Monday, August 6, 2007

Using medical services in developing countries

This posting comes in 3 parts:
1. Medical emergency
2. Elective medical treatment by foreign doctors or dentists
3. My observations about medical services

Medical emergencies
I am an avid traveller to developing countries - having been to about 30 of them. In that time I have avoided serious medical ailments, though it has at least given me an idea of what I can expect in different countries in terms of costs, services and competency, as well as the risks from poor food preparation. So let me describe those situations.
1. Haiphong City, Halong Bay, Vietnam in 2001: This is a few years ago now, but I'm quite sure nothing has changed. I was sweating profusely with a bad fever. I went to a local first aid hospital where I managed to find a doctor that spoke English. He was rather young looking, but in my search for symptoms I noticed a yellow spot on my leg. I thought maybe an iodine deficiency or something. Actually it was just an old bruise. Anyway he seemed to have less of an idea. Really I got no help. So I decided to go to Hanoi, as I know there was a international hospital there with western doctors. Within an instant I was diagnoses flawlessly. I had food poisoning from a local restaurant where I was eating daily. Sick despite being very selective about what I ate. The other issue I had in Hanoi was a fungal infection. Basically a big 'moon-shaped' inflamation around my anal passage to be medically correct. Well I paid $US120 for that profound advice, which didn't bother me much because I was just relieved I didnt have some rare skin disease, but they charged me $20 for a generic fungal cream that would cost $6 in my country, and $3 locally. Well I will be wiser in future. They are really praying on the fact that you dont know if foreign medicines are available in the country, and where to get them. Because whom do you ask for advice - few speak English, and who knows where a drug store is unless you've need one in a developing country....well its not easy in Vietnam...but Philippines is easy.

2. Lipa City, Batangas, Philippines: Lipa is a small city 80km south of Metro Manila. It has a small hospital. I paid Y600 ($US12) to see a GP. Being a foreigner I pay alot more, but the good news is that I go to the start of the queue (20-people long). I suspect they are free patients. He gave me little time, in fact he had an assistant gather all the info, so I spent just 1minute with him...I did however get the chance to sit down. In that one minute he referred me to a urologist. The urologist had the same system, a queue outside, which I didnt have to wait through, but that was little comfort because he kept me waiting for 90mins inside his office along with 6 other people - not patients mind you, but sales people from pharmaceutical companies - Pfizer and a competitor. I thought this highly suspicious, but I guess at least he is letting them compete against each other. I'm just wondering to what extent commission will feature in the selection criteria. But anyway...he kept me waiting so long...then again....he offers me just a 30sec appointment which cost me P800 ($US16) because he has another appointment. On reflection I am paying about $US720/hour for services that would cost me $US350-400/hour in the west...and I'm waiting twice as long as any western medical centre....go figure. I didnt even get to sit down, and he sends me off to the lab. The lab seemed to be where all the work was done. Yet that cost me just P220 ($US5). I didnt bother returning to the specialist for an opinion...I just interpreted the results myself.

3. Medical Central, Robinsons Galleria Shopping Mall, Ortigas Centre, Metro Manila: I went to a local medical centre in Metro Manila. This is by no means an upmarket one. A nurse gets your pulse, and asks you the basic questions, then you wait 30-40mins for a doctor. At this place I was treated like any other patient. Thats a good thing. The service at this place was much better though since I had a 15min consultation, though I found that the staff has a low level of medical knowledge.
Another ok medical centre I found was on the 5th floor of the Shangrila Mall in Ortigas Centre, Metro Manila. Its the place I would go for minor ailments.

4. Medical City Hospital, Ortigas City, Metro Manila: This is a private hospital, and is considered one of the best in the Philippines. I found the standard of medical care equal to, if not better than any I have received in the western world. The catch though is that I paid for it. I had a blood test, stool test and scan of my intestinal organs and 2 consultations for P16,000 ($US320). Not cheap by any means. But problem resolved....I was tired after 3 weeks of non-diagnosis.....thats 3 weeks of diarhorea...and the advice....you have a bacterial infection...drink more water, avoid alcohol and oily foods. :) There are 2 other private hospitals in Metro Manila which have a similar standing of service:
5. Asia Hospital - further info coming??
6. St Lukes Hospital - further info coming??
7. Another??

What became apparent to me is that hospitals are very good because they offer a higher standard of care, they have the capacity to carry out most tests you need to perform...though I suspect if I wanted to get tested for the antibodies that would prove I had celia disease, I might need to go to a western hospital. But as it was I just had an intestinal infection and not a gluton intolerance. The cost of a room in a public hospital is about the same as a hotel (P2000 or $US40 per night). Consultations and testing might just be P1000-2000 ($US20-40) compared to P15,000-20,000 ($US300-400) at a private hospital.

Elective Medical Treatments
There are alot of skin treatment places in the Philippines though I have no idea as to the quality of care. I suspect they are not high because of the lack of codification of standards. There is however certainly a trade-off between standards and price. I'd hate to risk using a dodgy service provider who sees $$$ without any duty of care.

I met a foreign guy who was friends with a Filipino girl who recommended that I go to a certain dentist for care. I was accustomed to paying $US110 just to clean and checkup in Australia, but I paid just P600 ($US12) in the Philippines. But get this - I went to an upmarket dentist in the Rockwell Centre, Makati City, Metro Manila. This guy is well qualified and attends conferences in the USA. His equipment was more modern than anything I'd seen in Australia. Dont know why Australian dentists are so tight with their equipment. Never found one with digital cameras..but maybe that has changed since. I can tell you that the level of care and attention that I received from this upmarket dentist far exceeds anything I received from the 5-odd dentists I've been to in Australia.
Though I note that when it came to receiving 'significant care' like the recapping of 2 teeth, the cost went up considerably. I was quoted $US750....and I suspect this pricing was more in line with western prices. I suspect the motive was that I no longer appeared to have a Filipino friend. So the moral of this story is...you will get more competive prices if you have Filipino friends....better still if they ngotiate for you over the phone.
I believe there are similar opportunities to avail of cheap medical services in Thailand and India. But dont go to westerners in developing countries, as they will charge you more for the privilege, and its just possible they are there because they breached some ethical standard in their home country. Such doctors can more readily pay off an official in Asia to get a licence here. Asia is so corrupt. Alot of Asian doctors are educated in western countries....to varying degrees.
Actually my observation is that the quality of formal medical education is not so bad in developing countries, but that the low attention to medical standards and training after they have graduated is the problem. Perhaps someone can comment on this. The reason I say this is because I think you might learn alot of theory at university (in whatever subject you do), but without training in applied medicine, you are likely not going to develop into a fine doctor. That observation comes from personal experience and talking to a young medical graduate from the Philippines. He's a smart guy, and I think the lack of institutional support in the Philippines on the training side would have undermined his capacity to provide good service. So I think its more important to recognise doctors that have worked overseas as opposed to have studied their full degree in the USA. Another qualifier I will make. I think in diagnosing conditions, critical thinking is an important capability, and I dont think Asian culture is conducive to those skills. Even the western world tends to marginalise critical thinks in adulthood, but its worse in Asia. So if its not familar to them, they are unlikely to offer helpful advice.

My observations about health service
As a foreigner there is a tendency for them to charge you a 'foreign price' as opposed to the local price. They dont tend to do that however if you are accompanied by a Filipino, or better still the initial inquiry is made by a Filipino national. In case you are wondering...servicing foreigners is a very controversial issue in the Philippines. Every year the best graduate doctors, programmers and others from the best universities get offered jobs overseas. Critics argue that some of these people received free education yet render no service to Filipinos. The reality is however that these Filipinos repatriate huge amounts of money back to the Philippines - equal to 30% of the national GDP.

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