Can Shanghai Deliver The Disney Experience

I recently visited Tokyo Disneyland and it brought into stark relief just how difficult it will be for Shanghai to deliver a quality Disney experience.  The Shanghai Disney Park is scheduled to open in November 2015.  I have visited the two parks in the US as well as Hong Kong Disney so I should know what to expect of a Disney Park. Two areas that will be difficult for the Chinese to sustain are the cleanliness of the park and the cheerful environment for visitors. Here’s why.  

To the Chinese there are distinct divisions between public space and private space.  Thus in public space it is okay for your child to poop and pee in the street, gutter or over a garbage can.  It is okay to throw your waste anywhere.  Simply put, it is not your problem.   Thus I expect the park to need more than average cleanup. I hope there are plenty of employees around to direct parents to restrooms when their toddler needs to “potty”.   I also hope there are signs at the entrance that say diapers require on all infants but actually that is too much to hope. Therefore Disney employees should be prepared to clean up “Hazardous waste” daily. 

The next part of this problem is the person who cleans a public space.  Often this is an older person who has retired from another job. Because the retirement age is 50 for women and 55 for men, there are many middle aged people who must find work to survive.  Street sweepers make the minimum wage dictated for each area, about 1100 rmb a month.  This beats the 100-300 rmb that the government gives for retirement.   Each person cleans several blocks of street gutters and picks up trash.  Many supplement their income by separating recyclables. These people aren’t expected to work too hard and so don’t.  Disney will need to be especially careful about this ingrained attitude to hire good cleaning people.

The indoor cleaning people in China also need serious education about what constitutes clean.  The classrooms and offices at my university are really dirty.  Since windows are open all the time (to prevent disease) the fine grit from the pollution blows in.  I never saw anyone actually use cleaner in a bathroom, and I never saw anyone clear with more than a dirty rag and dirty bucket of water.  Many of the uneducated are afraid of cleaning products being bad for them and so won’t use any.  This is a concern in areas with a lot of people since antibacterial bathroom cleaners are important to contain the spread of disease.  When I had to do administrative paper work, I would walk from office to office for official stamps (chops) to verify my position, pay, etc.  Each office was covered in grime.   No one thought it was their responsibility to have a clean work environment.  Of course I brought in products from home and cleaned my office.  In my apartment building, the cleaning crew mopped and cleaned glass every day.  This didn’t stop residents from throwing things on the floor where they would sit for 24 hours waiting the next cleaning. However, a higher standard can be enforced, if the cleaner is trained and paid more.

In summary, Disney cannot assume that a cleaning person actually knows how to clean, nor how to use modern cleaning products.  Fortunately, in the three years I have been in China, more restaurants and stores are putting toilet paper in their bathrooms so I feel confident that Disney will help reinforce this new trend in China.

Second, the cheerful attitude.  In China, employees are trained to say welcome when you enter a store.  They will also follow you around to be helpful.  Something that makes westerners feel smothered but it makes the Chinese feel important.  Thinking you are important is part of the Chinese psyche.  (Thus VIP cards and programs are big.) The Chinese are famously bad at standing in a cue.  Before the 2008 Olympics, they had groups of volunteers giving cue training to Beijing residents.  I think part of the reason Chinese people have so much problem with standing in a cue is that they want to think they are too important for that. In an overcrowded country, you can see how this would make you feel special.  Along with this, it is part of the Chinese culture to talk down to

employees. It makes you feel superior.  I expect that the Shanghai Disney will need employees willing to enforce the “rules” consistently and not allow line cutting etc. All while keeping their smile.   The Japanese are a rule driven people so this is something they do very well.   We could count on exactly the same answer and behavior from each employee at the Tokyo Disney Parks.  The Chinese are also likely to raise a loud fuss if they think you have dented their dignity.  Disney should hire “behavior monitors” who can help people learn how to cue and also defuse conflicts.  

Chinese employees who interact with the public do not usually greet you with a smile. In general, people work because they have a work ethic, not because they love their job or feel rewarded by it. They will do the job and exactly that job. Which is why tipping is not part of the culture here. I’m sure Disney does cheerfulness training at other parks so should be prepared to handle this component of the new cultural challenge that China represents. 

While China is used to crowds, paying to enter the park and then getting in a 2 hours line is not a quality Disney experience.  Chinese are very money conscious and will expect value for their entry fee. I hope that reasonable crowd controls are enforced so that visitors can have a good experience.  If too many people are let into the park – in the name of greed, it will quickly get a bad reputation and discourage both Chinese and foreigners from visiting.

Visiting Lhasa, Tibet

Duane and I visited Lhasa, Tibet earlier this month. A fascinating place with an ancient and conflicted history that today is still one of the most religious places on earth. So this blog will be more about political and social history than a travel log.

Lhasa City

First, Duane and I were planning to go to Lhasa and then Kathmandu when the earthquake hit Nepal one week before we left.  We cancelled the plans for Kathmandu and hoped that we would still be allowed to visit Lhasa.  To visit Lhasa, any non-Chinese person must have a Tibetan Tour Permit.  This is not issued until a couple days before you leave so after the earthquake I was afraid we wouldn't be allowed to go.   There were casualties on the Tibetan side of Mount Everest and some of the relief efforts were crossing into Nepal along the Friendship Highway that runs between Lhasa and Kathmandu.  In addition roads going towards the Mt Everest Base Camp were only open to Relief vehicles.   Fortunately our plan was to stay in and around Lhasa, so we got the tour permit. The other requirement for visiting Tibet is that you will have an approved guide accompany you everywhere.

   

Prayer Flags on the top of houses.  Usually a
Chinese Flag is also present

 Some historical background before I tell you about the current situation in The Tibetan Autonomous Region.   I know my American friends will be disappointed to learn that most of what you think you know about Tibet came from a CIA campaign in the 1960’s.   During this period there were large not very covert operations along side the Tibetans to push back the Chinese who had invaded Tibet in the 1950’s. The US view of Tibet was shaped by the need of the US government to gain support for their actions.  That doesn't mean everything you were told was a lie just that it was a selective dissemination of information.

The first time I heard the Chinese version of events was while attending graduate school.  I had many Chinese classmates. One told me, they learn in school that the Chinese invaded Tibet to end slavery.  Well I thought that was nonsense.  However, it turns out that Tibet did indeed still have slavery in the 20^th century. Buddhists believe in reincarnation. The Tibetans believed that if you were born into a poor or surf family it was because of your past life sins. And, they were very cruel to these people. Of course that isn't why China wanted Tibet but ending slavery is an easy sell. You can see how muddled the picture is becoming.

Historically, Tibet has been a very unstable region with many periods of governance by others. Many of the Chinese dynasties did claim Tibet; however there were varying degrees of supervision. Many allowed the Tibetan some form of self-rule. The last dynasty, Qing, did include Tibet and had large military outposts in Tibet. It was during the post dynasty period (1919 to 1949) that Tibet had complete self-rule.

 

Potalba Palace- In the past, home to the Dali Lama

 The Mongols also held Tibet are various times in history and are quite close to the Tibetans both ethnically and religiously.  Tibetan Buddhism was exported to Mongolia during the period of the Khans. It was the Mongols who introduced Buddhism to China during the times when the Mongols invaded and ruled China.  When Mongolia was annexed into the Soviet Union,  it gave the US even more reason to try and keep Tibet from becoming pro-soviet.   At one point even the UK tried to expand their empire into Tibet from India. 

One can hardly imagine a worse fit than Communist China and Buddhist Tibet.  Sixty years after the Chinese takeover, Tibet is still “resisting” assimilation.  China calls it Tibetan Liberation and will celebrate 60 years of liberation this summer.  There is no way militarily that the Tibetans will ever defeat the Chinese and with each new generation the Chinese slowly work to instill new thinking in the population.

Two cute little girls who watched me shop

An example of this is the educational system here.  Education was provided solely by the Buddhist monasteries prior to the current Chinese governance.  It was common for 2 out of every three children to become monks (for life) as both a way to get an education and because Buddhism reigns over every part of Tibetan life.  The monasteries had thousands of monks.  Several in the Lhasa area had 6,500 monks at the time of the takeover.  Now the Chinese allow no more than 600 Monks at any one monastery.  In addition the Chinese opened non-religious schools to educate the populous.  However if you lived in a village; there wasn't a school. Or if your parents had suspicions about the schools you didn't go.  

Currently in Tibet, there are a pretty good sized number of ethnic Tibetans in their 30’s or older who did not go to school.  This may be one of the reasons that the Tibetan language and customs are still very much alive – “home schooling”.  Just like in other areas of China there is a big push to provide more education.  Currently if a child does well in elementary school, they can get into a boarding school located in mainland China.  Boarding school is quite common here as the children living in small towns and villages move after 6^th grade to a boarding school to get a better education. Oh, and the parents pay for this education! Of course, the Tibetans want education for their children but it comes with a cost.  The children will speak nothing but Chinese at school and will learn the Chinese version of their history.

The Chinese use a wide variety of measures to control the Tibetans.  First Tibetans are not allowed to have passports. They have Chinese identification cards.  Therefore they are not free to go to other countries.  Until recently many traveled illegally through the Himalayas to India. The Tibetan Monks who travel to the US come from the Tibetan communities in India.  A few years ago the Chinese government offered money for Tibetans to return and then tightened the border.  Speaking badly about the Chinese will get you black-listed.  This means you won’t be able to get a job.  These is still great advantage to being a government official, especially in Tibet. There is a lot of political power available to make life difficult for dissenters as well as monetary kick backs to “clean up” someone’s record.

In addition there are a number of things the Chinese government does to keep this type of dissent out of the ears and eyes of the mainland Chinese Citizens.  For example no map or globe is allowed in China that shows Tibet or Taiwan in a separate color. (As in not part of China). 

Visiting Tibet today is a fascinating experience.  Tibetans are very proud of their religion and ethnic origin.  While they all speak Chinese, they would rather speak Tibetan. I shared a bench with an older lady who lit up when I greeted her with Tashi Delek.  Every day there are large crowds of locals and pilgrims who circumambulate the Potalba Palace and the Jokhang Temple.  Many devout Tibetans (which is a redundant phrase) walk around the Potalba Palace praying while holding their prayer beads or prayer wheels. Once inside the religious part of the palace, they will pray in the assembly hall, as well as in front of many special statues often leaving a small donation in every location.  At the Jokhang Temple, some pilgrims prostrate (lay on the ground) every step of the way, thus inching around the 1 km circle.  The Jokhang Temple has 4 large incent burners that pilgrims feed as the make the walk.  Prostration is an important expression of Tibetan devotion ideally Tibetans will prostrate themselves 100,000 a year.  Each motion involves touch their hands to the foreheads (representing the mind), mouths (speech) and chest (body) before lying flat with arms outstretched.

I personally found the Buddhist religion quite complicated.  There are many representations of the past, present and future Buddhas.  There are protectors some of who look pretty scary.  My favorite was the compassionate Buddha with 1000 eyes.  The one who sees everything you do and is still compassionate. This is the patron Buddha of Tibet.

Sera Monastery Debating Monks

The Sera Monastery is famous for the debating monks.  It is actually the older Monks quizzing the newer ones.  It was a lot of fun watching their dramatic style.  The teacher Monk Slaps his hands together for a quick answer and slaps the back of the hand for a wrong answer.   Sere Monastery is also where the locals bring their children for blessing of good sleep and no nightmares.  Each child received a black mark on their nose from the Monk.

Ganden Monastery

The Ganden Monastery is 45 km outside Lhasa, on a mountain top.  (Elevation over 14,000 feet).  There are spectacular views all around.  This Monastery was damaged after the Chinese invasion and then destroyed during the Cultural Revolution.  The majority of it has been lovingly rebuilt with traditional materials. This Monastery was founded in the 1400’s by Tsongkhapa. The Tibetans call these Monks the yellow hats. This was a major teaching Monastery and is where the current Dali lama took his final examinations. 

Pray Flags going up the mountain near Ganden Monastery. Directly center in the
picture are the barracks for the military stationed at Ganden Monastery

Around Ganden Monastery is a small village that reminds me so much of the buildings of the American Indians.  We could see the clay bricks baking in the sun, and the piles of Yak dung used as fire starter.

Many women in Tibet still wear the traditional dress on a daily basis.  In other words this is not a dress up costume for ceremony.  I loved the style so I had one made for me.  The apron signifies a married woman but you’ll notice that it is a decorative item not a practical one. 

I found that kindness was the bedrock of the Tibetan people.  They are very kind and civil towards each other and just as kind to guests.  For most part, what you see is a Gandhi-esque type determination to maintain their language, alphabet, and way of life against a behemoth more interested in homogeneity. 

There is no Emergency in Chinese Medicine

First let me start this blog with three stories.

Soon after we moved here, one of Kenny’s friends happened upon a scooter accident. The man was lying on the ground convulsing.   She moved to help the man and was physically held back by the spectators.  She yelled in Chinese, I’m an American Doctor.  Still they wouldn't let her through to help the man.  She told me. "All I wanted to do was hold his head so that it wouldn't hit the concrete."

My neighbor and her 5 year old son, went to a Mall near our house.  Just outside the Mall she saw a women jump to her death from about the 5^th floor.  She shielded her son from seeing this.  A group of spectators formed.  No one checked to see if the woman was alive.  My friend asked her driver to call for an ambulance.  The ambulance came 25 minutes later.  The spectators were still there.  The dead woman was still holding her purse. No one had even moved to cover her.

Duane, my husband, works in the downtown area.  He often walks around at lunch time. One day he saw a taxi hit a man on a scooter. The scooter driver landed on his head.  Duane has been instructed to not get involved with any accidents despite that fact that he was an EMT in the states for years.   Again it took 25 minutes for the ambulance to get there.  Each ambulance carries a nurse and doctor.  The doctor got out checked the scooter drivers pulse,  decided he was dead,  went back to the vehicle and let the driver and nurse pick up the dead man and put him in the ambulance.  Duane suffered for weeks because he was unable/not allowed to help the accident victim.  He is hardwired to help.

There are so many words to describe these situations:  heartless, archaic, and inconceivable.  How could people stand around like that and do nothing??  Even if I knew nothing about medicine, I could hold someone’s hand, cover them with a coat, or call their family – if the person was conscious.  In summary, demonstrate compassion.

So why isn’t that happening in China? First, no one has a right to emergency medicine.  When you get to the emergency room, you will not be treated without someone paying the 3000-4000 rmb fee first ($600-800).  Helping someone on the street can make you responsible for this fee.  I haven’t been able to confirm that there is a good Samaritan law here so getting involved makes you responsible.  Unbelievable, the person you helped could come after you for money for their “recovery”.   Your act of good will may come back to haunt you.

Second, there is no first aid or EMT training here. The education in China is very narrow.  You never learn to do more than just your one job.  The majority of citizens young and old wouldn’t have a clue what to do. And may do more harm than good.  Think early 20^th Century America.

Next is the Chinese concept of Guanxi.  You only care about your family and you only help your friends who can in return help you.  Everyone else is a non-entity. This is also related to the over population and competition. In a country with serious competition for resources from education to good jobs, one less person may be a good thing.  China has had recent famines (1950-60) and the Cultural Revolution (1966-76) which turned family members against one another. Both affected the altruism of the people living in China today.

In the case of the suicide, there are numerous social pressures involved.  Approximately 300,000 people commit suicide each year here. Although you can imagine how difficult it is to get reliable statistics on something like this.  The ratio is 3:1, female to male.   In China the family is still responsible for taking care of the elderly.  Therefore every Chinese parent is personally invested in seeing his one and only daughter or son marry well and get a good job.  The parents’ future depends on that money. 

Sheng nu is the term for any unmarried women over the age of 27.  It means Leftover.  This is a term recognized by the government and carries serious social stigma.  Thus unmarried status is enough to cause depression and suicide.  One of China’s “unmentionable” topics is divorce.  There are 10,000 divorces each day in China.  About 20% of the marriages fail with in the first 3 years.   Thus, young women in their 30’s have yet another reason to be depressed and seek suicide as an option.

In another context, consider these human qualities as they relate to the Chinese military.  A country where people don’t care about others (in a general sense) and have no personal history of helping anyone outside their family.  The Chinese military may be large in number but it is untested. Now it is made up of young people who are single children. Will today’s young soldiers run away rather than protect?  Or stand and spectate as a fellow solider dies? 

The next time someone rants about a lack of values in America, think again. We have far more compassion than we think. 

My Chinese Health Care Experience

Each year, the employees of the University get a free health check.  This is performed at a small hospital/clinic on the Medical School campus.  It takes all morning and is very extensive.  Oh and it is completely free!  So last year I decided to take advantage of this to experience Chinese Healthcare for myself.

This exam would cost a lot in the US as it includes many – usually separate – tests and procedures.  The blood draw included testing  for lipids, cbc, several hepatitis B antibodies, and a CA125 test for women (used to detect ovarian cancer)  and PSA test for men.  Other tests include, an EKG, Chest X-ray,  Eye exam, glaucoma test, pap smear, blood pressure, and an ultrasound exam for thyroid, breast, abdominal aortic aneurysm, and ovaries.

First you sign up online for your appointment.  There is a two week period and each morning approximately 300 people are seen.  When you arrive, you check in and enter a large room with benches and examination room doors off all sides.  China still uses doctors and nurses for all healthcare so technicians are not part of the healthcare scene.  The physicians are both male and female but nursing is still pretty much an all-female profession.

Another thing I should point out is that China doesn't have HIPPA laws and your information is shared with anyone near enough to see or hear your results.  Although,  the written report was given in a sealed envelope.  Privacy also has a different meaning in China.  The number of people in the country and the number of people served by the clinic is a single day doesn't allow for the kind of privacy you have while seeing a doctor in the US.

First we had our blood drawn,  I was given two q-tips to hold on the puncture afterwards to stop the bleeding.  This didn't work very well for me and I bled for quite a while and got a nice big bruise on my arm. 

When we went to the ultrasound room, there was a queue on the bench outside the door.  Inside the door there were 5 chairs along with the nurse at a computer and a bed with a drawn curtain.  The patient was on the bed with the doctor, as he examined the patient and looked at the ultrasound screen, he called out the findings to the nurse who then typed them into the report.  So the 5 people in the chairs, the person waiting their turn behind the curtain and the patient on the bed all hear the details.  No one but the doctor and next patient can see behind the curtain.  Since all patients for this were female, the ladies seemed okay with this.   The doctor spent about 10 minutes with each patient. Far less time than would be allotted in the US for an ultra sound exam of anyone one of these areas.  I have heard Western doctors here say, ‘The Chinese doctors won’t miss anything big’.    The doctor picked up the inflammation in my thyroid and the cysts in my breasts.

The EKG (ECG) was performed by a very old machine and a dated technique.  I had clamps on all 4 limbs and then the machine had suction cups instead of leads.  I have been told by US doctors that this is completely acceptable.   The doctor looked at the strip (graph) right there and noted my inverted T-wave.  This usually means you have had a heart attack.  I always have to explain that I haven’t had a heart attack it is an infantile anomaly.  Hard to do when you don’t speak much Chinese.

For the Pap smear, there was more privacy, but not much time. Patients were told to take one leg out of their pants and panties and hop up on the table.  It was all over in about a minute.   I told my Gynecologist this story.  He roared with laughter and said he should try that kind of assemble line medicine. 

Several other things I noticed.  The blood pressure was taken by the small modern automated machines.  These are very popular in the US but not considered the most accurate.  I was surprised a troop of nurses didn't take the blood pressure.  I also noticed that almost everyone there had a systolic pressure close to 140.  That is the cut off for high blood pressure in the US.   This is interesting because the population here is chronically dehydrated and they eat a very high salt diet.  Not sodium chloride but mono sodium glutamate. 

I refused to be weighted because I didn't want “the whole world” to know how much I weighed.  Again no privacy.   This caused a stir of course.  And my Chinese colleague got to explain this to the nurse. (I'm just that crazy laowai.)   Because my friend had to help me with the language I had even less privacy than the other patients.  I had to adopt sort of an “out of body” mind set to keep from being mortified with embarrassment.   This year, when the health checkup came, I politely refused saying I have to do it all in the summer in the US.  

As you can see there are some pluses and minuses to this system.  The CA 125 blood test for ovarian cancer is expensive, about $175 in the US.   It is NOT used nearly enough in the US, yet here every women received the blood test and for free.  In the US, ovarian and uterine cancer are STILL not detected early which puts women at greater risk.   Personally, I am glad to see independent testing labs springing up in the US where a patient can get his own blood workup. 

Ultrasound of Thyroid with inflammatory areas
highlighted.

I have been on Thyroid medication for more than a decade. Yet,  I have never had a Thyroid ultrasound.  I asked my doctor in the US.  “Do you just assume that all women with low thyroid hormones have Hasimoto’s Disease.”  (That is the name of the inflammatory thyroid disease.)  She said no and sent me for an ultrasound.  While it doesn't change my treatment, it is important to know that you have a chronic inflammatory disorder because it can lead to other inflammatory problems. 

One the minus side, the speed at which these tests are performed means that they are not very thorough.  A small breast cancer could easily be missed.   Many of the exam rooms did not have paper on the table and there was no cleaning between patients.  This is typical for China.  Yes the doctors do where gloves for say a Pap test, or rectal exam but may not for a less invasive test.   I have always thought that because of the sloppy cleanup between patients, it would be very easy to spread disease here.  I have had other expats tell me the same thing in x-ray and MRI rooms, no cleanup.   More people in the population wear masks here.  That is good if a sick person is trying not to spread their germs to others.  If you wear a mask to keep from getting sick then you also have to make sure that you don’t touch an infected surface or person. Thus it is less effective. 

 Smoking is still very popular here so while a chest x-ray every year may seem excessive,  it is necessary.   Hepatitis B – the viral kind – is also very prevalent here.  There are 400 million people in the world with Hep B.  One-third of them live in China.  There are vaccination programs now to protect kids, although the rate of vaccination is not yet high enough to really control the disease.  It is common for a mother to pass the disease before birth.  There is a lot of discrimination against Hep B carriers.  They can be turned away from schools and jobs.  There are laws to prevent this kind of discrimination but it still exists.  I am unaware of any programs to vaccinate adults.  I sure the vaccine is available here but I don’t think there is the education or the motivation to make this a priority in China.

I think the employees at the University are grateful that their employer provides this service for them.  I know that other large companies also do this but it certainly isn't universal.  Of course, the University Employees are also going to be more educated and seek out healthcare when they have a problem.   However, the scope of learning here is very narrow; you can’t assume that education in one field connotes education about health or the body.  China is still very much in the era of “the doctor knows all” and questions are not asked.

China has a large population of people who are self-employed or employed on a more temporary basis and thus would not have access to health care or health insurance.  Health insurance here is relatively new. It is generally just catastrophic care (with a lot of exclusions) and for those with stable employment. The employer is required to pay 80%.  The Chinese Government’s goal is to have 85% of the people covered within the next few years.  That is not realistic at all.  But then numbers can be manipulated to say anything.

All in All, An interesting experience but not one I'm willing to repeat.

Healthcare In China

Hello Friends and Family,

This will be the first of a series of posts about China and my observations about the healthcare system here.  There is a general rule followed by Expats that you don’t criticize your host country.  But at this point, I want to share my observations and research in the hope that we will all get past the sound-bite opinions and packaged perceptions.

First I need to correct the American way of thinking.  Communism and Socialism are not the same thing.  China doesn't have socialized medicine nor do they give more than a superficial bow to a government backed retirement system.   

China has always called it Communism with Chinese Characteristics.  This is a favorite phrase here.  In summary, it means that communism didn't change many of the basic tenements of Chinese Culture.  Meaning: the family takes care of the elders and it is the family as a collective who must take care of the sick or the infirm. 

When the decision was made in 1970 to institute the one child policy, government officials seem to have forgotten to consider how this would affect the family’s ability to care for the sick and elderly.  I have to say that after seeing the overpopulation here.  I have a better understanding of why the policy was considered necessary.  In 1970, at the time the policy was enacted, each women had an average of 5.3 children. In addition, China experienced serious famine and starvation for several decades. There was no way to feed all the people. Every day, I see the after effects of childhood starvation in the small stature and soft bones of the elderly. 

Saying I understand why they did it, doesn’t mean I agree with the forced abortions or ridiculously old fashioned approaches to birth control and sex education.  I’ll have a whole lot more to say on that in the future.

So let me give you some examples of how the healthcare system works here.  In theory, anyone can see a doctor for 1 yuan.  (16 cents).  The idea of clinics is new here so primarily you will go to the hospital and are seen in the department covering your problem: Cardiology,  orthopedics etc.  You will need to register with the hospital and have a hospital ID card first.  You will pay for your visit in advance and if an IV or medication is required you will stand in the cashier line a second time before it is administered.  The doctors have 5 year bachelor degrees here, meaning they don’t have the education of American doctors and they are dealing with a very uneducated population.  There is nowhere near enough medical facilities and you will register and wait hours to see the doctor.  Waiting areas are packed, with the windows wide open, no heat or air conditioning provided.   In order to make up for the low cost of seeing a doctor, you will most likely get an IV drip.  I know this sounds like massive over kill until you understand more.   The lowest price for an IV drip is 125 yuan.  There are short, 30 minute drips and long, 2 hour drips. There are different names for these in Chinese.  If you need antibiotics for an infection this is how you will get it.  If you walked in with hives, you would get a cortisone IV.  

The clinical pharmacy field here is not well developed. There are many pharmacies but it is unlikely that it will be staffed by anyone besides a clerk.  Those who do get a bachelor degree in pharmacy are likely to work at the hospital.  In addition,  the pharmacist may only deal with traditional Chinese medicine (TMC) compounding, mixing herb etc.  In which case, the pharmacist would be filling a prescription from a TMC doctor.  I have never heard of a person leaving the doctor with a prescription for western medicine.  If you actually go home with medication you will get it at the hospital.  

TCM Pharmacy

Another reason for the IVs and hospital provided medication is that amount of fake and poor quality medication here.  There is a lot of medication here that was meant for animals in other countries.  Also the doctors can’t be sure that someone will take a 10 day supply of medication on schedule. Thus it is quite common for someone to be told that they will need to return every day for 3 or 5 days for an IV.

Western Medicine Pharmacy, I appreciate getting
Amoxicillin without a prescription

Soon after arriving here, I read an article in the English language daily about a nurse that went to Singapore to work.  She was severely reprimanded for giving a patient his medication early.  She learned how important this is and stated that in China you get the medication whenever it is convenient for the nurse.  This kind of comment gives you a general idea of the training here.

Nurses learning to Smile.  2013

A hospital stay is a family affair here.  They will be an important part of the patient’s care.  Although there are a few VIP wards that may be different, generally China still has beds in wards. Each ward room has one bathroom.  No shower.  A 6 or 8 bed room is typical.  That one bathroom will also be used by the family members helping the patient.  Again the windows will be open as fresh air is considered very important to alleviate germs.   Since many of the cities here have terrible air pollution,  the air is NOT fresh!!  Hospitals don’t provide food and so the families will be feeding the patient.  Outside the hospital, street vendors will set up daily to sell food to the families of patients. Families coming from outside the city will spend the entire time in the hospital. It is unusual for them to get a hotel room because that is considered too expensive.  The family will be paying for the entire operation and stay. 

It is also common to have a hospitalization here where your bed will be left in the hall. If the wards are taken and you must be hospitalized then your bed will be left in the hall, possible for a week or more.  Again the family will be there to assist you.  You can get a pretty good idea of the desperate need for more hospitals and facilities

China could easily be ground zero for a massive viral/bacterial outbreak.  While masks are frequently worn (for the wrong reasons) gloves are still not mandatory.  That is to say gloves are usually worn but it isn’t 100%.  There is unlikely to be any clean up between patients on say an exam table and paper on the table is optional.  I have friends who have been in MRI rooms with blood on the walls. The training for the technicians is minimal so they just don’t understand why any cleanup is necessary.  A cleaner will often use the same bucket of dirty water for the entire day while mopping. 

Our company, as well as many other international companies, doesn't allow us to have medical care here.  There are two western clinics staffed with doctors from the US and Europe.  If we need care beyond their capabilities, we will be flown to Bangkok or Singapore. 

As we all know in the US, the Chinese government has plenty of money.  So why isn't healthcare a priority?  Why aren't new hospitals and better training a priority?   Healthcare barely gets mentioned at the federal level.   The ugly truth – if your country is terrible over populated would you want people to live longer?