NANJING, July 8, 2002 — Half a world from home, a traveler wonders if he will find good medical care in a developing country, especially if he is already taking several medications for chronic health problems. I knew, of course, that the Chinese have modern medicine. But I also was wary of their devotion to traditional, herbal medicine, something I had already benefited from yet remained suspicious of. I was soon to learn a bit about emergency care in China.

I was awakened this morning by a tapping at the floor-to-ceiling windows covering the wall of my room on the 36th floor of the hotel. Reminded by the noise of Poe's Raven, I arose, half expecting to see a bird or a "rare and radiant maiden whom the angels named Lenore." When I looked, however, I beheld five lithe young men, each suspended by an ordinary one-inch rope, scrubbing the building—from a height of over 500 feet! So intent or well-disciplined were they that, when I took several pictures using a flash, they didn't so much as glance from their work. Perhaps such concentration is essential to their survival. Or maybe management has ordered that they not look for gorgeous nakedness within the rooms.

As the men in bucket seats lowered themselves toward earth I began to feel queasy, although heights had never bothered me. When time and the washermen had passed, I felt weakness and the beginning of a fever. Not long thereafter I telephoned my former student, Li Mang, who soon arrived with a thermometer. She took my temperature, read the result—over 101 degrees—and insisted I go to the emergency clinic of the hospital, a hospital she knew intimately because her father had already been there for weeks. I offered no resistance, having none to offer.

The emergency entrance to Nanjing Hospital looks new although associated buildings are old. In my experience, the only comparison I could make of the large emergency waiting room was with the one at Yale-New Haven (YNH) in New Haven, Connecticut. Here, the large reception area was somewhat more dimly lighted, and the woman wielding a cloth mop appeared to need more soap and a scrub brush to clean the tiled floor.

Among the few patients (a further contrast) there were two people with cuts and bruises as if from a collision or fall and another without visible injuries. My processing, after I paid 5 yuan ($.60) began with registration and without any question of eligibility, whether or not I had insurance, or related matters. At a cost of 10 yuan (($1.20), my blood was tested for white corpuscles indicating an infection—which indeed was the case. Then my blood pressure and temperature were checked; I recited, through Li Mang, what medicine I was taking for my present condition (none), but I was not asked about the five medications I have been taking for many years for cardio-vascular disorders.

I was then given a choice of either an injection of penicillin in the buttock or, for greater effectiveness, an intravenous infusion lasting an hour. I chose the latter, paid 154 yuan ($18.50) and retired to another room. There I joined about three dozen people being similarly treated. Each patient sat in a large chair with pull-out footrest and a plastic bag of medicinal solution hanging from above. There were almost twice as many people as patients because each patient appeared to have brought along a spouse or friend.

The total cost of my treatment was about 170 yuan ($20). I asked Li Mang what would happen to a poor person who was ill and came to the clinic without any money. She said he would be ignored. But, I persisted, what if he was, say, bleeding to death and fell to the floor? He would die, she said. I said I could hardly believe that a humanitarian organization in a socialist country would refuse to minister to a dying  person. But, I was told, unlike in the West, there is no free medical care in China except for high-ranking Party members and those whose employers reimburse patients.

My one exprience suggests that emegency care in China is swift and cheap by Western standards. Even given the millions of people in Nanjing, there are enough hospitals to handle patients with little or no crowding or delay. However, this is due in part to the refusal to provide free service to the poor, a practice not common in the free-market societies of the West. I am shocked by this callousness in a country whose heavy emphasis is on social improvement.

In minor mitigation, I should point out that China is developing a social security system which, as in the West, may alleviate the condition of the poor.