Sunday, September 13, 2009

The Final Installment of the Adventure in Oz

I am now a visitor in Singapore. I am rounding out my final few weeks here, and then I will be heading back to California to start a new adventure a little closer to home. There are so many stories to tell about that, but before I can get to them I MUST finish the tale of my odyssey in Oz.

I have lots of thoughts on moving back and leaving Asia - I've already chatted with friends in 8 countries who are happy for me, but sad that I'm leaving - even though in some cases I haven't seen them in person more than once in my entire time here. Yet, I feel sad that I will no longer be a short flight and only one timezone away. We've all been laboring "side-by-side" across a region 7,000 miles tall to build something great out in the wild wild east.

It's been an amazing ride that has been such a strong factor in my own perception of the world and its cultures, that I will need some time to really reflect on exactly how much I am taking away from this experience. In the meantime, I still have a slightly older story to tell...

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I will be using pictures to guide my memory as I recount the odyssey of my Aussie road trip way out woop woop. When we left off, Melanie and I were returning to Sydney from our Northern jungle adventure in Queensland. Eric was flying in from California to join us for my birthday and then for our whimsical rural odyssey road trip.

Melanie wanted to pet a koala, so after a few days gorging on devonshire tea in Sydney and celebrating my birthday at Bondi Beach, we headed to Featherdale Wildlife Park on the way to the Blue Mountains. Australia is full of these wildlife parks, kind of like mini-zoos with animals a lot more up close and personal. I always find it fascinating to think that these animals are normal in Australia - going to one of these parks for an Aussie is almost like Americans going to a "zoo" containing raccoons and squirrels. Instead of goats in the petting zoo, Aussies have kangaroos and dinosaur-resembling emus.

This wasn't the first time I'd pet a koala or kangaroo, since I'd been to Australia a number of times before and no trip is complete without a little trip to the wildlife park, but every time I'm struck by how oily koala fur is. Their fur is thick and matted, and they have killer claws for climbing trees, but they stay looking cute and cuddly, dozing off to sleep as tourists come by and pet them. The kangaroos have softer fur, especially the babies, and I wondered if the kangaroos at this park ever needed to go on diets. The park sells kangaroo food that is used all day to attract them out of their sleeping stupor, but almost none of the kangaroos were interested - I would probably not be interested either if people were waking me up all day to feed me alfalfa from an ice cream cone.

The Australian wildlife parks also often have a collection of Australia's infamously deadly reptiles. Here is a close up of the world's deadliest snake, the inland taipan. This snake is so deadly that at any one time it has enough potent venom to kill 80-100 people. Its bite is more than 700 times more powerful than a cobra bite, and yet there isn't a single recorded case of someone dying from this snake! He really did look scary, even through glass, but apparently in the wild he would be the one slithering away from me. I hope he'd slither away fast....

We got only a few feet away from a 14-foot saltwater croc. Luckily, this was the closest that we got to one (at least that we knew about - perhaps Melanie and I were just moments from death on those Queensland beaches....), but the boys cleaning the cage didn't seem to mind the lack of bars as they poked it with sticks to distract it from eating the guy trimming the bushes around his watering hole. How 5 guys could stand inside a cage just feet from this crocodile, poking him with sticks, and not even appear to be paying close attention is one of the many wonders of Aussie culture to me. "Hey Mick, I was so pissed last night I don't even remember!" "Yeah! Good on ya!" {Snap} "Mick? uh oh, we lost another one...."

After petting koalas and escaping deadly snakes, we headed to the three sisters by Katoomba in the Blue Mountains. It was wicked cold and we stayed outside just long enough to take pictures before heading somewhere inside to find food. I was sad to discover that the lovely "aboriginal" folk tale about how this rock formation came to be is apparently not aboriginal, and was cooked up by the tourist industry because people weren't as interested in the story of how the soft sandstone eroded over thousands of years. How is that not interesting?

Eric and I jumped in front of many Australian landmarks - Katoomba was the first of this trip. After our photo session we went into Leura, a close-by tourist village, to try to find food. Given that it was wicked cold in July, many places in Australia have taken to a "Christmas in July" theme, to which this town was very conducive. I half-expected Santa to come right down the chimney of the old Victorian house that was now the Thai restaurant where we ate dinner. It is funny that even for people who grew up in a country where December is summer, they still feel Christmasy when it's cold outside. Along with devonshire tea, sports hooliganism, and the accent, Christmas in July is probably a holdover from the British who must have had a hard time living in the wild bush and burning a yule log when it was 100 degrees outside.


After exploring the wildlife at the designated park, we explored Sydney's very own wildlife by visiting the fruit bats in downtown. In the Botanical Gardens you can stroll past statues of historical figures, eat a lovely ice cream, and walk below trees full of cat-sized bats who hang out all day, occasionally stretching their huge wings to let everyone walking below know that indeed, they are huge bats. The best part about the Sydney bats is standing at the edge of their area and watching unsuspecting people walk past, look up, and say "holy shit -are those bats?!!!"

After Melanie headed back to the US, Eric and I embarked on an unplanned odyssey. "What should we do? I dunno, wanna drive?" So we decided to rent a car and head in the general direction of Melbourne with 5 days and an Atlas that labelled every town in Australia as "A quaint little town."

Our first stop was Wallongong, "Australia's next tech capital" (or so the investment-seeking literature in the hotel room stated). We headed out of Sydney via the Princes Highway and decided we'd go as far as we wanted and then stop. We had a GPS and a car full of stuff, and everything else was up to whim.

The first night we decided to get to Wallongong because it seemed like one of the biggest cities on the map between Sydney and Melbourne. When we thought we were getting close, we asked our GPS to show us hotels, and surprisingly it pointed out the only hotels were right on the side of the road. We pulled into a small town, confused about how this could possibly be the largest town between Sydney and Melbourne, (but it is Australia, who knows?) and pulled up to the only accommodation, a road house on the freeway.

When we walked in everyone stared at us. People were playing slot machines and watching footie and drinking a lot of beer. We walked up to the bartender and shyly asked about accommodation. Looking surprised she said, "yeah, we have a room - but it's not ensuite." We asked if she could show us and she took us around a dark dingy staircase to a tiny hallway with cockroaches scurrying across the floor. "Holy shit! What did we get ourselves into? We're only a few hours from Sydney, and this is the biggest town?" Old drunken, wrinkled people stood in their doorways smoking and followed us with their eyes silently as we walked past. "It's only $50 a night," the girl shrugged. "This is $50 a night! What did we get ourselves into!" I thought. After walking back downstairs past the cockroaches, I decided that I'd rather sleep in the car than at this deliverance-inspired lodging and we decided to get back on the road.

About 10 minutes later, the sign to Wallongong popped up on the side of the road and we discovered for the first of many times on that trip, that GPS was not actually the greatest tool on earth...we'd almost spent the night in a random dirty town 5 miles outside of Wallongong! Instead, we found our way to a modern Novotel to a room with a balcony, a whispy curtain, and an Italian restaurant across the street. The next morning, watching the sun bounce off the sea through the curtain, I appreciated more than I thought I could have, the fortune of saying no to Mr. GPS.
Throughout our odyssey, Eric and I decided that we would go where the wind and the road signs pointed. On a number of occasions, this policy led us down unpaved dirt roads labelled "scenic tourist drive," which, while sometimes scenic, frequently led us down 3 hour detours that popped us back onto the main road about 2o feet past where we started.

On one such occasion, we were looking for another "quaint little town" from our atlas and turned down a road towards "Tilba Tilba" (not to be confused with the neighboring town of "Central Tilba.") After about 10 minutes on a dirt road seeming to lead farther and farther towards the center of a primeval forest, we stopped to figure out our plan and take in the scenery in the mysteriously dusty forest (above). About 2 minutes after stopping and taking some pictures, we were moments away from death as a massive oil tanker came charging down the windy dirt road towards us, no doubt surprised to see hapless tourists snapping pictures of the trees. Being run over by an oil tanker was pretty much at the bottom of my list of expected dangers at that moment in the rural hilly forest (about on par with being eaten by a shark), and I felt like the surreal experience was sent as a good reminder of how our luck could go when we least expected it. After our near death experience, we quickly turned our car around and found our way back to the main road where the actual turn out for Tilba Tilba was 20 feet farther...

That night we stayed at the Two Story Bed and Breakfast (the town was known for its very descriptive names). We went into the general store next door to inquire about the bed and breakfast and the woman running the store also happened to own the bed and breakfast.

"Do you have an ATM?" we asked

"Just check over at the post office" she informed us. We walked outside and discovered that the post office was on the other side of the wall. We waited for a moment, and she joined us through a door from the general store. "Now loves, what do you need?" I pinched myself to make sure that I wasn't actually in a Monty Python skit...

We wandered around the cute little town until 5pm when we could join the "session" down the street at the only place open - the pub. We had to wait until 7 for the food, so we decided to pass the time by trying out every beer on tap. We learned that one of the stores on the main street (and only street) was closed because the owner was bitten by a snake and had a stroke- "but that's not so bad, he was lucky really..." Mick assured us. Mick was the name of 4 different farmers taking in the social scene at the pub that night, and by the time 7 o' clock rolled around we'd been invited to eat venison from someone's deer farm, and had witnessed a verbal contest for who had the biggest possum. Mick won that contest...

Along the road we also came upon the Bega cheese cooperative. It isn't every day you have the chance to taste 10 kinds of cheddar cheese, so we stopped to check it out. Bega is the oldest dairy cooperative in Australia, and I like to think of it like stopping in Kraft, Nebraska, except with a beautiful ocean just over the bend from the cheese factory. Bega has made its way all the way to Singapore, and it was actually exciting to see where it all begins. We knew at that point, that we'd been on the road in rural Australia a bit too long :).


In keeping with our random rural odyssey, we managed to make it to the Victoria border not on a main highway, but on a small dirt road. We were once again, ever so slightly out of place, as one kind woman slowed her car and asked us if we were lost and if we needed directions as we stood by our car taking pictures with the Victoria sign. "Nope, thanks!" we said. She looked a bit dismayed, but continued on her journey. Later that day we discovered the town of Bendoc, which has an old rusty gas pump, a closed servicemen's club, and a bridge, and then drove through another primeval forest with huge 10 foot tall ferns before we reached the next closest town, 5 hours down the road - it was the same town we started in....


Along the way, we managed to see a lot of wildlife. Unfortunately, most of it was dead. Despite the warnings, we counted 57 skippies carked on the verge (dead kangaroos on the side of the road), 17 carked wombats, 7 carked foxes, and 5 carked rabbits. No one collects the carcasses, so they lie on the side of the road while nature takes its course, and we only counted carcasses that were intact enough to identify. There's something disturbing about seeing the animals rotting by the road, like no one cares enough, but then I'm reminded that in nature, no one cares, and that leaving them there to be eaten by birds is actually the most natural result for them. Still, while this is natural, I'm certainly glad that we don't have the same policy for people, it would be an ugly world if we just left people there...


Along with our hunt for real rural Australian life, we were also on a hunt for the best devonshire tea. I could eat devonshire tea all day, but luckily, I don't live in a place where that's an option. If I lived in Australia, I'd have to live close to the beach so that I would have motivation to get outside and exercise all the time to make up for the excessive amount of scone consumption.

The best thing about Devonshire Tea in Australia is that it doesn't even have to include tea. It's the term for a scone with clodded cream and jam and a hot beverage - either a "coffee" which could be any drink that has espresso (although not a watered down American coffee - if you want that you have to go to Starbucks because they're the only people in Australia serving drip coffee), or your choice of tea. If you're lucky, they'll have a good espresso machine and loose leaf tea, and even when you've been driving for days in the countryside, it's likely you will stop by a mom n' pop tea shop that has some of the best coffee you've ever tasted. The winning scones were on the 3rd floor of QVB in Sydney, but the scones from the quiet beach-side towns certainly won in atmosphere...

One day while driving, we approached another "quaint little town" according to our atlas. The town of Bombala wasn't exactly what I would call quaint, unless you call a freeway stop "quaint." But Bombala had two things that endeared it to my heart forever- a historical road house B&B with a renovated jacuzzi bathroom, and wild platypi.

Having been to Australia 6 times, I have made it a lifelong dream to see the elusively shy duckbill platypus in the wild. Many Aussies chuckled and wished me luck, but there by the road was the Shangri-la of all Australian turn-off signs - "Platypus Reserve."

We drove down a dirt road for about 10 minutes and arrived at a river bank with a little observation area and sign. We had arrived at the largest concentration of wild platypi in New South Wales. There they were - just below us, frolicking in the water! After tromping through jungle water in dangerous creeks in the North in search of wild platypi, Bombala, NSW won the award for best wildlife in my book. We stood there squinting and taking pictures for about half an hour before some birds came and the platypi disappeared under the water.
After visiting wild platypi, and relaxing in the historical road house jacuzzi, we hit the road again and made it to the town that includes the turn-off for the snowy mountains. Since we'd just been frolicking in the sun at the beach, we decided it would add contrast to our Australian experience to play in the snow in the mountains. One thing everyone should be aware of - the Snowy Mountains, aren't very snowy....

Growing up 2 hours from Lake Tahoe, I didn't realize how much I took fluffy piles of snow for granted until driving up to the Snowy Mountains to witness the almost complete lack of snow in the middle of winter. It wasn't that it was a bad snow year, we stayed in Jindabyne, a town that was purposely built below the snow line because in Australia it is illegal to drive where it could snow without proper tires, even when the weather is nice.

We thought we'd go throw some snow-balls, but discovered that to even get to the snow we'd have to pay over $100 just to take a funicular up to where there was snow. So alas, we took a little walk in the chilly air, and packed up the car and headed back, with only pictures of snow in the distance and fantasies of Tahoe skiing to tide us over.

On the way back towards Sydney from the Snowy Mountains, we were lucky enough to encounter another one of Australia's wonders- the huge fiberglass objects. In my previous Australia experiences I've been fortunate enough to see the big banana, the giant prawn, and the enormous quoka, but the giant merino was quite a treat. It was the largest of the giant objects I've seen, and even had a museum of Australian wool farming inside of it! The Merino looms above a gas station and sells $15 tea towels, and I have to say that they could improve their customer experience more if they included a giant merino devonshire tea cafe. Alas, we had to settle for learning about the Australian wool industry, pawing at cashmere scarves, and taking pictures under its utter....

To really finish up the Australia experience we stopped through Canberra to check out the capital. Bill Bryson didn't like Canberra very much in his book, "Down Under" and many of the Aussies I know who had been there said "Don't bother" so we headed into the capital city to experience boredom for ourselves.

It was quite sprawling and there were many people looking stressed out in suits, and for the most part it reminded me very much of Sacramento. It certainly wasn't as busy or grandiose as DC, and it had an air of a small town wanting to be big - just like Sacramento. We went into the old parliament buildings that were a museum to Australian democracy where old Australian ladies explained the history of Australia's parliamentary system to us, making sure that they referenced the differences between England and the US.

One difference - we don't still have pictures of the Queen all over our museums of democracy. We also don't have big scepters in our democracy, which I think is a real shame. Think if Obama could sit above congress with a big wand-like scepter, maybe even with a crown. Now THAT would be exciting. Sadly in Australia these days, the queen isn't around enough for the scepter to really get enough use. If the queen had been around, then it probably wouldn't have taken until the 1960's for the Aussies to install a women's bathroom at their parliament house. I learned all about how much the few female parliamentarians put up with, while reading the placard in the first women's bathroom, which contained a boarded up urinal (did they expect women parliamentarians to be a temporary problem?). It was a good reminder of how far women have come in such a short time.

On our last night out woop woop, we stayed at "Australia's oldest consistently functioning inn" in a "quaint little town" called Picton, which was a reasonable day's drive from Sydney. Even though it was relatively close to Sydney, it still had a rural feel, and when we rolled in at 7pm, the only place in town to sleep that was still open was the George IV pub. We took a room that had a creaky bed and a door that wasn't exactly the right shape to cover the opening, and it definitely felt like it hadn't changed at all since it opened early on in Australia's criminal history. The bathroom was outside, across the pub's outdoor back area where people could go to drink after they'd been kicked out of the pub. It was a crazy night.

We went to the pub for food and drink and slowly people with instruments started surrounding us. We asked if we should move and a farmer named john said, "oh, no. Not at all!" And as the evening went on, more and more people gathered around us. "Are you sure we shouldn't move?" we asked. "Of course not!" And so we were surrounded by mandolins, guitars, and violins, as all the local musicians came in for their Thursday night jam session at the pub.

People played Irish and Aussie folk songs and drank, and I felt like I'd been transported to a different time -where music night at the local pub was the entertainment of the week. It was AWESOME. John discovered that I sing, and after a while I agreed to sing "Summertime," and some of the musicians sang and played along with me. After I was done, John said "It looks like you do deserve the prime seats!" ("I knew it!" I thought, "We were supposed to move!"), but for the rest of the night, we didn't have to defend our prime seats any more, and we sat with the crowd, singing and listening as people played as much of the song as they could remember and then moved on to something else.

At the end of the evening, prompted by the bartender yelling "everybody out!!!" the group requested one last song and I decided to finish it off with an aria. I sang "Mon coeur s'ouvre a ta voix" from Saint-Saens' "Samson et Dalilah" and watching the room full of drunk farmers sitting quietly and listening was amazing. Music really does bring people together, and the next time we go through Picton, we're invited to join Thursday music night officially :).

After over a week experiencing a different version of Australia than I'd ever seen, we returned to Sydney for some R&R before heading back to California and then me back to Singapore. As we watched the sunset on Sydney Tower, a storm brought a rainbow that seemed to say, "time to leave Oz." After a long journey down the brown dirt road, we were finally ready to go home.

Friday, September 11, 2009

Back to Adventures in Oz

Given that I am now mostly recovered but still not feeling up for a night of rooftop bars, I have remembered that I did not remotely finish telling the tale of my recent sojourn in Oz.

The last time I wrote about it, I left off with my sister, Melanie, in the Mossman Gorge in the Aboriginal heritage land on the drive to Cape Trib where the paved road ends.....

Melanie and I went ziplining in the jungle, where you pay to be strapped to a harness and to swing from one giant jungle tree to the next across a rope. It wasn't nearly as scary as it sounds, since we spent about 5 minutes swinging and about 1.5 hours waiting for the other people in our group to be harnessed and swing across, but the 5 minutes were totally worth it. Firstly it was an excuse to rent a car and go up to a place so deep in one of the world's last ancient jungles that the paved road ends and only the people with four wheel-drives, a truck snorkel, and an iron will dare to tread.

We could see the sea from our waiting platforms in the canopy, and we met a fascinating Maltese man with a semi-Scottish accent who claimed to have worked in shipping on the North Sea before moving to Australia to bum around. Most Europeans are able to take part in a work holiday program with Australia where they can get visas to work there for a year or more, as long as they don't work in any one place for longer than 3 months. This means that many of the touristy outdoors activities are run by 20-something Europeans who are bumming around Australia working for tour boats and coffee houses. Melanie was a fan.

On our way back from ziplining, after spotting a large scary bird on the side of the road that just may have been a cassowary (or, as I like to call them, dinosaur bird), we stopped at a little cafĂ© where they served piping fresh fish n’ chips and Devonshire tea. One of the things I love most about Australia is that you are in one of the most remote places on Earth and yet, you can pull over and get a latte and a scone at a place that has wild cassowaries, crocodiles, and stinging jungle plants. I have always loved contrast between civilization and nature – golf courses, well-manicured gardens with forests around the side, Singapore (see the article on my urban jungle quick-sand experience for evidence of the “nature” side of Singapore)- and Australia really embodies that contrast. Plus, you can drink the water…

We then spent a few more days of mostly tropical rain entertaining ourselves in Palm Cove before we headed back to Sydney to meet up with Eric for my birthday. We discovered a movenpick ice cream parlour on our last day in Palm Cove that revolutionized our afternoon with creamy mint chocolate flakes – sad we didn’t see it sooner, but probably better for our health.

On our way back to Sydney we were somewhat bemused at the Cairns airport when no one, not a single person, ever checked our ID. We weren’t the only ones who found this strange, as the couple of Aussies in front of us looked equally confused when the security guards told us to put our IDs away at the security counter before even pretending to glance at them. It seemed so foreign for no one to care- even in India they pretend to care (they just don’t look at your ID very carefully. I’m pretty sure in some cases, depending on the person, you could get away with showing them a library card).

By the end of the tropical Australian adventure we were both ready to get back to civilization – which is pretty ironic, given that Coastal Northern Australia isn’t really the most uncivilized place with it's fish n' chips, movenpick, and Cole's grocery stores. Yet, there was something about worrying that you could be eaten by a crocodile on the beach or attacked by a killer dinosaur bird that just gave it that sense of adventure, even on the more “developed” coastal side of Queensland.

The adventure wasn’t nearly over yet, because I still had 4 more days in Sydney with Eric and Melanie, and then a week long odyssey driving down dirt roads and drinking with farmers named Mick…


View of the Great Barrier Reef and Australian jungle from Daintree National Park


Ziplining (upside down!)

Stylish ziplining outfits - Safety First!

Snorkeling at Paradise Reef in the Great Barrier Reef


Snorkeling


Beach at Palm Cove - not during killer jellyfish season


Daintree Ice Cream Banana Plantation - they only use their own tropical fruit!

Mossman Gorge

Sugar Cane Plantations

Achtung- Crocodiles will eat you!

Stay to the left!


Daintree National Park - the real Australian jungle


Monday, September 7, 2009

Notes on Healthcare from the Mer-Lion's Mouth

Maharaja’s Revenge Strikes in Indonesia

I've been lying in bed for days after getting a serious case of 3rd world food poisoning on a day trip to Bintan in Indonesia. This has allowed me to spend lots of time contemplating the importance of a good healthcare system, and to think about my opinions of how these things should work, given my ability to compare Singapore and the US. Even with all this time on my hands, there are still issues that are so complicated that I don't feel like I can form a finite opinion about how I think it should work, and all I can say is that I don't envy our president.


Last weekend, I made the classic mistake – I forgot that I wasn't in Singapore. Bintan, only 55 minutes by ferry from Singapore, looks kind of like Singapore, charges all fees in Singapore dollars and at Singapore prices, caters to Singaporeans, but in the end, it’s still Indonesia, and their water isn't from Singapore. Eating salad there was a terrible, terrible mistake. Beware of the food at the Nirwana Gardens Resort...

During the last week, I first got to experience the Indonesian medical system, or lack thereof. A “doctor” at the resort gave me acetaminophen to cure my excruciating stomach ailments and I had to call my lovely boyfriend, Eric, in the middle of the night, so that he could try to help me from far, far away. He called a number in the US for medical emergencies and I ended up talking to a doctor in Philadelphia who advised me to get back to Singapore if I could. This whole time my poor French roommate, Augustin, who was so, so helpful, and his poor Japanese guests who he was entertaining, all had to accompany me back to Singapore on the ferry – an experience I hope to forget as soon as possible.

After 2 days of serious pain, I started to feel better and was then struck with a second round of symptoms which I am now, once again, recovering from.

Thoughts on healthcare

This week I visited an American doctor from Minnesota at the “International Medical Clinic” that boasts that it is the "expats' top choice." Everyone in the entire clinic was foreign, and even the receptionist was an Aussie. Something about having a doctor’s office in Singapore look and feel just like a doctor’s office in the US seemed comforting, I didn’t even mind the golden-curled children chasing each other around while coughing all over everything. Dr. Mike’s Midwestern accent was the icing on the cake.

While it looked and sounded familiar, one thing was decidedly not familiar, and that is the attitude and procedures around paying for healthcare. Even with the most robust insurance available in the country, you always pay in advance and then get reimbursed when you file your claim. This means that you need to have the funds available on hand to pay for all of your medical services up front. Since the doctors don’t deal directly with insurance companies, it seems much, much more like a restaurant than a hospital, and you can choose your medicine based on the cost.

I find this particularly interesting because with the American healthcare debate, one idea that keeps coming forward is how things would be different if people knew how much their medical care cost up front– or if they had to put forth more of their own money for more expensive drugs or procedures. Would that reduce waste in the system?

Yesterday, when my symptoms relapsed and I ended up drastically dehydrated, my roommate, Shabnam, went with me to the A&E (ER) because it was after normal clinic hours. The first place we went was the “cheaper” hospital, Gleneagles, which we went to because the non-english-speaking taxi driver couldn’t understand us when we said “St. Mary’s.” Gleneagles had a 1.5 hour wait to talk to anyone and a staff who was exclusively interested in identifying and quarantining swine flu, yet required all people entering the hospital to fill out a form with the same pencil, which must have been oozing with swine flu from the last 100 patients – way to go, geniuses. When we found this out, we called Mt. Elizabeth, which was basically down the street, and they only had one patient waiting. Mt. Elizabeth is the more expensive hospital.

So, in Singapore, like in the US, one hospital was full of people using the ER as a normal doctor’s office, but unlike the US, the competition was clear and transparent. Mt. Elizabeth was like the newest American hospital with attentive staff and immediate attention, and the only difference was a 20% increase in the cost – something that didn’t matter to me, because my insurance covers any hospital in Singapore.

While I was lying at Mt. Elizabeth on an IV to rehydrate me, they brought me forms to sign to authorize that I was willing to pay extra for the tests to find out what was causing my problems (which turned out not to be what they tested and instead they tested just for the mineral content in my blood – way to go to make an extra buck…). But think of being in an American hospital, if you asked them to find out what was wrong with you, and they brought you some forms to sign to say that you were willing to pay? What if you didn’t have the money, and you knew they wouldn’t let you leave the hospital at the end of the night without paying? Would you accept the treatment? Would you roll yourself out of bed and head home hoping you just get better? Does this happen today? It might, I just haven’t had to experience it.

At the end of the night, before I left, I stood at the registration desk charging my care on my credit card. After I had been in their office for 3 hours from being sick, I stood at their registration desk waiting for card authorization, since their job with me was done, it apparently wasn’t their job to make sure that I could sit. Now I will submit the forms to my insurance provider who will reimburse me sometime in the next 2 months.

Since my care wasn’t that expensive, I’m not worried about how this is going to affect my finances, however, the immediate payment/reimbursement system can be a nightmare if you require any kind of ongoing treatment. A woman at my office moved to Singapore from Australia and discovered that she had breast cancer. Since her husband had a job in Singapore, she stuck around to get her treatment here. Once a week she charged $7,000 on her credit card for chemo. Can you imagine what that would do to your finances, if like her, you had to wait up to 8 weeks to get reimbursed? Good thing she has good savings and credit – what about the majority of the population who wouldn’t be able to afford that? What then?

Part of why Singaporean medical care is cheaper than the US is that the government subsidizes a lot of the medicine. However, many people are also limited in their choices of care because they can’t afford to pay extra to get seen immediately. This seems to be the case in all government sponsored healthcare systems, and I don’t think that there is any way out of that inequity.

I think that in general, the Singaporean system of showing you how much your care costs, and allowing you to upgrade to a better doctor or a better hospital because you can afford it is necessary. If I wasn’t that sick, I could go to the local clinic under my building and pay only $15 for a consultation. When I care most deeply about excellent care, I can pay $15 for a taxi to take me to Orchard to see an American doctor and pay $139, that I can then get reimbursed, because my employer sponsors additional insurance.

With an American government-supported universal healthcare system, there will have to be some level of inequity, unless we want everyone to be forced to wait at the dingy hospital out of “fairness” like they do in some particularly socialized European countries. I don’t think that the world is fair, and I think that people should be able to pay extra or have extra insurance to get the level of care they feel they need. The people who can’t afford that, are generally the people who don’t have insurance now anyway, so waiting 1.5 hours to see a doctor while not being bankrupted by the experience, is still a step up. I think that Singapore has this right – everyone can see a decent doctor, anyone who can, can pay more to see an excellent doctor. It’s socialism and capitalism at the same time.

I also think that it is good that people can see how much their care is costing so that they can make informed decisions. I don’t think it’s ok to be forced to pay on the spot, nor to be reminded that a potentially life-saving procedure will cost you your life savings. I think that more awareness is necessary, but people should not be forced to put their family’s finances above their own lives. I think that a compromise would be to show people the costs and require them to pay a percentage based on what insurance they have, say, 10% of the costs (lower or higher depending on your insurance premium – a very common system in Singapore) to make people feel invested, but not pressured to avoid a necessary procedure.

While I was initially shocked by how obvious it is that healthcare in Singapore is a “business” (it is in the US too, we just like to pretend it’s not because we don’t like the idea of profiting from people’s misfortunes), I found it to be more helpful in the end to feel like I could choose a doctor and hospital just as I could choose a restaurant, and that if I didn’t like something, I could just pick up and go down the street. This system here, clearly leads to higher standards to attract more customers, which creates a much better level of care than I have received in the US, even at the newest of medical centers (where I got to enjoy being treated for food poisoning after returning from India).

I will admit that one of the downsides of the “business” aspect of medical care is that I have not felt sure in some cases whether a doctor is offering me medicine because I need it or because it leads to more profits for the hospital. I found this to be especially true when talking to Singaporean doctors, who tend to hand out antibiotics and TamiFlu like candy, with almost no inspection of the patient beyond a short conversation and a weighing by the nurse. But, then in Singapore, those medicines tend to not cost remotely what they would cost in the US, so it isn’t really a big deal if they throw on some extra acetaminophen with my antibiotics.

Overall, my assessment is that the level of service that you receive in Singapore when you can pay slightly more through insurance or your own pocket, is far higher than the level of service I’m used to in the US. The ease of getting into a clinic is also astounding – I called the clinic in the morning and got in to see a doctor 2 hours later with no history with the doctor or clinic at all.

I like to know how much things cost, but I don’t like to pay up front, and I think that insurance should pay at the forefront (from the patient’s perspective). I think that a universal level of healthcare for everyone with the option of upgrades is really the most American option for a healthcare system – it’s the government ensuring the right to life, liberty, and the pursuit of happiness, while not limiting your ability to seek better standards for yourself, which is another principle that Americans hold very close to their hearts.

In the end, the most important thing to me in my recent experience has been having people around me who can take care of me, and that isn't something that the US or Singaporean systems are equipped to provide. Augustin has been bringing me food and drinks during lunch and after work - he even went across Singapore to the Carrefour to get Campbell's chicken noodle soup. Shabnam spent 4 hours with me at the hospital last night, and both have consistently taken care of me. While I am still reminded how alone I am in this far away country, particularly lonely when I am sick, they have been the best roommates I could have asked for as I await the days when loneliness and longing will no longer be a symptom of my everyday life.

Wednesday, September 2, 2009

Another Hungry Ghost Week

This week I have missed finishing the tale of my Aussie adventure because I have been busy (a rather unusual state of being for me in Singapore, I will admit). So, instead of continuing that story (which I must finish), I will write an update of the Singaporean things I've done this week.

This week I have:
  • Lounged in the living room with my roomies while sipping Australian sparkling wine to help digest an unreasonable amount of Shanghainese dumplings. Taught them the concept of "that's what she said" when Shabnam said "I'm always in and out so fast I can't even enjoy it...." (referring to Singapore, of course...)
  • Watched a romantic comedy with Shabnam. "The Proposal" with Sandra Bullock was ok and made Alaska look a hell of a lot more appealing than I suspect it would be in, say, February. My favorite moment is when she tries unsuccessfully to feed a husky puppy to an eagle to get her cell phone back. Fortunately, she doesn't succeed. Unfortunately, I want to have a husky puppy now.... My favorite moment in the entire experience was not actually in the movie, but the "turn off your cell phone" message before it where they showed an asian girl with a chain saw covered in blood screaming and then showed the message on the screen "turn it off or she'll cut it off..." You just don't get weirdness like that in the US unless someone is really trying.
  • Gone to an Irish pub called Muddy Murphy's across from the four floors of whores. Having long heard lore of one of the most famous government-sanctioned brothels in Singapore in one of the ritz-iest part of town (prostitution is legal here), I was confused to learn upon a brief look at the building that there are about 12 floors, not 4 - why is it called four floors of whores? When describing the location to a colleague he asked if it was across from the Starbucks..and indeed it was. Those Starbucks really are everywhere....perhaps some people need a pick-me-up before they go in?
  • Bought 5 bottles of wine at the Fair Price because they were under $20SGD - seriously? They are giving it away....
  • Walked home for 20 minutes contemplating what day of the week it was, and ended up being wrong....
  • Discussed the hungry ghost festival with my neighbors in the lift as they stood there with burning incense for 26 floors. "It is good. Anyone can do it, Singaporeans and other people." Enjoyed the burning piles of paper, incense, and open hawker take-out boxes all over the street for their fantastic cultural value. Singapore really does have some real character sometimes.
  • Watched the "dancing dragon" festival with my roomies in front of a mall at Orchard, in which people in dragon costumes have to jump across a difficult obstacle course and not let their head pieces fall off (we didn't see anyone succeed...).
  • Listened to Thai classical music in front of the Thai embassy for the "Thai cultural festival"
  • Viewed the online wedding album of Pavla, my Czech pen pal who I "met" in 5th grade on the last day of school when my teacher received a packet of letters from the newly formed nation of the Czech Republic.
  • Bought a ferry ticket to Indonesia for tomorrow!