Notes from the bed and breakfast

Discharged from the hospital yesterday and had an uneventful night in the local bed and breakfast that has served as Amy’s home for the past 10 days. Typically the first day or so out of hospital is difficult, or so I have always told my patients, because there is no one to provide for your needs and one is more physically active. Most of the time the patient is exhausted and even seems to take a few steps backwards. Although I am tired I do feel that the pain and mobility is improving steadily. Sitting up can be uncomfortable – after all they did create four holes in my lower abdomen. I am not ready for doing sit-ups just yet.

While it fresh on my mind I should share an observation of health care in South Africa. They are one of the few ‘westernized’ countries that does not have a national health insurance (guess the other). Private practice is thriving. My second day in the hospital I was somewhat surprised to be waiting in the radiology waiting room, assuming it was for transport back to my room following a CT scan with bladder contrast. In fact we were waiting for the bill which they handed me as they gave me directions to walk back to my room! Later that morning the pathology lab came to my room and asked if there was someone there who could come downstairs and settle my bill from the morning blood draw. Amy and I got the impression that one needed to travel the day with credit card in hand, sort of a pay as you go system. It was both maddening and funny. In some ways it makes sense from a business model point of view, collect while you can rather than run the risk of not being paid. Fortunately for us it turns out we just turned the bills over to the US Embassy Health unit. Seems they will pay, give me the bills, I will send to my insurance who will pay me and I will reimburse the US government. I am only liable up to my annual deductable. The actual care seems to be every bit as good as one would receive in the US.

Other noteworthy experiences include: patients are to bring their own pajamas, no one uses hospital gowns – kind of nice, less dehumanizing, but unexpected if one doesn’t actually have pajamas! Amy ran to the local store and bought me some; every morning at 4:45 am the sisters (nurses, not Catholic nuns) start the day with a hymn sing and prayer – nice, but perhaps a little early; tea is served three times a day, with cucumber sandwiches in the evening; and apparently infectious disease consultants are quite rare in South Africa, though I must say they might benefit (I was unable to convince the surgeon that oral levofloxacin is just as good as IV…some things are universal).

Thank you again for the prayers and thoughts.

Jim