Hospital Emergency Rooms

1 Aug

Milad after his injury in China.

During the last two years, we have had a number of emergency room visits with our children in China and one most recently in the United States.  The last one (where Milad tripped while running, hit the ground, falling on his forehead and cutting it open on our last night in Nashville a few days ago) made us think about the differences in our experience in Chinese and American emergency rooms.

We were in China for a couple of months, still trying to settle in, when we had our first emergency room visit with Milad.  Here is a little background and description of what happened that night.  Milad had been having ear infections since we got to China.  In fact, he may have had them before, without our knowledge, but we had discovered them when he had to do a complete checkup before enrolling in preschool (called kindergarten in China). The infections didn’t seem very serious but I was told at the the kids’ and maternity hospital where he did the checkup that I should take him to the big children’s hospital to check them out.  The children’s hospital visits were quite a challenge for me since no one seemed to speak English there.  The first time I went, I first went to the wrong building, then they sent me to the right one, then I went to the ear department only to find out I had to first go to register downstairs to get a card and book for him (I had one from the other hospital which I thought I could use but apparently each hospital has their own), then pay to get a number and then finally see a doctor who spoke almost zero English.  She looked at his ears, then sent me to pay for a test, then I did the test and took the results back to her and she told me to come back a few weeks later.  With all the confusion the whole hospital visit had taken about 2 hours.  I came back a few times after that, always with the same results.  The last time, on top of the ear infections, he got a cold and that time she prescribed medicine for him.  By then, I knew the routine but when Milad’s turn came, I went to the wrong “room 4” which was closed.  So I found the nurse at the info desk and luckily she spoke some English.  She found the right room and then I asked her if she could stay to help us since we didn’t understand the doctor.  She did and together we went from the ear test, to getting the medicine back to the doctor to explain the dosage, etc. (and in between each step you have to go to pay more money).  The whole thing took a while and we talked to her while we went through the different steps.  She was very sweet and we wanted to invite her to our home so we got her number.  That was a week before Milad’s accident.  We had tried to get together that weekend but it hadn’t work out.

On the day of his accident, after dinner, Milad was running, slipped on water which had leaked out of the bathroom (our bathroom had no bathtub or even a barrier around the shower area so often water would cover the bathroom floor or even leak out of the bathroom after a shower) and hit the sharp door frame and cut his forehead open.  Oh my God!  He was bleeding a lot and Peiman put his finger on it to stop the bleeding.  It did stop and didn’t look so bad and Peiman thought maybe we didn’t need to go to hospital but I thought we should.  We decided to call our nurse friend.  She was at home as she had finished her shift but when I explained what happened she said she would go back to the hospital to meet us since we didn’t speak Chinese.  When we got there, she was there with her “head nurse” who also came from her home to help us.  We went first to the emergency, which was crowded with children with various injuries.  We were quickly told to go to the doctor on duty, bypassing some people with less serious injuries who had numbers.  The doctor looked at Milad’s head and then sent us for a blood test (to check for infection, I believe). We were then sent to another building – the inpatient building.  There we talked to a doctor who knew a little English and the head nurse called another doctor and told him the situation and he then talked back and forth to us and the nurse on the phone until we understood the situation.  Well, it turned out that the cut was VERY deep – all the way to his skull.  They said they would put him under general aneasthetic but we were scared to do that because it involved some risks and would also mean we would have to stay overnight in the hospital until he had digested his food.  So we asked them if they could do local and that we would help hold him down.  They finally agreed and, well, as they had said, the local aneasthetic did little to numb the pain for him and it was really excrutiating.  Peiman and I held him down and sang removers of difficulties (a Baha’i prayer revealed by the Bab) while they did four stitches deep inside to bring the two sides closer before doing another 7 or 8 on the surface.  Oh, and I forgot to mention that they actually called another doctor, one of the best in the hospital to come from home to assist the doctor there.  They really did an amazing job.  It turns out that that hospital for kids in China (they rank everything in China).  We then had to give him (I guess) a tetanus shot (though he had recently had one).  It was the longest lasting shot I’ve ever seen.  Poor Milad – he was so amazing though.  Right after the surgery he was back to his cheerful self and wanted to “run” around (which we stopped him from doing a long as we could).  During the whole process, the nurses stayed with us and our nurse stayed with Roya while we were in surgery which was such help since we had no one to watch her.

Really, it was unbelievable.  If we hadn’t gone for the ear infections, we would not have met the nurse and we would have been COMPLETELY lost without her and her head nurse.  In fact, every time we had some emergency or other need while in China, we always had a Chinese friend or acquaintance to call on for help.  The kindness and love that has been shown to us by Chinese people has really been the key reason why we love living in China so much.

Milad awaiting his stitches at the hospital in Nashville.

But I digress.  When we went to the emergency room in the United States, we were struck by several things.  First, it was empty – well, there was one person there ahead of us.  Yet the whole process took as long as our visit to the Chinese emergency room which was crowded with injured children.  The reason it took so long is that a lot time, the doctors and nurses just looked like they weren’t “doing” anything.  For example, after they put a cream on Milad’s head to freeze it, which they said would take 20 minutes, they came in to do the stitches one hour later.  Yet we saw them kind of hanging around their station just outside the room and only saw them with the other patient for about 15 minutes.

Another difference is private versus public space.  In the US, the space was very compartmentalized.  You went inside a room to see the triage nurse, back to the waiting room, then to another room to register, back to waiting room, then inside a locked area, where we were in our own curtained off room where we were the whole time and people came in to do different things until finally stitching Milad.  In China, the consult room was open and had several people (who had more severe injuries or whose numbers were up) lined up and waiting as the triage nurse saw the first in line.  Everyone saw what everyone else had done to them while waiting.  The only time we were in a private room was for the actual stitching.  There was also no locked areas inaccessible to the public.  Even the inpatient area was fully accessible by anyone by elevator.  People staying overnight in the inpatient area did not all have a room to be in since there wasn’t enough space so there were portable beds all along the hallway where kids were sleeping with their parents sitting by them.  Whenever I was offered for my kids to get a different kind of treatment that required them to stay overnight, I really did not want to do it as I did not see how I could sleep in the hall (or rather sit by my kids’ bed while they slept).

Finally, the way money was charged was very different.  In China, you always go to the cashier to pay for a service before it is given (no matter how much you’re bleeding).  Presumably, if you can’t pay, you can’t get treated.  In the US, I wasn’t even able to find out how MUCH the whole thing would cost – no one could even give me an estimate and I am still waiting to receive the bill at our address in Canada.  Besides the obvious practical implications, perhaps this also has to do with how people treat money in both countries.  In North America, money is a taboo subject, something not discussed (how often have people asked you how much you make?)  In China, strangers who have just met me have asked me my salary (even when I started understanding this question, I continued to say that I didn’t understand what they were asking as I didn’t feel like discussing this topic).  Money is just a practical part of life.  And it makes sense, you pay, you get the service.  But, as I said, what if you can’t pay?  I have no idea.  In the US, it is good that they treat you no matter what but I wonder what happens if you can’t pay, esp. if you are not living in US – how do they make you pay?  (I am planning to pay my bill, of course, however painful it’ll be).  Even though I don’t know what it will be, I estimate it will be at least a few hundred dollars, about a seventh of the cost we incurred in China.  And that is the cost of care in different countries.

I guess that brings this post to an end – it turned out rather long but editing myself has always been my problem (right now I am supposed to be cutting down an article based on my MA research I’d like to submit for publication).  I hope it is at least an interesting read.


5 Responses to “Hospital Emergency Rooms”

  1. Peiman August 1, 2010 at 8:40 pm #

    This is just a comment forced on me by my dear wife so she could have a comment. I have no comments, you have said it all, perhaps more.. btw where does everyone find time to read and write all these stuff? Who is taking care of the kids… ok ok this is a good summary and surely future anthropologists will have a field day digging into all these none sense blog figuring what life was during last days of the old world order. Good work KLARA

  2. felisha14 August 2, 2010 at 5:09 pm #

    Thanks for starting a blog. I really enjoyed reading it, I hope Milad is on his way to a full recovery. I thought of getting Evan a helmet, since he is crawling and standing and banging his head into things but some people think that’s crazy. Maybe it is, but at least it would prevent a serious accident. Just a thought.

    • klarasadventures August 3, 2010 at 2:15 am #

      I wouldn’t worry about it at this stage because they just don’t get much speed so they usually don’t get seriously hurt. Milad didn’t start getting hurt until he was two and running around like crazy. And at that point, you can’t really make him wear a helmet either. My friend, Sanjana, suggested praying a prayer for protection every day – not a bad idea. As many people have also told me, boys will be boys and get hurt and there’s not that much we can do because even with super vigilance it can happen so I think prayer is the only thing we can do (although with littler ones you can take steps to make their environment safer).

  3. Jarome August 23, 2010 at 4:18 pm #

    Do you feed Milad anything with a lot of sugar in it by any chance?
    And are you serious, that you estimate the hospital bill in China will be 7 times what you pay in the US? Impossible! US is the most expensive health care in the world, No?

    • klarasadventures August 24, 2010 at 8:03 am #

      Ooops, I meant 7x (not one seventh) but actually it was more like 10x. I am applying for a lowered price since our monthly income is so low (the cost was close to half our one month’s income!) In the meantime they keep sending me bills and raising the price higher and giving me a limited time to pay…

      I don’t give him sugar AT ALL! Seriously, people (esp. old Chinese women) keep trying to give him candy and I fight them off. If he ever gets any chocolate or something, he goes even more nuts. It’s a challenge.

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