Treatment Not Cheaper Than in the U.S. or the U.K.

Exploitative Practices at Raffles Hospital Even while Being Ill-Equipped on a Sunday

My recovery is still not complete, but my metabolism is such that even for a minor ailment the healing process takes long.

But let me not digress as the purpose of this post is to focus largely on the cost factor in medical treatments in Singapore for the benefit of those who chance to read this.

The three days I spent at the Mount Elizabeth Medical Centre cost me S$18,400 – covering hospitalisation, ERCP and the gallbladder surgery. In addition, I spent around S$2,000 on treatments spread over six days prior to hospitalisation. I am bound to incur some post-discharge review costs as well.

The costs were much more than what I anticipated. A Google check showed that if I had opted to have myself treated in the U.S. or the U.K. that will have set me back by roughly around the same amount.

If I had gone to India instead, treatment at the best of the hospitals there will have cost me around one-fifth of what I spent here. Such hospitals have world-class facilities and engage doctors who can match the best anywhere.

Even within ASEAN, countries such as Thailand and Malaysia offer international-standard medicare at a fraction of the costs one may have to fork out in Singapore and the West. It is thus no surprise that medical tourism is gaining traction in those countries.

Chennai Roads and Post-Surgery Rides: On my way back home after discharge from the hospital, the taxi ride was largely smooth except when it had to ride over speed-breakers. Even during the ride I couldn’t help imagining what my fate will have been if I was returning to my home in Ambattur after surgery.

With some of the world’s worst roads there, the ride will have been hellish for me. In fact, even the roads leading to the MM Hospital (run by the Madras Medical Mission) in Mogappair near Annanagar are in such awful shape that it is a mystery as to how patients have been surviving the rides there. You will not move an inch without bumps. But then in India who cares about the welfare of the people! The country’s leaders only care about the elite, so the areas they live in are well tended.

Quality of treatment: Now back to the treatment in Singapore. It was on a Friday evening, when I was working out at a gym, that I started to experience severe chest and abdominal pain. As it persisted, I stopped exercising, took a shower and went to a clinic. A basic ECG there made sure that it was not cardiac pain, so the doctor gave me some antacids and some stomach/gastric medicine. But, even as I was returning home, I vomitted in the cab (using the plastic bag the driver gave me) and I started to shiver because of high fever. That night and the next were perhaps the worst I had lived through – with unbearable chest and abdominal pains.

$450 for a blood test at Raffles Hospital: On Sunday morning I went to a clinic near my home and the doctor there referred me to the Raffles Hospital. There, at the Emergency section (since it was a Sunday), the doctor on duty examined me and wanted some blood tests to be done. I had to fork out S$450 for this– something that will have cost me less than $100 in any other hospital in Singapore. Costs are generally higher on Sundays. But I thought five times the normal cost was a little too high though I had no energy to argue over it.

What annoyed me was that two hours after the blood sample was taken, the report that was delivered was only partial. The full report, they said, would only be available the next day, thereby making a mockery of higher payment on a Sunday.

Then I was advised to go for an ultrasound scan, but the specialist was not available then. The normal cost for it there is S$100, but if I wanted the specialist to come over to do the scan I was told I would have to pay S$360. Even then I will have to wait for two to three hours for it to be done. Cost was not an issue for me thanks to my insurance coverage. I found it shocking to find how ill-equipped (on a Sunday) and exploitative one of Singapore’s premium hospitals was.

I felt it made no sense for me to pay more and wait several hours. Even if I had waited for the scan to be done there, no specialist (gastroenterologist/surgeon) will have been available there that day to treat me based on the results.

So I asked for the scan to be done the next morning. But I was told the earliest available slot was 3.45pm on Monday, and that I would have to fast for six hours before the scan. If one has to fast so long, the best time for a scan will be in the morning. So I requested that I be given time in the morning for it. The hospital said that was not possible.

Then I asked them how long I would have to wait for the report after the scan. “Three hours,” was the casual reply. That meant the report would have been ready by 7pm by when all specialists would have disappeared.

Mount Elizabeth: At this point I lost my cool, made my displeasure clear to the staff there and left the Raffles Hospital. Then my wife called the Mount Elizabeth Medical Centre, an equally big (if not, bigger) hospital here, and requested a scan slot for the morning. They were quick to accommodate me for one as it is something that takes only around 15 minutes.

The result was out in an hour and I was able to talk to a surgeon and a gastroenterologist the same day.

A few years ago, my second daughter had been admitted there after she spent more than a week at the KK Hospital where she was advised to go for an appendicitis operation after a scan. She had very high fever and was feeling anaemic, but it occurred to me it was wrong diagnosis. So I immediately moved her to the Mount Elizabeth hospital where a paediatrician was able to bring her back to normal within a day without any surgery. That was a happy experience for me then, something that made my decision to stick to Mount E this time easier.

Not so Satisfying This Time: Generally, specialist care in Singapore is world-class. But I cannot say this time it was wholly satisfying for me though I was pleased with the doctors. Post-discharge care, through reviews and advice, have been good as well. I was not lucky with the support staff -- lab technicians, nurses, etc. Some were good and some not so good.

When I went through ERCP, the sedation did not last the full procedure and, as a weakling even on healthier days, the discomfort I will have been through is not hard to imagine though I was still in a daze. But it appears the sedation issue is not uncommon and occurs at hospitals globally.

Then, the next day, after the surgery to remove the gallbladder, I was in agony as no painkiller had been administered. It was done only after a request from me. It took a while as the nurses had to get permission from the doctor to give me an analgesic (meperidine/pethidine). This is understandable, too, as this high-alert drug is a narcotic compound as well. Yet, I cannot help wondering if there is no painkiller other than an opioid analgesic.

Also, I still have pain on my wrist caused by the needle for intravenous administration of antibiotics. Even while in the hospital, there were clots a couple of times and that had to be cleared through a liquid infusion.

Even the blood sample was not taken clean. When a second round of tests had to be done (as the first was at the Raffles Hospital) the same vein was used for the jab and that left me with a small swelling for a week.

The bottomline is that things could have been done better at Mount E. High costs have to necessarily translate to better care.

--G Joslin Vethakumar

But GDP Contractions and the Minus Syndrome in the Global Economy are Alarming

I am getting used to long breaks from blogging. But a pause, either forced or voluntary, has seldom exceeded two weeks – plus or minus a day or two!

In this instance, it is plus a few days, but it is minus that is writ all over. This M-word assumes a new significance with this resumption in blogging as it is now a new me, minus one organ. I am not sure how many organs the human body has – perhaps less than 40. Whatever that count is, I will have to subtract one from it having had my gallbladder surgically removed a couple of weeks ago.

I don’t know if I took the right decision. Three days of severe abdominal pain were all it took for me to heed the advice of surgeon Dr Jeyaraj Prema Raj (who performed the gallbladder surgery) and gastroenterologist Dr Benny Ang Cheng Nee (who carried out the ERCP) of the Mount Elizabeth Medical Centre, even without getting any local second opinion.

However, a paediatrician cousin of mine did reassure me that I would be fine with it, pointing out that gallbladder surgery was common. I am quite close to her and I valued her opinion.

And a day before my hospitalisation, when I was at my late friend NS Kumar’s home to pay my last respects to him (my earlier post was devoted to him), his doctor daughter, who was here from London, told me I would emerge a new person from the surgery. She was already in mourning at her father’s wake, and it was sweet of her to offer me her thoughts.

Oily, Fatty, Spicy: The implications of the surgery are simple – I will have to avoid oily, fatty and spicy food as much as possible although my doctor said there was no need to go overboard with dieting. For someone who loves Indian food, I could not have ended up with a worse bargain. I will perhaps get used to bland food and that may be a blessing in disguise! Even if I follow a strict diet regimen, I may have to brace up for regular bouts of diarrhoea although I hope I will be among the 10% who escape that.

There was cheer from it all, too! Soon after I posted my blog on my health, some friends whom I had not been in touch with for quite a while either called me or wrote to me to wish me a speedy recovery – from New Zealand, India, the U.S. and the U.K. I was really touched, particularly considering that my circle of friends is very limited. That goes to prove that the quality of friendship is more important than having a heap we can gloat over. It was particularly heartening to note that they had been reading my blog regularly as their way of being in touch with me.

That positive side amid the negativities aside, it is too late to be discussing my minus-one decision that was arrived at after all necessary lab tests, including an ultrasound scan of the abdomen. All I can do now is hope that it was the right decision, as the doctor put it, since it may help me avoid pancreatitis in future.

Minus Syndrome in Global Economy: So, being in the Minus zone does have some pluses spouting positive connotations occasionally!

But where it gets alarming is in the economic mayhem enveloping the world. My absence from blogdom did not mean I had turned into a Rip Van Winkle. Newspapers and television have been ensuring that I am not cut off from the world. So I have been closely following how the developed world, from the U.S. to Singapore, has been slipping deep into minus territory with negative GDP rates.

Singapore Prime Minister Lee Hsien Loong has even cautioned that a GDP of minus 8 is a possibility.

Nonsense from Obama: While that is too grim, even pretentious, a projection and does not merit any close scrutiny what really made me chuckle is Barack Obama’s dream that the U.S. will emerge stronger than ever from the mess it is trapped in.

He must be either living in a world of make-believe or behaving like jingoistic Third World leaders who fool their people with such pronouncements far removed from reality.

For one thing, amid an unprecedented GDP contractions budget deficit is expected to be in the range of US$3 trillion (around double the figure that was put forth by the government). This is a figure so astounding that it represents around 20% of the GDP.

With this kind of scary details, Obama is out to fool not just Americans but the world as well by trying to paint a rosy future picture for the U.S.

The U.S. is already showing evidence of being infected by the Third World syndrome of protectionism and nationalisation that point to the failure of capitalism and market mechanics. I am not against protectionism as that is something we are so used to in Asia. But what amuses me is that the world (at the recent ASEAN summit in Bangkok, for instance) is still advocating a free market, unregulated economy.

When saner minds are clear that the future lies in the emerging world and that the American model of hype and hyperbole will not work any more, it is strange that Obama is taking shelter under populist garbage and even winning acclaim for it within the country that we believed was made up of an enlightened populace. That foundation has now begun shaking dangerously!

--G Joslin Vethakumar