One of the main concerns for foreigners planning on moving to a new country is healthcare. For seniors, it’s often vitally important due to health that is declining or because the potential resident is wisely looking ahead to the future. Health issues are also of primary concern for families with children. Most of the younger folks that contact me about moving to Bali generally don’t mention health as an area of immediate concern. A few years ago, I helped an American couple in their move to Bali; they lasted less than a year because they chose Ubud as the place where they wanted to live, and when one of them had several severe health problems requiring medivac, they decided to return back to the States.
Over the years, I’ve been covered by health insurance at the school where I taught so the cost of healthcare wasn’t an issue for me; now that I am retired and have no insurance, cost is certainly a concern when I think about healthcare for myself and my family. Fortunately the cost of adequate healthcare here is still reasonable so we’ve weathered out broken arms, childbirths, dengue fever, typhoid and more. And while many expats here have some form of insurance, I know a number of others who don’t and who haven’t been as lucky as we have with their healthcare issues.
When I was describing my recent visit to two local neurologists, the first thing my wife – an ardent Indonesian nationalist – asked was if they had been trained in the United States. No, I answered. Europe? Again no? Singapore? No, no, no. Why the sudden interest in where my doctors were trained? It has something to do with the well-known fact that seats in medical schools in Indonesia are available for sale. Not all medical students buy their way into school, but some do and for Indonesians whose interest in health and illness sometimes borders on the obsessional, information about the quality of local doctors is actively sought and shared. So, quality medical services and healthcare are important topics for both expats and locals.
Over the past twenty-four years, I’ve had several operations here in Bali, as well as being hospitalized for dengue fever and typhoid. I’ve been in hospitals frequented mostly by locals as well as a hospital that was popular a few years ago with expats and tourists. Some recent health issues related to possible brain malfunctions have required that I go through some extensive testing including an MRI, an EEG, blood work and cognitive testing. My Balinese doctor told me to get down to Denpasar for these tests as they are not available in Singaraja. So the question of where to go came up. Many expats and wealthy Indonesians travel to Singapore, Malaysia or Thailand for treatment. I’ve done that in the past and have had mixed results. This time I was looking for good treatment at a reasonable price. Part of the problem with going out of the country for medical care is the need for an exit/re-entry permit. Then too there are expenses for airfare, local transportation and accommodations. This is before getting to the costs of examinations, doctor fees, medicines and follow-up care. I decided to look locally for a neurologist and a hospital with the necessary facilities.
Living in Bali today is a completely different experience than it was when I first arrived here decades ago. Websites, blogs and social networks like Twitter and Facebook have created a space for expats, tourists and locals to share experiences, information and resources. I used a few Facebook groups on Bali to discover what hospitals are currently getting good reviews from people living in Bali. After a few hours of comparing information from Westerns and Indonesians, I narrowed my search for neurologists to two hospitals in the south. I eventually chose the relatively new hospital Siloam in Kuta, which opened for business just six months ago. As I was to discover, the patients that I observed throughout the day were a mix of Westerners and upscale Indonesians. For Westerners who are uncomfortable with the idea of being taken care of in an Indonesian hospital, Siloam offers an international experience that I believe most Westerners would be quite comfortable with.
A Day at Siloam Bali
A brother-in-law drove me down to Kuta (leaving at 06:30 in order to arrive at the hospital in time for a 10:00 appointment). We negotiated the heavy southern traffic and made it to the hospital with 30 minutes to spare. Siloam is housed in a new mall on Sunset Road (I was surprised that Sunset Road is the actual name of this street; I always thought that it was a name Westerners gave to the real Indonesian street name). We parked in the back and came in through the Emergency entrance. I was immediately impressed with the cleanliness and orderliness of the hospital: a large registration and cashier desk with a sufficient number of personnel so that we were waited on immediately. I explained that I had an appointment and within minutes was accompanied by a young lady up to the third floor where my neurologist saw patients. The clerk at the registration counter here had my appointment on the computer and within minutes sat down with me to help me fill in the registration form. Shortly after 10:00 I was led by a nurse to the neurologist’s examination room. As my Indonesian was better than her English we conducted the initial interview primarily in Indonesian with English thrown in when necessary. After taking an extensive medical history, she gave me some cognitive tests that I was already familiar with from my research on TIA and Alzheimer’s. She concluded that I had short-term memory problems (I had already come to the same conclusion from my own testing), but that other than that I appeared to be in excellent health for a man of my age. She suggested an MRI (which I expected) as well as an EEG to check for epilepsy. The epilepsy suggestion surprised me as I had epilepsy as a boy but had not mentioned it in the medical history part of the interview. Plus points for her thoroughness. She also ordered blood work as she wanted to make sure that I had no liver issues that would become relevant for any necessary medication.
I was concerned about the costs of the tests and consultation and inquired about the total cost for the day. She wrote down everything that needed to be done, gave it to her nurse who went off to the front desk to find out how much these examinations were going to set me back. In the meantime, she explained in detail just what would happen for the rest of the day. When the nurse returned when, we went over the itemized costs which amounted to approximately $275, which was well within the budget I had made the night before. When I paid the cashier for the day’s program, she charged me an additional $275 dollars and explained that the original estimate was wrong. We discussed this briefly, she showed me a list of prices, and I shrugged it off and paid the new bill thinking that I would discuss the difference later with my neurologist. I set off for the first of my tests – the MRI.
Accompanied downstairs by a nurse, I was seated in the waiting room in the radiology section. A nurse from Radiology arrived quickly and carried out an interview related to having an MRI. She asked me to wait. I ended up waiting about an hour for the MRI due to a backup of patients. The waiting room was sparkling clean with magazines and a television equipped with Indovision and a water cooler. I passed the time scanning the internet on my tablet. A young lady from the cashier’s office came up to explain that I had been overcharged. We went back up to the third floor where everything was straightened out, and I was refunded $275 along with a sweet apology. I’ve never been refunded money by a hospital before, but have been given extra charges at the last minute both in Bali and the U.S. Another big plus for Siloam: efficient and honest.
The MRI technicians explained in detail the process of the scan and efficiently carried it out. I was sent back upstairs to await the results and to prepare for the EEG. My doctor came out and told me to go downstairs and have something to eat as the EEG would take several hours and she wanted me to be comfortable during the procedure. I went down to the mall section just outside the hospital and ate a quick sandwich with an iced tea. While I ate, I compared this experience with three other hospitals that I had been in over the past five years: Bumrungrad in Bangkok, Mount Elizabeth in Singapore, and Kasih Ibu in Denpasar. I found that my experience with Siloam compared favorably with Mount Elizabeth, surpassed Kasih Ibu and offered less extensive coverage than Bumrungrad, but for the price and availability of follow-up care was a more than suitable substitution for Bumrungrad.
After my quick lunch, I returned to the third floor where I began the preparation for the EEG. The nurse worked carefully in marking the spots on my head where she was going to attach the electrodes, all the time explaining what she was doing and checking to make sure that I was comfortable. It has been years since my last EEG so I had forgotten about how boring this test can be. After we finished, I had a final consultation with the neurologist who explained the results of the MRI and what medication she was prescribing and why she was prescribing it. I needed to visit another neurologist to have the results of the EEG read because she wasn’t a specialist in reading EEG results, and my neurologist made a little map for me showing the location of the doctor’s office where she had already made an appointment for me later in the evening.
Armed with the MRI scans and the EEG readout, my brother-in-law and I made our way through the early evening traffic of Kuta and Denpasar to the second neurologist’s office. Far from the sparkling new hospital, her office was similar to most of the doctors’ offices that I’ve visited in Bali – slightly dingy, lacking any wall hangings or medical charts, just a simple plain room. But the doctor was highly professional. We settled quickly on using Indonesian for the interview and examination with the occasional English medical terms thrown in. She read through the EEG printout, looked over the MRI scans, did a brief medical history and then we settled in for a lengthy hour discussion about the results of the tests, what they showed and what they didn’t show. She called my other neurologist and they discussed the results and the prognosis. It was decided not the prescribe the medication for epilepsy at the time because of a lack of evidence that epilepsy was the problem and instead go with medication for a TIA with a two-week “kontrol” period after which I would return to the hospital for a follow-up visit to decide where to go from there. I was given a lengthy list of things to do and not to do – no motorcycles, no snorkeling, no heavy home repairs, less time on the computer, etc. Both doctors went over everything that had happened during the day in detail and made sure that I knew what I was supposed to do and why. Total cost for the day including the consultation with the second neurologist was approximately $325. So how does the experience rate in terms of the quality of the medical services and the costs?
I was continually looked after throughout the day; there was always someone – a doctor, nurse or clerk – explaining what was happening and why. There were some wait times for the tests and the results, but certainly no longer than I have experienced anywhere else in the world. The hospital facilities were modern, clean and organized with an efficient staff, some of whom spoke English quite well, others who spoke it passably enough for a non-Indonesian speaker to understand what was going on. However, as neither neurologist spoke much English, that would be a problem for many foreigners. This alone would give a foreigner a good reason to make a trip to Bangkok, Malaysia or Singapore for this type of testing. As I’ve been medivaced to Singapore for a TIA four years ago, I felt that the level of care was comparable with what I experienced at Mount Elizabeth with the exception that the doctors and nurses at Siloam spent more time with me discussing what was happening. The neurologists believe in taking a cautious approach to my problem and explained that because four days had gone by since my most recent attack, it was difficult to find the “trigger.” Medication and lifestyle changes and adaptions that were prescribed were similar to those given four years ago by the doctors in Singapore and Sumbawa. As always, I checked the medications online and found that they are commonly used for situations like mine.
That being said, If I wasn’t concerned about the necessity of follow-up care, I’d probably go through the hassle of leaving the country and flying to Bangkok in order to access the resources of a major international hospital like Bumrungrad that has more neurological specialists. But because of the possibility of needing follow-up examinations and care, I’ve found that Siloam is an excellent local option. My how things have changed over the past several decades, and, at least as far as healthcare is concerned, changed for the better.