When I mention to someone that we live in Shenzhen, China now, it is only a matter of time before the topic of the Chinese medical system comes up. “Are you forced to drink tea made from (insert weird animal part here) weekly? Or daily?” “Does acupuncture take the place of real live medicine?” “Will doing tai chi in the park at 5am really solve all of my health problems?”

We’ve had a relatively smooth introduction to China on the health front (our visa situation was a different story). No visits to the emergency room, and our one visit to a pharmacy was painless. But we get it. We’re intimidated by the Chinese health care system as much as anyone would be, when faced with a plethora of misinformation from movies and that oh-so-intimidating language barrier.

Health and wellbeing away from home is a really varied topic for expats, as evidenced by the recent Aetna International “What is wellness?” survey. There’s some really interesting feedback in there from other expats and expat families, but in no particular order, here are the most common questions we’ve been asked about staying well in China and our own experiences.

In no particular order, here are the most common questions we’ve been asked about staying well in China.

What has your experience been with healthcare in China so far?

We had brief physical exams when we arrived in China (for our residency permits). We each had one full physical as part of Julie’s company’s annual benefits. We went to a pharmacy once.

How did you navigate the experiences you’ve had so far?

Ugh. Very carefully. There are whole clinics dedicated to annual physicals and there are plenty of signs in English, with nurses barking orders in (broken, but understandable) English. The full physical was eye opening, because it was a totally local experience and a peek at the difference in a patient’s interactions with medical staff in China. There is very little talking, as you are shuffled swiftly from room to room to get a blood sample, ultrasound, EKG, and X-ray. There is not even as much as a “ni hao” as they strap on your lead vest for the X-ray or grab your arm to take blood. It is efficient, but lacking in any sort of personal touch. They just mail you the test results a few weeks afterwards.

The pharmacy was pretty easy once we looked up the medicine we were looking for and its Chinese translation. For prescription medicine, you need to go through hospitals in general, so thankfully we haven’t had to embark on that endeavor yet.

How have you dealt with food allergies/sensitivities?

I have celiac disease. Yup, it’s one of the cruel circumstances of my life, my pizza-loving, gluten-filled life. In my case, my symptoms are not very severe, and therefore, I can deal with being ‘glutened’ from time to time. That said, China is a VERY difficult place to be gluten free. Soy sauce is literally in every food. I eat at home a lot, where I can control the ingredients, I buy gluten-free soy sauce in the US when I visit, and I go to our neighborhood Mexican restaurant way too frequently. But honestly, much of the time, I eat gluten and deal with it. For those with severe allergies, I’ve heard of people having small cards printed that explain their allergies in local languages.

For those with dairy intolerance, China is perfect. A vast number of the Chinese are lactose intolerant as well, so the local fare is entirely devoid of cheese, cream, or other dairy products for the most part. Though they do have a fascination with cheese tea (large cups of tea with a salty, cheese-foam on top) and are willing to wait in incredibly long lines to get it, which is hard for me to understand on many levels.

What do you do in an emergency?

Fortunately, we haven’t had an emergency yet, but when we do have one, we know which hospital to go to in town that has an English-speaking staff. There is an equivalent of 911 in China, but let’s just say we probably wouldn’t be great at explaining our emergency over the phone if we found ourselves in such a situation.

How do you go to the doctor/dentist?

In China, most people go to a hospital for everything. Even dentists are in hospitals. If you’re sick with something pretty normal, you make an appointment (via phone or app) at a hospital, get checked-out, etc. The hospitals are well-equipped with all the machinery and specialists so it’s pretty easy to get sent to a different department and even fill a prescription onsite. For Western expats, we are used to different doctor’s offices and hospitals. Thanks to the demand, a small number of Western-style doctors’ offices have cropped up, which basically only serve foreigners who have an issue going to the hospital to get their sore throat checked out. These offices typically charge higher prices, but also often accept foreign insurance plans. On the dentist front, we plan on going to a stand-alone dentist office when it comes time for a check-up.

What about the air quality?

Air quality is something I literally never talked about, thought about or even considered as a kid growing up in America. In China, talking about air quality is akin to talking about the weather. Actually, they’re usually part of the same conversation. “Wow, it’s been cold this week. Yeah, and the air quality is so bad.” Shenzhen has a reputation for having good air quality, but in this region, the air is worse in the winter and we’ve definitely noticed. We can look up the official numbers online, and also, you can tell from our view. In Shanghai, the majority of people wear filtered air masks in the winter, and buy home air filters. In Shenzhen, where the air is better on average, we see fewer masks. We haven’t purchased them yet, but on a day like the one below, we’re tempted.

Below, you can see how our view changes when the sky is clear, versus a heavy pollution day. It’s not awesome.

What about insurance? Do you have it?

Yes, we have insurance. There is a public form of insurance, which has many of the same qualities of American plans – a co-pay, a portion that you pay out-of-pocket, a portion that gets paid, etc. The differences are that the prices are always clear up-front and procedures and drugs are cheaper. The expensive Western clinics charge much higher prices, but you can buy supplemental insurance to cover this. We have a plan that will cover us globally. For many expats, it is common to go to Hong Kong for more major procedures (childbirth, non-emergency surgery, etc.). Our insurance covers us there.

Do people work out? Are there gyms?

I read in a book recently that the average American walks 500m per day, not including walking around his/her home. That number just shocked me. Shenzhen itself is one of the better walking cities in China. Since it is such a newly developed city, urban planners designed plenty of green space, walking trails, and bike lanes. Keeping that in mind, there are a lot of active people in Shenzhen, and yes, there really are people doing tai chi in parks early in the morning. One of our favorite traditions is plaza dancing, free organized low-impact dance classes in community plazas in the evening.

We do go to a gym, one that’s right downstairs from us, and it’s very well-equipped. There are classes and lots of weights and cardio machines. From what we’ve heard, this is one of the nicest gyms around, and is relatively expensive from what we’ve seen advertised around. But it’s super convenient and we actually go, which is really the battle, isn’t it? The members are probably half Chinese, half foreigners.

One funny quirk is that people in China don’t go to work too early and tend to shower at night rather than in the morning before work. Therefore, early morning workouts aren’t really a thing here. The gym doesn’t open until 8am and is pretty much a ghost town except for foreigners. Come 7pm, and the place is jammed with locals who just got off work.

What’s the best part of staying healthy in China so far? The worst part?

We really enjoy the overall active lifestyle that we have in China. We also really like how active people are in the community. There are tons of families out walking in the evenings and on weekends. Even the older generation are out and about, usually running after their grandchildren. On long runs along the waterfront running path near our apartment, we see plenty of other people outside doing the same. Add on all of the walking that big cities require of its citizens and it’s pretty great.

Our least favorite part of staying healthy in China is our still relative unease with using the healthcare system. We haven’t yet dealt with an insurance claim, and it’s just so foreign here, it’s intimidating.

Oh, and if China could figure out the gluten-free soy sauce thing sooner than later, that’s be great.