The little bug found a new host in my little Estelle yesterday. She came down with a high fever in the early hours and had been coughing and sniffing just like her mom. While I'm nursing my own illness, I have to take care Estelle too. I need a break!
As we discussed whether to take our first step out of Singapore, a major concern was the kids' health. In Beijing, we chose an apartment near an international clinic. Chinese hospitals are almost always crowded and we weren't sure about the quality of care and medication they disburse. Although we speak Mandarin, the terms we and the Beijing doctors use might be different and we didn't want to risk communicating the symptoms incorrectly.
Before we left, we visited our GP and discussed the list of medications we should take with us. We stocked bottles of paracetamol (for fevers), cough mixtures, smecta (for diarrhoea), rehydration salts, among others. When we left for Beijing early 2006, Estelle was 3 and Jules 8 months old. Hey, we have already had a combined total of 4 years of experience.
Estelle tends to develop very high fevers whenever she is ill. Perhaps her immune system is fighting extremely hard but it's very scary when she peaks at 39ºC. During these times, no amount of paracetamol or sponging seems to work. If her temperature only falls down to 38ºC, it's time for me to take a break. For other kids, 38 is when parents panic.
Nevertheless, it is helpful to always have familiar medications at hand and I like to bring some basic ones even when we are just taking a short holiday. Pharmacies in other countries may not have the same medicines we have at home: they may come in different brands or different dosage or a completely different formula altogether.
In Singapore, paracetamol is often prescribed for fevers. Although ibuprofen seems to work better, it is more caustic and should be taken after food. In Finland, I was prescribed ibuprofen to bring down my fever and also for my inflamed throat. Today, Estelle was prescribed Naproxen for fever and inflammation.
Paracetamol (or other analgesics) is good to have to temporarily lower the temperature or relieve pain. Fevers usually mean that the patient is fighting an infection so if the fever persists for more than 2 days, it's time to see a doctor.
I find it complicated to self-medicate coughs, especially for children. There are some medications our GP wouldn't recommend for children under 3 years old, like codeine. Then we have to see if it comes with running nose, or phlegm, or wheezing, or how long it has gone on for... During these times, it is best to leave them in the hands of professionals.
Good and affordable healthcare is an aspect Singaporeans take for granted. Fees at government polyclinics is around S$10 or less and private GPs start at S$20 or so for consultation. In Beijing, consultation at the international clinics typically start at around S$80. When Estelle needed antibiotics and other medications, the bill came up to S$200. This was when we realised the importance of health insurance. During our first year in Beijing, we could only claim up to 30% of total bill. Now, our total expenditure is reimbursed. It makes a great difference to how we approach healthcare concerns.
We are thankful that our health insurance now covers all that we are charged. In Finland, consultations start at around €30 at private clinics and practically free at public clinics and hospitals, I'm told. The welfare system here takes good care of every one although some medications are still expensive. Like Jules' cough mixture which comes at around €30 per bottle, furthermore it is not subsidised by KELA, the social welfare department. Today, we spent €14 on two types of medicines.
In terms of healthcare - comparing the level of service and quality of medicines - Finland is actually more affordable than China.
The cost of a medicine is largely tied to its branding. A generic drug costs just a fraction of a similar one from a big-name pharmaceutical company. In Singapore and Finland, the quality of generic drugs can be trusted and generic drugs are commonly used by public healthcare services.
International clinics in China only use medicines made by branded pharma companies. I think this is to allay foreigners' fears about the authenticity and quality of the medicines. Not only do patients pay more for the brand, the clinics further mark up the prices since foreigners thought them to be "trustworthy" sources. They also know that expatriates are usually insured by their companies and cost is not an issue. My friends and I complain about the prices and competence of some doctors but where else can we go?
At Beijing's Vista Clinic (Kerry Centre), I find Dr Pauline the most attentive paediatrician. She tries to connect with the child and find out all symptoms. I think she's from the Philippines so it's easy to communicate with her in English.
When Jules had hand-foot-and-mouth and I showed similar symptoms, another doctor told me I was "heaty" and should take some Chinese medicines to "cool down". Adults don't get this disease, he laughed. It turned out that adults CAN be infected and I WAS ill. I've never had so many ulcers in my mouth all at once and it was really painful to eat or drink. I could fully empathise with my son, whose usual hearty appetite was curbed for over a week.
Many Finnish people speak English and the doctors I've seen so far were happy to discuss the condition of the patient and discuss the medicines they prescribe. Their open attitude is certainly very assuring for patients and parents like me.
Estelle took the medications before she slept and she has not coughed since. She is perspiring as she sleeps, which is a good sign because this means her fever is subsiding.
Hopefully, I can have a good rest tonight.
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