How to be healthy and stay healthy teaching ESL TEFL English in China

I guess one of the main issues that concern us if we come to China or are thinking about coming to China is our health. We may have heard about the bad food, the bad air, the smoking, the pollution, Asian flu, Avian flu, Japanese Encephalitis, Gutter oil, the poor driving, the lack of health and safety, rat meat, dog meat, dodgy baby milk, fake food, fake medicines, fake fake fake!

And yet we still come. As if we will be immune from all this stuff or that we will be able to cocoon ourselves from all of this using our obviously superior Western know how and canniness.  That 1.4 billion people live happy 'normal' lives here seems to pass us by. Nevertheless I guess if you do want to live here and live in a little Western bubble thats probably possible in most of the big cities, although I guess if you live in the sticks thats going to be slightly impossible.  I mean Ive just visited a wonderful town, in the mountains in Anhui Province. It reminds me of Shangri La. But its a three hour drive down the mountain to the nearest hospital.  There are no rescue helicopters out here my friends.

In the mountains with my dog Snooky.

I've been here in China nearly four years now and I've been pretty healthy but I have had occasion to use the local health services so I can give you some insights into what its like to live in China and the health issues, from my perspective.

If you are planning to come to China first you need to chat with your doctor and visit your local travel clinic to get your inoculations up to date.  Some jabs the doctor can give you free of charge on the NHS and some you have to pay for at the travel clinic.

I actually saw a doctor, for reasons which will be come clearer last Friday, here in China, and he was most insistent that I get the Japanese Encephalitis jab and the Rabies inoculation asap. One inoculation which I do get regularly here in China is the Flu jab which costs about 100rmb (£10) at the local international travel clinic (this international doctors clinic would do it for 250 rmb plus a 500 rmb consultancy fee - these are not Chinese prices but prices for foreigners (i.e. Engineers here working for Western Companies).  So the local travel clinic is fine for local prices. I will also try and get the Japanese Encephalitis jab done there too - I will add this later as I hope to have the Flu jab in the next week or two when it becomes available.

Whilst you are at your doctors if you are on any prescription medicine you can ask him for a 3 months supply - I say this because this is all my doctor told me that he could supply me with.  I have a friend who works as a teacher in Chengdu who gets his brother to pick up his regular 3 monthly supply of medicines, which my friend orders online, and then gets them posted to him in China.

Of course many of these prescription medicines are available over the counter here in China. Im my case I can buy the Ventolin puffers and the Brown Steroid puffer for my Asthma (which hardly bothers me in China - I have a buddy also who says he barely uses his Ventolin here). If I catch a cold, I tend to end up with a chest infection for which my UK  doctor prescribes an antibiotic and a steroid - Prednisone both of which I purchase at the local pharmacy - over the counter, for less than £2 should I need them.

The standard antibiotics I use if I have a bad chest - purchased over the counter.

I also use Omeprazole for reflux - once upon a time caused by work related stress I believe, now caused by too much spicy food at the Szechuan Hotpot place - I can purchase this over the counter here.

My local street food place  - the oil is good here

The only thing I cannot purchase is a very good migraine remedy called Maxal Melt (Oral Lyophilisate - Rizatriptan ) so I have to hope the '3 month' supply will last. Again I believe my migraines were the result of workplace stress - which I do not have here and so my very few migraines are often tiredness or too much alcohol.

 You might also want to bring with you the medicines you use at home bought from the Chemist and which work for you. Here are some of the things I bring.  Lemsips - they work for me when I have a cold or flu and these little sachets are like gold dust amongst the expat community - you cannot get them or anything similar here.  Lemsip or similar day (8hr ) tablets to get you through a teaching day if you do have a cold - make sure its got something similar to amphetamine in it to keep you going!

Although you can buy this in the local pharmacies, but you do need to show your passport because they log who is buying it because  I believe it has stuff in it that can help to make metamphetamine - its good stuff and helps the work day when you have a cold. 

I also bring a lot of Anadin Extra because that works for me if I do have a headache and I haven't found anything similar in China. I also bring Ibuprofen tabs for aches and pains when Im running - but you can buy Ibuprofen in China over the counter.

I also bring cough medicine (Pholcodine) because it sorts out any post viral cough I suffer with and I haven't found anything similar in China.

Olbas Oil is a life saver if you have a cold, you can sniff it or the recommended usage is to steam your tubes - a couple of drops in a bowl of boiling water, cover your head with a towel breath it in for as many minutes as you can bear it and a good nights sleep and clean tubes will be yours.

Of course you know what you need and its worth bringing it just to make life that little bit easier should you succumb to a bug - and remember, if you have never been a teacher before, schools are bug factories. Once one of the kids gets something you will too. Its a fact. And these kids come to class dying, toting holdalls full of drugs and chinese remedies sent to them by their parents.

Thats what you can do before you come to China. So whats it like if you are ill once you get here?

I've personally had a couple of run ins with the Chinese Health Care system and to be honest I'm pretty confident that its okay and that it works.

Hospital waiting

A few stories.

My first experience of the Chinese Health care system was due to a road traffic accident. You can read about it here - with pics.  Like most of the other expats I purchased myself a motor scooter once I got here (around £400 brand new)  - it got me to school, I didn't have to wait for the bus etc.  One dark dismal halloween night me and my passenger got sideswiped by a Chinese driver. I was knocked unconscious and my pillion got his leg broken, at the ankle, quite badly.

He was taken to hospital, obviously, I visited the next day.  To get my bit over quickly, I was examined for concussion and had a CT scan and an X-ray to check for hidden damage. I was fine, it cost around £6 (60rmb if I remember correctly).

My friend spent 10 days in hospital, had his leg operated on. Our employers do have health insurance for us, but it is generally accident and emergency insurance - of course this kicked in. Although the school wanted money up front from my friend as he lay in his sick bed. He did point this out and they went away and found the up front money elsewhere.

Whilst he was in hospital he was looked after, not by a nurse, but by an Ayi - an aunty. They live in the hospital and you pay them - around £10 per day to look after you domestically - i.e. feed you, wipe your bum etc. The nurses are only concerned with medical care. My friends ayi was lovely and she cried when he left.

The actual surgical work was looked at by NHS doctors when he went back home to recover (and let NHS doctors check it all) and they said that the work was good.  My friend was back at work after a few weeks away.

As an aside, my colleague, a Canadian teacher was knocked off his motorbike by a taxi driver just this week. He broke his arm. Of course the taxi drivers insurance covers it. But the driver did try to blame the foreigner for the accident so that he could counter claim. But the Police CCTV saw the accident very clearly. My colleagues arm is all plastered up and he's back at work.

My other experience of Chinese Health care was a couple of winters ago when I succumbed to a kidney/urine infection. I couldn't stop pissing one night - I was up all night. Next day I was taken, with a Chinese teacher, to the local hospital, for that is where you see the doctors. I paid my money, saw the doctor. He sent me for blood and urine samples. Then for an ultrasound. By the time I was back, the blood and urine results were back. The doctor prescribed me antibiotics and Chinese herbal medicine. It cost around £12-15 if I remember correctly (120-150 rmb) and took about 90 minutes.  I followed this up around three or four weeks later because I still had some discomfort. The same procedure - turned out I had a couple of little kidney stones/grains.

Now to more recent matters.

In the summer I saw my own doctor in the UK. It turned out that my prostate is slightly enlarged. Now this could be age related or it could be more sinister. nevertheless I had the PSA blood test and the ultrasounds. My UK doc was happy with the results but wanted me to follow up in 2 months, by which time I was back in China.

By asking around I found a very nice Pakistani intern Doctor - on his 10th year here in the South Eastern University Training Hospital in the city. So I met up with him and he walked me through the procedure with the Chinese doctor. So blood test, ultrasound scan was done at a cost of around £25 I think (250 rmb) - So I got the result.

The Chinese doctors want me to do a biopsy which would cost around £800 (8000rmb) because it includes a five day stay in hospital.  A biopsy procedure in the West is an outpatient appointment.
Also when I looked at the numbers, from the UK test and the Chinese test (as a layperson but who has worked with data) the numbers looked similar to me.

So I wanted another opinion.

I contacted my British doctor - but he would not comment. The practice manager was at pains to tell me that if I was out of the country for too long I would not be applicable for some NHS treatment.

Another UK doctor I contacted would not comment either.

So I went to a local international clinic and had a consultation with an Australian Doctor. This cost 840 rmb (around £84) but I spent nearly 90 minutes with him. We went through the numbers and the outcome was my numbers were static and we would test again in two months - but a biopsy was preferable at sometime soon in the future.

My problem of course is that I am not an engineer on a lucrative contract with good medical insurance I'm a teacher with local emergency insurance so the cost of accessing local international standard health care with be prohibitive - as per the 800+rmb consultancy fee.

So a dilemma. At the moment I am pretty convinced that my enlarged prostate is age related not anything more sinister. But a biopsy would prove that one way or the other.

I have decided on two solutions - given that I don't really want to spend 5 days in a Chinese hospital and my Aussie doctor is not convinced that the procedures followed would give us any confidence in the results.

So I have asked the doctor to see if he can find somewhere local, like the international hospital, where we could have confidence in the correct procedures and if the price is right I'd have it done and pay by credit card.

The other option is wait on the December PSA result see whats happening with my blood i.e. are the results static or reducing or are they rising? What ever the case I would go back to the UK see my Doctor and get an appointment for the Biopsy. Come back to China to work awaiting the biopsy date and then fly back to the UK for the appointment. As a ticket home could be less than the 8000 rmb it would cost for the procedure here and I have total confidence in the NHS that seems to be the best option.

So the point of telling you this is for most health issues, including emergency care, the Chinese health system is fine, in my opinion. But for something a bit more complicated such as a prostate issue then life gets a bit more complicated.

The problem is, as teachers, we are not being paid pots of cash (unless you are in an International School) so International Health Insurance is prohibitively expensive.

Heres a quote I did online today:

Payment Frequency	Premium	Annual Premium
Annually	£2,770.00	£2,770.00
Semi-annually	£1,468.10	£2,936.20
Quarterly	£740.97	£2,963.90
Monthly	£249.30	£2,991.60

Your details:

• Country of residence: China

 Another company quoted £ 2,200.00  or £220 a month.

Many teachers are only earning about £600 a month so to pay around £250 a month for the lowest /basic cover becomes untenable from my point of view I do earn more than 6000 per month but I still wouldn't want to pay over 2000 rmb a month. 

Another solution I have heard of which bends the rules a little is to use Backpacker insurance, especially if your contract is only 10 months and you plan to go home. 

A backpacker quote I got today with no declared medical problems

• Policy Price
  help
• Max Excess
  help
• Medical
  help
• Cancellation
  help
• Baggage
  help
• Activities covered
  help

Policy Price£448.64<p>The total price you pay for this policy </p>

Max Excess £60 This is the maximum amount you have to pay per person per claim. For example if you have a £100 excess and make a successful £500 claim, you will receive £400. Please check your policy documents for more details. This excludes Personal Liability excess which is usually £250.

Medical £10m This is the maximum amount you can claim per person for medical expenses and repatriation if needed. Please check your policy documents for more details.

Cancellation £5,000 If your holiday is cancelled, this is the maximum amount per person you can claim for travel and accommodation costs that can’t be recovered. Please check your policy documents for more details.

Baggage £1,500 This is the maximum amount you can claim per person if your baggage is lost, stolen or damaged. Please check your policy documents for more details.

Activities coveredshow all<p>These are specific activities that you are covered for whilst you are away (for example bungee jumping, banana boating, jet skiing) should it lead to a claim. Please check this to see if all the activities you will be undertaking are covered.</p>

More Details »

EXCLUSIVE Exclusive brand to MoneySuperMarket, not available on any other comparison site

And another

Company 

Defaqto Star Rating

Price

Medical

Cancellation

Baggage

Options

Backpacker Light

£242.92

£5 Million 
(Excess: £200)

£2000
(Excess: £100)

£1000
(Excess: £100)

So it might make sense to take out the Backpacker insurance and be 'travelling' whilst you are in China.

So all in all my advice is do your preperation bring drugs and medicines you need or think you might need with you. Check with your employer about the scope of your medical insurance and on arrival make sure you get a copy of the policy with your name on it.  If you need minor medical care use your local hospital - take a Chinese friend/teacher with you - but some of the doctors I've seen do speak enough/some English. Buy the Backpacker insurance if you think you might need it - I haven't and if you have the means buy health/medical insurance.


For the pollution I use this mask: Totobobo

Strangers in a strange land - Teaching ESL TEFL in China

I was walking up a street in a mountain village in Anhui Province, China. Not many foreigners get there. Indeed I think AJ, my friend and I are probably the only foreigners ever to go to this town (Four years ago Tom and Peggy - American friends came as well). We are there because AJ is married to a Chinese woman, they have a son, Titus, and grandma and grandpa live here.

 Na Na

Grandpa

Actually grandma and grandpa live outside of the actual town, even higher in the mountains, where they raise pigs and grow tea. Anyway I was out for an evening stroll with a Chinese friend walking up the street through the village.  We passed a bunch of women idly chatting, as they do, on the side of the road.  'Oh!' one exclaimed as she clapped eyes on me, 'So thats what foreigners look like. They are so hairy and so big and strong'.  As we walked away I could hear them discussing the 'laowai' (foreigner) for many minutes.

Look at the Laogai - So thats what they are like!

 Then later as we walked down the hill back to grandmas we met a guy herding his two cows back home.  We exchanged a 'good evening' and he asked where I was from. We told him I was English and he said 'Good, so you are not an enemy like the Japanese or the Americans'.

Piggies

Na na in the tea fields

Thats the thing about China, we are strangers here, even in the big cities like Nanjing you get gawked at. Mouths drop open at the very sight of you. People surreptitiously film you on their smart phones, and not so surreptitiously - just blatantly walking up to you standing next to you whilst their mate takes a picture. There must be hundreds of pictures of me all over China taken with or by random strangers. I simply don't know what they do with them. Do they show their friends? 'Hey look at this - a foreigner!' or 'Hey look at this - me standing next to a foreigner!' They all have TV, computers and smartphones, so they have seen foreigners before, but maybe just not in the flesh, so to speak.

Its because we are strangers to this culture that we often find things that are jarring or difficult to understand. This is often because we view this culture through the judgemental lenses of our own cultural values and mores. This, in the jargon of sociology, is called Ethnocentrism. This means judging an alien culture using the values of your own culture.  So for example, if we went to an African village, where the local witchdoctor has a powerful influence on that society, we might suggest that this is just backward thinking because we know (or science has disproved, or religion killed them all) that witchdoctors simply cannot summon up spirits and cast spells and so on. This is what rational thinking, science and religion in the West has taught us.  But in that village the power of the witchdoctor is very real to these people.  If we deny that we are being ethnocentric.

So every day in China we come across stuff happening which we think is inappropriate behaviour or just plainly 'wrong'.  Like the motorway toilets we encountered on our journey to the mountains. Don't worry I will not provide the photographic proof.  Ok having a ceramic hole in the ground is a popular solution all over the world - even the French do that right and they are meant to be fashionable and tres chic.  But one would think that a society that claims over 5000 years of civilisation would have come up with motorway services toilets that are little more than a trough along the floor and no doors on the cubicles!  It gets worse. At the temple we visited there was just the trough, no doors and no walls. (To be fair, our Chinese friend - a city girl - was appalled too and not just because they had been used a lot in the last few hours - you can imagine)

Even at school the cubicles, and I even hesitate to use the word 'cubicle' because it suggests walls, to the ceiling, where as here, in school, the walls are waist height, and there are no doors.  I only use these toilets for a pee. Plus I only go for a pee at the last minute before class because I personally find it uncomfortable to be hailed by one of my students with a 'Hello Teacher!' as he is crouched over the hole merrily doing his business. Neither do I want to see one of my male colleagues doing the same thing, usually enjoying a cigarette at the same time. But this, in China, is normal. One does the business and no one blinks an eye. Kids, on the street, also seem to have a free pass to have a pee when they need to everywhere and anywhere. I have seen young children held over waste bins on the metro and kids having a poo on the pavement usually onto a piece of paper or card judiciously provided by grandma and grandpa.  Of course in our eyes this is pretty disgusting but for most people here no one bats an eyelid. (Im going to contradict myself here a bit because sometimes, just sometimes, if a parent or grandparent is letting their kid have a pee or something worse on the metro, I have seen people remonstrate - so some don't let it go, so maybe attitudes are changing.)

When in Rome  - AJ and Titus - we were stuck in a traffic jam

Its the same with hawking and spitting. I have to say its usually a grandma or grandma who is hacking something up from the deepest darkest recesses of their lungs and then gobbing it out onto the pavement. But I have seen people gobbing on the floor of the restaurant. Ive had it done right next to me in a bar. And it is blooming disgusting from my point of view, but its normal here. Its what people do. I have to add their are some funny ideas about health and illness so having a good gobbing session might have its roots in some of the ideas about health. Some of the more strange ones, from our point of view, is eating a particular part of an animal is good for your particular part. So an animal heart is beneficial for your hearts health, brain for brain and so on. Ive been trying to buy elephant penis on the same basis, but no luck yet!

Another thing is when the weather is cold you can't drink cold drinks or have ice cream as its cold and you will be ill. If a girl has her period, she must not drink or eat cold things. Don't ask me, I don't know why. Recently I went to a doctor to follow up something I had checked in the UK. Here the doctor wants to do a biopsy which would mean a five day stay in hospital, in the UK its a quick outpatients procedure. There is an over compensation on all things medical and heath related - again maybe this is because its from a Western perspective, but some things are just difficult to 'get'.

On our way to the mountains we drove for about 12 hours. This was not because of the distance, usually this journey would take about six hours, but this was the start of the Golden Week holiday and everyone wants to get back to their hometown to spend it with their families. The traffic jams were horrendous and most of the traffic jams were caused by the atrocious driving of the Chinese. Most of these drivers seems to have learned their driving skills from playing Grand Theft Auto on the computer. They have no lane discipline. They do not look ahead and anticipate what is happening up front. Many of them will be on their mobile phones and some might even be using the phones or the screens in their cars to watch TV or movies - whilst driving.  Consequently people are constantly being rear-ended.  The roads are wide and flat, the average speed is low, around 100/120kph (fortunately this keeps the death toll down) but we pass smash after smash after smash. Ironically a lot of the smashes involve new cars. This is because many of the 'country boys' (and girls) who are working in the cities want to go home with evidence of their success - the new car. We can tell they are new because many of them still don't have a registration plate - that takes about 30 days to get.

Shunt

One explanation for the bad driving maybe because many of these new drivers never experienced sitting next to their dad or mum as they drove, for the simple reason is that mum and dad may have never owned a car. Car ownership is still relatively new here. So good driving skills and behaviour behind the wheel have not been passed on.  Coming down a single track mountain road after visiting the Temple the front car in our party came face to face with another pilgrim out to seek enlightenment. A stand off ensued with the usual honking of horns, gesticulating and shouting. Finally the single car submitted as our side had the greater number of vehicles waiting.  However, as soon as we got to the place where it was wide enough to pass the Chinese member of our party in the lead car, leapt out of his car and continued the yelling and gesticulating - it was full on road rage. Of course the other driver got out and took his coat off preparing for fisticuffs or kung fu or something - but it was basically handbags at dawn and it was left to the women of the party to cool the tempers down and get us on our way.

Road rage - China style

One of the most irritating things for me, and other teachers in other schools so this is not an isolated case, is the poor management skills/procedures followed by our managers. Things are constantly told to us at the last minute or even late. I have mentioned elsewhere that its not that unusual to get a call.

'Rob, where are you?'
In my apartment. Why?'
'You have a class....'

Frantically checks iPhone diary

'No I don't. My next class is tomorrow'
'Yes you have a class now - the 5th class'
'No'
'Yes, we changed the timetable didn't anyone tell you'
'No because thats your job'
'Sorry'

Runs out the door.....

Take this week for example.  We have just had a weeks holiday, as I have been outlining above. Last night (Wednesday) was the final night of the holiday at around 18:30 we got a message telling us we had to work Saturday because we have just had seven days off but the local education office likes to pull one back. Usually we have to work a Sunday to pull a day back.(Yesterday - Friday I was told that the Saturday classes were canceled because of a basketball tournament - surely one might think that the staff knew of a tournament before they organised the Saturday classes). Thats Chinese holidays for you. So regardless of the fact that you might have made plans for Saturday or even the whole weekend the school admin thinks (well they don't think, thats the problem) they can just drop these changes on us. I think this is because the Chinese staff are not much more than indentured labour. Once they are on campus they are not allowed off campus, we are.  They work godawful long hours many from around 7am to 9pm and have to be at their desk or teaching all day. If they want to/need to go off campus they have to get a paper signed by the boss allowing them off campus - the security guys on the gate do check the paper.

Often we will be requested to do something at the last minute with little regard for what we might already have in hand. So for instance their might be some random and unspecific admin task they decide they want us to do and we get told it must be done by the end of the day. One example is the lesson plans, they wanted us to write the whole semesters lesson plans and hand them in the next day! Of course we said no.  They got them but in a very stripped down form and with in a few days, not a few hours.

So if you are coming to China to teach ESL or to do something else, these are a few of the things that might seem strange to you. And most of them are just minor inconveniences that I have managed to write a blog about. Most don't happen every day and most are ignorable and do not really spoilt the adventure that is China. This is a great country and the people are really nice, so my advice is do try to meet as many Chinese people as you can and make friends with them - they will, really, show you a good time and help to make life here easier. Don't live in a bubble of expats - who bring with them their own inconveniences. Be a stranger in a strange land and enjoy those inconsistencies and jarring moment - because thats life and life is for living my friends!