Patients in the front lobby waiting for their number their number to be called.
Imagine taking your children here or seeking urgent help for yourself in this chaos. This was in Shanghai, a first-tier city, so keep in mind that these are much better-than-average facilities. I visited hospitals in third-tier cities that looked like they had been abandoned until recently; hallways were dark, floors were dirty, beds were messes of blankets and floor mats, and in one instance, the urinal emptied onto the floor.
Here, I squeezed into a packed elevator and rode it up to the 15th floor, with people pushing out and shoving in, hearing the weight alarm beep, and shuffling out again, for several stops on the ride up. In another stuffed elevator, a woman at the control panel screamed violently at a passenger whose bag was blocking the door. In Chinese, there are no polite words and phrases like “Please move.” In the 15th floor lobby, people with tumors and other obvious maladies were waiting shoulder to shoulder, or making room so that a physician could take pictures of a screaming little girl’s deformed hand as her parents stretched her wrist out against the wall. There was no privacy, no order, no expectation to be seen in a timely or sympathetic fashion. China, to any civilized visitor, is a nightmare experience of constant crowds, filth, noise, and stress.
Waiting in line and pushing through the masses in a modern Chinese hospital.
My Hospital Experiences in Semi-Urban China
The first time I entered a Chinese hospital, I was tagging along with Aunt Fong as she visited her sister, a nurse. I wanted out.
Once we were in the exam room- a bare, concrete floor with peeling plaster walls, filled with only a clunky wooden table, and a metal cabinet with glass cupboard doors, illuminated by the dim fluorescent bulb overhead and the street lights filtered in through the barred windows- I thought this must be a place where Chinese police take suspects to confess. To get out of that hospital, I probably would have signed whatever bogus papers they put in front of me, detailing my alleged crimes against their People’s Republic.
I seriously was giving thanks to God that I did not presently need the services of the hospital. This was at night, after hours, when there were no patients in the lobby or quiet hallways, so I was spared from seeing anyone suffering. About two months later, I did need the services of the larger city hospital, badly.
At Sanda (kickboxing) practice, my instructor would always pair me up with his nephew, who was easily many levels above the rest of the class, and who never pulled his punches when it came time to pummel me. It happened that he and I were sparring in front of the older students in the class (a lot of elementary and junior high-aged students also came to practice after school, but they were usually occupied with horseplay at the other end of the gym). Whenever there is an audience, the act increases in intensity and commitment. I never set out to hurt anyone while sparring, but the goal of landing blows means pain is never completely avoidable, and the natural rhythm of two sparring partners will go back and forth and often escalate. My instructor’s nephew and I often had sustained battles that were basically real fights, only lacking a referee and a bell to separate us. I had to bring more intensity than I naturally preferred; the beatings would not soften on my account.
That night in October, when my sparring partner and I were the center of attention, he was landing shots and getting the best of me as usual. I became frustrated, but I didn’t try and rush at him in anger. Without much thought, I quickly snapped my left leg up and let a kick fly against his face. The timing for a head kick is difficult to make, but this strike landed solid. There was an audible thud, I saw my opponent’s pupils rattle, and I stepped back in shock.
I started pleading how sorry I was; my instructor applauded me and told me good job, not to worry, there would be no hard feelings. I still feared a reprisal from a young man who was very capable of dishing one out. As he went into the bathroom to wash out the blood in his mouth and check for injuries, I meekly retreated to the edge of the mat to check my foot. Meanwhile, all the older students were in an uproar, telling me enthusiastically how great the kick was and encouraging me to knock him out, pumping their fists and cheering “K.O.!” I suspected they also had received punishment from my sparring partner’s fists and shins.
On my foot, there was a small cut, right on the top of the base of my second toe, the small joint where the metatarsal meets the phalange. I wanted to wash it off and put a bandage on it, but everyone forbid me. Aunt Fong even put a plastic bag around my foot before I took a shower. The locals were more terrified of their water supply than I was. They might have been right to be so cautious, but over the next few days, things went from bad to worse. Their methods- rubbing the gash with alcohol swabs and taping a square of gauze over it- did me no good either.
The day after the incident, I was walking with a limp and feeling shameful that such a small wound would force me out of practice. I couldn’t understand why my foot was so stiff and painful from one gash. It was no matter, I consoled myself, I had no school the next week because of the National Day holiday, and I could relax and recover on my vacation in Shanghai.
Aunt Fong and I had planned the trip, but business prevented her from joining us at the last moment, so I went with Uncle Jiang by train and met his sister and her daughter in China’s largest city. They were on holiday, too, and our group met up with Uncle Jiang’s son, who lived and worked in the city, for a few days of sightseeing.
Limping my way through the Shanghai crowds.
The first day, I soldiered on, hobbling through the shoulder-to-shoulder and chest-to-back street crowds. Back at the hotel, we examined my foot and saw it had bled through both the gauze and my sock. The yellow, orange, and pink discharge look awful, and my foot was swollen and painful to the touch. Removing or slipping on my shoe caused me to wince sharply in pain. I tried to convince myself that my wound would heal in a few days and I could tough out the pain, but Uncle Jiang saw things otherwise. After checking my foot and replacing the gauze, he said no more outings (no discussion), so our group spent most of the next two days in the hotel room. I did get to walk outside on occasion to get something to eat.
I at least got in one day of sightseeing in upscale Pudong, Shanghai.
For the remaining time on our Shanghai holiday, my foot swelled more and more, and when I took off my shoe in the crowded train station as we waited for our homebound train, the wound was so infected that it oozed out pus when I touched it with an alcohol swab. It was disgusting, painful, and scary all at once. I was afraid for my foot.
After a breezy ride back from Shanghai on the G Train, Uncled Jiang and I took a taxi straight to a hotel restaurant to meet Aunt Fong some of their old medical college colleagues. After eating, she whisked me off to the medical college hospital for what would turn out to be a traumatic afternoon.
The street in front of the hospital was closed to traffic, so knickknack and toy vendors rolled out tarps to hawk their wares, and patients and their family members poured out to the lobby’s many open doors like ants out of a mound. Since Aunt Fong worked for the medical college affiliated with the hospital, she led me around as she pleased, trying to find a doctor she knew personally. We never stopped at a desk to check-in or pause at any time to sit and fill out paperwork and wait. Aunt Fong rushed through the place, with me limping behind, the scenery pouring over me and stupefying my thoughts. Aunt Fong cut through the crowd without turning her head; I oscillated left and right between patients with bandaged heads and open wounds and the huddles of country farmers on the chairs and on the floor. The atmosphere was not unlike the bedlam of the nearby street markets. Any area was fair game for sitting or lying down, the sound of people loudly talking rang through the halls, patients crowded around doctors as they filled out prescriptions one-by-one for the scattered line-up of people in the exam room, and the building interior looked as if it hadn’t been maintained in the past 30 years.
Looking at the walls with thin paint and the floors worn smooth, the old white window casings and wire grating, I was aghast how doctors could practice medicine here and how patients could convalesce while lying in a mess of blankets, for example, in a bed in the hallway. American hospitals try and remove the unpleasantness and make the painful, uncomfortable experience as tolerable as possible. Their freshly painted walls, bright lighting, area carpeting, padded chairs, wall art, informative posters, private waiting rooms, and well-ordered interchange between departments all project sterility and a soothing sense of expertise. While the fear of procedures and bad news prevents patients from relaxing, the hospitals have been designed and built to reduce as much anxiety as can be.
I don’t know what to compare the Chinese hospital environment to, except the many other dilapidated public buildings in China in need of a good janitor and maintenance team, or better yet, a wrecking crew. I will say this: whenever I’ve seen pictures of America from around the turn of the 20th century, I have always gotten a feeling that the buildings were unclean and full of cracked glass and dirty residue that gathered in the corners. I would question: is this the poor photographic quality, or was the world really so dingy back then? The people themselves looked desperate and skeletal, having grim, hollow expressions and wearing clothes that appeared tattered and dirty, as if they had been collecting dust in an attic. If the people were dressed nicely, as many were, I marvel at how dignified they looked in contrast to the casual gym shirts, sweat pants, yoga pants, jeans, and sandals of Americans today.
Skeletal, grim, tattered, dirty, dingy, cracked- that is how the Chinese hospital looked to me. It was as if I were wearing X-ray specs from an old comic book, only instead of see-through, the filter placed over my eyes made everything dirty, dim, and faded. Every square foot of building and every haggard figure combined to form a visual masterwork on the themes of urban despair and the horrors of poverty. It would be futile to try and tally all the character traits of the twelve-story building and its hundreds of inhabitants, their dusty cotton jackets and dirt-stained hands. All I can intimate about the hospital in writing (it deserved an oil treatment from a Realist painter) is the feel of my pallid complexion and stiff throat as I tried to calm myself and will my shaky body to walk smoothly through the halls of grime, injury, and disease. I was filled with disquiet and I brindled like a leashed animal being dragged forward after it smelled medicine and fear, although I had to play the part of a steady man of reserve.
Please don’t misunderstand my narrative on the hospital and its patients. I do not look down on the poor or disparage them (I’m poor by American standards, but that is a very relative standard). My terror was in the confines of a chaotic facility where poverty and pestilence joined forces to put on a show of suffering. A local friend I met, who had spent two years studying in America, told me that the government had opened up the city’s hospitals to all the surrounding country towns, so the facilities had become overrun with mobs of travelers seeking help. Relatives of the ill often did not have the money to afford a simple hotel room, so they would lay out cardboard and blankets and sleep in the elevator lobbies. In the wild mix of humanity, filling every exam room and waiting area, could be found the local city residents, in casual clothes, and the rural poor- no romantic country swains of pastoral imagery, but more like the crowds who mocked and scoffed at Don Quixote, wearing thick, all-weather coats and pants.
The different types of people were so many, and so intermixed, that I could not separate who was who or what office each area performed. I was overwhelmed. People walked into exam rooms as they pleased and watched the physician over his shoulder as he wrote a prescription for someone else. The talking never stopped. But as rude and unruly as the masses were, I could not help but feel great sorrow and pity when I saw painfully sick men on a hospital bed in the hallway (there was not enough space for every patient in the rooms) surrounded by family members who were weary from standing around all day. I felt helpless, not having a way to heal or comfort these people.
After Aunt Fong found a couple different doctors to ask for information (she never paused to greet anyone, she would immediately start speaking at someone and they would answer right back) we got on an overcrowded elevator (the only kind of elevator in a Chinese public building), headed for the 11th floor. She walked straight past the Nurses’ Station counter and into the small doctors’ and nurses’ office. One of Aunt Fong’s friends from the luncheon, herself a medical doctor, was along with us, and she and my aunt hurriedly made conversation with the staff in the office until they found the doctor they were looking for. A faceless man wearing the uniform white lab coat and face mask sat me down on a chair and set my injured foot up on a stool. After examining the infected wound and making some remarks to Aunt Fong and her friend, he went to the cabinet and pulled out a large pair of tweezers, cotton alcohol swabs, and a metal pan.
Aunt Fong’s friend looked at me with pity and gripped my shoulder. Aunt Fong grabbed my hand and told me, “Close yo’w eyes.” I focused, trying to recite familiar psalms in my head as the doctor went to work. The acute pain of the tweezers inside my skin caused me to grit my teeth and breathe hard out my nostrils. I thought it was terrible but I could suffer through it. The doctor’s work took time, and the waves of pain soon made me start to sweat. Before long, I began to feel flushed with intense heat.
I opened my eyes just enough to see the doctor finishing. I weakly tried to wave him away. My neck could no longer keep my head erect and I knew I was about to pass out. Aunt Fong and her friend urged me to sit up, but I remained slumped over with my head between my knees. They lifted me under their shoulders, and with one Chinese woman under each of my long arms, they walked me past the Nurses’ Station and into an exam room. The sight of a six-foot tall (nearly two meters to them) limp, foreign body stumbling forward with assistance was quite a sight for them and I inspired a lot of giggles when I returned the next week for a check-up.
I stood out in China.
After lying down for a while and regaining the color in my face, we were back on the elevator, going down and turning away surplus doctors and patients who tried boarding on the floors between the eleventh and the ground.
There was still the matter of the bones in my rigid foot. Aunt Fong led me down another hallway and grabbed a radiologist who was having a smoke in the hallway, outside the X-Ray room. He held his lit cigarette with one hand as he adjusted the camera above my foot with his free hand. I quietly laughed at the scene, unthinkable now in America, and let the comic relief soothe my earlier experience.
My foot healed, slowly, and after several more doctor visits (with alcohol swabs and metal pans, but no tweezers) and a few months’ time, I was able to curl my toes again and walk without limping. I never saw a bill for any of those visits. I assumed that in China it was all about who you know (which it is) and Aunt Fong had called on her relationships to help me out. Really, I just followed her, received care, and didn’t ask questions.
At the university, I did pay once for antibiotics when I came down with bad, flu-like symptoms. Two students escorted me from room to room and helped translate for me so the doctor could write me a prescription. I learned from the students that their mandatory student health insurance cost 100 yuan per year, which is around 17 American dollars.
Yet, there was one incident that did threaten to leave me with an onerous medical bill, which brings me back to the Monday after the awful weekend bus trip. After two days sitting in pain for hours at the sales office and declining food, I lay about Aunt Fong’s apartment, reading books and not even stirring to eat. I got up several times throughout the day to use the toilet, but other than that I did not have the strength to do anything other than lie in pain. Rightfully worried, Aunt Fong took me to the hospital that night.
By luck, I was able to go to the newly built city hospital on its first day open to the public. It already had people sleeping in the elevator lobbies and lounging on the steps outside, but the equipment inside was clean and unused. Before this hospital was available, the closest “Western” hospital was a short train ride away in Nanjing. Sue, the Australian, made her husband, Grant, promise to immediately take her there if anything serious ever happened to her.
A nurse inserted an IV into my arm, and she let two bags of fluid drain into my dehydrated body. An hour later, I stood up to go back to Aunt Fong’s. Or so I thought.
I made it into the elevator with her, but as the doors started to close, I felt my body slumping to the ground. For a moment, I lost consciousness, then I struggled to blink open my eyes and watch as the elevator’s button panel tilted to an oblique angle before me. Aunt Fong was making panicked noises as she tugged on my arm and pulled me out of the elevator. The sounds were murky, but I could hear her crying out for help and running down the hall. The clamor of footsteps came rushing back to me, and I couldn’t open my eyes wide enough to see the doctors or nurses, but I felt two of them pick me up and sit me in a wheelchair.
“Fong bian,” I breathed out softly. I needed to use the bathroom, I told them, immediately. It must have been the IV fluids; I needed to clear out my system. They wheeled me to the bathroom quickly, then two aides cautiously watched me over the squatting toilet, and in a dire moment like that there was no thought of shame. I sat back on the wheelchair for a short ride, then they transferred me to a bed and rushed me down the hallways as fast as they could push me.
The fluorescent lights overhead blurred past my vision like dashed freeway lines. I struggled to blink my eyes open, afraid that if I closed them I would slip away and fall asleep in the biblical sense. I could hear the doctors’ urgent voices and Aunt Fong asking panicked questions as she ran alongside them. Repeating the refrain of familiar psalms in my head, I willed myself not to lose consciousness.
I was taken to the top floor and wheeled to an open stall in the Intensive Care Unit. Sometime during the rush, a nurse squeezed two tubes of glucose into my mouth as another gave me two or three injections- I’m not clear on how many I actually received. I remembered that a friend of mine who trained in emergency medicine told me that the glucose was a disgusting, gelatinous blob, but going down it tasted sweet and smooth to me. If the FDA allowed it, I’m sure companies could market it as a new snack for sugar-happy American children; many of the yogurts and puddings on store shelves are not far off.
Aunt Fong told me that she stayed with another nurse by my bedside that night. After I was started on a new IV drip she watched me drift to sleep and then worried over my heart rate on the monitor. In the morning, a doctor who spoke English told me that they were concerned about my heart rate because it was so slow. “In fact,” he said, “last night it stopped two times.” I learned that the hospital wanted me to stay for two more days as they built up my dehydrated body with IV fluids and monitored my heart.
Most of that first morning I spent alone, then Uncle Jiang and Aunt Fong came by to visit me. Aunt Fong brought me a bowl of noodles to eat, and for the first time in a few days I was hungry. Uncle Jiang kept me company for a while when Aunt Fong had to go to her office or attend department meetings at her medical college. He and I didn’t talk much to each other. I just read from my e-book and he would look up English words in his pocket electronic translator or frequently instruct me, “Rest. Rest. You must… have a rest.” He would motion toward me as if pushing my forehead back to recline.
When it was only Aunt Fong and me, I told her, “I thought I was going to die last night. I thought I might die here in China.” She told me she feared the same thing and said that if I had died, she would die, too.
Over the next couple days, my boredom was greatly relieved when a few friends I met through Aunt Fong came and visited me, her nephew brought me some movies to watch, and the university’s Director of Foreign Affairs, Mr. “Oliver” Zhang, stopped by to give me some chocolates and offer condolences.
By the second day, I felt decent enough to really walk out of the hospital (I was tired of having a nurse follow me into the bathroom and hold up the heart monitor attached to my body by round stickers), but the doctors still wanted to perform one more test. A man I assumed to be a senior doctor at the hospital, due to the squad of nurses and interns following him around, filled a syringe full of silver liquid and plunged it into my IV tube. My heart rate, which had recently settled into the 50’s after surging up and down the first day, zoomed up to 130 beats per minute, then plateaued and gradually slowed down. The head doctor gave me a thumbs-up, smiled, and exclaimed, “Very good!” My heart rate while asleep was below 40 beats per minute, which alarmed them, but the test proved my heart was in good condition and pumping at a healthy pace.
The silver test fluid also blurred my vision for the rest of the evening, but that was the last I had to endure. The nurses monitored me overnight again, and in the morning I was free to go. Walking out, I observed the loungers lying on the floor of the elevator lobby and the overflowing trash bins. I pointed out to Aunt Fong how disordered and slovenly things were, especially remarkable since this was the first week this hospital has been open. As I had tried pointing out to her many times before, China does not “need time.” The problem of China is not modernization, infrastructure, or money. As a trashed, brand new hospital shows, the problem is the culture of the people. They feel clean in their conscience when acting dirty. This is not to pick on poor farmers who had no change of clothing or clean beds to sleep in. Poverty doesn’t force people to throw their trash on hospital floors.
My view from my top floor hospital window. The window pane itself was clean, it was the outside which was so dirty.
Naturally, I was relieved to put the whole experience behind me. I thought it would all be over after I walked out the doors, just the same as my other escorted hospital visits. Then, I watched Aunt Fong on the phone in her dining room, pacing the wooden floor,nearly in hysterics with the person on the other end. After she hung up, she hugged me, in tears. I owed the hospital a couple thousand dollars for my stay. Aunt Fong wasn’t speaking on the phone to the hospital, though. She related to me that she was speaking to the heads of my university, and she had become so emotional because of what had happened to me. She expected my school to take responsibility, and they ended up covering my bill.
I don’t understand how it all worked out, I was simply full of thanks that I was treated and it was paid for. As part of my university teaching contract, I didn’t have health insurance, only a very small stipend for healthcare expenses. I asked about this before I signed on the dotted line, and the university said that China’s healthcare was “different.” No fuller explanation was ever given, I think mostly because the Chinese themselves don’t understand their systems.
I inferred from the way banking and other institutions were run in China that healthcare treatment (appointments, procedures, and payment) must be based on relationships and the discretion of the business. What I mean is, a person cannot go to a Chinese bank and expect the same treatment for the same services every time. The bank isn’t governed strictly by a system of policies. If the bank teller tells you she cannot make a money transfer without certain documents and several mangers’ approval, as an example, you cannot tell her that the teller you spoke with last week did it all by himself without needing any extra documents. If she says it cannot be done, then arguing about written rules or past experience is moot. Chinese culture does not place a great amount of value or authority in written policies and standards. Business relationships are extensions of personal relationships. How your individual case is handled, in law and business, is largely up to the mood of the authority figure.
A friendly mediator in this environment is likely to tell you to jump through hoops or wait until another time. Have patience, because “that’s China.” Now, I was never directly held up by this type of runaround, but I was aware of the way the system worked. At any moment, the baton of responsibility and social power might be passed. In the Chinese mentality, people did not expect to get anywhere or receive the treatment they desired unless they had personal connections to someone with power, who could pull the right levers, in which case no paperwork was needed and all problems were solved. Perhaps the Chinese are mostly right about how the world works, and they have only made an implicit social phenomenon explicit.
So those were my hospital experiences in China. There were other times I visited hospitals- I visited a major hospital in Shanghai, I briefly walked through a hallway and bathroom of a city hospital in semi-rural China, I went to a patient room in a small hospital near my university by walking up unlit stone steps in a dark alley, I visited a new mother and her infant daughter lying in a narrow room with a row of five beds and other women and their families pressed close together, and I saw a young man with a broken arm wrapped up in the sorriest looking cast and sling I have ever seen- but I mention these major episodes in the spirit of my other stories written here. I do not offer, I could not offer, a survey on the Chinese healthcare system. What I can share is my individual experience, which another foreign traveler would share much of if he ventured into the heart of China (except the 3-day stay, hopefully), and I can share my perspective on particular Chinese customs and culture.
If you ever set foot in the real China, you very likely might see things differently; I’ve met people who are both much more enthused and much more jaded on China than I am. One thing, though, you could not disagree over with me: visiting a Chinese hospital will make you count your blessings in having lived in the West.
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