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Dr Layla McCay Headshot

The Strange Joy Of Visiting Foreign Hospitals

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I have a nerdy hobby that's usually only indulged in adversity: I love visiting foreign hospitals.

Give me the choice of viewing a museum or a hospital on vacation and I will opt for the latter -- only as a passing visitor, ideally. Foreign healthcare can be a risky business, wherever you are, and I'd hate to ever need major treatment, but I think there is something fascinating about seeing a different health system at work: hospitals are great equalizer as people around the world have the same health problems and aspirations and they tend to get the same sorts of treatment.

Every country has a different way of approaching healthcare delivery, and that's what I enjoy. Since no health system in the world is perfect, all sorts of things can be learnt and improvements made by examining any foreign health system. And with my academic hat on, I love to do that -- I've worked on and published international comparisons of healthcare quality, safety practices, kidney failure treatment, and mental health. But when I leave my academic hat at home and set off abroad, what I really like is to wander the hospital halls and get a feel for anecdotal differences.

I first developed my taste for foreign hospitals as a medical student. In Japan I wandered the pristine halls of Osaka University Hospital, ostensibly charting objective healthcare outcome differences, but really marveling at the anecdotal nuances of difference in ward rounds (the doctors worshipped, the patients obedient), payment systems (trained in a free-at-the-point-of-access system I am always intrigued by payment processes), and self-referring to specialists (often the wrong ones) rather than using general practice gatekeepers.

Belize was different as I was working for an NGO set up along US clinic lines. My favorite times were when I got to visit the beleaguered local public hospital and see how the state addressed healthcare. The operating theatre may have been dusty from lack of use (they lacked key surgical equipment so couldn't operate), but the wards were full and busy. Accustomed to hearing constant complaints by patients about hospital food in Britain, I was intrigued to see that here they relied on families providing meals and laundry services for their sick relatives. But for all the obvious differences, I still remember my thrill of recognition, of collegiality, on encountering a Glasgow Coma Scale poster on the wall of a clinic - almost identical to the one in my home hospital, in my medical textbook, in my lectures.

And when I was working at Harvard, and my required tuberculosis test came back apparently positive due to international vaccination practice differences, I reveled in the opportunity for a field trip to the shiny and beautiful Brigham and Women's hospital for an x-ray to prove I didn't have TB.

My travels for work these days focuses on health policy, which tends to involve more office visits than glimpses into clinics and wards. But behind the policies are always the people. So when I go on vacations, it's a silver lining of the cuts and scrapes my wife and I tend to pick up on our adventures that I often get a sneaky peek into foreign hospitals.

In Cambodia upon falling into a large, allegedly old landmine hole, a random man on a motorbike conveyed us to the local private maternity hospital, where I handed over $20 for x-rays, watched their attempt to get the ankle in the universal positions for the x-rays, and secretly lamented not getting to see the public hospital (our motorcyclist in shining armor told us pessimistically "I take you there, you die."). Last year in Peru I was grateful but bitterly jealous that my wife got to go to the local hospital for supplies when I was ill with altitude sickness. In the US I marvel at the health insurance administrators who wear clinical-like garb and stroll into Emergency Room cubicles with their computers to ask their own clinical questions. And last week in Burma, a fall from my bike took me to Outpatients in Mandalay, where I waited along with monks in saffron robes and prancing children in traditional make-up, watched nurses in tall hats industriously writing their notes in school jotters, and departed with the same bandages I've previously been given in Britain... and the US... and Cambodia.

Universal health care is a term that's used a lot in health policy speak. It's presented as something that a country either has or doesn't have. But taken literally, healthcare as a concept is of course universal. Everyone in the world accesses some sort of health care at some point, however informal. The quality and practices may vary wildly, but the principles are usually the same - as are many of the hopes and fears of the patients, relatives, and healthcare staff. The way different systems deliver healthcare can teach us lots of things, and not just about medicine.