Colorado native Natalie Todd arrived in Shanghai just four weeks ago and has already fallen sick. In the midst of attending class and acclimating to the place that will be her home for the next four years, she has come down with a sore throat and symptoms of the common cold. A singer, Todd is concerned that her voice will suffer if her symptoms continue to persist. But Todd is not the only student that has fallen sick.

“There has definitely been a lot of kids who got food poisoning because they ate street food, [and] there are a lot of kids who have the sore throat, have the little bit of a cold,” Todd said. “There is definitely something going around.”

Todd is one of 295 students that made the move to China in the past month as NYU Shanghai welcomed its inaugural class. When NYUSH opens its portal campus in Pudong next fall, that number will double. That number will climb to 1800 when the university is at full capacity three years from now, said David Pe, associate director of student life at NYUSH.

Like Todd, study abroad students have also fallen sick. NYUNY junior Trisha Goyal, who spent last spring in Shanghai, battled a harsh cough for the entire semester, was at times prescribed four different medications while simultaneously advised to take antihistamines she brought from the United States, and missed a week’s worth of class due to prolonged episodes of fatigue.

“Always being tired, it slows you down and you’re not able to think as much and you’re not even able to get your work done on time,” said Goyal, who experienced lethargy as a side effect of her medication until she left Shanghai in May.

Goyal joins 1300 other students that have studied abroad at NYUSH since the site’s inception in 2006. That number has grown steadily from 40 students per semester to 120, Pe said.

While the university continues to expand, both current and former students have expressed concern over their health, citing poor air and food quality and a lack of resources at NYUSH as potential causes. But for the administration at NYUSH, these concerns have not been vocalized.

“We’ve haven’t had anyone come to us and say you know we’re not doing enough,” Pe said. “I think, being informed, being aware, and having the resources has, from our understanding or my take on it, been satisfactory to the community. No one has come to us saying you know we need x, y and z, or anything else, I haven’t had that.”

NYUSH currently occupies part of the campus at East China Normal University. Residential space is offered at ECNU’s campus and in Zhongshan Park, an area about 10 minutes away from campus by taxi.

Unlike NYU’s portal campuses in Abu Dhabi and New York, the current facilities at NYUSH lack a running health center. There is no primary care physician or nurse on campus; there are only mental health counselors.

NYUSH has also partnered with two hospitals in Shanghai, Shanghai United Family Hospital and ParkwayHealth. Both operate with international healthcare organizations in China. All students are enrolled in HTH Worldwide, Pe said, a global health insurance plan that all NYU students receive when they study abroad. This service, he said, enables NYUSH to provide a standard level of care to its students.

Tyra Liebmann, dean of students at NYUSH, said that the university explored a partnership with ECNU to use its health center but decided to continue the partnerships that have proven successful in previous years. She also said the university is currently rolling out more educational materials to encourage students to make safe and healthy lifestyle choices.

“We have a local number that you can call that connects you directly to the [24-hour] health and wellness exchange in New York,” Liebmann said. “We’re excited to roll that out this year as another  resource to students.”

However for some students of the incoming class, these resources seem limited.

“I was extremely, I don’t want to say disappointed, but I was a little shocked that we have mental health care on campus but we don’t have physical health care,” Todd said.  “If I have a cold or if I just have a little concern I have to drive all the way to the hospital and take like a 70 RMB taxi ride to get there. I was a little disappointed with how that was set up because that was something they definitely didn’t make clear at the beginning.”

A 70 RMB taxi ride is equivalent to 42 AED, or $12 U.S.

At the start of the semester, students are given emergency health care cards with the address of cooperating hospitals in Chinese, and are encouraged to carry them around at all times. Medical professionals from the provider community are also brought on campus every semester, Liebmann added, to educate the student body on topics covering health and nutrition.

Even though emergency cards are provided, additional issues surrounding transportation to and from the doctor have been raised.

Goyal, who lived in NYUSH’s residential space in Zhongshan Park, said it took her 20 minutes via taxi to get to the doctor from her apartment and 35 minutes via subway. The closest subway to campus is 20 minutes away, she added, and felt she was more susceptible to falling sick while riding a cramped and crowded subway.

NYUNY junior April Zhao also spent last spring in Shanghai and purposely visited the hospital farthest from campus to avoid lengthy waiting times. Zhao, who speaks fluent Mandarin, accompanied classmates to the doctor and even to the hospital when her roommate had fallen sick.

“She didn’t speak Chinese that well so she needed someone to go with her to the ER so I went with her and I stayed with her for four hours at the emergency room,” Zhao said.

“For me and some of my friends, if we got sick we could talk to the cab drivers in Chinese and it was a lot easier … but I can see how it is a problem [for students] who weren’t native speakers,” she added.

Despite these obstacles, some students were able to navigate the system. NYUAD senior Joshua Shirley spent last spring in Shanghai. To prepare for his semester abroad, he requested his immunization history at the health center in Abu Dhabi. When prescribed medication from Shanghai United, Shirley double-checked the medical ingredients online.

“You always try to doctor yourself these days, as much as you can,” he said.

NYUSH is still in the planning stages in regards to how space will be allocated in Pudong, Leibmann said, and whether or not a health center will be built remains undecided. But some students are strong advocates for the construction of one.

“I can’t imagine going to school in Shanghai and living there for four years without a proper health facility to really track, and have formal physicals, that’s mandatory for all students,” Goyal said. “I can’t imagine not having that.”

Even though Shirley was able to navigate the healthcare system at NYUSH, he didn’t expect the air pollution in China to take such a heavy toll. He fell sick in just the first two weeks of the semester.

“It started first as sort of a cold. The mucus goes black, and you notice it because of the pollution,” Shirley said, who lost 15 pounds during his first two weeks in Shanghai.

As with Shirley, both Goyal and Zhao felt that exposure to air pollution negatively affected their health. Goyal said her doctors cited air pollution as a contributing factor for falling sick. Zhao, who spent weeks suffering from an inflamed respiratory system, said her doctor told her the same.

“I didn’t think it was going to be that bad. Especially after I got sick, I could feel the pollution worse because my respiratory system was the one that was affected during my stay there,” Zhao said. “I could actually feel each particle going into my lungs and I felt really bad at that point.”

China has been known for having heavily polluted air. According to the Global Burden of Disease Study 2010, a report released on Dec. 15, 2012, outdoor air pollution ranked fourth in mortality and health burden in East Asia where it contributed to 1.2 million deaths in 2010. Additionally, outdoor air pollution contributes annually to over 3.2 million premature deaths and over 74 million years of healthy life lost.

Dr. George Thurston, director of the Program in Exposure Assessment and Human Health Effects at the Department of Environmental Medicine, NYU School of Medicine, co-authored the 2010 GBD report. There has been a dramatic increase in air pollution in China, he said, and it is expected to continue to increase.

“I have had this discussion with faculty members who are considering going to Shanghai which has very much higher air pollution than the other campuses like Washington Square and Abu Dhabi,” Thurston said. “That’s been a concern that people have, because there are very high levels, especially in the winter time.”

Everyone is affected by air pollution, he said, but some can have more severe consequences depending on their prevailing health. He said that those with pre-existing diseases like asthma and diabetes face bigger risks. Long-term exposure to air pollution can reduce the growth rate of the lung, he added, and contributes to the early onset of debilitating respiratory conditions.

“From the long-term exposure [of air pollution] you tend to get the loss in your quality of life as well as a loss in your life span,” Thurston said.

However, Thurston said that if individuals limit their exposure and remove themselves from harmful environments, the body has a way of recovering.

Thurston advised that individuals living in polluted areas should practice prudent avoidance to health risks by minimizing their exposure to air pollution. There are a few things individuals can do, such as installing HEPA filtration systems to filter indoor spaces or checking U.S. embassy monitors to get the latest reports of air quality conditions. However, he said that individual efforts are limited compared to broader environmental policy.

“Ultimately, the only solution to this is to reduce the emission sources,” he said. “You can run but you really can’t hide from it.”

Minimal exposure is what NYUSH communicates to students outside, Pe said. The university follows the alerts that are issued throughout the city and notifies students via email when levels are especially high. Pe also said that the university recommends students to download the app that monitors air quality, a tactic that Shirley followed, in addition to using masks and purchasing air purifiers if needed.

However, Thurston said masks probably give individuals a false sense of security.

“In terms of particles, they’ll go right around that and into your lungs. That won’t stop pollution,” Thurston said. “In the short term people can avoid the high pollution days but it’s hard to say. There is no simple way to avoid the breathing of the air if you want to live your life.”

As students like Todd continue to adjust to life at NYUSH, students from NYU’s global network will continue to study abroad and make Shanghai their temporary home. Shirley suggests to be up to date on immunizations and to download the app that monitors air pollution while in China. Goyal recommends visiting a doctor prior to departure, as well as visiting ParkwayHealth at least once a month.

However, they also noted that there is room for improvement at NYUSH. Goyal said it would have been helpful if the university had provided more information about what over-the-counter medications were not readily available. She also would like to see the implementation of an ongoing and formalized follow-up process among RAs, staff and students.

“I just think that that support system is not solidified and they’re still a work in progress,” Goyal said. “NYU is a tier 1 university, it should have every program solidified and everything before just launching it. Students are not guinea pigs. That’s not how it works.”