World ? Asia ? China

China: Staying Healthy

Staying Healthy

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. Tuberculosis is making a frightening resurgence in many parts of the country and due the explosive growth of the canine population, rabies is on the rise again. Less than 10% percent of dogs have been vaccinated (75% is considered the minimum standard in other parts of the world).

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. 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 treat minor problems, and who will be aware of the best place to send foreigners for further treatment.

If you regularly take a nonprescription medication, bring a plentiful supply with you -- don't rely on finding it in China. 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. Misprescription 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 healthcare as possible. Much of it is not good for your health. To put things in perspective, China was recently ranked 144 out of 191 countries for its healthcare services.

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. 800/311-3435; 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).

Common Ailments

The Chinese are poorly educated when it comes to health risks and personal hygiene. Spitting has worsened as smoking and pollution has increased. Even in the most prosperous cities, men and infants use the sidewalk as a public toilet. Be aware that contagious diseases including TB, rabies, and syphilis are rising steadily.

Stomach Upsets -- The greatest risk to the enjoyment of a holiday in China is one of stomach upsets or more serious illnesses arising from growing levels of pollution and 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.

Respiratory Illnesses -- 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.

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.

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, 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 uneducated about sexually transmitted diseases, which are rife. In addition, it was recently estimated that more than 10% of the population are Hepatitis B carriers and AIDS is a growing problem. In short, you should not undertake intimate activities without protection. Condoms are widely available, including Western brands in bigger cities.

What to Do if You Get Sick Away From Home

If you have any significant health information or regular prescription, ask your doctor to write a summary of the condition in case a problem develops. If your glasses break its nice to have a photocopy of the prescription to make it easier to get replacements. Some of this is not needed for short trips so be your own judge based on length of stay, your health, and what you plan to do.

Very few health insurance plans pay for medical evacuation back to the U.S. (which can cost $10,000 and up). A number of companies offer medical evacuation services anywhere in the world. 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 $225 individual, $350 family; you can also purchase short-term memberships.

U.K. nationals will need a European Health Insurance Card (EHIC) to receive free or reduced-costs health benefits during a visit to an European Economic Area (EEA) country (European Union countries plus Iceland, Liechtenstein and Norway) or Switzerland. The European Health Insurance Card replaces the E111 form, which is no longer valid. For advice, ask at your local post office or see www.dh.gov.uk/travellers.

If you suffer from a chronic illness, consult your doctor before your departure. Pack prescription medications in your carry-on luggage, and carry them in their original containers, with pharmacy labels -- otherwise, they won't make it through airport security. Carry the generic name of prescription medicines, in case a local pharmacist is unfamiliar with the brand name.

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