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China

Health & safety

Before you go

Further reading

Lonely Planet’s Healthy Travel – Asia & India is a handy pocket size and packed with useful information including pretrip planning, emergency first aid, immunisation, and information on diseases and what to do if you get sick on the road. Other recommended references include Traveller’s Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills – check out the website (www.travellingwell.com.au).

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Insurance

Even if you are fit and healthy, don’t travel without health insurance – accidents do happen. Declare any existing medical conditions you have – the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared. You may require extra cover for adventure activities such as rock climbing. If you’re uninsured, emergency evacuation is expensive (bills of over US$100, 000 are not uncommon).

Make sure you keep all documentation related to any medical expenses you incur.

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Medical checklist

Recommended items for a personal medical kit:

Antibacterial cream, eg Muciprocin

Antibiotics for skin infections, eg Amoxicillin/Clavulanate or Cephalexin

Antibiotics for diarrhoea, including Norfloxacin, Ciprofloxacin, or Azithromycin for bacterial diarrhoea; or Tinidazole for giardia or amoebic dysentery.

Antifungal cream, eg Clotrimazole

Antihistamine – there are many options, eg Cetrizine for daytime and Promethazine for night-time

Antiseptic, eg Betadine

Anti-spasmodic for stomach cramps, eg Buscopan

Decongestant, eg Pseudoephedrine

DEET-based insect repellent

Diamox if going to high altitudes

An oral rehydration solution (eg Gastrolyte) for diarrhoea, diarrhoea ‘stopper’ (eg Loperamide) and anti-nausea medication (eg Prochlorperazine)

Elastoplasts, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers

Ibuprofen or another anti-inflammatory

Indigestion tablets, such as Quick Eze or Mylanta

Iodine tablets (unless you are pregnant or have a thyroid problem) to purify water

Laxative, eg Coloxyl

Paracetamol

Permethrin to impregnate clothing and mosquito nets

Steroid cream for allergic/itchy rashes, eg 1% to 2% hydrocortisone

Sunscreen and hat

Thrush (vaginal yeast infection) treatment, eg Clotrimazole pessaries or Diflucan tablet

Ural or equivalent if prone to urinary infections

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Pack medications in their original, clearly labelled, containers. A signed and dated letter from your physician describing your medical conditions and medications (using generic names) is also a good idea. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity. If you have a heart condition, bring a copy of your ECG taken just prior to travelling.

If you take any regular medication bring double your needs in case of loss or theft. In China you can buy many medications over the counter without a doctor’s prescription, but it can be difficult to find some of the newer drugs, particularly the latest antidepressant drugs, blood pressure medications and contraceptive methods. In general it is not advised to buy medications locally without a doctor’s advice.

Make sure you get your teeth checked before you travel, and if you wear glasses take a spare pair and your prescription.

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Recommended vaccinations

Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and can give specific recommendations for you and your trip. The doctors will take into account factors such as past vaccination history, the length of your trip, activities you may be undertaking and under­lying medical conditions, such as pregnancy.

Most vaccines don’t produce immunity until at least two weeks after they’re given, so visit a doctor six to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received.

The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow fever zone within the six days prior to entering China. If you are travelling to China directly from South America or Africa, check with a travel clinic as to whether you need yellow fever vaccination.

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Recommended vaccinations

The World Health Organization (WHO) recommends the following vaccinations for travellers to China:

Adult diphtheria and tetanus Single booster recommended if none in the previous 10 years. Side effects include sore arm and fever. A new ADT vaccine containing pertussis is also available and may be recommended by your doctor.

Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years protection. Mild side effects such as headache and sore arm occur in 5% to 10% of people.

Hepatitis B Now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually headache and sore arm. In 95% of people lifetime protection results.

Measles, mumps and rubella Two doses of MMR recommended unless you have had the diseases. Occasionally a rash and flu-like illness can develop a week after receiving the vaccine. Many adults under 40 require a booster.

Typhoid Recommended unless your trip is less than a week. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available; however, the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur. A vaccine combining Hepatitis A and typhoid in a single shot is now available.

Varicella If you haven’t had chickenpox discuss this vaccination with your doctor.

The following immunisations are recommended for long-term travellers (more than one month) or those at special risk:

Influenza A single shot lasts one year and is recommended for those over 65 years of age or with underlying medical conditions such as heart or lung disease.

Japanese B encephalitis A series of three injections with a booster after two years. Recommended if spending more than one month in rural areas in the summer months, or more than 3 months in the country.

Pneumonia A single injection with a booster after five years is recommended for all travellers over 65 years of age or with underlying medical conditions that compromise immunity such as heart or lung disease, cancer or HIV.

Rabies Three injections in all. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally headache and sore arm.

Tuberculosis A complex issue. High-risk adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Only one vaccine is given in a lifetime. Children under five spending more than three months in China should be vaccinated.

Pregnant women and children should receive advice from a doctor who specialises in travel medicine.

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Dangers & annoyances

Crime

Travellers are more often the victims of petty economic crime, such as theft, than serious crime, although an American was stabbed to death in broad daylight in Běijīng in 2008. Foreigners are natural targets for pickpockets and thieves, but you shouldn’t have any problems as long as you keep your wits about you and make it difficult for thieves to get at your belongings. Certain cities and places are worse than others – Guǎngzhǒu, Guìyáng, Xī’ān and Zhèngzhōu are notorious, in particular, for petty crime. Incidences of crime increase around the Chinese New Year.

High-risk areas in China are train and bus stations, city and long-distance buses (especially sleeper buses), hard-seat train carriages and public toilets. Don’t leave anything of value in your bicycle basket.

Hotels are generally safe; many have attendants on each floor, who keep an eye on the rooms and guard the keys. Dormitories obviously require more care. Don’t be overly trusting of your fellow travellers; some of them are considerably less than honest. All hotels have safes and storage areas for valuables – use them. Don’t leave anything you can’t do without (passport, travellers cheques, money, air tickets etc) lying around in dorms.

Carry just as much cash as you need and keep the rest in travellers cheques. Obviously you will need to equip yourself with more cash if you’re travelling to remote areas, as you may not be able to cash your travellers cheques; take a money belt for your cash, passport and credit cards.

A worrying trend is the increasing number of reports of foreigners attacked or even killed for their valuables, especially in more rural locations, so be vigilant at all times. Travelling solo carries obvious risks; it’s advisable to travel with someone else or in a small group.

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Loss reports

If something of yours is stolen, report it immediately to the nearest Foreign Affairs Branch of the PSB. Staff will ask you to fill in a loss report before investigating the case and sometimes even recovering the stolen goods.

If you have travel insurance (highly recommended), it is essential to obtain a loss report so you can claim compensation. Be warned, however: many travellers have found Foreign Affairs officials very unwilling to provide a loss report. Be prepared to spend many hours, perhaps even several days, organising it. Make a copy of your passport in case of loss or theft.

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Pollution & noise

Pollution is a serious problem in China, and can make travel unpleasant for everyone, especially if you have allergies, skin conditions, or chest, eye, nose and throat problems. According to the World Bank, China has 20 of the world’s 30 most-polluted cities and, by some measures, Běijīng is the world’s most polluted city. With some estimates predicting that China’s air pollution could quadruple over the next 15 years, an environmental disaster could be in the making. As such, although a trip to China for ancient health regimes such as qì gōng looks good on paper, you may actually be doing yourself harm.

Casual disposal of litter is also an issue. Throughout China it is common to see fields and trees festooned with plastic bags, and rubbish is thrown willy-nilly on the street.

The Chinese are also generally much more tolerant of high decibels than most foreigners. The Chinese government long ago launched an anti–noise-pollution campaign and, as a result, numerous cities have banned the use of car horns within the city. Yet screeching hawkers, yelling mobile phone users, roof-lifting karaoke parlours and high-decibel background noise can all make China a deafening experience.

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Queues

In China, the instinct of large numbers of people with a common goal (a bus seat, a train ticket, purchasing a SIM card, ordering a Big Mac etc) is to form a surging mass; however, queuing has been heavily promoted over recent years and forming a line is far more common these days.

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Scams

Con artists are not just increasingly widespread in China – their methods are becoming ever more audacious. Well-dressed girls flock along Shànghǎi’s East Nanjing Rd and Běijīng’s Wangfujing Dajie, dragging single men to expensive cafes or Chinese teahouses and making them foot monstrous bills. ‘Poor’ art students haunt similar neighbourhoods, press-ganging foreigners into art exhibitions where they are coerced into buying trashy art. Just say no.

Also watch out for itinerant Buddhist monks preying on foreigners for alms. They approach visitors and, after asking them to sign a book, ask for a donation along the ‘give-as-much-as-you-see-fit’ line. Travellers can feel pressured into giving money, and it can also be hard to work out if the monks are genuine or not.

Don’t leave any of your belongings with someone you do not know well; it could be the last you see of them.

There’s a plague of dishonest businesses and enterprises. The travel agency you phoned may just be a gang of card-playing con artists cooped up in a cigarette-smoke-filled hotel room.

Be alert at all times if changing money on the black market. One trick is for the moneychanger to take your money, then ask to recount the money he has just given you; once he takes the money back, the last you see of him and your cash is his heels moving at velocity down the road. If buying a black-market train ticket, ensure the date, time, destination and ticket type (eg soft sleeper) are correct before handing over your cash.

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Spitting

Spitting is one of the banes of modern China. Campaigns to stamp out spitting have been partially successful in the major urban centres; there is less public spitting in Guǎngzhōu, Shànghǎi and Běijīng, where people now abstain or spit into rubbish bins. But you will still see much phlegm flowing – and don’t be too surprised if the hawker you just bought a snack from turns around to blow her nose into her fingers.

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In transit

Deep vein thrombosis (dvt)

Deep vein thrombosis occurs when blood clots form in the legs during flights, chiefly because of prolonged immobility. Though most blood clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they may cause life-threatening complications.

The chief symptom of DVT is swelling or pain of the foot, ankle or calf, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and difficulty in breathing. Travellers with any of these symptoms should immediately seek medical attention.

To prevent the development of DVT on long flights you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids, and avoid alcohol and tobacco. Those at increased risk should wear compression socks.

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Jet lag & motion sickness

Jet lag is common when crossing more than five time zones; it results in insomnia, fatigue, malaise or nausea. To avoid jet lag try drinking plenty of fluids (nonalcoholic) and eating light meals. Upon arrival, seek exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.

Antihistamines such as dimenhydrinate (Dramamine), promethazine (Phenergan) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. Their main side effect is drowsiness. An herbal alternative is ginger, which works like a charm for some people.

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While you're there

Air pollution

Air pollution is becoming a significant problem in many Chinese cities due to increasing industrialisation. People with underlying respiratory conditions should seek advice from their doctor prior to travel to ensure they have adequate medications in case their condition worsens. It is very common for healthy people to develop irritating coughs, runny noses etc while in urban Chinese centres as a result of the pollution. It is a good idea to carry symptomatic treatments such as throat lozenges, and cough and cold tablets.

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Altitude sickness

There are bus journeys in Tibet, Qīnghǎi and Xīnjiāng where the road goes over 5000m. Acclimatising to such extreme elevations takes several weeks at least, but most travellers come up from sea level very fast – a bad move! Acute mountain sickness (AMS) results from a rapid ascent to altitudes above 2700m. It usually commences within 24 to 48 hours of arriving at altitude, and symptoms include headache, nausea, fatigue and loss of appetite; in fact, it very much feels like a hangover. If you have altitude sickness, the cardinal rule is that you must not go higher as you are sure to get sicker and could develop one of the more severe and potentially deadly forms of the disease. These are high-altitude pulmonary oedema (HAPE) and high-altitude cerebral oedema (HACE). Both of these forms of altitude sickness are medical emergencies and, as there are no rescue facilities similar to those in the Nepal Himalaya here, prevention is the best policy. AMS can be prevented by ‘graded ascent’; it is recommended that once you are above 3000m you ascend a maximum of 300m daily and have an extra rest day every 1000m. You can also use a medication called Diamox as a prevention or treatment for AMS, but you should discuss this first with a doctor experienced in altitude medicine. Diamox should not be taken by people with a sulphur drug allergy.

If you have altitude sickness you should rest where you are for a day or two until your symptoms resolve. You can then carry on, but ensure you follow the graded ascent guidelines. If symptoms are getting worse, you must descend immediately before you are faced with a life-threatening situation. There is no way of predicting who will suffer from AMS, but certain factors predispose you to it: rapid ascent, carrying a heavy load, and having a seemingly minor illness such as a chest infection or diarrhoea. Make sure you drink at least 3L of noncaffeinated drinks daily to stay well hydrated. The sun is intense at altitude so take care with sun protection.

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Food

Eating in restaurants is the biggest risk factor for contracting traveller’s diarrhoea. Ways to avoid it include eating only freshly cooked food, and avoiding food that has been sitting around in buffets. Peel all fruit, cook vegetables and soak salads in iodine water for at least 20 minutes. Eat in busy restaurants with a high turnover of customers.

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Heat exhaustion

Dehydration or salt deficiency can cause heat exhaustion. Take time to acclimatise to high temperatures, drink sufficient liquids and do not do anything too physically demanding.

Salt deficiency is characterised by fatigue, lethargy, headaches, giddiness and muscle cramps; salt tablets may help, but adding extra salt to your food is better.

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Hypothermia

Too much cold can be just as dangerous as too much heat. If you are trekking at high altitudes or simply taking a long bus trip over mountains, particularly at night, be aware. In Tibet it can go from being mildly warm to blisteringly cold in a matter of minutes – blizzards have a way of just coming out of nowhere. If you’re out walking, cycling or hitching, this can be dangerous.

It is surprisingly easy to progress from very cold to dangerously cold due to a combination of wind, wet clothing, fatigue and hunger, even if the air temperature is above freezing. It is best to dress in layers; silk, wool and some of the new artificial fibres are all good insulating materials. A hat is important, as a lot of heat is lost through the head. A strong, waterproof outer layer (and a space blanket for emergencies) is essential. Carry basic supplies, including food containing simple sugars to generate heat quickly, and fluid to drink.

Symptoms of hypothermia are exhaustion, numb skin (particularly the toes and fingers), shivering, slurred speech, irrational or violent behaviour, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy.

To treat mild hypothermia, first get the person out of the wind and/or rain, remove their clothing if it’s wet and replace it with dry, warm clothing. Give them hot liquids – not alcohol – and some high-calorie, easily digestible food. The early recognition and treatment of mild hypothermia is the only way to prevent severe hypothermia, which is a critical condition and requires medical attention.

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Insect bites & stings

Bedbugs don’t carry disease but their bites are very itchy. They live in the cracks of furniture and walls and then migrate to the bed at night to feed on you. You can treat the itch with an antihistamine.

Lice inhabit various parts of the human body but most commonly the head and pubic areas. Transmission is via close contact with an affected person. Lice can be difficult to treat and you may need numerous applications of an antilice shampoo such as Permethrin. Pubic lice (crab lice) are usually contracted from sexual contact.

Ticks are contracted after walking in rural areas. Ticks are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms such as a rash at the site of the bite or elsewhere, fever or muscle aches you should see a doctor. Doxycycline prevents some tick-borne diseases.

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Avian influenza (bird flu)

Bird flu or influenza A (H5N1) is a subtype of the type A influenza virus. This virus typically infects birds and not humans; however, in 1997 the first documented case of bird-to-human transmission was recorded in Hong Kong. As of 2008 there have been 27 confirmed human cases in China, of whom 18 have died. Currently, very close contact with dead or sick birds is the principal source of infection and bird-to-human transmission does not easily occur.

Symptoms include high fever and influenza-like symptoms with rapid deterioration, leading to respiratory failure and death in many cases. The early administration of antiviral drugs such as Tamiflu is recommended to improve the chances of survival. At this time it is not routinely recommended for travellers to carry Tamiflu with them; rather, immediate medical care should be sought if bird flu is suspected. At the time of writing there have been no recorded cases in travellers or expatriates.

There is currently no vaccine available to prevent bird flu. For up to date information check the World Health Organization (www.who.int/en/) and avianinfluenza.com.au (www.avianinfl uenza.com.au).

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Dengue

This mosquito-borne disease occurs in some parts of southern China. It can only be prevented by avoiding mosquito bites – there is no vaccine. The mosquito that carries dengue bites day and night, so use insect avoidance measures at all times. Symptoms include high fever, severe headache and body ache (previously dengue was known as ‘break bone fever’). Some people develop a rash and diarrhoea. There is no specific treatment – just rest and paracetamol. Do not take aspirin. See a doctor to be diagnosed and monitored.

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Hepatitis a

A problem throughout China, this food- and waterborne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment for hepatitis A, you just need to allow time for the liver to heal. All travellers to China should be vaccinated.

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Hepatitis b

The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by contact with infected body fluids, including via sexual contact. The long-term consequences can include liver cancer and cirrhosis. All travellers to China should be vaccinated.

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Hiv

HIV is transmitted via contaminated body fluids. Avoid unsafe sex, blood transfusions and injections (unless you can see a clean needle being used) in China. Always use condoms if you have sex with a new partner and never share needles.

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Influenza

Present particularly in the winter months, symptoms of the flu include high fever, runny nose, muscle aches, cough and sore throat. It can be very severe in people over the age of 65 or in those with underlying medical conditions such as heart disease or diabetes – vaccination is recommended for these individuals. There is no specific treatment, just rest and painkillers.

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Japanese b encephalitis

This is a rare disease in travellers; however, vaccination is recommended if spending more than a month in rural areas during the summer months, or more than three months in the country. There is no treatment available and one-third of infected people will die, while another third suffer permanent brain damage.

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Malaria

For such a serious and potentially deadly disease, there is an enormous amount of misinformation concerning malaria. Before you travel, be sure to seek medical advice to see if your trip warrants taking antimalaria medication and if it does, to ensure that you receive the right medication and dosage for you.

Malaria has been nearly eradicated in China and is not generally a risk for visitors to the cities and most tourist areas. It is found mainly in rural areas in the southwestern region – principally Hǎinán, Yúnnán and Guǎngxī bordering onto Myanmar, Laos and Vietnam. There is more limited risk in remote rural areas of Fújiàn, Guǎngdōng, Guǎngxī, Guìzhōu, and Sìchuān. Generally medication is only advised if you are visiting rural Hǎinán or Yúnnán.

Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. Diagnosis can only be made by taking a blood sample.

Two strategies should be combined to prevent malaria – mosquito avoidance and antimalaria medications. Most people who catch malaria are taking inadequate or no antimalarial medication.

You should always take general insect avoidance measures in order to help prevent all insect-borne diseases, not just malaria. Travellers are advised to prevent mosquito bites by taking these steps:

Use a DEET-containing insect repellent on exposed skin. Wash this off at night, as long as you are sleeping under a mosquito net. Natural repellents such as Citronella can be effective, but must be applied more frequently than products containing DEET.

Sleep under a mosquito net impregnated with permethrin.

Choose accommodation with screens and fans (if not air-conditioned).

Impregnate clothing with permethrin in high-risk areas.

Wear long sleeves and trousers in light colours.

Use mosquito coils.

Spray your room with insect repellent before going out for your evening meal.

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Rabies

This is an increasingly common problem in China. This fatal disease is spread by the bite or lick of an infected animal – most commonly a dog. Seek medical advice immediately after any animal bite and commence post-exposure treatment. Having pretravel vaccination means the post-bite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply an iodine-based antiseptic. If you are not prevaccinated you will need to receive rabies immunoglobulin as soon as possible, followed by a series of five vaccines over the next month. Those prevaccinated require only two shots of vaccine after a bite.

Contact your insurance company to find the nearest clinic that stocks rabies immunoglobulin and vaccine. It’s common that immunoglobulin is unavailable outside of major centres – it’s crucial that you get to a clinic that has immunoglobulin as soon as possible if you have had a bite that has broken the skin.

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Schistosomiasis

Also known as bilharzia, this disease is found in the central Yangzi River (Cháng Jiāng) basin. It is carried in water by minute worms which infect certain varieties of freshwater snail found in rivers, streams, lakes and particularly behind dams. The worm enters through the skin and attaches itself to your intestines or bladder. The infection often causes no symptoms until the disease is well established (several months to years after exposure) and damage to internal organs irreversible.

Avoiding swimming or bathing in fresh water where bilharzia is present is the main method of prevention. A blood test is the most reliable way to diagnose the disease, but the test will not show positive until weeks after exposure. Effective treatment is available. There is no way of knowing if water is infected.

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Stds

Sexually transmitted diseases most common in China include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine seek immediate medical attention. If you have been sexually active during your travels have an STD check on your return home.

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Tuberculosis (tb)

Medical and aid workers, and long-term travellers who have significant contact with the local population, should take precautions against TB. Vaccination is usually only given to children under the age of five, but adults at risk are recommended to have pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.

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Typhoid

This serious bacterial infection is spread via food and water. Symptoms are headache and a high and slowly progressive fever, which may be accompanied by a dry cough and stomach pain. Be aware that vaccination is not 100% effective so you must still be careful with what you eat and drink. All travellers spending more than a week in China should be vaccinated.

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Giardiasis

Giardia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardia, but work in Nepal has shown that they are not specific to giardia. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is Tinidazole, with Metronidazole being a second option.

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Availability of health care

There are now a number of good clinics in major cities catering to travellers. Although they are usually more expensive than local facilities, you may feel more comfortable dealing with a Western-trained doctor who speaks your language. These clinics usually have a good understanding of the best local hospital facilities and close contacts with insurance companies should you need evacuation.

Self-treatment may be appropriate if your problem is minor (eg traveller’s diarrhoea), you are carrying the relevant medication and you cannot attend a clinic. If you think you may have a serious disease, especially malaria, do not waste time – travel to the nearest quality facility to receive attention.

Buying medication over the counter in China is not recommended, as fake medications and poorly stored or out-of-date drugs are common.

To find the nearest reliable medical facility, contact your insurance company or your embassy.

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Traditional medicine

Traditional Chinese medicine (TCM) views the human body as an energy system in which the basic substances of (vital energy), jīng (essence), xuè (blood, the body’s nourishing fluids) and tǐyè (body fluids; blood and other organic fluids) function. The concept of Yin and Yang is fundamental to the system. Disharmony between Yin and Yang or within the basic substances may be a result of internal causes (emotions), external causes (climatic conditions) or miscellaneous causes (work, exercise, sex etc). Treatment modalities include acupuncture, massage, herbs, diet and qìgōng, and aim to bring these elements back into balance. These therapies are particularly useful for treating chronic diseases and are gaining interest and respect in the Western medical system. Conditions that can be particularly suitable for traditional methods include chronic fatigue, arthritis, irritable bowel syndrome and some chronic skin conditions.

Be aware that ‘natural’ doesn’t always mean ‘safe’, and there can be drug interactions between herbal medicines and Western medicines. If you are utilising both systems ensure you inform both practitioners what the other has prescribed.

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Traveller’s diarrhoea

Traveller’s diarrhoea is by far the most common problem affecting travellers – between 30% to 50% of people will suffer from it within two weeks of starting their trip. In most cases, traveller’s diarrhoea is caused by a bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics. Treatment with antibiotics will depend on your situation – how sick you are, how quickly you need to get better, where you are etc.

Traveller’s diarrhoea is defined as the passage of more than three watery bowel actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell.

Treatment consists of staying well hydrated; rehydration solutions like Gastrolyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.

Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It can be helpful, for example if you have to go on a long bus ride. Don’t take Loperamide if you have a fever, or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic.

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Amoebic dysentery

Amoebic dysentery is actually rare in travellers and is overdiagnosed. Symptoms are similar to bacterial diarrhoea, ie fever, bloody diarrhoea and generally feeling unwell. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs: Tinidazole or Metronidazole to kill the parasite in your gut, and then a second drug to kill the cysts. If left untreated complications such as liver or gut abscesses can occur.

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Intestinal worms

These parasites are most common in rural, tropical areas. Some may be ingested in food such as undercooked meat (eg tapeworms) and some enter through your skin (eg hookworms). Infestations may not show up for some time, and although they are generally not serious, if left untreated some can cause severe health problems later. Consider having a stool test when you return home to check for these and to determine the appropriate treatment.

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Women’s health

Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 14 and 28 weeks), when the risk of pregnancy-related problems is at its lowest and pregnant women generally feel at their best. During the first trimester there is a risk of miscarriage and in the third trimester complications such as premature labour and high blood pressure are possible. It’s wise to travel with a companion. Always carry a list of quality medical facilities available at your destination and ensure you continue your standard antenatal care at these facilities. Avoid rural travel in areas with poor transportation and medical facilities. Most of all, ensure travel insurance covers all pregnancy-related possibilities, including premature labour.

Malaria is a high-risk disease in pregnancy. WHO recommends that pregnant women do not travel to areas with Chloroquine-resistant malaria.

Traveller’s diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many of the drugs used to treat various diarrhoea bugs are not recommended in pregnancy. Azithromycin is considered safe.

Supplies of sanitary products may not be readily available in rural areas. Birth control options may be limited so bring adequate supplies of your own form of contraception. Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as Clotrimazole. A practical alternative is a single tablet of Fluconazole (Diflucan). Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.

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