On Hospitals in Indonesia

On Tuesday, Zac had surgery – to finally remove the metal plate installed at huge expense after our helicopter evac from Mongolia, where he’d broken his arm so spectacularly that one person who saw the X-ray described it as a “stuntman injury”.

And, unusually for us, all proceeded without any drama at all. He was back at school the next day, fully functional (although no sport, bike-riding or motorbikes until his humerus is more like a limb and less like a piece of fine Swiss cheese), and remains mysteriously resistant to my attempts to pump him full of superfoods. He’s also had no pain relief since the day of surgery.

Which causes me to think about hospitals, and what makes a good hospital, and what we expect of hospitals, and why.

As a Brit, I don’t expect much from a hospital. I expect staff who know their stuff, caring, if required, and to be allowed out as soon as possible, thank you very much. I don’t expect a hospital to be a place I’d choose to spend time in, and, given that healthcare is free (funded by taxation), I don’t expect anything terribly fancy by way of aesthetics.

I was slightly discombobulated when the chap who examined me shoved a gloved hand up my vajazzle with just the line “I’m going to examine you” (I’m not sure what I was expecting – perhaps flowers? A gin and tonic, at least?)

I opted for a very knackered historic teaching hospital to have Zac, on the basis that if something went wrong, which it didn’t, I’d rather have specialists and ICU on hand, and that a teaching hospital probably had good specialists not to mention a decent ICU.

There are, in fairness, few worse times to have a baby than over the Saturday night to Sunday morning shift change, where both sets of staff are missing a chunk of their weekend and some – perish the thought – may even have been out all night, or close to it.

But – ya know! There was a machine, to monitor my spawn’s heartbeat. There were doctors on hand, should one be required (in the UK, delivery is midwife-led unless you’re high risk), and the fact that one of the windows in the room in which I delivered had broken some time ago and been patched with plastic binbags didn’t bother me, because the machines worked and the staff knew what they were doing.

It probably also helped that I didn’t have any delusions about birth being a pleasant process. I was absolutely livid, obv, to learn that my carefully honed birth plan of “hold out until it gets really painful then hop me full of every drug you’ve got” wasn’t going to happen as I’d held out too long (it happens!).

Further, I was slightly discombobulated when the chap who examined me shoved a gloved hand up my vajazzle with just the line “I’m going to examine you” (I’m not sure what I was expecting – perhaps flowers? A gin and tonic, at least? – but, anywise, I certainly wouldn’t call it birth rape, because, well, he really wasn’t going to be examining any other part of my anatomy in the circs, and in comparison to the obliterating agony that midwives euphemistically refer to as “Do you feel like pushing, yet?” any number of indignities pale into insignificance), we both went home six hours after he was born, both of us healthy, fit and well.

Which is what you want in a hospital, right?

Hygiene was so lax that I, as a foreigner with one of those horrible tummy bugs people tend to get in sub-Saharan Africa, was allowed to use the loos INSIDE THE OPERATING THEATRE. On the plus side, they didn’t seem to use the operating theatre very much.

Some hospitals, however, are definitely below par. The clinic in Mongolia, where Zac eventually arrived with his broken arm, had some nice elements – friendly, delightful staff, relaxed approach to food in rooms, enormous woodburning stoves, etcetera. Yet it was also lacking some key elements of a functional hospital, such as running water, X-rays and, umm, basic medical training.

Still, it was preferable to the hospital in Mopti, Mali – which, I learn to my surprise, is referred to as the “Venice of Mali”, presumably by people who’ve visited neither Venice nor Mali – where I was hospitalised twenty years ago.

Hygiene was so lax that I, as a foreigner with one of those horrible tummy bugs people tend to get in sub-Saharan Africa, was allowed to use the loos INSIDE THE OPERATING THEATRE. On the plus side, they didn’t seem to use the operating theatre very much, which while unfortunate for the many people who undoubtedly died of operable conditions, probably spared them septicaemia, not to mention my stomach bug.

Further – and this was in the days before mobile phones or internet, so if you wanted to know something you had to go to a place with a phone and ring someone – the French-speaking doctor asked me to read the (French and English label) on my antibiotics to find out whether he could take them for his angine.

I didn’t check out the hospital in Siwa, Egypt. Given the advice from locals was to bus it nine hours to Alexandria rather than darken its portals, I figured I’d let my wound from our car crash sort itself out with some aloe vera rather than risk bad stitching (I had bad stitching on a knee injury in Israel, which was OK, because, you know, it wasn’t my face, but didn’t encourage me to risk it again).

That worked out fine, in the end. I have a small dent in my forehead, which I suppose I could attribute to duelling in Heidelberg if trying to impress, although I guess a jeep smash in the Western Desert with a Bedouin smuggler also sounds exotic, if a little more low rent. And scars, unless disfiguring, are souvenirs, in the end.

Our private room had floor-to-ceiling windows, a white leather sofa, Kiehl’s products in the private bathroom, and a lovely console thing which enabled you to work everything from the A/C to the flatscreen TV to the curtains and the lights from the comfort of your bed.

The ne plus ultra of hospitals, in our experience, was, of course, The Union in Hong Kong, an enormous private emergency hospital, where our private room had floor-to-ceiling windows, a white leather sofa, Kiehl’s products in the private bathroom, and a lovely console thing which enabled you to work everything from the A/C to the flatscreen TV to the curtains and the lights from the comfort of your bed. (No, we weren’t paying.)

The staff were stunning – Zac’s surgeon had qualifications coming out of his ears, while the nurses were efficient as only the Cantonese can be. And the testing equipment on the lower levels where, between a terrifying allergic reaction and some unnerving test results, we spent more time than I would have liked, would have put the very best London hospital to shame.

Zac’s treatment there, where his plate was inserted, cost a cool US$20,000. I’m told it’s where all the top CEOs in Hong Kong go, when the duck and dim sum finally clog the arteries, and I’m not bloody surprised. But I come from a country where healthcare is free. And a corollary of free healthcare is that it tends – as we also found in Greece, when Zac had routine surgery there – to be functional, rather than pleasant.

The Union was a delightful treat. I’d have to be a gadzillionaire to go there again.

Given most of the myriad motorcycle accidents on Bali end up there, their orthopaedic team are more than familiar with the art of unscrewing plates from bones.

In Indonesia, and on our own dime, we chose Sanglah, which is the teaching hospital for Bali. Sanglah seems to be where anyone who’s seriously ill on the island ends up anyway, not to mention where you end up if you need a specialist, so it made sense to start there in case anything went wrong.

It’s not sheeny-shiny and pretty like the more bule-focused hospitals, and it certainly doesn’t have a marketing department, but given most of the myriad motorcycle accidents on Bali end up there, their orthopaedic team are more than familiar with the art of unscrewing plates from bones. We went for the Amerta wing, where foreigners and wealthier Balinese usually go, which felt like a European state-run hospital.

And, so far, we’re pleased. Zac has a neat-looking wound – he got sunburn on the old scar, so we asked the surgeon to remove the keloid scarring, which he did. He went into surgery on the nail (despite my forgetting his X-ray); he had minimal post-operative pain; the orderlies and surgeon were lovely; and he got his metalwork to take home.

Coming out of anaesthetic, he was hooked up to an appropriate machine, with an orderly on hand to help him to the loo when he needed it. He was sent into surgery with a wristband with his drug allergy on it (which I’d expect), but five different people asked us about the drug (it isn’t one they use in Indonesia, which was encouraging.

Further, I wouldn’t expect an Indonesian medical team to explain to Zac exactly what was going into his IV line. But they did. Which is how we know he had antibiotics during surgery. And, though it’s odd as a Briton where medical care is free to think about hospitals in monetary terms, the cost came in at almost exactly the estimate I’d been given – I’ve heard of bills running to three or four times estimate in other hospitals on the island, because of unnecessary procedures and ludicrous charges for things like changing bandages.

Indonesian medical culture still dishes out antibiotics like sweeties, like the rest of the world used to fifteen years ago.

That said, some of the protocols were different and – please note that I Am Not A Doctor – not different in a good way. There was no ECG before anaesthesia – they don’t offer them unless you’re over 40. This didn’t matter to us as Zac’s a healthy 14-year-old boy who’s had two surgeries under general anaesthetics already, and there’s no heart disease on either side of the family, but might well matter to others considering paediatric anaesthesia. (That said, I’m sure we could have requested one.)

The bandaging was old school, and, Zac thought, on the tight side, so he rejigged it (that Outdoor First Aid course is still paying dividends!), and then we went down to a more modern skin strip.

Further we were shipped off with five days’ worth of prophylactic antibiotics, in addition to the IV antibiotics during surgery – while that could be a function of a tropical climate, where it’s easier to get infections, and Zac’s taking them, I think it’s just that Indonesian medical culture still dishes out antibiotics like sweeties, like the rest of the world used to fifteen years ago. I’m mystified as to why he was prescribed mefenamic acid instead of, ya know, Ibuprofen, so we swapped in Ibuprofen that evening and Zac’s had no pain since.

Fundamentally, though, we’re happy with his care. The wound’s healing well, we have follow-up on Tuesday, the surgeon seems to have done a good job, and as our first real introduction to hospitals in Indonesia (bar the eye infection in Manado), we’re both pleased.

And, to be honest, isn’t that what hospitals are for? You go in, they do the job, they send you home – all sorted!