Hospitals Here and There

The other day we spent a good hour on the phone with our health insurance, trying to sort out some billing issues. We were missing a refund, one doctor got paid twice, and a whole heap of charges were tangled up in indiscernible insurance jargon. The whole mess brought me back to Hugo’s hospital stay, three months ago.

While I was in the hospital, I kept saying to myself, and to anyone who asked how we are, “I’m just thankful that this happened while we are at home. If Hugo had to be sick, I’m so glad that it was here, where we have access to the best medical care in the world.” What I meant by that is, I’m glad I’m not in Indonesia. 

Most expats living here make the assumption that healthcare here is uniformly terrible. There is a conviction amongst many foreigners that practically any aliment more significant than a flu virus must be treated outside of the country. So many people I run into, for example, are surprised to learn that I elected to have my baby here instead of evacuating to Singapore or to the US.

It is true that in Indonesia, there are hospitals with inadequate medical supplies, insufficient Rh negative blood, and incompetent doctors. I’ve experienced staggering degrees of medical ineptitude first hand. (A doctor once told me that I had a stomach ache and vomiting because I ate my lunch at one PM rather than the conventional twelve noon, and then prescribed me some medicine for irritable bowel disorder, which was, PS not safe for breastfeeding.) Still, that is not the entire picture. There are great doctors here. I trust our family doctor with my kids lives. Literally. 

Still, when I was holding my feverish baby in that Michigan hospital, I said I was so glad to be there. And I was. 

Upon reflection, however, I realise that my gladness stemmed more from my cultural assumptions than it did from any objective medical fact. 

I assumed that doctors in America, white, male, privileged doctors, would be better than doctors in Indonesia. Because I understand the nuanced cultural cues, modes of communication, the basics of the medical system in America, I assumed that the care would be superior. In an American hospital, I wouldn’t have to second guess diagnoses, or read between the lines, or decode cultural cues, and that made me more comfortable. I assumed that the communication between me and the doctors would be more direct, complete, and egalitarian than it would be in Asia. 

I assumed that doctors educated in America would be better, hospitals would be better, and the care would be better simply because America is better. The known and familiar is categorically superior to the unknown, the outside. So goes the thinking of the culture shocked.

It turns out, thought, that this was not necessarily the case.

The American doctors thought that Hugo might have Kawasaki’s disease, which is an autoimmune disorder that causes inflammation of the blood vessels in children. This disorder is more common in Asia than it is in the US. It can be difficult to diagnose, especially in small children like Hugo. There is no test, so a diagnosis is made on clinical observation. Hugo exhibited some, but not all of the symptoms. Ultimately the American doctors decided that Hugo did not have Kawasaki’s and decided not to treat him.

However, one symptom that Hugo exhibited was brushed off by the doctors. His BCG injection site was red and inflamed. I asked about it several times, as it was unusual. It didn’t sit right with my mother’s intuition. Every doctor dismissed it as a coincidence.

Later when I discussed Hugo’s hospital stay with my Indonesian doctor, he informed me that this red, inflamed BCG site is, in fact, a sign of Kawasaki’s. The doctors in the US missed it. And it would have been caught, and treated were we in Asia. 

Score one point for Indo.

During the course of Hugo’s hospital stay, he had several echocardiograms. The echoes lasted a good hour, with Hugo having to be restrained on the bed, screaming himself purple. During one of these echoes, apparently, the cardiologist discovered a hole in Hugo’s heart. That’s a bit scary. But even more so, is the fact that the doctors failed to even mention this to me. Which is astounding, really. I mean, this seems like a fairly significant piece of information, one which should be share with the patient’s mother, right?

I only learned of the hole when my doctor in Indonesia read the hospital report, deciphered some jargon, and sent Hugo for a follow-up echo here. 

I was dreading the follow-up echo, as the previous two were so miserable for Hugo. But the Indonesian cardiologist had an easy, calm manner. He invited me to sit on the table and hold Hugo on my lap so that my boy would feel more secure, and performed the echo just like this. He took breaks whenever Hugo was getting uncomfortable, talked me through the process, explaining what he saw. There was no need to wait for the specialist to interoperate the results. This was the specialist. He was right in front of me. He talked to me like a real, human person. It was a much more humane experience than what we had encountered in America. 

My doctors in America missed two critical problems in my boy. They failed to communicate with me, and they likely misdiagnosed a pretty serious illness. They were rigid and unwilling to waver from policy to make us more comfortable (allowing us to co-sleep, for example, or letting me hold Hugo while they preformed the echo.) I am confident that if we were in Indonesia, being treated by our doctor here, this would have been different. 

Two more points to Indo.

I’m not going to go as far as to say that doctors in Indonesia are better than those in America, or that the Indonesian healthcare system is just as good as the American. It is not. We live in a privileged First World bubble surrounded by intense need and inadequate healthcare. We have good doctors, we can afford to go to the best hospitals, and at the first sign of trouble, we can be airlifted to Singapore. This is not the typical Indonesian experience. We’re lucky. 

But, I have learned from this. I’ve found that a great deal of my thinking about the quality of doctors, of healthcare, and the trustworthiness of the medical system is influenced by cultural assumptions, in-group prejudice and xenophobic beliefs. And I’d hazard that this is true with the vast majority of foreigners who live here. When you’re sick, you want what’s familiar, you want what is clear, you want to be home. You assume that what is know is better than the unknown. And this is simply not always the case.