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Shady Business

Sicko health care gets personal

By Adam Matthews
Published: Dec 01, 2007

There are no perfect places to be afflicted with traveler’s diarrhea. Only bad places and worse places. Hong Kong, home of 2003’s SARS epidemic, one would assume, is one of the latter. And Lamma Island, a charmingly bohemian fishing village with no cars, that’s a 40-minute ferry ride from Hong Kong’s Central District, is no exception. People come to Lamma to get lost, not avail themselves of their one health clinic, which is open just four hours a day.

So on a blazing Saturday morning in late June, I’m scheduled to check out of my guesthouse. I am in absolutely no position to do so. Face down on the bed clutching the pillow, my skin is tingling, my t-shirt is soaked in cold sweat and my upper body is wracked with swirling vertiginous nausea. Every five minutes, I limp across the room to the toilet, battling diarrhea that allows me the time to contemplate the cause of my condition. I’ve narrowed down the culprits: the four glasses of what may or may not have been white wine (China’s latest knockoff is grain alcohol flavored to taste like wine), the painkillers I took for my hangover (perhaps they were also fake) or (most likely) some undercooked beef and Chinese broccoli over crispy noodles at the restaurant frequented by triad members.

Finally, there’s a knock on the door. It’s the housekeeper. Someone has booked the room. She moves me next door to a mustier room with no view for double the money. Weekend rates, she explains politely. The view is inconsequential. When I’m able to raise my head off the pillow, all I see is a moldy ceiling or the fetid carpet. I need a doctor.

Shielding my head with a fisherman hat, I make my way down to the local clinic, a small one-story concrete building beside a Buddhist temple and across from the concrete soccer pitch. After forking over $220 in Hong Kong dollars – Hong Kong residents just show their ID cards – I am ushered into an air-conditioned room with a clean white linen hospital bed, where I promptly faint from exhaustion. A nurse offers me a thicker, fouler tasting, Gatorade-like drink. Moments later, a business-like doctor sees me. He hands me a week’s supply of four different medications and some advice: stay away from the spicy food. Oh, and nix the drinking. I stumble back to the guesthouse. I will be staying another night.

Moments later, though, the diarrhea, dizziness and nausea returns. Perhaps, I think, I need longer-term care. I walk back down to the clinic. With my records in hand, I am dispatched via mini-ambulance to the ferry. Somehow, miraculously, throughout the dizzying 40-minute ride, nature doesn’t call.

As my ferry docks on Hong Kong Island, there are two paramedics waiting for me with an adult-size ambulance. After a decade in America (I’m Canadian), my first thought is how will I pay for this? Thirty minutes later, we arrive at Ruttonjee Hospital. An hour later, I am on an IV. I am suffering from dehydration. Three hours later, after being counseled by a doctor with a far more agreeable bedside manner, I am ready for release. So, I ask, I just walk out? The doctor nods.

But four days later, I feel dehydrated again. After paying $220 HK, I am back at the local clinic. I refill the pills and rehydrate myself. The next day I return to New York. The total bill for one hospital stay, two clinic visits, six different medications and two ambulance rides comes to $440 HK, about $56.25 in American dollars.

This is roughly the same amount I paid for a week of Strattera, the brand name ADHD medication that my private insurance covers. My departure date for Hong Kong didn’t fall into the short window of time when I can renew my prescription. Despite having coverage, it comes out of pocket—but, being “covered” by HIP has forced me to recalibrate my expectations. Three years ago, a HIP bureaucrat determined that Strattera wasn’t medically necessary. After a two-month battle, they conceded that their judgment was wrong and reimbursed me.