A Story of Medical Treatment in Bali.
Last month I got a letter from a reader recounting what must be a rather typical medical experience for many of us here in Bali. I offer it because it addresses several important points that anyone living here would do well to consider.
Medical treatment in Bali has unquestionably got better in the last few years and will no doubt improve substantially over the next year or two, for a variety of reasons. That being said, I don’t think anyone would seriously argue that there is not room for an ocean of improvement. Medical treatment here remains a complete lottery, you might be well treated or well-advised but you would be a fool to bank on it. Tests may or may not be reliable, and even if they are, the interpretation may be so “off” as to be laughable if it were not so dangerous. I know of more than a few cases where someone with a minor ailment has been diagnosed with a major life-threatening disease like cancer, following local tests and had radical treatment urged upon them. Fortunately in all cases, the person concerned got a 2nd opinion in Australia or Singapore and in each case the diagnosis was shown to be a load of rubbish. That is very worrying for obvious reasons. The lack of consistency in treatment and record retrieval or availability is also something for us all to be concerned about.
I hold no brief for medical insurance companies, in fact I dislike. Make no mistake, they are in it for the money and you would be naive to think otherwise. Many of them play all sorts of tricky games when it comes to what they actually will cover and pay for. It is not even a question of reading the small print, it is a question of interpretation and they are the ones who decide. Until you have the misfortune to get seriously sick you will never really know if you’ll get what you’ve been paying for for so many years.
Nevertheless, it would be a brave person indeed not to have any medical insurance at all and I really recommend anyone who isn’t covered to look into it sooner rather than later. My advise is to get the basic coverage covering in-hospital treatment and forget about the small out-patient stuff. The only key additional option you really want is the medical evacuation. That way your premium will be fairly reasonable. Brokers come in all shapes and sizes and you should check them out carefully, almost as much as the cover itself.
The whole question of medical insurance is a fascinating one and when I can get around to researching it, I greatly look forward to casting a hard consumerist eye over it.
Of course on reading Mr H’s experience one can’t help remembering that he is one of the fortunate ones. The majority of people living in Bali don’t have a fraction of the options that most of us foreigners living here do. Nonetheless even if it does come across a bit whingey it doesn’t not negate the points raised and we would do well to consider them.
Mr H’s Story
As an expatriate living in Indonesia for about 8 years, first in Jakarta and most recently in Bali, I am not entirely unaware of the shortcomings of patient care or should I say, money care?) in Indonesia’s medical sector.
We are not poor, but neither are we rich. We can pay for good medical assistance. In June this year we went on holiday to Europe and suddenly my feet became swollen and I felt great pain in my heels. I figured this was because I was not used to wearing closed shoes anymore and switched to sandals. After two days everything went back to normal.Some weeks later I had the same symptoms again and since the pain continued, I went to see an internist in Bali.
Some friends who are long-term Bali residents had already recommended this doctor. I made an appointment and after some search found the doctor’s practice. My appointment was at 7.00 p.m. and I was on time.
The waiting area was alongside a pharmacy, all without air-condition. Having lived in the tropics for 20 years I don’t need air-condition myself but I do wonder how this, and other pharmacies can keep and store delicate medicines in such an environment.
The waiting lounge itself was dirty and crowded with people. I wondered how a doctor could allow his place to be like this? People were even spitting on the floor. After waiting for over an hour I had to go to the toilet. This was enough to make me leave immediately and cancel the appointment. I am not a hypochondriac, but in a place like this you are more likely to catch a new infection rather than get better.
The next day I decided to try one of the two multinational medical centers with 7/24 service and experienced doctors from various countries. Here I was checked with X-Ray, EKG, blood pressure etc. and asked to come the next morning for a complete blood test after fasting for 12 hours.
The same day I got the results and was told to see a cardiologist, since according to the X-Ray my heart was enlarged and the other findings showed my blood pressure was too high. Additionally, the blood tests showed my uric acid levels were slightly elevated.
I saw the cardiologist the same day. He measured my blood pressure, made an EKG and prescribed some drugs against high blood pressure. That was it.
Days later the swelling and the pain was still the same and I wasn’t satisfied with the answers I’d been given about my health condition, so with the help of friends in Singapore I made an appointment with an experienced and reputable cardiologist there, whom I saw last August.
Careful tests were made; blood, oxygen intake, treadmill and EKG, EKG again, 2 D Echo-Doppler (Ultra sound) etc. The result showed that my heart was not enlarged, but normal and in fact in perfect condition. However the hemoglobin content of my blood is too high and consequently the blood too thick, which harms the blood circulation. As a result my blood pressure is too high. It was confirmed that my uric acid levels were indeed too high.
I was given medication against high blood pressure, a blood thinner and a medicine for the high uric acid. The swelling disappeared after three days and I had no pain anymore. The doctor asked me to come back after three months.
Unfortunately the story does not end here.
In September I had a light accident with a motorbike, which resulted in some superficial and some deeper wounds in both my legs. We treated this at home with the usual medicine such as Jod, Benadryl etc. However it did not get better and the inflammation was still there after several days and my feet started swelling again.
So I went back to the same Medical Clinic. The wounds were treated, cleaned, covered with antibiotic cream and I was given antibiotics to take for five days. I explained the story about my swollen feet and the doctor asked me what medication I was taking. I couldn’t give the specific names at the time and said I would provide this information on my next visit. Some days later I returned to the clinic again, since the wounds were still hurting and inflamed, and my feet still swollen.
Needless to say, this time was a different doctor on duty. During my four visits to the clinic I have seen four different doctors. How can they possibly treat you properly and with any continuity I wonder?
Anyway, besides the Indonesian doctor, there was also a foreign nurse present. While this doctor was studying the report from the previous doctor, my wife tried to give her the nurse results from the tests in Singapore and the names of the medicine I was taking, which the first doctor had requested. The foreign nurse became quite excited, since the doctor was wearing rubber gloves and was not to touch the papers we brought. In the event they only looked at the names of the medication, but paid no attention to the medical reports from Singapore.
I had the distinct impression that none of them knew what to do and the doctor recommended me to see a cardiologist again, since he was convinced the swelling came from my heart. I recounted my earlier experience and there was no further mention of my seeing a cardiologist.
Then next best explanation they decided was the swelling might be caused by the damaged tissue of my legs.
End result: I got more antibiotics to take, now every 6 hours instead of three times a day, for the inflamed wounds, but I still have my big feet. If after this most recent treatment the wounds are not much better, I will have to visit the clinic again. At which time I assume I will see doctor No. 5 and can go through the whole story yet again, but will still have no answer to my problems. So now I ‘m going to try a different internist this week, as I really don’t want to wait without effective treatment until my next appointment in Singapore in early November.
I am forced to conclude that medical care in Bali is well below average, to say the least. The “Emergency Clinics” are staffed with young, inexperienced Indonesian doctors, educated abroad, but who can really only handle routine cases such as ‘flu and other minor illnesses. The fees are not cheap, and are certainly on a par with fees charged abroad.
I hope, I will never have a serious illness in Bali.
Mr. H., Bali, October, 2003
Postscript from ParacelsusAsia:
Bet’cha 100 to 1, yer got gout Mate!
