We examine the medical examination process for expats headed for China and discover that an overweight executive with high blood pressure, a bad back, and poor vision has nothing to worry about..

"You have fatty kidneys!" the doctor said in broken English, sounding like he had never seen anything like it before. Peter took it in, and asked the doctor "Is it serious?"

Expats shouldn't worry: few people fail the medical check

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, permitted to carry out the health check for foreigners. Each expatriate that applies for a residence permit in Shanghai needs to go through this examination, and they all have their humorous stories about what happened, which always makes for good 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 few people fail the immigration medical check, and for those that do, it is either for serious heart conditions that they might not have known about or for communicable diseases that they should already have known about. An overweight executive with high blood pressure, a bad back, and poor vision has nothing to worry about.

Can I do the medical exam in my home country?

People entering the People's Republic of China for work often assume that they need to enter on a Z visa (working visa). Most overseas consulates and embassies of the People’s Republic of China also will 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.

The truth is that there are only three countries in the world, Japan, Singapore, and Hong Kong, from which the Shanghai immigration department accepts health check results in lieu of the Shanghai health check (and only from certain hospitals in those countries). If you are coming from anywhere else in the world and had to do a medical check in that country prior to coming to China, you will have to repeat it (although they usually will accept your X-ray results if they are adequately labelled).

The medical exam—what happens?

Some people are unaware of what they are about to go through for the medical check. One expatriate, 'David', got to stage 5 in Figure 1 (see the end of this article), and the doctor asked him, "Do you have anything wrong with you?"

"No!" said David. The nurse put on a stamp, and handed the 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. He waited in another line and when he got to the front he realised that he was being asked for money—RMB 750. That seemed okay, because 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 would be done. Simple. What were his friends going on about with this business about X-rays and blood tests? The woman put a “chop” on his form, and pointed to a room next door and told him to wait.

Bemused, David went next door. Obviously, he was waiting for the official receipt, which they must keep in a secure location because it took so long to receive. 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 sank in that David was in for a bit of a wait. People were being called to the far door, and none of them had come out yet. He started to remember 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 toward the next room. He went in wondering who would tell him what to do with it, but it became obvious when he reached an area of cubicles and was told to "change clothes" by the little old lady sitting in the corner.

He wondered if he should take all his clothes off to put on the robe or if he was allowed to keep his underwear on. He decided to play it safe and leave his underwear on. It's pretty cold out there, he reasoned to himself.

When he shyly emerged from the changing room, he was directed to room one. 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!" Obviously, she was a professional; she had the syringes and needles next to her, so she must know what she is doing. A wad of something was put in his hand, some iodine on a tissue was wiped on his vein, and the nurse picked up the needle.

David had given blood many times before, and knew that it was a test of skill for the nurse to get 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 is what he thought until she turned back around, picked up the needle, and jabbed it into his arm. Whoops, wrong place. Try again. Whoops, wrong place. Try again. The nurse took a second to recheck his veins, then jabbed the needle back in and finally it appeared okay as blood began to flow into the syringe. She filled the last of three test tubes. David was just starting to realise that he had two additional holes in his arm, and that a bruise was starting to form, when he was told, "room six."

Room six 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 measured, and finally get to change out of the robe and put their clothes back on.

After the medical exam

On your way out, all the documents you have collected are given to the nurse at the counter, and you fill in a form that indicates whether you want the results couriered to you, or whether 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 torturous 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, and the like), and the other is any irregularity with your heart.

If you didn’t know about these things prior to your exam, then it is probably a good thing to be alerted to them. And if you did, your immigration consultant should have informed you well before this point that your application would be refused. In general, it seems that less than one percent of immigration applications are refused on medical grounds.

The report

The final report that you receive back is really quite interesting. It is more thorough than a report you would receive from your general practitioner and, if you are 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 have received your results, you can apply for the work permit and residence license.

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.

 Business travellers, which are usually deemed to be a short term stays for the purpose of conducting brief business or consulting trips, are not considered residents, and therefore do not need a work permit, which means they don't need to go through the medical check.

NOTE: Although this account was written for US expatriates, the same rules apply for travellers from Europe.

A health check is needed for all of mainland China work permits. There is no national standard for this, so immigration is slightly different for each location and the health check will vary in terms of what is required in different cities.

Nigel Crockett, GMS, is the business development manager for Santa Fe Relocation Services in Shanghai, People’s Republic of China. He can be reached at +86 13801919129, or e-mail ncrockett@santafe.com.cn.

Reprinted with permission of Worldwide ERC®, from the January 2006 issue of MOBILITY.

Figure 1: Process for medical exam

Subject: Expat health issues, immigration process: China