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Low standards of public hygiene, stress and overcrowded conditions are to blame for most of the health problems that beset travelers 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 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

No vaccinations are required for China, except for yellow fever if you’re coming from an area where the disease is endemic, but a hepatitis A jab is recommended. A signifi­cant health hazard for travelers. Hepatitis A is a viral infection spread by contaminated food and water which causes an inflamma­tion of the liver. Symptoms are yellowing of the eyes and skin, preceded by lethargy fever and pains in the upper right abdomen. The traditional one-shot vaccine gives pro­tection for three months.

The less common hepatitis B virus can be passed on through unprotected sexual con­tact, transfusions of unscreened blood and dirty needles. Though the disease occurs worldwide, it’s especially prevalent in parts of Asia , so it’s worth asking your doctor about the vaccine (three injections over six months), particularly if you intend to travel through Asia for six months or more. Additional injections to consider, depending on where you are going and when, are meningitis and rabies (a serious problem in Tibet and rural areas of China ) – again, check with your doctor Remember also that a tetanus booster is required every ten years.

Visit a doctor as early as possible before you travel to allow time to complete any courses of vaccinations you need. You should have all your shots recorded on an International Certificate of Vaccination. If you have any longstanding medical conditions, or are traveling with small children, consult your doctor and take any necessary medi­cine 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 traveling extensively Ire the cities, where the language barrier make getting hold of the appropriate medicines difficult. Include bandages, plas­ters, painkillers, oral rehydration solution, medication to counter diarrhea, vitamin pills and antiseptic cream. A sterile set of hypoderm­ics may be advisable if you will be in the country for a significant period, as re-use of hypodermics does occur in China.

General precautions

There’s no point in being overconcerned your health in China , but it’s an easy to become stressed and exhausted, leaving yourself vulnerable to infections. Travel at an easy pace, and treat yourself occasionally to upmarket accommodation god. Take vitamin pills (you can buy in many clues) if you think your diet is in variety.

Personal hygiene is one area you can and it pays to be meticulous, Wash ands often and don’t share drinks or cigarettes. When in the shower, always wear flip-flops or shower shoes, provided free at 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.

With the majority of China’s waterways highly contaminated, water is a potential cause of sickness. Don’t drink unboiled tap water, or use it to clean your teeth; avoid ice in drinks, and the ice lilies sold by street side en­trepreneurs. The Chinese boil drinking­ scrupulously, and every hotel room is equipped with a Thermos, which the floor attendant will fill for you. Bottled water is ale from supermarkets, though it often disgusting. If you stick to this and drink tea or carbonated drinks in restau­rants should be fine. If you have to sterilize yourself, boil it for at least ten minutes ­to kill micro-organisms; at altitude, however water boils below 100°C, so you’ll – use other methods. Iodine tablets are effective, but leave the water tasting rank, and they are unsafe for pregnant women, babies and people with thyroid complaints. If you’ve got the space, a water purifier, which removes contaminants by fil­tration, is ideal – they’re available from spe­cialist outdoor equipment stores before you leave home.

As for food, eat at places which look busy and clean, stick to fresh, thoroughly cooked food, and you’ll have few problems. Beware of food that has been precooked and kept warm for several hours. Shellfish are a potential hepatitis A risk in Asia , and best avoided if raw or not thoroughly cooked. 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, though many restaurants provide disposable sets: 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 unfamiliar food. The sudden onset of diarrhoea with stomach cramps and vomiting indicates food poison­ing. In both instances, get plenty of rest, drink lots of water, and in serious cases replace lost salts with oral rehydration solution (ORS); this is especially important with young children. Take a few sachets with you, or make your own by adding half a teaspoon of salt and three of sugar to a litre of cool, previously boiled water. While down with diarrhoea, avoid milk, greasy or spicy foods, coffee and most fruit, in favour of bland foodstuffs such as rice, dumplings, noodles and soup. If symptoms persist, or if you notice blood or mucus in your stools, consult a doctor.

Dysentery is inflammation of the intestine, indicated by diarrhoea with blood or mucus and abdominal pain. There are two strains. 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. A prompt course of antibi­otics should restore you to health.

Giardiasis 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 dis­ ease is treatable with an antibiotic, Flagyl, under medical supervision. If you’re heading for Tibet , where the disease is a particular problem, you will not be able to get the appropriate antibiotics there, so take some with you (you may need to get a prescription from your doctor for this).

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 absorbed effectively.

Mosquito-borne diseases

Mosquitoes are widespread throughout southern China, so travellers here need to be aware of the risk from mosquito-borne diseases, particularly if you’re visiting tropical regions such as Hainan Island and southern Yunnan, or if you want to make a summer­ time trip through southwestern China.

Carried by the anopheles mosquito, malaria is caused by a parasite which infects the blood and liver. Symptoms are flu-like fever with hammering headaches, shivering, and severe joint pain. If you’re travelling in a high-risk area it is advisable to take preventative tablets, although medical opinion varies on the safety and effective­ ness of the different drugs available. The current favourite is mefloquine, though some people experience unpleasant side effects with it, and the malarial parasite is showing resistance to it in some parts of China : con­sequently, it’s best to talk the various options through with your doctor. Note that you need to start taking all anti-malarial medica­tion some time before entering a malarial reglon, and then continue for a few weeks after leaving, as the parasite can lie dormant for a while; again, consult your doctor for advice. Women should always consult a doctor before taking any malarial prophylac­ tics, as they can affect pregnancy. None of these precautions is infallible, however. A blood test will confirm the diagnosis and, if caught early, treatment can be quick and effective.

Aedes aegypti mosquitoes, identifiable by their black-and-white stripes, are responsible for transmitting dengue fever, a viral dis­ ease whose symptoms are similar to malar­ia, though there’s sometimes also a rash spreading from the torso over the limbs and face. There’s no cure, and though symptoms subside on their own after a week or so of rest, chronic fatigue can dog you for months afterwards. A more dangerous strain called dengue haemorrhageic fever primarily affects children. If you notice an unusual ten­dency to bleed or bruise, consult a doctor immediately.

The key measure with both diseases is to avoid being bitten in the first place. Mosquitoes are most active at dawn and dusk, so at these times wear long sleeves and trousers and avoid dark colours, and use repellent on exposed skin. Repellent containing about forty percent DEFT (diethyl­ toluamlde) is effective, but the chemical is toxic and prolonged use can cause side-­ effects keep it away from eyes and open wounds, and young children. Good alterna­tives based on natural ingredients are sold under the names Mosi-Guard Natural and Gurkha.

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. Tuck the edges in well at night, sleep away from the sides and make sure the mesh is not torn. Many nets are already impregnated with to repellant, but need retreating every six months; all the gear is available from trav­el and good travel shops. Air conditioning and fans help keep mosquitoes is do mosquito coils – extremely effective indoors – and insecticide sprays, both available in China ,

Respiratory infections

The most common 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, intense pollution and the widespread habit of spitting, which rapidly spreads infection. Initial symptoms are sore throat, chills and a feeling of malaise, followed by prolonged bouts of bronchitis. Drink lots of fluids and get plenty at, though if symptoms persist you should seek medical advice.

More serious is tuberculosis, a respiratory disease transmitted by inhalation, and spread by coughing and spitting so it’s not I to see why China has a high incidence. 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- many people are immune thanks to previous, mild infections or through child­hood vaccinations. Especially if your trip will involve spending a lot of time on crowded ns and buses, it’s worth consulting your for about your TB-immune status.

Sexually transmitted diseases and AIDS

It is doubtful that China was ever, as the government suggests, a place where prosti­tution didn’t exist and sexually transmitted diseases were a foreign problem – and this tore is certainly not true now. Thanks to the contemporary, more liberal, climate, a burgeoning sexual revolution and the refusal of many men to use condoms, STDs have flourished, AIDS among them. The govern­ment is becoming far more open about the problem, admitting recently to several million Chinese being infected with HIV. Paranoia about the disease, and its transmission by foreigners, is rife, and you may find that if you turn up at a Chinese hospital the first thing they will do is test you for it. The more common 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 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 get to Hong Kong, where blood is reliably screened, and 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, requiring a cou­ple of weeks to acclimatize to the tempera­ ture and humidity, during which time you may feel listless and tire easily. Don’t under­ estimate 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 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 – signified by infrequent or irregular urination – drink a salt-and-sugar . Heat stroke is more serious and may require hospital treat­ment. Symptoms 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 can cause 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 – Tibet and the north in particular – that get very cold indeed watch out here for hypothermia, where the core body temperature drops to a point that can be fatal. Symptoms are a weak pulse, disori­entation, numbness, slurred speech and exhaustion. To prevent the condition, wear lots of layers and a hat (most body heat is lost through the head), eat plenty of carbo­hydrates, and try to stay dry and out of the wind. To treat hypothermia, get the victim into shelter, away from wind and rain, give them hot drinks – but not alcohol – and eas­ily digestible food, and keep them warm. Serious cases require immediate hospitaliza­tion.

Altitude sickness

You should be aware of the dangers posed by the high altitude in several regions of China, including Tibet and areas of Xinjiang , Sichuan and Yunnan . At altitude, reduced air pressure means that the blood does not absorb oxygen efficiently and so – until your body adapts after a week or two, by produc­ing more red blood cells – you may suffer from AMS (acute mountain sickness); most people feel some effects above 3000m. Symptoms vary, but include becoming easily exhausted, headaches, shortness of breath, sleeping disorders and nausea; they’re inten­sified if you ascend to high altitude rapidly, for instance by flying direct from coastal cities to Lhasa . Relaxing for the first few days, drink­ing plenty of water, and taking painkillers will ease symptoms, some of Lhasa’s hotels even have oxygen on hand. For most people the symptoms pass, although having accli­matized at one altitude you should still ascend slowly, or you can expect the symp­toms to return. Medical opinion is divided about the usefulness of acetazolamide (Diamox) to ease the symptoms; discuss this with your doctor before you travel.

You should also be aware that if, for any reason, the body fails to acclimatize effectively to altitude, serious conditions can develop. To compensate for reduced oxygen in the body, the heart beats faster, trying to circulate avail­able oxygen more rapidly. In consequence, fluid can be forced from the blood through thin membranes into the lungs or brain, caus­ing potentially fatal pulmonary oedema (characterized by severe breathing trouble, a cough and frothy white or pink sputum), and cerebral oedema (causing severe headaches, loss of balance, other neurologi­cal symptoms and eventually coma). The only treatment for these is rapid descent: in Tibet , this means flying out to Kathmandu or Chengdu without delay. If symptoms have been serious, or persist afterwards, seek immediate medical treatment.

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 it’s unlikely that staff will speak anything but Chinese, so take along a phrasebook or a Chinese speaker. The selection of reliable Asian and Western products available is improving (though always check expiry dates on brand-name products), and its also pos­sible to treat yourself for minor complaints with herbal medicines. Contracepoves are widely available, as are antibiotics. The staff will usually be able to help if you describe your symptoms

Large hotels often have a clinic for guests offering diagnosis, advice and prescriptions – ask an English speaker from the reception desk to accompany you, Beijing, Shanghai, Guangzhou, Hong Kong and Macau have clinics specifically for foreigners where staff speak English. If you are seriously ill, head straight to a hospital – your accom­modation or 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 of major towns and cities in the guide. You will be expected to pay for your treatment on the spot, but it should not be too expensive. Keep all medical hulls and receipts so you can make an Insurance claim when you get home.

If you’re interested in being treated according to traditional Chinese medicine – of most use for minor and chronic com­plaints – many hospitals and medical colleges have attached traditional institutes, while some hotels have their own massage or acupuncture services.