Tuesday, April 26, 2005

Life and Death in a Hong Kong Hospital

I can sometimes be called grumpy but I don't normally think of myself as threatening. Indeed, most of the time I am a rather genial, if slightly paunchy middle-aged guy. There are times, however, I wish I were more intimidating and one of those times was last night. But, before I tell you why this is so I must give you some background

My mother-in-law is dying a slow and lingering death from liver cancer, compounded by a series of strokes.

She can no longer move her left arm.

She can no longer feed herself.

She hasn't been out of bed in two months.

She is incontinence and on a catheter.

She wears a diaper.

She is loosing weight at an alarming rate.

It is physically taxing for her to speak.

She cannot even roll over by herself.

She has had a chronic ear infection for several years and is deaf in one ear.

She has cataracts.

My mother- in-law has open bed sores. Yet as far as I can tell the hospital does little if anything to treat them. They cannot or will not change my mother-in-law into a water mattress to alleviate the bed sores.

Despite the FACT that she cannot eat without help they have not placed her on an IV for even fluids, much less glucose. How hard would that be?

They never talk to her that I can see.

They don't help feed her.

They only change her when absolutely necessary and then they do not clean her well.

She has been in the Caritas hospice in the So Uk area of Hong Kong for just over two months. The hospitals in Hong Kong, even those like Caritas that are partially funded with non-governmental money are abysmal places. The staff, with some exceptions is uniformly rude and calloused to the point being un-professional.

I hope that when this life draws to a close for me I don't have to be confined in one of them. This whole experience has left a very bad taste in my mouth. A simple truth has intruded itself upon my consciousness. Socialized medicine is an evil. It is dehumanizing to the patient and the patent's family. The best that can be said is that it is a cruel joke. When the government controls the whole system there is effectively no higher authority to appeal to for justice.

Now the hospital wants us to put her into a nursing home because she has used up her allotted time in the hospice. So, in a socialized medical system it isn't about need it is about rationing. Don't you dare take longer than 21 days to die you evil free-loader you! I don't think they have a set amount of time that one can be in this hospice but they have a greater need than they have space. Because of that they try to limit the entry to the most severe cases. This principle breaks down when all the cases are severe.

Think of the description given above. Should the staff ask that a patient in that condition be moved to a nursing home? My wife has been asked several times, "When are you going to find a nursing home for your mother?" It has gotten to the point where she avoids the nurses because she knows what they are going to ask her.

Pardon my misconception. I thought that a hospital hospice for terminal cancer patients was an appropriate place for an old woman with a few weeks to live to go to die of liver cancer; especially since she needs constant supervision. Am I wrong about this?

They have suggested that we hire a Filipino maid, rent or buy a hospital bed and keep my mother-in-law at home. Would you as either the patient or family like that option? This is despite the fact that we do not have the room for either the mother-in-law or the maid in our apartment. Is a teenage maid from Manila a suitable health care worker? I understand that they have a waiting list. I do not think that simply shuffling people who need help out of the hospital to homes where they are cared for by domestic servants is an adequate answer to that problem.

I am not asking that they giver her care like a 5 star luxury spa-hospital. I do wish that they provided adequate care. I don't think that most patients in most Hong Kong Hospitals get adequate care if the situation is indicative of the whole system. Indeed, Caritas is doing a better job than the government hospitals such as Yan Chai or Princess Margret.

The promise of socialized medicine, espoused by well meaning politicians was adequate treatment for all. This is a promise that they have not kept. I could, quite honestly understand this if the whole medical establishment in Hong Kong were not run by the government. I cannot understand it when there is a socialized system in place. The government needs to either do the right thing or get out of the health care industry.

I am speaking of this because my wife had a late meeting and I went to the hospital last night (April 25) to feed this sick, feeble and dying old woman. While it is a good thing to do, the problem is that we HAVE to do it. If one of us doesn't go she doesn't get to eat. That is a different thing than saying I don't want to do it. There are just nights we cannot do it and, in truth, it shouldn't be our job anyway because the hospice should not be a self-serve hotel room but a medical facility. But, if we don't go then the hospital staff will let her dinner sit there until it gets cold and then maybe try to shovel a few bites into her mouth, if they have time, before they remove the tray.

She is dying of cancer but the way the hospital treats her you'd think we wanted her starved to death. Terry Shivio's husband would love this place.

On second thought, maybe a teenager from Manila could do a better job.

The feeding is hard for me because I cannot talk to her. She speaks only a somewhat obscure form of Chinese which I do not so there could be no conversation. I have nerve damage down one arm so feeding her requires using fine motor skills in my left hand which is difficult for me. Nevertheless, I went and spent three hours with her and fed her and brushed her hair and gave water to drink. She is my wife's mother; how could I refuse?

When I left the hospital I was angry. I simply feel that the level of care is so incredibly bad. I wish I were more intimidating. Perhaps then I could confront the system here. To do that I'd need Li Kai-Shing's money or Hu Jing-Tao's political clout; not much else really counts in Hong Kong. I have neither.

Perhaps instead, I'll just find somebody in the hospital authority that makes a bazillion dollar a month income doing essentially nothing except finding ways to avoid a well deserved pay cut or early retirement and punch his/her lights out. (For those not used to Americanism; to punch someones lights out is to beat them until they are unconscious) But then that would make me as evil as the people in the hospital authority that are more concerned about their huge salaries than actually running hospitals. So I guess I won't do that either.

Until next time
Fai Mao
The non intimidating blogger

Monday, April 18, 2005

Death and ......

Friday was the deadline for filing US Federal income taxes.

If you live overseas then you have until June 15 to complete the forms.

I find it absolutely repugnant that I must fill out tax forms for a nation that I do not live in and have not set foot in for nearly 10 years. The overseas income allowance is a joke. The complaint that the wealthy would use this as a way to avoid income tax is overstated as most of the people who live overseas are not wealthy. Indeed, a large percentage of them are missionaries and I've never seen a rich missionary. Don't get me wrong, I believe that people should support their government. I pay the income tax I owe in Hong Kong. However, I live in Hong Kong. I derive very little if any benefit from being a US citizen. Indeed, in some countries in Asia, rightly or wrongly, I pay higher visa entry fees and am a target of terrorist kidnappers simply because I carry an American passport.

The US needs to change this law. As awful as this sounds the US Congress needs to look at Canada. This is perhaps the only area where the sniffling, whinning, limp-wristed, socialist pig, cowardly beavers have a better law than the US. (Can you tell I don't much like Canada?)

The Canadian law works something like this:
If you are a Canadian citizen who lives outside of Canada and
you have no property in Canada, or a bank account, drivers license or Canadian ID other than a passport, or a residence in Canada and you spend at least 335 days outside of Canada then you do not owe Canadian income tax. Period, end of issue.

There are probably some tweaks I would give this with regard to IRA's and things but if Mr. Bush wants to reform the US tax code I suggest he start with this law.

Your over taxed blogger