Monday, November 5, 2007

Why I seek healthcare in Singapore

"Take off your shirt," the old doctor said rudely.
He was angry because I only unbuttoned my shirt upon seeing him for a check up last December.
I followed his order and asked him not to be mad, but this only made him more furious. "How can I check if you don't take it off? You should know it. It's not your first visit here," he said.
I met him for the first time two and a half years ago at a private hospital when I discovered a lump in my breast. He was not friendly, though he was not rude either, so I felt okay. It was a nurse at the hospital who upset me.
I had been lying down on the hospital bed for more than six hours to have my first session of chemotherapy when the nurse told me the quantity of drugs I had brought with me was not enough. I purchased the medication at the Indonesian Cancer Foundation (YKI), which sold medicines at low prices. It was late in the afternoon so I could not object when the nurse said she would buy more drugs from the hospital's pharmacy for me.
For the following chemotherapy session, I brought the same drug and the same quantity of it that I had purchased at YKI for my last visit. This time there was no problem. I later learned that I had been cheated by the nurse in the first chemotherapy session.
In response to my strong protest, the nurse apologized and returned my money, which amounted to more than Rp 300,000 (US$35).
"Maybe she was confused," was the only comment the doctor in charge made when I complained about the nurse.
During the chemotherapy, I often felt nauseous and lost 10 kilograms. But soon after, I recovered and I feel very healthy.
Despite my bad experiences, I continued my treatment here. Upon the recommendation of a friend, I saw another oncologist in another hospital in West Jakarta.
Many Indonesians seek medical treatment abroad due to the poor quality of medical services here, spending around US$600 million a year doing so. Most, more than 100,000 people a year, go to Singapore.
But it was not until last month that I planned to go abroad, after beginning to feel like I was being tortured rather than treated.
My new doctor was friendly, but he had so many patients that I had to wait for hours before seeing him for only 10 minutes.
He told me the cancer had spread to my bones and that I could be paralyzed if it was not properly treated. Besides prescribing medicine, he said I needed to wear a brace and referred me to the hospital's Medical Rehabilitation Unit.
A doctor at that unit confirmed I had to wear a brace for three months. She said I could not take it off except when I went to bed or had a shower. A man in white uniform then measured my body and told me to pay Rp 480,000 cash for the brace. He initially insisted that I pay in advance, but later accepted Rp 100,000 as a down payment.
The brace had a metal frame that caused me great pain (see picture). Three days later, I threw the brace away and decided to go to Singapore.
"Stupid," my Singaporean oncologist commented about the brace.
She gave me a 30-minute infusion and said that even though the cancer had affected by bones, my condition was far from serious.
"Cancer cannot be cured, but you can live with it and many people have lived with it for many years," she said.
When I explained my experience to Kartono Mohamad, the former chairman of the Indonesian Medical Association (IDI) and health activist, he said many doctors in Indonesia are too busy to update their medical knowledge.
Medical sciences develop new medicines and new treatments are invented along with the disclosure of new studies and the results of new research. No matter how busy they are, doctors must spare the time to read and follow medical developments so they can know what is best for their patients.
What is also important is that doctors, and also nurses, must learn about exhibiting appropriate mannerisms. They should treat all patients properly, regardless of their financial status.
"At medical schools, students are never taught about mannerisms and empathy for patients," Kartono said.
If doctors empathize with their patients, they will unlikely be arrogant, as happens with many doctors here.
The Health Law says doctors and nurses must comply with professional standards and respect patients' rights, especially their right to information. But the facts show many doctors fail to provide patients with the necessary information and the law does not stipulate punishment for such violators.
The law serves the interests of the Health Ministry rather than the people, Kartono said. No wonder there are mounting calls for a revision of the law to better protect the nation's patients.
Other than the need to revise the Health Law, the country also needs a corollary hospital law to guarantee qualified medical services in hospitals. It is apparent that the lack of legislation on hospitals has allowed for the commercialization of medical services with little attention being paid to quality.
The business of hospitals in this country, which is currently "highly unregulated" -- as Kartono puts it -- must be properly regulated to protect patients.
The lack of this important law motivated Kartono to create a draft hospital bill, which he then sent to the Health Ministry. He is yet to receive a reply, or any news on the development of the draft.
Health is a crucial issue that needs to be addressed seriously. Indonesian patients have long suffered because of poor medical treatment and services. The government and legislators need to prioritize the drafting and deliberating of more appropriate bills.
It will take some time before Indonesia has a proper hospital law. In the meantime, hospital administrations, doctors and nurses must make efforts to improve their services -- or at least learn to respect their patients.

---I wrote the story for The Jakarta Post, printed on May 30, 2007

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