[Living in Antalya -- 40] Hospital observations

The hospital I finally settled on for my treatment is large and modern and to my mind, accustomed to the British NHS system, has the appearance of a five-star hotel. It is scrupulously clean, generally well lit with copious amounts of natural sunlight, and staffed by smartly dressed and friendly personnel. Even the signs around the hospital are remarkably efficient and thoughtfully translated into English. But the one thing that I have had ample opportunity to do during the many hours spent inside this hospital is ruminate on the many cultural hospital differences between Turkey and the UK.

The patients

For instance, the patients. Back home most patients turn up for their appointments on their own. Some may occasionally take a spouse or parent along for something that may be traumatic or worrying, but generally it’s a job we do on our own. Here, this is not the case at all. This becomes immediately obvious in the large and spacious entrance hall.

Here, on either side of the doors are several comfortable seating areas, consisting of large armchairs and tables, a TV and a water cooler. These are always full to overflowing, clearly not just with patients, but with whole families, many of whom have made the trip into Antalya from nearby towns or villages. They consist of parents, grandparents, uncles, aunts, children and probably some cousins, too. They come prepared to wait for the day with bags of food and drinks aplenty. And wait they do -- all day if necessary.

This phenomenon is repeated all over the hospital, outside the doctors’ consulting rooms, the patient is surrounded by never less than three family members and frequently more. I have no objection to this custom in theory -- although I wonder how so many family members can afford the time away from work -- but in practice, it often results in a lack of available chairs for the patients themselves.

The other noticeable difference about the way Turkish and British people wait is what they do while waiting. And believe me there is always a lot of waiting to be got through. Many “appointment times” turn out to be block bookings -- a so it’s pretty much a first come first served type of system.

Now I always go armed with a bag containing at least one book, a newspaper or two, a book of crosswords and anything else I can find to distract my mind during the endless waiting. In the UK, waiting rooms were always supplied with large quantities of out-of-date and obscure magazines -- I even remember quite clearly getting hooked into a whole series of ornithology magazines once. But I have never yet seen anyone else in the hospital produce any kind of reading material. At most, in some departments, a daily newspaper appears and one or two people may cast their eye over this, but for the rest, they just sit.

Despite bringing the whole family on these jaunts, surprisingly little conversation takes place. For the most part, they just seem content to wait in mutual and companionable silence. Of course the quiet is punctuated by the inevitable noise of mobile phones -- usually these are calls from the remaining family members, not able to join the trip checking up on progress -- the use of which is very much frowned upon inside hospitals back in the UK. Here it is commonplace throughout -- not just for the patients and their entourage, but also for the staff, who make regular use of their mobiles even during consultations and operations.

The system

In the UK, the doctor is clearly in charge of the patient. Here it’s not that clear cut. For instance, having been sent for a scan/X-ray/PET scan, etc. -- knowing what to do with this result is not as obvious as you might expect. The radiologist may suggest going to see a brain surgeon, oncologist, neurologist -- but does not automatically follow this up. In other words the patient is free to ignore this scan and do nothing or go to a different hospital or set off to find the appropriate department and make an appointment.

In the UK, there would be no choice in the matter -- an appointment would be set by the hospital for some time in the future -- allowing the patient no say in the matter, and failure to turn up for said rendezvous would elicit a ticking off in the form of a letter from the hospital and probably a new date would be set.

Here, the patient can make appointments on days and at times that are convenient and, there is no stressful waiting around to hear from the hospital either by post or phone call for the next appointment. For me the Turkish system works well. I am able to control my visits to hospital and set the times to suit me. But it concerns me that there must be some people who fall by the wayside and perhaps ignore the recommendation and fail to turn up for follow-up treatment.

I am in the fortunate position of being a paid up member of the SSK system through my workplace and am therefore entitled to “free” health care. This has worked well for almost all of my treatment -- although on occasions small and unexpected charges have suddenly been demanded. The odd TL 25 for a consultation with the surgeon or a rather heftier TL 150 to see a professor were within the realms of acceptability, but when after being administered my first dose of chemotherapy, we were ushered into an office in order to discharge ourselves and suddenly asked to pay a cool TL 1,200, alarm bells began to ring. We had had no warning of this fee and no explanation of why there should be any additional charge. Coming from the UK, it goes against the grain to pay for health care in any form. However, this being Turkey, when the cashier noticed the look of horror on our faces, the amount was instantly reduced to a quarter of the original amount -- still unsure of the procedure, we paid up and scarpered off before there could be a further change.

Overall, my experience of Turkish hospitals has been positive. I am being treated quickly and efficiently -- in a sparkling clean environment by friendly and professional staff. I’m not sure I am still completely familiar how the Turkish system operates, but one thing is clear: It is necessary to remain alert, keep notes -- something I’m not convinced all the doctors do -- and by doing this it’s possible to feel very much in control of my care.