Staying Healthy

Greatest Risks

The greatest risk to the enjoyment of a holiday in China is one of stomach upsets or more serious illnesses arising from low hygiene standards. Keep your hands frequently washed and away from your mouth. Only eat freshly cooked hot food, and fruit you can peel yourself. Avoid touching the part to be eaten once it's been peeled. Drink only boiled or bottled water. Never drink from the tap. Use bottled water for brushing your teeth.

The second most common cause of discomfort is the upper respiratory tract infection or cold- or flulike symptoms in fact caused by heavy pollution. Many standard Western remedies or sources of relief (and occasionally fake versions of these) are available over the counter, but bring a supply of whatever you are used to. If you have sensitive eyes, you may wish to bring an eye bath and solution.

If you regularly take a nonprescription medication, bring a plentiful supply with you and don't rely on finding it in China. Feminine hygiene products such as feminine napkins are widely available, but tampons are found mainly in Hong Kong.

General Availability of Healthcare

While the names and addresses of reliable (and very expensive) clinics with up-to-date equipment and English-speaking foreign doctors are given in this guide where available, in most cases they are not. So should you begin to feel unwell in China, your first contact should be with your hotel reception. Many major hotels have doctors on staff who will give a first diagnosis and treatment for minor problems, and who will be aware of the best place to send foreigners for further treatment.

Be very cautious about what is prescribed for you. Doctors are poorly paid, and many earn kickbacks from pharmaceutical companies for prescribing expensive medicines. Antibiotics are handed out like candy, and indeed, dangerous and powerful drugs of all kinds can be bought over the counter at pharmacies. Mis-prescription is now a significant cause of death in China, including the habit of prescribing a combination of Western drugs and Chinese traditional "medicines," which react badly with each other. In general, the best policy is to stay as far away from Chinese health care as possible. Much of it is not good for your health.

Before You Leave

Plan well ahead. While a trip to Hong Kong or Macau can be made with little extra protection, a trip to mainland China, depending on its duration and time spent outside larger cities, may require a few new inoculations, especially if you haven't traveled much in the less developed world before. Some of these are expensive, some need multiple shots separated by a month or two, and some should not be given at the same time. So start work on this 3 or 4 months before your trip.

For the latest information on infectious diseases and travel risks, and particularly on the constantly changing situation with malaria, consult the World Heath Organization (www.who.int) and the Centers for Disease Control in Atlanta (www.cdc.gov). Look in particular for the latest information on SARS, which may continue long after the media has become bored with reporting it. Note that family doctors are rarely up-to-date with vaccination requirements, so when looking for advice at home, contact a specialist travel clinic.

To begin with, your standard inoculations, typically for polio, diphtheria, and tetanus, should be up-to-date. You may also need inoculations against typhoid fever, meningococcal meningitis, cholera, hepatitis A and B, and Japanese B encephalitis. If you will be arriving in mainland China from a country with yellow fever, you may be asked for proof of vaccination, although border health inspections are cursory at best. See also advice on malaria, below.

While You Are There

Mosquito-born malaria comes in various forms, and you may need to take two different prophylactic drugs, depending upon the time you travel, whether you venture into rural areas, and which areas they are. You must begin to take these drugs 1 week before you enter an affected area, and for 4 weeks after you leave it, sometimes longer. For urban tours, prophylaxis is usually unnecessary.

If you visit Tibet, you may be at risk from altitude sickness, usually marked by throbbing headache, loss of appetite, shortness of breath, and overwhelming lethargy. Other than retreating to a lower altitude, avoiding alcohol, and drinking plenty of water, many find a drug called Diamox (acetazolamide) to be effective, and used with caution. For most, one sleepless night is all you will have to endure.

Standard precautions should be taken against exposure to strong summer sun, its brightness often dimmed by pollution but its power to burn undiminished.

The Chinese are phenomenally ignorant about sexually transmitted diseases, which are rife. As with the respiratory disease SARS, the government denied there was any AIDS problem in China until it grew too large to be contained, and it still issues estimates of the spread of infection that are highly conservative. In short, even more than at home, you should not undertake intimate activities without protection. Condoms are widely available, including Western brands in bigger cities.

Staying Safe

China is one of Asia's safest destinations. You must still be cautious about theft in the same places as anywhere else in the world -- crowded markets, popular tourist sights, bus and railway stations, and airports. The main danger of walking the ill-lit streets at night is of falling down an uncovered manhole or walking into a phone or power wire strung at neck height. Take standard precautions against pickpockets (distribute your valuables around your person, and wear a money belt inside your clothes). There's no need to be concerned about dressing down or not flashing valuables -- it's automatically assumed that all foreigners are astonishingly rich anyway, even the scruffiest backpackers, and the average Chinese cannot tell a Cartier from any other shiny watch. If you are a victim of theft, make a police report (go to the same addresses given for visa extensions in each city, where you are most likely to find an English-speaking policeman). But don't necessarily expect sympathy, cooperation, or action. The main purpose is to get a theft report to give to your insurers for compensation.

Street crime increases in the period leading up to Chinese New Year as migrants from the country become more desperate to find ways to fund their journeys home. Be especially vigilant at this time of year.

Harassment of solo female travelers is slightly more likely if they appear to be of Chinese descent, but is very rare.

Traffic is a major hazard for the cautious and incautious alike. In Hong Kong and Macau, driving is on the left, and road signs and traffic lights are obeyed. In mainland China, driving is on the right, at least occasionally. The rules of the road are routinely overridden by one rule: "I'm bigger than you, so get out of my way," and pedestrians are at the bottom of the pecking order. Cyclists ride along the sidewalks, and cars also mount sidewalks right in front of you and park across your path as if you don't exist. Watch out for loose paving slabs caused by these selfish SUV drivers; usually they only spurt up dirty water, but twisted ankles sometimes occur, too. Cyclists go in both directions along the bike lane at the side of the road, which is also invaded by cars looking to park. The edges of the main lanes also usually have cyclists going in both directions. The vehicle drivers are gladiators, competing for any way to move into the space ahead, constantly changing lanes, and crossing each others' paths. Pedestrians are matadors pausing between lanes as cars sweep by to either side of them. In cities they tend to group together and edge out into the traffic together, causing it to swing ever farther out away from them, often into the path of oncoming vehicles, until eventually the traffic parts and flows to either side, and the process is repeated for the next lane. Whether it's more hair-raising to be in the vehicle or on the street is an open question. Driving tests are laughable, and even though China only has 2% of the world's cars, it already has 20% of all traffic-accident fatalities. The latest scourges to watch out for are rechargeable electric bicycles, which silently whiz along the sidewalk catching many pedestrians completely unawares.

Visitors should be cautious of various scams, especially in areas of high tourist traffic, and of Chinese who approach and speak in English: "Hello friend! Welcome to China!" or similar. Those who want to practice their English and who suggest moving to some local haunt may leave you with a bill that has two zeros more on it than it should, and there's trouble should you decline to pay. "Art students" are a pest: They approach you with a story about raising funds for a show overseas, but in fact are merely enticing you into a shop where you will be lied to extravagantly about the authenticity, uniqueness, originality, and true cost of various paintings, which you will be pressured into buying for dozens of times their actual value. The man who is foolish enough to accept an invitation from pretty girls to sing karaoke deserves all the hot water in which he will find himself, up to being forced by large, well-muscled gentlemen to visit an ATM and withdraw large sums to pay for services not actually provided.

Dealing with Discrimination--In mainland China, in casual encounters, non-Chinese are treated as something between a cute pet and a bull in a china shop, and sometimes with pitying condescension because they are too stupid to speak Chinese. At some sights, out-of-town Chinese tourists may ask to have their picture taken with you, which will be fun to show friends in their foreigner-free hometowns. ("Look! Here's me with the Elephant Man!") Unless you are of Chinese descent, your foreignness is constantly thrust in your face with catcalls of "laowai," (or "gweillo" in Cantonese areas) a not particularly courteous term for "foreigner," and a bit like shouting "Chinky" at every Chinese you encounter at home. Mocking, and usually falsetto, calls of "Helloooooo" are not greetings but similar to saying "Pretty Polly!" to a parrot. Whether acknowledged or not (and all this is best just ignored), these calls are usually followed by giggles. But there's little other overt discrimination, other than persistent overcharging wherever it can possibly be arranged. Indeed, in general, foreigners get better treatment from Chinese, both officials and the general public, than the Chinese give each other, once some sort of communication is established. People with darker skin do have a harder time than whites, but those with no Mandarin will probably not notice. Hong Kong and Macau are both more tolerant, although souvenir shops and markets will overcharge wherever possible. Hong Kongers married to foreigners know to leave their spouses at home when they shop for dinner.