Disparate expectations

Last week President Barrack Obama urged doctors to work with the government to rein in health care costs before they cripple the government and its health care system. The US government spends 15% of its GDP on health care provision yet some of its citizens are still not able to afford health care. The hospitals have the most up to date equipment and patients attending the emergency room are often over-investigated because doctors are afraid of being sued in case they miss something. Patients undergo CT and MRI scans at the drop of a hat; the doctors are practising defensive medicine.

Contrast that to my experience in a foreign land last weekend. During my trip to Cambodia to donate stationary and personal hygiene products to primary and middle school children, I took the opportunity to visit one of the 3 big government hospitals in Phnom Penh. It is a 300 bed hospital providing emergency and routine care to the people living in Phnom Penh and the surrounding districts. Its intensive care unit was not air-conditioned and had bare tiled walls. There wasn’t even a fan on the ceiling. The patients were lying in basic metal framed beds. Some of the patients’ nursing needs were provided by the relatives camped next to the patients. Oxygen is delivered from a large cylinder rather than piped oxygen through wall outlets. Neurosurgical patients do not have the luxury of intra-cranial pressure monitoring after their surgery for traumatic head injury. The ventilator machine looked like it was in need of major maintenance. The state of the operating theatres was just as grim. The operating rooms had 1960s operating tables. Every room was really bare and gloomy. If you have a brain tumour and require surgery, you can forget it as they do not have the equipment to do it. If you need a total hip replacement, you have to go overseas. If you have a 1 cm stone stuck in your ureter and you want minimally invasive surgery to remove it, you have to go overseas. If you cannot afford it, then you can have it treated locally but you will end up with a large incision in your flank. In the hospital, imaging is limited to standard x-ray and ultrasound scanning - no CT and certainly no MRI.

Patients in the United States expect their doctors to be able to discover all the ailments in their body because they have the technology. Even with the best facilities, sometimes doctors are still unable to diagnose everything. In the United States, this could be construed as making a mistake and the doctors and hospital get sued. If only the hospitals in Phnom Penh were to have 10% of what is available in a typical American hospital, the Cambodian people would be overjoyed. Sue the doctor if he inadvertently misses a small tumour or a rare condition? Not likely.