The smog is caused by industry, cars, and the need to provide electricity for over a billion people. Most of their electricity is generated by coal, which is plentiful there. The country is in the process of replacing a lot of that coal-generated power with cleaner hydro-electricity, but that will take time. The pollution is very bad; my eyes burned and my throat was scratchy the entire time we were there.

I'm not sure what you're asking about getting sick. We had travel insurance which would have paid to get us home if we were so ill that we couldn't continue on the trip. The ship does have a doctor, and of course, there are doctors in the cities. All of the guides speak excellent English, so I'm sure if there were a medical need they would assist you.