Insurance decision will cost an expat no matter what

Part 4: It’s gonna hurt

(In my three previous posts, I explain the complicated decisions expats must face regarding their healthcare, especially when the unexpected occurs.)

When expats consider medical insurance, they quickly learn the decision about getting or foregoing it can be complicated.

What they don’t always accurately take into account is how the costs of insurance will grow and how risky the lack of it can be.

Having it is expensive. Not having it can cost a bundle too.  Worse, not having it can be dangerous.

With insufficient insurance, inadequate personal resources or both, a patient who is unable to receive quality care in his or her adopted country or another one could end up permanently maimed.  Or Continue reading

Advertisements

Deciding where and which treatment to get took days

Part 3: Lucking out

(In Parts 1 and 2, you can read how I came to be self-insured and how I struggled to decide what to do about my injury.)

1 (9)

The proof is the putting in of my bionic bone

Bangkok made the most sense to be treated.  But which hospital, which doctor?

Online, I checked three reputedly very good hospitals in Bangkok looking for a specialist whose training was not confined to Thailand.

I found an orthopedic surgeon at arguably the best and most expensive hospital in the country, Bumrungrad, which is among several there favored by many expats and medical tourists. A middle-aged Thai who has had training in the U.S., Dr. Siripong Ratanachai, telephoned me twice and answered my emails quickly before I reached Bangkok and connected us to each other via the Line free message service.  (He asks and answers questions at all hours, even months post-op and sometimes with just a whimsical emoji in response to a condition report.)  I count myself lucky to have found him.

Next came more decisions.  While making them, I lived on massively unhealthy and effective doses of ibuprofin.  Hey, it worked!

My subsequent choices related to getting to Bangkok and staying there.  It took the rest of Tuesday and Wednesday — two and three days since my fall — to complete my research so as to book airline tickets, arrange for wheelchair assistance, ascertain that the crutches that I had acquired would be acceptable onboard our hour-long Bangkok Airways flight, figure out how long we might need a hotel at a competitive price and then make a reservation there.

Thailand adjoins Cambodia, but we were, after all, engaging in international travel with no notice.

Immediately following my flight on Thursday, we met with my exceptionally patient doctor after my admission to Bumrungrad, which has its own waiting area at the airport and a free shuttle van to the hospital.

Dr. Siripong confirmed what I had discovered online about screwing my bones together as a poor option.  According to him, that approach would result in my right leg becoming about an inch shorter than it was prior to surgery and require me to put no weight on it for six weeks. As I recall, he also said that such treatment results in a 30-40 percent risk of problems in the future.  His remark about ensuing problems was consistent with what I had read, the rest of what he said being news to me.

I had a total hip replacement at 6 a.m. that Friday morning and was, incredibly to me, out of bed by 4 p.m. using a walker for a few minutes.

(I have been aware that post-op treatment these days means getting the patient out of bed as soon as possible.  It helps that they don’t stint on painkillers at Bumrungrad; their use explains why I am smiling in Part 1, I suspect.   I did put a stop to opioids after two days, and any pain was by then not a problem.)

I was on crutches the next day, out of the extraordinary hospital after my fourth night, by which time I could manage experimentally indoors without a cane, and had an unremarkable follow-up appointment with Dr. Siripong the next Monday.

I was instructed  to send him photos and videos from time to time and visit again at some point.  Call me a bad patient, but my recovery has been so swift and easy that I was in touch only twice.  I’m guessing Dr. Siripong understands why I haven’t otherwise messaged him.

Next: It’s gonna hurt no matter what

Email: malcolmncarter@gmail.com

Being diagnosed, picking doctor not a walk in the park

Part 2: New York or Bangkok?

(In Part 1, I discuss how exposed to major expense are expats who elect to go without medical insurance tailored to living abroad.  I also explain what went into my decision on purchasing a policy.)  

1 (2)

One day after surgery. I thank drugs for my smile and the hospital for my fashion statement.

Let me say that I never have thought of myself as the fragile sort of person who could easily break a hip like so many older men and women who topple because their bones give out while they are upright.  For them, such a fracture is usually the cause, not the result, of a fall.

After all, as I am inclined to boast, I work out daily with a combination of lifting weights or sweating on an elliptical training machine.  Then there are walks of several miles most days as well so as to help me manage my weight.

I also enjoy hiking, frequently upward, on vacations, so I’m unusually fit for someone my age, I like to think.

I confess viewing with horror the prospect of being referred to as “elderly” should I be so described as the victim of a crime or a collision with a motor vehicle.

My level of fitness undoubtedly contributed to my uneventful and quick recovery.  My bones, according to my doctor, are strong.

I broke my hip on a Sunday evening in July, and an x-ray Monday morning Continue reading

An expat’s perspective on health care and immigration

BNH-Hospital-bangkok-premium-clinic-thailand-ogocare-2

BNH, the hospital in central Bangkok where I have received annual check-ups.

Technically, I am not an immigrant, though I make my home in Cambodia.  I have only a mailing address in the United States.

What I am is a retired expat whose year-to-year visa allows him to reside in Phnom Penh, where my savings go far indeed.  It is a good life, but it is one without a citizen’s rights (such as they are in Cambodia) and without dependable medical care.

Fortunately, I am an expat in excellent health now into his 70s.  Should I develop problems, the quality of my medical care here generally is suspect and its cost would be prohibitive for anything serious.

You see, I am uninsured outside the United States.  Even if coverage were obtainable from a reputable firm at my age Continue reading

For many Cambodians, giving birth is perilous journey

maternity 6

Far too many Cambodians live like this in the provinces, even within Phnom Penh limits, with few having either the means for or access to (or both) maternity healthcare that normally is appropriate.

This post is published verbatim with the permission of Banyan Blog, where it originally appeared. The writer’s insights are always worth reading, and I highly recommend the blog as well as its Twitter feed. The source of all but one of the photos, which I have added to the Banyan Blog post, is Kuma Cambodia, funded by a Norwegian association that goes by NAPIC.

One of the most dangerous moments in a woman’s life is giving birth, especially when access to quality medical care is not easily available.  In Khmer, the term to give birth is called “ch’long tonle” which means to “cross the river”. The elders use this phrase to describe the dangerous journey of crossing the river, which was oftentimes difficult and dangerous. Some would make it, others would drown. The phrase is appropriate in describing the perilous and uncertain journey of childbirth.

According to UNICEF, Cambodia’s maternal mortality rate is 170 per 100,000 live births (2013). While the rate has improved significantly since 1990 (1,200 per 100,000), it is still one of the highest in the world. The biggest challenge is Continue reading

Most expats face disadvantage when living in Cambodia

20150316_114442

This randomly photographed clinic is larger than most. Such clinics can be found all over Phnom Penh.

Not even Cambodians defend the quality of medical care in Cambodia.  The king routinely jets off to China for checkups, and top government officials also head to other countries for the best care.

Ailments that otherwise are treated routinely elsewhere in Asia demand quick flights to Thailand, Malaysia or Singapore.  Examples might include a sinus infection, certain bone fractures and diseases that internists in other nations can easily diagnose.

A related issued is that no one knows how reliable are drugs with foreign labels, and they fill the shelves of numerous pharmacies.

For me, the issue relates to Continue reading