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CHINA -
HEALTH |
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Low standards of public hygiene,
stress and overcrowded conditions are
to blame for most of the health
problems that beset travellers in
China. If you do get ill, medical
facilities, at least in the big
cities, are adequate, and the largest
cities have high-standard
international clinics for foreigners.
For minor complaints, every town has a
pharmacy which can suggest remedies,
and doctors who can treat you with
traditional Chinese or Western
techniques. You'll need to take a
phrasebook or a Chinese speaker if you
don't speak Chinese.
Before you go
It's advisable to visit a doctor as
early as possible before you travel
to allow time to complete any
courses of vaccinations you need. If
you have any longstanding medical
conditions, or are travelling with
small children, consult your doctor
and take any necessary medicine with
you. It's also wise to get a dental
check-up, and if you decide to take
a course of anti-malarial tablets,
start taking them before you go.
It's worth taking a first-aid kit
with you, particularly if you will
be travelling extensively outside
the cities, where the language
barrier can make getting hold of the
appropriate medicines difficult.
Include bandages, plasters,
painkillers, oral rehydration
solution, kaolin and morphine for
diarrhoea, vitamin pills, antiseptic
cream and a sterile set of
hypodermics if you will be in the
country for a significant period.
General precautions
There's no point in being over
concerned with your health while
travelling in China, but it's
sensible to be aware of the dangers
and take sensible precautions. China
is not an easy country to be in, and
some visitors, particularly if they
are travelling quickly or on a very
tight budget, find it exhausting and
stressful, thus leaving themselves
vulnerable to infections. A good
general tip is not to be too hard on
yourself. Travel at an easy pace,
and treat yourself to decent
accommodation and food, at least
occasionally. Take vitamin pills
(you can buy them in Hong Kong and
Beijing) if you think your diet is
lacking in variety.
Personal hygiene is one
area you can control and it pays to
be scrupulous. Wash your hands often
and don't share drinks or
cigarettes. When in the shower,
always wear flip-flops or shower
shoes, provided free at most hotels
- look under the bed. The smallest
cuts can become infected, so clean
them thoroughly and apply an
antiseptic cream, then keep them dry
and covered.
Water is a potential cause
of sickness as its quality varies
widely across the country. Don't
drink unboiled tap water, or use it
to clean your teeth; avoid ice in
drinks, and the ice lollies sold by
street-side entrepreneurs. The
Chinese boil all their drinking
water scrupulously, and every hotel
room is equipped with a Thermos,
which the floor attendant will fill
for you. Chemically treated bottled
water is widely available from
street stalls, though it tastes
disgusting. If you stick to this and
drink tea or carbonated drinks in
restaurants, you shouldn't need to
take any further precautions.
However, if you're heading off the
beaten track, it's well worth taking
a water purifier with you.
While boiling water for ten minutes
kills most micro-organisms, it's not
the most convenient method.
Sterilization with iodine tablets is
effective, but the resulting
beverage doesn't taste very pleasant
and you'll probably want to filter
the water as well. (Iodine is unsafe
for pregnant women, babies and
people with thyroid complaints.) A
range of low-cost portable water
purifiers, which sterilize and
filter the water, giving the most
complete treatment, is now
available. Made by Pre-Mac, they are
available in the UK from British
Airways Travel Clinics and
specialist outdoor equipment
retailers (call 01732/460333 for
details of local stockists); in
Ireland through All Water Systems
Ltd, Unit 12, Western Parkway
Business Centre, Lr Ballymount Rd,
Dublin 12 (tel 01/456 4933); in the
USA and Canada, contact Outbound
Products (tel 1-800/663-9262; in
Canada tel 604/321-5464).
As for food , the two most
important considerations are to eat
at places which look busy and clean,
and to stick to fresh, thoroughly
cooked food. Beware of food that has
been pre-cooked and kept warm for
several hours. Fish and seafood are
risky as local water pollution
levels are extremely high, even in
many rural areas. Fresh fruit you've
peeled yourself is safe; other
uncooked foods may have been washed
in unclean water. The other thing to
watch for is dirty chopsticks
. The disposable chopsticks provided
in most restaurants are fine but
other chopsticks are often just
given a quick rinse and put back on
the table. If you want to be really
sure, bring your own pair.
Intestinal troubles
Diarrhoea is the most common
illness to affect travellers,
usually in a mild form while your
stomach gets used to the unfamiliar
food. Rest and rehydration is the
only treatment required, and it will
probably be over in a couple of
days. The sudden onset of diarrhoea
with stomach cramps and vomiting
indicates food poisoning; again,
rest up for a couple of days and the
sickness should pass. In both cases,
it is important to drink lots of
water and in serious cases replace
lost salts with rehydration solution
(ORS); this is especially important
with young children. Take a few
sachets with you, buy it at any
pharmacy, or you can make your own
by adding half a teaspoon of salt
and three of sugar to a litre of
cool, previously boiled water. At
the same time avoid milk, greasy or
spicy foods, coffee and most fruit,
in favour of bland foodstuffs such
as bread, rice, dumplings, noodles
and soup. If symptoms persist, or if
you notice blood or mucus in your
stool, consult a doctor.
Dysentery is inflammation
of the intestine, indicated by
diarrhoea with blood or mucus and
abdominal pain. There are two
varieties, bacillary and amoebic.
Bacillary dysentery has an acute
onset with discomfort, fever and
vomiting, plus severe abdominal
pains with bloody, watery diarrhoea.
In mild cases recovery occurs
spontaneously within a week, but a
serious attack will require
antibiotics. Amoebic dysentery is
more serious as bouts last for
several weeks and often recur. The
gradually appearing symptoms are
marked by bloody faeces accompanied
by abdominal cramps, but no vomiting
or fever. If left untreated, amoebic
cysts enter the bloodstream and may
cause long-term problems, but a
prompt course of antibiotics should
restore you to health.
Giardia is distinguished
by smelly burps or farts,
discoloured faeces without blood or
pus, and fluctuating diarrhoea; left
untreated, these symptoms disappear
but recur around once a month. Again
the disease is treatable with
antibiotics under medical
supervision. If you're heading for
Tibet, however, where the disease is
most likely to be a problem, you
will not be able to get the
appropriate antibiotics there, so
take some Flagyll with you.
Typhoid and cholera are also
spread by contaminated food or
water, generally in localized
epidemics. The varied symptoms of typhoid
include headaches, high fever and
constipation, followed by diarrhoea
in the later stages. The disease is
infectious and requires immediate
medical treatment but it's also
difficult to diagnose. The first
indication of cholera is the
sudden but painless onset of watery
and unpredictable diarrhoea, later
combined with vomiting, nausea and
muscle cramps. The rapid dehydration
caused by the diarrhoea rather than
the intestinal infection itself is
the main danger. However serious the
vomiting and diarrhoea you can treat
cholera with plenty of oral
rehydration solutions, but if you
can't retain enough fluids, get
medical help.
Finally, if you're suffering from
diarrhoea, remember that oral drugs
such as anti-malarial and
contraceptive pills pass through
your system too quickly to be
effectively absorbed.
Malaria
Malaria is not widespread in
China; it's only a problem in the
south in summer and all year round
in tropical areas such as Hainan
Island. Even there it's not common,
but you should still take
precautions. The key measure is to
avoid being bitten by mosquitoes
which carry the disease. Though
mosquitoes lurk all day in dark,
humid environments like bathrooms,
they are most active at dawn and
dusk. At these times wear long
sleeves and trousers and avoid dark
colours. Use repellent on
exposed skin. Sprays and lotions
containing about forty percent DEET
(diethyltoluamide) are effective and
can also be used to treat clothes,
but the chemical is toxic; keep it
away from eyes and open wounds, and
follow the manufacturer's
recommendations carefully,
particularly with young children.
DEET has been known to cause bad
dreams, nausea and dizziness. Good
alternatives based on natural
ingredients are Mosi-Guard
Natural and Gurkha
repellents.
Most hotels and guesthouses in
affected areas provide mosquito
nets but you may want to bring
your own if you intend heading to
any rural areas. A net which hangs
from a single point is the most
practical. Many nets are already
impregnated with pyrethroids, but
need retreating every six months;
all the gear is available from
travel clinics and good travel
shops. Tuck the edges in well at
night, sleep away from the sides and
make sure the mesh is not torn.
Air-conditioning and fans help keep
mosquitoes away, as do mosquito
coils and knockdown insecticide
sprays , both available in
China.
If you're travelling in a
high-risk area it is advisable to
take preventative tablets ,
although medical opinion varies on
the safety and effectiveness of the
different drugs available.
Mefloquine is widely regarded as the
most effective since the
malaria-carrying mosquito is now
largely resistant to chloroquine.
However, mefloquine has some
unpleasant side effects such as
dizzy spells, nausea and
neuropsychiatric disturbances, which
can persist after you've stopped
taking the drug; ensure you discuss
any concerns you have with your
prescribing doctor. Women in the
first months of pregnancy or during
lactation should avoid mefloquine
and it's also important not to get
pregnant for three months after
taking the drug. The most common
alternative is daily proguanil (Paludrine)
combined with weekly chloroquine (Avloclor).
Note that you need to start taking
tablets at least a week before
exposure, and then continue with
them for four weeks after leaving a
malarial region. Many doctors in
Australia are now prescribing
Doxycycline, a low-level antibiotic,
as a malaria preventative, and it is
used as standard by the Australian
Army.
None of these precautions is
infallible, however. Symptoms
of the onset of malaria are flu-like
fever with intense headaches and
shivering, with later joint pain. A
blood test will confirm the
diagnosis and, if caught early,
treatment can be quick and
effective. If you can't get to a
doctor straight away, take 600mg of
quinine three times a day for seven
days.
Respiratory infections
The biggest hazard to your health in
China is the host of flu
infections that strike down a large
proportion of the population, mostly
in the winter months. The problem is
compounded by the overcrowded
conditions, chain-smoking, pollution
and widespread spitting, which
rapidly spreads infection. Initial
symptoms are fever, sore throat,
chills and a feeling of malaise.
Afterwards, severe coughing and
bronchitis set in, making for some
very uncomfortable nights.
Initially, try drinking lots of
fluids and get plenty of rest. If
symptoms persist, you are advised to
take an antibiotic such as Tetracycline,
available at pharmacies or on
prescription from a doctor. As with
all antibiotics, it is important to
complete the course, usually four
tablets daily for five days.
More serious is tuberculosis
, a respiratory disease transmitted
by inhalation, and spread by
coughing and spitting - so it's not
hard to see why China has a high
incidence. The disease becomes
active when the body is weakened by
fatigue, other forms of illness, or
malnutrition. It strikes at the
lungs and in a small number of cases
can be fatal. There is no need for
visitors to be overly worried about
the disease, though budget
travellers, who spend a lot of time
on crowded trains and buses, are
likely to be more at risk than other
tourists. Those embarking on
prolonged travel should consult
their doctor about their TB-immune
status - many people are immune
thanks to previous, mild infections.
AIDS and other sexually transmitted
diseases
It is doubtful that China was ever
as strictly moral as the government
suggests, a place where prostitution
didn't exist and sexually
transmitted diseases were a
foreign problem, but it's certainly
not true now. In the contemporary,
more liberal climate, with a
burgeoning sexual revolution, STDs
have become much more common. As
yet, though, China has only a minor
problem with AIDS , though
there are bound to be more than the
official number of two thousand
cases in the country. Paranoia about
the disease, and its transmission by
foreigners, is rife, however, and
you may find that if you turn up at
a Chinese hospital the first thing
they will do is test you for it.
There have even been cases of hotels
burning their bedsheets after
foreigners have stayed in them.
The more common diseases, gonorrhoea
and syphilis , identifiable
by rashes around the genitals and
painful discharge, are treatable
with antibiotics, available from
doctors. As ever, it is extremely
unwise to contemplate unprotected
casual sex. Local Chinese condoms
vary in quality, but imported brands
are available in big cities. If it
becomes essential for you to have an
injection or blood transfusion in
China, try to make sure that new,
sterile needles are used - to be
sure, bring your own. Similarly,
don't undergo acupuncture unless you
are sure that the equipment is
sterile.
Environmental hazards
Parts of China are tropical and here
it can require a couple of weeks to
acclimatize to the temperature and
humidity, during which time you may
feel listless and tire easily. Don't
underestimate the strength of the
sun in tropical areas such as Hainan
Island, in desert regions such as
Xinjiang or very high up, for
example on the Tibetan plateau. Sunburn
can be avoided by restricting your
exposure to the midday sun and by
liberal use of sunscreens, sometimes
available in China. Dark glasses
help to protect your eyes and a
wide- brimmed hat is a good idea.
Drinking plenty of water will
prevent dehydration , but if
you do become dehydrated - signs are
infrequent or irregular urination -
drink a salt and sugar solution (see
under "Intestinal
Troubles"). Heat stroke
is more serious and may require
hospital treatment. Indications are
a high temperature, lack of
sweating, a fast pulse and red skin.
Reducing your body temperature with
a lukewarm shower will provide
initial relief. High humidity causes
heat rashes , prickly heat
and fungal infections .
Prevention and cure are the same:
wear loose clothes made of natural
fibres, wash frequently and dry off
thoroughly afterwards. Talcum or
anti-fungal powder and the use of
mild antiseptic soap helps too.
At the other extreme, there are
plenty of parts in China that get
very cold indeed. If you're
trekking in Tibet or visiting
northern China during the winter, it
is essential to be prepared. Hypothermia
, where the overall body temperature
falls, is the most serious
condition, and can be fatal.
Symptoms are exhaustion, numbness,
slurred speech and dizzy spells. To
prevent the condition, wear lots of
layers and a hat, and try to stay
dry and out of the wind. Sugary food
will help raise the body temperature
but alcohol lowers it. To treat
hypothermia, try to get the victim
into shelter, away from wind and
rain, give them hot drinks and
easily digestible food, and keep
them warm.
Getting medical help
Pharmacies , found in all
towns, can help with minor injuries
or ailments. Larger ones sometimes
have a separate counter offering
diagnosis and advice, though you're
very unlikely to find staff who can
speak anything but Chinese. The
selection of reliable Asian and
Western products available is
improving (though always check
expiry dates on brand-name
products), and it's also possible to
treat yourself for minor complaints
with herbal medicines.
Contraceptives are widely available,
as are antibiotics. You'll have to
ask for what you want, so take along
a phrasebook or a Chinese speaker.
The staff will usually be able to
help if you describe your symptoms.
Large hotels usually have a clinic
for guests offering diagnosis,
advice and prescriptions - ask an
English speaker from the reception
desk to accompany you. Beijing,
Shanghai, Guangzhou and Hong Kong
have clinics specifically for
foreigners where staff speak
English. If you're interested in
being treated with traditional
Chinese medicines - of most use
for minor and chronic complaints -
many hospitals have attached
traditional institutes, while some
hotels have their own massage or
acupuncture services. If you are
seriously ill, head straight to a hospital
- the local CITS might be able to
give you useful advice in an
emergency. Addresses of clinics and
hospitals can be found in the
"Listings" sections under
major towns and cities. You will be
expected to pay for your treatment
on the spot, but it should not be
too expensive, although foreigner
surcharges may well be added. Keep
all medical bills and receipts so
you can make an insurance claim when
you get home.
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