Tuesday, December 29, 2009

Siem Reap clinic vs hospital

Yesterday was a stressful day, but I finally got to experience Siem Reap's notorious Royal Angkor International Hospital. I have heard so many stories from travellers and expats about outrageous fees (you can read one customer's experience here). One expat told me, for instance, the hospital often recommends patients do an MRI scan, whether necessary or not. The impression many Siem Reap expats have of this hospital is that it is out to make as much money as possible from insurance companies. And, after yesterday's experience, I have to say, I left feeling the same.

This was what happened.

A Malaysian man working in Singapore had come to Siem Reap for a four day holiday with his Thai girlfriend. He wrote to me about hiring Phoen the tuktuk driver. On the first evening they went to see the sunset at Angkor and then ate at one of the restaurants at the Old Market itself after trying to get a table at Khmer Kitchen. The next day, W messaged me at 9am to say he had stomach pains and could I let Phoen know to pick them up a bit later. He felt better and they went to see the temples.

At 2pm the pains were back and I told Phoen to take him to Ly Srey Vina, a clinic I'd been to. I assumed he had eaten something bad.

W called to tell me it was his appendix and to fix it would cost US$1200. I still had no idea how serious it was until Phoen came to my house because he wanted me to see W. I left on his tuktuk for the clinic. It was about 5pm.

W seemed ok and was able to sit up, but the doctor told me his appendix had ruptured and they recommend immediate surgery. It was highlighted in blue on the medical report that they consider this an emergency.

One problem was the clinic does not have credit card facilities and W wanted to pay with his card. Seriously, how many people carry around US$1200 with them on a short holiday?

As W has travel insurance, I suggested we try the Royal Angkor International Hospital for two reasons. Firstly, because I stupidly believed it's a proper hospital and would have better facilities and secondly, I thought, it's a good idea to get a second opinion. (A lesson I learned from this experience is sometimes you just have to trust your Cambodian doctor - some of them really do know their stuff).

We took the Ly Srey Vina car to the hospital which is just before the Siem Reap airport. The drive down National Road #6 was just 5 minutes. The driver called the hospital to tell them to get ready for an emergency and we alighted at the hospital's emergency entrance.

At the hospital, a young man in a white coat started asking W the same questions: did you have diarrhoea, when did the pains start, do you have any drug allergies. By now, W was in serious pain. I got annoyed and said we brought along the medical report from the clinic, which we had given to the nurse. Why don't you read that. He then said, "Yes, ok, the doctor will be down in a minute." I thought I heard him say "I am only an M.O (medical officer)."

Ten minutes later, the doctor came down from the third floor. He read the report and said "We can operate but we have no anaesthesiologist."

You've got to be kidding. What kind of hospital advertises "24-Hour Accident & Emergency service" with no anaesthesiologist on hand? How is it a small clinic down the road can have an anaesthesiologist and not an "international" hospital?

I asked if he could get an anaesthesiologist from another clinic to assist him, since this was an emergency, but he said "Cannot. Not qualified."

The doctor, who is Thai, then said, "We go to Phnom Penh for the operation". I asked how? Are you flying him? Amazingly, they had planned to drive there. Phnom Penh is 315km from Siem Reap so even if we sped at 100km/hr, it will still take us over 3 hours. Three hours on the road for an emergency. Seeing how worried I was, the doctor told me "You don't worry, I go with him, I do the operation."

(Later, W's Thai girlfriend told me the Thai doctor had said to her, while they were conversing in Thai, that he is a "nose doctor" and would not be able to work on W. I thought I had heard wrongly and clarified with her: she repeated he was a plastic surgeon. I suppose the hospital has a plastic surgeon on hand for accident cases (smashed face, anyone?) - but even then, what good is that without an anesthesiologist?)

I asked about flights and they said we can book a flight with Cambodian Angkor Air but they were not sure of the flight times. It was about 6pm by this time.

I asked about Bangkok and he said medivac (medical evacuation) to Bangkok will cost US$15,000.

Finally we decided to return to Ly Srey Vina and I told the Thai doctor so. W was in much pain by now (he had already been given one morphine jab at the clinic but clearly it was not enough). W decided to take the hospital's ambulance back to the clinic as the pain was unbearable. We were informed the cost was US$50 which we had to pay in advance. Ly Srey Vina charged half that. I had already told the couple to expect huge fees, so none of us said anything.

The nurse volunteered (I guess she is used to trying to justify the cost): in addition to a driver, we would have a hospital staff member would sit with us in the ambulance. (I wondered how much the drive to Phnom Penh would have been - a thousand dollars?) I went to the counter to help the couple settle the bill as they prepared to board the ambulance and we left.

Later, W's girlfriend told me she was given a form saying consultation was US$120 (so, up 20% from a year ago, according to what this customer said ). The girlfriend was upset, saying "We pay US$120 for nothing."

She had assumed I had paid the consultation fee in addition to the ambulance fee, but I told her I was only charged for the ambulance. We wondered if the hospital waived its fee because they did nothing of use, or in the drama, simply forgot to charge us. Frankly, I think it was the latter.

Five minutes later, we were back at Ly Srey Vina, where Dr Vuthy, a former war surgeon, would operate on W. Dr Vuthy arrived at the clinic about 10-15 minutes later, by which time, the girlfriend was in tears. She said W had turned very pale - but where was the doctor?

Dr Vuthy had removed a small lesion from Alan previously and he did a good job so I felt confident. He explained he would have to clean the abdomen of pus as the appendix had already ruptured. The surgery would take an hour.

I got us coffee from the Caltex down the road and sat waiting for Dr Vuthy to give us news. An hour and a half later, he emerged to say it went well and our friend would be ok, but W would have to stay in the clinic for a few days for observation and to ensure there was no serious infection.

Later, another doctor at the clinic told me if W had waited another hour, it would have been very serious indeed - and later reading on the Internet about appendicitis, I was so thankful we chose to return to the clinic for the op.

About appendicitis:
"The classic symptoms of appendicitis are abdominal pain and loss of appetite. Abdominal pain usually begins in the center of the abdomen, around the area of the navel. Later, the pain may move downward and to the right, to an area called McBurney's point, which roughly corresponds to the location of the appendix....

There is no specific incubation period (the time it takes for symptoms to develop) for appendicitis. Once the appendicitis symptoms appear, it can take as little as 48 to 72 hours for the infected appendix to rupture. If the appendix ruptures, the infection will likely spread to other areas of the abdomen, increasing the risk of serious complications and making treatment more difficult."
I am so glad W is fine. It's a terrible thing to be ill on holiday, and worse if you have a major sickness in a third world country. Thank goodness W and I had been in contact. I doubt if tourists know where to go in case of an emergency. No doubt they would be taken to the Royal Angkor International Hospital if they ask their hotel or tuk tuk driver, simply because most people in Siem Reap know of this hospital because of its advertising efforts.

This is why I am writing this blog post. There are alternatives to the Royal Angkor International Hospital and in case you need an anesthesiologist at 6pm on a weekday, the hospital may not be your best bet.

The Thai girlfriend said in Bangkok if you are sick, doctors and nurses would be rushing to help you, but here, everyone moves so slowly. I have to say I agree - people and processes in Cambodia move much more slowly than what I am used to in Singapore, but I am just thankful for the Cambodian doctors who helped W. It's made me more confident about healthcare options here.

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