Saturday, February 28, 2009

Nagoya City University Hospital

A few years ago, I needed some surgery that wasn't available on Saipan, so I was faced with finding a surgeon to undertake my care.  Part of the issue for me was that I wanted to get the care close-by, and being self-insured, I needed it to be cost effective.

My main four choices came down to Australia, Hawaii, Manila and Japan.  I visited one of the top surgeons in Sydney during a trip there, and I wasn't impressed.  I scratched Manila off the list pretty quickly.  I've had a fair bit of experience with patients going to Manila for care, and although one of the surgeons I've worked with there is good, I've found that in general, the delivery was not up to the standards I expect when sending a patient to a major medical referral center.  Sorry guys, but that's the truth.  I wouldn't go to Manila unless it was a last resort.  I'm sure many have had good experiences there, but seeing many of my patients return, I haven't been too happy with the quality of care they received.

Hawaii was an obvious choice because, well, it's US quality medical care.  The problems with US care is that it's expensive.  If I'd had the procedure in Hawaii, it would have cost me $10K.  If I had had insurance, my 20% co-payment would have been $2K, for an outpatient procedure.  So, I just held this option in reserve.

I started to look seriously at Japan.  In the world of medicine, Japan is one of the areas, along with the US and parts of Europe, that lead medical research and publish in medical journals.  I know the quality of care there is top-notch, and that the cost is reasonable.  I ended up finding one of the best surgeons in the world for my condition, and headed there for my surgery.  I was very happy with the quality of the care I received, and the cost was only $2K.  That included the surgery, and five days in the hospital, getting fed and watered.  The system of care in Japan is a little antiquated, and many expatriates in Japan complain about it for this reason, but as someone in the medical field and as someone who has experienced the care first-hand, I think that the care is on par with anyplace in the US, and even better than the US, it's cost effective.

After I returned, I tried to convince the powers that be to start looking at Japan as a place to send our medical referral patients from the CNMI.  It close, it's cheap, and the quality of care is outstanding.  It's taken a while, but finally the CNMI has a relationship with the Nagoya City University Hospital (NCUH), and we have liaison people on the ground to help patients navigate a foreign country.

Nagoya City University Hospital is an 800 bed medical center (CHC has 72 beds).   The first patient from the CNMI that went there was an infant, a few days old, who was on the way to Hawaii for cardiac surgery, decompensated while on the tarmac in Nagoya, and was taken to the NCUH where the pediatric cardiac surgeons did an outstanding job on a very complex surgical procedure.  Since that time, the relationship has deepened, and in the next few weeks, I hope to send the first ophthalmology patients there.  This should provide closer and less expensive care than is available in Hawaii, and  as high a quality of care.   I'm looking forward to using NCUH as a referral center.

Sunday, February 22, 2009

Truth, Death, Unity and Classroom Cataract Surgery

Because of my book, I was invited to give the keynote address to the University of Guam during their faculty development day on Friday.  I just shared some thoughts that were on my mind.  I think in some way, the points I raised had to do with some of the anchoring principles of my life.  It was also an opportunity for me to try out some of the stand-up comedy material I had been working on, and most of the jokes got laughs.  Here were my key points.

1.  "Truthfulness is the foundation of all human virtues.  Without truthfulness, progress and success in all the worlds of God are impossible for any soul."  Before I really started to think about this principle in my own life, I used to "fib" so much to avoid embarrassment or to stay out of trouble.  Being committed to total truthfulness required me to change the way I did a lot of things, but it was a liberating process.  It's a pain, and I feel I sell out pretty easily at times.  But it's still one of the key principles that I think everyone can benefit from.

2.  We're all gonna die.  Really.  Remaining conscious of this truth on a daily basis helps lend clarity to life.  This can be done by bringing oneself to account each day.  "Bring thyself to account each day, ere though art summoned to a reckoning, for death unheralded shall come upon thee and thou shalt be called to give account for thy deeds."

3.  The motto of UOG is "Unity in Diversity."  Unity requires that as individuals we refrain from faultfinding.  The process of higher education gears us toward "critical analysis" which makes faultfinding a natural way of life.  Faultfinding is an intellectual activity that is quarantined to one's mind.  But the real problems arise when we mention the faults of others -- when faultfinding moves to backbiting.  It's endemic in our culture, and there is a need to establish "no backbiting zones" around our mouths, and even our ears, so we don't participate in this corrosive force.

4.  Cataract surgery brings vision.  Teaching brings vision.

The faculty were appreciative of having a speaker who wasn't there with charts and numbers, and as someone said, "we're all human, and it's nice to remember that at times."