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Being treated for a medical emergency in a foreign hospital can be a scary proposition for Americans.

How will they communicate with doctors and nurses? What is the quality of care like? Will insurance cover the cost?

Military hospitals may be more comfortably familiar to servicemembers and Defense Department civilians overseas, but sometimes they don’t have the specialists or equipment to handle rare or more critical conditions. That leaves patients with two options: going back to the States for treatment or checking into a local hospital.

But it doesn’t have to be such a difficult choice, military doctors and patients who received care in local hospitals say.

In fact, some doctors at military hospitals encourage their patients to seek care in a local hospital.

“I feel very confident in referring patients to the neurosurgeon at the University of the Ryukyus,” said Lt. Cmdr. Robert Ecker, staff neurosurgeon at the U.S. Naval Hospital on Camp Lester, Okinawa. “As a matter of fact, I’ve had five patients treated there. They have one of the top five endovascular surgeons in Japan.”

Japan has “first-world medical care,” Ecker said.

‘The right choice’

One of Ecker’s patients is Chip Steitz, 52, the spokesman for Department of Defense Dependents Schools-Pacific. Steitz suffered several strokes early this year that were due to blocked circulation in his carotid artery. The first stroke occurred while Steitz was on leave in Chicago, but the problem was not diagnosed properly until he returned to Okinawa and suffered another stroke.

“It became apparent here that he suffered from a genetic weakness in his cardiovascular system and he needed a carotid stent,” Ecker said.

The stent, a self-expanding flexible mesh, was inserted into the artery in his neck to counter a buildup of fatty plaque. It’s a rare procedure, but Ecker referred Steitz to Dr. Akio Hyodo at the University of the Ryukyus, who had trained at the Mayo Clinic in Rochester, Minn.

“It was absolutely the right choice,” Steitz said. “Okinawa is our home. Rather than fly to the States with all the expenses — hotel fees, car rental — I had the procedure done here and was able to go home and recuperate with my wife and friends nearby. I probably only had to take off half as many days as I would have needed had I gone back to the States.”

Recent exams have shown the operation was a success and Steitz’s health is back to where it was before the seizures, he said.

Building a network

U.S. military hospital officials have established a network of Japanese facilities they feel comfortable about in referring patients.

In the past year, for example, 66 critically ill patients at Yokota Air Base have been transferred to local hospitals for emergency care, according to Lt. Col. Catherine Bard, the 374th Medical Group’s chief of medical staff.

“We have chosen our Japanese referral facilities very carefully based upon their capabilities and our patients’ needs,” Dr. Bard said. “Because of that, our host-nation hospitals … have repeatedly done an excellent job for us and our patients.”

Nearly all the local hospitals Yokota refers patients to have the Japanese equivalent of the Joint Commission Accreditation, the organization that assesses quality of U.S. medical facilities, Bard said.

Navy Capt. Gerald R. Cox, executive officer of the U.S. Naval Hospital on Camp Lester, says local hospitals are often used.

“Although this is the most robust overseas hospital in the U.S. Navy, there are some exceptions to what we can do,” Cox said. “We do not have a cardiologist, for example. So, we refer our cardiac patients to Chubu Hospital, which has an excellent staff of cardiologists.”

The agreements with the off-base hospitals in Japan have saved the military millions of dollars since 1999, because patients receive care locally instead of being sent to military facilities in other countries or back in the United States, officials said.

The patients who go off-base often find medical care in Japan and South Korea can be less expensive.

Steitz estimates the operation he underwent on Okinawa would have cost twice as much — or more — in the States.

And an MRI costs less than $600 in South Korea but can run well over $1,000 in the States, U.S. officials said.

Care barriers

“Of course, there are cultural and language barriers,” he said.

For example, nursing standards can be different, with family members more involved in feeding and bathing patients. And the nursing staffs may be less able to communicate in English than the doctors, many of whom receive some training in the United States.

Another difference is the attitudes of some doctors, particularly older Japanese doctors, who may seem to be more paternalistic in their relationship with patients, Cox said.

“But those are small things to consider in exchange for being able to be treated close to your home,” Cox said.

Indeed, Cox said his son is getting his braces at the orthodontist at the Seventh-day Adventist Medical Center in Nishihara.

Staying in touch

Doctors from the Navy hospital make rounds at the local hospitals when there are American patients and hold lectures with their Japanese counterparts, Cox said. The Navy hospital also has an internship program for six Japanese physicians.

Bard said communication, pain management and food are generally the biggest concerns military doctors have for patients in a Japanese hospital. To assist Americans in Japanese hospitals, the 374th Medical Group has added translators to its staff and made better use of cell phones for remote interpretation.

“For pain management … there is a cultural difference in the area of pain perception and management, but we are steadily making improvements,” Bard said.

Food always will be an issue — no matter where a patient is treated.

“It is not uncommon for patients to complain about hospital food in the U.S.,” Bard said. “Food served in most Japanese hospitals is typically Japanese style. It is different, but it is nutritious.”

Still, Yokota’s work with area Japanese hospitals has been tempered by a few bumpy experiences, Bard conceded.

“Have we had patients who have had less than total satisfaction with their care at a local Japanese hospital? Yes,” she said.

“Fortunately they aren’t common,” she added. “In the 2½ years that I have been here, there has not been one life lost at a local Japanese hospital that was the result of the care received there, and many lives have been saved.”

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