Within Shanghai's often ultra modern and efficient medical system there is a disease that is preying on people. It's a disease that can cause permanent harm, sometimes death. It is the disease of the illegal medical clinics which flourish in outer suburbs and attract their patients from poor people, migrant workers who do not qualify for the city's health insurance or unfortunates who seek quick cheap remedies for illness.

Like the attractive 20-year-old Xiao Li who attended a clinic in Minhang district, complaining of the symptoms of a common cold or flu. She died the next morning after suffering an anaphylactic shock from an intravenous antibiotic she was given at the clinic.

The "doctor" was 35-year-old Cong Shanguo from Anhui Province. He was unlicensed to practice and in fact only had a diploma from a medical trade school which trained nurses or medical technicians, not doctors. He was running the underground clinic in Minhang district in 2005 and had never had a license for it. He has now been arrested and thrown into jail, on the orders of the local prosecutor, for medical fraud and malpractice, according to the Jiefang Daily.

Medical fraud is when an unlicensed or unqualified person offers medical diagnosis or treatment or establishes a clinic. These illegal clinics are usually hidden away in apartment blocks or small villages in the suburbs and rely on word of mouth or small, localized advertising to attract business.

Thousands closed

Last year the city government shut down 2,052 illegal clinics, confiscating 3,295 boxes of medicines and 39,267 medical instruments in the process. From this, 191 cases were handed to the police and 102 people were prosecuted for criminal offences. Some 33 percent of the clinics raided offered dental treatments.

The section chief surnamed Fu with the supervisory department of prevention and control of infectious diseases at the Minhang Institute of Health Inspection said, "Most of the illegal clinics in Shanghai deal with general medicine, gynecology or dentistry. In recent years, there's a new trend with the emergence of illegal cosmetic treatments."

Located in the outer suburbs of Shanghai, Minhang is one of the districts where illegal clinics have thrived. Before 2009, there were more than 500 clinics there but after crackdowns Fu said there were only about 100 left now.

Ni Yiyuan is one of the many people who wish that there were no such things as illegal clinics. The migrant worker was diagnosed with gallstones in 2011 and her doctor had suggested surgery but the cost was prohibitive, she thought. Her husband found a business card advertising a clinic locally and they decided to have the gallstone operation at the clinic which promised to perform the operation for a great deal less.

However, when she was given a 60-yuan ($9.65) antibiotic IV drip she suddenly felt her temperature drop and struggled to breathe. She was rushed to hospital where she was treated and recovered. The "doctor" at this clinic was Xu Feng whose medical training consisted primarily of some village-based courses in nursing and medical technology.

Xu said that he opened the clinic because he could not find any other work in Shanghai. With only some basic medical training, he handed out business cards to workers on a neighboring building site. He had no idea that Ni had a history of allergies and had not inquired. The local prosecutor said that Xu had been caught for similar offences twice before and this time he was sentenced to seven months in jail for running an illegal clinic. 

The problem is often a matter of economics. "Most of the clients of these illegal clinics are migrant workers and low-income residents who are ignorant about professional medical practice and believe that these clinics are more convenient and cheaper than the State hospitals," Fu told the Global Times. "Migrant workers have been accustomed to outdated and very basic medical care in their hometowns, where people just have to answer a few easy questions to get medicine quickly."

To help relieve the economic burden on migrant workers and dissuade them from using the illegal clinics, Minhang district is now offering pregnant migrant women a 600-yuan obstetrical examination, half the price of a public hospital exam. It leads the city with this move. As well, for workers with minor complaints like flu or coughs, Minhang is also offering discounts at general hospitals. Patients will be able to see a doctor and collect prescribed medicine for 10 or 20 yuan. "This is an effective way of preventing cash-strapped migrant workers from seeking out illegal clinics," Fu said.  

Another reason some elect to go to these clinics is privacy. "Especially if they have a venereal disease, people are too embarrassed to go to public hospitals. They are afraid their friends and relatives will learn about this while the small clinics will be more discreet."

Fu explained that in the past, power poles around the city were plastered with small advertisements claiming cures for venereal diseases - often the cures were "secret prescriptions handed down from ancestors" and able to end the embarrassing diseases forever. This sort of advertising is not as common these days.

"There are also many gynecological clinics equipped with ultrasound machines which can tell pregnant women if their embryo is male or female. If it turns out to be a girl, a woman could seek an abortion," Fu said.  

Cosmetic marketing

Unlike the usual illegal medical clinics, the new wave of cosmetic treatment clinics target young well-paid women. "In hair and beauty salons, staff will often suggest that customers undergo simple beauty treatments like eyebrow tattoos or laser hair removal," Fu said. "But all of these treatments are illegal if the clinics involved are not licensed as medical institutions." 

Most illegal clinics don't have sterilizers and are hotbeds for the transmission of infectious diseases like hepatitis. To cut costs, some clinics buy substandard medical materials or out-of-date medicines. 

Fu said these bargain basement clinics could be highly profitable. "They only need to rent an apartment. Their instruments and drugs are cheap if they buy recycled stuff. And they don't bother with disinfecting. The amounts they charge are a lot less than legal clinics or hospitals do and this is their big appeal."

Chen Shouping is a dentist who runs a private clinic in Pudong New Area. He told the Global Times: "The problem is also, to some extent, the fault of medical instrument and medicine manufacturers who don't check licenses when they sell their equipment and medicines. Anyone with cash can buy directly from a manufacturer."

Most of the tragic outcomes of these illegal clinics are the result of malpractice and the harm, when not fatal, can last a lifetime. Sometimes the illegal clinics come in unexpected forms.

A head dentist with a city hospital was given an administrative penalty in 2007 after performing restorative work on a patient's teeth in his own home, rather than at the hospital, the Shanghai Evening Post reported.

The patient, a 36-year-old woman, wanted to have three teeth fixed before she traveled to the US in 2003. She went to see Zhang Qiang, who was the head dentist at a hospital and a former classmate of her husband. Although the woman only wanted three decayed teeth repaired, Zhang talked her into a comprehensive restoration work and offered to do this at his home, telling her it would save her time and money.

She paid 45,000 yuan for the dental work but after a month she was suffering agonizing pain and swelling in her jaw. She was unable to chew and could only eat noodles or rice soup. She and her husband tried to meet Zhang (he had promised to fix the problem) when they returned from the US but he refused to see them. They then took him to court, asking for 700,000 yuan in compensation.

The court sided with the woman, saying a third party evaluation showed that she did not need the extensive restorative work that had been carried out and that Zhang had performed this at his home which was not licensed as a medical institution. He was ordered to pay her 230,000 yuan in compensation. But the damage the woman suffered has meant she has had to undergo a series of operations and her teeth will need expensive and constant care for the rest of her life.

Not uncommon

Treating people at home is not uncommon. One dentist surnamed Zhou said, "This is a common practice and it is what the market demands." Zhou works in a public hospital in Jiaxing, Zhejiang Province, but outside her work hours she sees patients in her apartment's garage - essentially another illegal clinic.

In her 8-square-meter garage, Zhou acts as dentist, receptionist, and assistant. But her patient list continues to grow. Some people often have to wait for an hour to see her. "People choose my garage clinic because it's convenient and cheap. Just to register at a hospital now costs 10 yuan for every visit, not to mention having to wait for hours. Normally a ceramic tooth replacement costs 700 yuan at my hospital. Here I only charge 500 yuan."

She doesn't think private clinics are necessarily unsafe and said that patients can also receive bad treatment at public hospitals. Her garage clinic opens every night from 6 pm, and runs during the day on weekends. "I don't have any spare time - there are too many patients," she said.

She said that often in public hospitals doctors will run several tests before wanting to make a diagnosis - in these small clinics there is more efficiency.

"It's actually quite easy to learn how to fix teeth or carry out an abortion. A beginner can learn what to do in a month. But without proper treatment, there might be complications. Even in major hospitals, things go wrong because doctors get careless. The difference is that hospitals can be held responsible for this," she said.

In 2008, China introduced new laws to crack down on illegal clinics. Anyone caught running a clinic without a proper license or qualification will be fined 8,000 yuan and the clinic and staff will be placed on a blacklist to ensure they cannot do this again.

If an offender is caught for a third time, he or she will be charged and can face three years in jail for offering diagnoses or treatments illegally. If the clinic has caused serious harm, they can be imprisoned for between three and 10 years. If their actions cause a death, they face a 10-year sentence.

The garage dentist Zhou said the problem was that in her hospital the government required that the hospital was responsible for its profits or losses, so doctors were encouraged to prescribe expensive medicines or order more tests on patients, otherwise they would find themselves trying to live on a very basic wage.

"If the costs of medicine and treatment were less, there wouldn't be so many patients coming to my garage."