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 and respiratory viruses, consult the World Health Organization (www.who.int) and the Centers for Disease Control (www.cdc.gov). Look in particular for the latest information on respiratory viruses such as SARS, bird flu, and A(H1N1), 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 malarial prophylactics, below. Tuberculosis is making a resurgence in many parts of the country and due to the explosive growth of the canine population, rabies is also on the rise again, although the risks in tourist areas are minimal.
General Availability of Health Care -- Advanced facilities staffed by foreign doctors are in Beijing, Shanghai, and Guangzhou, and excellent facilities in Hong Kong; these are listed as appropriate in this book and can also be found in local expat magazines. If you need to go to a Chinese hospital outside of these places, try and head to the biggest hospital in a large town. Foreigners who do end up in provincial facilities often get special treatment, but you may not consider it special enough.
Contact the International Association for Medical Assistance to Travelers (IAMAT) (tel. 716/754-4883, or 416/652-0137 in Canada; www.iamat.org) for tips on travel and health concerns in the countries you're visiting, and for lists of local, English-speaking doctors. The United States Centers for Disease Control and Prevention (tel. 800/232-4636; www.cdc.gov) provides up-to-date information on health hazards by region or country and offers tips on food safety. Travel Health Online (www.tripprep.com), sponsored by a consortium of travel medicine practitioners, may also offer helpful advice on traveling abroad. You can find listings of reliable medical clinics overseas at the International Society of Travel Medicine (www.istm.org).
Far fewer travelers get sick in China than India, Egypt, or a host of other tourist destinations in less-developed countries. However, if you're here for a while, there is of course a chance you'll fall ill somewhere along the way.
Respiratory Illnesses -- A billion Chinese spitting, pollution, and the contrast in temperature and humidity between freezing dry air-conditioning and sweltering summer heat, makes a respiratory tract infection the most likely illness to affect you in China. If you're lucky a sore throat might be the worst of it, but cold- or flu-like symptoms are also a possibility. A good range of local products can be used to treat respiratory infections (Golden Throat can stop your throat from getting too sore), but if you have a fever, are in serious discomfort, or the illness hasn't improved after 48 hours, see a doctor.
Stomach Upsets -- In many less-developed countries around the world stomach upsets are the most likely cause of illness for visitors, but, in China, where fresh food is cooked at high-temperatures, this is less of a worry. That isn't to say that it never happens and you should forego basic personal hygiene, but don't let worrying about what you eat dominate your trip to China. Keep your hands frequently washed and away from your mouth. Choose busy restaurants, with a high turnover, and only eat freshly cooked hot food, and fruit you can peel yourself. Drink only boiled or bottled water and use the same to brush your teeth. Never drink from the tap.
Malaria -- Mosquito-born malaria is present in parts of China's deep south, but unless you are going to be spending a lot of time out in the jungle during the wet season, it isn't a serious risk. If you will be visiting malarial regions for extended periods then it's worth considering prophylactic drugs. There are various prophylactics available, but you should ensure that the type you take is effective against the strains to be found in your destination. Often these drugs need to be taken up to a week before you arrive in the malarial zone, and for up to a month after you leave, and some (notoriously Larium) can have unpleasant side effects. Also bear in mind that even if you take anti-malarial prophylactics, if you are bitten by an Anopheles mosquito carrying the virus, chances are you will still get malaria; the drugs simply buy you a little time to get to hospital (although they can also mask the symptoms, making it more difficult to diagnose).
Other Risks -- If you visit Tibet, you may be at risk from altitude sickness, usually marked by throbbing headache, loss of appetite, shortness of breath, overwhelming lethargy, and paradoxically, difficulty sleeping. Other than retreating to a lower altitude, avoiding alcohol, and drinking plenty of water, many find a drug called Diamox (acetazolamide) to be effective. Locally, Hongjingtian is a widely available over-the-counter substitute.
Standard precautions should be taken against exposure to strong summer sun, its brightness often dimmed by pollution but its power to burn undiminished.
As people have more money, time, and enjoy more social liberties, there has been something of a sexual revolution in China. This has led to the spread of sexually transmitted diseases (including AIDS) and, in spite of educational attempts by the government, knowledge about the subject among the general populace remains limited. In short, you should not undertake intimate activities without protection. Condoms are widely available, including Western brands in bigger cities.
No matter how good your pre-trip health is, it's worth taking a basic first aid kit and a selection of your preferred over-the-counter medicines with you. If you have a chronic illness, ask your doctor to write a summary of the condition before you leave in case a problem develops while you are away. Pack prescription medications in your carry-on luggage, and leave them in their original containers, with pharmacy labels -- otherwise, they might not make it through airport security. Also take note of the generic name of your prescription medicines, in case a local pharmacist is unfamiliar with the brand name. For glasses (or contact lens) wearers, it's also worth taking a copy of your prescription with you, which will enable you to replace them if they get lost or broken, and will also allow you to take advantage of cheap opticians and buy a spare pair. You should also make sure you have some form of medical insurance, ideally a policy that includes emergency evacuation. If you're ever hospitalized more than 150 miles from home, MedjetAssist (tel. 800/527-7478; www.medjetassistance.com) will pick you up and fly you to the hospital of your choice virtually anywhere in the world in a medically equipped and staffed aircraft 24 hours day, 7 days a week. Annual memberships are $250 individual, $385 family; you can also purchase short-term memberships.
What to Do If You Get Sick Away from Home
For accidents and emergencies, head directly to the nearest large hospital, ideally one in a big city. For minor ailments and illnesses your first contact should be with your hotel reception. Many major hotels have doctors on staff who will treat minor problems, and who will be aware of the best place to send foreigners for further treatment. If the doctor gives you medicine, make sure you ask what each tablet is for as there is a tendency to prescribe a veritable candy-store of different colored tablets and a complicated schedule of when to take them, but some of them might just be multi-vitamins.
For coughs, colds, and minor stomach upsets, local pharmacies generally stock a wide range of over-the-counter medications (including many that are prescription only in the West), but you should make sure you understand the possible side-effects before taking anything, and ideally consult a doctor. 8 SAFETY
China was long touted as one of Asia's safest destinations, but this is changing. Physical violence is still virtually unheard of, but petty theft and scams are definitely on the rise. So 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. Despite the rise in crime, 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, wear a money belt inside your clothes and avoid obvious displays of wealth). 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.
Harassment of solo female travelers is very rare, but is slightly more likely in the northwest of the country.
Traffic is also a 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, and 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. There's safety in numbers, though, and in cities those on foot tend to edge out into the traffic together. 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 latest scourge to watch out for is rechargeable electric bicycles, which silently whiz along the sidewalk catching many pedestrians completely unawares.
Visitors should be aware of various scams in areas of high tourist traffic, and be wary 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. Fake "art students" who approach you with a story about raising funds for a show overseas are another pest. In fact they are merely enticing you into a shop where you will be lied to extravagantly about the authenticity and true cost of various paintings, which you will then be pressured into buying. However, don't let fear of being scammed stop you from meeting locals and interacting; most Chinese who approach you just want to meet a foreigner and if they suggest anything that sounds sketchy, simply say no.
Dealing with Discrimination
In general foreigners receive better treatment in China than the Chinese give one another, but there are also some ingrained cultural stereotypes and darker skinned travelers may have a harder time than lighter skinned travelers.
As a country closed for so long to outside influences, the Chinese are fascinated by foreigners and their long noses, round eyes, and strange hair. In remote spots, and conversely at major attractions that draw tourists from around the country, you may quickly find yourself the center of attention. Being stared at and having your photo taken with your newfound friends can get old fast, but it's important to remember that many Chinese come from foreigner-free towns and may only have seen a laowai (literally "old outsider") on TV up until this point, so meeting you is an event to be commemorated and discussed for weeks to come. Some foreign visitors even grow to love this "fame," and as more and more Chinese learn English, you might even get some conversation; if not, a quick smile and a "ni hao" usually leaves everyone happy. Of course there are times when you really want this attention (at a hotel reception or police station, for example) and everyone seems to ignore you, or worse still, just laughs at your requests. Laughing often hides embarrassment at not knowing how to deal with a foreigner, and you should refrain from getting angry or shouting; frustrating as it may be, persisting is the way forward.
Note: This information was accurate when it was published, but can change without notice. Please be sure to confirm all rates and details directly with the companies in question before planning your trip.