The Hospital

Now the hospital. A few things stand out.

My first impression of the hospital was the crowd. The main lobby is always busy… always. I wonder what they are all waiting for.

There is a huge Ganesh idol in the lobby, but I have not actually seen any of the multitudes of people in the lobby actually doing any poojas at the idol.

There are separate pediatric and adult emergency rooms.

There are LOTS of nurses. The nurse to bed ratio was 2:1 in the emergency room and close to 1:1 in the normal rooms. Sammy was checked on by four different nurses within a few minutes of arrival. During the stay, he was often checked on; much more often than would normally be the case in an American or German hospital.

The quality of care was certainly on par with an American or German hospital. Unless the American health care system gets overhauled soon, expect to see more and more medical tourism.

The doctors seemed less pompous and friendlier than American and German doctors. OK, they were no more forthcoming with information unless pressed, but their bedside manner is certainly warmer.

The décor was a funny mix of modern luxury appointments and what I call the military base look. By this, I mean functional and well worn with little expenditure on making it look fancy. If I had to guess, I’d reckon that the hospital was being remodeled on a department by department basis; possibly with an eye toward medical tourism.

The pricing structure of everything follows your choice of room. If you take general (several patients per room), then not only is room quite cheap, but the pharmacy costs, physician consultations, lab tests, MRI/Ultrasound, etc. are all scaled down. Moving up to semi-special (2 patients per room) and special (1 patient per room) increases the cost of all of these things; as does moving on the luxury rooms, executive, deluxe and ultra-deluxe. At first, we considered the possibility that the quality of care would scale with the room. After all, privately insured patients in Germany get clearly preferential treatment over those using the public insurance corporations. The administrator that checked Sammy in was adamant that the room choice did not affect the care and told us to only take the luxury rooms if fancy décor, air conditioning (not needed at this time of year) or broadband internet were important to us. We had Sammy in a special, so that we were alone and had a place for the staying parent to sleep. Daniela and I agree that this is an interesting and fair way to scale the cost of health care; charging the high end patients more and giving them a reason to feel that they got something for their money, while subsidizing the bottom end of the scale.

An interesting thing on the pricing scale. We paid for Sammy’s post discharge prescriptions after he had been cleared for discharge (and we had paid up). The prescriptions, some of which were the same, were a fraction of the original cost, post discharge; using the same hospital pharmacy. I have to conclude that the default price is general and everything scales up from there.

One thing did give us consternation; though it was the only thing. On the first evening, Sammy was X-rayed. We laid him down on the gurney. The technician moved him into position and moved the dolly with the photographic plate under him. A tech on the west would start laying lead shielding mats over the other areas of his body and shoo us to a safe area. After all, x-rays are not exactly healthy. Instead, this one asked Dani:

Could you please hold him in this position?

On a final note, the orthopedic surgeon, Dr Chakravarti, is awesome! He is competent and very, very nice. He even stopped by our house the other day to check on Sammy and see how he is doing.

Better

Sorry for the dearth of follow ups. It has been a busy week. After coming back from the hospital, we had a five year old who was prescribed “bed rest” for two weeks. That kind of thing keeps you busy…

Sammy went for an MRI this morning. We’re pretty certain that he is fine, but this is to be sure. Most likely it is something called “irritable hip”, which is essentially a cold that you catch in your hip joint. It goes away on its own, but requires a couple of weeks of keeping off the leg. It might be early stage Perthes disease. This is very unlikely, but having the MRI images as a reference would help if the symptoms ever came back.

I promise to get back to my regularly scheduled India observations tomorrow and talk about the hospital.

A housecall… and a trip to the hospital

Yesterday, Sammy woke up with a terrible pain in his leg. He experienced excruciating pain every time he moved it in the slightest. By late afternoon, we became concerned that it was not just a pulled muscle or a bruise. We needed to speak with an orthopedic specialist or take him to an emergency room. The problem was that we have never used a doctor here in Bangalore and don’t really have an idea which hospitals were good and which ones were not. There are world class medical institutions here as well as places where the care is substandard. Added to this was the fact that this was a Sunday on a long weekend (today is Republic Day). I started to google, but that was just added to the confusion.

So at Siva’s suggestion, I walked next door to Raju, our neighbor. Although a researcher, he is an MD and might at least know who is good and where to take Sammy. Raju immediately picked up his cell phone and called another neighbor a couple of streets over. This neighbor, Dr. Chakravarti, is a well known orthopedic surgeon here.

Dr. Chakravarti, or Chukie as Raju calls him, stopped by our house to take a look at Sammy. He told us that he could not be certain without a battery of test, but Sammy likely had an infection in his hip. He picked up his cell phone and contacted a physician on duty at Manipal Hospital. He ordered blood samples taken, an X-Ray and ultrasound. He then told the fellow on the other end of the line that we’d be there in 45 minutes. We quickly packed – including Sammy’s toy leopard – and took Sammy down to the hospital.

We got into a minor fenderbender in front of the hospital gate (an idiot T-Boned our car, but that is another post for another time). I did not care and just pulled into the hospital parking lot anyway. We carried Sammy in into the front door, past the Ganesh shrine in the main lobby and into the pediatric emergency room. As we waited for the colleague that Dr. Chakravarti had called to come down, several nurses (called “sisters” here) stopped by Sammy’s gurney to check on him. This impressed the little guy:

This is a good hospital

The duty physician quickly came to the same initial assessment as Dr. Chakravarti. They drew a blood sample from Sammy and sent him for an X-Ray. We left Daniela with Sammy overnight as the nurse was off getting pain killing syrup for him. Apparently they had a full program. He had an ultrasound at 11:30 PM and Dr. Chakravarti called Dani at 3AM in the morning to give her a status update. At around 4AM, they started him on antibiotics.

He has fluid buildup in his left hip, possibly from an infection. His blood seems relatively normal and according to the X-Ray and ultrasound, there is less fluid buildup than expected. This is good news. In the worst case, they might have had to open the joint and use a syringe to drain it. I’ll be going to the hospital in a couple of hours to take over from Dani. I’ll post an update later.
The irony here is that we had planned to go down to Nagarhole National Park this weekend and do a jungle safari. I had called around to the various lodges and everyone was booked out. We had been disappointed, but now we are sooooooooo glad that this did not happen while we were in Nagarhole. This was serendipity. For that matter, it was a huge help that Raju knew who to call, that Dr. Chakravarti stopped by and that he took the case seriously enough to call Daniela in the middle of the night.

I think we have to send flowers to a few people when this is over.