Sunday, June 5, 2016
Is this a dagger which I see before me? Healthcare in southwest China
My heart was thumping fast against my rib cage, and I was sucking in the thin mountain air in short gasps. A heavy weight across my midriff pinned me down on my back. In the narrow, claustrophobic tunnel, I knew I couldn't move or escape. I was trapped. I willed my monkey mind to seek solace in my 'happy place'. Then the banging and hammering noises started again, followed by a long, strange silence. I swallowed hard. This was going to be a long ordeal.
Getting an magnetic resonance imaging (MRI) scan, like a whole host of other experiences in China, can be harrowing. But also like many things in China, it is cheap. Though, the fact that the MRI cost one-tenth of the price of a scan in the West wasn't the main reason for voluntarily subjecting myself to this procedure. I was worried that something might be seriously wrong in my body.
The short-tempered, harried white-coated doctor — after emerging from an emergency surgery session with a patina of sweat on his brow — suggested I try an MRI in case there was some dead bone floating around in my side. "However, a little expensive," he said, before another patient pushed through the crowd around his desk. I decided it was better to book myself in and endure half an hour of discomfort in order to help find out what the problem was.
For many expats living in China, healthcare is either a major concern or a blind spot of denial. Insurance companies like to prey upon fears. A couple of years ago a foreign teacher working in another part of China fell while hiking in Tiger Leaping Gorge, damaging his neck and back, and required an airlift to Hong Kong. Treatment set his family and friends back over US$100,000. You or I could be knocked over crossing the street in China, and it could be the most expensive event in our lives. Conversely, one could spend decades in the People's Republic without a scratch and only minimal hearing damage. Insurance policies range from about 10,000 yuan a year for basic in-country care, to US$4,000 or more for comprehensive coverage.
Soon after I first moved to China I somehow got emails from an insurance company offering comprehensive medical insurance including repatriation services to the United States. I declined this, not just because my place of birth is elsewhere and I am not sure if I would like to be medivacked to Los Angeles, but because the annual premium was about ten times what I earned annually.
While it might be considered irresponsible not to have medical or travel insurance, there are less financially damaging options, which range from using local health services to getting your carcass to more modern medical facilities in Hong Kong or Bangkok. Self-medication is always an option as well.
Even thought Google is blocked, many foreigners living in China use internet resources for information on medical conditions and their cures. There are a host of websites which are useful for differentiating between spicy food stomach and appendicitis, or a headache and terminal brain tumors, though if you are a hypochondriac you might find yourself over-diagnosing life-threatening illnesses. Search engines can help with the translation of names of Chinese medicines, most of which seem to be freely available over-the-counter, and very reasonably priced on the Mainland.
Due to language and cultural challenges, it is always a good idea to have a foreign doctor friend — either living in the same area as you, or accessible overseas online — for a second opinion, reassurance and less good news, such as 'you have a week to live'. Always best to hear that in your native tongue. Paid services such as SOS International provide over-the-phone professional advice, foreign-friendly clinics and free flights if you are knock, knock, knocking on heaven's door. One foreign doctor I know based in Hong Kong who does medical evacuations every week into China says his company would either get requests to 'come quickly' — meaning the person is dying, and no one wants the hassle of repatriating a corpse — or 'take your time' — meaning by the time they arrive, the hospital will have clocked up dozens of unnecessary but costly tests, such as finding that the foreigner doesn't have the gene for spitting or talking loudly on a mobile phone.
Then there are the much-lauded foreign expert clinics around Yunnan, such as the Kunming International Clinic , which costs about the same as 24 hours in a Korean-style bathhouse, but is much better for your body and soul. The Kunming International Clinic occupies possibly the cleanest, tidiest hospital in southwest China, and if you can bear coming face-to-face with queue-jumping double-chinned expats swapping tips on double-dipping insurance claims, you will eventually see a doctor who speaks English and will tell you to cut out the expat holy trinity — McDonalds, KFC and Starbucks.
The only internationally-recognized hospital in Kunming for proper insurance purposes, as far as I can tell, is the appropriately named Richland International Hospital. They have a foreign liaison who speaks English, and prices are less than your weekly shopping bill from the nearby Metro Supermarket.
If you are outside of Kunming, there are local hospitals, which vary in quality. While there might be one or two staff who speak a little English, you really need to be fluent or have a Chinese friend to help navigate through the complex system. Hospitals visits are cheap, but in keeping with the Communist ethos, there is a strict 'no money, no honey' policy, which will see you returning to various counters to pay before you can get seen to, be zapped for X-rays or procure medicine. Overnight stays can be more costly, and often the hospital will require a huge deposit, and then deduct various items against the funds.
In Chinese hospitals, the function of the nurses is to administer drips and medicines and make sure they are charged against the account. There isn't much in the way of care. Don't expect a hot nurse to kiss you goodnight. Usually someone will have to bring food in from outside, as most hospitals don't provide anything to eat for patients. Freelance helpers can be engaged for various tasks — fetching food and water, taking you to the bathroom, buying you slippers and pajamas.
Many Chinese hospitals also still don't use very good cleaning methods, and the poor hygiene practices mean you might be exposed to more germs than necessary. Smoking is common among patients, family members and doctors. The observation room for X-ray scans in one hospital I visited reeked of alcohol. It was 8am and the smell was from the technicians, not their cleaning fluids. At least now disposable needles are used, whereas a couple of decades ago you risked getting infected from a blood test.
There are now many new private hospitals, which provide more specialized services at a higher cost. Unfortunately in China, some locals gets duped by doctors into having procedures and surgeries which aren't necessary. In public hospitals, expect crowds, long waits, and delays. The worst experience I've witnessed was at First People's Hospital of Yunnan while helping someone who had been evacuated from northwest Yunnan after a week in a hospital there. Just imagine holding a person's stool sample and trying to get it in the small window with a hundred other pushing, shoving punters carrying similar deposits also trying to get their number twos into the opening.
Of course, this is China, and there are ways of beating the 'too many people, not enough resources' paradigm — find someone with connections, and slip them a few red notes with pictures of Chairman Mao on the back.
Hospitals in China may offer the option of Western medicine — usually generic drugs or occasionally more expensive imported meds — or Chinese treatments, which can vary from black pills to needles in painful places. After ten days of trying various medicines to kick a respiratory infection, I chanced upon a small clinic in Chengdu, which turned out to be a military Traditional Chinese Medicine (TCM) shop. After some pulse-taking diagnosis I was given some pouches containing unknown components, which cured my ills in 24 hours.
Chinese culture might be 5,000 years old, but there is a widespread belief that pretty much every medical or other problem — including hangovers, fatigue from study, feeling sorry for oneself — can be solved by an intravenous drip. Anecdotally, this treatment works best if you are wearing your pajamas, and ideally should be witnessed by at least a dozen members of the public.
Regardless of your insurance status and risk threshold, it is a good idea to have an emergency stash of money, information on any of your lovely Western quirks such as blood type or allergies, and a network of friends who you can rely upon in the unlikely event of a heart attack — or the more likely scenario of being bruised or broken in a traffic accident. Having some first aid knowledge could save a life, though there may be a risk of being sued or beaten up if you play the foreigner good Samaritan and help a local in distress. But attitudes and behaviors are changing. Last year, when a young foreigner had an allergic reaction to peanuts in a small village near Lijiang, several Chinese tourists helped, including quickly procuring medicine.
My old friend, 91-year old Dr Ho of Baisha, says for a happy life, don't smoke, don't drink, don't eat too much meat, don't have too much salt, and most importantly, don't worry. I'd add to the mix, drink lots of water and go for a walk each day. "I can treat long-term conditions with Chinese medicine from the mountains," confided Dr Ho to me once. "But if you fall off your bike, go to the clinic across the way, as they can stitch you up. They have much better eye-sight than I do."
As a foreigner in China, be prepared to find yourself doing more self-diagnosis and treatment than you may ever have anticipated. Never will two substances take on such as importance as Pepto-Bismol and Loperadine, for spicy stomach and to stop unpleasant trips to the bathroom.
A buzzer rings, I open my eyes and feel my body being pulled out through the tunnel of the MRI to see again the bright lights of the sealed treatment room. The middle-aged nurse who I am sure must have been sacked for being too rough in the woman's high-security prison scowls at me as I knock the earmuffs to the floor and try to clamber down the stairs while hitching up my trousers. "Come back in 2 hours," she says without smiling. "See him," she motions in the direction of the chain-smoking guy who is tasked with analyzing scans.
I stumble out into the glare of mid-morning sunlight, and catch sight of the Jade Dragon Snow Mountain glistening in the near distance. For my first meal, I will make French toast, and to your health and longevity, I will drink a second cup of strong Yunnan coffee.