The longest way to surgery in Asia
Long term readers who subscribe to my newsletter might remember a few years back I wrote a very personal newsletter about experiencing colon pain and having a colonoscopy in South East Asia. It was a smorgasbord of misdiagnoses, the unknown, impending death and getting the all clear.
For the past number of years wherever I’ve traveled I’ve sought out the best doctors and hospitals to give me answers.
Last week that all came to ahead as I experienced a building pain in my left side. 24 hours later at 11.30pm I was lieing on surgical table going under for a 2.5 hour emergency surgery.
I’m writing this to both document for my long-term journey and in the hope that maybe it will help others. Either people thinking of having a surgical procedure in Asia or by way of accident need to have it.
I’ll list the countries I’ve been in hospitals in for this and other minor ailments. While everyone is sure to have a different experience, these were mine.
My emergency surgery
After dinner the pain kept getting worse. It was my left side. By midnight I was in and out of bed unable to lie down. I suspected, and hoped not, that it was a strangulated colon or internal blockage. I took painkillers. But by 3am I knew I had to quit the fight and surrender to the idea that I needed a hospital.
I was bounced between several hospitals looking for a doctor who was on duty. It seemed crazy. Why were there no doctors around? I’d been in an ER before and new the scenario. Take a painkiller and wait for the “real” doctor to arrive.
Finally, I met one who wanted me to have an endoscopy and colonoscopy. This meant a purge. Clean out the colon and stomach first before anything else. Again it seemed bizare but the painkillers were kicking in and I was relaxing into a temporary relief.
Purge over with the next morning it was into the hospital. I was knocked out for both the endoscopy and colonoscopy. An two hours later I was walking back into the doctors office.
She swung her laptop around and showed me the uneventful endoscopy. Then she got a little excited about the colonoscopy.
“See this? It’s your appendix!”
I looked at the mutated creature at the bottom of my cecum. Last year I’d had another colonoscopy and it was all clear.
“I came in with a pain on my left,” I said knowing exactly where the appendix is.
“And you’ve been having a pain in your right for how many years now?”
“So I’ve had an appendix problem all along?”
“We need to get it out, now!”
Off to emergency surgery
Again that confusion that reeks most of Asia’s ER’s. Apparently the surgeon my primary doctor wanted was on holiday. I had to choose from three others. Just names. Random names. I refused and asked that my primary doctor choose. She did. I’m glad she did too as the surgeon was extremely nice and well versed in my background. We both agreed on an exploratory lapappendectomy.
By 11.30pm I was being wheeled into an operating room. I wasn’t nervous at all. I knew it had to come out and there really isn’t any alternative at this stage but to accept ones fate. Instead I chatted with the scrub nurse who was struggling with shaving my mid-section. He called over another nurse who helped out as she used to shaving people going into neurosurgery. Not exactly the type of chat you’d expect to be having before your own surgery.
“I need to pee,” I suddenly realized.
My surgeon came in, “Don’t worry, we’ll give you a catheter”
I tried desperately not to think about the catheter. Instead I talked about just watching the 1900 hospital drama The Knick as oxygen tubes were placed up my nose and a respirator over my face. All I could think of was Clive Owen and his cocaine addiction. My surgeon had none of the signs. I wished them all the best and then the lights went out.
Waking up from surgery
2.5 hours later I woke up. Everyone was in green outfits. I blurted out something about is everything alright and got lots of reassuring answers. My hands were completely numb. Apparently I was stretched out on the operating table which caused that. Then the pain hit. By gosh did it hit. I literally felt like I’d been cut open down the middle. Well … I had been.
The staff nurse asked for that annoying pain grade of 1-10. I liken 10 to being curled up in a ball screaming so I gave a fluctuating 8-9. A few seconds later a felt the cold rush of pain reliever gushing in through my IV unit. Then it all went fuzzy again.
By the next morning I was groggily awake when the surgeon came in. All I could think of is how tired the guy must be and how did he get the energy? He raised my bed up. Appendix removed, adhesion’s removed and a hernia repaired.
I needed a corset type belt to be wrapped around me along with two antibiotics, saline and a wonderful buzz inducing painkiller that sent me back to fuzzy land again.
That vomiting feeling
Nothing lasts for ever and the fuzzy land turned into vomit land as I felt my stomach needing another purge. I blame the room for spinning. Now, if you have stitches right below your stomach. Which is not yet wrapped in its protective corset. And you want to vomit. Trust me that the idea of projectile vomiting yourself into bursting your stitches open and let your guts literally spew out ala the scene from Alien is not that comforting.
Instead you grasp the kidney curved bowl whose shape you always wondered about before. Wrap it around your chin and let the vomit rise up without clenching your stomach. All this when everyone around you is watching on rather helplessly.
Needless to say the kidney bowl catches 70% of the liquid while the rest warmly rushes down your cheek, over your neck and shoulders before pooling along your upper back. I lay there in that post vomit semi-euphoric stage for a few seconds. Gently wondering if and when the nurse would clean up the mess. They didn’t. Instead I was offered anti-vomit pills and another dose of pain medicine. Fuzzy land came back.
A few hours later and I’m awake again. No vomiting. This time I simply went into shock. The whole shiver and shake thing. No one seemed to concerned. More fuzzy juice please. I thought of Clive Owen and the Knick again. Jeez this fuzzy juice is nice.
Days of recovery
I travel. I don’t own pajamas. My surgical gown was a little messy so I lay naked under my sheets for days. The nurses got more than an eyeful more than once. This was particularly true when it came time to remove my catheter.
Now, if you don’t know what a catheter is please do a search on it. All I can say is that when it was in it was wonderful. I didn’t have to get up to pee. It just came out on its own as need be. Wonderful!
Sadly, no matter how often I asked the nurse for some more time with my new friend the catheter she just shook her head. It had to come out to prevent infection. By the end of her shift the rubber gloves were on and I was thinking of anything but the tube being pulled out.
For those wondering, it hurt less than I thought, though peeing for a few days was a little sore.
I was allowed more fuzzy land juice after that. Though it must be said they were getting a little stingy with it by now.
Back on solids and get out of hospital
Hospital food in Asia is not so bad. It’s plain. Dare I said I even had chicken with rosemary and lemon sauce. I can’t even find that easily in a restaurant in Asia!
The doctors came and went and slowly broke the news to me that it looks like I’d been traveling the world for the past few years with an infected appendix. We won’t know until the lab results are in. But the bottom line is I have a high tolerance for pain and a super charged immune system which both helped and hindered.
I could have died was said a few times. It could have been so much worse – so reassuring!
My mind now rang back to all those other doctors over the years who did not spot this. These were doctors from all over the world not just Asia.
My faith in medical practitioners is about as high as my knee these days. And thankfully there’s nothing wrong with my knees.
Recovery from surgery
I’m not going to go into any more intimate details here. I’m not out of the woods yet apparently. Lab tests are due back and I’m still not allowed to be prone. I have three holes in my stomach and one is oozing. It will take several weeks before I’m up and about properly. Long-term recovery is not being discussed for another two weeks. At the moment it’s all about rest, recuperation and listening to the body.
I have antibiotics, pain relievers and meds to protect my stomach from the former meds. I have a support corset. I have a lot of people to thank for helping me during this unexpected event. If there’s one thing you need when you go into a strange hospital anywhere in the world it’s people around you. Sometimes you end up in the right place at the right time.
I no longer have fuzzy juice … but somehow that’s okay.
After this I’m going to backtrack belated posts from my travels in mid-north Thailand during my recovery.
Meanwhile I leave you with this advice:
The hospital billing section doesn’t care about what’s wrong with you, they just want their money – and they won’t let you out until you’ve paid.
Below are some tips on where and what hospitals are like in Asia. I hope it will help some people out in what to expect when the unexpected happens and you need a hospital in Asia.
Experience with hospitals in Thailand
Private and public hospitals are normal here though there are some high end private hospitals. Public hospitals are crowded but strangely I found evening times relatively quite though with long waits. Language is a real problem in public hospitals. Doctors know English but nurses and receptionists struggle.
In private and super private hospitals everyone seems to speak English aside from the odd nurse. But you pay for this addition to service. Some of the hospitals in Thailand look like they came out of a science-fiction movie or at least a high end hotel. They’ll cost a lot as well. Though still below western costs.
Doctors seem more interested in following their own set diagnostic route than listening to a patient. High end hospitals seemed to have a financial agenda in giving you the most expensive treatment. Reception in high end hospitals are like that of a hotel and you will be treated like second-tier royalty most of the time.
Pro’s of Hospitals in Thailand:
- Sanitation is top notch
- Doctors are up-to-date
- Hospitals are easy to reach
- Nursing care is professional
Con’s of Hospitals in Thailand:
- Language can be a problem in public or low-end private hospitals
- Price of high end hospitals can reach crazy proportions
- Prescribed medicine is not always available outside the hospital
Tips on going into hospital in Thailand
If you can, shop around hospitals until you find a doctor and hospital you are comfortable with. Ask for all the pricing upfront as some hospitals charge high registration fees. Some hospitals also offer discount cards if you will be receiving treatment there over the long term.
Experience with hospitals in The Philippines
Hospitals in the Philippines some in several flavors. Good private hospitals, semi private and public. Public hospitals to a foreigner might come as a shock to many. There are people everywhere. The hallways are cramped and doctors only attend at certain times (there are no substitutes).
Private hospitals are cleaner but vastly more expensive than public. Doctors here are often trained abroad. That doesn’t mean they are great. Some seem very dated and I liken them to an 80’s style of education.
On both counts Doctors and nurses have a good grasp of English. The most frustrating linguistic thing is dealing with receptionists who are not so friendly nor speak English. Sadly nursing staff in many hospitals are paid minimum wage or below minum wage. There’s an overaabundance of them so replacement is easy if they complain. A sad thing to note for medical care.
Pro’s of Hospitals in The Philippines:
- English is widely spoken
- Cost is less than the west
- No waiting times for scans
- Nursing care is excellent considering they are paid minimum wage
Con’s of Hospitals in The Philippines:
- Sanitation is not be best
- You need a care giver to accompany you (without one there is no one to fetch your medicine or help you)
- Medicine in The Philippines is very expensive compared to the rest of South East Asia
- Complicated billing structure
Tips on going into hospital in The Philippines
Cash is king. Credit cards only really work in private hospitals. If you are going into surgery or spending overnight you really need someone with you to help. It’s really important you ask the doctor about the hospital care. Some hospitals expect the patient to buy some of the procedural equipment and medicine in person.
Experience with hospitals in Malaysia
Hospitals in Malaysia are both private and public. I found it hard to reach both on public transport as they all seemed to be located on city outskirts. There are smaller clinics in the inner cities but they mainly attended to outpatients with minor issues. English was widely spoken by doctors, staff and receptions. Public hospitals are crowded and often intimidating. Insurance is often asked for in private hospitals with bills disproportionate to paying in cash.
I found the doctors in Malaysian hospitals to be very up-to-date in procedures and diagnoses. There was an honesty about doctors genuinely wanting to refer you to another doctor who would know more than they would. There was never any rush to do anything other than solve the problem.
Nursing staff were very good. I wouldn’t class them as overly caring but certainly very professional.
Pro’s of Hospitals in Malaysia:
- Well versed doctors
- Billing structure made sense
- Cost of medicine is low
- Doctors fees were low to acceptable
- Receptionist understood issues and worked well
Con’s of Hospitals in Malaysia:
- Can be crowded and confusing in registration
- Being referred to other doctors in other hospitals
- The look of administration greed when they see you have health insurance and the crazy prices thereafter
Tips on going into hospital in Malaysia
Ask for the cost of everything from day one. Try mentioning your insurance doesn’t cover this as the price may drop. Remoter hospitals seemed less crowded (and easier to deal with) than city hospitals.
Experience with hospitals in Nepal
Public and a few private hospitals dot Kathmandu but outside the valley you are mainly dealing with public hospitals. Some doctors are well trained but others seem dated. Nurses are very kind but in very short supply. Hospital receptions can be chaotic to say the least.
Sanitation is an issue in Nepal and you’ll want to think twice about elective surgery there. Medicine in Nepal is very cheap though you do need to look out for counterfeits. English is spoken by nearly everyone.
There are sometimes foreign doctors working in both public and private hospitals in Nepal. There’s not much of a chance to shop around though as they are in demand. Quite often doctors are more inclined to relieve you of symptoms than treat the cause. Preferring instead to send you back to your home country.
Pro’s of Hospitals in Nepal:
- Possibly some of the cheapest medical care in the world
- English is widely spoken
- Medicine is cheap
Con’s of Hospitals in Nepal:
- Crowds in public hospitals
- Lack of hospitals
- Two-tier pricing
Tips on going into hospital in Nepal–
For complicated issues don’t if you can help it. But for accidents like broken bones etc then they are fine. Though it’s very important you have medical insurance in Nepal as they know insurance companies payout large sums. Sadly two-tiered pricing is also rampant in Nepal so foreigners are charged more than locals.
General tips in looking for a hospital in Asia
- Unless it’s an emergency shop around. Doctors and hospitals vary greatly in every city everywhere in the world. Don’t be afraid to tell them exactly what you are doing. They won’t mind. It’s Asia and it’s a business like anything else.
- Get travel insurance that will cover you. Pre-existing condition travelers are as good as toast these days with insurance. They simply won’t cover you. Be prepared. Everyone else is mad not to be covered if you are traveling. Many countries will charge you more these days just because you are a “foreigner”.
- Get the prices of everything itemized. You’d be surprised what things aren’t included in procedures or treatments.
- Public hospitals are very cheap and good for minor issues. Just expect long waits and somewhat worrying conditions. Bring cash.
- If language is a problem ask for a translator. Don’t let linguistic confusion end up with you getting a lobotomy vs a lab test.
- Be prepared to hire a caregiver. Many hospitals in Asia ask for one to be present. It’s hard to be discharged without one. If you know know one then ask the hospital to get you one (expensive) or ask a nurse if they have any out of work nurse friends that you could pay. Ask what a nurses daily salary is first just so you know rough estimates.
- Hospital pharmacies are more expensive than the ones outside the hospital. Try buying your medication outside the hospital and you could see a 50-25% reduction in costs.
- Get travel insurance
- Don’t have travel insurance? Then you gotta pay cash or credit card and it won’t be a nice experience. Don’t have the cash? They’ll most likely take your passport from you until you do have the cash.
If you’ve had surgery in Asia and have any tips do let me know in the comment section and I’ll add them here. At the very least it might help others who are thinking about having surgery done in Asia or have ended up in hospital in Asia.
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