My life in China, Part 9- Healthcare in China

*Please note, this is a repost from October 2020. My wife’s aunt and grandmother are both healing and doing well.

How to even approach the topic of Healthcare in China? It’s a pretty broad issue and one that the US hasn’t gotten right either, which is important to note right at the beginning of this post. I could probably start a blog just on this topic. There are so many differences, places we could learn from each other, and ways to improve. But there are some striking disparities worth discussing that contributed to my experiences while in the country. Also, recent events in my life make this post relevant, if not a bit difficult.

Last week, this discussion seemed like a natural transition from eating strange things, as food directly led to some of my medical experiences. The differences between the US and China healthcare were also fresh in my mind. Just a month ago, my wife’s aunt slipped on some mud and received a compound fracture in her arm that required emergency surgery. Worse, she also fractured her spine and is now confined to bed for a month while it heals. After her fall, as she sat there with her bone protruding from her arm, no one helped her. She called out, but all were wary even to get close. Eventually, someone at least helped her call her son. It is a common problem in China that has led to people dying in the street in the world’s most populous country. This is due to the psychology 101 concept of diffusion of responsibility, aka the Bystander Effect (the more people there are, the less we feel compelled to help as we think someone else will help). Additionally, the onlookers were also afraid that they might get sued if something went wrong, which leads to similar situations in the US.

But, as I noticed it was time to write a post, and I sat down to get to work, the topic hit a bit closer to home. Two days ago, my wife’s grandmother had a stroke. The remarkable woman just celebrated her 90th birthday and is just a tough old bird. She knew China before Communism and experienced firsthand World War II and Japanese atrocities. She survived the Great Leap Forward, Chairman Mao’s failed agricultural collectivization that led to famine and the death of 45 million people. During the Cultural Revolution, she was forced to the countryside and made to work on a collective farm as the Communists imprisoned her husband (where he remained for 25 years). Yet, she still managed to eke by all while taking care of five children on her own. She has generally seen China change from an agricultural society to a superpower in her lifetime, all while surviving terrible hardship. She is currently in a Chinese hospital as I write this post. It is so hard to see someone as tough as her in this state of helplessness. As I will discuss, being in a hospital is not always a good thing and puts a massive strain on a family. American healthcare is costly and certainly has its issues. But, in many ways, it is still a better experience than you would find in China (or many places in the world), and I think that is important for us to remember and be thankful. 

As an aside, my mother is a nurse, my sister works in elderly care, and my uncle is a physician, so medicine runs pretty deep in my family. I spent a good part of my childhood in hospitals and nursing homes and have gone through three grandparents’ experiences moving through the system, beginning to end. As a patient or an onlooker, I’ve visited ICUs, ERs, nursing homes, assisted living facilities, surgical wards, and been in the back of an ambulance. In China, I have also seen inside hospitals, both small and large, on multiple occasions. I’ve taken Chinese medicine (including traditional), had a strange physical when renewing my contract, been to a dentist, and have experienced my wife and members of her family getting care, so I’ve personally seen both sides of the coin. When I hear stories from my Chinese family or experience the Chinese healthcare system myself, it often rubs me wrong, and I would love to see it improve. I hate to cast China in a bad light, but some of what I discuss inevitably will do that. Please keep in mind, as a developing country, China’s system is quite advanced, and overall, Chinese life expectancy is high (just a tad below the US). But, as in most things, there is room for improvement. 

Obviously, getting sick anyplace is not fun. The only things you want are the comforts of home, but these are hard to come by in a foreign land. Food, familiar medicine, healthcare, and sometimes even how health is culturally interpreted and treated are all different, leading to frustration and discomfort. But, when you throw in a foreign language into the mix, suddenly it gets dangerous. 

Luckily, while I was living in China, I did not have any severe medical emergencies, just a bit of food poisoning here and there, some sinus infections (pollution-related), and the touch of the flu (didn’t have access to a flu shot then). Some of us foreign experts were not as lucky. My first friend in China, the Englishman who lived next door that I briefly spoke about in a prior post, had to leave after only a month due to heart palpitations caused by something in the environment (he was fine as soon as he left). He didn’t have the chance to teach a single class. China is certainly not without its dangers, but luckily I stayed reasonably healthy other than that recurring sinus infection that continued with me long after leaving the country. It was a lovely parting gift.  

But a few years ago, I did get seriously ill while visiting my in-laws. I had tried something new, a cornbread-like bun filled with meat and wild vegetables. It came back with a vengeance in the middle of the night, and it was fierce indeed. As I sat in the bathroom, there was even a brief moment that I thought I wasn’t going to make it and had to call out to my wife for a glass of water. The illness was so fast and I lost so much fluid that I came very close to passing out. It was easily the sickest I had ever been, and it was terrifying. We were at my in-law’s house, so this was very much a fun for the whole family kind of situation, and we were all very concerned (especially my in-laws).     

You see, I’m allergic to amoxicillin and cefalexin, two common antibiotics. The nature of this allergy makes it difficult to know what other antibiotic allergies I may have. The situation above was the first time I had been seriously sick in China, and clearly, I needed medicine with a bit more oomph than some Tums (the Chinese equivalent are Hawthorn flavored, a very Chinese flavor, which I think is neat). Getting some antibiotics that weren’t going to make me worse was hit or miss, and we were relying on whether the English translations on the bottle were correct.    

It’s medicine, it must be correct, right? Well, there are a few issues with that assumption. The Chinese language is beautiful, with thousands of years of history. It is wonderfully practical and elegant in many ways, but it is also not always the most precise, especially in translation. There are about 50,000 characters in total, with an educated Chinese person knowing about 8,000. This may seem like a lot, but there are 273,000 unique words in an English dictionary, with the average English speaker knowing between 20,000 to 35,000 words. There are many flaws in the English language (grammar and pronunciation, to name two), but not many would say it is an imprecise language, far from it. Of course, you can’t make a direct comparison. A Chinese speaker gets much more information from context. Also, many concepts captured by an English word are done so with multiple characters in Chinese, but you get the point. English and Chinese are very different languages. 

Chinese is also an ancient language, and sometimes new additions in the science and technology realm have to re-purpose antiquated words. For example, diànhuà, Chinese for telephone, literally means ‘electric word,’ or diànnăo, Chinese for computer, literally means electric brain. You see? Elegant and practical, but translations sometimes are not specific enough when delineating between two similar things, such as antibiotics. 

Lastly, although the bottles often have English translations, or at the very least, the Latin scientific terminology, being an English Language teacher in the country, it was hard to trust they were correct. I knew there were some pretty large inadequacies in English language proficiency and, generally, a lack of caring if they spelled translations correctly, if they were accurate, or even made sense. With signs in airports, train stations, Chinese government offices, hospitals, and major tourist attractions (or even English textbooks) being full of terrible translations and errors, you quickly realize how relying on this English was scary. Lack of attention to detail was acceptable with many things (and sometimes quite comical), but it took on a new light when dealing with something that could kill you (and indeed not funny). 

You may be thinking, well, why not just ask a doctor? First, that is not really what a doctor does in China. I will make that clear right in the beginning. There is no notion of care as we interpret it in the west (including preventative care, rehabilitation, physical therapy, etc.). In the west, we can say I’m visiting my doctor, but a primary-care physician is a foreign concept in China. Hospitals are only for treatment and/or tests, and typically just for something significant. You don’t want to visit a Chinese hospital just for a sore throat or a bit of diarrhea. Waiting in line for hours and subjecting yourself to god knows what is a waste of time unless you think it is something like strep or dysentery. Why? In the west, a doctor’s visit is often to get a prescription. They do a physical, look at your medical history, maybe run some tests, and determine what medicine will be most likely to make you well (without killing you). But, when you take prescriptions out of this mix, things change dramatically. 

Let me give you an example. China loves to use antibiotics. When someone is sick, they go to a pharmacy (more like a medicine store) and grab a packet of pills. If they remain ill, they go to a clinic and get a bottle of antibiotics in an intravenous drip. But what about a prescription, you may ask? Basically, what I’m saying is anyone can get antibiotics. No doctor’s office visit is required, and thus, no qualified medical professional determining if such a bazooka method is necessary. Do they have prescriptions in China? Yes, as in a doctor’s suggestion of an adequate medicine sense of the word, but it is not a gateway for entry. Have a runny nose? Hop over to the medicine store and buy some antibiotics. Is it something more serious like a persistent cough? Your local technician with a 2-year degree can strap you to a bottle of overkill if you’re willing to pay. Have a sore throat? Get a bottle. Muscle ache? Bottle. Oozing sore? You guessed it, grab a glass bottle and stick a needle in your arm for a few hours.

I’ve been to these clinics. For one, needle safety is a bit too lax for my comfort zone. Sterility means a pressure cooker, which is fine as it will kill any pathogens, but what if the person on duty the night before forgot to turn it on? If we’ve learned anything as a species, we know that human error is common. Yikes! And two, why are there so many people, many of which look perfectly well, getting intravenous antibiotics? Well, most have no medical knowledge. They don’t understand how antibiotics work, but they do know that they do work. If it cures one illness, it must work for all diseases. Pills do the trick, but the medicine must be stronger if you inject it right into your veins, right? With the rise of antibiotic-resistant bacteria, this is terrifying. This slack use of these vital tools is not just an issue for China, but the whole world. 

In my case, we were lucky. My wife and mother-in-law took a trip to their local medicine store and chose wisely. I took something (still don’t know what exactly), and it worked. The fever went down and I eventually got better. When you look up the Latin online for this particular medicine, it says that it is an antibiotic, but it is careful to note that only the Chinese use it. Logically, this makes me wonder why. Did it not pass FDA approval? Does it have some terrible side-effect? Who knows. At least it worked. I’m just glad I didn’t end up in a hospital. 

Chinese hospitals are generally old, dark, dirty, cold (or hot depending on the season), and not particularly inviting. Many of the facilities I have visited have single-pane windows in wooden frames, cement floors, and peeling paint, much like my first classroom. They are incredibly crowded and loud. Ventilation is poor, making them stuffy and smelling of disinfectant and bodily fluids. There is no soap in the bathrooms or a way to dry your hands (something you would think is pretty essential). Spitting is prevalent, smoking too, even with plenty of signs. There is no such thing as privacy. The sicker you are, the more onlookers you’ll get. If you are a foreigner, forget about it. The staff is knowledgeable but overworked and underpaid. An American doctor may see perhaps 50 patients on a busy day. In China, the average is 100, and their salary with bonuses, commissions, bribes (you heard right), and a second-job is about $30,000 a year. Working 11 hour days, six days a week, this is nothing, even considering the exchange rate (Chinese law sets a maximum workweek for physicians at 40 hours, but study after study shows that this is not happening and the average workweek is more than double).

As another aside, when my wife’s aunt needed surgery, her family was shocked that the doctor refused the money they tried to give him to perform the “good” surgery. Yes, this is why I include the mention of the bribe above. It is common knowledge in China that some doctors squeeze this money from the family, threatening them that they will not provide them the “good” surgery if they don’t pay. Is this a distinctly Chinese problem? No, but think how scary it is when healthcare is missing governance and that moral compass we take for granted. 

Is healthcare expensive in China? Yes, but it is nowhere near as expensive as in the US. However, you get what you pay for, and as mentioned above, sometimes you have to slip a little extra for the “good” medicine. Is top-end western quality care available? Yes, indeed, if you can afford it. For most, it is a dirty and dingy hospital. Also, it depends on your location. If you’re in a smaller city, don’t expect much, even if you have the coin to spend. If things are serious and you have the time, it’s best to travel to a tier-one city- in Baoding that would be the Province’s capital of Shijiazhuang, or better yet, Beijing. In my wife’s hometown, it would be Dalian. 

If things are serious and they admit you to the hospital, it means you get a bed and proximity to treatment if needed. That doesn’t sound so bad. Ah, what about food? What if you need some water? What if you need to use the bathroom or need assistance getting in and out of bed? What if you fall? What if you need an MRI? How are you going to get there, and who is going to help you onto the table? A Nurse? That is not what a nurse does in China. An orderly or medical assistant? These positions do not exist. Hence, the importance of family. Yes, all care in a Chinese hospital depends on the family. If you don’t have a family, sorry, I don’t think you’ll make it. I should also note here that Ambulances are just taxis with a siren. The drivers have little to no medical training. 

And we return to why my wife’s grandmother being in the hospital is so tough on her family. Luckily, my mother-in-law has four siblings, so they can take turns being there, but none of them have any medical training, like moving a limp body without hurting the person or what foods are best for someone who just had a stroke. The problems are endless. Currently, her grandmother can’t speak, but there is no such thing as a speech therapist (or at least it is not prevalent). It’s scary to think about what that is going to mean for her quality of life. Luckily, she seems to be much improved today. She’s getting some sensation back to her mouth and tongue, so we are hopeful. But this situation has made my wife and me think very hard about my in-laws’ future and our options. For those from my wife’s generation and beyond (the children of the one-child policy), the kind of care currently required is almost impossible. With us being in the US and my in-laws in China, there is no way we could do this remotely, but moving them here and going through the immigration process is daunting and as there is no longer permanent residency in China, it is really impossible for us to move there. Saying it will be a challenge is an understatement.  

I know this post wasn’t particularly rosy, but I hope it was enlightening. It certainly wasn’t easy to write, and it has taken a few days to draft. I wanted to get it out yesterday, but I couldn’t get it right. I realize that it may come off as an unfavorable view of China. Still, it is the truth from my experience, and experiences related to health are incredibly formative and informative.

Are all things related to health terrible in China? Definitely not. There is a lot of wisdom, especially in traditional medicine. Generally, the Chinese value a holistic approach to health, a concept where the US can learn much. Many traditional Chinese treatments have gained scientific backing like acupuncture and the prevalence of some herbal supplements. In my house, we have a drawer full of traditional Chinese medicine. Sure, I am skeptical of much of it, but some things work quite well. What would I do without the Chinese cure-all, red flower oil (hong hua you), the little green cold pills that knock you out, their super-strong cough drops, or their incredibly durable band-aids soaked with a triple antibiotic? How much better do I feel drinking hot liquids instead of iced drinks? The benefits are endless. Sometimes I complain and dispel the myths, but sometimes it is hard to refute 4,000 years of wisdom, and I need to swallow my pride along with the handful of Chinese pills.  

Cheers!