Managing your child’s health care needs in Beijing
When Josh Toronto was 18 months old, he developed a lump on the side of his neck. His mother Barbara took him to a Beijing clinic, where the doctors diagnosed mumps and started him on antibiotics. But the lump continued to grow. Barbara suspected her son might have a staph infection, but the expat doctors who examined him disagreed. After three weeks on antibiotics and a stint in the hospital on an IV, the family called in a Chinese specialist. She agreed with Barbara: Josh had staph. By now the lump was so large that Josh required surgery. After consulting with their pediatrician back home, Barbara and her husband opted to return to the States for the surgery. Fortunately, their medevac insurance covered the journey home and allowed them to remain in the States while Josh recuperated.
Today Josh is a healthy third-grader at ISB, with a crooked scar on his neck as a reminder of what transpired. His mother is certain his condition would have been diagnosed more quickly back home, but she is quick to point out: “Since Josh’s illness seven years ago, a lot has changed in terms of quality and availability of health care for kids in Beijing.” She remembers how scary it was at the time to be far from home with a sick baby. But Barbara also remembers the support she got from other expats in Beijing: Church friends stepped forward with casseroles and offers to babysit her other children while she was away. She also credits her “fabulous ayi,” who put in extra hours to make sure the household ran smoothly.
Barbara offers this advice to every expat: “Develop a support network as soon as you can, however you can.” Get to know fellow church members, neighbors and co-workers, she says. “They’ll be the ones who will step in when the bubble bursts.” Steve Pittman, a former law enforcement officer and now a security consultant in Beijing, concurs. “You need to know who has medical training and can assist in an emergency. You need to know who has a car to transport people to the hospital. You need to note who is home during the day. You need to think about the worst case scenario and prepare for it.”
Pittman’s advice stems from personal experience. In 2004, his daughter Estee began complaining of headaches and vision trouble. Her parents took her to Beijing United, where an eye exam revealed loss of vision. BJU sent Estee to Tiantan Hospital for an MRI with contrast, which revealed a tumor on the tenth-grader’s pituitary gland. Estee was medevaced to UCLA Medical Center, where a neurosurgeon determined she needed an immediate operation to remove the tumor. Every six months since, she has returned to Tiantan Hospital, along with her parents and a translator, for a follow-up MRI to ascertain whether or not the tumor has returned. “It was, and still is, hard on Estee,” says Steve. “One of the possible side effects of an MRI with contrast is death, and talking to your child about that is really difficult. It scared her – and us.”
Despite the availability and high quality of Western medicine in Beijing, medical evacuations can and do happen. According to Dr. Robyn Searl, an Australian physician at International SOS, there are not many medical evacuations of children in Beijing. “Most problems can be taken care of here. But we do medevac three or four premature babies and several children every year.” Dr. Martin Springer, chair of the department of critical care and ER at Beijing United Hospital, concurs that children rarely need to be evacuated from Beijing. “A medevac is not an immediate process,” he points out, explaining that in most true emergencies, there simply wouldn’t be time to wait for an air evacuation.
Most pediatric problems can be dealt with at Beijing United or other local hospitals. Even so, Elena Makeeva, the marketing manager at International SOS, advises expats to “always carry a cell phone and be sure it is charged. Carry copies of your insurance card and passports. If you are a member of International SOS, you can contact us for help while you’re traveling – bring our emergency numbers with you. And make sure someone back home has a copy of your itinerary.”
Barbara Toronto strongly recommends using an insurance company that will pay for a medical evacuation, as a private jet can run in excess of USD 50,000. The next step is ensuring that your children are covered while in China from day one – especially if you are planning to give birth here. Dr. Searl suggests talking to your insurance company and reading the fine print carefully: What’s covered? What is excluded? How long do you have to notify them after emergency treatment or the birth of a baby? Be prepared for all outcomes, she says, and “get your newborn onto your insurance policy well before he arrives.” In addition, Dr. Searl points out, “even in an emergency medevac, you need to have all of the proper paperwork, which means the baby is going to need a passport to leave China. Even the most attentive embassy will take a minimum of one business day to process the paperwork.” So, suggests Dr. Searl, if you have a high-risk pregnancy or are at risk of pre-term labor, you might want to consider giving birth in your home country.
Most evacuations of older children are handled on commercial flights, and the availability of an air ambulance is usually not an issue. Dr. Springer’s bigger concern in dealing with emergencies in Beijing is the lack of accessibility to modern ambulances. More often than not, he says, what few ambulances there are in the city can’t get to you in time, especially in suburbs like Shunyi, where many expat kids live. Many embassies recommend transporting distressed family members to the hospital in their own vehicles or cabs for immediate treatment.
“Physicians think of the time immediately following a trauma as the ‘Golden Hour,’” explains Dr. Springer. A few unfortunate patients are going to die within ten minutes of being injured, and there is nothing anyone can do to save them. But for the majority of trauma patients, the intervention they receive in the Golden Hour after their injury will determine whether they live or die. “If a bystander is able to administer CPR to a drowning victim, that person has a chance to survive. If no one nearby knows CPR, that person will likely die while waiting for an ambulance,” says Dr. Springer.
For this reason, Dr. Springer recommends that all expats in Beijing take basic first aid and CPR courses. Both Beijing United and International SOS offer first aid classes in Chinese for household staff members. He suggests that residents of large housing complexes push their management companies to offer first aid training for all employees – especially lifeguards. “Drowning is the number one cause of death for children,” he notes, and Dr. Searl agrees. “I myself have pulled kids out of the pool where I live,” she says. “Parents are letting their ayis supervise the children at the pool, but they don’t realize that many ayis can’t swim.”
“You need to take responsibility for your kids’ safety in Beijing,” stresses Dr. Springer. “Parents arrive in Beijing and decide that their children no longer need car seats, no longer need bicycle helmets. But bicycle helmets reduce the collision death rate by 70 percent.” He and Dr. Searl also both point out that China has no requirement for child-resistant packaging on medicines or cigarette lighters, so it’s best to make sure these items are out of reach. Remind your ayi that chemicals and cleaning solutions should not be stored under the sink. And although smoke detectors aren’t required, it is a good idea to make sure they are installed in your house.
The most important safety precaution to take is vaccinations. “At the very least,” says Dr. Searl, “you need to make sure your child has all of the vaccinations required by your home country. But you might also want to look at the US vaccination schedule, as it is the most comprehensive.”
“We’re well-equipped in Beijing to handle most any emergency involving children,” says Dr. Springer. “But as a parent, you need to use common sense to protect your child on a day-to-day basis.”
Are You Prepared for an Emergency?
- Make sure your health insurance is valid in Beijing
- Buy medevac insurance. Talk to your provider and make sure you know what it covers: Where will they fly you in an emergency? Will they pay to fly family members to accompany the patient? Is there a cap on what they will spend per incident? Per family?
- Establish a network of neighbors who can watch the dog, pick up kids or prepare meals in an emergency. Store their numbers in your cell phone and wallet
- Carry emergency numbers with you
- Carry addresses of ER clinics – make sure they’re in Chinese so a taxi driver can read them
- Enroll your ayi and driver in a first aid course
- Keep your cell phone charged and carry it with you at all times
- Keep a stash of emergency cash on hand
- Have passports readily available
- Avoid emergencies – childproof your house and yard. Download and print an extensive safety checklist such as this one from the Kidsafe of Western Australia website.
When You’re Traveling
- Carry copies of passports and insurance cards
- Bring your cell phone, an extra battery and a charger
- Bring the number for your country’s embassy
- Make sure someone else knows your itinerary
- Avoid long-haul buses, as drivers are often speeding and sleep-deprived; consider taking the train instead
- Have younger children memorize their phone number and address
- Older kids should carry cell phones; program all emergency numbers into the phone
- Older children should consider taking a first aid course
- Younger children should use car seats and booster seats; learn how to determine which type of seat your child needs at the Driver Knowledge website.
- All kids need to wear bike helmets; learn how they should fit at this guide from the United States National Highway Traffic Safety Administration.