Australians Abroad - Manila Envelope - Manila

The Medical System

Hear the one about the expat who woke up in the gutter in Bali/Manila/Goa/Kuantan/ minus a kidney. Everytime I hear this story it makes me laugh that there is anyone left who takes it seriously.

I have even heard Filipinos repeat it but this time the victim is one of their countrymen and the place of the alleged surgical theft is Australia or the United States. It's like the old "mad man with the axe on the roof of the car with the kids stuck inside" yarn that we repeated to scare the pants off our younger friends in primary school.

It seems that Australian travellers overseas become very emotional about medical matters, especially about the quality of medical services in Asia. There are always the horror stories, tales of terrible accidents and inadequate emergency treatment and aftercare in some developing countries.

A few years ago, when we lived in Vietnam, we feared the prospect of needing emergency medical care in Hanoi. We were well versed in organising a quick emergency medical evacuation - there were certainly many of our friends who needed them. Luckily, though, we managed to avoid needing any medical attention, short of an occasional Japanese encephalitis booster shot, or a visit to the Swedish Clinic or the Israeli doctor for medication for a stomach bug.

Here in Manila, where many Filipino doctors have studied in Europe, Australia and the United States, and where good hospital facilities are available, it is still hard to shake the old expat fear that the medical attention they receive in developing countries will not be as good as that available in their home country.

Well, that's how I felt anyway. Three weeks ago, after months of seeing Manila through a haze of painkillers for a badly herniated disc, I found myself facing the prospect of surgery here. I'd left treatment far too long to be able to take the long flight back to Australia. I had a son in his last term of Grade 6 and had been told that, should I return to Perth for the operation, I would be unable to fly back to Manila for some weeks.

So, it was time to find out just what exactly was the state of Manila's medical facilities. First of all, I had to find a surgeon. I went on the advice of a well-connected Filipino friend. The orthopaedic surgeon she suggested diagnosed and then set out his surgical plan for me. But, how did I know how good he was?

I asked him for, and received, a list of patients on whom he'd operated for the same condition. I also asked for his educational and professional biography, which he faxed me that afternoon. I found he had extensive training in Italy, Switzerland and the United States, after finishing his initial medical studies in Manila.

I contacted a surgeon in Australia and faxed him my diagnosis and copies of my X-rays and then rang him to see what his surgical plan would be. It matched that of my Manila surgeon almost exactly. I rang my Manila surgeon's former patients and had long discussions with them regarding the procedure and the aftercare. So far so good.

I emailed my Manila expat network asking for their experiences of surgery in Manila and that is where the little stabbing doubts started to surface. "Are you mad?" one expat wrote. "Go back home or to Singapore for surgery." At this stage, for me it was not a case of where to have surgery, but when. I was getting pretty shaky about the whole thing by then.

But many friends were supportive and told of good experiences, offering advice and making the whole experience a little easier to handle.

Next I checked out the hospital. Makati Medical is the biggest hospital in Manila. It is situated right in the heart of the city and, despite an occasional horror story, has a good reputation. The week before surgery I checked out the room I wanted - there is a good choice from suites on the ninth floor to a "bring your own" set-up in the lower stories.

I asked to see the hospital's operating rooms and was allowed to see how they sterilised their instruments. Try this in an Australian hospital and you'll probably be locked up.

So it was with some trepidation, despite all the research, that I curled up in my ninth floor "suite" (yes, it even had a dining room with seating for six, several lounge chairs and a sofa and a separate kitchen with fridge and microwave) to watch some cable TV on the eve of the surgery. The anaesthetist visited and I was taken by surprise. She told me her complete surgical and aftercare plan, all the while holding my hand (did I look that scared?).

The hospital priest visited. Father Ray and I had a rather stilted conversation in which he seemed to be ascertaining whether I was going to be scared to death or not. Not to worry, though, there was a chapel just a quick hobble down the hall from my room.

The dietitian came by and asked me if I would like Japanese, American or Filipino food. Then the evening meal arrived - five courses. And then the snack for my companion arrived. There was so much action in the room with nurses and doctors visits that I was losing track of the TV show.

In Manila, the various expat groups have their own blood donor register. Though I had asked my doctor if I needed any, leaving plenty of time to contact the matching donors, he told me I wouldn't lose "more than a cupful" during the surgery.

Next day, however, one hour before the procedure, he changed his mind. Luckily, the organisers of the Australian and New Zealand Association blood donor registry, found a donor and, with my husband as the other donor, gave blood for testing and crossmatching. The problem with finding out late about needing two units of blood is that it takes several hours for the testing to be done and in Manila, it takes extra time, after an available donor is found, to get through the traffic to the hospital. Knowing that the doctor had performed the same procedure that morning, I had to wonder what made him change his mind.

In addition to the ward nurses, I had also organised two private nurses (at the grand cost of $80 for both) to be bedside from when I returned to the room until next morning. Previous experiences with surgery in Australian hospitals had left me with awful memories of being ill and unattended and then having to deal with less than friendly staff reluctant to wake up a doctor to authorise pain relief.

So off I went after many "God Bless You's" from the nursing staff and even a "Jesus is sitting on one side of you and the Holy Spirit on the other" (I was really beginning to feel a little crowded on that gurney). It seemed everyone was praying for me. I felt like a bit of a fraud, after all, it was just back surgery and not a triple bypass.

I don't quite know what I said to the surgeon just before the lights went out, though the doctor did tell my husband later that he told me it was "too late to back out now, ha ha." What a joker!

Well, as you can guess, it all worked out for the best. I woke up safe and sound, feeling pretty jolly good with no end of staff hovering around and - absolutely no pain. Later that night, I tuned into the cable TV and was spoonfed pumpkin soup. The anaesthetist visited, the doctors visited, the nurses visited, the dietitian visited yet again. My private nurses sat through their vigil and left.

My husband popped in and sat at the dining table with his computer and caught up with some work. My son arrived after school and tried to catapult me across the room as he figured out how to work the hydraulics on my bed. Friends rang, flowers arrived, chocolates were scoffed.

One dear friend even arrived with Australian pate, a jar of Vegemite and a Vogue Living magazine (among other things). And then I was ready to go home.

So now, I'm almost back to normal. No pain, no fear of hospitalisation here. And I'm wondering just what all the fuss was about in the first place. Still, though, I know there are expats in Manila whose medical experiences have not been as good as mine.

For major surgery, and anything other than simple elective procedures, I would still return to Australia. But this whole experience has taught me that if you do your research and find out for yourself the quality of medical expertise and facilities, it is possible to have a good medical experience in a developing country - oh, and, yes, I do still have my kidneys.

Judy

May '99 1998