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Expatriate woes in Singapore

Year: 2002
Setting: Gleneagles Hospital, Singapore
Position: Private general practitioner

I am the first and only French private general practitioner in Singapore. I discovered years later from the ambassador that my registration with the medical council required an intervention of the French government. During my first months of private practice at Gleneagles Hospital, Goh Jin Hian, son of the Prime Minister Goh Chok Tong, is my mentor. He later became executive director at Parkway Shenton. Most of my patients are expatriates living in the lion city and tourists. I am the primary care physician of reference of 16 countries including several ambassadors. I soon discover features peculiar to expatriates. Many of them take advantage of their stay in the Malay Peninsula to experience the luxury of resorts in Indonesia (Bintan), Thailand (Phuket) or Indonesia (Bali), for example. My cases include the following:

Bone fractures
* An elderly woman visiting her son broke her coccyx on the first day of her stay after skidding on the marble floor, which had been thoroughly polished by the maid.
* Another older woman also broke her coccyx after falling backward in the Bukit Timah nature reserve when she was scared by a monkey that jumped off a tree to explore the contents of her backpack.

Bali souvenirs
* A young Brazilian came back from a weeklong holiday on the island of the gods with dengue fever. Her fever was associated with was an itchy skin rash (on her left forearm), which is a rare characteristic of the disease.
* A Swiss teenager developed restless legs syndrome following the use of ecstasy bought on Kuta beach (I published the case in Medical Progress).

Sports hazards
* A U.S. executive got struck by lighting while playing golf in Johor Bahru across the Malaysian border.
* An ambassador broke his ankle playing tennis, but refused to wear a cast out of vanity.

Rare viral diseases
* A case of hepatitis E contracted in Cambodia in which the patient’s only complaint was tiredness (I published it in Medical Progress).
* A case of acquired cytomegalovirus in which the symptoms were a mixture of flu-like syndrome and gastrointestinal disorders (I published it in the Singapore Medical Journal).
* Early AIDS infections because the viral load could not be used for screening purposes, only to monitor treatment.

I also faced unique medical circumstances with the 2003 SARS epidemic and the 2005 tsunami caused by the earthquake in Sumatra.

Lesson for the doctor: No matter how well-prepared you are for a new professional experience, you will be confronted with novelties. Venture and learn!

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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