“YOU HAVE FATTY KIDNEYS!”

“You have fatty kidneys!” the Doctor said in broken English, sounding like he’d never seen anything like it before. Peter took it in, and asked the Doctor, “Is it serious?”. The Doctor repeated “You have fatty kidneys!”. Getting a little anxious, Peter asked again “What does that mean?” The Doctor lost his patience with Peter, sat up, looked him straight in the eyes and said “You just fat!”

Peter was having an ultrasound in the only official clinic in Shanghai, China, that is permitted to carry out the Health Check for foreigners. For every expatriate that applies for a residence permit in Shanghai, they all need to go through this examination. Everyone has their own humorous story about what happened, harmless mostly, but always a good topic of conversation for expats when they get together.

ANXIETY AND STRESS

The immigration process begins with this Health check, and it is often a source of stress and anxiety for expats. The reality is that very, very few people fail the immigration medical check, and for those that do, it is either for serious heart conditions that they might not have know about, or for communicable diseases that they should already have known about! The overweight executive with high blood pressure, a bad back, and poor vision has nothing to worry about!

Figure 1 below shows the process that you go through when you have a Health check in Shanghai. It looks surprisingly complicated, but it actually flows relatively smoothly for the majority of people.

Figure 1: Process for Medical Exam

This article is intended to take the mystery away from the Medical examination process, which starts with the biggest query.

CAN I DO THE MEDICAL IN MY HOME COUNTRY?

People entering China for work often assume that they need to enter on a Z visa (working visa). Most overseas Consulates and Embassies of the PRC will also say that this is correct – however there is a catch. In order to apply for the work permit, you must first complete a medical check. I have several friends who went through the medical check Overseas, only to find out that they had to repeat it (with the exception of the X-Ray) when they got to Shanghai.

So heres the truth… There are only three countries in the world that the Shanghai immigration department accepts Health Check results in lieu of the Shanghai Health Check (and only certain hospitals in each country). The countries are Japan, Singapore, and Hong Kong – if you are coming from ANYWHERE else in the world and had to do a medical in that country prior to coming to China, you WILL have to repeat it (although they will usually accept your x-ray results if they are labelled adequately well).

THE MEDICAL EXAM – WHAT HAPPENS

Some people are totally unaware of what they are about to go through for the medical check. One expatriate (We’ll call him David) got to stage 5 in the process above, and the doctor asked him “Do you have anything wrong with you”. “No!” came David’s reply. The nurse put on a stamp, and handed that papers back to him.

The nurse was then kind enough, in her broken English, to tell him to go to the next room, and gestured that he should show them the form when he got there. Another queue – and when he go to the front he managed to make out that he was being asked for money – RMB 750. That seemed ok, since it was the same amount that his company had requested he have ready to pay the bill. David was starting to think that this whole health check business was pretty straightforward – all he had to do was pay the fee and he’d be done. Simple. What were his friends going on about with this business about x-rays and blood tests? The lady put a ‘chop’ on his form, and pointed to a room next door, and said “Wait”.

Bemused, David went next door. Obviously he was waiting for the official receipt, which they must keep in secure locations if it took so long to get. Others were waiting too, so they probably get all the receipts at the same time.

As people started getting called up by number, it gradually sunk in that David was in for a bit of a wait, people where being called to the far door, and none of them had come out yet. He started to recollect what his friends had told him about the process, and after a short while, David’s number came up. David was a little anxious about it. Walking through the white door, he was ushered into a little corner on the right and given a well-worn cotton robe and a wristband, and pointed towards the next room. Going in, he was wondering who would tell him what to do with it, but it became obvious when he reached an area of cubicles, and a was told “Change clothes” by the little old lady sitting in the corner. The next decision was to wonder if he should take ALL his clothes off to put the robe on, or was he allowed to keep his underwear on? He decided to play it safe and leave his underwear on “its pretty cold out there” he reasoned to himself!

When he shyly emerged from the changing room, he was directed to Room 1. Two ladies were chatting away to each other, seemingly unaware that anyone had entered the room. The first lady put her hand out and said “arm”, so David obeyed and pushed his arm out to her. Obviously she was a professional, she had the syringes and needles next to her, she must know what she’s doing! A wad of something was put in his hand, some iodine on a tissue was wiped and his vein, and the nurse picked up the needle. David had given blood many times before, and knew that this was the test of skill for a nurse – getting the needle carefully into the right place the first time. But the nurse lost interest, and started chatting to the girl next to her – at least that’s what he thought until she turned back around, picked up the needle, and jabbed it into his arm without much of care about where it landed! Woops, wrong place. Try again. Woops, wrong place, try again. Third time lucky now, the nurse took a second to recheck his veins, then jabbed the needle back in – finally it appeared ok, blood began to flow and she filled the last of three test tubes. David was just starting to realise that he had two additional holes in his arm, and the bruise was starting to come up, when he was told “Room 6”.

Room 6 is an interesting room for men. Most men have never experienced an ultrasound, but that is exactly what they get. This is where Peter, mentioned above, found out about his fatty kidneys!

There are a few more rooms after this. Patients have an X-ray, an EKG, a physical exam, have their pulse and blood pressure taken, and finally you get to change out of the robe and put your civilian clothes back on.

AFTER THE MEDICAL

On your way out, all the documents you’ve collected are given in to the nurse at a counter, and you fill in a form that says whether you want the results couriered to you, or if you want to pick them up. Most people elect to have them couriered.

The anxious wait for the next four days while the medical exam is evaluated is tortuous for some. But generally there is no need to worry – the authorities are only looking for two reasons to disqualify you from working in China, the first is any communicable disease you might have (HIV and other STDs, TB, etc), and the other is any irregularity with your heart. If you didn’t know about these things prior to your exam, then its probably a good thing to be alerted to them, and if you did – your immigration consultant should have informed you well before this that your application would be refused. In general though, it seems that less than 1% of immigration applications are refused on medical grounds.

THE REPORT

The final report that you receive back is really quite interesting. More thorough than you’d expect from your GP, and if you’re lucky you might even have some pearls of healthy wisdom written on the last page for you. A humorous comment I heard was “Patient is overweight with poor cardiovascular abilities. Prescribe more exercise, avoid fatty foods, and patient may want to use drugs to assist with weight loss”.

Overall, the medical check in Shanghai is a routine process. There is no need for anxiety, and you actually get some professional feedback on your general physical shape – something that many busy executives would otherwise never have got around to having professionally assessed. Once you’ve got your results back, you can apply for the work permit and residence license – but these are different stories for another time.

THE MORAL OF THE STORY

As exciting as it is, the medical check is only one part of the immigration process. There are steps prior to it, and after it. Most of the time these steps are relatively simple, and provided you have a quality immigration consultant guiding you through, there should be no issues. Doing it yourself might work for some, but the efficiency of a professional immigration consultant through the process pays off in the long run.

Nigel Crockett (GMS) is the Corporate Sales Manager for Santa Fe Relocation Services in Shanghai, PR China.  For any relocation related enquires you might have, please contact Nigel on +86-13801919129, or email ncrockett@santafe.com.cn for an obligation free discussion.