Later she chose the Huashan Worldwide Medical Center.

"The working staff speaks good English and they treated me very well," she says.

When she got an inflamed right foot early this year, the Brazilian also went to Huashan. "I trust the doctors there," she says.

German Hog Weiss echoes Negreiro's findings.

The overseas student in Fudan University got dermatitis this spring.

With the help of his Chinese friend, he went to a local Chinese hospital and soon recovered.

"It is inexpensive and the doctors there are also very effective," he says.

Most doctors recruited for the international department of Huashan could speak fluent English, but learning to provide medical services for patients from a different cultural background was not as simple as just providing private rooms and Western food. It required detailed consideration to make them feel at ease.

For example, most Western patients are inclined to be independent and get back on their feet as soon as possible, while Chinese patients expect more care from families and hospitals and prefer resting until fully recovered, Gu says.

"It would be incredible for Chinese patients to take a shower the next day after surgery, but Western patients want to resume their normal lives as soon as possible," says Dr Jack Zhang, who has been working at the center for about 10 years.

Compared to joint venture medical institutions such as Parkway Health Clinic and United Family Hospital, international service departments in public hospitals such as Huashan Hospital and Shanghai Children's Medical Center may be able to offer more specialized advice, especially when dealing with difficult and complicated diseases.

Though most full-time doctors in international departments play a similar role as general practitioners at foreign-invested medical institutions, there will also be specialists to help diagnose and treat difficult ailments.

In addition, the close connection between public hospitals and other local medical institutions such as the health bureau and some research institutes can provide extra medical help in urgent cases.

It usually costs less to see a doctor at a local hospital compared to a foreign-invested medical institution. For example, it costs 500 yuan (US$73) for the first consultation at the Huashan Worldwide Medical Center and 300 yuan for following visits, compared to about 1,500 yuan each time at United Family.

All types of medical services are necessary in Shanghai due to the increasing number of expats, says Dr Gu.

"Limited international departments in top public hospitals cannot handle patients in such large number, while foreign-invested medical institution and clinics cannot provide professional treatment for difficult ailments. The best way to solve the problem is to establish a network among the different types of medical institutions," he says. "The network is already established."

Gu says foreign patients could choose any one of the three for first diagnosis, and foreign hospitals and clinics always transfer patients with difficult and complicated problems to public hospitals if necessary.

(Shanghai Daily August 18, 2009)