March

Where I grew up, we often said March would arrive like a lion and exit like a lamb.  Things are different in Jakarta.

For us, March arrived like a lamb.  We had a nice family vacation scheduled in Singapore, I was buying the first property for our new Real Estate business, and we had tickets to attend the St. Patrick's Day ball and spend that night in a suite at the JW Marriott, the location of the ball.

Then the lamb bared its teeth and transformed into a lion.  The Friday before the ball, my wife and I joined our friends at an Irish Pub to welcome in the holiday and watch traditional Irish dancers.  We had a great time and were looking forward to taking the kids to a carnival at our daughter's school the next day and then attending the ball with the same group of friends. 

We arrived home from the dancing to find our two-year-old son struggling to breath in his sleep.  We had taken him to the doctor earlier in the day due to a persistent cough.  The doctor said he was fine.  His lungs were clear and he did not have a fever.  They gave him some antibiotics and an antihistamine.  When we arrived home, he still did not have a fever but he was definitely having difficulty breathing.  We woke him up, planning to give him some medicine, and he immediately vomited.  We observed him for about twenty minutes before deciding to take him to the emergency room.

The ER put him on a nebulizer minutes after our arrival.  The nebulizer should rapidly resolve breathing issues.  His blood oxygen wasn't improving and remained below 90%.  The doctor also indicated that his secondary muscles were now controlling his breathing.  Those muscles kick in when the primary muscles become so fatigued from labored breathing that they fail.  There is no back up to the back up.  Jakarta lacks a respected pediatric respiratory care center, so the doctors advised us to do a medical evacuation (MedEvac) to Singapore immediately in case his lungs started failing and he needed assistance breathing.

The next twenty-four hours happened very fast....and without sleep.  My wife and son took the MedEvac flight.  I worked with the airlines and hotel to reschedule all the flights and room reservations we had for our vacation and I followed them with our other two kids about six hours later.  I even had time to take our daughter to her school's carnival for about an hour before we caught our flight.

After checking us in at the hotel, we all met up at the hospital where I spent the night with our son while my wife returned to the hotel with our infant son and our daughter.  For the next four days, I slept at the hospital at night and spent the days at the hotel with our other two kids.  My wife did the opposite.  Thankfully, our hotel - the Rasa Sentosa - had a Kid's Club that entertained our daughter all day, every day.

Our son spent those four days on antibiotics, fever reducer, and getting blood tests and chest x-rays.  Nothing conclusive in any of them.  Eventually he started feeling better and they decided he had a non-specific viral infection in his lungs that caused him respiratory distress.  He never really felt sick, but the doctors were really worried.  We just tried to keep his spirits up and have as much fun as we could.

On Wednesday, our son received a clean bill of health and checked out.  The pediatrician seeing him requested we have a follow up appointment on Friday.  Our "Family Vacation" was also the time for my wife and I to receive our annual physicals, so I had mine on Wednesday while my wife swam with the kids, and she had hers on Thursday while I went to the beach with them.  We had big plans for the weekend to help everyone forget the medical stress we just experienced.

The appointment with the pediatrician was Friday afternoon.  He had been swimming all morning so we expected a clean bill of health.  To our surprise, she said his lungs sounded bad and readmitted him to the hospital.  We ran through the same battery of tests.  This time, they discovered he had Influenza B and started him on those treatments.  He remained in the hospital until Monday.  We finally left Singapore on Wednesday.

What was supposed to be a five-day medical vacation with two days of physicals and three days of fun became a ten-day medical emergency for our two-year-old.  This is the second medical scare he's given us.  I hope there isn't a third before we get to leave.

Hospital Pictures:

 

Having Fun Pictures:

 

 

 

 

Another Illness

If you read through the 3-year blog history, you'll find that illness is just as much a part of the Indonesia experience as anything else.  In the first fifteen years of my professional career, I probably missed two weeks of work due to illness.  In the three years I've lived in Indonesia I have missed nearly a month.  We're sick more often, and with harsher illness.  Last week was yet another example.

When I arrived home from work on Monday, I told my wife I felt "odd".  My skin felt raw and I was warmer than usual.  Thirty minutes later I was shaking with chills and skipping dinner.  Ninety minutes later, after the kids are in bed, I'm curled up in a ball on the couch burning with a 102 (39) degree fever and trying to stay warm with a blanket.  Medicine isn't bringing my fever down.

I fell asleep at 10 PM.  My wife woke me a few hours later to make me take more medicine.  I was burning up.  I was surprised when she told me I'd been asleep only two hours.  I would have sworn I'd been asleep at least six.  It was a rough night after that.  Between fighting the fever and frequent trips to the bathroom, I hardly slept.

At  8 AM the next morning, after all the kids were at school, I went to the medical clinic.  I was able to see a doctor within twenty minutes.  She took my vitals, asked my symptoms, and walked me to the ER.  I spent the next several hours in the ER hooked up to an IV under observation while they ran some tests.  They were trying to keep me hydrated and bring down my fever.  They were able to keep me hydrated.

Around noon they gave me my diagnosis:  Amoebic Dysentery.  Ugh.  Same thing my daughter had last year, though our symptoms were slightly different.  They gave me three different pills, one to kill the amoeba, one to help the issues that pill would cause in my stomach, and a third pill to fight the nausea caused by the other two.  I would be taking 750mg of Flagyl three times a day for the next five days.

The medicine alleviated my symptoms almost immediately.  My fever disappeared within hours, and the other symptoms began to improve.  However, the medicine was brutal.  Flagyl has a list of side effects and I experienced every single one of them.  The worst for me was the headaches and the nausea.  They left me incapacitated and in the fetal position for hours at a time.  I kept trying to play with the kids but did not have the energy to do it.  Being light headed didn't help either.

I stayed home from work on Tuesday, Wednesday and Thursday.  I went back to work on Friday simply to honor a family rule:  We do what we have to do so we can do what we want to do.  I had a farewell party to attend and was hosting a poker party Friday night.  If I didn't go to work, I wasn't going to do either of those events.  Toughest day of work I've had in recent memory.  Several times I doubled over to catch my breath.  I did make it through the day, however, and attended the farewell party and the poker game, though everyone commented I looked very ill.

It's now Tuesday, a week after my trip to the ER.  I took my final dose of Flagyl on Sunday AM and I still have the side effect of a sour taste in my mouth, though it's not as bad as it was yesterday.  For the most part, I feel better, but I'm about 10 pounds (4 kg) lighter and don't have my full energy back yet.  My appetite is slowly returning.

I went back to the medical clinic tonight so they could run more tests to confirm the amoeba is gone.  They said it would take an hour, but realistically I don't expect to hear anything until tomorrow.

The worst part for me is knowing that my daughter went through this.  She's a tough little kid.  She had a lot more energy than I did!

Family Is Complete

Before our latest addition joined us in July, my wife and I had already decided he would be our last child.  The only question remaining was how to guarantee he would be our last.  After studying the long- and short-term effects of the various contraception options (pill, IUD, tubular ligation, prophylactics, vasectomy, etc), we determined the vasectomy was the best option.  No issues with hormone changes, reversible, no ongoing expenses, etc.

I was supposed to complete the procedure in July during my paternity leave.  The doctor advised us to wait until after our son was born to confirm no complications and that our minds would not change.  Our son is healthy, we haven't changed our mind, so I'm in Singapore and, after this morning's procedure, I can say our family is now complete.

I didn't record the surgery and I'll spare everyone a "verbal video" and just say:  "OUCH!"  Honestly, it wasn't that bad (other than the initial shot delivering the local anesthesia - which, after the first didn't work I made him do again) and I'm not even on pain medication.  Although, for some reason I'm no longer able to think clearly, as if the procedure disconnected my brain or something......

The more interesting part of my trip is what happened at the hotel.  We so enjoy the Shangri-La Hotel that we joined their Golden Circle Club after our last trip to Singapore.  When I arrived, even though I had booked a Deluxe room in one of their towers, they had upgraded me to a suite!  I think it may be because we've booked a suite each of the last two months - once in Jakarta, once in Singapore.  So, instead of recuperating in a simple room, I'm in a room with two bathrooms, two TV's, a dining room, a living room, a sitting room, and a balcony that overlooks the pool.  Overkill, to say the least, and something I would better enjoy if I was on a romantic getaway with the wife, not surgery.

I have one final post-operative examination tomorrow before I get back on a plane to return to Jakarta.  We have a birthday party to attend tomorrow night and I hope I'm up for it!

Return from China

Monday I flew back to Jakarta from China.  I knew I'd have a late night Sunday, so I planned ahead and booked an afternoon flight.  This meant a late arrival into Jakarta, but Tuesday was a holiday (Buddhist New Year) so I knew I could sleep in.  The only interesting part of the trip occurred on my Singapore to Jakarta flight.  I'm sitting in my business class seat when an enormous Indonesian sits in the seat next to me.  He was so big I was tempted to ask if he held a job that was responsible for his size.  When he started sleeping the moment after he sat down, I thought it better not to wake a sleeping giant.  While waiting for baggage, several airport staff, including security, rushed up to have their picture taken with him.  He exited the airport shortly before I did so I asked my driver if he knew who it was.  He informed me it was Ade Rai, the number one body builder in Asia.

Tuesday morning I didn't sleep in as long as I had hoped.  We decided to make a return visit to Taman Safari.  We do this with all our guests...did I forget to mention my cousin arrived?  She is the solution to our Singapore nanny dilemma.  She'll be with us until 1 July when my mom takes over.  Anyway, we decided to take her to see the animals.

I was quite impressed with the strides my daughter has made with her fear of animal encounters.  In prior visits, the idea of being close to the animals was always more appealing than actually being close to them.  This time, the fear was gone and she fed everything, including the elephants.  My son even got in the act of feeding the large beasts.  He knew exactly what to do when I gave him a mango and walked him to the elephant.  He put that tiny green fruit directly in the gaping maw, only to see it fall to the ground.   I would say there is no fear in that boy, but we also finally had the opportunity to ride the elephants...and my son wasn't exactly happy about it.

 

 

 

On our return to Jakarta our son gave us the scare of my life.  It is a long drive back from the zoo and I was making the most of the opportunity by taking a nap.  Our nanny calling our son's name in a panic woke me like a bullet firing in the car.  I turn around and my son's eyes are open and rolled in the back of his head.  I touch him and he feels like food fresh from the oven.  I pull him out of his car seat and onto my lap and he is as limp as a rag doll.  I thought I was holding my dead son.

I steeled my nerves and was preparing myself to give artificial resuscitation.  I checked his breathing - it was shallow, but there.  His heart was racing.  Our nanny said she had watched him have a seizure and that his lips had turned blue, that's why she started calling his name.  Our daughter starts freaking out whining:  "I don't want my brother to die, I don't want my brother to die."

My wife retrieves the fever reducer from the diaper bag and I instruct our driver to pull over as soon as possible at a gas station.  I want ice.  Minutes later we're pulling into a rest area that happens to have a Starbucks.  Despite the efforts of the staff, I was able to procure some ice and napkins, and, in addition to the fever medicine, we were able to bring his core body temperature down.  After twenty minutes of rubbing his chest, neck, back and head with cool water, our son became responsive and started voicing his displeasure.  He then proceeded to vomit all over himself and my wife who had the bad luck of just taking him from me.

I called ahead to the emergency clinic and asked if there was anything else we could or should do while we traveled there.  They said to just keep doing what we were doing.  Ninety minutes after holding my limp son in my arms, we arrived at the ER.  Ninety minutes after giving him fever reducing medicine, which did definitely reduce his fever, the ER nurse reported his temperature as 103.6.  I can only imagine how high it was when I picked him up.

We spent a few hours in the ER and left with five different medicines to give him.  The doctor said the seizure was likely a result of the fever and is common in young children with fevers.  No long-term damage is expected other than the reduction in years of my own lifespan for having the scare of my life.

Medical Update

I do not have glaucoma.  A bit of an anatomy lesson:

Our eyes are filled with a pressurized fluid.  Without this fluid, our eyes would collapse like a deflated balloon.  We need the fluid to maintain the correct shape which, in turn, keeps our vision accurate.  Behind our eyes is a blood vessel that feeds the optical nerve.  If the pressure in our eyes increases, the eyeball itself will push hard on this vessel, and blood won't make it to the nerve, which leads to blindness.  This is what happens to people with glaucoma, but it takes time.  That's why an annual pressure check can detect a problem and, through daily treatment with pressure reducing eye drops, prevent the eventual nerve damage.

The test I took during my physical used a burst of air to check for increased pressure and found it - to a high degree.  So why did the test read high and I don't have glaucoma?  Because I have keratoconus.

Keratoconus, which I've known about for over ten years, is the term for a coning of the cornea (the cornea is supposed to be perfectly spherical).  The pressure tests use a series of complicated mathematical formulas based on the laws of physics to determine the pressure of the fluid in the eye.  One of the inputs to this formula presupposes a correctly curved cornea.  I don't have this, so the results are widely skewed.

Today, I did a number of follow up tests, including the original air test.  The two primary tests they did today were a corneal thickness test and a laser picture of my optical nerve.  The corneal thickness test was a bit odd.  It involved first numbing my eyes with drops and then using a tool similar to a ballpoint pen to poke at the surface of my eye and measure the response.  I'm glad I couldn't feel it.  Before I left, they did a final examination to validate none of their tests scratched my eyes.

I took a total of seven tests and spent over two hours at the office.  Based on the results, we're returning to Jakarta tomorrow; our good news/bad news thought for the day.

On the plus side, it looks like my keratoconus has improved, too....but I still can't read the fine print on the back of food packaging.

I'm glad it's over, I'm glad I don't have glaucoma and, most of all, I'm glad I don't have to monitor the city morgues and obituaries for dead pilots so I can request an eye transplant; I hear they are required to have perfect vision without correction.

A week in the life

Life in Jakarta has finally found a normalcy.  It took two years, moving to a house, and trying dozens of different activities before we finally found the people, the lifestyle, the schedule and the activities that are clicking for us.

Last week Friday I hosted my first poker game in over three years.  For over fifteen years, dating back to my sophomore year of college, poker was a monthly event.  A time for the guys to get together and shift $20 around to each other, discuss sports, jobs and family over the course of four hours.  Between my Tuesday night Futsol and the guys I've met through my wife's friends, I have my poker group again.

Saturday we spent back at Kemang Club Villas.  Even though we've moved, our rent there was paid through April, so we can still use the facilities.  Many of our friends still live there, too.  We swam, chatted with friends, and our daughter got to play with her friend who had recently moved to China and is visiting in Jakarta for the next two weeks.  Saturday evening, we had dinner at Hacienda with two other couples to celebrate finally closing out the lease on my business in the US.  The wife of one of the couples is a month behind us in her pregnancy, and her husband plays Futsol with me on Tuesday nights, so we have a lot in common.

Even our children are getting into the routine.  Living in the museum-sized house we now call home, they have mastered riding scooters and scoot cars around the living room, dining room, and kitchen, navigating the furniture like an obstacle course.  Our driveway is big enough that I've introduced my daughter to a version of kickball with ghost runners.  She always wins.  They have play dates, they swim, they run around outside.  This is what home was like for us in Arizona.

That's not to say all is perfect.  Traffic is still a major drag on our spirits.  Anyone who has ever attended a major sporting event and suffered the time it takes to leave the parking lot knows what a trip to the grocery store feels like.  Everyone living in a big city complains about traffic.  Until a trip to the grocery store is a three hour event, well, I'm not interested in hearing the complaint.

Quality medical care is still problematic.  We've been blessed with excellent health, the occasional cold not withstanding.  But we're making yet another trip to Singapore for medical care.  During my annual physical they did a routine eye exam.  One of the tests was for glaucoma.  My test came back positive.  I sent the results to my ophthalmologist in Phoenix who agreed with the findings and recommended I get some additional tests and, if they confirm the initial tests, begin immediate treatment for glaucoma.

So on Sunday, we're making the trip back to Singapore for an undetermined period of time.  I get retested on Monday.  If the results are clean, we'll return to Jakarta on Tuesday.  If the results confirm the diagnosis, we'll be in Singapore another three to five days so I can begin immediate treatment.  Not the best news I've ever received, but, like the keratoconus diagnosis ten years ago, it's treatable and it doesn't have much of an impact on my lifestyle unless I ignore it.

A few other quick notes:

Neither the maid nor the nanny wanted the motorcycle.  One said she couldn't drive a manual transmission and she was afraid it would get stolen where she lives.  The other said it was so old she was afraid the police would pull her over all the time and harass her to confirm it met driving standards and she didn't want to have to deal with that.  So, $120 down the drain...unless I can find a buyer for $150!

We've solved the help issue....I think.  We're flying down my cousin (my father's, brother's daughter) to help us out from 12 May through 1 July.  My mom will pick up the help from there (assuming she gets back to me....hint hint).  This means I get to go to my friend's wedding in Shanghai in mid-May!  It's my first trip to China and I'm really looking forward to it, even if it is only for two days.

We've started doing yoga regularly on Wednesday nights.  I've done yoga before, but never made it part of my regular routine.  I feel great for a full 24 hours after the session.  If you've never tried yoga before, I recommend you take a class and decide if it is right for you.  I now split my Futsol and Rugby nights with a night of yoga, and we'll probably add another night of yoga.  It makes us feel that good!

Singapore

I'll get this one out of the way as I sit here waiting for yet another late night conference call.  One of the bad things about working in a satellite office is that meetings with corporate are always on THEIR schedule, and it is seldom good for mine.  Between the 6 AM meetings to start my day and the 10 PM meetings to finish my day - sometimes with the same people - finding enough time to sleep is difficult.

That's why Singapore came at just the right time.

Per usual, we took the 8:30 flight out of Jakarta.  We arrived at the airport much earlier than normal.  Our new house is closer to the freeway, which cuts about twenty minutes off of our airport commute.  Checked in without a hitch.  Normally I would then obtain a stamp indicating I am allowed to leave the country without paying a $250 departure tax because I have an Indonesian tax ID.  Turns out, that office closes after 7 PM now so I didn't have to show anything!  Interesting concept - pay a tax if you leave before 7 PM.  Are they trying to get people to take later flights?

Saved me a line, so I didn't complain.  Stood on line for immigration and discovered that two different agents were serving my line - SCORE! - so we moved twice as fast.  I hand over our four passports and he asks me where the departure cards are.  I show him the departure cards the immigration agent who processed our multi-entry visa stapled to the passport.  He said he couldn't use those and I needed to fill out new cards for everyone.

UGH!  Back to the ticket counter, time to fill out the forms, back in the immigration line - which by now had split into two lines, one per agent.  Lost my twenty minutes.

We stop so our son can eat dinner and he decides this is the time to go on a hunger strike.  Wouldn't eat a thing.  Not even if I put sugar on it.  Five bucks down the drain.

We arrive at the gate and check in.  The gate agent looks at my wife and says:  "Do you have a doctor's note saying she can travel pregnant?"  I reply:  "No, your website says it isn't necessary under 30 weeks.  Nor did your corporate office when we called to confirm.  She's only five months."  "New policy.  Anything over 3 months needs approval." 

That's when the fight began.

Long story short, we signed a liability waiver and they let us on the plane.  I expected better from Singapore Airlines.

Once we arrived in Singapore, everything went smoothly...except our son started convulsive vomiting shortly after we entered the room and I had to call room service to come and change the sheets.  (That's one way to guarantee they are fresh!)  We all finally crashed around 1 AM.

Our trip to Singapore had two purposes:  see some doctors and find a place to live.  My wife had her medical appointments on Friday morning and we were able to confirm that yes, indeed, we are having another son (which means I only have to save for one wedding!! - notice the use of 'we' and 'I') and that the baby is healthy and, like his siblings, growing on the large end of the average.

After the examination of our incubating son, it was time to tend to our birthed son.  He had a fever, diarrhea and was still, as they say in Singapore, throwing.  Doctor gave him a quick, ten minute look over, told us he had an intestinal issue, and sent us on our way with an antibiotic she didn't want us to use unless he wouldn't drink fluids and a bill for $100.  I guess that's what peace of mind is worth?

The doctor's visits out of the way, we took a tour of three new serviced apartments near Orchard Road.  My favorite was the three bedroom unit walking distance from the metro station.  My wife's favorite was the place we stayed at last time that requires me to take a taxi to work every morning and charged extra for internet and the only sports channel worth watching.  Anyone want to place a bet on where we'll be residing?

We finished Friday with dinner at Muchos, a relatively new Mexican restaurant on Clarke Quay and then watching Shrek 4 back in the hotel room.  I was out by 8 PM - before my daughter.  I finally woke up at 7 AM Saturday morning.  I needed my sleep.

I had my annual physical at 8:30 Saturday morning.  This was the most extensive physical I've ever received and more than any insurance company I've ever been a part of would have approved for me in the US.  I had the traditional bloodwork and urine tests as well as the consultation with a doctor.  That's about standard for my US annual exams.  Then they did a resting EKG, a vision test, a treadmill stress test, a body fat test, ultrasounds of my internal organs, a chest X-ray and a urine flow test.  Three hours later, I was back on the street with instructions to lose weight (15 pounds!) and eat more salt to increase my blood pressure.

Saturday afternoon we did a little shopping and had lunch at Subway.  We finished our stay with dinner at Black Angus and watching Despicable Me for a third time.

The biggest event that happened on this trip?  Our daughter did the whole trip without her beloved blanket, DeeDee.  We made a big deal about this major event in her life and bought her a gift of her choice to celebrate.  She choose a book (that's my girl!), eschewing the option for shoes or a new dress.  She even threw the blanket in the waste basket when we arrived home.  Of course, when we checked on her Sunday night, she obviously had second thoughts.  There she was, at the foot of her bed, holding on to her blanket.  The blanket was not on the bed, though, so she at least made a step in the right direction.

We may make one more trip to Singapore before moving there.  If not, we'll move after our daughter's recital at the end of May and stay there until we have a passport for the new addition (name still under discussion).  We're still looking for someone to stay with us for our duration in Singapore to watch the kids while we deliver child number three.  If you know anyone looking for 8 weeks off near the equator, let me know.

Shopping, Doctors and a Family Reunion

Sunday in Singapore was as I expected.  We woke late, had the buffet breakfast, and went to the grocery store.  Singapore is the closest approximation to Western society we can get within a few hours of travel.  Whenever we are there, we load up on the groceries we cannot find in Jakarta.  For me, that means five large bags of whole rolled oats.  Yum!

After our grocery visit, we spent the rest of the afternoon at the hotel pool.  We met a Navy pilot who had participated in the recent show of force off North Korea.  The aircraft carrier he is based on was in Singapore's port for the weekend.  He had flown his wife down for the weekend from Japan.  They had a daughter our son's age.  Being from Texas, and living in Japan and on an aircraft carrier, they missed Mexican food.  We told them about Clarke Quay.  A few hours later, as we sat at our table at the newly named, newly branded, and newly menued Octapas, we saw them walk by.  They had eaten at Muchos.

Monday was medical visit day.  The dermatologist told me one of the dots I thought was a mole was actually a wart.  He cut it off.  Tests will indicate if it is genetic or viral.  I asked how I could have received a viral wart.  As he rattled off the ways, the only one that stood out to me was massage.  He told a story of a female attorney who had visited the spa at a high-end resort in Singapore.  Two weeks later she was in his office covered head to toe in nearly 3,000 warts!  I won't be going to the spa anymore in Jakarta.

Brief tangent:  my parents both come from fairly large families.  My mom's side, in particular, has a significant gap from eldest (my mom) to youngest (my uncle).  Therefore, I have cousins the age of my children.  My mother is the same way.  She has cousins who are younger than myself.  One of them happened to be in Singapore on business on Tuesday.  He joined us for breakfast before we did the second part of our medical visits.

Tuesday was referral day.  The one mole I wanted to have removed because it hurts when I bump it is on my eyebrow.  Dermatologist said that a plastic surgeon would have to remove it because it is too near a muscle and dermatologists aren't trained for surgery near muscles.  He was concerned he could make a mistake and "it would end up looking very ugly".  So, I went to a plastic surgeon.

I leave Singapore with oats for cholesterol, sliced and diced, and more medication than free samples week at the nursing home.

I must be getting older.

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.

Odds and Ends

Living the life of a bachelor again reminds me why so many of us leave it for the confines of marriage. The most difficult part is the meals - eating alone. It's tough to go out to a restaurant: "Table for one?" They don't like it either. Wastes a perfectly good table. The like us to eat at the bar, with all the other lonely castoffs. At least I know mine is temporary.

I've been meaning to get around to a few things on my blog, and now is as good a time as any. I try not to get too political here - I have a different blog for that - because this is my story about living abroad. My recent medical experiences in both Jakarta and Singapore have provided timely insight into a current national debate in the US, and I've now decided, after much internal debate and consideration, that I am in favor of some type of nationalized health care.

I'm a free-market capitalist to the core. Any economist worth his degree, however, will admit that, in the interests of efficiency, the government has to take on some roles. For me, those roles have been limited to: educating the populous, protecting the populous (police, fire, military), providing reliable transportation (roads), regulating (minimally) commerce, and negotiating internationally. I will now add providing basic health care to the population to my list of essential government functions.

Anyone who has had a baby recently and viewed their insurance payout information knows how expensive it is. Nearly $10,000 if you have an epidural and a vaginal delivery. In Singapore, if we had to pay it out of pocket, the cost would be $1,400, including three nights in a private room. My endoscopy, which my father tells me can cost well over $2,000 in the US, had a total cost, including filling my prescriptions, of $500. The procedure itself was just $300.

Health care costs in the US are out of line. Much of this is due to the fact that doctors have to carry malpractice insurance that costs them $100-$200k per year. They have to earn $200,000 just to cover their premiums. It's obvious to me why small towns no longer have doctors. They can't make enough money to cover their premiums, pay their office expenses, and still earn a living.

Another major contributor is the amount of relatively healthy people who visit the ER for a cold. ER's are required by law to not turn anyone away. They can't deny someone treatment for not having insurance. When these people don't pay their bills, the hospitals have to make up the cost somewhere - so they take from people with insurance. If everyone has insurance for basic needs - annual check ups, annual colds; and everyone has catastrophic insurance for major medical like severe car accidents, this problem goes away. We also would still have an auto industry and more small businesses.

Everything in between those two extremes - basic, preventive care and catastrophic injury (like amputation) - would need to be covered by private insurance. Viagra, Ritalin, xanax - those would all be covered by private insurance.

If third world nations are able to keep medical costs low, I would think the US could do a better job. My advice to Obama: Think big, start small, start now.

Tomorrow I'll post on the other topic - career management.