Wednesday, July 09, 2008

Lucky Country

the healing hands fountain in front of the hospital where i work
(photo from flickr)

I've been working here just a over week, and I still can't get over how lucky "public" patients here are. I know that all medical systems have their flaws, and Australia is no exception, but compared to back home, they don't know just how fortunate they really are.

I work in a public hospital (government funded) in one of Perth's outer suburbs, a fairly small one relative to my old medical home. It's a 200 bed hospital that's just inching its way towards secondary hospital status - by Australian standards that is. We don't have an ICU and as a rule (strictly enforced) we cannot have intubated patients or toxic patients here. We don't have complete specialist cover and have to refer some of our patients to the bigger centers in Perth who need consults.

Despite this, in this little hospital, we have access to diagnostics and resources that my fellow co-residents and I would have killed for. All you have to do is order them, arrange for a schedule, and most of the time you get results within 24 to 48 hours. For blood work, you can get them as fast as half an hour. I know this must sound routine to someone who works in a first-world insititution or even a private hospital back home, but for us, it was all but a wistful dream. To top it off, puiblic patients don't have to pay a single cent.

And the drugs! All you have to do is write it in the chart, and it's all provided for. Antibiotics are given regularly, without fail. No need to run around looking for donors, worrying about where you are going to find your patient's next dose. And this covers discharge prescriptions as well. No need to wrack your brain cells and make up unconventional combinations looking for the cheapest option.

I'm often given amused smiles by my fellow residents when I'd give a delighted, "Oh, you have that (can do that/can give that) here? Wow! I've never seen that done (given to a patient) before!" Believe me, I've said it so often, it's become almost embarrassing.

On the other hand, they can't wrap their head around the idea of relatives who ambu-bag patients who cannot afford a mechanical ventilators, let alone patients who ambu-bag themselves. The concept of young patients dying simply because there are no medications to be had is unthinkable to them. And treating empirically based on a clinical diagnosis is almost akin to a joke. Yet these are realities that I and fellow doctors who work in government hospitals in the Philippines lived with every single day.

Being exposed to all this excess, I can't help but being a great deal envious in behalf of the many needy patients back home. And sad, because given the place health is given in our national budget, to have something like this back home is something of a pipe dream. As it is, the government cannot even pay trainee doctors a decent wage for service hours rendered; it is never going to have enough to cover the health expenses of even just the Filipinos who find their way into the hospitals across the country. The ever-upward spiraling prices of health care in the world makes the unlikely almost impossible.

Whenever I hear someone here griping about how lousy their health care system is, I'm always tempted to make the retort, "How about I send you to the Philippines in place of one of the patients we have in the wards?" Just a day in, and I'm sure they'll realize what we all know to be true - they're still pretty damn lucky.


rlbates said...

Very nicely said.

Manggy said...

This post left me both laughing and heartbroken, Dr. Claire. I can just imagine your amazement-- an emotion I look forward to being too familiar with, with any luck (cross my fingers!). We are fortunate to be trained so well back in PGH, that it somewhat makes up for the lack of resources, but I keep thinking about all those patients who could have been saved had the results come in faster/ meds were available/ we were better at avoiding nosocomial infections, etc.

dr_clairebear said...

@rlbates: thanks! :)

@manggy: you said it! it was good training, but it was also frustrating to know what to do but have no funds to do what had to be done.

Tramadol Guy said...

Take a positive look in life and you'll overcome those struggles that you will encounter.

Anonymous said...

australia puts a great premium on health care. i think same goes with canada.

Bone MD said...

Geez, that scenario of our SD beds patients in med ward doing the self ambubag-ging, makes me sick.

I guess in our country the only ones who are lucky are those in power that haven't experienced the poor man's crisis.

Keep learning Doc!


The upcoming TBR 16 will be hosted by Doc Gigi in her blog, Beyond Borders: The Lei Si Chronicles. Call for articles is up in her blog!

Got meloinks? said...

hi koalabear. :-) hi doc claire. and you didn't mention their accent yet. how does the ill speak in OZ English?

do the aussies follow american guidelines?

you know, hearing the stories of my Pinoy friends abroad, they tend to count their blessings and tell the natives, "you ain't seein' nothin' yet."

and you're no exception.

dr_clairebear said...

@mari: that they do! pero mahirap din kasi pila-pila rin pala dito. :) parang PGH!

@bonemd: self-ambu bagging is a sight all too common in the med wards. nakakalungkot talaga.

@meloinks: mas british kesa american, but they use harrison's as well, so may kuwenta naman ang libro ko dito. :)