Health
Part of A Better Guide to Běijīng’s Practical A–Z
‘They say it’s a very healthy post, and perfectly suitable for children,’ replied Grant-Howard in the completely colourless tone which in diplomacy implies doubt. ‘The riding,’ he went on more briskly, ‘is first class, and the cheapest in the world. Quite average ponies for a tenner, and plenty of polo.’
Ann Bridge, The Ginger Griffin, London 1934
At least the main characters in this particular novel survived, but in Peking Picnic, another Bridge novel, one falls ill and is dead in 24 hours, an event treated as regrettable but commonplace by the diplomatic community of her day.
Eighty years later Běijīng certainly isn’t ‘suitable for children’ nor older people, nor anyone with any respiratory sensitivity on very many days a year, mainly due to world-beating and instrument-busting levels of atmospheric pollution. But there are steps that can be taken to relieve the problem.
What follows is a general introduction to the health problems you may encounter and how to avoid or deal with them. But remember that new medicines are constantly being developed and medical opinion changes. So consult professionals.
Family doctors are rarely right up-to-date on travel medicine, but should be able to point you to specialist travel clinics and hospital tropical medicine departments. Consulting a travel clinic is absolutely vital, especially if you are pregnant or travelling with children. As some vaccinations cannot be taken together or involve multiple injections, make contact at least three months before you plan to travel.
In most developed nations these injections are no longer free, and if you need to have several the expense can be considerable. If you’re baulking at the cost, do not go on-line asking for advice and looking for hearsay confirmation of the ‘Well I didn’t have any jabs and nothing happened to me’ kind. The only people whose advice is worth hearing is that of medical professionals in the field, and the only on-line sources of reliable information are government agencies such as the following:
The Centers for Disease Control and Prevention, www.cdc.gov
The National Travel Health Network and Centre, www.nathnac.org
Public Health Agency of Canada, www.phac-aspc.gc.ca
World Health Organisation, www.who.int/en (particularly useful for rapidly updated information on outbreaks of ‘bird flu’, such as 2013’s H7N9).
No vaccination is 100% effective, and reducing risk by cautious eating, attention to hygiene, and, beyond Běijīng, the use of insect repellents is also important. However, keep risks in proportion: You are far more likely to die in a road accident within in a mile or two of your own home than from any disease picked up in or around Běijīng.
Before you leave
Immunization against typhus in 1935 Běijīng:
They were thin, wrinkled, resigned old men; beggars by profession. They sat on three hard chairs in a small room opening off a laboratory and full of guinea-pigs in cages. Their ragged trousers were rolled up above their knees and to the dwindled calves of each were clamped a number of little shallow boxes. The sides of the boxes which pressed against the flesh were made of gauze, or something like it; and each box contained 500 lice. For two hours every day, and for the wage of twelve Chinese dollars a month, the three old men pastured, between them, some 18,000 lice.
Peter Fleming, News from Tartary, London 1936
The essence of 30 lice went into each of the three necessary anti-typhus injections. Although Fleming is here describing a Western clinic, some believe that the idea of variolation, the transmission of matter from one human to another to prevent disease, was in use in China in the late Míng, and perhaps even earlier.
Begin by making sure that the basic immunizations you should have even at home are up to date, and get boosters if necessary. These include polio, diphtheria and tetanus.
In China it is best to carry as much paperwork as possible, including an International Certificate of Vaccination, if you have one.
Health checks are rarely made except at land borders, and even these are usually perfunctory, although at all entry points you’ll walk-through detectors that will measure your body temperature, and if you have a fever (and if someone is paying sufficient attention) you many be stopped, inspected, and questioned.
The need for other inoculations will depend on exactly where you travel in China and the time of year. If you plan to stay mainly in Běijīng and other urban areas, mosquito-borne diseases such as malaria and Japanese B Encephalitis are best avoided by use of clothing, repellent, and insecticide impregnated nets on short trips out of town, although there is currently no risk of mosquito-borne diseases in Běijīng. However, inoculation may be advised for the following:
Typhoid fever, caught from contaminated food and water. There are two possible regimens. A single injection, which requires a booster every three years if you will be repeatedly travelling in affected areas, or an oral vaccine in three doses taken on alternate days with a validity of one to three years depending on exposure.
Meningococcal meningitis is an infection of the lining of the brain caught in the same way you catch a cold. A single injection covers you for three years.
Cholera, an infection of the intestine from which existing vaccines only provide partial protection, and are now rarely offered.
Hepatitis comes in a form communicated quite easily through shared utensils and low hygiene (hepatitis A), and in more dangerous forms that require the exchange of body fluids (mainly hepatitis B) as well as other rarer forms for which there is no vaccination available. Immunization against hepatitis A is important because of poor hygiene standards, and many doctors recommend immunization against hepatitis B to avoid further complications should you receive treatment with contaminated blood or equipment.
Both diseases attack the liver and cause weakness and lassitude, but hepatitis B can be life-threatening and since the vaccine was only added to China’s vaccination system long after its invention, and was long unaffordably expensive for rural residents, it is thought that more then 100 million Chinese carry the virus.
For hepatitis A one injection gives one year’s protection, and a second a year later will cover you for life. For hepatitis B there are two injections given one month apart and a booster six months later, giving 90% protection for a lifetime. Fans of alternative medicine may like to know that the Chinese Ministry of Health and the State Administration of Traditional Chinese Medicine has recommended an intravenous drip made from ‘sophora-rhubarb’ to cure viral hepatitis. Others will prefer the security of science.
Japanese B Encephalitis is a severe brain infection carried by mosquitoes to which you may be exposed in rural areas, especially during rainy periods. Three injections are needed over a one-month period to give two years of coverage which can be boosted if necessary. Areas at risk vary over time, but this vaccination is not usually recommended for those staying in Běijīng and other major cities.
Mosquito-born malaria comes in various forms, and you may need to take different prophylactic drugs, depending upon the time you travel and whether you venture into rural areas, although for Běijīng prophylaxis is not currently recommended.
You must typically begin to take these drugs two weeks before you enter an affected area, and for four weeks after you leave it. Dangers vary over time, but if you are staying within the areas covered by this book, malarial prophylaxis may not be necessary. If venturing into malarial areas, ignore scare stories about side-effects of malarial medication and insist on taking it — in this case the dangers of illness far outweigh the risks, and the medication should be backed up with serious attempts to avoid being bitten. Cover up exposed skin from dusk until dawn, wear repellent, and use insecticide-impregnated bed nets. Pregnant women need to take particular care.
You don’t need yellow fever vaccination for China, but if you are arriving from a country with yellow fever, you may be asked for proof of vaccination, which in some countries is only available from a limited number of specialist centres.
While You Are There
Colds and sore throats are the common lot of those travelling in China for more than the briefest of periods, so if there is a proprietary medicine you usually use for relief, bring a supply with you. The causes are the general lack of hygiene in China and the lack of resistance to unfamiliar versions of these everyday diseases. Unhygienic spitting is common and has a long history:
And everyone of the chiefs and nobles carries with him a handsome little vessel to spit in whilst he remain in the Hall of Audience — for no one dares spit on the floor of the hall — and when he hath spitten he covers it up and puts it aside.
Marco Polo, The Travels, 13th century, Yule-Cordier edition
For some these problems come in the slightly more serious form of upper respiratory tract infections. Chinese doctors will prescribe low doses of antibiotics which should be avoided if you merely have a cold (which antibiotics cannot anyway cure), but the entire course taken if you genuinely have something worse, sometimes with additional Chinese medicines which should be avoided. You can ask your doctor at home to prescribe a course of broad spectrum antibiotic to take with you, but follow the instructions exactly.
Běijīng has at times of the highest levels of air pollution on the planet, so bad that, unlike the Great Wall, it actually can sometimes be seen from space. Airborne particulates are commonly very many times the internationally recommended safe maximum. The levels of pm2.5s — tiny lung-penetrating particles with both short- and long-term health impacts, which the government until recently kept secret, average five times the WHO recommended daily safe level. Its figures for pm2.5 particles, larger pm10 particles, ozone, etc. are often manipulated to make results seem better than the reality, with claims for numbers of ‘blue sky’ days large enough to make any Běijīng resident guffaw.
The US embassy monitors several kinds of pollution using machines placed on its roof, and has connected them to Twitter, now blocked in China (see twitter.com/beijingair). The US has ignored Chinese government demands that their machines be shut down for fear of spreading ‘disharmony’ (justified dissatisfaction with the government), and this finally forced the government to start publishing its own figures, although these are typically substantially better than those coming from the American machine. This is partly because the Běijīng figures are an average from machines spread right across territory that includes much countryside, and partly because lies will be told whenever the truth looks inconvenient. Interpretations of the figures, such as what constitutes light and heavy pollution, are also more vastly generous than international standards.
Beijing only had 13 days considered ‘good’ on the US index in 2014, with 70 days of moderate air pollution, 64 at unhealthy for sensitive groups, 148 unhealthy days, 45 very unhealthy, 14 deemed hazardous and one day that registered at ‘beyond index’, i.e. beyond the scale. Weather conditions in Beijing and the surrounding regions often compound the particulates generated by coal burning, cars and industry, with cold winter air trapping the pollution.
In early 2013, in what expats dubbed an ‘airpocalypse’, AQI (Air Quality Index) readings rose to record-breaking levels and following a barrage of negative reporting overseas, Xīnhuá (the Chinese state ‘news’ agency) was forced to move from reporting dense fog to admitting the crisis, eventually reporting an even higher number than the Americans — 993 on a scale that originally ended at 500, and several multiples of the emergency level. The internationally recognised maximum exposure is to an average of 25 over a month. There were highway closures and mass cancellations of flights.
In February that year a Deutsche Bank report forecast that due to coal-fired power station construction and further increases in traffic, air pollution would be 70% worse by 2025 and indeed in 2014 the ‘airpocalypse’ was subsequently repeated more than once, and again in January 2015. The over-500 report on the US embassy’s machine was reprogrammed to read ‘beyond index’ instead of the ‘crazy bad’ it reported the first time the scale was exceeded.
Claims that air quality has much improved now are always followed by days when the pollution is beyond index. In 2019 it was claimed that Běijīng had now moved out of the world’s top 100 most polluted cities, although residents found this claim hard to swallow. That are ‘better’, still means ‘shockingly unhealthy’. Ignore fatuous on-line advice of the ‘I live in Běijīng and I never wear a mask’ kind, which is no different from ‘I run into traffic without looking and I haven’t been run over yet.’ The particulates exist, and the only argument for not taking precautions is that a visit may be brief. In 2020 the Helsinki-based Centre for Research on Energy and Clean Air reported 22,000 air-pollution related deaths among Běijīng residents in the first six months alone.
In 1996, in an even then long overdue effort to reduce traffic congestion and pollution, the city’s PSB (police) announced that minibuses and jeeps would only be allowed inside the third ring road every other day, based on whether they had odd- or even-numbered licence plates. But this ran directly counter to the declared national policy of developing the auto industry into an ‘economic pillar’, and so the regulation was quietly dropped. Restrictions were revived for the Olympic period in order to help improve the atmosphere by taking one fifth of cars off the road each day, depending on the final digit of their licence plate numbers. This remains in force, although military vehicles and official vehicles of all kinds are free to ignore the regulations, and the rich have moved to acquire second vehicles so as to avoid personal inconvenience. At times, e.g. during the 2014 APEC meeting, restrictions are temporarily tightened further.
It doesn’t help that Chinese standards for fuel quality are set by government-monopoly fuel companies, and permit sulphur content levels five times higher than in Europe, or three times that in the US. China is already the world’s biggest car market, and the county’s air is also thick with sulfur dioxide, nitrogen oxides, ozone, lead, mercury, and other pollutants, mostly blown in from a ring of factories in surrounding Héběi Province, which is home to most of the cities in China’s pollution top ten. This means that the pollution is often worse at night than it is during the day.
Those with ‘smart’ phones now run the air quality apps which are blocked on some servers but not others, and which provide both the official and US-generated figures for cities across China, and issue alerts. There’s some suspicion that China will shortly attempt to compel Apple and Android stores to censor themselves and prevent Chinese from downloading such apps. These also provide alerts when pollution reaches levels at which a mask is recommended. The only effective masks are those with N95 or N99 ratings and thus capable of excluding most pm2.5s if properly fitted (men ideally need to be clean-shaven), and at such times should be worn both indoors and outside. Reliable masks (foreign brands) can be found quite widely in China, but more reliably at home, and in the disposable varieties very lightweight, although the reusable varieties with replaceable filters are likely to be more effective. Look in hardware shops and pharmacies for supplies before leaving home or order on-line. There are instructions on how to wear masks effectively here: www.moh.gov.sg/content/dam/moh_web/PressRoom/Current_Issues/2013/haze/mask/Wear%20N95%20Mask.pdf. There’s a live pollution map for all of China at aqicn.org/map/china. Read it and weep even before the smog reaches your eyes.
The high ozone levels are enough to give many visitors temporary respiratory problems which antibiotics won’t cure, so don’t take them.
Diarrhoea, vomiting and a variety of bowel problems are caused by poor toilet hygiene and bad food and water, but standards are much better than they used to be, and these problems can be largely avoided by taking simple and obvious precautions. Wash your hands as often as you can (often not possible at public toilets in the street, and there will usually be no soap, so go into hotels and familiar Western fast food outlets) and make use of the bathroom in your room in preference to other options. Carry disinfectant wipes and a few sheets of toilet paper with you.
If faced with ancient gnawed chopsticks request disposable ones (small particles of food embedded in chopsticks can also transmit hepatitis A), or take your own.
Do not drink tap water — this is no time to be macho: not even local people do. Drink tea, boiled water, bottled water (although in recent government tests fewer than 50% of local brands reached the required and anyway inadequate standard), and soft drinks. Everywhere you go there are kettles or thermoses of boiled water to hand, even on trains and in the most undistinguished backstreet hotel. Boiling won’t get rid of the heavy metals and other contaminants, but is fairly successful at killing bacteria. Hotels typically supply one or two bottles of locally produced bottled water for free. When shopping for yourself paying ¥3–¥5 is wiser than ¥1–¥2, and ¥16–¥18 better still.
Remember that in China the waste you deposit in the public lavatory today may be tomorrow’s fertilizer, still collected by ‘honey wagons’. Do not swim in China’s lakes or rivers. Unless in top-end hotels and restaurants do not eat salads, other cold dishes, or any fruit that cannot be peeled and, having touched the outside, don’t touch the inside before eating. Avoid fruit with damaged and broken skin. Eat only piping hot food that has been freshly cooked for you. Do not walk around bare foot. All these measures will help you avoid parasitic infections. They may seem excessive, and hardy long-term residents may mock. But if you have a week in Běijīng why pointlessly risk spending half of your time only travelling between bed and bathroom?
If you do get diarrhoea, it is essential to replace lost fluids. Take with you a few sachets of oral rehydration salts which can be dissolved in mineral water or in boiled water which has been allowed to cool. Seek help if diarrhoea is bloody or extremely profuse.
Cases of sexually transmitted diseases are rapidly increasing in China, particularly gonorrhoea and syphilis, both extremely nasty and increasingly resistant to treatment. Visiting students and other long-stayers are asked to provide proof of a recent AIDS test, but not those on tourist visas. Amongst its many other ‘greats’ and ‘betters’, China claims to have a wider variety of types of AIDS strains than anywhere else. There’s widespread ignorance about sexually transmitted diseases of all kinds, once known to Chinese medicine by names such as ‘plum poison’, and ‘white mud’, and still the subject of rumour, superstition and hearsay. Many hundreds of thousands of cases are reported per annum, but since embarrassment and the availability of penicillin and other drugs over the counter play a role in these figures, the true number is probably far greater. In 2014 there were a reported 104,000 new HIV/AIDS infections, 14.8% more than 2013.
Condoms are widely available in Běijīng and other major Chinese cities in corner shops and supermarkets, and familiar imported brands can often be found. These are likely to be considerably more reliable than local products, although buy from reputable outlets such as Watson’s as fakes abound at sex shops. If they’re cheap, they’re fake, and likely perforated. Note, too, that popular prejudice is based on fact, and sizes made for Asian markets are smaller than those for the West. Bring supplies from home.
You will find more choice of imported brands in branches of Hong Kong shops such as Park ’n’ Shop, Watson’s and Wellcome, mostly located in the basements of larger malls such as those along Cháng’ān Jiē, in Wángfǔjǐng, and Cháoyáng Mén Wài Dàjiē.
All extra-marital sex is officially frowned upon in China (and that between foreign men and Chinese women more than most) but goes on anyway. One city charges a ‘sin tax’ on unmarried couples who live together. Another fines women ¥200–¥2000 if they prove not to be virgins during a required pre-marital check-up. Back in 1998–9 there were widespread protests at a proposal to make extra-marital affairs illegal.
The summer sun can quickly damage your skin. Keep yourself well covered with sunscreen, carry the tube with you for topping up, wear sunglasses with proper UV protection and consider a hat, however ‘uncool’ this may look.
As if the atmosphere wasn’t bad enough, smoking cannot be avoided in China, where no smoking signs are often purely decorative, although Běijīng was one of 15 cities to ban smoking from restaurants, hotel lobbies, etc. from 2008, at least in theory. One in two of the world’s cigarettes are made in China and 350 million Chinese smokers consume 2.5 trillion of them a year. 63% are men and 3.8% women. The WHO estimates that smoking kills one million Chinese every year, and that deaths and health complications resulting from smoking cost China ¥500 billion in the decade up to 2015. Extreme tardiness in taking action to reduce smoking may have been caused by tax revenues of around ¥1000 billion over the same period. In June 2015 the government finally banned smoking from kindergartens, schools, child welfare institutions, women and children’s hospitals, fitness and sports venues, historic sites open to the public, and indoor public places. But in China inconvenient rules are to be ignored if no one’s watching. Pointing to no smoking signs is often enough to make smokers guiltily put out their cigarettes.
Treatment and Emergency Assistance
They are ignorant of the difference between arteries and veins, nor do they understand the circulation, looking upon the several pulses of the body as the effects of separate causes. All diseases are attributed by them to their favourite doctrine, “hot and cold influences.” They have a certain knowledge of the use of drugs, and of mercury in particular, but their remedy above all others is acupuncture. So days ago my groom had an attack of diarrhoea, and his medical man pricked him underneath the tongue for it.
A Freeman-Mitford, The Attaché at Peking, London, 1900 (written 1865)
There has been almost no rigorous scientific testing of the remedies or the simplistic assumptions behind traditional Chinese medicine or TCM (for impotence eat tiger penis). Nevertheless in 1999 the Chinese launched a continuing campaign to promote traditional Chinese medicine overseas, calling on scientists to conduct research to prove the medicines’ effectiveness. Only a tiny number have been registered by the US Food and Drug Administration for testing, but dozens of others are imported either as food or nutritional supplements. While much is herbal, some treatments involve parts of endangered species and substances such as bear bile, extracted under conditions so inhumane as to defy description. Some contain known poisons and have been banned overseas, but their sale sometimes continues under the counter and this has led to prosecutions following the deaths of consumers. It’s not merely that the claims for these medicines are unproven, but that even the ‘medicines’ themselves often fail to contain what they claim, making them doubly fake and possibly even more risky.
If you wish to experiment with acupuncture, ensure that disposable needles are being used or select a more hygienic country in which to turn yourself into a pin cushion. Even in hospitals needles may be reused, so consider taking a needle kit with you in case of need. These are widely available at travel shops and specialist clinics.
If you need a doctor most hotels can supply one swiftly, but to ensure high standards of care call one of the international hospitals and clinics with Western-trained doctors of assorted nationalities, and mostly open 24 hours for emergencies. Those from countries with national healthcare systems will be shocked at the prices — perhaps the equivalent of US$100 merely for a consultation. But don’t take chances with Chinese hospitals. Take out travel insurance which covers you for emergency repatriation and call your embassy or consulate for advice if necessary (see Embassies and Consulates for telephone numbers). Foreign-run and staffed hospitals and clinics in Běijīng include:
United Family Hospital (北京和睦家医院, Běijīng Hémù Jiā Yīyuàn) Jiàngtái Lù 2 (朝阳区将台路2号), m Jiàngtái (Line 14), northeast Běijīng beyond the Fourth Ring, close to the former Holiday Inn Lido on the way to the airport, t 5927 7000, 5927 7120 (emergencies), www.unitedfamilyhospitals.com.
International SOS Clinic (国际SOS, Guójí SOS) Suite 105, Wing 1, Kūnshā Building, Xīn Yuán Lǐ 16 (朝阳区新源里16号琨莎中心1座105室)), northeast Běijīng between Second and Third Ring Roads, t 6462 9112 (clinic appointments), t 6462 0333 (dental appointments), t 400 818 0767 (emergencies). www.internationalsos.com/clinicsinchina/en/Beijing.aspx
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