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The Hazards of Doing Business in China
By I. Dale Carroll
You
notice it immediately when you arrive in Beijing. Pedestrians and bicyclists
fill the streets so densely it seems impossible just to breathe, much
less drive through traffic.
In a country the size of China, it might seem
odd to feel claustrophobic. But most of China, with a fourth of the world's
population, is either mountains or desert. The majority of Chinese are
crowded along the coast, where there often are at least 3,000 people for
every square mile.
During my trips through more than 100 countries
as a physician, I have seen almost every type of health concern, some
anticipated but many that were not. Few countries have as wide a range
of contrasts.
For despite its dramatic beauty, and its enigmatic
people, one of the biggest challenges in parts of China can simply be
getting a breath of fresh air.
Pollution levels in Beijing easily rank
it as one of the 10 worst cities in the world. From November to April, smoke
from coal fires adds to the usual industrial and traffic output. In the
spring, strong north winds bring choking desert dust storms.
Air Quality
It is against the law to spit in public in
China. But when the air is so thick that it congeals in the back of the
throat, many Chinese consider it the only option. Travelers with asthma
or emphysema could find themselves confined indoors rather than risk an
acute flare-up of their ailments. Although some recent travelers report
signs of improvement, it is not unusual to see thousands of pedestrians
and cyclists wearing protective facemasks.
Despite this, many foreigners seem impressed by the orderliness and cleanliness
they find. China is an ancient and well-ordered culture. Traffic moves
in predictable, controlled patterns unlike the chaos found in most Asian
cities. And the streets - rather than being filled with garbage and sleeping
bodies as in some other Asian countries - are spotlessly clean. (The Chinese
had indoor plumbing and flush toilets while the ancestors of most Westerners
were still living in caves.)
Standing
on Ceremony
In the shadow of their 5,000-year-old heritage,
the Chinese can be quite formal and adhere strongly to protocol.
In China, where humility is a virtue, the people
expect the business conversation to be conducted by senior officials,
says the guide, Kiss, Bow or Shake Hands,considered a bible of
frequent business travelers (www.kissboworshakehands.com).
"If subordinates interrupt, the Chinese will be shocked."
Meetings in China's centers of business are
conducted in suits and ties, with much bowing, hand shaking and exchanging
of business cards. (Bilingual business cards lettered in gold on the Chinese
language side are considered a good choice for foreign business travelers).
Protocol calls for ceremonial introductions,
from the most to the least important person, always using titles but never
first names. Having an interpreter in addition to the host's helps decipher
the subtleties of conversations.
Never
be Late
The casual sense of time in most third world
countries doesn't work in China, according to the guide. "It is very
important to be punctual in China, not only for business meetings but
for social occasions as well. Lateness or cancellation is a serious affront."
And because the Chinese language lacks verb
tenses, it's difficult to establish past, present and future during discussions,
it cautions. Both parties should clearly understand when a meeting is
scheduled, although business appointments will be spent building relationships
and rarely will include a discussion of plans.
Business is never a dinner item, either, although
meals with Chinese business acquaintances occur often with both sides
expected to take turns hosting.
When it's time to present business plans, expect
to present them repeatedly as successive levels of Chinese executives
use the opportunity to scrutinize the Westerners trying to cut a deal.
It's wise to take several sets since photocopying service is scarce there.
And don't use colors, as the significance of some might be offensive to
the Chinese.
"Never exaggerate your abilty to deliver...because
they also will investigate your claims," cautions Kiss, Bow or
Shake Hands.
Delaying
the Decision
Since sealing a deal could take several trips,
it’s best to be flexible with deadlines. It's an old Chinese tactic
to delay decision making until the last possible moment when an outsider
might become desperate and they know they can negotiate a better bargain.
If a business plans to use Chinese plants and
workers, several visits will need to be made to those facilities. Expect
them to be clean, but spartan and somewhat antiquated, with simple, labor
intensive technology. International business expansion, however, is beginning
to foster some modernization.
Communal
Courtesy
During such visits, foreigners can expect the
staff to meet and greet them with applause, which is expected to be returned
by the visitors. Presenting a gift is part of the protocol, but should
represent the company and not be something personal.
When a decision finally is made, the Chinese
will do it as a group, and only after careful consideration and a thorough
check of facts.
Chinese laborers work hard and keep long hours.
And travelers are often surprised by their lack of physical strength and
stamina when compared with Westerners. My observation, corroborated by
others, is that you can't expect Chinese workers to lift 50 pound bags
as their counterparts would in the States, but when they clock in they
will work until the job is done.
Western
Watch
American
companies with employees in China will need to remember that most U.S.
Occupational Safety and Health Administration (OSHA) requirements still
apply to their overseas staffs, according to the Gorgas Institute of Tropical
Medicine at Cayetano Heredio University in Peru. An occupational medicine
or travel medicine consultant can ensure an American employer is in compliance.
And health
risks faced by foreigners in China are often not the ones they expect,
said John Aldis, M.D., until recently the U.S. State Department's regional
medical officer at the U.S. Embassy in Beijing. While travelers are usually
well protected with shots and preventative medication, the main health
problems, according to Aldis, are not communicable diseases.
"The most
common health problems you see in China are the ones you expect to see
in Kansas City," he said.
Altitude can
be a hazard for those who venture inland. Much of China is over 8,000
feet high, and in order to reach some places it's necessary to travel
roads reaching altitudes of more than 17,000 feet. With oxygen less than
half that at sea level, it can be a real danger for travelers with heart
or lung diseases, although even healthy persons can experience altitude
sickness.
Unexpected
Risks
The greatest peril remains traffic, a main
cause of illness and death among Americans abroad from accidents or heart
attacks. Traffic in China can get you either way. In major cities, the
sheer volume of pedestrians and bicyclists makes driving difficult if
not impossible. And in an accident involving either one, the motorist
is automatically considered to be at fault.
When two motorists collide, the norm is for
bystanders to judge who is at fault even before the police arrive, and
a foreign driver can count on being tagged as the guilty party. Traffic
is a lesser problem in rural areas. But roads are barely maintained, local
drivers poorly trained and livestock in the road can be a hazard. Many
regular travelers to China suggest hiring a local driver.
If you have an accident and need medical care,
avoid being treated with blood or blood products. According to leading
infectious disease specialists worldwide, posted on the definitive Pro
Med bulletin board, the blood supply in China is not safe although safety
precautions are improving rapidly. And very few Asians have Rh negative
blood, so it might not be available for a non-Asian who needs it.
Crime
and Punishment
Crime is usually not a major issue
for foreign visitors, and muggings don't often happen, according to Travax,
a travel and travel medicine guide updated weekly (www.tripprep.com).
But a wallet can quickly disappear from someone who's distracted by a
rare, noisy dispute.
Such low crime doesn't preclude the possibility
of having legal problems, either. Local authorities seem intent on ensuring
that foreigners do not break the law, and often keep a close watch on
them. Passports, visas and other papers can be checked by officials at
any time and for any reason so it's essential to always carry them.
If personal papers are lost, everything will
stop for a foreign visitor until they are replaced. In a dispute between
a foreigner and a Chinese business person, it's standard for the foreigner's
papers to be confiscated until the dispute is resolved.
So how do you prepare for such a trip?
As usual, an ounce of prevention will usually
prevent the need for a pound of cure. Read up on the culture and learn
as much as possible before leaving home. Seek introductions in advance
and make sure contacts are in place. Allow plenty of time.
A
Healthy Start
A thorough physical and dental exam before
leaving can prevent potential problems. And it's wise to take a copy of
all medical records and prescriptions, plus a full supply of medications
and hygiene items not likely to be available locally. Those items could
include glasses, contact lenses or even hearing aid batteries.
An AIDS test might be required to work in China,
and it will be required for anyone staying there more than six months,
according to the U.S. State Department. A U.S. test might be accepted,
but an AIDS test could be mandated for a business traveler upon arrival.
With disposable syringes and needles not available in China, it is best
to take a supply just in case. These, plus prescription medications, could
require a physician's note to justify having them.
Health insurance should be checked before leaving.
Most plans don't cover medical care abroad, and none cover medical evacuation
- which alone can easily cost $70,000 should it be necessary. Specific
trip and evacuation insurance should be available from your travel agent
or travel medicine specialist.
Even having insurance might not prevent a large
cash outlay. Most doctors and hospitals abroad expect cash at the time
of service and don't handle insurance claims or take credit cards.
In major cities, physicians at larger hospitals
have training and skills on a par with their Western counterparts. They
might not speak English, however, and hospital equipment and facilities
are apt to be outdated and quite spartan by Western standards.
The best health protection to have is to relax
and enjoy the trip. Don't overcrowd the schedule, expect and enjoy interruptions,
and take along that most essential of items - a sense of humor.
For additional
information regarding health care in China, the brochure, "Tips for
Travelers to the People's Republic of China," can be obtained from
the U.S. State Department. For a qualified travel medicine consultant
check the International Society of Travel Medicine's web page at www.istm.org.
Dr. Carroll's
web site, which provides information and tips for international travellers,
is located at www.travdoc.com
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