vrijdag 2 maart 2012

Singaporeans do things differently: health care

Warning: this is a long post! For proper advice on emergency healthcare in Singapore, please read this comprehensive and wonderfully informative post by the Bostonian Expat.

Dutch healthcare ranks among the best in the world in almost all areas - except that of communication with the patient. Non-Dutch patients tend to feel the doctor is not paying enough attention and are bewildered by the general consensus that if you're not squirting blood everywhere or turning blue in the face, it's probably best to "see how it develops in the next few days". This means they send you home. 

Without any type of medication, I hear those bewildered non-Dutch people ask. Not even some kind of placebo, just to put your mind at ease? The answer is no, dear care-expectant foreigners, not even a fake sugarpill will they prescribe for you. Dutch healthcare is of the tough-love school. They send you home without any type of medication - or even a follow up appointment. You may call again if it doesn't get better. (Though they will allow you to take a common painkiller. You know, if the pain really gets too bad at night. But don't call before morning.)

Well, this is not how it works in Singapore, fellow Dutchies. Over the course of several of E.'s coughing attacks (which generally last for about a month), some eye and ear infections, and a couple of unidentified rashes which caused child care panic (she is prone to heat rashes, we live in the tropics, you do the math - but the child care centre likes to have doctor's letters backing my diagnosis up before they let her back in the door) I have done some anthropological fieldwork in the comparative study between the Dutch and Singaporean systems.

E. has a pediatrician here instead of sharing my general practitioner as she did back home. I can call them anytime within office hours (yes! I can get beyond the answering machine after noon and speak to an actual human being!) and they usually will arrange for a same day visit. I might have to wait for a bit (like an hour) - but then that's no different from back home. And since it's a baby and child clinic the waiting room is filled with toys, so E. feels right at home. And they have glossy magazines that are only a few months out of date instead of several years and if you're early enough there even might be today's newspaper! 

Other visitors
Since I've been told Singaporeans only get eight weeks of maternity leave (counting from when the baby's born) and five annual sick days to take care of a child, I expected to see a waiting room filled with helpers. But that's not the case. Maybe we go to an expensive clinic (I wouldn't know, I just picked the nearest one the insurance covered) but almost all children are accompanied by either a dad or a mum or even both (usually when it concerns a tiny baby). There are helpers in the waiting room - in that case the parent gets to read the glossy magazines (lucky her!)(the men pretend to have important business calls).

Hearsay and self diagnosis
"I hope you don't mind me saying so, but it looks as if your daughter could be hyperflexible", a mummy in the waiting apologetically commented. That would interfere with E.'s walking. So I asked the doctor (since I was there anyway, for immunizations this time) and she referred me to an orthopaedic surgeon. I was in shock: hearsay being taken seriously! Back home, whenever I tell the doctor that according to Google I might have cancer, they just roll their eyes. Yes. Visibly.*

Insurance coverage
So I called the surgeons office, made an appointment, showed up on time to be informed that my insurance would not cover visits to that particular hospital. However, the next day he would be practicing at another hospital, which the insurance did cover, so if I was willing to wait? 

This would never happen in the Netherlands - insurers might offer "incentives" such as shorter waiting lists if you go to their preferred clinics, but they wouldn't dare actually denying you reimbursement. 

On the other hand, I only had to wait for a day, and it all happened within a weeks' time of the original appointment at the pediatrician's. That also would never happen back home. (E., it turns out, is flexible, but not hyper. Although sometimes we find that hard to believe.)

I went to the clinic to get one of my "really she's healthy now let her back into school"-letters. "No medication?" the assistant checked while handing me the letter. I shook my head. She didn't let go of the letter. "No, really, no medication?" No no, I smiled. She tried to stare me down. I snatched the envelope out of her hand and made a run for it before she could fill my bag with little brown white-labeled bottles.

Singaporeans love their medication. At this point in time E.'s medicinal cupboard consists of:

- dentinox (to soothe teething)
- otrivin (nasal spray, two bottles)
- tussikind (homeopathic cough medicine)
- bisolvon (cough medicine)
- wood's (cough medicine)
- mucosolvan (to solve mucus)
- ventolin (to open up airways)
- paracetamol as pills
- paracetamol as pink sirup
- singulair (to open up airways)
- an inhaler 
- nebulizer medication
- saltwatermix for the nebulizer

They made us give back the actual nebulizer itself, spoilsports. And I just threw out a bottle of Zyrtec, some antibiotics and a bottle of Kaloba. 

The amount of medication I have fed my sixteen month old baby boggles my mind - and even so, we try to minimize it by lowering dosages as soon as she seems to be getting better.

But what's even more mind boggling to me, as a cynical Dutch care consumer: I have to take everything they tell me on fate because the medication is handed to me WITHOUT any kind of explanatory or cautionary leaflet. So of course, Google is our friend. (And, as usual, a very two-faced friend it has turned out to be!)

On the other hand, every single one of those medications as well as the medical equipment was handed to us in the clinic itself. So no calling around to "homecare centres" or visiting pharmacies a minimum of two hours later to enable them to label the bottle properly and to prepare a lecture on how the doctor prescribed one thing but really it should be another thing and would I please read the accompanying leaflet very carefully as they are not clairvoyant and would prefer not to be held accountable.

Follow up appointments
These are the bane of my existence and the reason that, on average, I spend one afternoon a week at the clinic. I calculated this and it seems to be an actual fact, rather than a figure of speech to exemplify my exasperation. 

The clinic advertises with an immunization package offering a discount if you get all the necessary ones done at their place. They even throw in a free chickenpox one! Back home, immunizations are considered a matter of public health. Insurance has to cover it, no questions asked. This is a tiny window into a truly liberalised healthcare system, where clinics and hospitals compete on price.

As we have lovely wide-ranging expat insurance, I haven't had to research local insurance and so come up against the reality of liberalised healthcare. But the murmurs I've heard on Singaporean forums give the impression it might be either a time consuming or a money consuming task to get yourself and your family healthy. Rather like finding the right flight for the right price.

It's not all different
The Singaporean system is one of the best in the world, according to the WHO, and definitely scores above the Dutch system in terms of communication and listening to the patient (well, its mummy anyway). It takes a bit of getting used to, I find, all this friendliness and attention. E. even gets a little bag of nibbles to take home!

But however many times I might have been, I still feel reluctant to call in between appointments. The fear of seeming like a hypochondriac or inconveniencing the doctor who'd obviously be much better employed doing life-saving type stuff, instead of listening to my low grade whining, is just too deeply ingrained. But when I do pluck up the courage (or get so badly sleep deprived that medicating E. with dozens of syrups and pills seems preferable to nature taking its course) the doctors and nurses are just really lovely.

E. however is not blinded by all this niceness: she might play her heart out in the waiting room, she might munch happily on crackers on her way out, but she still screams from the top of her lungs while inside the doctor's office.

So maybe we shouldn't worry so much about her lungs after all.

*And quite rightly so. The last time I came in for a cervical cancer check I turned to be pregnant with E.

1 opmerking:

  1. Singapore is really improving in medical field day by day lot of good health care centers are there one of them is mt elizabeth medical centre Singapores