China is vast and the health issues many and varied. Here we help assess the risks for travellers
My best friend was working in the Gobi, travelling with Chinese colleagues. Two of the group suddenly developed a debilitating illness and fevers over 39ºC. Of all the possible diseases in China, what could it have been? They’d visited crowded Buddhist caves, so could it be SARS? Bird flu? Or Japanese encephalitis? They went to the local hospital for treatment.
In China even locals struggle to find competent medical help – so what if the patient had been my English friend? How do you find a doctor and then communicate with them, given that little English is spoken in China?
In a country as vast as China it is hard to be prepared for all possible risks. The biggest threat to any traveller’s health – anywhere in the world – is accidents, especially road. In China, an average of 100 children are killed on their way to or from school every day.
It is also important to pack for the climates: from the chill of Tibet to the extreme heat of the deserts. And it is wise to be as fully protected as possible from communicable diseases. You must be up to date with the necessary jabs.
Urban and densely populated areas are usually malaria free. Indeed, the risk of serious (falciparum) malaria is restricted to a few regions, mostly away from tourist areas – the key risky areas are Hainan Island, Yunnan province and sometimes Guangxi. Malarone, doxycycline or Lariam antimalarial tablets are recommended if travelling there.
There is variable risk of the less-dangerous forms of malaria in some regions close to the Yangzi, Yellow and Zangbo rivers, where chloroquine or proguanil (Paludrine) antimalarials are usually suggested. Therefore, when planning your malaria prophylaxis, you’ll need to know where you are going. Even if visiting lower-risk regions it’s worth travelling with long clothes, repellents and bed net.
Chinese sanitary arrangements make a big impression on Western visitors. There is usually no privacy (most toilets don’t have doors) and cleanliness can be less than adequate. Some even rely on foraging pigs to dispose of excreta, so if you do eat pork, consider the phenomenon of parasite life cycles and make sure it’s well cooked!
The Chinese have a reputation for eating almost anything, including snake, dog and lots of aquatic animals. As with eating out, choose freshly-cooked, piping-hot dishes, and avoid lettuce and soft, unpeelable fruits. Perhaps ask for advice if faced with colourfully tr anslated dishes on your menu such as ‘husband and wife torn lung pieces’.
Partly because of the way the rural Chinese dispose of excreta, there is an array of weird parasites you can get from raw food. In the warmest part of the country, raw or slightly pickled fish can give you gnathostomiasis, clonorchiasis or opisthorchiasis (all nasty-sounding worms!), while eating raw snails or water plants (eg caltrop or water chestnut) could give you one of several interesting intestinal flukes. Avoid these by only eating properly cooked food.
There are about 20,000 deaths a year from rabies in China (of similar magnitude to India) despite the fact that you don’t see many dogs. Pre-travel rabies immunisation buys peace of mind when travelling. It also means that, if bitten, you don’t need the scarce and potentially hazardous rabies immune globulin injection.
Schistosomiasis (bilharzia) is a debilitating disease that affects more than one million Chinese, mostly in the east and south, including Guangdong, Shanghai, Fujian, Guangxi and Zhejiang. The Oriental form of this microscopic worm spends part of its life cycle in amphibious snails, which can migrate when ponds dries out so can’t be controlled by draining their habitat as they are in Africa. The Chinese schistosome parasite also penetrates human skin much faster than African worms, so less water contact is necessary to acquire this nastier form of the infection. Those travelling to the south and east should find out where the disease is a problem and avoid swimming or bathing in open fresh water in these parts.
Avian influenza continues to simmer in parts of China. The main reason for its emergence was crowded living conditions, combined with people living close to their chickens and ducks. An ordinary traveller is at minuscule risk of acquiring bird flu, but avoid sleeping in accommodation where birds are roaming about the house.
Japanese encephalitis occurs in south and east China. It is a horrible mosquito-borne viral infection that can kill or cause brain damage. Travellers risk it if they sleep close to pigs and rice fields; protect yourself against dusk-to-dawn-biting insects.
So what of the Gobi team? Food parasites are rare in dry areas, bird flu wasn’t likely and doctors excluded mosquito-borne diseases. The sick individuals were given intravenous antibiotics (drips are popular in China), plus ten other remedies.
This didn’t cure the fever; in fact, one patient had an allergic reaction. Taking ten prescribed medicines is asking for trouble, but some Chinese doctors think multiple prescribing will cure everything, thus enhancing the doctor’s reputation.
In the end the team fled to Beijing, to doctors they knew and trusted. The patients recovered despite treatment they’d received. They probably had tonsillitis.
Dr Jane Wilson-Howarth is a GP who has lived in parts of remote Asia for 11 years. She worked on improving healthcare delivery