Fat in Singapore-my story

Posted on June 17, 2013 by Expat Bostonians

Recently I’ve had a number of conversations about fat-from the technical to the political.  But there’s also been a discussion about what it’s like to be fat in Singapore, and I’ve been asked to share my story.

I am fat.  This is a simple fact.  The baggage brought to this fact, however, isn’t so simple.

car

Me sitting on my first car in 1996

I’ve never fit the image of the perfectly thin female body type.  Even as a little kid, I was thin everywhere but for a tummy.  Until after I injured my back at 16 and stopped being active, the best description of my body type was stocky with a bit of extra fat around my stomach.  Looking back, I see a lovely young girl and young woman.  At the time, I hated my body-loathed it-because it wasn’t the super lean body of my peers.  Over the past 18 years since that injury my body type has gone from stocky to fat.  I’m not going to explain, justify, or pathologize that change.  I don’t owe an explanation for my body.

I could fill a thousand blog posts discussing my experiences from childhood until now that relate to weight, my relationship with my body, the psychological impact people’s treatment of me (from friends and family who genuinely care, but in their well-meaning comments) have hurt me and deeply impacted my self esteem, popular misperceptions about weight and weight loss and my body, and so forth.  But for the purpose of this post, we’ll pick up right before we moved to Singapore.

Screen Shot 2013-06-16 at 12.56.51 PMRavi, myself and Ellie, Singapore Zoo, Feb 2010

Prior to moving to Singapore, I read a lot of books and blogs about life here.  I knew, walking in, that Singapore isn’t the easiest place to be fat.  When we came for our look-see visit to Singapore, I did some looking and couldn’t find one plus sized store.  The British Chain Marks & Spencer carried up to a US 18 (UK 20) but that was too small. At the time, though, the only way that it affected me was to ensure that I bought a lot of clothes before moving here.

IMG_4641The first photo of me that I posted on the blog-E and I at Palawan Beach in SG, 2010

Over the years, I have mostly rejected the idea that my life would be better when I was thin, or that weight loss would make me a better/more worthwhile person.  So in my day to day life, I just can’t be bothered to worry about what others will think of my outfit of choice, or that I’m daring to be fat in public.

However, this is not to say that being fat doesn’t affect my life-in general and in Singapore.

I’ve gotten emotionally devastating comments from doctors in the US. Two days after losing my first pregnancy, my OB (at the time) said I’d never carry a pregnancy to term while fat-that I’d effectively killed my wanted pregnancy with my fat.  I still kind of want to show up at her office with my two girls and say “SEE!! F**K YOU!!”–that’s how much it damaged me at a fragile moment–that it still profoundly affects me almost 6 years later.

Knowing that doctors in Asia have the reputation of being extremely hostile to fat patients (and have a lower number than the west for what constitutes healthy), I avoided doctors as if they carried the plague here.  Until I decided to get pregnant, the only time I sought out medical care was when I needed antibiotics.  I made a point of finding a medical practice with expat doctors because I thought they’d be less hostile.  The irony, then, is that while it has taken a bit of effort (5 OB’s before I found one I liked) the doctors who have been the least hostile toward my weight have been Singaporean.  Not without exception, but the doctors I trust most today are Singaporean, not Western.

IMG_5385In the pool, 2010

I have a great deal of privilege in Singapore.  As a white expat, my weight may be unattractive, or even mock worthy, but there’s a perception that Westerners-and perhaps especially-Americans, are fat.  My local friends get far more crap than I do about weight for being a lot thinner than I am.

The reality is that I can buy clothes in the US and have them shipped to me–privilege.

I’m married, which means I don’t have to swim in the dating pool here.  From what I’ve heard, this would change my relationship with Singapore and my weight.

IMG_82232010-Photography Class

I’ve had a few encounters where someone has fat shamed or mocked me.  There have been  instances where a child has called me “fat” in a cruel or mocking tone.  I’ve had a cab driver try to give me weight loss advice. I’ve had a doctor or three strongly suggest Weight Loss Surgery without admitting that there were risks.  People here are sometimes/often blunt to the point of what Westerners would consider rudeness about all kinds of things-not just weight.

At the same time, these last three years have been a time of education for me.  While I’ve had a far healthier relationship with my body in the past 9 years than ever before, it’s only been the last few that I’ve begun to learn about the politics of fat, largely thanks to the writing of Lesley and Marianne on xojane.  This year has been a year of breakthrough for me in finally learning to separate the notions of weight and health, and have been introduced to the idea of Health at Every Size.

I think that my entry into fat politics was well timed.  Because while I haven’t experienced a lot of direct antagonism about my body, living in Singapore can be very damaging to a person’s self esteem.

20130612_104050One of a million similar signs

When it comes to Singapore, the most damaging aspects of being a fat person here is dealing with the everyday cultural landmines.  The thing about getting shamed/bullied by an individual is that (mostly-with noted exceptions) I can write an individual off as rude or an asshole.  A deeply entrenched social norm?  That’s far harder to distance yourself from, especially when there’s no counter voice to shout it down.

The photo above is from my gym.  My gym is also a spa that offers “slimming” services.  Slimming centres are huge here.  They have a big ad presences-even ads that wrap entire buses. These aren’t the equivalent of Weight Watchers or Jenny Craig, but centres that focus on slimming treatments like the one above.  If I want to hold a vibrator against my body, there are other places where it will accomplish a far happier result than against my stomach.  While I do roll my eyes so hard they almost fall out of my head when it comes to these centres (including the displays of slimming cream I walk by every day at the gym) I’d be lying if I didn’t say that they wear on a person.

I mentioned above that I knew that I wouldn’t be able to buy clothes in Singapore before I moved here, although it’s not quite true.  I underestimated the effect this would have on my psyche.  While I’ve been shopping at plus sized clothing stores in the US for years and my size has fluctuated, I’m not in any danger of being sized out of the ability to shop.  Department stores carry my size, and upscale department stores like Lord & Taylor carry designers like Michael Kors in my size.  Clothing sizes do vary country to country (I’m usually 1 size larger in the UK and Australia than I am in the US).   However, Singapore (Asia as a whole to my understanding) has radically different sizing–bluntly stated, I’ve been in a store with a 6x size and it’s still too small (I’m a 2x in the US).  I have friends here who are a Small/Medium in the US are an XL here.  The sizing differential is damaging to the point where I’ve gone from seeking out the few boutiques that carry “plus” sized clothes only to learn that their notion of clothing for fat people is barely plus sized in the US, or had a 6x not fit me to actively avoiding them because I know it will lead to serious body dysmorphia.

Screen Shot 2013-06-16 at 2.36.58 PMsource

Singapore does not have employment discrimination laws.  A job may legally require that you be a certain sex, age, nationality, or have a specific appearance.  A few weeks ago there was a an article that the government was “not ruling out” anti-discrimination laws…but this article implies that the only discrimination that they are considering legislating is to disallow hiring foreigners before Singaporeans. (There is legitimate criticism of nationality based preference, but that’s not the focus of this post).  Many applications require that you submit a photo as well as your CV.  Let’s not pretend that requiring a photo won’t weed out candidates for all sorts of superficial reasons, including weight.

Screen Shot 2013-06-16 at 2.56.38 PMsource

The above roast has men’s (larger) and women’s (smaller) portions.  Clearly this is not just sexist, but anti fat.  Yes, I’ve ordered the men’s portion and gotten the “look” because of it.  Because I’m transgressing sexual or weight norms? Your call-but mine is both.

Screen Shot 2013-06-16 at 3.01.32 PMFat and Happy in Singapore

So how to conclude my story?

I’d say overall I’ve reached a point of peace with Singapore.  When I get fat shamed it kind of blindsides me because I’ve made myself oblivious to it/have conditioned myself to roll my eyes at it to the point of desensitization.  I often find the sexism, racism (particularly aimed at foreign workers-maids and construction workers most, and all expats to an increasing degree) anti-gay sentiment far more troubling.  Yes, the entrenched sexism relates to fat bias.  Yes, the fat bias is aimed far more at women. But I’m far more worried by Elanor saying that “girls can’t do x” (which happened a few days ago and had me seeing red) than I am by someone insulting my weight.

That said, you may want to me to admit that other countries also have fat bias.  They do.  The US is no stranger to fat bias.

But one of the things that strikes me every time I go home is this feeling of my gut unclenching.  For while I may get fat shamed in the US, it is at least common to see someone who looks at me.  Most malls have a store or five I can shop at.  In Singapore I compartmentalize/repress/desensitize myself as a coping strategy to the point where I don’t realize how tense being fat in Singapore makes me until I feel that relief.

The key difference, I think, between the US and SG is that in the US there’s a community.  There is a fat activist movement back home.  The notion of Health at Every size is gaining traction.  When a professor tweets that fat people don’t have the willpower to complete PhD programs, it created a PR storm of anger and condemnation (including domestic and international coverage/condemnation of the remarks), as well as a response from the body acceptance movement in the form of a tumblr called FuckYeah Fat PhD’s.

My belief is that there wouldn’t be a huge backlash against a professor who said that here.  As an example about sexism as opposed to fat bias, last year a 27 year old PhD candidate asked the man credited with founding modern Singapore, Lee Kuan Yew, “Given the big influx of immigrants here in a short time, and a dilution of the national identity, what can we do to create a sense of belonging and foster social cohesiveness?”  LKY’s response was a discourse on how SGean women aren’t having babies, badgering personal questions about her personal life, and a warning about the declining quality of her eggs, ultimately telling her to get her PhD AND a boyfriend. (source–blog article quoting a newspaper article and critique)  While the national (government controlled) newspaper published a letter from AWARE (a local women’s NGO) text here, I went through many pages of google results without even one mainstream media article coverage of the event.  Most of the responses that I did find were that those who had an issue with LKY’s comments were making a mountain out of nothing at all (source).  Not exactly the same thing as fat bias, but a clear enough example to demonstrate why I don’t believe there would be any mainstream backlash for a comment regarding weight.

Would I leave Singapore over the fat bias? No.  There’s no utopia-not when it comes to weight bias, racism, sexism, homophobia, and so forth.  There are plenty of positives about life in Singapore, which I’ve devoted hundreds of blog entries to. Today I am pointing out a negative.

That said, due to the sensitive nature and high trolling potential of this blog post, I’m making the rare choice to close comments.  

Filed under: Assimilation, Culture Shock, medical, politics, Random Stuff, Singapore | Comments Off

Recovering

Posted on March 29, 2013 by Expat Bostonians

I ended up in the hospital again.  While my review of Mt. Elizabeth Novena does paint a fairly appealing hospital experience (as hospital experiences go), I wasn’t terribly thrilled to land back there eight days after being released.  I even ended up on the same ward (although in a different room).   Things went well for the first few days-I’d been religiously doing my PT and had even increased some of my PT exercises.  However, the side effects from one of my medications began to make life very unpleasant, and my orthopedic doctor took me off it.  This turned out to be a huge mistake, as 24 hours later I could barely walk and was in intense pain.  I was immediately re-hospitalized.

Screen Shot 2013-03-29 at 8.18.17 PMsource

The simplest explanation for what happened is that post tearing the disc (the purple bit between the bones in the picture above) I developed a lot of inflammation and swelling, which pushed on and irritated the nerve root.  In my case, this then resulted in intense pain down all the way down my legs, straight through to the toes.  Muscles in my legs would in turn spasm (if you were to put a hand on my leg just above my knee, you would’ve felt something jumping around, as if I had one of those aliens from the movie trying to burst through my skin).  My ability to walk was compromised to the point of needing a walker to get to the toilet.

We had to decide between trying injections of cortisol (a steroid) next to the nerve root and doing surgery (as the disc itself was bulging and pushing on the nerve–effectively the same surgery I had in 2006 on the disc below the one I tore).  Surgery is obviously a really major step, and I wanted to avoid the more challenging recovery if at all possible.  So we elected to go with the injections.  As I have a mild bleeding disorder, we had to bring in a hematologist and do some bloodwork to find out if I would need special medication to prevent bleeding in the spine.  So lots of delays, lots of painkillers to the point where I just couldn’t handle anything more challenging than the occasional facebook update.  I mostly watched a lot of video on my laptop and slept.

I finally got the injections on Tuesday, and turned out to be one of the 10% of so of special snowflakes who have a bad reaction to the injections.  Adding the fluid of the injection just pushed on my nerve more and sent my pain into orbit.  I had to be so heavily sedated that they put me on a bit of oxygen to ensure I was breathing adequately.

Luckily it was a short lived reaction and I woke up on Wednesday of this week feeling reasonably good.  (Reasonably good meaning there was constant dull pain, but not sharp pain.)  We were able to manage my pain using only oral medication and without additional doses/supplemental injections/etc.  I was allowed to come home yesterday.

At the moment I’m home, and I’m on a lot of medication still.  I’m only allowed to walk for 5 minutes at a time (followed by mandatory resting of at least 45 minutes).  I’m tired, but my sleep schedule is (unsuprisingly) very chaotic and messed up.  My in laws are taking good care of us, and when they leave my mom is going to come to help, so I have lots of support.

Right now I have about 75% odds of not needing surgery.  With diligent PT, not pushing myself too hard too fast (something that may have contributed to my relapse this time), and a bit of luck I’ll be able to rehabilitate the injury.  Once our support goes home (late May/early June) I’ll be putting Rhiannon into daycare for part of every day to allow me to continue my rehabilitation process.

Yes, we have considered hiring a maid.  It is an option I’m grateful (sort of) to have on the table, but one I am deeply conflicted about, and would prefer not to need.  Luckily it is a decision we don’t need to make for a few months, and a lot can change in a few months.

Posting is going to be a bit scattershot depending on how blur my medication is making me on a given day and my rehabilitation schedule.  Please bear with me.

Filed under: Acts of Supreme Clumsiness, headdesk moments, medical, Singapore | 10 Comments »

Mt Elizabeth Novena Hospital

Posted on March 15, 2013 by Expat Bostonians

Last week when I injured my back, I headed to Gleneagles Hospital, which is the closest hospital to my condo.  Once it became clear I needed to be admitted, though, I ended up at Mount Elizabeth Novena.  Mt. E Novena is a sister hospital, and was the only one with a private room available.  Strange as this may sound, I loved it and not just because I was very high on painkillers.

Screen Shot 2013-03-15 at 3.31.19 PMsource

Mount Elizabeth Novena (which I’m going to abbreviate to MEN) is a really new hotel-less than a year old.  According to their website, it’s the first new private hospital to be build in 30 years.  It is the first hospital in SG to have only single rooms-206 standard single rooms, 37 deluxe rooms, 8 junior suites, and 3 regal suites (plus some day surgery beds and ICU).  I don’t think I have to sell anyone on why a single room is preferable, if you have a choice in the matter.

MEN’s approach to creating a new hospital is the somewhat cheesy, if accurate, idea of a hospitel–a cross between a hospital and a hotel.  I’d mock it, except that half the time that I mentioned my hospital, I would slip and call it my hotel or my hotel room.

MEN amenities

For one, the bathroom comes stocked with Crabtree and Evelyn “La source” products-shampoo, conditioner, mouthwash, and bodywash.  They also provide you with a hairbrush (a pretty decent one, actually-I forgot mine and my hair was really tangled–it was strong enough to actually get through the tangles, which is better than most hotel furnished ones will), a tooth brush and toothpaste, and a few other amenities I didn’t take advantage of.

The bathroom itself is large.  The shower has bars if you need help standing (as I did a bit) and a seat if that makes showering easier.  Lots of hot water.  They provide you with washcloths, hand towels, and bath sheet sized towels (and there’s a hamper under the sink for them when you’re done).  There are several emergency pull strings in case of an accident or need for help.

My room was very large.  There was the bed, a very large sofa, which if you removed the back cushions became a proper bed.  There was a chair by the couch.  One wall had a counter running the length of it which also served as a desk (with a chair) as well as counter space for your stuff.  There was a large wall mounted flat screen tv (which in theory also had internet connections-I never turned it on, preferring my laptop).  The room had a safe (which I didn’t use, but noted).

The two nicest parts, I thought, was that there was a built in fridge behind a door (it’s actually a minibar, but you can take out their stuff and put your own stuff in, which I did), and the internet speed.  They have extremely fast wi-fi, which was awesome.  It was actually fast enough that I was able to download some movies and tv off iTunes to keep occupied.  My only issue with it was that it occasionally just stops and you have to reconnect, which only really became a hassle when I was trying to skype (it would shut off and I’d lose the connection).

MEN hallway

The doors to the room are soundproofed so you don’t get ambient noise.  As most people kept their doors closed, it also made walking through the halls (part of my back rehab plan) a quiet and pleasant experience.

In terms of service-they have a wide menu but I didn’t want any part of anything on it.  Although there are western options, they are more European than American.  There’s a cafeteria, which Ravi told me was more of the same kind of fail (no sandwich bar, no pizza bar, etc).  Apart from that, there’s only a Starbucks in the hospital.  Luckily it’s across the street from Novena Square (which connects to Velocity and is a quick walk from United Square) and Ravi kept me in American food between delivering food to me and supply groceries from the Cold Storage at United Square.

They also have “butlers” who were sweet enough to get the crazy ang moh pitchers of ice water instead of the “healthier” warm water that is standard.  They also delivered a Straits Times Daily.  The ladies who cleaned the rooms were also all sweet-there were two ladies who did our floor and I chatted with them about their kids and mine (who were of similar age).

MEN nurses

The nurses were also a bunch of sweethearts.  They were quick to respond to a call, but tried not to impose too much, allowing patients their privacy.  Once they met my girls, they asked after them and made a point to say hello when my own little Nurse Ellie took me for my walk through the halls (sometimes accompanies by the mini-nurse Rhiannon and their Dad).  They were quick to dispense pain meds when I needed them, and let me delay the same pain meds as I began to heal (rather than insisting they stick to a strict schedule with them).

The only real complaint I had is that the billing department didn’t really seem to have their act together when it came to contacting my insurance.  We were told there were delays in getting reports, and then they needed my signature, but didn’t realize it, and so forth.  I was on the phone back and forth with my insurance agency a LOT trying to figure out what they needed so that they could send the promise of payment.  Further, the billing department didn’t seem to have an accurate understanding of my diagnosis and the estimate they gave Ravi was more than double what my cost actually was.  But things seemed to be settled by the time I left, although I still need to check with our insurance company to make sure that everything was properly submitted and paid for.

Overall, I’d say that my stay was as pleasant as it could be.  Obviously, I was in a lot of pain, and I wish I hadn’t had to be hospitalized at all.  I’m going to have an ongoing relationship with the hospital as I’m there 3x a week for physical therapy right now, and I’ll be following up with the orthopedic doctor regarding treatment for my back as the healing process begins.

I’m not in constant pain anymore, although my range of motion is limited and my stamina sucks.  I can walk, but I can’t pick up stuff–even my purse (having lightened it and everything) is a bit heavy at times.  I’m not allowed to pick up either girl, even just to pick up Rhi to change her diaper.  Ellie has been a huge help-I can’t really bend down and look for stuff, so E has gotten my shoes, retrieved stuff out of the fridge and so forth for me  My in-laws arrived yesterday and will be here as long as we need them, which is a huge relief.

It’s difficult and frustrating to be so limited, but I know from experience that it is crucial I take care of my back.  I had back surgery in 06, and the disc that is damaged now is the disc directly above it-both are now totally degenerated.  I know that if I push too hard too fast I’ll just end up right back in the hospital, and if I don’t take my recovery seriously I’ll likely further damage my back as well.  So I am going slow and steady and following my doctor and pt’s advice.

At some point I’ll talk about how insurance here differs from the process of insurance and such in the US, but I’ve been thinking a lot about my assimilation series and I want to get back to that for now.

Filed under: Acts of Supreme Clumsiness, Expat to Expat Advice, general places, medical, Random Stuff, Singapore | 1 Comment »

Home Tomorrow

Posted on March 11, 2013 by Expat Bostonians

Good news-I get to go home tomorrow (Tuesday).

I want to take a moment to say thank you.  People have reached out via twitter, facebook, email, comments here on the blog, and text to say they care and to offer help.  I’ve not been lonely in my hospital room with friends visiting and brightening up my days. Ravi and the girls have been supported.

Last year I wrote a post talking about how I felt like we’d become part of a community here in SG.  Over the last week I’ve really seen how that community pulls together in times of crisis.  My family has been very loved and supported over the past (almost) week by our community-the online community, the Singaporean and the international community.

Thank you.

Filed under: medical, Random Stuff, Singapore | 2 Comments »

Hi from the hospital

Posted on March 9, 2013 by Expat Bostonians

If you follow me on Twitter or on Facebook you already know this, but….

Screen Shot 2013-03-09 at 12.14.23 AM

I’m in the hospital with a torn disc in my spine.  I had surgery on one disc about 6.5 years ago, and that has been a problem area for me since 1996, but this is a new disc altogether.  You know, just to be different and shake things up.

Out of nowhere (from my perspective) as I was bending down to put Rhiannon in her stroller on Wednesday, it felt like two things happened at the same time-as if a person wearing brass knuckled punched me in the small of my back and as if a rubber band snapped inside my spine.  I would later find out from my doctor that this was the moment the disc in my spine tore.  (If you’re a medical type, it’s the L4/L5 disc…the one that was operated on was L5/S1)

I managed to get my kids home with some help from Ellie’s teachers at GUG (putting the girls into their car seats, my stroller into the car and so forth) and a new vocabulary of swear words as I drove.  Each time I hit the gas or the brake, a starburst of pain would explode from my back up to my shoulders, around my hips and down my legs to my toes.  It was super fun, but easier than dealing with a cab at that point.  I got the girls upstairs and deposited Rhiannon in her crib, where she could be safely contained.

At this point, having had back injury stuff since 1996, I knew several things.  I knew that the problem was in the same general area as my compromised/operated on disc.  I knew that the pain was severe enough that it was serious.  I knew I was probably going to get an MRI and likely get admitted to a hospital.  I knew that my lift limit had just reduced from 25 lbs to 10 (at best) and that Rhiannon is 17.  Picking up Rhi was potentially going to damage my back further.  I also knew that it was impossible for Ravi to get home at that moment.  So I did what I could to pacify and keep the girls safe (Rhi-milk and a nap, Ellie-snack and her ipod/tablet/crayons and asked her to be in the room with Rhi so Rhi wouldn’t get lonely and cry).  I iced my back for an hour and then did heat.

Luckily, my friend Claire was able to get there a few hours later (although toward the end before Claire got there the only thing I could do to keep Rhiannon from sobbing inconsolably was to stand next to her crib holding the iPod, showing her Elmo’s world) and she was able to pick up Rhi and feed her.  Our new sitter arrived at 6.  Claire took me to the hospital and stayed until Ravi had come and I’d been seen.

Had the MRI at Gleneagles and then was transferred to Mount Elizabeth at Novena.  This hospital was build a year ago and it’s the best hospital in SG-if only because the wi-fi speeds are AMAZING.  Also, it’s gorgeous and I keep calling it a hotel by mistake, so there’s that.

I’ve been here since Wednesday night and will hopefully get out Sunday. Rehabbing the back will mean weight lifting restrictions for 6+ weeks (including no picking up Rhi), intensive physiotherapy (including how to protect my back when doing mom stuff like putting a baby into a stroller), swimming, and time.

I’m a bit too blur on painkillers to write anything serious or cohesive.  But maybe I’ll try to get something together in the next day or so.

Send your happy/well wishes thoughts to Ravi, who is home with the girls on his own.  Even once I’m home, he’ll have to be here until my in-laws arrive (and I’m deeply grateful for in-laws who can drop everything and come help) so pretty much next week.  He’s a great dad, but of the two of us, I’d say he’s having the rougher time of it than I am.

No, we’re not getting a maid (although I considered it-and that’s a whole other post).

Filed under: Acts of Supreme Clumsiness, medical, Singapore | 6 Comments »

Expat Wife = Easiest Job in SG?

Posted on December 10, 2012 by Expat Bostonians

The easiest job in Singapore has to be expat wife.

The quote above showed up in the @hellofrmsg twitter feed earlier today (a person the account follows, not a specific comment to the account).  As I am an expat wife, I wanted to address this comment, but I knew it would take more than a series of tweets to do a fair job of addressing both the truth and the misconception of this comment.

First I think it important to note that the comment, and this entry address the life of expat wives in Singapore.  As my mother in law, and my friend Emily can attest, being an expat wife in other countries (the US and Japan respectively) is an entirely different ballgame than what I’m experiencing.  This entry is also based on my experiences, those recounted to me by my friends, the assumptions I’ve dealt with both here and back home, and does not necessarily accurately reflect every expat wife’s experience in Singapore.  However, this is the only point of view from which I can address this topic.

I’m going to try to address this without getting defensive, although I think it understandable that my very first reaction was to feel defensive.  Let’s hope that I can do it justice.  Please let me say as clearly as I can–at no point am I trying to evoke pity for the plight of the expat wife.  I hope only to promote understanding of what it is like to be in my shoes.

An acknowledgement of privilege.

I think that before I can address the assumptions inherent in the statement that “The easiest job in Singapore has to be expat wife” that I find problematic/troubling, I have to address the parts of that statement that are absolutely true.  I have to acknowledge the privileges inherent in being an expat wife.

Although not universally true, it is true that most working expats are compensated at a higher rate than locals. 

There is a lot of anger directed at foreign talent, and at expat wives for this privilege.  This anger is understandable, and absolutely in need of addressing by all parties involved.  I will say that my husband is well compensated for his work.  However, he is not the person who placed the numeric value on his job skills, nor is he the person who elected to hire him.  He applied for and accepted a job.  We have no knowledge of whether there was a local applicant for the position, or how they were evaluated in relation to Ravi.  The companies doing the hiring need to disclose what it is exactly that has them seeking out foreign talent–if local talent can be hired more cheaply, there isn’t a lot of logic in hiring an expat at a higher compensation.  If there are skills that they are looking for that local education isn’t providing, the MOE needs to address that.  But while we personally are not responsible for this trend, Ravi and I are participating in it, and our/expat ability to pay higher prices is partially responsible for driving up cost of living (among other reasons—expat wealth is not solely responsible for a cost of living increase).

Please do keep in mind that these interpretations of the tropes and perceptions of expat wife-dom are again based on my own incomplete understanding.  Please do educate me further about the assumptions behind this statement.

Due to our husband’s financial compensation, many expat wives have the option of staying home.

As an expat wife, I do have the luxury of being a stay at home mom.  This is not a privilege many/perhaps the majority of local moms share in.  Some local moms, like my friend J, have been lucky enough to have generous maternity packages.  But she is returning to work in part for financial reasons (and in part for personal reasons, including feeling fulfilled by her work).  This tension between stay at home moms and moms who would like to stay home but do not have the resources to do so exists in many cultures, including the US, and is not unique to Singapore.  However, expat wives are a visible symbol of this privilege and the frustration and resentment is understandable.  However, again, I don’t set policy for Singapore.  Singapore does not have the most family-friendly hiring/working/firing conditions for moms OR dads, and that is something I know that many are working to address.

The other truth that is inherent in my (and other expat wives) can afford to take extended vacations.  When my best friend Kate got married last August, I took the girls and went to the US for almost the entire month so that I could be there for the last bit of planning and to host the bachelorette party.  Before Ellie was in school/I had Rhiannon, I would often turn my husband’s two week trip home to the US into a month-long trip for Ellie and I.  I could, I suppose, take the girls on vacation without Ravi, but apart from going back to the US (where I have my in-laws, parents and friends for support) it’s not much of a vacation.

But our ability to do this is enviable.  Before I married Ravi I wasn’t in the financial position to afford regular vacations.  My family didn’t have a lot of money, and I was 20 before I ever flew in an airplane.  Growing up, I was jealous and envious of my friends who did get to go to Disneyland or to exotic places like California (I grew up on the other side of the US in Massachusetts), much less to places like London.  I dreamt of visiting them, but doing so was out of my reach.  I didn’t marry Ravi for his income, but I’d be lying if I didn’t openly admit that the income has increased my standard of living exponentially.

Expat wives sit around and shop on Orchard Road while everyone else does all the work.

The most common trope of expat wife-dom that I’ve seen is that we shop on Orchard Road, get pedicures, and gossip with other expat wives while our maids take care of our children and our homes.

Some of this is absolutely true.  I’ve met expat wives that fit that trope, and there’s a reason I’m not really friends with most of those women–we have very little in common.

But while I don’t fit that exact profile–I don’t often shop on Orchard Road (apart from Kinokuniya books at Takashimaya and occasionally Jasons’s Marketplace), and I don’t have a maid (anymore), there are assumptions in there that are true.  I am lucky enough to be a in a position to have a cleaning service, and I have a twice weekly babysitter.  I like a good pedicure (although I think my last one was over six months ago–babies and pedicures aren’t necessarily compatible).  I like to hang out with my friends–expat AND local.

More to the point, the assumption speaks to perceived luxury.  It is true that I have the resources to shop at more expensive grocery stores (although I definitely don’t have the buying power to even walk into Louis Vuitton or Prada).  I could hire another live in maid if I wanted to–and that I have the option of hiring a cleaning service that is more expensive than my live-in helper’s wages (although not wages+food allowance+taxes, I believe, although that’s not the point).

Growing up without money, I was frustrated that others seemed to get things so much more easily than I did.  I’m 90k in debt because I had to take out a lot of money to pay for my bachelor’s and master’s degrees.  Although as a teacher I was compensated at about the median income of the US (50K USD),  I had no ability to afford a home in one of the most expensive housing markets in the US–I was looking at a lifetime of renting.  If I had married another teacher, we would have needed loans to pay for our children’s education.

Expat wives expect Singapore to accommodate them, and not the other way around.

I hope that most days this doesn’t apply to me or my friends.  But it is true that it applies to some.  To this I can only say that there are assholes in every walk of life–be they expat wife, cab driver, teacher, or sales clerk.  And there are days it applies to me, when I am the asshole (I share a day like that in this entry).

We get to live abroad, and that is a rare privilege.

Living abroad at all is a rare and wonderful privilege.  We (including myself) often lose sight of that in our day to day lives.  This is a million miles (figuratively) away from what I expected my life to be at 34.  Living in Singapore as an American is one of the easiest places I could live–I speak the local language (sort of-see this entry for an English/English FAIL), foods that are familiar to me are easily available, the water is clean, the schools are good, and a thousand other things I likely take for granted, when compared with being an expat in another location.  To be fair, my only other experience in living abroad was that of a student living with a host family in Aix-En-Provence, France when I was 20 for one month-where again, I more or less spoke the language (sort of-in a grammatically deficient form), I had my housing and food largely provided, and I didn’t have to work.

Further, I get to participate in daily Singapore life in a way that Ravi doesn’t.  He works a ridiculous amount of hours.  He works in Singapore, but only gets to be part of it on weekends.  And that’s just not the same experience.

Addressing the problems/troubling aspects of the statement

Now that I have tried to address the truths of the statement, I’d like to address the problems in it.

The conflation of expat with the words wealthy, white, and Western.

I know a number of expats.  Not all are western-my friend Y is from Indonesia, and she’s technically an expat wife.  Not all are white-my friends W, M, J, A, and P (P blogs as Notabilia) are western expat wives, but are of Asian extraction, not Caucasian.  My friend E is both white and western but not wealthy.

This assumption that expat=white is really problematic.  My non-white friends have all shared experiences where a different set of expectations have been placed upon them because people assume they’re Singaporean, or think that they should fit a different set of stereotypes.  I see this trope constantly–an example from twitter is the question of “what salon is good with expat hair?”, and I recently received a media request to help them find “expectant expat women” who were using “local medicine” for a reality program–a request I correctly interpreted to mean that they wanted some white blonde girls who were using TCM for prenatal care to be a spectacle on a western show.

Obviously terms like “expat” and “American” are universally problematic because few people fit stereotypes (or fit them completely).  But I think that when we’re addressing a comment like “the easiest job in Singapore is expat wife” it is important to draw attention to the stereotype being addressed.

I’d also like to add the assumption of straight, but the truth is that if you are an expat wife in Singapore you are either bisexual and married to a person of the opposite sex (such as me) or you are straight.  Which is a whole other topic to get into another time (the heteronormative aspects of life in Singapore that I struggle with).

The assumption of a certain lifestyle

I know a number of expats.  None of us (American or otherwise) are members of our nationality based “club” (the American Club, the Dutch Club, the British Club and so forth).  Roughly only half have maids.  Most of us are stay at home moms–but we are involved, hands-on mothers.

Very few people come to Singapore on “expat packages” anymore.  Ravi has what is called a “local package.”  His company paid to relocate us, and put us up in a temp apartment for one month.  That is it.  We don’t get a housing allowance, or a school allowance, or any of that.  Which is not to say “feel bad for me”-I’m just sharing that the financial/corporate support is very different from 10 or 20 years ago.

What I’m getting at is that few of us have the lifestyle imagined.  Which brings me to my next point.

Statements like this only serve to push expats and locals further apart, rather than help us connect.

I am deeply grateful for my expat friends, American and otherwise.  Being an expat is a unique experience, and it helps you get through the day to know that some of your friends understand the parts with which you struggle.

I am equally grateful for my local friends.  Kirsten, J1, J2, J3, M, D, and my many local friends whom I’ve only met on twitter or via their blogs (such as Singapore Actually) are vitally important to my day to day survival in Singapore, probably more than I can ever express to them.  I am a stranger in a strange land, and they are my guides.  They’ve advised me where to find stuff, what restaurants they enjoy, recommended pest control services and dry cleaners, and they are my first line of information when I just don’t understand something.  I know they will be the people who will help me navigate the confusing process of getting Ellie into a local P1 class when the time comes.  And just as there is no universal expat experience, they have a wealth of different experiences that help me form a better, multidimensional view of the topic we’re discussing.

However, finding local friends isn’t easy.  You can’t just walk up to someone at a store or on the street and ask them, “will you be my Singaporean friend?”  In my case, social media (my blog and my twitter particuarly) and people who were willing to reach out to me were my entry to friendships with locals.  If I weren’t a social media/internet sort of person, it would be hard to find local friends.

There is an assumption in both the local and the expat communities that they are “other” from ourselves.  Statements like that only build resentment and further firm that assumption.  As an expat wife, I want to be defensive.  As a local, I might feel a twinge of resentment.

But the truth is that my local friends and I have a lot in common.

Those of us who are moms want the best future for our children.  We love them, and want them to turn into wonderful people.  We might feed them differently, or discipline them differently, but we all share the same end goal.  We like food.  We like many of the same movies.  We support each other when we’re having a bad day, and provide a shoulder to cry on.  We step in and pick each other’s kids up from school if someone is going to be late.

My friend Kirsten and I share a love of Broadway musicals.  We have a similar snarky sense of humor and I’ll miss her snark during the New Year’s Eve show, as she’s currently abroad in a graduate program.

I’ve been lucky enough to attend a local friend’s wedding reception, and another friend invited us to her home for Diwali.

I would love it if every expat had a great group of local friends.  Maybe we’d have less animosity if they did.

There are often things that aren’t easy about being an expat wife

Let me again reiterate that I am not seeking, nor do I deserve, pity.  I have a great life.  But there are things that are less easy here than they would be in my home country, and my purpose in sharing those here is to shed some light on the parts of being an expat that aren’t part of the public discourse in the same way that the parts of our life that are priviledged are.

  • It isn’t easy to be 10,000 miles away from my closest friends and family.  Yes, I skype, tweet, blog, and facebook to stay in touch.  It doesn’t make losing a relative but not being a position to fly home for the funeral easy.  It doesn’t make missing out on friend’s weddings easy.  It doesn’t make them missing out on being a daily part of the girls lives easy.  it doesn’t make days where someone posts “who wants to go to X” on Facebook and I want nothing more than to go to X with them, but can’t because I’m on the other side of the world easy.
  • It isn’t easy to learn how to navigate the ins and outs of daily life in Singapore, especially the parts that you think SHOULD be easy.  I had to learn how to use a washing machine and dryer again.  I didn’t know what to do when we lost power, and I was frustrated because it seemed like such a basic thing to know.  For that matter, I didn’t know how to call an ambulance…something that became vitally important when I was laying on my floor with a broken leg.  These moments of confusion, especially the longer I’ve been here are extremely frustrating because I feel like I *should* know how to do them.  But they’re not situations that your “moving to Singapore” guides or seminars cover.
  • It’s not always easy to explain your life to your friends back home.  Some parts are just so mundane–I take the kids to school, I do grocery shopping, I drive.  Others are weirdly different–the country is smaller than my home state (which is a small state to begin with), and I’m still not used to the nonstop heat.  But then there’s the middle ground–stuff that’s too mundane to be interesting, but not exotic enough to be interesting either–such as what it’s like to hire a handyman and navigate a home repair (we don’t have the 150 dollar deductible/then hire a handyman yourself dynamic back home).
  • It’s definitely not easy to have a maid.  I’ve written pretty extensively about this (20 posts).  But let me boil it down to some essentials.  For those of us who come from cultures where it isn’t the norm to have live-in help are ill-prepared to be effective managers of live-in help, and the MOM “training” just isn’t adequate.  There are major cultural differences.  Having a stranger live in your home, especially if this is an abnormality for your home culture is problematic.  Having a maid didn’t just fail to work out for us because she stole things from us (although obviously, that was an issue), but because I sucked at being a maid’s employer.
  • It’s not easy to raise third culture kids.  If I were raising them in the US, I’d have a lot of understanding of their day to day experiences, inasmuch as any parent has.  Raising the girls in Singapore means that they are having a radically different childhood from our own.  Which is partially the point.  But it isn’t always easy to navigate how to parent them in a way that supports their growth and respects who they are/how they identify when you don’t necessarily understand their experiences.  For me this is compounded by the fact that my children are biracial, and no matter how much I learn about Indian culture-I’m not Indian, I’m not a person of color and I will never completely understand their experiences.  Something I plan to write about is that when I was filing my police report on losing my purse in Vegas (Oh yeah, I need to share about that too), the officer asked me what race my children were and when they didn’t have biracial or “other” she asked me “what do they look like-white or asian?” and used that, to my extreme discomfort.  It’s not easy to support a child who is learning Mandarin (which I’m so excited by) when I can’t read the weekly summary of what they’re doing in Mandarin class (because it’s written in Mandarin), I can’t speak the language to help her gain vocabulary, and as she ages I can’t support her homework.

Some final thoughts

I didn’t write this post to attack whoever first said that “the easiest job in Singapore is that of Expat Wife.”  I always meant to address being an expat during my week as curator on @hellofrmsg and this was an entry point to do so.

Filed under: Culture Shock, customs, Expat to Expat Advice, Helpers, Housing, Identity, medical, money, Singapore, Third Culture Kids, With Kids | 23 Comments »

500

Posted on May 19, 2012 by Expat Bostonians

This is my 500th post at Expat Bostonians.

I began the blog on March 8th, 2010; 2 years, 2 months and 9 or 10 days (depending on how you count the time difference) ago.  A blog seemed like the logical way to keep our friends back home apprised of what life here in the Lion City was like.  Before I moved here, the only things I knew (or thought I knew) about Singapore was that some American kid had gotten caned here when I was in high school, and that chewing gum was illegal here.

In honor of my 500th post, I thought I’d share some of my favorite posts in chronological order.

2010–Lots of factual posts (what does the money here look like), not a ton of introspection.  I think I was so busy taking in Singapore that I couldn’t really process it.

Our look see visit to Singapore — This is a favorite post because it’s my baseline.  It contains my first photos and impressions of Singapore.  This is a post I look back at to see how far I’ve come.

Awkward–My first post about hiring a helper.

4th of July, Singaporean Style–Our first big American holiday spent in Singapore, and a favorite memory to this day.  I’ve loved the American 4th of July event both years we’ve been here, and I’m looking forward to our third in a few months.

Palawan Beach–Our first visit there, and contains some of my favorite photos.

Thailand, Part 2–Describes one of the coolest things I’ve done in Southeast Asia-the Siam Safari in Phuket.  A 6 hour adventure that tried to balance eco-tourism with preserving culture, and the struggles that come with it.  I’m a nerd, so learning on vacation=YAY.  Also-BABY ELEPHANTS! Extremely long entry, but one of my all time favorites

Christmas out and about in Singapore–I was totally thrown by stores being open and seeing Christmas treated as just another state sanctioned holiday.

2011-I got to know more people and began to really participate in the blogging community here.  I started writing posts that tried to get to the why instead of the what.  WHY were things the way they were instead of a book report.

Happy (sort of ) New Years–I live tweeted the NYE special with Kirsten and this post shares some of the highlights. Sort of New Years because it was 2011 in Singapore but still 2010 in Boston.

Skin Whitening…it’s a “thing” here–One of the first posts discussing my discomfort with the way whiteness is idealized here.

Having a Maid…the bad and the ugly–Singapore practically expects you to have a maid, but few people talk about the negatives.  This post explored the negatives both from the culture clash perspective and the issues within Singapore itself (the racism and abuses).

What do I do when the power goes out and other questions I forgot to ask–just when you think you’ve figured out expat life, something happens to totally upend your sense of comfort.

Hong Kong-Goldfish Market and Street Markets–On our child-free vacation in Hong Kong, Ravi and I visited the Goldfish Market in Hong Kong and it was another really memorable vacation moment.

Bad Expat (Part 1-ur doin it rong)–In which I explain all the ways I suck at being an expat.

Seth Rogen talks about Singapore–and SG isn’t happy–this was the first time I felt like I could explain and understand both sides of a US/SG critique and conflict of humor.

Things you don’t see/hear in Singapore–After a trip home, I began to realize there are some things I never see or hear in Singapore

Maids, Cultural Expectations and the Importance of Modeling (expat to expat advice)–A post that really talks about the cultural issues (small and big) that come with having a maid.

Pink Dot 2011–I was so proud to be at Pink Dot (an celebration of all love, particularly LGBT love and the only pro-gay event in Singapore) last year, when Google stepped up as the first ever corporate sponsor.

A negative experience at a doctor’s office and maybe some news–It feels strange to put such an angry post on my “favorites/top” list.  However, I think it is well written and it clearly articulates an issue I’ve had repeatedly with older male doctors in Singapore-being condescended to/spoken to as if I were my 3 year old.  As an expat, you have to constantly negotiate cultural issues, and, in general, it is best to learn to bend and to be flexible.  However, it is also okay to have lines that you can not, under any circumstance, cross.  This experience was one of them.

Our second 4th of July in Singapore-Our second, and equally memorable 4th of July in Singapore

My tale of laptop woe grows–I take my laptop to a certified apple repair center, tragic hilarity ensues

Comparing Singaporean and American Pregnancy Guides–After having a baby in the US, I wanted to read a local pregnancy guide to figure out how the approach locally was different.

My first name is not Crystalann–I like the post more because of the really interesting conversation it inspired in the comments section about names and culture.

Validation-The post I wrote after my first fiction short story acceptance

Santa Cruz Boardwalk-A wonderful day with Ellie on vacation.  Ravi was sick, and I was pregnant, so it was one of our last big adventures just her and I before the baby arrived.  I also love the pictures.

Why I didn’t want to be in the US on 9/11-On the 10th anniversary of 9/11, I was in the US and I was reminded of many of the things I don’t like about being an American, and why we have such a bad reputation abroad.

Just WHAT is in those 8 suitcases Part 1 and Part 2 –A photo essay of the kind of nonsense we bring back to Singapore from home.

Prenatal care in the US vs Singapore–Shh, don’t tell anyone, but I might like Singaporean prenatal care better.

Rhiannon Arcadia-I got to announce and post a picture of my newly born 2nd child.  Of course it’s a favorite.

An American Halloween in Singapore–We go trick or treating!

Happy Birthday Elanor–her 3rd birthday post

Slutwalk Singapore 2011–I took the girls to slutwalk because I want to raise them to be strong independent feminists.

Wicked Green Carpet and Gala–I won tickets to the black tie gala premiere of Wicked in Singapore.  My friend Kirsten and I and our lack of social skills went…hilarity ensued.

Oh Christmas Tree—We had a great Christmas Tree, until the cats went on the offensive

Disconnect-Firing B was not a highlight of my blog, but it was one of the most significant events, and for that reason, I need to include it.

2012-I’m really proud that so far in 2012, I got nominated for a Singapore Blog Award, was named a top blog by InterNations and have started contributing professionally at White As Milk.

Irresistible-The book with my short story in it was published (the short story is under a pen name, but if you read the book, you’ll be able to figure it out, trust me)

That does not mean what you think it means–English vs English FAIL

Lessons learned from my negative maid experience–I take ownership of my mistakes in the whole B debacle

What I love about Singapore that has nothing to do with my children–I had to really think about this as all my reflexive answers have to do with my kids.

Where are you from–I share a story about Ravi and wonder aloud how my 3rd culture kids are going to react to their home culture…or if they’ll even consider it their home culture

Stuff I wish I hadn’t brought to Singapore–Things that I’ve found around the house that have me wondering just what I was thinking when I brought them to Singapore

Elanor and the ACA–why health care matters–Elanor’s story (warning–possible triggers as it does graphically describe what happened to Ellie at a week of age, including how close she came to death, and includes a photo from intensive care)

When I was six–What life was like for me in small town MA as a kid in the 80′s

My misconceptions about Expat Life–Boy did I have it wrong on some things.

Ways that living in Singapore have changed me—the shallow edition

Wild Life Sydney Zoo at Darling Harbour–the highlight of our trip to Australia

My bank is trying to Punk Me-another absurd/hilarious tale of customer service hell

Filed under: Acts of Supreme Clumsiness, Asia, Attractions, Australia, Before the Move, Boston, Culture Shock, customs, Expat to Expat Advice, general places, headdesk moments, Helpers, Holidays (Not Singaporean), Hong Kong, Identity, medical, North America, Phuket, politics, Pregnant Expat, San Francisco, Singapore, Sydney, Thailand, Third Culture Kids, Travel, Travel by Continent, Country, Uniquely Singapore, US, With Kids | 4 Comments »

Odds and Ends

Posted on May 9, 2012 by Expat Bostonians

I haven’t done one of these in a while, so I thought I’d do an odds and ends post to wrap up/update on some stuff and comment about other small things that don’t merit individual posts.

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Rhiannon’s Surgery

The wound has healed nicely and we get test results next week.  I’m feeling a lot better about this post-surgery recovery than her first surgery recovery (which involved an infection).

In the mean time, Rhiannon (who turns 7 months on Sunday) has been reveling in her new-found love of solid food.  Witness below (the food was a mix of banana, apple, blueberry and one other berry).

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The Car

We did decide to sign a one year lease on the car after test driving it for a few months.  It might technically be a hundred dollars a month more than I’d been paying with cabs (after parking and gas are figured into the cost), but the freedom is worth it.  Never stressing about how weather (rain) will affect my commute, shift change, or standing with two young children while the cab I texted for drives past me is worth it.

I will caution you that after a trial month or two, the idea of going back to cabs sounds pretty dreary.

There weren’t really any new terms added to the lease–the one difference being that the penalities for accidents if someone else were driving the car were spelled out in a way they weren’t when we were just trying it out.  However, I don’t lend out my car, so that’s not an issue.

And yes, I still occasionally turn on my wipers instead of my directional.

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When I was six posts

First Bookjunkie posted an article on White as Milk about her life in Primary one (first grade)

Then I wrote an article about my childhood

Then Katrjin did…her memories of expat third culture kid-dom here in Singapore (part 1 is here, part 2 is now up!)

Then Kirsten wrote about her life as a kid here in Singapore on SEA Youth’s website.

Please–let’s get some more!!!  Claire?  Laura?  Kelly?  Pleeeeeeeeease?  Anyone–write it, link it.  No matter how “normal” you think it was, I promise someone here will find it fascinating.

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If you’re into theater, and you want to indoctrinate the kids, you should know Annie is coming to MBS from July 10 through August 5.  More info and tickets here.  Yes, I will probably go (if I’m in town) but I think E just might be too young to sit through it, much to my sadness.  Thanks to Kelly who gave me the heads up.

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Ellie is still taking violin, and managed to add ballet to it.  It all began with my stupidly allowing her to take a trial class and ended up with The Nutcracker on repeat in my car.

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Remember how I had a story published in a book?  Well, if you like your books, electronic, Irresistible: Erotic Romance for Couples is now available on Kindle and Nook.  Given the recent popularity of 50 Shades of Grey, and erotica…I thought it was worth mentioning.

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We re-signed our lease for a year.  In the end, looking for a new apartment wasn’t the right choice this year.  Ravi’s work is above a stop on the (not yet open) downtown line–it makes more sense to stay put until that stop opens and then to figure out where would be a better location.  For now, walking distance to Great World City and about midway between E’s school and R’s work is the right decision.  Plus, moving sucks.

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The cats are fine.  Gandalf weighs more than my almost 7 month old.  Kero has finally stopped (fingers crossed) trying to climb the curtains.  Both have mostly forgiven us for going on vacation (they had a pet sitter, but we were on their list for a few hours or so).

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Our next trip to the US will likely be late summer.  Kate, one of my dearest friends is getting married, and I will absolutely be there.  And then we’ll stick around for a few weeks on either end.  The rest of our travel plans for the year will be dictated by one of Ravi’s cousin’s weddings late this year, and then how many vacation days/how many miles we need to fly to keep our frequent flier status for next year.

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If you want to see all of our Australia pictures, I’ve put an album on the Expat Bostonians facebook page (it includes far more than what I’ve shared here).  Go, “like,” and enjoy.

Like this one!

Filed under: Australia, Boston, cars/driving, Education, Guest POV, Housing, medical, North America, Random Stuff, Singapore, Sydney, Theater/Shows/Events, Third Culture Kids, Travel by Continent, Country, US, With Kids | 4 Comments »

Rhi’s Surgery

Posted on April 25, 2012 by Expat Bostonians

I mentioned last week that Rhiannon was having surgery this past Thursday (April 19).  I wanted to wait until it was over to discuss what was going on, and why surgery was necessary.

Rhiannon is in a very small percentage of children (less than 1% we’re told) who have a very serious reaction to the BCG (tuberculosis) vaccination.  In Rhi’s case, she received the BCG vaccination at birth as is customary here in Singapore.  BCG is a standard vaccination in most countries (although not the United States), although it seems to vary pretty widely  by country as to when the vaccination is given.

The super short version is that the lymph nodes closest to the vaccination site (the ones in the crease between her thigh and stomach) began to swell, and got so large they needed surgery.  The first surgery was performed at Gleneagles under circumstances I’m still upset about (no anesthesia, not in an OR, no tests run on the nodes).  Rhi got an infection, so we ended up at KK, and we switched to a surgeon there.  The wound closed for about 8 or so weeks, and then split back open because more nodes were getting inflamed and swollen.  We spent the last 6 or so weeks trying non-surgical solutions, but finally the decision had to be made for a second surgery.

Unlike the first surgery, this one would be performed in an operating room, under anesthesia at the hospital.  The nodes removed would be sent out for study and evaluation to see exactly what we were dealing with.

Last Thursday I got up far earlier than anyone in our house usually does, and took Rhi to KK Children’s Hospital for the surgery.  We were moved from admissions to a waiting room to day surgery to their waiting room to the operating theater’s waiting room, and finally the operating room over the course of two hours.  I held Rhi as they administered the gas that helped put her to sleep.

During the hour or so it took for the surgery, I grabbed a quick breakfast, bought a guilt gift for Rhi, and went to the parent waiting area in the hall outside the operating theaters.  Ironically the parent waiting area is located next to a sign that says “no waiting in this hall.”

guilt gift

I was on the phone with a friend when the surgeon came out to tell me that it was done.  He showed me the really big lymph node that he’d removed and was sending for tests (I’ll spare you the gory details), and said she’d done very well.  She had needed to fast for a number of hours prior to surgery due to the anesthesia, so once she was out of surgery, the first priority was nursing her. After Rhi’d taken a nice full feed, she smiled and interacted with the nurse and I for a while before falling asleep.

Boredom combined with a lack of sleep began a long discussion of the wallpaper on my twitter feed.  The creepy, creepy clown wall paper.

    

When you’re stressing out, sometimes you need to focus on something stupid like whether or not the clowns in the recovery room are just creepy, or zombie clowns.  Rhi was sleeping and we were waiting to be admitted up to a room for observation. Many thanks to my tweeps who played and chatted along, helping to keep me distracted.

Eventually we were moved up to a ward, where I am happy to report the wallpaper was covered in lions and zebras and elephants–not a clown in the room.  As happened last time, I had to have about 5 discussions regarding Rhiannon’s eating habits (specifically that she is exclusively breastfed and no I don’t want them giving her water and no she doesn’t need formula-yes I use it on the occasional date night, but I don’t do a daily supplement, and yes I was serious).  I eventually wrote and taped a note to her crib that said something to the effect of

Dear Nurses and Doctors

I am exclusively breastfed by Mommy.  Please do not offer me

  • formula
  • water
  • baby food

Thank you,

Rhiannon

Coupled with this was the extreme discomfort the nurses and doctors had with my breastfeeding her.  Specifically my comfort level of breastfeeding without needing a cover, a curtain, a KEEP OUT sign, or an armed guard.  That I would call out “come in” and be completely comfortable with speaking with them while nursing visibly unnerved them.  As it is a children’s hospital, and as they are pursuing certification as a breastfeeding friendly hospital, this strikes me as an area with a lot of potential room for improvement.  If you want to be breastfeeding friendly, you need to understand that plenty of moms are going to be comfortable nursing publicly.

We killed about seven or eight hours in the room.  I watched a lot of downloaded tv on iTunes, Ravi came for a visit (which freed me to go grab lunch), and then Ravi and Ellie visited after school.  Ravi had taken the day off to parent Ellie and provide support to me at the hospital while E was in school.

Rhi slept a lot (not shocking given the anesthesia and the pain killers they gave her) and nursed, and did some playing.

playing in the crib

Around eight o clock we were given permission to go home.  She went home on an antibiotic (which she finished up today), and with a bandage over the wound site.

Rhi got tylenol (paracetamol) on and off over the weekend.  Sunday was a rough day, but that had more to do with teething than her surgery.

This past Monday we saw the surgeon so he could take a look at how the surgical site was healing.  He said it looked great.  I was able to get some of the initial test results–that the lymph node wasn’t malignant and that there was no bacterial infection present.  We’ll need to wait until Mid-May to get the rest of the test results.  A best case scenario is that we’re done and the first surgery just didn’t get all the infected nodes.  The worst case is that she had a very rare reaction and actually contracted tuberculosis to the extent that she’ll need a 3 month course of treatment (but the odds are quite low).

I want to thank you guys for the well wishes I’ve received, and the concern you’ve shown for our family.

Tomorrow we return to less medicalized content, I promise.

Rhiannon is doing great…this photo is from today, taken at Amazonia as she terrified me by trying to push up onto her hands and knees (I just know crawling is going to happen far too soon).

Filed under: medical, Singapore | 15 Comments »

When your child has a medical emergency (expat to expat advice)

Posted on February 28, 2012 by Expat Bostonians

One of the scariest things you can deal with as an expat parent (or while traveling with kids) is what to do when your child becomes sick unexpectedly. 

In what seems like a deeply ironic twist of fate, I had planned to write this entry yesterday.  Instead, I got to live it.  But more about that later.

Like many things, pediatrician offices run differently here than at home.  In Boston, I wouldn’t even THINK about a pediatrician’s office that didn’t have a 24 hour nurse/on call doctor line.  However, it’s just not how things run here.  When the doctor’s office closes, it has closed.

So, what to do when your child gets sick on a weekend (keeping in mind most pediatricians have hours on Saturday morning at least), or after close of business?  Or if they have a medical emergency at any time of day?  You have two choices, depending on the severity of the situation.

Option 1-Private Hospital (Gleneagles, Mount E, etc)-use only for minor issues

I’ve chosen this route when my children have had what I consider to be minor issues like vomiting or signs of a ear/throat infection.

When you go to a private hospital, there is a GP on who is running the A&E department.  S/He will triage your child, and will either call your pediatrician for their opinion over the phone or to come into the hospital to treat your child themselves. If you do not have a regular pediatrician, they will call someone affiliated with their hospital to take the case.

Keep in mind, this may involve a doctor coming in from their home.  Which will take time…30 minutes to an hour, depending.  But in the case of something minor, they still may be seen faster than they will at a public hospital, depending on the queue at that hospital.

If your child needs to be hospitalized for whatever reason (when Rhi had gastrointestinal flu, for example), there is NO DOCTOR on the floor.  Any changes in your child’s condition will necessitate a call to the pediatrician at their home or office and for them possibly to come in.  In our experience, the doctor will pop in 1-2 times per day any way, before and after office hours…but when something needs to be dealt with during office hours, there will be a delay in addressing that concern as the nurses do not have the ability to give you so much as a Tylenol (panadol) without a doctor’s okay.

If you need an ambulance, you shouldn’t be going to a private hospital.  I speak from experience when I tell you that, for example, that Gleneagles and Mt E share an ambulance and it will be a long time before a private hospital’s ambulance comes.  You should only be going to a private hospital if it is something where you can drive the child or get in a cab.

Option 2–Public Hospital–KK Women’s and Children’s Hospital–serious concerns/in an emergency

I should say that any public hospital will be able to address an emergency situation for your child, but serious cases will be moved to KK anyway, so if you are even remotely close to KK, just go there directly.

Let’s revisit that comment I made at the start of this entry—living out what to do in a medical emergency.

Elanor was getting into the car yesterday when she put her finger into the locking mechanism in the side of the door (the actual locking mechanism, not the door lock on the inside of the car).  It sliced into her pinky finger of her left hand, and just from looking at it, I knew we were dealing with an emergency situation that was going to end in stitches.

In an emergency, if you need an ambulance, you need to call 995.  Average wait time is 20 minutes, I’m told.  In ours, we were at United Square, which is a less than 5 minute drive from KK, so I packed the girls into the car and drove us to KK, almost throwing my keys at the valet in my rush to get us out of the car and into the A&E.

When you enter the A&E, you’ll push a button to get a queue # to see a nurse who will triage you and decide how to prioritize your case.  When we got there, there was a line of 20 people to see the triage nurse before us.  In a situation like ours (child spurting blood everywhere), approach someone and you’ll get prioritized.

You’ll register (or if you’re on your own with the child, someone will come to register you at some point) and be sent to the waiting room (or in an emergency, you’ll be escorted directly to a doctor).  The waiting room is sectioned off into a regular waiting area and the “fever zone” (although, in my experience, people do not heed this and fever kids can be found scattered throughout the entire waiting room).  In the waiting room are large screens with the room numbers listed.  Your number will appear next to the room number you should go to, in order of the triage nurse’s decision of who needs priority.  If you are something like an ear ache, expect to wait a while.

Once you’re seen, the doctor will begin the correct course of action.

waiting for an x-ray

The major difference between a private hospital and KK is that KK can address concerns immediately.  X rays can be done without someone coming in from their home.  If your child is admitted, the doctor on the floor can address any changes in need immediately.

In Rhi’s case, they decided she needed more frequent inhalation treatments and were able to address that need immediately.

Back to Ellie–she needed an x-ray (a nurse stayed with Rhi while I went into the x-ray room with Ellie) and once they confirmed that there was no break, they knew that E would just need stitches.  We had to wait until it had been three hours since she’d last eaten (7:30) as they wanted to sedate her for the procedure, and given her age, I absolutely agree that it was the best way to give her stitches.  If she’d been conscious she would have been flailing and screaming and much drama would have ensued, even with a local anesthetic.  At some point Ravi arrived, with a game plan that he’d take Rhi if she woke up so I could concentrate on Ellie.

The sedation was given via injection, and then I was asked to leave for about 30-45 minutes.  I grabbed dinner at the McDonalds at KK (they get points for most edible western food option of the various hospitals I’ve been at for this reason) while Ravi and a sleeping Rhi kept me company.  We arrived back upstairs moments after Ellie had been wheeled out of the procedure room.  I managed to breastfeed Rhi while Ellie was slowly working her way out of sedation.

We were at KK for about two hours post procedure waiting for the sedation to wear off and for E to stop vomiting (it’s sadly normal to vomit a few times post procedure).

E watches Curious George on a phone as she works her way out of sedation

We left with panadol (tylenol for my US pals) and an antibiotic.

Elanor is doing well today…she was offended that I dare even consider keeping her home from school today.  She is being (mostly) good about leaving her bandages alone.  We go back tomorrow to have it looked at, and the stitches are supposed to dissolve in about two weeks.

Insurance

Worth noting that regardless of whether you choose private or public, both suck at dealing with insurance.  Unless there’s an admission, you’re best off paying the bill and then claiming it back from your insurance.  Just a heads up that at some point, someone is going to expect you to lay down cash or plastic before you leave.

Which should I pick?

In the end, although the wait is longer, I would default to KK.  You’re never going to be waiting for someone to come in from their home, and if a situation turns critical, they are the ones who are equipped to deal with it.  If you child needs admission and you’d prefer them to be at a private hospital (as I did when Rhi had gastroenteritis and needed fluids) you can always transfer them after they’re seen and stabilized at KK.

Please feel free to add on, share experiences, etc. 

Filed under: Expat to Expat Advice, medical, Singapore, With Kids | 8 Comments »

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