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We saw:  Airplanes, our first look at Beijing


We saw:  Summer Palace, Tiananmen Square, Forbidden City, Peking Duck


We saw:  Great Wall, rickshaw ride, Beijing hutong


We saw:  Beijing school, Big Wild Goose Pagoda


We saw:  Terracotta Warriors, Shaanxi Museum


We saw:  World Financial Center, downtown Shanghai


We saw:  Jade Buddha Temple, the Bund, Chinatown


We saw:  Airports ... and too much of the Shanghai tarmac


We saw:  Great Wall, rickshaw ride, Beijing hutong


We saw:  Terracotta Warriors, Shaanxi Museum


We saw:  Jade Buddha Temple, the Bund, Chinatown

Is this hell or a communist hospital?

A few had never flown before. A few others had never used an ATM.

And one of the young ladies in our China travel group had a wicked peanut allergy that required us to give every chef the third degree … or risk having to harpoon her with an EpiPen. (Had goober and girl met, I think we would have merely been required to firmly poke her in the leg. However, in my mind, I would be John Travolta in" Pulp Fiction", plunging a syringe full of adrenaline right through the breast bone of a frothy-mouthed, bloody-nosed Uma Thurman.)

As any parent can tell you, traveling with kids in tow is nothing like a business trip or a second honeymoon. More planning, patience and courage are required.

And when the kids aren't all yours — as was the case with 21 of the 22 young people in our group of 26 — the demands are all the greater. After all, wouldn't you just die if your plane took off while a straggler was still standing in the checkout line at the duty-free shop? Or if one of them thought it would be real cute to try to sneak a box of Cubans past the grim-faced TSA agent with a jones for cavity searches?

Debi has already developed worry calluses: She had helped lead or chaperone four previous trips abroad. Her fellow teacher and chaperone Lori Lundgaard helped shoulder the responsibility for this one, and that included recruiting travelers, conducting fundraisers, gathering travel documents, making room assignments, starting phone trees … the sheer amount of logistical maneuvering would lead you to believe they were planning to attack China, not visit it.

I, on the other hand, am more or less a useless appendage, although I have learned the two paramount rules of traveling with a large group of kids: Count heads before departing for and after reaching each new destination; and treat every bump, bruise and sniffle before they become oozing boils, sprawling hematomas or whooping cough. Debi learned this long ago, which explains why she lugs enough medicine in her purse to pass for a pharmaceutical sales rep. She carries pills to relieve pain, pills to cure motion sickness, pills to clear clogged noses, pills to make you poop, pills to make you stop pooping.

Unfortunately, none of that indemnified us against an off-the-itinerary field trip through a communist health care system.

One of the kids, Paige, boarded the first flight with a small blister on her right heel. By the time we landed in Beijing a little more than 24 hours later, her foot had plumped up like a Ballpark Frank, and the poor girl was limping. The blister was infected.

A foot wound would be bothersome anywhere, but it can be catastrophic in China, which I'm fairly certain is derived from the Mandarin for "land egregiously inhospitable to feet." People spit big, mucous-laden globs on the sidewalks. Kids pee in the gutters with their parents' consent. And the carpets in most establishments we visited appeared to be vacuumed once every five years, whether they need it or not.

In other words, no one walks around China barefoot.

The initial plan was to swing by the market down the street on the morning of our first full day in China. We would pick up some topical antibiotic and bandages before heading on to the tour of the Summer Palace. One trouble: The Woo Mart across the street (no kidding, that's what it was called) didn't open until 9 a.m., by which time we were supposed to be an hour into our first excursion. Our tour director, Robert, was adamant the entire group not be delayed for the sake of just one person. So Debi was to stay behind with Paige and her sister, Cambria, take them to purchase the necessary supplies, then take a cab to rejoin the group later in the day.

It seemed a bit ridiculous to us for Debi and the girls to surrender a half day to an errand that would take 15 minutes back home. But so be it. Like I said, the kids' health comes first, and if Woo Mart employees insist upon working banker hours ...

By the next morning, our irritation was moot. Paige's foot had swollen yet more overnight, and Robert, inspecting it for the first time, declared that "in China, we do not walk on feet like that." Paige needed to see a doctor, so Robert called for a cab and gave Debi, Paige and Cambria the address for a university hospital in Beijing, which caters to foreigners.

It sounds almost like the setup for a slasher flick: Three forlorn females amble into a dimly lit communist hospital with Mengele-era equipment and gruff orderlies who don't speak English. But Debi actually was pleasantly surprised by their first experience, which proceeded in a fashion that was well-orchestrated if a bit inefficient.

Paige was immediately seated in a wheelchair and whisked into a "surgery room," where her heel was cleaned and inspected. Meanwhile, Debi was taken to a window to get — and pay for — a patient ID card required of non-citizens. No problem. She swiped a credit card. Paige's wound was dressed by a doctor, who seemed competent and concerned. He prescribed both oral and intravenous medicine, the latter to be administered in the hospital that night. Debi was directed to a pharmacy to buy the medicine — and again swipe the credit card. (Oddly, not only did she pay for the drip bag, the drip bag was handed to her to give to the doctor.) The physician wanted Paige to stay off her feet, but Debi explained that would be almost impossible given the nature of our trip. So they talked him into crutches … which required yet another trip down the hall and another swipe of the credit card.

The trip and its a la carte purchases consumed most of the morning, but the three were able to meet up with the group for a tour of Tiananmen Square and the Forbidden City a bit after mid-day. Though relieved, they were not out of the woods — Paige was to return to the hospital for a second IV treatment that night, and she needed one more the next evening, too, which posed a challenge since we would be leaving Beijing for Xi'an the next morning.

The nighttime treatment in Beijing was to take place in a second hospital closer to our hotel, and our tour company, EF Education Tours, arranged for an interpreter to take Debi and the girls there. At the last minute, Robert decided it would be a better idea to return to a clinic in an annex of the hospital they had visited that morning. Upon arrival, Debi walked in ahead of the group to make sure they were in the right place, only to discover a waiting room brimming with hocking, coughing, bleeding patients, all awaiting treatment that didn't seem forthcoming. Now this had slasher-film potential. Debi didn't even let Paige go inside; they made a bee line to the place they had been that morning.

The staff there seemed a bit annoyed to see them again, but after some grumbling, treatment resumed.

But it did not pass quickly.

Already exhausted from the day's activities, the party didn't return to the hotel until 1 a.m. — with a 6:30 a.m. wake-up call pending. One reason for the delay was that the hospital was old and equipped with dated instruments — for example, there was no IV machine to speed along the medication, just an old-fashioned, gravity-powered drip bag. It was administered in a six-bed room, where the lights were kept on as doctors consulted with some patients as others tried in vain to sleep.

Debi and the girls got the impression that even simple supplies were scarce. For example, the wound made by the IV needle, which would have been quickly swabbed with disinfectant and covered with a BandAid in the United States, was instead patted with some strange adhesive strip to stop the bleeding. Debi also noticed that a bathroom that lacked toilet paper during their morning trip still had not been restocked that evening. (Indeed, toilet paper, napkins and other paper products seemed in short supply everywhere.)

Debi arrived at the hotel that night tired and frustrated, but her nerves would be more severely tested the next night at the hospital in Xi'an.

Toting a raft of paperwork to explain Paige's condition and the Beijing doctor's recommendations, the trio passed through the main entrance through heavy plastic strips — "like walking into a Sams Club," Debi said. The documentation did little good in Xi'an's foreigners hospital, though. For starters, the doctor spoke no English … which, of course, makes him perfectly suited to work in a foreigners' hospital. His bed-side manner was nearly as bad as his English, and he and the interpreter EF sent along spent most of the visit yelling at each other.

The bone of contention was the doctor's refusal to administer the IV bag Debi had lugged from Beijing. The drug was too strong for a girl Paige's age and should never have been prescribed in the first place, the doctor asserted.

Not only were they getting nowhere, they were getting no sleep. So Debi pulled rank and took Paige back to the hotel without the IV treatment. The swelling was going down, and this hospital had the sanitary standards of a gas station bathroom, anyway. Paige would continue to take the oral medicine and soak her foot in salt water each night. We would continue to monitor the swelling. At the first sign of regression, we'd take her back to the hospital.

Otherwise, we were finished with Chinese medicine.

Who knows if the the doctor in Xi'an was right about the potency of the IV. Who knows if there really were as many SARS patients as there appeared to be in the cramped annex waiting room.

And who knows if our foray into Chinese medicine was typical or atypical. After all, three trips to three hospitals in a land so vast and varied hardly makes any of us experts.

That said, the experience certainly is consistent with what the media has reported about medical care in the People's Republic.

AIDS/HIV, hepatitis B, tuberculosis, SARS, obesity and smoking present  threats that are lethal and mounting. Further, medical treatment is out of reach of about 500 million Chinese, according to a recent IMB Institute for Business Value report. They lack access to affordable care, they suffer inefficient use of what meager health care resources are provided and they generally receive low-quality care even when they can afford treatment, the report concludes.

In a recent blog on Forbes' website by Janet Carmosky, who lives in Shanghai, China's health care system is marked by:

  • • all-day waits outdoors or in crowded, noisy, cement-floor registration rooms;
    • numerous check-in desks, each typically reached after a queue that is only sometimes orderly but always long;
    • long lists of cellphone numbers of doctors who are relatives of friends, who can help you get some real care;
    • huge cash deposits required before admission;
    • four-figure bills from unnecessary diagnostic tests and prescriptions;
    • counterfeit pharmaceuticals;
    • nonexistence of reliable home care, elder care, hospice or rehabilitation.

An already tenuous system fractured further in the 1980s, as the government did away with the people's communes. As that mode of farming disappeared — and as many Chinese left the countryside to seek better-paying work in the cities — so did the "barefoot doctors," the grassroots providers who worked in rural medical centers. In 2005, the country overhauled its health care system, mostly in an effort to insure the rural poor who rarely received primary care.

Then, two years ago, China had another massive overhaul, this one aimed at providing universal health care.

Nothing has worked quite as intended.

Yes, China has reached 94 percent coverage, according to one recent news report. But what good is coverage when patients still have to pay out-of-pocket fees and large deductibles? Also, there are separate plans for rural and urban residents, which means many migrants from the countryside are not covered in the cities. Nonetheless, many from both the cities and rural areas throw the system out of kilter by seeking treatment in hospitals — where they trust the quality of care — and bypassing lower-tier service-providers like community clinics. Some doctors see as many as 50 patients a day in hospitals that line up beds in the hallways, the PBS report says.

China's streets also overflow with the destitute and sick, many of them maimed in industrial accidents that cost them their livelihoods.

One of the kids asked Robert why, in a communist country where the government presumably takes care of everyone, we saw so many people with serious medical problems.

"China has so many people, the government doesn't have enough money to help everyone," Robert said.

He said this without irony or bitterness.

It was a matter-of-fact statement about the unsettling reality of a communist utopia.

Paige hangs tough in a communist hospital.

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