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 ...and other reflections on the local health care system
by Sophie Dassy
Reprinted from November 2002 issue of Holistic Hong Kong in response to continued questions about birthing in Hong Kong.
Part one / Health care in general
It’s not like it’s the first time. I have spent seven years in Mainland China and already have two children. Two of the pregnancies took place in Beijing which does not sound like the most attractive place to receive care with first-class doctors who spoke fluent English… Nevertheless, HK does not appeal more to me when it comes to giving birth this third time around.
So far, from my experience with the kids, I feel very frustrated with the health care system over here.
For their first colds and flues, I went to see the Chinese private doctors in my neighborhood. They were force-feeding them with short courses of antibiotics (prescribed in little plastic bottles that neither mention the name of the medicine nor the contraindications associated with the product), thus twice ineffective. They were not enough to treat a bacterial infection properly and ineffective in the first place for viral infection!
I then started to make friends with the local pharmacist to supplement the medication and finish treatments myself, avoiding the extra cost of second-round consultations with these doctors and at last getting my hands on the medication notice!
After I took up a full-time course in aromatherapy, I started using Essential Oils for my kids’ minor respiratory conditions. When the latter turned into more worrying infections, I followed the advice of my school principal and went on Hong Kong side to find foreign doctors. So indeed, I did once go to consult a caring English doctor in Jardine’s Lookout. Very scrupulous, he did spend more time to take the case history of his patient… But when I had to make the journey two times to bring sterile urine of my still-wearing-nappies baby boy, I found the attentive care a bit too costly, both in terms of energy (running around the apartment after my naked son to get his first stream of pee), traveling (public transport is not exactly the place you want your kid to be when he’s got 39 degree fever), test fees and … antibiotics again which the doctor eventually prescribed "to be on the safe side".
To avoid more expenses, during another episode of high fever, I ended up in the emergency room of Princess Margaret with my son. After hours of waiting, he was sent for an X-ray, which I did not believe was necessary, and finally prescribed antibiotics as well. The only difference there being, they were antibiotics of the old generation, too high in dosage for a baby but free of charge. I ended up throwing away the whole lot.
Unfortunately, we also happened to find out about our children’s eyesight problem (long -sightedness, very rare among Chinese people) in HK. Since then, I religiously go to Caritas hospital for their regular check-ups. Once every six months on average. Hopefully, this is not happening too often because there, I find myself squeezed in for long hours in an overcrowded waiting room, which seems to welcome all the less valid people and most pitiful cases in the city. How do you explain to a three year old that the "things on wheels" he’s seen in the corridors are not bicycles but wheelchairs and why the grand-pa parked next to you is missing a leg? I guess, as my humanitarian-minded husband (he spends half his time visiting emergency programs in Africa or poverty-stricken regions in Asia) would say, it helps them discover the true things of life...
On the other hand, with time, I started to come across the same eye specialist regularly and seeing his familiar face brings a bit of human warmth in the consultation. I can now ask questions and get answers without having the feeling of making him loose his time or giving him the impression of challenging his competences...
My children have grown up now and I have become more confident in using aromatherapy and other alternative therapies like homeopathy to treat them.
Also, since the publication of horrifying figures about cases of bacterial resistance against antibiotics here, the government has launched a campaign to warn the public and the doctors, in both private and public sectors, about the dangers of overuse of antibiotics. HK is the place with the highest rate of resistance of some bacteria; it is a real danger and concerns all of us.
Some efforts have thus been made since I arrived here. In our new neighborhood, I even found a Chinese private doctor whose consultation fee is reasonable, and whose attitude regarding antibiotics is consistent with the newspaper cuttings he’s put up on his practice walls.
But I still do find the system very inadequate sometimes, and the discrepancy between the public and private system is just unacceptable. How come a rich society like HK allows such a schizophrenic shift between, on one side competent doctors who treat you like objects for peanuts and on the other, maybe not so competent caregivers who treat you warmly and smile even wider when you open your wallet or checkbook?
What does this say about the quality of life here? And the free access to a health care that would at least show the same quality as financial services, public transportation and other ultra-modern facilities?
In HK, economic development has not secured free access to high standard health care or education...
If you look for alternative ways to address health issues, there is not much more choice if you want the fees to stay relatively democratic. For a case of eczema for instance, I tried out Traditional Chinese Medicine in a local practice. The most difficult thing was to communicate with the doctors in Cantonese, not to speak about the bitter taste of the potions...
With no sign of improvement, I chose to see a homeopath. But there again, bills can make you feel dizzy. Consultations over thousand dollars make you expect miracles, which of course don’t happen every time… It makes it even more difficult to stick to one’s own principles of natural therapies.
Is a 50ml bottle remedy worth that much? Giving an hour of your time is such an exceptional thing in HK that it seems to justify the bills you pay with private practitioners.
Well to me this is just too much.
I might have been spoiled all these years in Belgium with the type of health care I had access to. Now if this is the case, it is definitely why I feel revolted in this present context. However I don’t think my experience in HK has only been the result of unfortunate circumstances. What I’ve seen so far is the signs of a reality that bites.
A year ago I read this article in the IHT about the health care system in France and how an English journalist became ill with esophagus cancer after a 20 year long stay in France. Describing the quick response of the doctors, and the straight-forward process that lead to tests, diagnosis, surgery and treatment, he finishes his article by saying he no longer wishes to complain about the high taxes he has to pay to be able to live there. Even if not yet out of danger, he most probably feels at peace with himself when thinking about the oncologists’ waiting lists that would have had his name on in the UK or the six digit numbers that would have ornamented his checkbooks for similar care in the United States.
Along the same lines, a close relative of a friend died of lung cancer last year before he managed to go for his appointment with a specialist…
My conclusion today about the HK health system is not optimistic… No matter how low the taxes are considered to be here, I still don’t see the point in paying them at the expense of a human, decent, competent, consistent and affordable health care system that anyone deserves.
Part two / Being pregnant
My disappointment did not have to stop there I suppose. I guess I needed to explore further the subject of health care in a well-off society. I became pregnant!
At first I didn’t even think about having the baby here. But slowly, both for financial and logistics reasons, it appeared that repatriating the whole family to Belgium for two months was not the perfect solution either.
And then what, I thought to myself as well, isn’t it time for me to thoroughly embrace my status of expatriate wife? This seemed a good way to prove myself that I had grown up through all these years abroad and that I was mature enough to face anything linked to my present condition…
However, in the back of my mind, I was thinking that, under other circumstances, I would probably have gone for a home birth. But compromise for compromise, I had to study all the possible options for giving birth in HK.
Once I got the confirmation of my pregnancy, I was referred to Princess Margaret Hospital for a first visit in the gynecology and obstetrics department. In the meantime I was curious to see what type of care they provided in my local MCHC (Maternal and Child Health Care) clinic where I used to go for my son to get his vaccine shots. "Small is beautiful" … and indeed these government clinics offer at least the advantage of basic care in a community spirit. Even if the nurses reckoned I would probably need to go back to Princess Margaret hospital for further check-ups (seen the little complications I had during previous pregnancies), they gave me the usual routine tests and made me see the GP on duty. The GP is actually the first and only doctor who ever gave me a vaginal examination. Not without making an odd comment though: she had this peculiar word about the poor vision she had of my intimate parts! I presume she has so little exposure to foreigners that she has never seen so much hair in her life!
I know that to English women, vaginal examinations are not common practice. They are routine in Belgium and I just wonder how the doctors are able to detect any cervix abnormality without this examination.
Anyway compared to similar routine tests I went through in Princess Margaret, I really do prefer the friendlier atmosphere of my local clinic but I did not have much choice.
Once a month I used to take my urine sample to the hospital, queue up to get my urine test strip and put it in my jar. After a vague sign of approval from a wandering nurse, I was getting a signal to discard my urine jar (find the toilets and a way to freshen up without soap or toilet paper) then queue up for weighing myself (without removing shoes apparently, no time I guess) and get a seat for the blood pressure machine. There you’re supposed to figure out how to put your arm in a metallic frame and push a button for the machine to measure your BP electronically. They have very sophisticated equipment indeed but I don’t quite understand how this helps to save time, much less how it contributes to the humanity of the service since they are still plenty of nurses in that same room anyway. Once this bit is done, you wait your turn for the interview with the nurse. Each time, you talk to another one and she will inevitably ask you the same question: when was the first day of your last periods? If by any chance you have another question, you’d better save it for the next round with the doctor.
Back to the waiting room, you sit until somebody calls your name in a microphone and indicates you a room number where a doctor (a different one every time again) sits on a chair behind a rosy curtain surrounding an examination table. If you insist, you can have a prescription for multi-vitamins and get a cream if you found out about any unusual vaginal discharge and itchiness. This, once again, without examining any tissue sample to identify the type of infection you might be suffering from. Then you basically lie down for the doctor to palpate the uterus position on your tummy and listen to the baby’s heartbeat.
So far I just had one blood test, an ultra-sound at the very early stage of pregnancy and another at 21 weeks. Unlike antenatal care in Belgium, there is not such a thing as a triple test (a blood test that checks hormone levels and tells you about your probability to have a baby with Spina bifida or with Down syndrome), no monthly routine blood tests for Toxoplasmosis (a parasite mainly carried in cats intestines you can find in uncooked meat or salads, that can transmit nerve defects to the fetus if crossing the placenta during pregnancy) either.
From another point-of-view, if you have never experienced the "Belgian" type of screening, you actually might feel less worried by possible abnormalities of your baby than I have been for my two first children...
I guess it’s just a bit hard for me to switch to the "no news, good news" philosophy which is the standard over here and this summarizes best what seemed to be the attitude of the two doctors who did my last ultra-sound at Princess Margaret.
In the examination room, my husband was asked to stay behind another of these pink curtains until the specialists had made all their necessary measurements. I was lying on a bed where my head was positioned far behind the screen so that I could not see anything myself! They were exchanging views in Cantonese while enumerating the names of my baby’s organs in English. We were left in the most perfect ignorance. Towards the end of the exam, they let my husband see some pictures, still leaving me out of it. Then finally they turned the screen towards me to have a peep.
I asked a couple of questions about the screening, hoping to be reassured. When I mentioned the absence of triple test and my concern for the Down syndrome, one of the doctors replied that this abnormality occurs much more often with Caucasian people than with Chinese people… And that, anyway, this type of screening can’t spot all possible birth defects... Exactly what I needed to leave the place light-hearted!
I really don’t understand how the progress of modern medicine can justify adopting such a mechanical, impersonal, inhuman attitude, in any case! I must be in an unpublished novel of George Orwell!
It was well about time to visit a few other hospitals...
As with everything else in HK, you have to be quick on the ball: the shop where you used to find your regular shampoo brand might have been replaced by a restaurant by the time you need to buy your next bottle.
It proves the same with health care… and Tsan Yuk hospital, recommended to me by both Hong Kong Chinese and foreign mothers. When I finally made the trip to the hospital hoping to tour the maternity ward, I was told they don’t do deliveries there anymore!
In total I have seen three public hospitals. Each of them has its advantages and flaws but you’re never able to combine decent conditions in both the "delivery" suite AND the post-natal ward.
In Pamela Youde, you have to share the labour room with another woman and if she reaches the stage of expulsion before you do, your husband has to leave the ward...
In Princess Margaret, there is no 1st or 2d class post-natal ward, so once your baby is born you share a ward with 39 other women and babies and ONE bathroom.
While checking what costs my insurance would cover, I decided to take a look at private hospitals. Of course, the Matilda International Hospital seemed to be the best possible choice so I decided to take a tour just in case I would be fortunate enough to get a refund.
It actually looks more like a 5 star hotel than a medical facility and this makes it really odd. Labour rooms all have private and separate toilets and bathrooms with a bathtub, and even massage chairs (for the husband said the PR!). Post-natal rooms are spacious, well equipped (personal TV sets with headphones!) and have breathtaking views. I just wonder if such luxury can be enjoyed at such a time… Also when I finally made the calculations (the 20.000 HK$ package doesn’t include doctors’ fees), I realized my insurance would barely cover a fifth of the total costs!
Forget about the Peak and there I go for the Adventist Hospital in Tsuen Wan...
A similar package there will cover all fees except meals, epidural injections, and, as usual, extra emergency procedures. Labour rooms are all private and have at least a shower room, the personnel looked friendly, and you have the choice between 1st, 2d and 3d principles class post-natal rooms. The only problem might come up if you wish to keep your baby by your side in the room (which seems quite natural, especially when breastfeeding...). Unless you stay in a single room, you can’t be sure the staff will accept that special request.
For a normal vaginal delivery, this last option looked the most appropriate to me. Nevertheless, it implied I would still have to pay for half the expenses myself.
So overall, the results of my investigation were not that positive. My options for a human delivery were very limited and I did not feel reassured at all...
Once you know all the possible obstacles to a smooth pregnancy-delivery-and after-birth journey, you fully understand how giving birth is indeed a miracle... And even if I’ve been playing the devil’s advocate in these lines, you surely must have understood by now how, to ensure a smooth nine months’ trip, you definitely need to look for other guardian angels than your local hospital staff! Nowadays, with such technical development and medical miracles on one hand and when research has proved the importance of your mind and emotional states to keep fit on the other, how come pregnancy and birthing don’t deserve better attention in this health care system?
Women should enjoy respect and best possible conditions to experience this universal and life changing experience of pregnancy.
Any change is an important stress factor in itself. Strangely, the stress factor seems to be more taken into account when it comes to the efficiency of HK cadres...
Women always had to adapt to a male-dominated medical system and we are still paying a price for this. As I have seen in HK hospitals, the presence of female nurses or midwives does not always guarantee a more adapted and compassionate care.
Only when a better balance between the masculine pole of care (focused on the health of human tissue) and the female side (which takes into account the broader aspects of feelings, relationships and environment) is reached will there be a chance of truly honoring life.
" (…) when this balance is achieved, much of what is now practiced in the name of health care will be deemed clearly unethical" (Jeanne Achterberg, "Woman as healer").
Part three / Giving birth at home…away from Hong Kong
The miracle happened: a friend found a place for me to rent in Brussels and contacted an independent midwife who has done home deliveries there for years. Providing that my gynecologist’s agreed, she said, there was no problem in having me under her care just a month before my due date.
Convincing my husband that this was the perfect solution did not take too long, and there I was flying back home at 36 weeks, together with my youngest child.
It took me a few days to adapt to a new environment, to pass the few last tests (blood and urine tests, ultra-sound with Doppler...), to discuss my plans with my doctor, and make arrangements with Mileva, the midwife.
I felt confident with her straight away. She did not approach the subject of birthing on medical grounds, adopting instead a very detached attitude to keep the conversation going to get to know me better... She certainly knows how much the state of mind of the mother plays a critical part in the course of a delivery. She kept different options open for me: I could choose to go to the hospital and have her attend me during labour, before my gynecologist arrived for the final phase; I could ask to give birth in the hospital but leave and come back home just a few hours later; or I could go for the whole thing and deliver at home (albeit a rented one). Mentally, after my "long march" for an appropriate nest in Hong Kong, I was ready for the homebirth. I’d read different books on natural birthing and was willing to take the chance. The immediate proximity of reliable medical infrastructures reassured me, and I was most inspired by Mileva’s personality, her openness, knowledge and experience. She is full of life, trusts the way Nature works and fully respects every woman’s capacity to find resources within herself to accomplish this tremendous effort of giving birth. I felt I could share with her the whole scope of emotions I was going through, and yet be my own master in the process.
It proved useful when I finally went past the due date and began to feel pressured by medical circles again. Doctors are trained to deal with pathological cases, so once more I became a candidate for possible complications. The gynecologist urged me to get more scans done. The shadow of a possible induced birth began to haunt me (my second child’s birth was induced…) but then again, the midwives reassured me during the compulsory monitoring every two days: the baby’s heartbeat was fine, I did not need to worry unduly… Nature had still plenty of time to play its role.
They were right, on the 20th of June, during another visit to the specialist, he found an opening. Later, I started to feel familiar movements down in my womb. We were at an exhibition based on "Touch" with the kids that afternoon, and at one exhibit, I sat in front of a curtain, with my hands discovering an object hidden behind: it happened to be a stone-carved statue of a primitive mother-goddess!
In the evening, around 8 pm, I called Mileva when I felt contractions were happening every five minutes. She set out her equipment in the bedroom, protected the mattress while I walked around, feeling the contractions become stronger and more painful. She let me move, stand or lie in any position I wanted. Around 10 pm, a younger midwife joined Mileva. It was her first home delivery, and she is supposed to succeed Mileva, who has already retired. The contractions were strong but bearable and their frequency still allowed me to breathe properly and rest in between. Mileva regularly checked the baby’s heartbeat on the monitor and everything was fine. My husband rubbed my lower back with massage oil I had blended especially for this occasion. The pain spread from front to back; apparently the baby’s head was slow to position itself in order to engage properly, due to a slight tilt in my sacrum. Mileva helped the baby rotate his head more quickly. This last stage felt endless, and I began to doubt that I could cope all the way to the end. The midwives asked if I felt any urge to push and helped me lie down. I could not bear to stay flat on my back and decided to go to the bathroom, followed by my husband. A bit later, losing hope to have the baby’s head engage properly, and feeling another contraction coming, I knelt down once again and was on all fours when I could not help releasing a loud growl… The midwives laughed as they realised I had reached full dilatation and was ready to push!
I lay down on the bed and began to push. When the baby’s head was half-way through, everything was suspended and strangely silent: we were waiting for my next contraction to push again, in order to avoid tearing the perineum… My husband found that particular moment very impressive. Unlike practice in hospitals, a midwife helps very actively during these last stages, she manipulates both mother and baby very carefully to allow good positioning, and attempts a smooth, progressive delivery without episiotomy...
So, at exactly 48 minutes past midnight, on the very first day of summer, there she was... Quiet and beautiful. After this moment of unusual intensity, Mileva waited until the umbilical cord stopped pulsating, before offering that my husband or myself cut it. It took twenty minutes, with Emma resting on my tummy... A very special and emotional moment...
A bit later I delivered the placenta, and Mileva gave me a few stitches for a light tear where I was cut in previous deliveries. That night, Emma slept between my husband and me. The other two children, sleeping next door, did not hear a thing. I felt an overwhelming sense of joy, peace and deep satisfaction and eventually fell asleep myself. In the morning, the children woke up to find the little wonder was resting just there, a few meters away from their own bed...
Should any readers wish to contribute their own thoughts on the local health care system or giving birth please
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