The dream
I remember googling the world university rankings for medicine many years back – Harvard turned up as the top result. Ah, what a waste, I thought. I could never study medicine in the US; their system is too different from Singapore's.
Ever since then, the Harvard dream has been left unfulfilled. So imagine my excitement when I received news that I was going on an exchange programme to Harvard Medical School with 14 other capable people! It was going to be fun. Especially since all 15 of us were going to live together in one house.
The house
Living with 14 people surprisingly went without a hitch. We shared four bedrooms and three bathrooms (which were often pushed to the limits of acceptable hygiene standards before one of us bites the bullet and cleans it). I had prepared myself for the difficulty in preventing clashes in one house. There would be a long queue of people showering before work and bedtime each day; fighting to use the washing machine and ironing board; and clamouring to use the pots and pans.
We were all mentally ready to sit down and discuss allocated slots for amenities and chores. Unfortunately, the hectic first few days, paired with jet lag, meant the cancellation of plans.
It was thus incredibly satisfying when everything fell into place. Our reporting time spanned 5 am to 9 am, which meant that there was always a free bathroom whenever one needed it. The standard deviation for dinner time was also wide from 5 pm to 11 pm. Pots and pans were washed up and ready for the next person's use almost as soon as a meal was completed. It was a sight to behold.
The food
A month in the US also meant getting used to American food. Or maybe not, as many of us decided to bring out our inner chefs for the first time. There were many hilarious moments, including accidentally cooking enough macaroni and cheese for 16 people when we meant to cook for four. Gradually, we moved from safer dishes like spaghetti to more adventurous ones like steak. Portions started emptying out as we impressed ourselves with what we had whipped up.
We had planned to exercise daily to keep fit but our discovery of cooking threw a wrench in the works, especially when our estimation was as poor as mentioned above. The only comforting thought was that we could tell others we became more "American"after a month – at least in terms of our average weight.
The healthcare
The pilgrimage to the US was eye-opening. First and foremost because I was attached to paediatric ophthalmology, but also because of the great differences between our systems.
Being at the best children's hospital in the US (for the sixth year running) gave us better insights into various aspects that make up a healthcare system. While both systems have their strengths and weaknesses, the experience allowed us to further appreciate Singapore's hospitals.
We saw how technology can play an important part – from online video translators to games for kids while removing their casts. Telehealth applied in all its splendour, allowing doctor consults to be conducted across 24 different countries. And the use of robotics for precise movements and incisions in surgery.
One of the greatest differences would be the degree of healthcare freedom. The US ranks high on the healthcare freedom scale while Singapore ranks lower. As a result, new therapies can be used in practice in the US as soon as Food and Drug Administration approval is received. Meanwhile, the journey from bench to bedside takes a longer path in Singapore. A new therapy would have to be in use abroad for at least half a decade before it will be introduced in Singapore. However, hospitals in the US have to individually negotiate agreements with pharmaceutical and insurance companies. That significantly raises the cost of healthcare despite broadening the range of treatment available.
It was also disconcerting to see the power insurance companies held over healthcare. One of the patients I saw was restricted to five follow-ups with the ophthalmologist; anything beyond that would not be funded. It appeared like an arbitrary limit placed on decisions that should have been under the purview of specialists – one that does seem to affect the quality of healthcare provided.
The patients
Though diseases were similar, the patients that they afflict were vastly different. Besides the clinically relevant disease demographics and genetics, it was refreshing to observe the social fabric through patient interactions.
Patients were incredibly friendly and were always welcoming when they heard I was an exchange student from Singapore. This was usually followed by a genuine interest in our country and education. The consultations would then end off with warm well wishes when they realised I have a final examination coming up.
In paediatric ophthalmology, I also had the privilege of observing the weird and wonderful – rare genetic conditions. As healthcare professionals, we are often excited to see rare diseases, but it is important to step back and consider the impact such conditions have on families as these conditions often accompany a child from cradle to grave. It is in this setting that I witnessed the incredible love and resilience of human spirit. Many parents drive hours to seek medical treatment and continue to shower their children with warmth and attention despite the clear fatigue, all while holding out hope for the chance of a cure in the future.
The takeaway
One month passed in the blink of an eye. Under the guidance of great mentors, I had the opportunity to practise surgery on porcine eyes and apply what I had learnt on real eyes (in controlled conditions).
I was fully immersed in another healthcare system, and from that, I saw the strengths and weaknesses that lie in our own. I also had the great pleasure of touring the US in an amazing group of 15, sharing some laughs before the final year hits.
Most of all, I am thankful to have my dream from so many years ago fulfilled. It is my hope to apply all that I have learnt to the Singapore context and to continue learning from esteemed institutions worldwide. With that said, it is time to face reality in Singapore once more – onwards towards the final examinations that so many have given me encouragement for.