A Public Health Stranger in the Land of Medical Care
Tuesday, February 23, 2010
I finally gave in and saw a health provider for my painful upper back. It felt like a bad stiff neck that normally would go away in a couple of days. Only it didn’t go away.
I made an appointment with an orthopedist. He had a tiny two room office in a fancy medical center complex. There was no examining table in the room only a bench. He spent about 3 minutes asking me questions and said I needed an x-ray, which I got immediately by going down the hall to an imaging clinic. I waited for the results and they gave me the x-rays to take back to the doctor.
Back in his office, the doctor said that my problem was inflammation. He recommended an injection of shincort and a course of the medication celebrex. I had never heard of shincort and asked him if it was like cortisone. He said it was a new and improved version. I am never eager to get invasive treatments, but I was in pain and desperate to heal (I signed up for a 168km bike ride at the end of the month) so I agreed to the shot as well as the celebrex. He said I would see improvement in 3 days.
Before leaving his office, I paid the bill, which amounted to $350 US dollars. I do have insurance but I am not sure what they will pay given that this is Singapore. The bill included no diagnosis and no codes which are usually required by my insurer.
I was no better after 3 days so I decided to find a physical therapist. I’ve had mostly positive experiences with PTs in the US (some of whom are my colleagues at the College). They usually give me ultra sound, nerve stimulation, and exercises. Here they are called physiotherapists. They are quite common but I could find none in the vicinity in which I live. So I picked one based its website and on the ease at which I could get there (about 45 minutes on the bus/train).
In a few days I was a patient at a clinic where Sylvia examined me. I told her the diagnosis the doctor provided but she didn’t fully agree. She asked me to lie face down on the examining table and started massaging and pressing my neck area. It was painful, but she said the massage would help and I told her to proceed.
After 10 minutes, she checked my next tightness and pain. It was less tight, but not good enough for Sylvia, so she pressed more. After 4 times of massaging and checking, she said that was all my neck could take in one session. She gave me a heating pad for 10 minutes and told me to return in a few days. When I left the office, I could actually move my neck to the right without pain for the first time in a month.
Every day, my neck improved a bit more. I returned to Sylvia for another treatment and it improved further. I was a happy and recovering patient. By the way, each treatment cost about $56 and I don’t know what insurance will cover. Most of all, I liked the hands on treatment – no machines- and I felt better.
I wanted to learn more about Singapore’s health system, but I didn’t think I would do it from a patient’s perspective. In 2000, Singapore’s health system was ranked 6th best in the world by the World Health Organization while the US was 37th. Check out (http://www.photius.com/rankings/healthranks.html) or for a rock’n’roll version:http://www.youtube.com/watch?v=yVgOl3cETb4
I can move my neck but I hope I can ride my bike for 168km.
Wednesday, February 3, 2010
Since the beginning of January, I have been living in Singapore. It is almost exactly halfway around the globe from my home in Ithaca. The plane from Newark that brought me here traveled due north to the North Pole, then due south to Singapore. It is a mere 85 miles north of the equator. Ithaca, it is not.
If you twirl a globe or look at a world map you will notice that the equator traverses mostly water. Going west from Singapore, it crosses Maldives then Somalia, Kenya, Uganda, Congo, Sao Tome and Principe, and Gabon in sub-Saharan Africa . It cuts across the Amazon in northern Brazil, Colombia, and Ecuador in South America. From there, it’s a long ocean passage west to Kiribati and Indonesia, with Singapore nearby.
This geographic location made me think about the health issues of people who live near the equator, where the weather is hot and sticky in some places, hot and dry in others, but always hot. Images of the equator conjure worries of insects with malaria and dengue fever, jungles with snakes and spiders, or deserts with scorpion and drought. The amount of sunlight and darkness hardly changes at all during the year at the equator.
Of the countries listed above through which the equator passes directly, most are poor with poor health data. For example, the life expectancy of Somalis is about 35 years, about 145 children out of 1000 die before the age of 5, and they spend an average of $18 per person each year on health expenditures (of course it is hard to spend when one does not have). Ecuador, along with Brazil, have the most healthy overall populations on the Equator. Ecuadorans live to about 73 years old, 24 children out of 1000 children die before the age of 5, and they spend about $297 per person each year on health expenditures. The other countries are somewhere in between according to the data from the WHO (http://www.who.int).
Singapore is quite a contrast. The average life expectancy is about 81 and only about 3 children out of 1000 die before the age of 5. These are among the best statistics in the world, significantly higher than the US even though Singapore spends only $1228 per person each year on health expenditures compared to about $6700 for the USA.
To explain this contrast could take awhile, but I will try to summarize here in two words: public health. Of course, it is more complicated than that. Singapore is a relatively new country forming in 1965 after a failed merger with Malaysia. (For an interest recent perspective on the current state of the country, try reading this piece from National Geographic: )
Singapore is also a country that carefully controls its borders, has low rates of unemployment and crime, high rates of home and apartment ownership in safe neighborhoods, integrates government ownership with private ownership of industry, and provides quality education. Most of which are strong determinants of health. The water is safe to drink and the island is malaria free (though dengue fever is a concern). To some, this has come at some cost such as the bulldozing of small (and less healthy) villages, severe criminal penalties for illegal drug use and trafficking, very high taxes on alcohol, and a government Health Promotions Board that enforces bans on smoking and spitting. It’s rare to walk more than a block without seeing some evidence of a health marketing campaign. Yet from a public health perspective, the results are remarkable.
Now that I am a resident, stay tuned for more comments about life and health in this part of the world.