GUANXI

The death of a Chinese flu patient reminds China’s middle class their lives hinge on personal connections

Obsession
China's Transition
Obsession
China's Transition

In late December, Li Ke’s 60-year-old father-in-law came down with a runny nose. Four weeks later, he was dead. Now, the day-by-day account of the 29 days of his illness and death in Beijing has gone viral on WeChat.

More than 100,000 people have read and shared the story, written by Li, who details his family’s efforts to secure hospital beds, flu medication and blood donations for the ill man. Each time, they have to turn to connections for help—making for a painful reminder to China’s affluent that in sickness, the power of your personal network, or guanxi, is as vital as your money.

The story, titled “A middle-aged man in Beijing’s flu season,” (link in Chinese) was posted on the WeChat messaging platform on Saturday (Feb. 10). Li doesn’t say what he does but some details, like the mention of an aborted trip to the Las Vegas Consumer Electronics Show, suggest he might work in China’s “new economy,” and that the family is well off. Li’s in-laws live with them and help care for their granddaughter. Local media quickly sought to confirm the story.

According to financial news outlet Yicai (link in Chinese) the patient was last treated at the China-Japan Friendship Hospital, a leading hospital in the capital. Li writes in his nearly 26,000-character account that on Jan. 16, the hospital detailed his father’s case in a video—this two-hour WeChat video (link in Chinese) from that day matches the progress, symptoms and patient details described by Li.

Li’s father-in-law first went to a small local hospital. At a second hospital, a chest CT scan showed a lung infection, and doctors told Li to get the old man admitted to a large, better hospital. But China faces a shortage of hospital beds, and the flu made things worse. China, like other parts of the world, is going through one of its worst flu seasons in years—in January alone, the death toll of those from the flu reached 56 (link in Chinese), according to China’s National Health and Family Planning Commission, higher than the toll (link in Chinese) from the illness for all of 2017.

“A hospital is not a hotel, and money cannot get you a bed,” the author realized, as he made rounds of phone calls to his friends, hoping to secure a hospital admission through a personal contact.

With no success, Li decided to head to Chaoyang hospital, well-known for treating respiratory diseases, but his request for immediate admission was denied. The author turned to another round of phone calls while his father-in-law had a series of tests and received oxygen assistance. They ultimately left the hospital and returned the next morning. But still no bed were available even though the patient was “hardly holding himself up,” wrote Li.

Finally, a friend of Li’s at another hospital—the fourth one for Li’s father-in-law—said he could get a bed for them where he worked. Li decided to go there immediately, because “it’s easier to coordinate with a friend in the hospital.”

The powerlessness experienced by Li in getting his father-in-law into hospital resonated with many who read the story. “It’s not unusual to die from serious illness, but this family, which has a relatively high income, was stranded so many times because they don’t have strong enough ‘guanxi,'” wrote (link in Chinese) one user of the social media platform Weibo, “This really terrifies me.”

The same day, Li was advised to transfer the patient to Chaoyang or Peking Union Medical College Hospital, because the patient needed to be in the intensive care unit (ICU), and the hospital couldn’t accommodate him.

“I nearly fainted,” wrote Li, who had just left Chaoyang the same morning, and had already called his friends earlier about Peking Union Medical College Hospital, an institution “impossible to arrange with so many politicians and businessmen in power eyeing on it.” Two days went by before a hospital willing to give the Li family an ICU bed could be found on Jan. 8. At this last hospital, the patient was confirmed to have influenza.

The patient’s condition continued to deteriorate, leading the hospital to try treating him with an artificial lung machine. This care was costing them as much as 20,000 yuan ($3,100) a day—they realized their funds would only stretch to 40 days. Li began researching the probability the treatment could cure his father-in-law and restore him to his former health, and found it to be startlingly low. He writes that night he has a nightmare where elves come to make a wager with him, and he only has a 5% chance of winning.

It wasn’t just the hospital beds. Every single thing his father-in-law needed required Li to turn to his personal network. At one point, Li’s father-in-law needed blood—enough blood that the hospital required the family to replenish supplies in its blood banks with donations. After he put out a message for help, his nephew—and the nephew’s coworkers— turned up to give blood.

During intensive care, the family also had little communication time—around five minutes per day—with the doctors. Doctors in China often work intense hours for far lower pay than their American counterparts. At times, that leads patients pay “tips” to be able to get time with a doctor or secure a hospital admission—or, again, rely on the help of guanxi. “Money is useless if you don’t have a government official title,” wrote Li.

Li’s father-in-law died on Jan. 24.

“Someone like the author who belonged to the middle class had to suffer like this, if the same situation happens on thousands of grass-roots family, they might not even know how to handle it,” wrote one commenter (link in Chinese) on Weibo. “The hospitals in Beijing and Shanghai are not for common people.”

On the question-and-answer platform Zhihu, medical professionals also weighed in with recommendations of how to approach the medical system, but also to express sympathy. “This article will give you a good idea of ​​how unrealistic it is to feel a sense of security from so-called financial freedom. One of the two middle-class anxieties, medical treatment and education, could crush your illusions, ” wrote one (link in Chinese), who appeared to be affiliated with a hospital.

Feng Tang, a former gynecologist and well-known writer, attributed Li’s ordeal to the fact that medical care in China isn’t market oriented. That means “you have to pick up phone and utilize ‘guanxi,’ even it’s 2018—40 years since China’s reform and opening-up policies,” wrote Feng (link in Chinese) on Weibo.


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