Having left the UK not long after the Conservative Party and
the Liberal Democrats formed a ruling coalition; I have watched the government’s
plans for the NHS unfold from afar with disapproval. Not that I fully understand them of course,
but I have learned over the years that if politicians are using what I call ‘Tony
Blair hands’ while masking the fact that they are saying very little of
substance by using carefully structured sentences with an unnatural attention
paid to linguistics, body language and tone of voice (it is all one big
popularity contest after all), then the issue is probably being clouded, often
for the purpose of big business being able to get a cut of some pie or
other. Whether it is being termed ‘restructuring’,
a ‘public-private partnership’ or ‘a choice based NHS’, it seems clear that in
a nutshell, in part or in full, the NHS is being sold off and equality of
access to healthcare regardless of income will likely soon become a thing of
the past. I had the misfortune to
experience a very serious food poisoning incident here in Indonesia just a few
days ago. With the above in mind, here
is a little insight into what seems a fully privatized health service, apparently
free from government intervention, something David Cameron seems keen on in
light of his ‘Big Society’ mantra.
I started feeling rather unwell at 8pm on Thursday night, while waiting in Surabaya airport for a flight to Jakarta. Yet to visit, I had booked an extra day off work so that I could spend a long weekend in Indonesia’s capital. Feeling mild discomfort in my stomach has been a fairly common occurrence over the years. It usually clears up after an hour or two, but I had an uneasy feeling this was something that had to be dealt with. I proceeded to the waiting room half an hour before my flight was due to depart, where I started to feel nauseous and began salivating a little. This usually only happens to me when I’ve had way too much to drink the night before; as soon as I start salivating I know it’s bathroom time. I went to men’s room, stood over the toilet waiting for the inevitable but nothing happened despite escalating feelings of bloating and nausea. Considering I was about to join the queue to board my flight I thought it best to force the issue so I put my fingers near the back of my mouth and swiftly began to bark soup. After being sick intermittently for five minutes I felt much better and figured I’d be fine from then on. I couldn’t have been more wrong. I felt ok as I showed my boarding pass and continued along the corridor to the stairs down to the runway. Then, while I was queuing at the bottom of the makeshift staircase leading up to the aircraft door the nausea returned. I boarded the flight and got to my seat as fast as possible and tried to will the sickness away (never works). Realising it was crunch time again I had to scramble past my bemused fellow passengers who were still putting their bags in the overhead locker and made it to a sink just in time, remaining there throughout the safety announcements as the plane taxied along the runaway, making it back to my seat just in time for takeoff after repeated knocks on the toilet door from the cabin crew insisting I returned to my seat to belt up. Then it really kicked in when the flight took off. As soon as the seatbelt light went off I was back to the bathroom, where I would spend the entire journey of around an hour sat on the toilet with my face in the sink, at first solids and then soon endless amounts of water gushing out of both ends. I have never lost even a fraction of that amount of water out of my body in such a short space of time. It was terrifying and was the first time while on an aircraft, being a nervous flier, that I worried more about the consequences of something other than a crash. A fever soon followed as I managed to return to my seat for landing, and was then immediately back to the toilet while everyone left the aircraft. The last one off the plane, I resolved to go straight to a hospital but was pleasantly surprised to find a health clinic in the airport. My initial feeling of calm soon turned to frustration and rage as I realized what lazy, incompetent staff I was faced with. I have a reasonable amount of Indonesian language skills, and made it very clear that I was very cold (I was actually worried about hypothermia or pneumonia such were the chills I was feeling but that I didn’t know how to communicate) and probably had serious food poisoning. It didn’t occur to them to get me a blanket of any kind, or even to improvise, even after I repeated what I had already said and was clearly shaking. Nor did they show any urgency whatsoever. The first doctor, a man around my age simply nodded his head and left the room. A few minutes later an old woman appeared. Again I asked for a blanket and she just kept asking me what my name was. I also said I needed antibiotics, but that I would die if I took penicillin. So she asked me what antibiotics I wanted to buy, and offered me Amoxycillin. I asked for clarification that it wasn’t penicillin and she seemed irritated at my questioning, not appreciating how high the stakes were for me if she got this one wrong. She offered it to me again, but my gut told me not to trust this negligent idiot with a bad attitude so I turned it down, even though, I am not exaggerating, I felt it not entirely unlikely that I would fail to make it through the night. I could only stand or walk for a minute at a time without feeling dizzy and needing to sit down, I was weak. I could barely carry my modest suitcase. I was dehydrated and felt like I was getting worse not better. I later found out that Amoxycillin does indeed contain penicillin and therefore likely would have finished me off had I taken it. That this useless excuse of a doctor is employed at a clinic in the arrivals lounge of the airport of the world’s second largest city is typical of the kind of things Indonesia really needs to address. I bought a couple of bottles of water and jumped in a taxi to the nearest hospital, projectile vomiting out of its window at regular intervals and somehow managing not to shit myself before arrival. Finally in an actual hospital with good doctors, nurses and equipment, I was put on a drip for rehydration and stayed there until late Friday night before going to my hotel. Not until after a whole load more confusion though.
Barely anyone in the hospital spoke any English, and my limited Indonesian turned out not to be enough as I was to discover that I not only lack hospital related vocabulary but that they also speak in a mad Jakartan dialect with a crazy accent. Shockingly, before what was clearly urgently needed treatment started, I was presented with a folder of potential bed types to choose from, ranging from 'standard' - a bed in a shared ward, up to 'executive' - private room with en suite shower, flatscreen tv, wifi etc. I was thinking "This isn't a hotel, I don't give a fuck, just help me!" Most of this was in a language I didn't understand, both in terms of the folder itself and the babble spouted by the woman holding it, all while I was laid on a stretcher vomiting intermittently and struggling to retain consciousness. After many attempts communicating with my broken Indonesian, I eventually understood that whatever room you chose, you still got the same level of medical attention and number of nurses etc. This was all I really wanted to know, so I made the cheapest choice. The more expensive choices were simply for more comfort and entertainment. I then had to provide my card for them to take a deposit of 2,500,000 rupiah, which equates to about 160 pounds, to guarantee I could pay for whatever treatment I needed. Only when the receptionist returned with assurances that my deposit had been taken did the ball start rolling. I was then asked a range of puzzling questions about what treatment I wanted. Again, I must stress, for every question I was asked I understood barely 20% of what was being said, all while vomiting and occasionally losing consciousness. Then the doctor tried in her broken English, asking me if I would like a white blood cell count, a red blood cell count, a check of my cholesterol among many other procedures. These are trick questions. They are designed to take advantage of someone needing urgent help. For each procedure there is an extra charge, and to the patient, it is not always clear which treatments you actually need, and which you are being encouraged to agree to purely to increase the value of your final bill upon leaving the hospital, and likely the doctor’s commission. This game has been played with me once before, when one day I developed an unknown and debilitating pain in my right heel. I went to a different hospital, in Surabaya, where I live and work. Fortunately on that day the doctor assigned to me had good English, and I was neither in immediate danger nor finding it difficult to speak without vomiting. In this instance, after agreeing to a cholesterol check and a couple of other ‘products’, I then realized what was happening and was able to receive clarification, only after repeated questioning, about what treatment I actually needed. Sure it is desirable, to tick every box on a list in front of us and subsequently (in an ideal situation) receive a clean bill of health, but at what financial cost? I intend to do this occasionally as I get older for peace of mind, but certainly not every time I get sick, in a healthcare system where checking for each individual detail has its own separate charge. So, as I lay on a stretcher at the end of my physical and mental tethers, having been taken to boiling point both by my fever and the cold, money focused attitude to my treatment shown by the hospital staff, I eventually managed to communicate that I wanted only the treatment that I needed to recover from the ailment I had, and that I wanted to know how much the total bill would be including the bed for the night and any medication (you would think the word “total” would in itself dictate that specifying individual charges were not necessary, but apparently not). I was assured 600,000 rupiah would be the figure (approximately forty pounds). Upon checking out the next day I was given a bill for more than three times that amount. I hadn’t been told when providing a stool sample deemed necessary for determining which course of antibiotics I was to be prescribed, that a laboratory analysis would cost 800,000 rupiah, and that every tablet and bowl of liquid rice or slice of bread I had been given had also been added to my bill, at a cost that would not look out of place on a London restaurant menu.
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| Unable to access healthcare. |
Considering that by the time I provided the aforementioned sample, it
was well into the next day and I had recovered dramatically, had I known about
the outrageous charge involved I would have declined the service. Relative to the cost of living in Indonesia,
for which I will use the cost of a convenient ready to eat meal as a guide, 800
000 rupiah is astronomical, and that was for the stool sample analysis alone. A take away pizza in the UK usually costs
around six pounds. In Indonesia, chicken
fried rice is about eighty pence. 800 000 rupiah equates to approximately fifty-five
pounds. Imagine if you had to pay over
four hundred pounds in Newcastle or Manchester for someone to analyse your
excrement in a process which only took a couple of hours, and that that
represented only about forty percent of your total hospital bill after a bout
of food poisoning. To put it further in
perspective, the average shop assistant in a mall, or waiter or other unskilled
worker usually earns around 1 million rupiah per month, while those off the radar
of officialdom – street vendors and rickshaw drivers for example, earn even
less. I have no way of knowing how serious
my condition was on Thursday night. It
certainly seemed it. Maybe if I were a
poor Indonesian shopkeeper I would have simply passed out outside the airport and
woke up the next day covered in shit and vomit and eventually recovered. Maybe
my number would have been up. Either way
I certainly wouldn’t have been able to afford hospital treatment.
What you have read above is an insight into how largely
unrestricted private healthcare functions. Sure, if you have the money, you’ll
likely get very good treatment that you need, possibly along with a whole lot
of treatment you don’t need in a building where parts of which at times
resemble the lobby of a five star hotel (for what purpose?). On the other hand, have very little money and
you’ll receive the worst treatment; have no money at all and you’re someone
else’s problem. As David Cameron spouts
about giving people the chance to choose the treatment option that suits them
best, I would like to ask him whether or not when he goes to an expensive
restaurant he informs the chef exactly how to season his steak. Does he choose how much brake fluid the
mechanic should add to his vehicle when it is serviced? Does he ask us, the people who elected him,
how to run a government? I am a musician
and an English teacher; you may be a journalist, a waiter, a butcher, a baker
or a candlestick maker. No parent
chooses what method I should use to teach their child. None of us are in any
position to choose the best medical treatment available to us. Did I have a
clue what antibiotic I needed, other than that it had to be free from
penicillin? Did I want the choice of
beds and entertainment when in such an urgent condition? We need a doctor to
tell us and swiftly treat us with the best remedy, just as we expect a Prime
Minister to run a government or a chef to make us a beautiful meal. You may
choose the best shirt or hairstyle with a party in mind. The best, in these instances represents opinion
and can be chosen. Medical treatment is
very different. Published medical trials
have determined what the best treatment is for every condition as a matter of fact.
Where there are two or more procedures whose test results have shown
similar levels of success, it is not us, the patients, who should choose
between them; a choice obsolete anyway as we would probably only be able to
afford one of them. This responsibility lies
of course with the doctor, who will take into consideration any allergies we
have, our medical history, our metabolism and any experience the doctor has
gained using such medication throughout their career. In a fully taxpayer funded public health
service, where staff are given bonuses not according to how much medication
they sell but instead for doing their job to the best of their ability, the public can have faith that regardless of
their income, if they can be returned to full health, they will be. Failure of such a service should not result
in selling it off to the highest bidder, but should instead result in
replacement of failing staff in key positions, better incentives in the right
places to drive better performance and the provision of a larger budget as a
matter of public spending priority (it wouldn’t amount to a lot of money) where
necessary to overcome what should be simple challenges like bed shortages or
waiting lists before allowing for the funding of the construction of what is
essentially a mall on the ground floor, as is the case at the publicly funded
New Victoria Wing of the Royal Victoria Infirmary hospital in Newcastle Upon
Tyne. Nearby Bishop Auckland recently lost
its accident and emergency department altogether, leaving those in life or
death situations having to travel ten miles for urgent treatment. Its children’s ward was also closed in 2009. Those mall funds would surely have been put
to better use there. There is absolutely
no reason why a public health service cannot perform better and fairer than a
private one if it is under the stewardship of a strong government department who
spends money in the right places and who generously rewards its staff for
performing well, while being ruthless with those who don’t.
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