Medical Adventures

Obtaining medical care in Jakarta can be interesting. While my own experience has been overwhelmingly positive, with a few notable exceptions, I've heard some interesting stories. Some could be communication mishaps, others are quite possibly just a different approach, then there are the incidents that are either the result of utter incompetence, or lack of training. Here are a few and you can decide for yourself:

1) Sunburn treated with acid. One of our friends is a fair-skinned woman from a country known more for cold, biting winters than for tropical summers. On a recent trip to Lombok, she spent too much time in the sun and returned with a rather severe burn. After exhausting the medical treatments recommended by other expats - Aloe Vera, hydrating lotion, pain killers - with minimal improvement, she sought the advice of the doctors at a local expat clinic. The doctor (an Indonesian national) prescribed a topical cream that she was to apply every night and leave on for twenty minutes before washing off. On the first night, she followed the directions and it started to burn. The next morning, she awoke with blistered lips and her skin more painful than ever. At the recommendation of another expat, she consulted with a dermatologist. When the dermatologist discovered that the previous doctor had prescribed a SKIN WHITENING cream (presumably to change the red skin back to white???), he told her to stop using it immediately because it contains acid and is the worst thing you can do to a sunburn. The dermatologist gave her a more suitable remedy. She called the expat liaison at the original clinic, who promptly fired the original doctor.

2) Dental scaling. Dental cleanings are typically uneventful. They scrape the built up plaque and tartar from your teeth, clean them with a paste and a spinning brush, floss between the teeth, and send you on your way. In Jakarta, the approach is a little different. The first step is the same - examine the teeth and remove the tartar. That's where the similarity stops. Instead of a brush with paste, they use a spinning pinwheel with metal fingers to "scale" the teeth. That's it. No flossing. No Xrays. In and out in ten minutes. I'll have to ask my dentist back in the US if that is very effective.

3) Eye care. I mentioned that when I was in Yogyakarta, I lost my contacts. After several phone calls with our local medical care facility, my insurance, and our internal HR people, I finally found a local opthalmologist who recognized the name of the eye disease I have (keratoconus) and said he could treat me. I contact my optometrist in Phoenix and get a copy of the prescription she gave me in the weeks before I left for Jakarta. Armed with that, I am hoping to see the local doctor, ask him to order the prescription I have, and then wait for my contacts. He had other ideas. First, he gave me a brief examination. Then, he had me sit in front of a machine that examined my eyes and printed out a prescription. Finally, instead of having me sit behind one of those fancy machines that optometrists use to do perform the "better like this, or like this" exam, he had me sit in a chair and wear very large, lensless glasses. From his briefcase, he withdrew lenses that matched the prescription the machine determined was correct for my eyes and tested my vision by having me read the chart. I couldn't. The glasses I arrived with worked better, but he was quite satisfied with what the machine provided him. He wrote me a prescription and referred me to a local optical shop to fill it.

Well, I ran an optical shop for 2 years, so I know a little about the optical industry. When I noticed that the prescription not only changed a full diopter (which is unheard of for one year), but IMPROVED, I asked him to explain it. He said that is what the machine recommended. I asked again why it would change so much in a year. He asked if I wanted to speak to the expat liaison. I said I did.

I explained my concerns. I've had keratoconus for nearly a decade and visited with several opthalmologists in Phoenix while confirming the diagnosis. They all referred me to the ONE person in Phoenix they knew of who could fit me for lenses. I told the liaison I did not expect that Jakarta would have that specialty. I also informed him that testing for any changes in the cornea is a standard part of the annual exam - at least the last 7 or so I have had. The machine required to perform this exam (it provides a topographical map of the cornea) was not in the room. Finally, because keratoconus involves a corneal deformity, and contacts are typically considered a medical necessity, and not a cosmetic improvement over glasses, it is the standard practice (and a practical necessity) to put a lens in the eye before correcting the vision. The local opthalmologist did not do this.

Long story short, I am going to Singapore on the 20th to see a specialist.

4) Treating an ear infection with massage. The title of this entry speaks for itself. As the story goes, a person I will call "Dave" went to a local doctor complaining of ear aches and problems with vertigo for several weeks. The doctor did a full examination, diagnosed an ear disorder best treated by massage and accupuncture three times weekly for several months. A colleague, shocked at the recommended treatment, insisted Dave go to an expat clinic. In fact, the colleague drove Dave there, accompanied Dave to the front desk and demanded they treat an ear infection. The clinic prescribed ear drops. Two days later, symptoms were gone.


Those are the stories. Keep in mind that for each one of those, we have dozens of examples where everything worked splendidly - and at an extremely reasonable price. Like the emergency room trip in Yogyakarta and treating the fevers and head colds I've experienced.

I sometimes wonder if local doctors dislike treating expats. I know many expats are critical and suspicious of anything a local doctor recommends. Many refuse to see a local doctor and insist on seeing an expat doctor. With experiences like the above, you can understand why. It only takes one bad experience to erase dozens of positive experiences.
 
One last note.  I intentionally am not naming any of the medical facilities or doctors involved in any of the above because defamation laws here come with jail time.  Even if the statements are true, sharing negative information is considered defamation.  So, here is my Law and Order disclaimer:  though all the stories are based on real events, any resemblance to a specific medical facility or provider is purely coincidental and unintended.

UPDATED:  Here is an interesting opinion from the Jakarta Post.