Kid friendly spacer devices for asthma

It's now been almost 6 years since the little miss has been diagnosed with asthma. As any parent with an 'asthmaticky' kid knows, your life is ruled by allergies and drugs, colds and infections. Every tiny sneeze or cough has the potential of turning into a major production of hospital visits and machines etc etc. And sometimes, you never know what causes the first little cough. But before you know it, the first ominous signs of a full blown attack appear... Hack, hack, hack...wheeze, wheeze... Panic all around. It's times like that that I'm glad I have my spacer devices. After all, studies have shown that if you put 2 puffs into the spacer chamber (manufacturers will say the devices are not meant for this so I leave it up to your discretion) it works as well as having a nebuliser. Obviously, they are referring to pure salbutamol nebs alone and not the ones that mix atrovent or pulmicort in. (disclaimer: if your child is having a bad attack, they need to be seen in emergency. I certainly don't advocate sitting at home giving them puff after puff while they turn blue).

In any case, what I've realized is that if it is truly possible to avert an acute attack, very often it will be if I can get the inhaled salbutamol into her before the symptoms get too bad. Obviously, once we get home we have to do major allergy management... Meaning she gets tossed straight from the car into the shower for a massive wash down, maybe antihistamines and inhaled seretide to follow. It all depends on our initial management of the first cough and how bad the subsequent attack gets.

So... In the last 6 years, we have tried 3 devices. The first one I won't bother talking about since it was an infant device and pretty impractical for toting around being about 18 inches long. The other 2 are the Able Spacer by Clement Clarke and the AeroChamber by Boehringer Ingelheim.

Able Spacer

This is manufactured by Clement Clarke and marketed by LifeTronic Medical Systems in Bandar Sunway. Priced at RM70 + RM40 for the mask. It's not widely available in KL and I had to email the head office to get the details of their local distributor. I got my first unit in Singapore when I forgot to pack kiddo's spacer on what I thought was a short 2 day holiday (smack upside the head for an 'I should have know better' moment). My wonderful uncle rushed us to Mount Elizabeth and this is what they gave us. We elected to have it without the mask as kiddo is almost 8 and quite capable of holding her nose and breathing through her mouth. The inhaler fits neatly into the body of the spacer device and is amazingly compact. Fits my handbag and her school bag with no worries about squashing the mask or having the canister fall out somewhere. It is also very streamlined on the inside which makes washing less of a worry. My concern is that the canister being stored inside will scratch the sides and cause the salbutamol particles to stick to the walls and reduce efficacy per puff, but so far, there doesn't seem to be any appreciable difference in the effect on kiddo during an attack using either device. The big plus point for me is that kiddo goes to school with it in the bottom of her bag and I know that if she needs it, both device and canister will be in the same place. No worries about squashing the mask, and since it's in a zip lock bag, dust either. Recommended that devices are changed for new when the silicone parts appear aged.

AeroChamber

This is manufactured by Boehringer Ingelheim. Priced at RM82 at last check today with the pharmacy of a local hospital. One of the most widely available devices in Malaysia and Indonesia. Comes with attached mask. This is the device kiddo has grown up with. Not massively large though a bit cumbersome to fit in regular handbags, and great for kids who can't yet control breathing just through their mouths. So in an acute attack, when coordination is not great, this little fellow is wonderful. It has more intricate parts though, so cleaning can be a bit tricky for obsessive moms like me. I can't stick a bottle washer in at risk of scratching the insides, nor can I completely dismantle it to clean all the itty bitty parts. Also the silicon face bit can get a tad tacky if dust gets on it. Generally recommended that devices are changed for new every 6 months or so depending on usage.

My take on the both of them...

Ease of usage : the AeroChamber is definitely easier as the kid can breathe normally through it without holding her nose.

'Tote-ability' : for now, the AbleSpacer definitely wins out. It is so incredibly compact and easy to carry. As kiddo gets older and her hours away from home longer, one of my bigger worries are what would happen if she gets an attack in school. Getting a call from school and having to rush her inhalers there while I know she is struggling to breathe is one of my greatest nightmares. I firmly believe in making my child as independent as possible and this little device certainly does that. As the inhaler is stored within the device, the 2 items are always together and she doesn't have to waste precious moments scrabbling around for a missing part.

Usability : the AeroChamber is definitely the easier of the 2 to use. The child can breathe normally through nose and mouth. With the AbleSpacer, the child has to be coordinated enough to take a breath in, remove the device while holding their breath, breathe out, then take another breath through their mouth only.

Price : the AeroChamber is the cheaper all round option at Rm82 (with mask the AbleSpacer comes to RM110). Although without the mask the AbleSpacer is less.

All in all, I'm probably not going to give up kiddo's AeroChamber at home anytime soon, but the AbleSpacer (without mask) is a great device that the child can use into adulthood (since it has also been shown that spacer devices benefit adults too). In all pract

icality, the AbleSpacer is so compact that it's the only reasonable option for kiddo and myself. I find that I now carry it everywhere because it fits all my bags. So that means we no longer chance going out without her inhalers and rush home at the first sign of a cough, we ac tually treat immediately. Also, being a girl, she's going to be carrying a handbag one day, and if she's anything like me, she'll only carry it if it'll fit her evening purse :)

Photos to follow. My iPad doesn't allow me to load photos to my blog weirdly enough...

Here they are:

First off, this is a comparison of what will be going into your mummy bag... Top device is the AeroChamber and accompanying inhaler. Bottom device is the neat little AbleSpacer with inhaler inside.

Here's the AeroChamber and inhaler stuffed into my bag. Now that I don't need a diaper bag anymore, I prefer smaller totes. This is a problem as I sometimes (often actually!) elect to leave the device at home. I know, I know... bad mommy!

Here is the AbleSpacer. Isn't that nifty?! Slots into a tiny corner of my bag. Most days I don't even notice that I've gone out with it when kiddo is not with me. I was looking for that effect actually. For it to become so much a part of my bag that I would unconsciously carry it everywhere...

So there you go. My 2 cents worth on spacers. I'm all for finding the perfect balance between my kid's needs and my own. Trial and error!

Dummies guide to the stages of sunburn

After having spent the last few days sun burnt ENTIRELY due to my own fault, I feel supremely qualified to expound upon it...

Stage 1 : 'Ooo... What a sunny day. Warm isn't it?' Unless you're flitting from car to air conditioned mall, sunblock might be a reasonable consideration here.
Skin colour : No change, possibly an attractive flush.

Stage 2 : 'Gosh, it's really hot out. Kinda feel prickly...' Even most morons (except me, obviously) would actually, seriously be considering pulling out the SPF 30 here.
Skin colour : Reddening, but nothing too alarming.

Stage 3 : 'Ow, the skin's really starting to hurt. Golly it's fierce out.' Pretty obvious it's get under cover time. But noooo, I was still chasing the kids (who were actually blocked and covered) trying to get some cutesy photos. The sarong about my shoulders was really too little too late.
Skin colour : Boiled lobster.

Stage 4 : 'DON'T TOUCH ME!!! NO hugs please...!' This is generally after you've got in from the sun and are trying to have that post sun shower. Fun and games, fun and games... I had to shower with kiddo's baby bath (my bath gel had exfoliating bits in it. NOT HAPPENING!) and alternate warm and cold water. The burns couldn't tolerate warm water and the normal bits couldn't take cold water. Picture this, hop to the side, turn on cold for burned bits while keeping normal bits away from stream of water. Another little shimmy, turn on a bit of heat, trying to avoid water splashing on the burnt bits. My burnt bits were as follows : face, forearms, upper thighs along bikini line (but only the sides. How??), back (a 2 inch strip between my tank and bikini, and the upper back between the tie and back of the tank), shoulders, back of my left knee (Huh??). Now imagine having to do the above little dance while avoiding all burned/ normal bits...
Skin colour : Over-boiled lobster.

Stage 5 : 'Yuck, starting to flake. Itchy... Hmmm, wonder if I can help it along...' DON'T DO IT!!!! Don't try to help the flaking along. I'm a compulsive fiddler, so I picked at my peeling nose. It got painful and very, VERY red...
Skin colour : Go home Rudolph, I'm leading the sleigh tonight... But if you DON'T pick, then you can be the 'snow' covered tree in the yard.

Stage 6 : 'Ewww, Mummy, you look like a molting snake!! Am I going to look like that too??' Flaking everywhere. Skin very dry, fault lines appear if you even move the skin... More itchy... Incidentally, not a good time to commit a crime. Too much trace evidence, they'd get you just by sweeping the floor...
Skin colour : Patchwork. If you can imagine very poorly sewn shapes that are fraying at the edges.

Stage 7 : When the flaking is over, if you're lucky, you have a uniform tan. IF.
Skin colour : Golden brown if you're lucky. Muddy brown if you're not...

So there you go, sunburns according to me. The whole process usually lasts about a week-ish. I'm hoping that by writing this down I will now, NOT EVER, forget the sunblock. I hope. Really. I will actually post on our Sambolo holiday after our move tomorrow (Yay!) and once I stop flaking all over the keyboard.

Temporary tattoos have hidden dangers..

Kiddo was at a friend's birthday party and got a lovely glittery temporary tattoo. I said yes knowing that she's had reactions in the past, but thinking to myself, 'Remember to wash it off later...' Well, what d'ya know, what with rushing to pack for today's Sambolo trip and dashing to the store at 8pm to get daddy a snorkel mask, I TOTALLY FORGOT!! Ugh! *smack self in the head* Added to that it was Daddy who did the bathing, so I didn't even see her till she was all covered up in her PJs.

This morning, kiddo woke up complaining of a tummy ache and when I felt the warm forehead, my heart just sank... I knew it! A forgotten tattoo! Out came the nail polish remover and thus commenced our 15min cleaning session. She was subsequently sent down for breakfast and instructed to drink lots and lots of water to, hopefully, flush out whatever chemical it was that was causing all this. Happily the tummy ache and fever settled within an hour of having the tattoo removed.

Googling temporary tattoos was an eye opener. Nowhere does it list the chemicals that go into them, it just says dyes should be US FDA approved. Then there are the 'water soluble slip layers' and the 'contact adhesives'. A whole lot of 'uh?'.

This has happened several times in the past. At first it was only after parties when we put down the tummy ache and fever to over excitement and junk food the previous day. The fever and tummy ache would go on for several days, probably until the tattoos eventually faded, but I didn't link the two before. Then we got a pack of these tattoos for fun and she had the SAME reactions at home. I could not believe it! But it happened EVERY SINGLE TIME we put it on! Since then, I've been pretty strict, no tattoos except for parties, and they get washed off the moment we get home. Unfortunately last night it got left on, and she had a whole night of marinating in those chemicals. Hopefully we got it off in time and her beach holiday won't be spoiled. Note to self... parties = tattoos! Inspect and WASH!

One man's food is another man's poison

It has come to me, rather uncomfortably tonight, that while avoiding shellfish is well and good (I have a horrendous shellfish sensitivity. Gives me heartburn like you wouldn't believe!), I should also, perhaps, be more cautious in scarfing down foods that are somewhat out of my usual menu.

While at Aladdin's cave (Kebayoran Market) yesterday, my maid asked if Mister and Missus would like to try cumi-cumi (cuttlefish). Being Malaysian and generally rather fond of my grub, I immediately said, sure, we'll try anything once... Except innards. I draw the line at that.

Well, IbuI stir-fried up a delicious plate of cuttlefish with chillies and 'stuff' (ginger and something else, I think). It was really yummy. Unfortunately. Because that meant I didn't realize the heartburn was coming on till I stopped for a breath and thought, 'Ooohhhh... My stomach definitely does not like that.' In fact I felt like I had swallowed a pot of chilli padi (for those Western friends who are prone to being the butt of practical jokes by Asian friends, if someone dares you to eat this cute little chilli, SAY NO! It's dynamite!). Totally unexpected. Cuttlefish isn't shellfish is it?!? Poor hubby. He's off to Hong Kong for work tomorrow and instead of some quality time with wifey, he has to put up with my moaning and groaning. Gaakkk...

Moral of the story, if you have ANY sort of food insensitivities/ allergies, BE CAREFUL! Especially if it's a food that you don't often eat. As some supermarkets back home sometimes post 'Come one, come all!' I shall now take myself and the towering inferno that occasionally doubles as my stomach off to bed...

What you really, REALLY need to know when you see a doctor

I was thinking back to our little trip to the doctor's for kiddo's vaccinations last week. First thing he asked me was, 'Where are her old records?' Oops. Um. In KL. And a copy with the school. But honest, guv, I can tell you what she had... Well, Doctor L was not impressed. He didn't tell me off but the ole brainbox was probably muttering something about mothers knowing better... So I came home and had a little think about it. I put myself (figuratively!! No dress up for me, please) back in my white coat (not that we really wore one that much... white coats and ties have been shown to be the largest germ collectors around) and stethoscope and thought about the information I always wanted my patients to have when they came in the room. Trust me, 'Isn't it in the records?' is NOT an answer.

First off, for kids, especially families moving all over the world, is a copy of the vaccination records. Try and stick to one place for jabs in any one country. And at the very least, have a list of all the vaccinations given. I have a friend who's kid has had vaccinations in about 5 different countries, and now at the age of 5, poor mummy can't remember what was given last year in the US. This record is pretty important because different countries have different vaccination schedules. So if you say, '5yr old jabs, Doctor' to someone working in a country with no 5 yr old jabs, but with 4 and 6yr old jabs, then good luck.

Next is a list of current medications and current illnesses. Saying, 'I've got arthritis and I take this little beigy pill' is not helpful in any way at all. Seriously, how many beigy pills do you think are out there? Answer, too many that fit your description. And all doing different things. It's a bit of work, but one of my ex-patients who got fed up of doctors giving her exasperated looks did the following. x illness - a, b, c drugs; y illness - d, e, f drugs. Amazingly helpful. She also put a list of drugs that didn't work on the list next to each condition. Made life so much easier... Crucial for kids with recurrent illnesses like asthma. It's useful to know what the kid needs under what circumstance. And how much. Big difference between puffing once a week and 3 times a day...

That brings us to the medical profession's favourite (not) question, 'any illnesses that run in the family?' At this point, we're cringing, waiting for the deluge of information about granduncle so and so's wife's cousin's daughter's blah blah. If your doctor's eyes are glazing over, you've gone too far. We need only blood family, folks. So NOT your spouse or their family, ok (unless you're bringing your kid to the paed, then your spouse's family history is relevant). Spousal issues are covered somewhere else. We need, succintly please, illnesses that seem to affect more than one generation. Or if there are 2 or more of the same condition within the extended family. Of note, you have to inform your doctor about cancers and genetic illnesses. It's useful to know what grandparents have passed from, and of course, any illnesses that your parents have. Doctors will usually ask about heart disease and cancers. But it's useful knowing about allergic symptoms that run in the family, e.g. asthma, excema etc. And some families do tend to have odd ailments running about. Trust me, I would know, our family has an odd nerve condition that only 1 neurologist in KL (ours) knows about. And that's because she had to go research this weird condition that initially affected both my dad and aunt. So when I went to see her with a bit of the same, her reply was, 'Oh yes... you have xyz (I certainly never studied it in med school!!). I can stick this ginormous needle into your arm and give you a confirmation. No?? Go read up the website then, you're ok for now.' Huh... Thanks, Doc.

Finally, my personal fav, 'Do you have any allergies?' The number of suddenly dumbstruck faces I've seen is mind boggling. 'Um, my mom said...' 'My mom is...' (No mate, you. Not your mom) 'Um. Wait while I call my mom' 'My mom never told me...' 'Let me ask my wife...' (your wife?!?) 'I, think, perhaps...' If you have never had a reaction and your mom has never said anything to you. It's reasonable to say, 'Not that I know off.' See... effortless. And if you have had a reaction, please remember what kind. E.g. If you swelled up and couldn't breathe, that's likely an allergy. Diarrhoea is not an allergy to an antibiotic, but if the last time you were given it you had explosive ejections (from anywhere!) for a week and felt like a dog, then it probably would be better to try another drug. Contrary to popular belief, doctors are not sadists and generally try to avoid the 'killing is better than the cure' scenario.

Well, I hope that was amusing and vaguely helpful. As for me, I'm going to take myself off and prepare to approach the school tomorrow for a copy of the copy of Kiddo's vaccination records...

Never trust dosages on the sides of bottles...

Kiddo had her booster DPT today. Much, much less traumatic than expected. Maybe it was the ice pack before that numbed the area, or maybe it was the nurse yelling, 'abracadabra, sim salavim!' right in her face. Whatever it was, it worked. No crying at all!! Just a rather bemused look on her face. What I call the 'is it worth bursting into tears' look. All in all it was ok until about 5pm, right after her Dora show (fancy that!), when she started to complain of an ouchie arm. Then came a bit of drama during the attempt to remove the plaster. Lots of cringing and shuddering and groans and whimpers. Following which mummy got fed up and ripped the half hanging plaster off in one fell swoop. Heh heh heh... (evil mummy) She was NOT amused. 'Stop laughing at me!!! It's NOT funny!!!' In any case, I decided to give her a dose of paracetamol before things got worse. On picking up the bottle, I saw printed on the side : 4-6yrs 1.5 teaspoons (1 teaspoon is about 5mls but NOT ACCURATE! Dosing spoons are infinitely safer), 160mg/5 ml, not more than 5 times a day.

Ok, at this point, all I could think was, 'please tell me I've checked the dosage in the past...' because for my kiddo, that would be an overdose. And as one of my consultants once said, 'Paracetamol should be a controlled drug. It's the easiest and nastiest way to kill yourself. It poisons your liver and you die horribly...' I remember shipping patients off to liver units with everyone up in arms over the fact that a much needed liver would be going to someone who willfully destroyed their own. Anyway, that's an argument I definitely don't want to start...

Back to kiddo's paracetamol. The recommended paediatric dose is 10-15mg/kg (UK 10, Aus 15) up to 4 times a day. Australia then caps the dose at 60mg/kg/day. Being UK trained, I go by 10mg/kg. That would bring kiddo's dose to 160mg 4 times a day. Total = 640mg/day max. 960mg a day if you use the higher Australian recommendation. Using the dosage suggested on the bottle, she would be taking 240mg 5 times a day. Total = 1200mg. That's 87.5% more than what she should be having!! Which also works out 25% more than even the higher Australian recommended dosage!! Last year at age 4 she was 14kg. Going by the dosage on the side of the bottle, she would have received 114% of her recommended daily dose! I shudder to imagine how much paracetamol parents out there are unknowingly giving their children thinking the dosage on the bottle can be trusted. Yikes!

From now on, I'm checking the dose of every drug that comes into this house. No more assuming the dose printed on the bottle is correct. After all, you know what they say about assumptions... If you assume, you make an ASS out of U and ME... So before you dose your kid, just do a quick google check on the recommended dose for that particular drug. Much easier to check than to deal with the consequences of damaged internal organs. Oh... and buy a dosing spoon. Teaspoons and tablespoons are only good for eating, not administering medicines...

To soap or not to soap, that is the question...

Soap, or to be precise, antibacterial soap. Advertised as being the solution to all our problems of household illnesses. But is it really the wonder product companies want us to believe it is? Today while I was standing in Hero supermarket perusing the half dozen brands of liquid handwash, I thought to myself, 'Do we really need all these chemicals inside the soaps to stay healthy?' So I decided to have a look around.

Many of the products contain Triclosan and Salicylic acid. Salicylic acid, ok, you make aspirin from it, and it's used on the skin to treat acne, so it's probably not that bad, unless you're going to try and chug the stuff. But Triclosan... Now that baby is a registered pesticide by the US EPA. Yup, PESTICIDE!!! It's a little like a bacterial bomb. Everything goes, friend or foe. Kaput. Now, I'm all for blitzing bad bacteria like salmonella, E.coli etc, but please, leave my normal skin flora alone. They actually protect you from colonization by other more harmful bugs. The other thing is that it's classified as a 'persistent pollutant'. Meaning it stays in the body as well as the environment. Studies have shown that virtually every creature on earth has some Triclosan in it. And humans, being the numero uno, top of the food chain consumers, are eating a little of it in EVERY MEAL!! Not to mention, washing it down the drain. Where it just gets stuck in the ground water waiting to get consumed and work it's way back up to us humans.

So, why am I making such a fuss about it? Well, Triclosan (also Triclocarban, the other product used) is postulated to cause cancer. Also if you're crazy enough to drink enough of it, then you could get lovely symptoms like convulsions, coma and death! Apparently, it also causes some skin irritation, but on the other hand, it affects your nerves temporarily so you can't feel it anyway. Of course, if you wanted to play devil's advocate, no one can actually produce evidence that proves 100% that it does all these nasty things so I will understand if you're not convinced.

The following points however, cinched it for me. By using so many antimicrobials (anti-bug stuff) on ourselves, we're actually encouraging resistant bugs. That's seriously bad especially if you get sick and nothing works. Also, studies have shown that if you wash your hands properly (10-15s rubbing all over with soap apparently), then there is no difference in illness (coughs, cold etc) rates between households that use antibacterial soaps and those that don't. Not forgetting the whole 'sterile house leading to increasing rates of childhood allergies' argument.

Suffice it to say, I opted for standard soap with as little on the ingredients list as I could get away with. Point of interest, I found Triclosan on the ingredients list for several leading brands of toothpaste. Except ones for sensitive teeth. Makes sense since it causes irritation. Wouldn't want THAT on a painful tooth!! Also on several antibacterial face washes, body washes. And this is just the beginning. Its been found in toys, cosmetics, shaving cream, kitchenware, blankets, humidifiers etc etc.

I just ransacked our supplies cupboard expecting to see Triclosan on everything. I admit to being a bug freak and buying everything with 'antibacterial' printed on it. Surprise, surprise... No Triclosan. But lots of 'antibacterial agent x%'. Hmmm... Doesn't inspire a lot of confidence does it... From now on, I shall endeavor to make this a phenol (group of chemical compounds that Triclosan and Triclocarban belong to) free household...

Day 5 : Hindsight is 20-20

I did something really, really idiotic today. Honestly, I know better than to bring up the issue of the dreaded vaccinations too much in advance, but I thought the kid would do better with some warning. After all, she doesn't like surprises. And it's only 4 days!! Well, more fool me. She started sobbing in the most heartbroken manner, kept going on and on about needing to have the ice pack and pretty plasters ready, not to mention the endless, 'I want daddy!!!! I want both of you to be there to cuddle meeee!!!' Come on. Please. He has NEVER been there for any of her jabs. Seriously, 'Can I have a half day off? My kid is having her jabs and I need to be there to cuddle her.' I can already imagine the looks. And to cap it off, in the middle of all the caterwauling, she suddenly declared, 'I wish it were already Thursday!' Huh? Come again? I thought you didn't want it!

We go through this whole vaccination melodrama every year. Last year it was the flu jab, this year the flu jab AND the regular scheduled boosters. Haven't even told her it's going to be 2! I can see how some moms might feel that it's not worth it, especially when you add the fears about risks of autism etc.

I remember back in medical school, we studied this concept called 'herd immunity'. In a nut shell, what it means is if you vaccinate enough kids, then the few who don't get vaccinated won't be able to catch the disease anyway. I guess if you're really convinced that your kid's 'herd' (this includes every single kid your kid is ever going to come in contact with) is fully immunised then it could be a valid argument for not giving your kid the jab. After all, there's been talk about a link between the vaccines and autism. Although I have yet to actually read anything that convinces me of a definite link. Circumstantial evidence, Your Honour...

When I weigh up the risks of death and permanent disability versus the risk of getting autism, which kids can get anyway, I tend to come down in favour of hauling her to the doctor when the guidelines say I should. This of course, is my opinion only, and I know parents who are vehemently against vaccinations of any sort. And that's up to them. Like I always say, you can but do the best you can for your kids, there will always be people who think they know better. And who won't be afraid of telling you either...

Are you listening to me, Doctor??

I remember back in the days when I was in medical school, 'communication skills' were the big thing. How to speak to your patients to get the best information, how to ask open questions so you get answers that are the patients own and not what they think you want to hear... And on and on ad nauseum. Well, I have had cause to visit a fair few medical practitioners since I've stopped working and I have come to realize a few things... It's easy to speak to doctors who are trained like I was. They're the ones looking earnestly at you and saying things like,'...and how did you feel then?' or '...what else happened after that?'. Things changed when we got here to Jakarta. For one, the poor air quality meant kiddo's asthma and allergies and what have you all made a massive comeback. Not to mention the food poisoning etc etc... So forever at the doctors clinics mean wading through a lot of chaff to get to the wheat.

The first thing I noticed was that people in general are very laid back and smiley here. Same for the medical staff. It's not that your problem is unimportant, but that's the way they are. Some more so, some less so. But in general, going to see a doctor here is a little like walking into a spa. They speak in the same soothing voice, same smiley face... I've essentially had to come up with a way of giving them information so that they get the important bits, and not wait for the polite pauses before they ask about the next symptom. I'm always concerned that they will forget something in the time it takes for the consultation to end.

This is what I do... I tell them everything that has happened in sequence, what I've done, whether it's been effective and what's happening now. E.g. I've had a cough for 4 days and a fever for 2. The fever goes away with panadol every 6 hours but for the last day I have had green phlegm and my chest hurts when I breath. 10mins condensed down to 1min. I never tell them what I think the diagnosis is because a) I don't want to influence their thinking b) I'm interested in their diagnostic processes c) there's a reason doctors are advised not to treat themselves or people close to them... I was once so annoyed by hubs complaining about a couple of spots that I missed the fact he actually had shingles!

Another thing I've noticed is that all the competent doctors in Jakarta only practice during office hours. Off hours, it's dicey. I have yet to see a doctor, or hear about someone seeing a doctor off hours that has left me feeling anything other than nervous. On our first trip here, kiddo fell and split her head open. We went to SOS and the doctor on call (she looked younger than my 20 yr old cousin!) had to call someone to ask for advice on whether she should put stitches in. Also consulted ME on whether the skull XRay was ok! Um... anxious mom dealing with freaking out husband and kids here!!! In any case, kiddo left sporting 3 stitches in the back of her, thankfully, unbroken head. Lots of other stories on weird and wonderful diagnoses to cover for the fact that some on call guys really have NO idea what's wrong with you... And obviously can't even make up plausible stories. Others are just forgetful. My husband got a metal splinter and the fellow forgot to ask about tetanus status! I had to ring the practice manager from KL where I was on holiday, and she had to then call the clinic and get it sorted. What a hassle!

Well, I discovered a handful of doctors that I trust. Top of the list is Dr.Ade, a GP at Global Doctors. She's there all week but not weekends. Lovely lady. Very competent though does appear very laid back. Very good diagnostically. The regular GP at SOS was good too though I have to say that I 'bonded' with Dr. Ade much better. For kids, the selection is better. Dr. Isabella and Dr.Lineus at Jakarta Women and Children Clinic are pretty good. Though I have had some raised eyebrow moments. Nothing horrific. Dr.Isabelle (different lady to that at JWCC) at Global is also very sensible and nice.

The one paediatrician I wish was still in the area is Dr.Johannes. He's a paediatric pulmonologist (chest doctor) who used to be at JWCC and is now somewhere in Tangareng. Not much bedside manner to speak of. Very brusque and hurried (unlike his other local colleagues) but he sorted out kiddo's asthma and allergies within 6weeks. Hats off to him, wherever he is...

All in all, medical services in Jakarta are probably not as terrible as made out to be. But how on earth do non-medical people decide which doctors to see?