significant difference between those that are in first tier cities in China and those that aren’t. The majority of people who’ve responded from the four 1st tier cities, Guangzhou, Beijing, Shanghai and Shenzhen have generally had good healthcare (which stands to reason), which as my post mentions, if we needed to we can at least fly out to one of these cities for better care, if not Hong Kong. They are still playing catch up in Xi’an but hopefully they get there eventually. Cheers, Nicole
Sad to say a colleague in China, Beijing no less, had similar stories a few years ago. His girlfriend went to hospital for an operation and he told us he had to go with her because they could not be sure that she would be adequately prepped for surgery (her body washed & disinfected, clean sheets etc). He also had to stay with her so she could get up to use the bathroom, make sure she had appropriate food, etc. As many problems as we have in the USA with our health care system (mainly that it is $$$$$$$$ if you don’t have insurance, and sometimes even if you do!), you can at least be assured of a good standard of care.
There was a story in the New Yorker last year about Chinese patients attacking doctors and hospitals out of anger at the system: http://www.newyorker.com/magazine/2014/08/25/under-the-knife
Thanks for your comment LJ. Yeh that’s interesting as I get the feeling the first tier cities are a lot better than China’s other cities….but I guess there is still a long way to go in some areas, compare to Western facilities etc. I did see those stories about the doctors. Too much demand for healthcare at the moment and not enough doctors to keep up. Thanks for stopping by. Cheers, Nicole
I’m sorry to agree with another of your readers that quite a few statements were exaggerated, “for humour”. I don’t see humour in any of the statements made here. Unfortunately, I cannot comment whether or not the claims made in this article are true or not, but some of the statements indeed are unbelievable. I’m an expat living here for more than nine years, and I’ve had more than these runny tummies or niggling colds. Never, never have my experiences been so bad. Of course, I’ve used my Chinese colleagues or friends as interpretors. And always carried a dictionary for reaching out for hard to translate words. Like, for example, athlete’s foot. The author, with due respect to her past, has not tried to accept the situation as an expat, rather expecting the world to change, just because she’s an English speaking person!
Good Morning @DushyantAnand FYI, we’ve already discussed on Facebook, but will put my reply here and yours back. Cheers.
Glad to hear you haven’t had any bad experiences. Just for the record, this article is not a criticism of China but a personal observation. If you take the time to look around my site and my page you will see that most of my posts are all about China and what a fascinating place it is, especially Xi’an where I am based. So because I am English speaking in China, I am certainly NOT expecting the world to change for me. IF I really didn’t like it here, do you think I would still be here? Would I be learning Mandarin every day? Would I be planning a book about this amazing place? I am here because I want to learn about China and I am enjoying this incredible experience. Most of my blog posts have fact injected with personal experiences, this is just my style, whether you like it or not is of course entirely up to you. I am completely at ease with the post on healthcare because it is fact. All of those stories happened. None are made up, but I guess you’ll just have to take my word and the word of many other expats and locals living here. I’ve also mentioned in the post how China healthcare has come a long way and how much is being done to improve it. Let’s face it, it’s a mighty big country with 1.3billion people and 656 cities, each very different as the comments in this thread attest to. There have been as many crazy stories as positive stories which is great! My post was a tongue in cheek look at life in China and yes if my 4 year old daughter gets very sick here, it is a major concern because we will need to fly out. I hope you can understand where I am coming from. Thanks for your time. Regards, Nicole
Your reply:
Good morning to you too, Nicole. Yes, I understand that none of your observations are fabricated, yes I understand that you love it here (don’t we all who choose to continue here?), I understand your concern for your daughter, (quite natural). My comments were not meant to be critical about your observations, actually I just wanted to highlight that you may have had a darn bad run of luck. Maybe it did not sound right. My apologies if I have offended you. Again, that wasn’t my intention. Maybe as a PS, you could add a few lines about some good experiences too, which could balance out the article. Please feel free to copy and paste my reply, in your article if you choose. Thanks to you too, for the courtesy of your detailed reply.
that’s not true at all. many international hospitals are now in major cites. different country different system. expat should go to vip division or international hospital. many thing mentioned in the article actually is friend`s experience, but the question is were u there?
and one more thing , if this expat is living in a very small town then i believe the medical service he/she can received is limited for sure just like every small town in the world.
Hi Vanessa, Thanks for your comments. Always good to get feedback from other people who’ve lived in China. Where in China do you/have you lived? We are in Xi’an…which has a big population but is in the north west of China so not near a major 1st tier city, thus the development has been much slower. We have only recently had access to an international hospital, so yes all the stories in my article are definitely true and from friends and fellow expats I know very well, not to mention my own experiences and that of my husband who looks after 450 staff in the hotel he runs. It is what it is and despite it, we are enjoying our amazing experience in China. Thanks for stopping by. Cheers, Nicole
Discounting some exaggeration for humour, I do hope you have better experiences in future. I have to say that my experience has been the opposite of those detailed above (well, except the loads of medicine and IV). My daughter was born in Chongqing 10 years back in a Chinese hospital and we were treated like royalty. The people we ve met in all these years here have been incredibly nice and welcoming too. That said, I understand how hard it is in a place with language barriers. Wish you all the best and look forward to reading more about your experiences.
Thanks for your comments Lom, appreciate those and glad you had such a great experience in Chongqing. I think the more I’m in China, the more I realise every city is very different…I’ve definitely met some lovely, helpful doctors here….it’s more the lack of knowledge and hygiene I think that’s left myself and many others a little concerned.:) That said, China is an amazing place and we are definitely having the experience of a lifetime. Stop by again. Cheers, Nicole
Hi Nicole,
I can understand. I’ve actually lived in 4 cities in China over a period of 13 years, and you’re right-each is different. Also, I think I have such good memories because my personal focus has been people and I’ve been incredibly lucky there. In fact, some of these experiences are captured in my book ‘Visa, Stickers and Other Matters of the Soul’, which is about bringing my daughter up in China.
Thanks Lom, would love to read your book. Where can I get it from? I am also in the (early) stages of planning to write a book on China…what makes this nation tick…a look at the people and who they are etc etc. Would also love to interview you in the future? Cheers, Nicole
Would be honoured to have an interview.
Book is available on Amazon.com and itunes, although I believe not in Australia. It’s more about raising third culture children than China per se, Na so be warned :-).
Best wishes for your book. Is it a memoir or a journalistic endeavour?
It’s so different if you live in Beijing, where there are a number of good quality international hospitals.
Personally I would never consider bringing up my child anywhere in China which wasn’t Beijing, Shanghai or at most another internationalized city like Guangzhou and Shenzhen.
Apart from the health care, but what are you going do about schooling? Are there any international schools in Xi’an?
jixiang recently posted…Five great China expat memoirs
Hey, thanks for your comments! Yes I imagine it really is quite different in Beijing. Apart from healthcare (and the pollution) Xi’an is fine for children. But for those two reasons alone. we will not be here forever. We are lucky to have the luxury and privilege of living in a hotel bubble, so generally can’t complain. It’s been a fascinating experience. My child goes to an international school (there are three) and it’s great. You’re right, just trying to make the posts amusing, but some people miss the humour. 😉 Ps just landed on your page about writing a book in China (of which I am one of those people who feels compelled 😉 ) Still in the very early stages, but would love to interview you? Cheers, Nicole
Hi Nicole,
sure, if you would like to interview me I would be honoured 🙂
You have my email right?
cheers, Gabriel
jixiang recently posted…Five great China expat memoirs
That sounds pretty dire and thank goodness you can fly out if necessary.
We have been pretty lucky in our postings the only one with truly dire medical was Nigeria and there the company ran its own hospitals with full capability. In Kazakhstan the hospitals were not great but we did have an International SOS, they had me fly out to Germany for an quick 10 minute (but rather necessary) emergency operation. It was fine because it was me – a nightmare would have been for one of the children to need that.
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