Health care is hard in another language

Those living in a foreign country expect to encounter the language barrier on a regular basis. What they may not anticipate, however, is how formidable that barrier can appear when it comes to dealing with their new country’s health care system.
Jad Michaelson, a tourism professor at Jangan College in Hwaseong, tripped and broke his little toe last year. He headed for Aju University in Suwon, which had an international clinic, but it was closed when he arrived at 7 p.m.
He was taken to the emergency room, but no one spoke English. He told the doctor, “I hurt my foot.”
Then the doctor squeezed his foot. “And of course, it hurt,” Mr. Michaelson says.
After X-rays were taken, he was told he needed surgery.
“They didn’t explain any other options,” he recalls. “And all of a sudden, they’re prepping me for surgery. They’re taking blood, trying to put an EKG on me. I’m like, wait a minute. North Americans want to be told everything. We make our own choices.”
He kept calling his friends to ask them to help translate, while the staff tracked down a Korean-American resident doctor, who told him that surgery would help his spiral fracture heal more quickly. But an alternative did exist: He could use a zip-off cast.
Mr. Michaelson prefers noninvasive measures, but he also says, “I don’t trust surgery here.” The clinic was clean and the equipment looked modern, but he was too scared to undergo surgery when the doctors spoke a different language.
Whether it has to do with the language barrier or different expectations of medical care, many foreigners can recount similar experiences in dealing with Korea’s health care system.

Quality of health care
Modern medical care in Korea is tied with Severance Hospital on Yonsei University’s campus. Since the hospital was founded in 1885, medical care in Korea has become on par with other developed nations.
Steven Chun, the general manager of the Korean branch of SOS International, the world’s largest medical management and assistance company, says the quality of care here is good.
Helen Brown, the president of Focus, a volunteer organization that aids expatriates in Korea (see related story below), agrees. “Hospitals are clean and well equipped,” she says.
Dr. John Linton with Severance Hospital, the only non-Korean licensed to practice medicine in the country, says, “Koreans have better dexterity then the West. Procedure-wise, I would much rather have a Korean working on me then an American. They are the best in the world. As an example, in plastic surgery, they are more advanced than the United States.”
But despite the quality of care, communication difficulties and cultural differences can make a trip to the emergency room even more stressful.
“There are some wonderful doctors here,” says Irving Gussow, an adjunct professor in the English literature department of Chung-Ang University in Hakseok-dong. “But communication is a problem.”
He should know. He fell on his face while trying to catch a bus and suffered multiple fractures in his nose. He had to undergo surgery.
During the diagnosis, the doctor kept using the word ‘reduction’ in English.
“I panicked. I’m thinking he wants to do a nose reduction. A nice Jewish nose like this is a masterpiece,” he says. It turned out the doctor meant a fracture reduction, another type of medical procedure.
If a foreigner is in a hospital where communication is a problem, Ms. Brown of Focus recommends using the written word, “as this is sometimes better understood.”
What often surprises expatriates is how business at hospitals is conducted. Doctors here have to see an enormous number of patients daily, so they’re not used to taking the time to talk to their patients.
Maurice Daniel, a mechanical engineer from the United States, was admitted to the hospital for a blood clot in his leg. During his seven-day stay and the outpatient monitoring, he asked a lot of questions.
The doctor eventually asked Mr. Daniel why he had so many questions. “He finally realized I’m trying to learn everything I can about this problem,” Mr. Daniel says.
Nurses in Korea also play a different role than their Western counterparts. One diplomat, who needed emergency care after suffering multiple leg fractures last year, observes that nurses here “are usually focused on monitoring the health of patient and medication, but in the West, the nurse assists in all aspects of care.”
“I’m not saying it’s better,” he adds. “I’m just saying it’s different.”
As a result, hospitals expect family and friends to take care of patients around the clock. David Hazzan, an English teacher from Canada, broke his ankle in three places and was hospitalized for over three weeks.
“The nurses don’t care for you like they do back home,” he says. “Here, your family is supposed to do that. And of course, you don’t have family here with you.” He was fortunate to have friends who pushed him around in a wheelchair and even emptied his bed pan.
His room, with its 10 beds, was hardly conducive to resting. “It was like a party every night in the room, drinking soju, smoking,” he recalls. “I didn’t mind as it kept my mind off the pain.”
The cultural differences extended to pain management as well. When the doctors had to reset Mr. Hazzan’s ankle, they gave him a muscle relaxant but no pain killer.
“It was really painful,” he recalls. “I kept asking for codeine or morphine, and the doctor laughed at me at one point. He thought I was kidding, I suppose.”
The diplomat with the leg fractures, who was hospitalized for 10 days, happened to know a nurse who had trained overseas. After she checked in on him, she told him he had received an amount of local anesthesia that a small boy would receive.
Only upon her request was the diplomat provided more pain relief. “It seems to be a cultural thing to suck up pain like a man,” he says.
Although they may use pain killers sparingly, Korean doctors are liberal with the shots. By the end of his visits, Mr. Gussow says, “I felt like I had a target on my backside.”
Pills are another favorite prescription. “It’s subconsciously driven by traditional culture where medicine is something to strengthen ones’ constitution,” Dr. Linton says. “In Western medicine, all medicine is toxic and an unnecessary evil.”
He says this idea has become so ingrained not just in doctors, but Korean patients. If he tells a 50-year-old foreign patient with the flu to take Tylenol or aspirin, the patient is grateful. But a Korean patient will ask why he didn’t get a shot or medication.

Emergency rooms
When it comes to urgent care, “in the daytime, the options are huge,” Dr. Linton says. Nights and weekends are a different story.
“In Korea, it’s not that there’s no how. There’s no who,” he says.
Many ERs are overcrowded, he says, and this makes it hard to take care of trauma patients, let alone focus on foreigners separately. Should the emergency room be filled, patients might find themselves lying on a cot.
Korea has a 24-hour emergency hotline, 119. Focus recommends calling this number first, as the government is trying to make it accessible to expatriates.
A few volunteer medical students who speak some English are rotated through the call service schedule, but there still is no guarantee that an English speaker will be available.
Those with international health insurance are usually given a local phone number. SOS International has insurance clients based in countries like the United States and Japan. For these policyholders and for SOS members, SOS has a 24-hour hotline that operates daily in Korea, providing medical advice in English, French, Japanese, Spanish and Korean.
For regular care during office hours, which are generally 9 a.m. to 6 p.m., Seoul has more than a dozen international clinics, some in university hospitals, that do business in English. Most of these places are staffed by Koreans who either grew up or trained overseas.
Many of the international clinics take a general practitioner approach, in contrast to local Korean clinics, which are specialized.

Payment and insurance
Whether visiting the ER or clinic, have some money handy. “No payment means no treatment,” Ms. Brown of Focus says. Those without health insurance must pay the full amount up front. In the ER, treatment is not given until payment is made by cash, check or credit card.
National health insurance is available at many Korean companies to employees, including expatriates. Those under the national plan pay the government-set prices, from which a certain amount is deducted, which is later paid by the government.
Policyholders are given an insurance booklet, which they need for treatment. If for some reason patients don’t have the booklet, some hospitals can find the insurance records by the alien registration number.
Without the booklet or the card, treatment is usually provided as long as full payment is made in advance. Most hospitals will refund the government-paid portion if patients return within a week with their insurance booklet and receipt.
Compared to the United States, health care is generally cheaper. But compared to the United Kingdom, where citizens are on the cashless NHS plan, it’s more expensive here. For those without national medical insurance, the cost might be higher than the government prices.
National health insurance does not cover cosmetic surgery and cancer (for the latter, separate insurance is available in Korea).
Also, some clinics won’t accept the national health insurance. According to Shin Gyu-jin, a group business director of Allianz, an insurance company, this is due to red tape.
“Some really small or private clinics, which can include some international clinics, don’t want to deal with the hassle of paper work and the government,” he says. It’s best to check before making an appointment.
Some companies offer their employees insurance coverage through international firms, which requires payment up front. Reimbursement is based on receipts.
Those without an employer-sponsored program will have to look in their home countries, as private medical insurance isn’t offered in Korea. Brooke Douglas, an English teacher from Canada, has medical insurance in Canada. The problem she faces is that while hospitals offer receipts, local clinics often will not.
For all the reasons mentioned above, most medical specialists and expatriates who have been through the Korean system recommend developing a strategy for yourself and your family before a crisis occurs.

International Clinics

The following list is for general help in Seoul.

* Asan Medical Center International Clinic: (02) 2224-3331/6
* CHA General Hospital: (02) 3468-3111
* International Clinic Itaewon: (02) 790-0857
* Samsung Medical Center: (02) 3410-0200
* Seoul Foreign Center: (02) 796-1871
* Seoul National University Hospital: (02) 760-2890
* Severance Hospital International Clinic: (02) 361-6540
* Soonchunhyang Hospital: (02) 709-9158

Additional help
* Dr. Sung Obstetrics and Gynecology Clinic: (02) 790-0802
* Focus: (010) 4769-8212 or (010) 8750-8212
* National emergency hotline: 119
* SOS International: (02) 3140-1924

by Joe Yong-hee