Traveling in China can be a thrilling, eye-opening experience for even the most weathered world traveler. The vastness of the country, the breadth of its cultures and the many thousands of years in which it has thrived all make for some of the richest, most beautiful landscapes and historical relics this great world has to offer. But there are many things traveling in China is not: easy, predictable and risk free being three of them.

You can plan a weekend getaway to New Hampshire and have a pretty dead-on idea of what it will be like and how it will go. You can plan a three week backpacking excursion through the Swiss Alps, and while there may be surprises along the way, even those surprises are of the variety that are to be expected on a trip through that beautiful, mountainous region complete with familiar, western amenities ("Oh my, honey! Look at this wonderful little bed and breakfast! It's not even in our travel guide!").

But while we may stumble across a hotel in Shandong that is significantly more awful than advertised, be humbled by our first squat-toilet experience outside of Leshan and struggle to consume some of the more exotic foods we are offered, that constant frustration and thrill is part of the package. But the one thing you cannot predict on any trip is this: horrible, unexpected, vacation-ending (or worse) injuries. In a place like China where the language and cultural barriers are so large, considering the prospect of a worst-case scenario can produce huge quantities of anxiety, particularly among mothers or other well-meaning, interested parties. But there are things you can do to help insulate yourself from surprises during a manageable medical procedure, and in the event of a horrific accident, if well prepared and insured you can get the best treatment possible and avoid the kinds of bills that will make you wish that tanker had landed on you instead of your husband. I am talking about having realistic expectations of what to expect at Chinese hospitals, and making sure you have travelers insurance.

What to expect at a Chinese hospital

While China is modernizing and urbanizing at a fantastic rate, the vast majority of the country continues to lack the kinds of medical resources that individuals from wealthy nations have come to take for granted. But that certainly isn't to say that proper medical treatment is out of reach or even not the norm; it is merely to say that the way you have always been treated in hospitals and on doctor visits is probably nothing like any experience you will have in China.

Don't expect to be able to converse in English. While many of the major cities (and some of the smaller ones) have hospitals with foreign wings/departments with English- speaking nurses and doctors, it is best not to count on it. When possible, bring someone with you who speaks Chinese, or at the very least someone who can assist you as you try to explain that you are experiencing terrible diarrhea through hand gestures and facial expressions.  Hopefully this person can also assist you with anything else you might need during your stay.

Chinese hospitals have a more do-it-yourself feel (not for things like operations, of course—I'm talking about getting yourself fed, your prescriptions filled, etc.), than you may be used to. You may have to pay a number of times; an initial fee (less than RMB 50) just to see the doctor, and then, once diagnosed, pay again for any treatments, medicine, further tests, etc. When it's busy, there will be lines, so be prepared to spend some time waiting, and the standards for privacy and queuing are different than in the West, so don't be afraid to shoo away interested or curious onlookers and forcefully establish your place in line.

Tom, from the great blog Seeing Red in China, works in a hospital in Nanjing and has put together an excellent list of things to know about Chinese hospitals. The basic gist is this: it may not be comfortable, it may not be quick, and it may not be easy, but it will be fine. As Tom says, "Most of the doctors in China are better than the hospitals they serve, so even though the hospital may look awful you can probably trust your doctor." That being said, don't settle for a tiny, local clinic when there is a major hospital within driving distance. The more serious the injury, the more serious you should be (and the hospital staff will be) about getting you to a major city or even out of the country.

Traveler insurance

If there is a persuasive argument as to why anyone wouldn't get travel insurance, I have yet to hear it.  The fact is, in the grand scheme of your travel budget, the small expense of insuring yourself against the tides of fate pales in comparison to what you'll be spending in the event of serious injury (not to mention that many plans cover property theft). The first time I came to China, I got travel insurance for 1/20 of the cost of just my plane ticket. While I never used it (woohoo!), I don't regret for a moment incurring that small expense. There are a ton of companies offering affordable insurance. Do yourself a favor and get some. If you need to be airlifted to a hospital, you don't want to be worried about the bill; you want to be able to focus on how you're going to get that live shark out of your stomach.

I used HTH Worldwide, and I've heard good things about World Nomads (price and availability depends on your home country, where you're going and what you're planning on doing), but do the research and find out what company is best for you and your trip. While reading the fine print of the various plans seems excessive and tedious, you don't want to go on a skiing trip and break your leg only to find that injuries incurred outside of ski resort bounds aren't covered. Do your due diligence and avoid surprises.

Another concern I've heard voiced is how you go about billing your insurance company directly in China. Short answer: you don't. Pay up front (cash only, for the most part), and keep EVERYTHING you get at the hospitals. Get them translated, and submit the originals and the translations to the insurance company. In the event of property theft, GET A POLICE REPORT. No insurance company is going to take your buddy Chad's word that your USD 1,500 camera got stolen at a massage parlor in Ningbo. As long as you keep everything honest and organized, it shouldn't be a problem. For the most part, any minor procedures at Chinese hospitals (food poisoning, infections, minor burns, etc.) will be affordable and possibly even cheap enough that getting reimbursed by your insurance company won't be worth the hassle. Travelers insurance is for the big stuff, the car wrecks, the extreme sporting accidents, the unexpected—and you don't want to be caught without it.

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