I am responding to the question raised concerning risk of contracting hepatitis while traveling in China. My knowledge is that of a lay person, but I researched and learned about this important health concern while living in China. Hepatitis is a catch-all term which is used to describe inflammation or infection of the liver. There are many different types of liver infection and, hence, many different types of hepatitis. Some are easier to catch than others. For instance, Hepatitis B is a blood-borne illness contracted mainly through sexual activity and IV drug use. If a person doesn’t engage in these two activities, their likelihood of contracting Hepatitis B is quite low. On the other hand, Hepatitis A is spread by the fecal to oral route. In China, where human waste is used to fertilize produce, transmission of Hepatitis A is a very real concern.
The hygiene rule is that all produce that one eats raw must be washed with particular attention to killing hepatitis (and food poisoning) germs. Additionally, water coming out of a tap is not always sanitized to the level of drinking water. Therefore, it is not sufficient just to wash produce in tap water before eating it raw. Food that is eaten raw should be washed and peeled, or dipped in boiling water, or rinsed in a mild disinfectant solution. I personally used to triple wash my salad greens in soapy water and then rinse them in bottled (boiled) drinking water. I thought this seemed sufficient. But many of my European friends also dipped the food in water that had a few drops of bleach or store-purchased disinfectant added (the exact recipe evades me).
The key issue, for me, was salad. Like many Americans and Europeans, I was used to having salad on a regular basis. It is not part of the typical Chinese diet, and I craved it. I once read that if one follows the folkways of a country with regard to food, one will likely be safe. The folkway in China is that people will eat salad, but they don’t eat it unless they are certain as to the standards by which it has been washed.
If a salad has been put out in a restaurant with the intention that it be eaten as a salad, it is likely that the food has been washed to a standard that is acceptable for human consumption. This will especially be the case in a hotel or place that caters to upscale or western tourists. On the other hand, often in a “down home” Chinese restaurant, greens will be put out with the intention that one take some greens and hand them to a chef to be parboiled or put into one’s boiling hot soup. I once watched with horror as a European tourist, obviously with a tour group, took some of these greens and began eating them as a salad. I was so concerned that I said something to her. Her reply was that “of course” it was a salad and “of course” they were clean. I felt she did not understand, so I told the restaurant manager, hoping he would enlighten the tour group that the greens for parboiling were not intended for use as salad. The restaurant manager assured me that no one would be so stupid as to eat greens from the area not designated as being salad greens. This highlights a bit of the culture difference.
In addition to asking how and where the salad ingredients have been washed, one also does well to ask where the dishes have been washed. Some restaurants will deliver dishes to the table in sealed plastic. This is a sign pridefully used to show that the dishes have been placed in an ultraviolet sanitizer. Outside of upscale restaurants, the folkway is that the first pot of boiling hot tea water is used to rinse one’s dishes personally. Before engaging in this activity, look around and notice whether (and how) the Chinese customers around you are washing their dishes using the tea pot water. In an upscale restaurant where the dishes are already sanitized, it would be insulting to the owner to wash one’s dishes. But in ordinary restaurants, if a pot of boiling water is brought to your table along with a large empty bowl, this is the sign that you should use the piping hot water to rinse off your chopsticks and eating bowls. Notice how the patrons pour boiling water from the teapot into their cup, letting it run down the vertical chopsticks as they do so. The water is then transferred to the bowl, which is also rinsed. Finally, the now-cool water can be used to rinse one’s own fingers (like a fingerbowl) and then poured out into an empty large bowl which has been put on the table for the purpose of carrying away the used “washing” water.
In the countryside, if the food is steaming hot when it is brought to you, that means it has been recently boiled. If it is not steaming hot, and if you have any reservations about cleanliness of the establishment (or how long the food has been sitting out), follow your better judgment and do not eat it! Finally, water should be boiled before drinking, preferably for five minutes. It is considered inhospitable for a host to offer water to a guest which is cool. If water is cool, the guest will have no way of knowing if it is clean or not. This is why every decent hotel in China will have a kettle in the room which is used for boiling drinking water. Bottled water can be purchased inexpensively at convenience stores and carried to one’s hotel room, as well.
I’m sure some people may take issue with what I’ve written. Some people would not be content (as I was) to triple wash but would rather insist on using the sterilizing solution or not to eat salad at all. Others, on the other hand, might be more intrepid and take more chances. The thing is that hepatitis is pretty serious. As is avian flu. These health risks are worth learning about and taking strong precautions to make sure one doesn’t come home with unwelcome souvenirs. (On the issue of avian flu, all poultry should be cooked to well-done, and egg yolks should be cooked until hard.)
Crossing Cultures 