Harbor, one of our more vulnerable orphans in foster care needs our prayers, he is sick, and he is not safe. He is in a foster family who loves him and is committed to doing everything for him. However, he lives in a world that is hostile to “throw-away” kids who are not very strong.
He had developed a high fever for nearly a week and when my colleague saw him yesterday, he was in need of urgent care. She immediately got to work getting laboratory tests, X-rays, and other studies to the best of her ability. But the small hospital in which our clinic is based doesn’t do a lot of the tests we needed to do to confirm our diagnosis. For you medical types, Kawasaki Disease is near the top of our differential. Well, it took quite a long time to get through the basic stuff, but it still wasn’t enough to make a firm diagnosis because the small hospital didn’t have the trained staff or the equipment to do certain tests. Meanwhile, he has high fever, and given his other chronic and complicated medical history, we needed to get some heavy duty antibiotics in his system while we waited on a plan for transport to another hospital where he could be admitted and where they may have the ability to do more specialized tests.
But, as everything seems to be, its complicated: The first question is of course, who will pay for the care? The docs want to know where can we can get the rest of the tests done, and will we have a shot of getting them to actually do the tests or give the medicines? Will the orphanage approve of the admission or anything else? Will the docs at all consider the American doctor’s medical recommendations?
The antibiotics we wanted to give at the first hospital was a bigger ordeal than it needed to be, but a decision (not ideal medically in this case) was made and we gave him something that was close. But wait, it was now 4:30pm and the regular IV nurse left for the day and the night nurse didn’t want to do the IV on this kid. We were still dithering about the transport and admission to the other hospital and it was important to get some medicine into his system, so we did what we could at the small hospital, knowing that the transport, admission and medicine administration would take quite a bit of time as well.
The hospital admitted him, and kept him on basic care overnight. No more tests were done that night. The doctor on duty admitted that our diagnosis and recommendations were worth considering but said he would consult his superior in the morning. Nothing else was done for him other than support him with oxygen (which he needs). Morning came. No supervisor doctor, no further testing. However, it was suggested (you might even say threatened) several times that we admit him to the ICU or he would be kicked out the hospital! Harbor needs to be in the hospital, but he is still far from needing ICU level care. We were assured by our Chinese doctors that this is illegal and they could not throw him out no matter what. What’s behind that? Yes, he is sick and he is requiring care from the staff, but he is actually far less than you would expect for his condition. Do they just want to turf him off their service? Are they afraid of him dying while on their watch? Is it because he is an orphan, and an orphan cared for by foreigners? The ICU has strict rules and NO visitors are allowed at any time. No guarantee that the care will be better their either.
One of the more challenging aspects for a foreign doctor here is that, apart from basic care that can be taken care of in an outpatient setting, with a basic panel of labs, tests, and medicines, we have no autonomy in the treatment of our patients. The frustration comes to a zenith when dealing with orphans who become seriously sick and needs inpatient care and specialized studies and medicine. Most of them already have complicated medical problems. When one of these little ones becomes acutely ill, and you have to fight hard to get even the most basic of care taken care of, the situation becomes a hard lesson in patience and grace.
It hard for us to respect doctors who wear a dirty white coat over NO shirt (males), shorts or jeans, and flip-flops smoking cigarettes outside the radiology scanning room. Seriously. Makes you wonder about their own self-respect. I’m not writing this just to denigrate my Chinese peers. If I may say something on their behalf, they are functioning as a part of an entire medical system that basically works against the patient.
Foreigners aren’t the only ones to see and complain (even if we can’t do much about it) about the system. The New York Times published this very interesting article last week about the growing discontent of hospitals and medical care by Chinese citizens. This discontent sometimes grows into horrible violence. I myself have had conversations with emergency department doctors who are looking to get out of that specialty because they fear for their lives sometimes.
This only serves to to reinforce and encourage my small work in educating a small number of Chinese doctors who also have some hope in a better way to practice medicine. I hope that they will catch the power of giving their all for the care of patients and then turn into powerful social change agents!