Santé! The joy of being sick in a 5 star health care system.

19 05 2008

Grand Piano in Raffles hospital lobbyWaiting room with internet stationWaiting room 1 at Raffles hospital Paying the bill!Santé!

Pauline Chan, my gorgeous Montreal-Chinese now Singaporean friend who I now almost call sister, wrote to me the minute I posted my blog last week.

-Helene, you mentioned that you would speak about the health care system of Singapore and this time I wish to contribute to your blog. I will call you later to discuss this because I don’t have time to ellabiorate; I have to have a surgery this morning. They offered me last week but I was too busy so I chose this Monday instead! Oh! And by the way Helene, I am the one who told you to go to the International clinic and not your colleague Paul at the office.

-Oups! Sorry Pauline, you gave me the phone number of the international clinic, but in fact, Paul sent me there. I guess health is a serious topic with a “0” tolerance in your family.🙂

But Pauline, I am surprised you want to talk about diseases and hospitals when you switched to text message instead of live phone calls on the day you found out I had mononucleosis and pneumonia! As if you could catch it talking to me over the phone!!

-I know Helene, isn’t that strange that I acted this way?? Anyways I got to go, the doc is waiting for me.

You might find it odd that we can actually choose the day of our surgery in Singapore or perhaps think that Pauline got lucky to have her surgery date so quickly, or even think that she has special network connections in the medical domain, but no… for us in Singapore it is business as usual.

My amazement with the health care system of Singapore started last September when I needed to find an Endocrinologist as a follow-up to the surgery I had in July, just before I left Canada. My only reference on the finding of such a specialist was in Montreal, two years ago, when I became ill and my GP suspected it had to do with my thyroid or parathyroid. He then told me:

-I will refer you to an Endocrinologist and my secretary will call to get you an appointment.

-Thank you doc! This seems simple enough.

The secretary was a bit more explicit:
-I will call to say you need an appointment and they will call you back within 10 months to a year to get you an appointment, which could take another year!
-TWO YEARS BEFORE I SEE THE SPECIALIST? What do I do if it is a tumor like they suspect? What if the current decalcification of my bones gives me osteoporosis at an early age if it is not stopped soon? What if…
-Sorry Mam but this is a” take it or leave It” sort of thing so what do you want me to do; call or not call?

10 months later they still had not called me back for an appointment and my health was deteriorating. I went back to see a doctor for something else and begged him:
-I am leaving for Singapore in two months and I am so worried, I don’t know what the health care system is like over there, I am afraid that it will not be of quality and If I need surgery, I will have no one to help me in Singapore, no support.

He felt very sorry and pulled a couple of strings. He sent me to his great assistant Natalina (cover up for the real name because I don’t want her to be blamed for helping me) who knows the who’s who of the hospital:

-Ms Blanchette I can get you an appointment next month with an Endocrinologist because I know the girl who takes the appointments!

-You are my savior Natalina and I will never forget you (I really won’t).

A month later I was sitting in what looked like the office of a war hospital with furniture of the fifties and the  “salmon and green paint peeling off the wall look”, which characterizes most Canadian hospitals. Piles of non-filed papers were lying on the desk of the secretary who did not dare to look at me once, even though I was the only one in her office. All I could think of is: How could I get my file on top of the pile?!
The entire place looked filthy and yet, I was in the biggest hospital of Montreal. For a reason I still cannot figure out, the girl hated me before I even opened my mouth. She wanted to let me know that she has power in this hospital section and she will certainly use this power if she has the opportunity. I was the opportunity: after all, I was sick and weak and, dam me, I needed her help.

Good enough, after my Endocrino doc told me I needed surgery very soon, he said:

-Go see my secretary and she will try to use magic tricks to get you into surgery before your departure for Singapore.
-YOU MEAN HER???
-Yes!

I felt as if I was in a TV show such as “Twin Peaks” or a Hitckok film; the machiavellian secretary who will try to kill me before the end of the movie!

Good enough, while the doctor was in the vicinity, she smiled and said that she will call her connections and advise me on Monday of the surgeont’s availability. She never called, never returned any of my 6 desperate voice messages and never took care of it. Power she had and power she used… just the wrong way. Three weeks prior to my departure for Singapore I was panicking, a tumor hooked on my parathyroids and now almost two years had gone by without getting the proper treatment.

In desperation I called Natalina again and begged her for help… and she came through! I had my surgery one week before I left. But a few hours before surgery, a medical error caused by the preparation team of the hospital forced the doctor to perform a more serious operation than expected. Never the less, the tumor was out and a week later I was leaving for Singapore.

So here I was, 2 months later in Singapore having to repeat the same trauma: FINDING AN ENDOCRINO THAT WILL BE KIND ENOUGH TO ACCEPT ME AS A PATIENT. Here in Singapore I have no connections and no Natalina, but I had also no choice.

My friend Jennifer who lived in Singapore and also had thyroid problems told me that she had found one of the best specialists of the country (or city).

-Go see a GP and ask for a referral for this endocrinologist.

Hearing that made me think of the long process and frustration I will need to engage to carry this mission, but I have no choice so here I go to the nearest clinic to take a number and wait in line…. for 2 minutes!  May I remind you that Singapore holds 5 million people?!

-Hi Doc Wong! I am here to get a referral to see this great Endocrinologist so can you help me?
-Sure says the doctor, let me call for you.
-How is tomorrow 9h30 am for you Miss Blanchette?
-Tomorrow? What do you mean tomorrow? I cannot make it at 9h30 tomorrow.
-All right then, when would you like to go?
-When do I want to go??? Wow!

2 days later I showed up at the Gleneagles hospital. I was first impressed by the surroundings and the clean well kept look of this older hospital. http://en.wikipedia.org/wiki/Gleneagles_Hospital_and_Medical_Centre

The first thing I hear at the doctor’s office is this joyful and smiley nurse saying:
-Hi Ms Blanchette, we were waiting for you so please come and sit down and another nurse will come to you, take a sample of your blood and the doctor will see you in 90 minutes with the results in his hands. I think it will be a better use of your time this way. You can leave and go walk in the park, but please be back at 11:00 am. Where are you from? She genuinely asked with the largest smile available.

-From Canada.

-Ah! that is why you have a French accent, are you from Montreal? (How do they know so much about the other side of the world??)

At 11:00 am, after a beautiful walk in the botanical garden of Singapore among swans and palm trees, I walked in the office again:
-No time to sit, Ms Blanchette, says the smile on two legs, the doctor is ready for you!

The doctor, a very competent one too, had my blood test results in his hand and was in deed waiting for me, shaking my hand as I walked in. After examination, he completed the visit by:

-Please go see my secretary; I want to see you again in two weeks and she will also help you finalize the bill.

Ouch! I forgot I have to pay; it is free in Canada!

-How much do I owe you miss?

-Well today is your first visit so there is a file preparation fee, the blood test and rushed results and also the doctor’s fee so it will be more expensive: The total is $200 Sing dollars ($160 cdn) + 7% tax.

I must have heard wrong, this is not expensive enough, in Canada the health care system cost the government (hence its citizens) way more than this. This cannot be!

Two weeks later, I showed up on time at my follow-up appointment. Again; the smile, the doctor waiting, etc. and the bill came to: $26.95 ($20 cdn) for my visit with the specialist.
-$26.95?????
-Yes miss Helene, we made a special for you today because the real price is $56
-You mean that in Singapore Doctors go “on sale”??🙂
-Do they have seasons, or boxing day too?
-No, we just like you.

Her smile got even bigger and just burst out laughing:
-Can your insurance reimburse you?

-Of course they will, but quite frankly I won’t loose sleep if I misplace the receipt!

-Why, is Canada’s health care expensive?

-Actually no, it is free, but the price to pay is high: You wait in emergencies for 8 to 12 hours on a good day, you stay in corridors for days with no dignity, trying to see a specialist can take months or years, getting surgery is a lottery ticket and if you come out of it OK, you may have contracted the C-difficile bacteria that is everywhere in hospitals. You don’t want to be sick in Canada or at least, not in Quebec. It is full of good people who have lost their faith, laughter, ideology and passion. The equipment is old, hospitals are really badly kept, often dirty and you have to go to private clinics if you wish for a bit of efficiency. Even there… a treatment can take up to a month or two and the cost…well more than here let’s say!
-Too bad for people there! But anyways, when do you want to see the doctor next?

I just love hearing that! It is music to my ears.

My recent health challenges of February and March with Pneumonia and Microplasma infections have lead me to many hospital visits. The first of these visits was in Canada for a prescription renewal and because I am no longer a resident, I had to pay $65 cdn ($100 SGD) to see a tired and stressed doctor for less than 5 minutes, after waiting for 3 hours.
Yet, back in Singapore I went down a long list of tests recommended to ensure they will carry the right diagnostic and all of it in the fastest turnaround time ever. I never waited more than 2 minutes in a waiting room (too bad because the waiting rooms are luxurious, comfortable and all equipped with internet stations to continue your business while waiting. See photo above).

At the Raffles hospital, a full annual screening test cost $425 SGD ($340 CDN ) and a hotel like buffet is available “for free” when you have your half time break in the morning. You have a choice of croissants or bakeries accompanied with freshly squeezed orange juice or apple juice.
-Coffee? Latte or Espresso?

A nice helper follows you around while you go through your tests to ensure you are not wandering around everywhere to search for the right doors.  Along the way, she introduces you to all the different staff that is joking and exchanging with their peers, WAITING FOR PATIENTS. Yet, we were hundreds of clients that day, but they succeeded to process us with grace in such an efficient way that they had time for a couple of jokes between two patients. An X-Ray is $32.50 and takes “in and out” of the hospital less than 5 minutes, the equipment is always the latest technology and the decor is worthy of mention.

The Raffles hospital (http://www.raffleshospital.com/virtual_tour_location.html) is one of the  private hospitals of Singapore and displays an automated Grand piano in the middle of its gigantic marble lobby. It is there to entertain passing by patients and visitors; the decor is the equivalent of a 5 star hotel. As for the staff, they are always available to help you in the most professional way. The process works like a clock; here you don’t feel sick, you feel important! You are not a patient… you are a client!

If you ever get tempted, they have an international section and people from all over the world are flying-in to get treated like real human beings.

I experienced dozens of tests, met at least 5 GPs and 4 specialists, always at the time and date I chose. The last one was an urologist and I booked the appointment 24 hours ahead of time. He too shooked my hand as if it was a business meeting and thanked me for my trust. At the end he asked me if I was pleased with his service. Oh! I almost forgot to mention that 24 hours after any treatments or visits, you receive an SMS with a satisfaction survey question: Were you pleased by the efficiency and the competence of the service you received yesterday?

-So Miss Blanchette, is that how I should pronounce your name?
-Yes, you are good.
-So the total for: the 5 X-rays of this morning, the urine tests and blood tests, the doctor’s visit and the 3 weeks of antibiotics is $358 SGD.
-Thank you, where do I sign?
-Can I shake the doctor’s hand again?🙂
-No worries, the doctor will call you tomorrow if the other results have something to show.
-I have never been worried one minute; I know very well that I am in good hands here.

Many of these great doctors called me at home at night, discussed my situation with me, apologized for disturbing me at home and carried on with a comforting attitude to explain some of their concerns while offering detailed possible solutions to my problems.

Seated in a Singapore airline Boeing 777 on my way to Shanghai, weeks after these experiences, I am still impressed by their attitudes and the way they made me feel I was in great hands. They demonstrated many times over how much they cared for human beings.

The non-private hospitals are as good here, so the less fortunate are not left behind. The government of Singapore has recently launched a new comprehensive health care program that should make everyone else think twice. It is a progressive coverage aligned with your income level. For example, if you earn less than $30,000 a year, health care services are completely free; coverage will reduce to according to your level of earnings and your choice of treatment. For expatriates like me, it is either my work insurance that covers it or I pay directly the hospital.

Last week, trough a yearly routine check-up, doctors suspected Annabelle (my house keeper) to have been exposed to tuberculosis as a young adult and that the virus is still dormant in her blood.

-She is not contagious and cannot transmit the disease the doctor says, but one day, when she is older and weak, the virus could reactivate itself and she would be very ill, likely to die from it if she does not have the proper care.
-We can thoroughly test her and engage in a preventive tri-therapy for 6 months to ensure she never develops the disease for the rest of her life, but this will be costly miss Blanchette
-I don’t mind, Pierre and I will pay for the preventive treatment because we both know that she will never be able to afford it later, when the disease decides to activate its destructive path.

The 4 major tests she needed to follow at the Tang Tok Seng Hospital totaled $650 SGD and she now needs a daily-supervised treatment at the clinic where they administrate the medication. The pills are free, paid in part by the government of Singapore. She will need to see the specialist every two weeks for $80 so all together, in six months, it will have cost us about $2500 SGD. Not that much for a human being’s future.

Meanwhile, in Canada, a friend of mine needed surgery, but the wait list was very long. He turned to the private sector and was willing to pay the $16,000 required. They could operate on him within 2 months. My friend was ecstatic about it. Unfortunately, last week he found out they could not do it at the private clinic and needed a hospital environment to pursue this surgery. He is now on a waiting list and hope to get his operation in 18 to 24 months!

A week later my mom was hospitalized for 4 or 5 days. When I tried calling her over Mother’s day, the phone would ring endlessly. I found out that it was because the phones are old, the cables dried and wires were badly connected. My brother fixed the phone and when I finally spoke to her and realised she was getting better, I could not resist to ask her:
-Mom, could you describe your hospital room for me?

With her happy but weak voice, she answered:

-It is filthy, old and the walls are peeling off salmon and green large chips of paint. But I have a new cotton curtain between my neighbor and me!

When I hung up the phone with my mom, I called back Pauline to ask her what she wanted to say in my blog:

-Well Helene, the service is fabulous, the facilities are gorgeous, the doctors are competent, the staff is smiley and not stressed and it was a very enjoyable and surprising experience.

-Well Pauline, you just resumed in 3 lines what took me an entire blog to describe! I like the way your mind works.

-How is your mouth after the surgery?

-I am fine, thanks for asking. Right now I have a swollen lip like Angelina Jolie.

-Pauline, weren’t you gorgeous enough as it is?

-It was not plastic surgery Helene, it was a cyst, and please don’t make me laugh, it hurts.

– All right then, I will send you a text message, in case laughing is contagious!

Sante! Cheers!


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One response

26 05 2008
Katherine

Your blogs sometimes make me cry with happiness Helene!

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