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

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. 

This entry was posted in Expat to Expat Advice, medical, Singapore, With Kids. Bookmark the permalink.

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

  1. katrijn says:

    Wow, I’m really glad I found your blog – this is exactly the kind of thing I’ve been wondering about (but luckily have not had to actually find out yet). What a shock it must have been when you saw the blood, but Elanor sound like a brave little thing and you like a very cool and collected mum. I hope when the time comes I’ll be able to keep it together that well! (So far, fingers crossed, bronchitis is the worst I’ve had to deal with and that just involved lots of appointments and lugging hospital equipment back and forth to our home, nothing dramatic.)

    • Crystal says:

      I’m kind of glad I broke my ankle last year because it taught us the lesson that we had no idea what to do in a medical emergency, and if someone was going to lay on the floor with a broken bone while we figured it out, better me than one of my kids. You’ll be fine…once everything is done, THEN you get to freak out.

      Ellie is a tough little cookie. She’s petite and adorable…but beneath that princess exterior is one tough little girl. She’s already over it (in attitude…the stitches and bandage are going to last a few weeks), while her dad and I are still kind of freaked out.

      Lugging hospital equipment doesn’t sound particularly fun.

  2. Amelia says:

    How scary! Poor little munchkin. Glad it was something (relatively) minor in terms of hospital stays – but gushing blood is always awful for the little ones. Thanks for sharing your experiences… I’ve been wondering what we’ll ever do if the kids get sick on a Sunday!

    • Crystal says:

      When I was 8 or 9, I tripped over a shoe and fell into a doorframe, cutting my forehead. My mom took my to the local hospital, who referred us to a regional hospital a half hour away because they felt a plastic surgeon should do the stitches (give that the gash was literally the middle of my forehead…and not a small cut). I insisted at the top of my lungs that I was not going to hospital #2 until my mom took me home so I could change my shirt…it had blood on it, and I was not going to hospital #2 with a shirt that had blood on it.

      I’ve always looked back at that and laughed. Now I look back and have so much empathy for my mom…as well as admiration that she didn’t toss me in the trunk and just drive to hospital #2 with or without my consent (half joking).

      Luckily E was mostly concerned that the bandage was so plain…which we fixed by applying an Ariel bandage over the hospital bandage. The joys of a 3 year old versus a tween.

  3. Kirsten says:

    I haven’t had experience with a child emergency, but with my mum. But then again if you read #shitmymumsays you know it’s more or less the same thing. Hehe.

    She was having really bad stomach pains (which turned out to be a small bowel obstruction) and I dialed 995. An ambulance will arrive a little quicker, but they will not take you to a private hospital. Since my mum had just had another medical procedure at Gleneagles (and therefore they had all the records) I had to call back, cancel the ambulance and then call Gleneagles to ask for an ambulance. It’s slower but in this case she ultimately got medical attention quicker – if we’d gone to a public hospital we’d have to go through all the records again and after triage they’d make her wait for hours. (Stomach pain has got nowhere near the dramatic urgency of BLOOD SPURTING EVERYWHERE, unfortunately.)

    • Crystal says:

      I love your #shitmymumsays tweets. I’m a little in love with her from them.

      Glad she’s okay, and you make an excellent point.

  4. R says:

    this reminded me of how i sliced my finger back then when I was in Boston, and had to go to the A&E, where I had waited for an hour before I got to see the doctor. But as you pointed out, insurance is the most important thing no matter where you are! The $2000 fees I incurred for needing stitches was fully covered! Hope Ellie gets well soon! 🙂

    • Crystal says:

      Can I just say that the bill at KK was only 90 dollars including the X ray, stitches and sedation. As you noted, in the US, that bill would have been over 10x that. Glad you had insurance…US medical costs are ridiculous.

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