I’m currently in the middle of a bike trip from Beijing to Hainan. This isn’t my first ridiculously long bike trip, I did something similar in 2008 when I went from Hainan to Beijing. But, unlike 2008 it’s a lot more ambitious. Not only did I start from a much lower level of physical conditioning, I’m also making a point of tackling more difficult terrain in western China. Instead of complaining that I don’t have a good camera with me, I brought my dSLR and am complaining that my neck hurts. To go with the camera, I did some pretty extensive research on minor sites of interest in China and will frequently go quite far out of my way to find something no one has ever heard of.

Since I started this trip at the end of March, I’ve done some pretty amazing things. I’ve camped on mountainsides, waded through calf-deep ice water, and taken photos of the inside of some Buddha Caves you won’t find on anyone’s itinerary. My good experiences have outweighed the bad ones but that doesn’t mean there haven’t been any bad ones. A month down the line, I’m still sufficiently pissed off at the cops in Zanhuang County, Hebei Province that I’m still planning on filing a complaint when I get back to Hainan.

For certain values of “good experience” last night was a good experience. If nothing else, it was a memorable one. It’s not the first time I’ve spent the night in a Chinese hospital but, after nine years here, it is the first time I spent the night in In-Patient as the patient. I don’t especially want to repeat the experience but, all things considered, given that it was not just a Chinese hospital, but a rural one in southern Gansu at that, it was an excellent experience.

As readers of Lost Laowai, I don’t need to be telling you about the Chinese medical system and the places where it badly fails. I doubt I’m the only person on here who has looked up their just received prescription online and found out that it was the wrong drug, or the wrong dosage. I know more than a few laowai who really hate the way in which many doctors and hospitals try to push extra expensive services not just on us but on anyone who looks like they might be able to afford it.

So when I say both here and in the original version of this article that I wrote for my crazyguyonabike journal that I had a “good experience” at a rural Chinese hospital last night, I don’t just mean “I came out alive”. I mean I had an experience that will be the standard of quality by which I hold up and compare every future medical experience I have at every hospital in China.

I’m not referring to things like the twenty three thousand photographs that were taken of me with every single member of the hospital staff. I’m in rural China. The number of photographs taken of me is proportionate to the amount of time I am willing to stand still.

I’m not talking about the hospital director making the decision to deliver me and my bicycle by ambulance to a town 20 kilometers away. Although I felt okay enough to try getting back on my bike, hospital directors generally don’t like patients leaving by bicycle. And taking me 20 kilometers away was not so much a “get rid of the foreigner” scheme as it was a safety measure since the town 20 kilometers away is also 300 meters lower.

I don’t mean the part where I wasn’t allowed to pay for any of my treatment or my overnight stay in the hospital. Going into rural China is like stepping into a time machine where people’s attitudes are 10 and 20 years (or more) out of step with the cities. No matter which way you cut it, resident of Hainan, cyclist from Beijing, or American citizen, I am an honored guest from far far away. I don’t expect free meals or spontaneous gifts but so long as I’m nice to people, they happen pretty regularly.

Plain and simple, it was the thoroughly professional way in which I was treated. I came in to their hospital with something they knew of but had never seen. They not only started with appropriate early measures, they spent extensive time quite late at night on the phone with other hospitals that had active experience making sure that they were doing everything right.

And, unfortunate though it may be, professionalism is not something I have come to expect from Chinese hospitals during my time in this country. To give a rather recent example, while I am very much aware that a sinus infection in not life threatening the way Altitude Sickness can be, the last doctor I went to see about the sinuses couldn’t even be bothered to look up the correct dose for antibiotics.

This is not the first time I’ve had Altitude Sickness. Without taking into account headaches or any of the times that I was unnecessarily surly to coworkers of mine (who may or may not have actually been incompetent) on my 2007 trip to work at the Tour of Qinghai Lake, I had four episodes of Altitude Sickness while in Qinghai including collapsing in the middle of the street and ataxia.

A few of my problems in Qinghai manifested as low as the 2200 mark but my really serious problems all started above 3500 meters. Given that I’m biking up to elevation rather than flying or driving, I didn’t expect to have any problems until a minimum of 3000 meters and, unless I’ve badly miscalculated my route or suddenly decide to go hiking, I had no plans to go up that high.

I’ve been aware that the air hasn’t been working properly since the first night I spent over 1000 meters, but the day’s ride only topped out around 2250 meters above sea level. I was tired when I got up to the top but, given that I’d been consistently biking uphill for the last 31 kilometers, being tired is par for the course. And with my evening stop point a full 400 meters lower, I didn’t expect anything other than slow recovery times. Expect the unexpected.

I found myself a guesthouse hidden down an alley off the main road. It was 15 yuan for the night so that should give you a good idea of the general economic condition in town. So far as I could tell from my limited exposure, it was also the only guesthouse in town.

Not quite feeling ready to get up and go, I was sitting in the restaurant where I ate dinner drinking tea and looking up information on Altitude Sickness on my cellphone. Getting 3G was probably one of the best things I’ve done in preparation for this trip even if I have to admit that it was completely unrelated to this trip. The people around me were very excited to have a foreigner in their town and kept trying to engage me in conversation and photos. I felt their excitement. I accepted their excitement. They weren’t being rude or pushy or annoying but I wasn’t interested in the slightest and continued to read through people posing around me, pausing only to look up at the lens before going back to my reading. On at least two occasions I went back to my reading after the red-eye flash and they got a picture of my hair.

After this went on for a while, one of the women said rather peevishly to me “you come to our town as a tourist to see what our lives are like and then you don’t interact with us at all. What’s that all about?” Something equally peevish and rather nasty almost came out of my mouth but the words hit my brain in time and I considered the fact that she might just be right. So I put my phone down and attempted to join a conversation.

Only I couldn’t catch my breath long enough to string two sentences together. Once I got the “I don’t feel very well” point across, I participated with nods and hand gestures and the occasional word or three but mostly sat there breathing. It wasn’t until I tried to do something other than poke at my phone or occasionally look up into a blinding flash that I realized, I couldn’t. After some time spent carefully considering the entire sentence, rejecting various versions of it for having too many words, and then realizing that even the shortest form was beyond my current abilities, I picked my phone up off the table and wrote “I think I have Altitude Sickness. Do you think the nearby clinic has oxygen?”


So I sat there and worked on catching my breath and crowdwatched. When new people came, I listened to the ones who had been there before share the bits of information they’d already found out about me and I listened to them talk about their lives and I concentrated really hard on getting enough air until it was obvious that long slow mouth breaths wasn’t going to do it.

I pulled my phone out again and wrote: “Oxygen. Is there a hospital? Do they have oxygen? I need oxygen.”

The hospital is 200 meters away. The best form of transportation is determined to be feet up until I stand up and take a tottering step or three out of the restaurant. It’s not necessary to know what “gait ataxia” is for them to come to the conclusion that the best form of transportation is anything but feet. Only the guy they know who is passing by on a motorcycle refuses to take me because I might be really sick and he doesn’t want the slightest bit of responsibility for a sick foreigner.

So, while the people from the restaurant stand there and argue about who they know who might have a car or a truck or a tractor or a bicycle that can be called to come and get me, I decide to start in the direction of the hospital. At the speeds I’m moving, the chances of them finding someone and that someone coming and getting me 50 meters down the road are better than my standing around waiting until I faint.

Little baby steps one foot in front of the other, jaw hanging open like a fish, long slow deep breaths. I don’t think I’d gone very far when I picked up the pack of drunk men in their early 20s.

Even when they aren’t already drunk, groups of Chinese men this age are usually one of things anyone who has been in China more than an hour or two hates more than anything else about China. They harass. They catcall. They repeat your words back at you in falsetto while their friends giggle stupidly. But while catcalls and harassing strangers from the semi-anonymity of the crowd are apparently great ways to show off your bravado, it seems that helping the pale faced stumbling foreign woman is also on the list of approved behaviors for packs of drunk young men.

Given that I was mouth breathing, they had to be pretty thoroughly sloshed to reek as strongly of beer as they did. One on my right arm, one on my left arm, holding me up, warning me of obstacles in my path, and helping me take my little baby steps. Considering that my helpers weren’t the steadiest on their feet and a fall would probably bring all three of us down, I struggled to keep my eyes open but consistently walking, breathing, and blinking all at the same time was a little too much for me.

We turned towards the hospital then, because someone knew a TCM clinic that was nearer, we turned around and went another direction before turning around again and going back towards the hospital. By now the surrounding crowd had swelled from just my pack of drunks to huge numbers of people, some of whom pushed in to see what was going on. One of my drunks gave a hard shove to a guy who was smoking a cigarette and, for a moment, before the smoker backed down and apologized, I thought there was going to be a fistfight.

Up the hill to the hospital. Lucidity came and went in waves. If it weren’t for the fact that, by now, there were well over 50 people in my crowd, I would have been uncomfortable being led down a dark alley through piles of construction material. I couldn’t have voiced discomfort or concepts like “where are we going?” and I figured nothing too bad could happen with this many people around.

Outpatient was rather definitely closed for the night but they found a doctor and it wasn’t long before I’d been sat down, my camera returned to me, and two of the largest men were being enlisted to roll the very large oxygen tank in. It had wheels but it really wasn’t portable. The members of the crowd who had succeeding in following us into the office were chased into the hallway. The nurse hooked me up to the tank while the doctor and I passed notes. (I already know I can’t understand Gansuhua however, when he tried speaking to me in Mandarin, I also couldn’t understand most of his spoken Mandarin.)

Everything I can find online seems to indicate that one of the signs of Altitude Sickness is an increased pulse rate. According to Dr. Xu, when I stumbled in and was first put on oxygen, I had a non resting pulse rate of less than 50 beats per minute. My usual resting pulse rate is in the low 70s.

While I sat there and breathed, he started calling people who actually had experience with Altitude Sickness. Locals, by definition are local. They were born at 1800 meters. Any tourist experiencing problems in the park a few hundred meters uphill from his hospital would be taken a few hundred meters downhill to the nearby town. So, notwithstanding the fact that Altitude Sickness doesn’t start being really common until 2500 meters, I wasn’t just the first foreigner they’d ever treated or the first foreigner he’d ever seen in person, I also had a problem he’d never had to deal with before.

By 9:30 in the evening, I was able to form short sentences without stopping in the middle to catch my breath. By 10:00, I could laugh at jokes. I had to prove I was hydrated before I was allowed to lie down. A glucose drip, a saline drip, and many many cups of water. But despite feeling very nearly normal with the oxygen tubes in my nose, when I was walked to the latrine at 11:00, I was panting and gasping before I made it down the hallway.

I’ve been mostly rural more often than not this trip so the hard wooden bed in the hospital room didn’t faze me one bit. I knew the concrete floor was specially mopped just for me. I saw one of the nurses getting a mop and a mop bucket and putting disinfectant in it. They really couldn’t have dressed the place up without demolishing it first but they tried their best. Other than the simple fact of the existence of a mop, mop bucket, and disinfectant for them to mop to speak for the level of cleanliness, I have to admit that my stolen glimpses into other sickrooms weren’t filthy gross so much as they were utilitarian and spartan.

Concrete floors. Hard wooden beds. Metal IV hooks hanging from the ceiling. But every bed in every sick room (not just the one I was in) had disposable single-use covers over the bedding. The glass in the windows was all there. And if they had a pit latrine rather than indoor plumbing, it was dug deep enough so it didn’t hardly smell half as bad as the flushies in Haikou South Bus Station.

Before I went to sleep, some kind of diuretic was added to my IV to help get rid of any fluid build up in my lungs. This was not done when I went on oxygen at the hospital in Qinghai Province but, frankly, despite the fact that I was at a much higher elevation at that time, I think I was much worse off this time. Furthermore, the doctors on the other end of the phone making the suggestions couldn’t be sure just how serve a case of Altitude Sickness I did have.

I don’t know if I had fluid build up in my lungs. It can happen with Altitude Sickness. I don’t know what (if anything) the diuretic did for the fluid build up I may or may not have had in my lungs. My annoying almost cough that’s been tickling the chest for half of forever at this point appears to be completely gone but, as I’m not actually moving around, I can’t tell for certain. The most obvious effect was the number of times my bladder woke me in the middle of the night to go pee.

I really did not like getting out of my warm bed to go outside to the latrine each and every time but it allowed the nurses the opportunity to see whether or not my off-oxygen condition was getting better. And it was. Each time I came back to bed, the nurse turned my oxygen down a little farther. And by dawn, the oxygen was turned off completely.

In the morning, after much consultation between staff members and other hospitals, and a photo shoot involving me and most of the doctors in full white coat dress standing over my bed, it was eventually decided that while monitoring my condition was a “not bad” thing, sending me 300 meters lower to breathe air with a bit more air in it was a better thing.

And that’s where I am now. Breathing the air filled air. Lying on the soft bed in a hotel room with Internet. Avoiding anything that even resembles exercise. Drinking lots of water, and getting ready for my next day’s ride. It’s another 400 meters of descent. I plan to go very slowly nonetheless. But I don’t think it will be a problem.

Check out more of Marian’s adventures from her currently ongoing journey from Beijing to Haikou, Hainan by bike.


  1. Mad respect, Marian! You are on the adventure of a lifetime, despite it being occasionally life-threatening. And yes, altitude sickness blows (is that a pun?)

    (I share your sentiments about the healthcare system here; when I was hospitalized for Encephalitis in Shandong province way back when, a reporter and photographer from the local newspaper suddenly appeared at my bedside. As there was nothing I could say or do to stop them, I also had to endure rounds of picture taking with the staff despite the fact that I had literally almost died just the day before! *sigh*

    • They asked permission before I went to sleep if I would mind having the entire staff of the hospital show up for a photo shoot in the AM.

      If they’d just shown up, or if they’d tried to sneak photos of me without asking, I probably wouldn’t have liked it very much either.

      But the whole thing about this situation that makes it so memorable was the fact that they were so professional.

      The inability to make the air work didn’t come as a complete surprise to me. Since I’ve had Altitude Sickness before, I recognized the symptoms long before they got to the seriously can’t breathe stage of things. Four or five days earlier I had a local doctor laugh at me and tell me I couldn’t possibly be having altitude related breathing problems at 1400 meters. He gave me a cough suppressant and told me to rest.

      I was born at sea level, grew up at sea level, and live at sea level. And while it’s hard to say who will and who won’t have Altitude Sickness, the chances go up when you’re a lowlander.

      I wouldn’t have been surprised if they’d just stuck me on oxygen, seen that it was working, and left it at that. That’s what they did to me in Qinghai. Instead the doc was constantly in communication with another hospital, reading my vitals over the phone, and making sure that I was getting the right meds (I’ve since found out that diuretics are also one of the treatments given to speed up acclimization to altitude) really impressed me.


      • Wow! I’m incredibly impressed with the levels of professionalism (and cleanliness) too.
        A very interesting read, and all the best to you on your trip and glad you’ve made a (full?) recovery. Let me know if you’re coming over to Yunnan and need any tips.

  2. That’s amazing that you are attempting this trek again! I hosted you in Beijing the last time at the tail end of your Hainan to Beijing trek. I don’t know anybody else who has bicycled across China. . Not even Chinese!

    I’d be so worried about those huge trucks on the highways, crazy weather in the mountains, about getting arrested or worse. I suppose your fluency in Mandarin helps a lot. Will look forward to reading your journal.
    Good luck!

  3. Wow–scary thing to read about. I mean, I’m glad it turned out okay in the end but it must have been really nerve wracking to go through (or maybe the low oxygen kept your panic at bay!)

    Thanks for sharing and good luck on the rest of your trip!

    • The first time it happened in Qinghai, it was terrifying.
      Come to think of it, it was pretty scary the second and third times.

      This time, I knew what was going on. Knew what the cure was. Had sufficient warning of what was going on that I could look stuff up on the internet and confirm that what I thought was going on was in fact what was going on.

      Makes a world of difference when you know what’s wrong with you and how to fix it.

  4. Welcome to Gansu! Any trip from Beijing to Hainan that includes Gansu definitely qualifies for a blog called “Lost Laowai”!

    As a physician in Lanzhou I completely agree with your assessment of the health care system. Most of the doctors in the big city hospitals here already know everything. We all know what pride does to one’s ability to learn new things, generally it means all medical progress stopped when the doctor stopped his or her training. I have found that the doctors that are the most enjoyable to interact with are either house officers at the big hospitals or rural clinic docs like the one you saw in the mountains – they are humble and eager to learn in order to do the best thing for their patients.

    When you have a chance could you email me more information about your translation company? Do you do technical translations? Do you have a fee structure posted online somewhere that I could look at?

    tom (1/3 of the International Medical Society of Lanzhou)

  5. Since Ryan was in Canada the past few weeks, the post took a while to go up. As of today, its actually “welcome to Guizhou”.

    I’ve never much like straight lines or main roads so its more surprising how often I know where I am than it is how often I’m lost.

    Will send you email tonight

  6. Dr. Paul,

    If the Olympic coach I used to date only thought I was 10 pounds overweight and the other Olympic coach I used to train with came up with similar numbers the only conclusion I can reach is that you know more than they do about sports physiology and human health.

    Despite the fact that there is no link between relative level of health, physical activity, and tendency to get altitude sickness you have correctly diagnosed my problem. I am not a competitive amateur athlete but am, in fact, a heart attack waiting to happen.

    Henceforth I promise to give up my seven pack a day smoking habit and all twinkies. All because you, Dr. Paul, have made me see the error of my ways.

    Of course, you’ll have to give me some time to quit smoking as I will first need to take up the addiction before I can break the habit, but you understand right?

    In the meantime I will try to come up with a way to lose 40 pounds. Other than amputation, I can’t think of anything right now but I’m sure, if it comes to that, I will be able to enlist the services of your hospital to perform the operation.

    Once again, I can’t thank you enough for your helpful and informative commentary. I hope that we shall see more of its kind in the future. Lost Laowai really needs it.


  7. I would have thought I was mocking the troll rather than feeding him. Sort of like when you taunt the alligators with a live chicken.

    Much to my surprise, he responded.

    I’ll put the book on my wish list.

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