Sick in Shanghai

Doctors, hospitals and medicine in Shanghai are very different and I had hoped to hold out longer before needing to learn about it all first-hand, but unfortunately, I developed a sinus infection toward the end of last week and found myself in need of a doctor.  For those of you who know me well, this does not come as a surprise.  What is surprising that I hadn't had a sinus infection for several months.

Chris and I attended a program within our first month in Shanghai called Shanghai 1-2-3, an introduction to expat life which included a talk by a Chinese doctor that was terrifying.  He told us that the 5 gallon bottles of water delivered to our home should only come from one of the three western companies (Nestles, Coke, or Watson's) if we want to ensure the water is clean.  He said that we would always encounter a certain amount of contaminated food, so the best bet is not to always buy our food from the same vendors, in order to spread the risk.  He warned that mold is a big problem (no kidding), as well as the air pollution - again, duh!  He indicated that some OTC and prescription medications available in the U.S. are not available in China, such as Epi-Pens, Benadryl, and several types of cholesterol and high blood pressure meds.  He told us of a good pharmacy locally, which can possibly refill a U.S. prescribed medication, although it seems smarter for us to go to a local doctor and get our medications filled there, so we have them on hand.

The doctor also told us some scary tales of trying to get emergency and regular medical care in Shanghai.  He indicated that there are basically 3 levels of health care in Shanghai for expats, the local hospitals, VIP or Expat clinics within local hospitals, or Expat clinics.  Each option has it's strength and drawbacks, but the reality is we might end up at any of them at one time or another.

The local hospitals are just that, local, Chinese hospitals, filled with Chinese-speaking doctors and staff and very few, if any, English-speakers.  They are open 24/7.  This is where the Chinese go if they need to see a doctor and no appointments are available - get there early and get in line.  I have been led to believe that children in obvious danger can get moved to the head of the line, but mostly, it's all about waiting.  And CASH!  

Yes, the doctor who spoke to us told us to carry at least 2000 RMB (approximately $300) on us at all times and to have at least 10000 RMB (approx. $1500) in a safe at home- which you need to bring with you to the hospital - because you pay first and then get treated and they only take cash.  There is little to no privacy, so don't expect a private room to discuss your problems with the doctor.  Being seen by a doctor at a local hospital can be an all-day affair, as you wait and pay at each step, whether you need blood work, x-rays, or whatever.  Most expats won't see the inside of a local hospital unless it's an emergency and the other clinics are closed.  We were also told it would be better, in case of emergency, to take a taxi to the hospital, as it will be faster and the ambulances really don't have trained medical personnel anyway - and you have to pay cash to them as well!  Peter checked out one of these local hospitals when one of the kids sprained a wrist and had a fairly favorable experience.  The one he used is only 5-10 minutes away by taxi.

The VIP or Expat clinics within a local hospital are somewhat more familiar - the staff speaks English and there are private exam rooms.  It is possible to schedule an appointment and their hours are slightly longer than those of the Expat Clinics, but not 24/7.  Some of these facilities accept international credit cards and can even bill some health insurance companies.  For us, I think the VIP clinic is an option for times when they're open but the fully Expat Clinics are closed and when inpatient hospital services are needed.  For us, if we need this type of facility, we will most likely use Shanghai East International Medical Center, which is on our side of the river, but will be a 30 to 45-minute cab ride, depending on traffic.

The fully Expat Clinics are the most expensive, but direct bill most insurance companies and will take international credit cards.   They offer a full range of specialists as well as all types of preventative testing as well as treatments.  This is the type of place I visited last week, Parkway Health, which is about 2 blocks from our apartment.  The reception desk and waiting are were just like an American doctors' office.  I made an appointment in advance and was given my choice of male or female doctor and was told the doctor's nationality (and whether a native English-speaker) when scheduling.  I arrived, filled out my paperwork, and, after a short wait, was shown to an exam room, where the nurse took my blood pressure and temperature, wrote down my symptoms, and took me to another exam room to meet the doctor.  

My doctor, an Australian woman, was very nice and seemed very knowledgeable.  Given my extensive allergies and medical history, I brought with me a listing of medications, surgeries, allergies, etc.  When she looked over my allergies, she asked about epi-pens, Medic-Alert bracelets and was very impressed when I showed her my Select Wisely allergy wallet cards.  Given my allergies to some antibiotics, she said she really only had one effective option for me, (Levofloxacin in China, but Levaquin in the U.S.) but that I should be aware that a rare side-effect was a ruptured Achilles Tendon - I've never heard that one before!  She was also concerned that I am allergic to an antiviral frequently used for Shingles, even though I don't have Shingles right now.  She wants me to call my U.S. doctor and find out what I was prescribed in the past for Shingles so I know what I can take should I get it again.  While Parkway Medical accepts our medical insurance, apparently I needed to call first for authorization, so I had to pay by credit card and can submit to my insurance company for reimbursement.  The doctor wrote my prescription, both for the antibiotic and some nasal spray, and the pharmacy right on site filled it, so I paid about $200 for the appointment and prescription and walked the 2 blocks home.  The whole process was quick and easy, but I can't call them in an after-hours emergency.

Now, as far as Traditional Chinese Medicine (TCM), acupunture, herbal remedies, meditation, etc., I believe you can request practitioners in any of the 3 levels of facilities.  I know that most of the medical facilities advertising for the expat community have both western-style doctors and TCM listed among their services.

Unfortunately, I saw the doctor on Friday and I'm writing this on Monday morning, still not feeling much better.  I'm calling CVS in Elmhurst today to find out what type of antibiotic my doctor there prescribed for my last sinus infection, just in case the Achilles-heel rupturing one doesn't kick this infection.