Hospitals Around the World
Actually it is grandiose to entitle this piece "Hospitals Around the World" because we have only had firsthand experience with hospitals in the USA, Japan and Australia. In addition we had some tangential experience with the system in Spain. Fortunately those are the only countries where we have required emergency medical care. Or should we say unfortunately? We found the contrasts of the systems to be worth writing about and thus -- this page.
Our international health care experiences began almost five years ago when we were living in Japan for a year. Tom developed some medical problems, including a kidney stone, that took a few weeks to sort out and more than a week in the hospital to treat after being diagnosed. The whole experience was fascinating to us, even enjoyable in some peculiar way, (as we looked at it in hindsight), and very enlightening.
Just as we were about to embark on our round-the-world trip Tom experienced pain from another kidney stone. His urologist decided that he should have it removed but the attempt to remove it failed, a stent was inserted, he was placed on antibiotics (which were prescribed through most of our trip), and we were told it would be okay to leave for on our trip. We were assured that there would be no difference in functioning from the stent. (Famous last words!) Arrangements were made for lithotripsy (a breaking up of the stone), when we arrived back home and we were on our way.
This procedure and the medication led to numerous problems and side-effects that are still being sorted out but which, in the short term, we realized caused internal bleeding, an ongoing fever, and other complications. Earlier in the trip he suffered some problems that led us to check into possible treatment in Spain and Japan, but in both cases decided to put it off a little while as Tom didn't "feel all that bad". Consequently, by the time we arrived in Australia, he required hospitalization, with emergency treatment necessary, including a blood transfusion.
The care he received in Australia and in Japan, and might have received in Spain were quite a contrast to that which we experienced in US. Through all of that we became even more curious about how the medical/health care systems work in various parts of the world, while hoping that we have no more first-hand experience. We'd really rather listen to other people's stories about other countries' medical care!
Let's start by talking about our health care here in the US both when we are traveling and when we are at home. While we believe that the care here is probably the most advanced and the best in terms of technology we also wonder if our prices are ridiculously high.
Our major concern, however, is that it has become increasingly a "big business" with care becoming more and more impersonal, with less care and poorer care being offered in the interest of saving money for the health insurance companies. We know that the era of Dr. Welby is over but we find it particularly distressing that many physicians have no idea who their patients are, are defensive when a patient asks pertinent questions about their own health, and treat people as objects (a collection of organs functioning within a machine) instead of thinking, feeling human beings.
Our favorite personal anecdote about the new health care in the US occurred several years ago. Our primary care physician at the time, who had treated Tom for more than 11 years, whose partner had treated Tom's first wife through her terminal bout with cancer, and who also was Marie's primary care physician, asked Tom during one visit, "How is Phyllis?" Tom replied, "She died six years ago." In addition, when Tom referred to his atrophied leg during a visit, the same physician asked "What is wrong with your leg?" He had no awareness of Tom's polio -- a rather important part of his functioning!!
Now we don't believe that this guy is heartless or unusual. In fact he is a rather likeable man who just has no idea who we are. We have found many other examples in the care we and family and friends have received and attribute a lot of it to the pressure that physicians have to treat their practices as merely a business and the patients as numbers. But we did find it in remarkable contrast to the care we received in other places. We found other contrasts in the cost of medical care and disparity in the delivery of services.
In the US we were shocked and appalled to discover, upon retirement, that our health insurance premiums would be the biggest chunk of our total expenses. In fact, our monthly insurance premiums totaled more than all of our other expenses combined. It seems that something is wrong with that picture. In addition, during the year that we lived abroad we had to continue paying a premium of more than $400 monthly to our HMO for the privilege of "waiting in line" for our return, even though we would have no coverage from that company while we were gone! If we dropped or suspended the coverage during that time we would not be able to pick it up again upon returning and would have to make arrangements for our own coverage at an even higher rate. Talk about double binds.
Prior to our most recent trip we contacted our present insurance company (a PPO) to see if we needed to get travel insurance for our medical care while out of the country. We were informed that any medical expenses would be reimbursed upon return, as long as the expenses were for an emergency and we had the necessary information in English. We can't even tell you what an experience it has become to get that taken care of -- several months after the fact, and with the most meticulous of record keeping on our part. (When things like this happen to us, we always wonder about the more disenfranchised members of our society who don't have the same resources that we do and we have a great deal of concern for them.)
Delivery systems themselves are quite different. In countries where there is socialized medicine the government provides basic medical care for everyone. From what we understand that is the way it works in Canada, England and Australia. The government program pays for any "necessary" needs at public hospitals. However, for "elective" medical care, which could include something as routine as x-rays, one has to schedule it in advance with the possibility of a months-long wait. We have read many news articles about the system that refer to people who have died while waiting for the procedures or operations that they needed to save their lives.
Consequently, private insurance, similar to ours, but not as costly, is purchased by those who can afford it to enable them to get better care in a more timely manner at private hospitals. From what we can understand it is similar to those people who are on Medicare in this country and have supplemental coverage at their own expense for uncovered expenses under Medicare.
That is just an overview of some basic differences that we found. We know that none of the systems are perfect and each has its own flaws, but we found them to be more dramatically different than we could have even imagined. And the experiences we had and would like to talk about are on a more personal level than just discussing the logistics.
JAPAN
During our earlier stay in Japan, Tom's problems began with severe pain in his back and multiple other symptoms. He was running a temperature, was shaky, and had numerous other complaints that we will not describe in detail. At that point we had little knowledge of how the system worked and how we should go about getting help. Consequently, we called a friend who escorted us to a hospital in our neighborhood. Until that time we had walked by Yamanashi Hospital almost every day and had no idea what it was.
The first visit became one of several visits that we made before his condition was diagnosed and the doctors decided to admit him for kidney stones. Perhaps the best way to tell you what happened next is to include an excerpt from our Letters Home that we wrote to friends and family about the experience.
Today is Tom's first day back at school. Yesterday he was discharged from the hospital as planned. The bottom line is that he is okay and he had nothing life threatening, but during his ordeal we didn't know that. During that time they suspected colon cancer and a number of other problems. We didn't know what was going on until the last few days of his hospitalization, when we got the results of his numerous tests. It turned out that he had kidney stones, an obstructed colon, an infection, and his blood pressure shot up. We don't know if he was kept in the hospital longer than usual because of being a gaijin, or if Japanese health care is just different. We are simply grateful for good care and devoted friends.
Hospitals certainly are different here, as is health care in general. When people have any health problem they go directly to the hospital, where physicians see them in the order they arrive. As far as we can tell, there are not separate physician's offices, and people do not have family doctors. When a person arrives at the hospital, they register, and wait in a large waiting room until they are paged and told which examining room they are supposed to report to. Physicians have hours on a rotating basis at the hospital and their schedule is posted. They may see patients at different hospitals, but they don't have their own offices.
We learned later that if we hoped to see a particular physician, that we should only go to the hospital on a certain day. Also, because of our special status (English speaking, Eiwa staff, or whatever reasons -- we could not fully understand), we had more freedom in requesting a particular physician. However, we learned most of that in retrospect.
Yamanashi Hospital is just around the corner from us, and we walked by it many times without realizing it was a hospital. However, prior to our personal experience, we had noticed patients, in their blue and white striped hospital pajamas, often with their IV contraptions in tow, walking around the area. After we discovered what hospitals look like, we realized that there seem to be hospitals all over the place, many of them small. We couldn't figure out the system, so we asked Mr. Nakayama who owned all the hospitals. He jokingly said, "Parents of Eiwa students." Actually, some are public and others are privately owned. Some are owned by physicians, and at least one is owned by the father of an Eiwa student!
When Tom first starting having serious pain, we called Mr. Nakayama (who lives 40 minutes by car in Yamanashi City) and asked for help. It was 11:00 PM on a Sunday evening. He decided that it would be best for us to try to find a doctor at Yamanashi Hospital since it was so close to us. (And he has a good friend who works in the office there.) He managed to have a doctor awakened to see Tom. After that we made four emergency trips as well as one scheduled visit, over the next few days, before Tom was admitted. Each time he saw a different doctor, each had a different hypothesis about what was wrong, and each said to come back if there was more pain. (That part is not any different from what one would expect in a US hospital.) Also, each time it was a challenge to communicate. Most of the doctors spoke some English, some better than others. When it was time to admit Tom, the physicians had a meeting and decided among themselves who would be his sole physician. The chosen physician seemed to have the best command of English and we thought that was probably the primary reason he was selected.
Both of us have health insurance that is provided by Eiwa. It costs us nothing, and it certainly came in handy. We were amazed at the cost of health care. In this country where the price of everything else is sky-high, health care is very reasonable. During one emergency visit, which cost us approximately $16, the total cost on the bill was $165. This included several x-rays, a sonogram, blood work, urinalysis, examination, hospital and doctors fees. The total bill for the hospital stay (eight days) was about $2250, including the room, numerous procedures, doctors' care, medications, etc. Altogether, all of our visits to the hospital cost us a total of about $100, and we filled out no paperwork! We pay four times that amount for one month's coverage of health insurance in the US, with benefits, which aren't nearly as good. (Although we have to continue to pay that premium for the time we are out of the country, we have no real coverage. Basically we are paying more than $5000 to US Healthcare for the privilege of waiting in line!) We don't know how Japan can provide medical care for what they do. We have heard that insurance is high for those who have to pay their own premiums, but we don't know what "high" is, and we think that most people are covered by their employers.
In studying the bill, it appears that food was $54, the room was $1297, numerous x-rays & a barium enema $429. The doctor's fee was either $319 or $193, and medications were $13.50. Our initial share of that bill was 10%, (just over $200) but that was refunded to us by Eiwa. We were told that it had something to do with his length of stay and the cost going over a certain limit. However, we wonder if it had something to do with Tom's status at Eiwa. We have no idea if it was special treatment or not.
The personal care we received throughout was wonderful. Mr. Nakayama made certain we got good care and his friend who worked in the hospital office checked on us regularly. The head nurse came to Tom's room soon after his admission and introduced herself to us, saying, "I am the head nurse of the hospital. I am taking English conversation classes. I want to do everything I can to help you. Please let me know if there is anyway I can help." After that she checked with us first thing every morning when she arrived at the hospital and last thing before she went home in the afternoon, as well as sporadically during the day. The day Tom left, she told Marie that if Tom had any more pain, he was to come back to "our hospital".
The medical care was good as far as we could tell. The doctor who was assigned to be Tom's primary physician was very thorough, explained everything clearly and told both of us exactly what to expect. He obviously had planned his presentation very carefully in order to cover all the bases, and it seemed as if he had rehearsed it. If we tried to interrupt to ask questions, it seemed to throw him off. So we learned to listen to him until he was finished.. We were amused one time when we were waiting to see the doctor and Tom was attentively listening for his name in Japanese and the number of the examining room to which he was supposed to report. Instead we heard, "Mr. Thomas Grant, please report to room # 14." Everyone in the waiting room looked at us. Those kinds of experiences are humbling. We continue to feel badly that our Japanese is so limited and everyone tries to talk to us in English.
Nurses, in general, were a trip. They were exceedingly good-natured and energetic. They were a little nervous about the English problem, but dealt with it with good humor. They made a chart for Tom so he could point to let them know what was going on. Most body functions were on it (kanji with the English translation) and the English was more indelicate than we would normally use at home. However, it served the purpose. Overall, we found the nurses to be great and very friendly and helpful, but quite different from those we know at home. They giggled a lot, even when dealing with some terrible problems with other patients. (Giggling is often a sign of nervousness in this culture.) They ran up and down the halls. They almost never wore rubber gloves, even when drawing blood or otherwise working with needles, and they usually left the syringe for Tom's IV laying on his tray in between administrations of his medication. Many things we saw in the hospital would have been considered highly irregular in the US. One night when Tom developed a high fever they brought an old-fashioned water bottle with a clamp, filled with ice water,to apply to his neck to help bring down his temperature.
The biggest difference we found in patient care was the role of the patient's family. When Tom was being admitted, Marie was given a list of things she should bring for him. This included towel and washcloth, slippers, personal care items, a basin for washing, chopsticks, teacup, and some other basic items. Hospital pajamas were provided. Throughout this experience, Marie learned many more kanji, as it was quite a challenge to read all the signs in the hospital, and it helped to relieve stress to have something difficult to study.
Wives, family members, and "less-sick" patients do much of the basic nursing care, as well as general maintenance. For instance, when the meals are brought to the rooms, the more able patients serve the less able ones. When patients are finished eating, the more able patients return their plates to the cart. Patients, or their families, are expected to do their own personal laundry and hang it on the roof of the hospital to dry. The sheets in Tom's room were only changed once while he was in the hospital. We figured out much later that Marie was probably supposed to wash the linen and change the bed. One day a very sick man was put in Tom's room. The first thing his wife did was scrub the floor, bed, table, and other surfaces in his area of the room. There were hospital housekeepers, but they did minimal cleaning.
One patient insisted that Tom should drink beer for his problem. He pantomimed what would be the effect of drinking beer and how much better Tom would feel. (We will leave that to your imagination.) After we spent several days humoring him by listening and smiling and agreeing, he became more insistent. Marie asked the head nurse about it and was told to bring beer to the hospital and put it in the group refrigerator. She said that Tom's was a special case and beer would be good for him. He felt peculiar about this but complied.
Patients are given quite a bit of freedom to wander about and are encouraged to go to the roof for exercising. From the roof there are beautiful views of all the mountains around Kofu and a panoramic view of the city. But to get there, one had to ride the elevator for one floor, climb one flight of stairs, step over a high door frame, and maneuver around discarded hospital furniture. Sometimes that was a little difficulty with the IV equipment. (There are many reminders around us that this society is not as litigious as the U.S. and that part we like. It seems that people are expected to take more responsibility for their own behavior and the consequences of that behavior. This has led us to speculate about how much liability insurance has driven up the cost of so many things in the US.)
Special rules were made for Marie. Although the normal visiting hours were 1-7 p.m., she was informed that she could visit from anytime in the morning until 9:30 p.m. Many people seemed to be concerned about both of us. Mr. Nakayama said that in Japan there is a saying that the caretaker needs to be taken care of. One evening on arriving home from the hospital, Marie found two flowering plants by the door. Another time there were two bottles of wine.
We got a call from New Jersey, asking how Tom was doing. One of the earliest exchange students called to say that her parents in Japan were very concerned about Tom and wondered what they could do to help. Since they didn't speak a word of English they were frustrated. Another call came from Kyoto. It was the sister of Marie's calligraphy teacher, Mrs. Ogawa. She had spent some time in the US and could speak English. She asked for information about Tom' condition that she could convey to Mrs. Ogawa.
The next evening Mrs. Ogawa came to the door, carrying her English-Japanese and Japanese-English dictionaries and a gift of fruit for Tom. She communicated that Marie must feel lonely and that she was concerned. This was a wonderful, touching gesture, which was truly amazing. Mrs. Ogawa had no idea where we lived prior to that time, and she did not know the name of the hospital Tom was in. Marie had only had a couple of calligraphy lessons and could not imagine that anyone would go to that much trouble for her. (But we would soon learn that Kaoru Ogawa seems to have unlimited energy and resources and often goes well out of her way to help. It was not long before she would become a "sister" to Marie.)
Other visitors to the hospital brought fruit, flowers, and baked goods, and much concern. The food was especially appreciated, since the hospital food was truly awful. (Even the Japanese patients and staff who were used to eating raw fish and other traditional foods made that assessment.) We're certain that it must have been healthy, as bad as it tasted. Tom did enjoy an occasional Snickers bar and Oreo cookies, and even a Big Mac that Marie brought him. And he enjoyed the barley tea that was served several times a day and is considered to be very healthy. I
It is also a custom in Japan that groups to which the sick person belongs give "get well" money. Mr. Chiba, Eiwa's principal, and the school's business manager paid an appreciated, but pro forma, visit and gave Tom 5000 yen. Mr. Chiba made a short speech and then gestured to the business manager who removed the envelope from his pocket and handed it to Tom. People with authority do not handle money. Later, Mr. Nakayama came with an envelope from the English department, which contained 10,000 yen.
Now that the whole experience is behind us, we are really touched and grateful for all the care and concern we received. However, at the time we were both pretty numb.
Update 1999: We recently read that patients give monetary or other gifts to their physicians after being treated, to help compensate for the low income that Japanese physicians receive. We did not know that at the time and wonder if we should have done so. Marie did bake muffins to take to the nurses to thank them for their good care, but now we wonder if that was enough. No one clued us in and we simply don't know. We'll never master the "gifting" ritual!
We found out since the time of writing that letter that some physicians do have their own small offices but as far as we can tell they don't have "privileges" at specific hospitals as they do in this country. If one of their patients need hospital care they will be seen by someone else.
This year we also had the opportunity to visit a friend who shares a very modern office with a pediatrician. Together they try to take care of the needs of babies, children, mothers and families, offering both medical care and psychotherapy and support. We were quite impressed with the office, the quality of care and the services that are offered. Apparently, what they have to offer is innovative enough in Japan that their work was featured in a national newspaper article. Subsequent to the newspaper coverage, they have been contacted by a publisher in Tokyo and asked to write a book about their practice.
Something that we have found particularly interesting is Japan's attitude about physicians and terminal disease. It seems that only one-third of the patients who have terminal diseases are given that information by their physicians. The attitude is that the doctor is "god-like" in that he/she knows what is best and decides whether the family or the patient should know the truth. One friend told us her father had died since we were there before. When we asked her what was the cause, she said that the family didn't know. He kept losing weight, couldn't eat and kept going back to the doctor for treatment. The doctor said that nothing was wrong. but her father just got sicker and sicker and then died. It was pretty clear to us that he had cancer but the family was not aware of that.
Another postscript from our medical travails in Japan -- although Tom had many, many tests and X-rays while receiving care there, he never received an MRI or CTscan and instead of a colonoscopy he was given a barium enema. We weren't certain then whether the newer methods were available or not but wondered at the time. However, we were told by various physicians that to learn about the latest techniques or to improve their skills the best place to train is in the USA. Thus, the physicians who have a fairly good grasp of English have probably trained in the the US and may have more advanced skills. Many doctors also read US medical journals to stay informed. (We were also told in Australia that many of the physicians come to the US for training.)
We do not consider ourselves experts on medical care in Japan. We have asked many questions of friends and students in Japan to ascertain whether or not our take is accurate. As with many topics that we ask our friends about, we often get conflicting responses. So all that we have to offer is our own experience and our observations with the hope that they are a fairly good representation.
SPAIN
Our experience in Spain was quite limited but we learned enough while there that we wanted to share it with you.
Throughout the time that we were traveling Tom continued to run a fever and had what seemed like a lot of blood in his urine. We were not comfortable with either of these problems, although our urologist advised us via email that neither was unusual or anything to worry about. We were told that he should stay on the same mega-antibiotic and Tylenol. Consequently, we didn't change his medical regimen but did consult with a wonderful, kind physician who was traveling with us and offered to help us if we needed it. Through the interactions with him, we discovered that he would be able to write out a prescription for other medication and get it for us in Spain even though his license was to practice in the US. We also discovered that it is possible to walk into a pharmacy and get antibiotics over the counter without a prescription of any kind, although it was something we couldn't imagine doing since we have concerns about the trend of overuse of antibiotics.
From what we heard from people in Spain and from a friend who received emergency care while traveling in Italy, it seemed that the system of public vs. private and necessary vs. elective procedures that we describe in Canada, Australia and England may be similar in these countries. Our friend who developed a sudden and severe kidney infection in Italy immediately had his level of care upgraded as soon as the medical personnel discovered that he had insurance that would pay for it. He also described getting multiple shots with big needles there sometimes hit the bones of his long lanky body, instead of medications via IV that Tom received.
AUSTRALIA
Throughout most of our travels, Tom continued to say that he felt "okay" and we never considered discontinuing the trip. However, by the time we arrived in Australia we knew that medical attention was necessary. At this point we had the advantage of being in a country where English was the official language and, most importantly, we were staying in the home of people who lovingly took charge and cared for both of us with compassion and just plain good sense. In addition, we felt that we got the same kind of care from the medical personnel. What a contrast to the system we have become accustomed to at home.
On the first day, a Friday, we arrived in Melbourne, Emma made an appointment for Tom to see a physician at the local clinic. We had a bit of a wait because the doctor had to make a cast for an accident victim. This was explained to us with an apology. Already we felt that we (and our time) were being treated differently than we would be at home, where long waits are often to be expected and usually there are no explanations. This set the stage for many of the experiences that were to come.
Our wait wasn't really that long and when the physician did see us, she personally apologized for the wait, immediately took a urine sample and told us what she found in it. She added, "He is a very sick man and needs treatment." She offered Tom the option of inpatient care or outpatient care. Anyone who knows Tom knows that he would never opt for inpatient care if given a choice, and so the doctor said she wanted him back the next day for blood work and that he needed to see a physician the following day.
Due to problems beyond our control, Tom was not able to go back until Monday and saw the same doctor on Tuesday. When she heard of the delay, she responded with a "Damn." She obviously was upset that the delay had occurred and we were pleased that she seemed to take a personal and genuine interest in his care. (We contrasted this to the very impersonal care that has worsened since the days of managed care in the US.) She proceeded with his tests and studied his lab work. Immediately she recommended that he be hospitalized, would probably need a blood transfusion, and she went into great detail to explain everything to both of us. The whole process made us feel as if we were equal partners in the medical decisions, that we were completely aware of the realm of possibilities, and that we had input regarding the treatment options.
Hospital care had become a necessity and was no longer a option. However, we did have a choice of hospitals. We chose the private route, where we were advised that our care would be much better. We also had a choice regarding whether we would be transported by private car or by ambulance. We chose the auto option, our hostess chose the hospital and we headed there. Tom was immediately admitted to the emergency ward. No wait necessary!!
After a period in an emergency ward in South Eastern Hospital, where all diagnostic tests were performed and Marie was fed by a concerned nurse, it was determined that Tom needed to be admitted. However, they had no empty beds for him there. Again we had the choice of a public or a private hospital and method of transportation. The staff arranged for him to go to Como Private Hospital where we traveled by private car. We couldn't have made a better choice.
The first thing we saw upon entering the hospital was the following sign:
MISSION STATEMENT
Como Private Hospital promotes the delivery of superior health care continuing our reputation of excellence achieved.
OUR PHILOSOPHY
We at Como Private Hospital make a commitment to:
... Respect our customers and treat them with dignity at all times.
... Provide compassionate, skilled care that meets the total needs and expectations of the patient and family.
... Evaluate the services provided within the framework of continuous quality assessments and be responsive to the needs of our patients, staff and visiting clinicians.
... Provide resources to maintain and enhance the professional and personal development of our people.
...Work with other health care providers to increase the range of services provided for the benefit of the community.
... Provide value to our customers whilst achieving an adequate return on investment.
Now both of us have worked in places where there have been high-sounding goals stated. We have found that a lot of the time they are empty words, like those of a politician running for office. Nowhere have we experienced the kind of care that this facility provided. They truly lived up to their mission statement and philosophy where we were concerned.
Bottom line, we were treated like human beings with minds, feelings, and concerns. At no point did either of us ever feel that we were being discounted, talked down to, or cut-off. You can't even imagine what that feels like unless you have the contrast of being treated (by the expert) as an object with no brain in one situation and a human being with a soul in the other. And, when one is an vulnerable as we were, a little kindness goes a long, long way. How we wish that more medical personnel were aware of the importance of the human soul but especially when one is physically sick.
At first Tom was put in a room with another patient, a man who was very friendly and wanted to be sociable. However, when the head nurse became aware that Marie wanted to stay, the nurses had a meeting and decided to move Tom into another room where there would be more privacy and where they also set up a cot and brought bedding and towels for Marie, as well as food. Throughout the stay it seemed that Marie's needs were valued almost as much as Tom's.The staff often asked her if she had eaten, wanted tea, or needed anything. We also were aware that even though there were specific visiting hours the hospital was liberal in observing them.
Tom's medical treatment followed a course that was about the same that we would expect in the US with the exception that more diagnostic tests were run and each procedure was carefully explained to us and we truly felt that we had options. For instance, at one point the physician mentioned that he would like to remove Tom's stent but thought it might not be a good idea at that time. When we asked him to remove it, since we thought it was a major factor in causing the problem, the physician scheduled the surgery for the same day. It turned out to be the best possible choice as the bleeding immediately ceased as did some other even more bothersome problems. We don't want to add too much detail here, but just try to imagine not being able to walk for more than 15 minutes without needing a bathroom.
When it was recommended that Tom have a blood transfusion it really shook us up. However, the choice was ours and when we expressed the minutest concern the woman who was the top person in that department came to the room to chat with both of us. She patiently answered any questions we had to ask about the possibility of tainted blood, record keeping, matching, the process itself and how it would be monitored. She also said that if we preferred not to have the procedure, that would be our choice. We felt no arm-twisting or pressure of any kind. We didn't feel that we were wasting an important person's valuable time and we felt respected. We sensed no annoyance from her. It made it easier to make our decision and more well-informed about what it entailed. (You need to realize that Marie is someone who has worked in hospitals and has also had the experience of losing two children because the laboratory made an error in typing her blood. So with that background one does not want to be a passive recipient of the health system.)
The whole hospital experience was an intriguing series of lessons in Australian culture. We heard different accents from different parts of the area and added various phrases to our vocabulary. When the nurse was getting ready to give Tom his blood transfusion, she said, "I am going to top you off, now." We learned that "Mister" means a rank higher than "Doctor" -- a surgeon or other physician with higher credentials. As one nurse said, it means, "Closer to God." (Tom has since said that it is a shame that he knows no doctors here that he can share that observation with!)
Food was another experience. Tom had the choice of small, medium, or large portions for his meals, and he was given a choice of white wine, red wine, or beer with dinner, as well as the other beverages one would expect. When he commented to the nurses about this, he was told that the patients would be upset if they didn't have those choices. (We must say that the food offered may not have been as "healthy" as that of the hospital in Japan, but it certainly was more tasty.)
The second day that Tom was in the hospital, his former very short-term roommate knocked on the door to see how Tom was doing. He said that he was being discharged, had had surgery for prostate cancer, his wife was also sick but just wanted us to know that he lived very close to the hospital and wanted to invite Marie to stay with him and his wife so that she could be closer to Tom. It wasn't an empty gesture but genuine. We were so touched and had a hard time believing the generosity of a stranger whose problems were greater than our own.
That was the pattern throughout our stay. After the first night in the hospital, Marie stayed with Emma's family, who enfolded her in the womb of their family. Michelle took time in her crowded schedule to drive her the 40 minutes from their home to the hospital early in the morning and returned to retrieve her in the evening. Marie broke up her days by exploring the town, where she would go to get lunch and dinner, and books and newspapers and pastries for Tom. The people of the town also welcomed her and asked questions about Tom and requested updates about his medical progress. It sort of reminded her of the small town where she grew up and where everyone has known the whole family for years. However, what makes this all the more remarkable is that this is a town in a foreign country on the other side of the world.
Other activities for Marie included walking the few blocks to Port Phillip Bay and along the walkway that extends for miles along the harbor. A centering experience. To our surprise, as he became strong enough Tom was allowed, and even encouraged, to go for walks to get some fresh air. So the two of us could explore the town a little and head for the bay. However, it was too far for Tom and we vowed to return there someday to explore the area when we both could enjoy the serenity of the seaside
Meanwhile, his medical interventions proceeded with the transfusion, removal of the stent, IVs, and compassionate care. There were no slip-ups and every procedure and medication was clearly explained. Although the medical staff seemed very competent to us and we trusted them completely, each medical decision was a collaborative process in partnership with us. This attitude made us like them and respect their medical expertise even more. (Note that the patients are referred to as "customers" in the statement of philosophy.)
A good illustration of the care he received comes from the interaction he had with one particular nurse. Everyone had difficulty inserting the IV needles into Tom's hand and there were numerous attempts at several sites during his hospital stay. (It was later confirmed by hospital staff back home that his skin is particularly tough, thus making the procedure very difficult.) Anyway, one nurse made numerous attempts and kept apologizing even though none of it caused any pain to Tom. After she was finally successful, the nurse bowed over the foot of the bed, arms outstretched and apologized. repeatedly, "I'm sorry. I'm so sorry." She was sincere and not joking. When Tom said it was no problem and didn't even hurt, she said she still was sorry because she knew it could have hurt.
In addition to the the medical personnel we found that all of the hospital staff were friendly and inspired confidence. This included everyone from the office personnel to those in housekeeping and the kitchen staff. We especially enjoyed the company of one of the housekeepers who hailed from Scotland, and a member of the kitchen staff who enjoyed teaching Tom about Aussie rules football, confiding that she liked watching the men run around in their "little shorts". Staff made certain that we didn't miss the Olympic swimming trials and gave us the lowdown on all of the Aussie athletes. All this made the days shorter and lessened our anxiety about Tom's condition.
When it was time for Tom to be discharged we were told that he was able to travel but "just." His physician indicated that he still had probable problems with internal bleeding and could benefit from an upper GI series; damage to the liver (probably as a result of the medications); and some other things that needed to be followed up on. Although his kidney infection had responded to the medication, he continued to have fevers daily and nightsweats. After discussing what he would do if Tom were his patient for the longer term, the doctor indicated that Tom was only allowed to leave the hospital because we were returning to the US the following day. (We were told that we couldn't travel into the Outback as we had planned since appropriate medical care would not be available there.) And so, armed with the doctor's summary, all of Tom's x-rays, ultrasound and IVP results -- all of which, along with all medical records, are considered the property of the patient in Australia -- we left the hospital and prepared to journey to Hawaii for the next leg of our trip. We knew that if he needed medical care there that at least our insurance would cover the cost, without the hassle we expected in getting our medical expenses reimbursed for our Australian adventure. (It has been even worse than we expected as we write this months later.)
A final note about the expenses of medical care in Australia to contrast it with that in Japan and that in the US. You might be interested in knowing that the total expenses -- for 2 visits to a clinic, care in the emergency room of one hospital, four nights in another hospital, surgery, numerous tests including ultrasounds, IVPs and other x-rays, and all the physician's charges, medications, and all other extraneous expenses -- came to a little over $2300 US. Compare this to over $6000 for the hospital's charge alone for the cost of the initial surgery, or Tom's follow-up care in the US which has included only two days in a hospital and no surgery, has already exceeded $30,000. Is anything wrong with this picture?
And so we said "Good-bye" to all of the hospital staff and to the Caters as we left Australia, with a vow to return when we both are in good health and can enjoy more of what the country has to offer -- for a longer period of time. In fact, this was the only country in all of our travels about which Tom said, "I could live here."
We definitely believe that our health care system is superior in its technology and research and offers the world the most knowledge in the field. When we compare our experiences we are aware of somethings and if we were medical professionals we would probably be aware of others. We know that that one medication that Tom was given in Australia is archaic and no longer available in the US and that the one medication that we tried to get for Tom in Japan is not available there yet. Furthermore, in neither place did he have an MRI or CTscan but ultrasounds and x-rays instead. When it was time for his transfusion we knew that Australia was the only country that we visited where we would even consider accepting donor's blood. We knew that the issue of tainted blood in Japan is still unsettled and know we would have to be in dire straits to accept any blood there.
On the other hand, lithotripsy was available at Como Hospital on a daily basis and could have been performed on Tom whenever it was required, whereas it needs to be scheduled more than a month in advance at our hospital where a mobile van brings the equipment for the procedure. And we wonder about some of the modern medicine that doctors are quick to prescribe. Some of the medications that were prescribed for Tom in the US directly caused a torn tendon in his only good leg, possibly caused liver damage and may have been responsible for a heart valve prolapse. And we are fairly certain that his fever was a direct result of the antibiotics he was on for so long. As far as we know, all of the care that he received here is the normal standard of care, among the most modern, and handled by well-qualified individuals.
We don't believe that it is coincidental that he only began to improve and started getting stronger after he was taken off of all of his medications. It has been a long, slow road to recovery and we are still trying to sort it out, but think that there is definitely a light at the end of the tunnel.
Meanwhile, we believe that given even the most modern medical care, the greatest technology in the world, and best resources, without the human element people will not get better as quickly as they would with listening, caring medical personnel who value them as human beings. Thus, we wonder if we had the choice of the most advanced medical treatment or the most humane medical treatment, which would we choose -- we suspect we know the answer.
BACK HOME
We can't help but note a final experience that contrasted with our international experience. While in Hawaii Tom developed a case of hives as a side-effect of the final antibiotic he had been placed on and he continued to feel poorly with his skin developing a yellowish cast. Finally Marie placed a call to our primary care physician back home informing her of the ongoing problems and the medical interventions along the way. Our physician gave us a whole series of things to look for that would necessitate a trip to the ER and also said that we should schedule an appointment with her immediately upon returning home.
Tom rested more than usual in Hawaii and prepared for our trip to San Francisco, where we cut our trip short. By then Tom had pressure in his chest, could hardly walk for a half block without his legs tiring and generally feeling weak (when he was used to walking 2-3 miles daily when well), he had lost a significant amount of weight and he simply did not look well. As we waited in the airport terminal for our 18th flight since we left home, we borrowed two airline blankets from an attendant and wrapped them around Tom to help him cope with his shaking fever.
Upon arriving back home, we decided to head straight to the ER since it was a holiday and no doctor's offices would be open. When we arrived at the hospital we were glad to discover that our physician happened to be in attendance and said she would see him as a private patient. However, the first thing she said upon seeing us was, "What our you doing here? Why did you come to the ER?" After hearing what was going on she replied, "Well I am going to admit him to the heart unit for his chest difficulties, but if it weren't for that there would be no need to admit him. Everything else could be taken care of fine on an outpatient basis."
And so we returned to the US and managed health care!
In closing we can say that if, given our druthers, we would choose to travel without any medical problems that would impact our trips in any way. However, we will say that, in retrospect, we are grateful for the experiences because they gave us more in-depth views of the cultures and gave us an opportunity to meet some beautiful people. Besides, one can get sick anywhere so we might as well be traveling!
