The Week That Was

This week, I went to see a dermatologist. Going to the dermatologist should be unremarkable and not worthy of a blog post. Should be. 

I visited the doctor because I have a lot of freckles and moles and I thought it was time for a full body inspection to check for irregularities. I also went because I am not happy with my face, specifically the skin on my face. This is a little game I play with myself and the medical profession. If I go to the doctor for something medically important I also reward myself with something quasi medical and less important. So in this case it was go to the doctor to have my moles checked and walk away with a miracle cream or pill that will make my face radiant.  

The appointment began normally enough with me filling out forms and being called in to see the doctor but from there it degenerated into the strangest, longest and least helpful medical experience I've ever had.

The doctor began by asking me where my family was from, not as in America, but before that. I said Eastern Europe and when she asked specifically where, I said Russia...which I then realized isn't Eastern Europe so I felt like an idiot. In fairness to me I wasn't expecting a geography quiz. Mr. Deep, upon his review of this post, informed me that part of Russia, the part west of the Ural Mountain range, is in Eastern Europe, so that's good. I hope the doctor is aware of this. She asked if Russian was the same as Celtic, which should have been my first clue that something wasn't right. She said she had just come back from a conference where she learned that gene therapy is the next big thing and that it's important for me to know where my family is from. Keep in mind she hadn't yet examined me or determined that anything was wrong with me that would require gene therapy so this discussion may have been premature. Also, if medicine is advanced enough and doctors can treat your illness by addressing at the gene level, can't they also "map" your genes? Does knowing what former Soviet town some of your family is from really matter in this case? 

She took me into the exam room. While we were waiting for my gown to warm (it's winter now remember) she said she'd start by examining my face which as I've already explained was my top priority as well. Unfortunately, she couldn't get the giant lighted magnifying glass to turn on. After five minutes she eventually gave up on the light and had me put the gown on. Once the gown was on instead of examining my body, she instructed me to return with her to her office. Fortunately I was still wearing my pants and my bra (and the gown) so I wasn't returning to her office completely naked. Back in her office she used some giant gun like camera to closely examine a spot on my face. She called her assistant in to help her load a close up photo of this spot onto the computer and then they both tried to figure out how to use some software to determine what the mystery spot was. Unfortunately, they didn't seem to know how to use the software and it took quite some time for them to come up with a diagnosis. It was finally determined to be dermal melanin. I don't have any medical training but I'm pretty sure dermal melanin and a freckle are the same thing. However, the doctor didn't seem sure and she removed a book from her shelf...A BOOK FROM HER SHELF! I suppose the reason for the book was to look up dermal melanin but she got sidetracked telling me about pills that contain Amazon tree bark extract that I should be taking to help protect my skin from the sun and she never actually opened the book. She left the room to get the pills to show them to me, not a new bottle because the pills were out of stock, but her own personal bottle. 

Meanwhile, I'm starting to feel nervous that this appointment is taking a very long time and I'm thinking that if we have to spend five minutes on every mole and freckle that I'm going to be there for two weeks. I decided that if she attempted to examine my body that I'd tell her I was out of time. But she never got back to my body...even though I was still wearing the gown.

Remember I'm vain, so I was still holding on to hope that she'd prescribe me some great serum for my face and I decided to stick it out and try to turn the conversation back to my face. Big mistake. 

She looked at my face and stopped just short of declaring it the biggest mess she's ever seen. She asked if I had allergies. Even though I said no she prescribed some kind of blood test to check. She then asked about my skincare routine but as I tried to explain it, she kept interrupting me to advise me that everything I was doing was wrong. She took some lotion and demonstrated how to apply products to the face. She said you press instead of rub. OK press instead of rub could be valid but she also told me that I should only be washing my face with water. I asked how I would remove make up using only water and she said I should use a face cloth, but hadn't she just said no rubbing? The whole conversation was making no sense. When I said that I sometimes use an RA cream, she asked me "what is RA cream?" At that point, I knew for certain that she had absolutely no grasp on reality and that I had to get out of there. What dermatologist doesn't know what RA cream is? She continued telling me all of the things that might be causing my problem face including saying that I had a bad habit of putting my fingers into my mouth. Only I don't think I do have this habit as I no longer bite my nails. She told me I might have streptococcus.   

The real kicker came when she asked me about my mattress and how old it is. I replied that we'd purchased it in 2013. She asked me if I vacuum the mattress. I should have lied and said that I do, because she then told me that she could see DUST MITE BITES ON MY FACE. Honestly, I have never in my life been told something so horrifying. Can you imagine? I couldn't escape this woman's office fast enough. It was all I could do not to go directly to a shop to buy a new mattress and then firebomb my entire house. Even though this doctor was clearly a bit off could I really take a chance on being eaten alive? I pulled myself together though and didn't buy a new mattress or a new bed or have my house fumigated and here's why.

Two days before this medical madness Gift, his sister and his brother came over for dinner. During the course of the evening I became aware that Gift's brother, Wiseman is his name, doesn't own a bed or a mattress. He sleeps on the floor of a shack where he has been living for the past few months. If the shack has a floor. I couldn't bring myself to ask if there is a real floor or a dirt floor. He also doesn't have electricity in the shack. Since then, I have been obsessed with the thought of Wiseman sleeping on the floor of a cold, dark shack.  At night when I am in my recently declared imperfect but still functional bed I am thinking of him and feeling concerned. And no, Wiseman is not an ex-con or a recovering drug addict trying to get back on his feet, he's just poor and he can't afford a mattress or a bed with the money that he earns from his job. It's that simple. 

I decided I am not going to let this doctor lead me down a path of craziness. Even if it's true that sunscreen is rendered ineffective if there is orange fragrance in it, I don't have time for this insanity. I don't need the pills the from the Amazon, I don't have streptococcus, I'm not going to get a full blood test and I certainly don't have mite bites on my face. Dust mites don't even bite. I looked it up. I will not become any more self-involved than I already am and will not start creating personal medical problems where there aren't any. Instead, I will find a bed for Wiseman and even if the bed is used, I think he will be really happy to receive it. Dust mites and all. 

Doctor Doctor

Before I moved here I wondered, what would going to the doctor in South Africa be like? What if I became seriously ill? Could doctors in Joburg successfully treat me? What if they couldn't properly diagnose me until it was too late? 

I know some expats who have their annual physicals when they make visits back home. But live away from home long enough and eventually you will need to see a doctor. And, if like me, you actually look forward to getting your teeth cleaned every six months then you will certainly need to see a dentist or a hygienist while you are living away. 

Fortunately throughout our stay in South Africa, Mr. Deep and I have remained healthy. However, I counted the number of receipts that we have for doctor visits and combined Mr. Deep and I (although mostly Mr. Deep) have visited doctors and dentists 35 times in less than 22 months! I know what you're thinking, that it's amazing that we were able to squeeze in any travel or safaris given the significant amount of time we are spending receiving medical attention. Mr. Deep asked that I clarify and tell you that most of these visits are for physical therapy or as it's called here biokinetics.

The first time I visited a doctor in Joburg I completely over complicated the situation. It was April of 2015, two months after we arrived. I had been feeling sick with a stomach bug and despite my best efforts to treat the illness with ginger ale and tums, I wasn't getting any better. 

Upon arrival I checked in with the receptionist. She told me the name of the doctor I'd be seeing and said I could "go through." Coming through or going through is South African terminology for "go on in." What I wasn't sure of was did she mean go and wait in the waiting room or go right in and see the doctor? Maybe I was delirious from sickness but I decided that she must mean that I should go directly in to see the doctor. 

I walked down the corridor and found the door with the doctor's name on it. It was slightly ajar so I entered the office. The doctor seemed a little surprised to see me. I explained that I wasn't sure if the receptionist meant that I should go right to his office or not (although it was becoming clear not.) He said that usually, and by usually I think he meant always, patients wait in the waiting room until they are called. I am sure he was wondering where in the world I was from where it's normal for patients to barge in to see the doctor. He was really nice about it though and proceeded with my appointment rather than sending me back to the waiting room. 

Overall I have found the medical system here to be quite good. While I don't know if the care I am getting is any better or worse than what I would be receiving back in the U.S., there are certain aspects here that are definitely better.

First, the wait times are very short. In South Africa I don't think I've waited to see a doctor for longer than 15 minutes. In the past I have waited over two hours even with a scheduled appointment.

Second, it's easy to get an appointment. If I were to call my doctor's office right now, they would ask me if I wanted an appointment today. I would not have to beg or cough dramatically into the phone in order to be seen. In the U.S. if I were to call a doctor today and ask for an appointment, I would be given the earliest available appointment which would be in March, 2017.  

Third, the doctors here are not afraid to prescribe drugs. Some people think this is a bad thing, but if I am feeling poorly enough to visit the doctor then I am looking for fast relief in the form of tablets. 

Fourth, results are given quickly. When I had annual blood work, I was called with the results the next day. When I needed a chest x-ray for my visa I got the films right away. When I had a mammogram the results were provided to me before I left the hospital.

For a year Mr. Deep and I paid for all of our medical expenses in cash. While visiting private doctors is sadly cost prohibitive for a majority of people in this country, to us the visits often cost less than our co-pay would back home. Although we were aware that we had some type of insurance for expats neither of us researched the matter. I am sure that this task was supposed to be handled by the Ops team, but it wasn't and eventually Mr. Deep got tired of seeing money fly out the window and requested that I submit the paid invoices to insurance to see if we might be reimbursed for any of our expenses.  

He handed me a stack of invoices and gave me the Cigna Global Health Benefits log in information. Of course I procrastinated the project for a while as I was busy with other things. Finally, I sat down to complete my assignment. The whole process was quite simple and straightforward. In fact, the only challenge I had was that in order to successfully submit photos of the paid invoices I had to install a "photo shrinker" app on my phone. Once that was done, I was able to quickly submit each claim.

The process for submitting claims via Cigna Global Health Benefits is as follows. First, register on the website (have your Cigna ID card handy for this.) Next, enter banking details for what is called ePayment Plus to allow reimbursement to be deposited directly into your bank account. After selecting which family member you are filing on behalf of, type a few sentences explaining the diagnosis/symptoms. For example, "visit to doctor for stomach illness" or "biokinetics for knee pain." Next, from a drop down menu choose the country where the expense was incurred. Upload a photo of the invoice you paid (remember you may need to shrink the size of the photo first as it must be less than 6mb.) Finally, agree to the terms and submit the claim. The whole process takes about 15 seconds.

As I submit claims Mr. Deep receives three emails from Cigna. The first, when a claim is submitted, the second when we are reimbursed for an expense, and the third when a new explanation of benefits has been posted to the website for our viewing. There is also an app called the Cigna Envoy App that can be downloaded to track claims but I have yet to try it.

A few days after I completed my claim submissions a miraculous thing happened and we started receiving payments from Cigna into our bank account. Nothing (not even birds) makes Mr. Deep happier than money appearing into his bank account.  

This post was sponsored by Cigna Global Health Benefits. All opinions expressed and experiences shared are my own.