Dealing With Illness While Living in Another Country

So, I’ve got cancer! Prostate cancer! My prostate cancer is not what this story is about though. This story is about how living in another country might have affected my diagnosis and care.

I’ve been traveling outside of the U.S. for the past fifteen years or so. Which has meant connect with health care systems and providers wherever I go. I’ve been to emergency rooms in Costa Rica, having had full cardiac work ups there. I’ve had emergency dental surgery in Colombia. And a colonoscopy and endoscopy in the Philippines. I take responsibility for my health seriously. I’m a self-advocate. To the point of clashing with some health care folks in other countries.

I suspected something was up with my health while living in the Philippines. I’ve been seeing a urologist there for the last five years, trying to stay ahead of any problems. After all, men my age and pigmentation are at high risk. My diagnosis, however, came during a visit back to the States. Which makes me wonder if I could’ve caught the cancer earlier, while I was in the Philippines.

Or, worse, if I didn’t follow-up while in the States how long would it have taken to learn of the cancer in my body. And this is why…

Health care systems have different personalities, souls if you will!

When comparisons are made of health care in various countries, or rankings, people usually talk about facilities, equipment, quality in terms of access and mortality or even the training doctors, nurses and technicians receive. What I’ve noticed is that few talk about the type of care that is valued in the country where they live.

I’m talking, though, about the ethos of a country’s health care system: where does its soul lie? In the Philippines, its soul lies in triage. It’s a take care of the symptoms presented. Like a giant MASH unit (that fictional Mobile Army Surgical Hospital depicted on the sitcom of the same name). Not devoid of caring! Anything but! Simply, problem focused! It’s a do what I say and you will feel better system.

Prevention is not practiced much in the Philippines. Patient participation in their health management is talked about though not widely encouraged. I had a run in over that very issue with a doctor, who was standing in for our twins’ pediatrician. “How do you like being responsible for your daughter being in the hospital.” were her words. I was floored, her God complex raging, because I questioned her advice. Fortunately, our daughter ‘s hospitalization was short and her problem minor. That was when the realization hit: the system simply does not align itself with helping patients be complicit in their own care.

Anticipating patient needs before problems occur is a systemic short coming. Certain doctors are aware of how certain issues impact certain groups of people. My urologist was aware that African American men, a group to which I am subscribed, are more prone to have prostate cancer than white males. That awareness did not translate into care that anticipated an assertive need for diagnosis or treatment. We had no conversations about the increased potential for my rising p.s.a. or growing prostate to indicate cancer. I got meds. Not education.

Therefore, the question those living outside their home country should ask themselves is whether the care you are getting is the care that will support sustaining your life?

Establishing relationships with doctors can be challenging in another country

In the United States, Costa Rica, and in many other countries you become a doctor’s patient. It’s almost like they adopt you. Philippine doctors generally manage patient care by conducting clinics. Most patients, if any, do not get individual appointments. Meaning if the doctor has clinic from 9:00 a.m. to 12:00 p.m. and you arrive at 8:30 a.m. thinking you might get to see the doctor first, if twelve other people had the same idea as you you will be number 13. And you might have to wait an hour or two from when the doctor got in to be seen. It’s also possible you might be told by the doctor’s assistant, who arrived at 9, that the doctor has to leave promptly at 11:30 and you should return the next day. And of course if you get there at 10, you might have to come the next day the doctor has clinic anyway.

Of course, if your problem is particularly urgent you can go to another doctor or the emergency room, where like in most places the doctor you see will be the doctor available.

A secondary issue, though one of great importance, is in many countries records management is not a priority. However, we know, the management of patient information is essential to patient care. Because continuity of care is critical to prevention and health management. When I lived in Costa Rica my doctor had a file that he pulled out every time I visited. In the U.S. health records are meticulously kept, usually computerized, and transparent to most patients able to get online.

My urologist in the Philippines did not keep meticulous records. He would write things down, notes on sheets of paper. He also largely depended upon me to know what had happened during previous visits. So, instead of verifying information I was responsible for its maintenance. And certainly there was no inter-hospital or intra-provider records management system. So going to see someone else or visiting an emergency room mean keeping my own records and bringing them to my primary care doctor.

Even our children’s vaccination records were basically kept by us. Their pediatrician, who is wonderful, would write their shot records in their children’s book and we would bring that book back for each visit. Therein was written all of their medical records, including vaccinations, since birth.

Understanding how where you live enables, or requires, your doctor(s) to manage the continuity of care you receive is critical to getting ahead of any problems that might come your way. Doing so becomes increasingly important as we age. My urologist is a wonderful person. Thoughtful, knowledgeable, and considerate. Does he have all of the tools I needed to get ahead of my problem. No!

Where you are may be cheaper. Is the savings worth it?

There is something to be said for being able to avail oneself of the latest technology has to offer in care management. Back in 2010, I had a portion of my thymus gland removed. A mass had been found that had attached itself to my thymus. The question of whether it was cancerous could not be known until the mass was seen. The first surgeon I visited explained that my sternum, that large bone going down the center of our chest, would have to be broken so they could get to the thymus. Recovery, he explained, from a broken sternum would be as traumatic as recovery from the gland’s partial removal.

Long story short, I found a doctor in Pittsburgh, I lived in Kansas City (MO), who would do the same surgery, a thymectomy, by going in between my ribs. Needless to say, I went to Pittsburgh. Fortunately, the mass was non-cancerous. Hate to think of having had my sternum broken.

Monitoring my prostate for close to two years depended largely upon a device used to measure its size during my office visits, blood tests and a CT SCAN. They provided educated guesses at best. My blood tests showed a consistent rise in my p.s.a.. The CT SCANS showed growth in my prostate. I never had an MRI. The hospital, where my doctor was located, had no such device. I would have had to go to a larger city for that. A trip, in hindsight, I should’ve made.

Good health care can depend upon the tools available. A triage system of health care does not push for the latest and greatest. Diagnosis and treatment depend upon a competent doctor making a good judgement. And that is abundantly available in the Philippines. What many of us, particularly of a certain mature age, need are both. Particularly those of us who have a history of having to fight for quality health care.

In Summary

Now let me say this again. Because I know some people will think I’m dogging the Philippine health care system. Or worse my doctors there. I am not. There is nothing they could have done to keep cancer out of my prostate. They are kind, caring professionals who treated me wonderfully well. What I am saying is; I wonder if being in a country more attuned to prevention could have allowed me to catch it earlier.

Health care systems have their personalities. They have their limitations, their challenges, and their excellences. If you intend to live in another country, know the soul of the health care system. Is it treatment, prevention, money? Or some combination of all. That is how the professionals will be oriented. And that will influence the care you receive.

I am in the States now. And have elected to have my prostate removed. I wish us all continued blessings.



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