Night at the ER — Questions I had during my stay.

I paid a surprise visit to the Emergency Room (ER) the other day because I developed an allergic reaction to an unknown source. I ended up having to spend the night at the ER for monitoring.

This was my first time staying the night at a hospital; I didn’t (or rather, couldn’t) sleep much, took intermittent naps but stayed awake for most of the time.

In the process, though, I saw many things that intrigued me. At some point I realised — I’ve never been treated at a hospital before. This was the first time I saw the proceedings of a hospital (ER) firsthand.

So I jotted down some points in my notes app and went to work. In the article, I will explore some questions I came up with during my stay, as listed below:

1. What contributes to the long wait times in the ER

2. Do domestic helpers face more challenges seeking healthcare in Hong Kong?

General Insight

Before you can receive any form of ER care, you must register at the reception and pay a fee.

Eligible persons, meaning those with HKIDs only pay a fee of $180 HKD, while non-eligible persons, meaning those without HKIDs have to pay $1230 HKD.

In general, HKID holders can receive care at public hospitals in Hong Kong at low rates, and a fraction of what non-HKID holders would have to pay. This will be explored further on in the article.

A brief comparison of the fees paid by HKID holders and non-holders.

Reference: Hospital Authority

1. Wait time

To be honest, I was more afraid of the potential wait time than my actual condition when I first got to the emergency room.

Which is funny, in hindsight, because I was concerned about my potential boredom instead of certain death.

The average waiting time in the ER for non-urgent patients was around 2 hours (measured from 2014-2016), while midnight wait times for that same demographic could go as far as quadruple that (8 hours, measured in 2018) at midnight.

So in some ways, my fear was not unfounded.

Triage — Patient Prioritisation

Fortunately, the ER has a Triage System. French for “to sort”, the objective of the system is to provide patients with timely treatment and allow effective utilisation of staff and resources.

Nurses assess and divide patients into five categories:

1. Critical

2. Emergency

3. Urgent

4. Semi-urgent

5. Non-urgent

Patients are treated in accordance to the urgency of their condition (1-5 respectively), and most urgent (category 3) cases will receive treatment within 30 minutes.

In the most twisted sense of the word, my condition was “fortunately” more on the urgent side, and I was given treatment right after the triage process.

Why Are There Long Wait Times in the ER?

The most straightforward answer is that most Hong Kong hospitals are operating beyond their capacities.

The hospital staff simply cannot accommodate the sheer amount of patients quickly. However, this is not an issue entirely attributed to understaffing.

Over half of the patients in the ER are there for non-emergency conditions. In other words, if the ER had only treated patients with urgent conditions, there would not be long waiting times.

“Long waiting time in A&E departments should not have occurred if only A&E cases are entertained...[similar to how] eye clinics do not see [patients with] chest problems and so on.” - Tsui & Fong, 2018.

In terms of supply and demand, non-emergency patients could visit private clinics or family doctors for medical assistance to shift the demand back to a more reasonable spot.

Therefore, the key to avoiding the disastrous wait time in the ER is simply: Don’t go unless it’s an emergency! Or go to a clinic!

Here’s a website that shows the live waiting time estimate for all ERs in Hong Kong!

https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=235504&Lang=ENG

“What if I just leave?”

When I first went into the ER and was lining up to register, there was only one counter open to process patients, which I wasn’t really happy about (but in hindsight was very reasonable, given it was the night shift).

However at that moment, within my slightly anxious mind a thought arose, “what if I just leave and go somewhere else?”

Amongst all the patients that leave the ER before they are seen by a doctor, 5% of them return within two weeks with worsened conditions.

(If I had left the ER that night, I think my condition would have worsened within the hour.)

Leaving Without Being Seen

There’s actually quite a bit of theory behind Leaving Without Being Seen (LWBS), which refers to patients leaving the ER before being examined and assessed by a doctor or a nurse

There are a few factors that increases rates of LWBS amongst patients, including:

• Crowded waiting areas

• Long queue lengths

• Expectations of wait time

Crowded waiting areas and long queues make patients anxious, which then make them “perceive the waiting time as longer than the actual waiting time”. This, in turn, increases the chances of patients LWBS.

Expectation of wait time usually comes from the patient's observation of the service rate — the rate to which patients are attended to by nurses or doctors.

In other words, less crowded waiting areas, shorter queue lengths and higher service rates could create perception of shorter wait time, decreasing the chances of patients LWBS.

Factors that cause patients to Leave Without Being Seen (LWBS)

All in all, if you don’t want to have a disastrous time waiting at the ER, it boils down to

1. Adjusting your expectations and,

2. Don’t go to the ER if it’s not an emergency!

Reference: Hospital Authority, The Hong Kong Polytechnic University, The Chinese University of Hong Kong

2. Domestic Helpers Seeking Healthcare

On another note, I saw many domestic helpers seeking care in the ER even at midnight. I remember hearing their names being called in hour-intervals, so they were probably there for a long time.

There was an instance where a nurse challenged another nurse, who had been able to answer an inquiry from a domestic helper despite her “heavy accent”.

At that moment, I wondered — would these potential challenges in communication translate into implications that would make accessing healthcare more difficult for domestic helpers?

Beyond that, it must be confusing and scary to have to navigate a foreign medical system. I wondered if Hong Kong had regulations in place to ensure the health and wellbeing of domestic helpers in general.

So my question is: Do domestic helpers face challenges in seeking healthcare in Hong Kong?

Existing Policy

Turns out, Hong Kong has a pretty good set of regulations to ensure that domestic helpers get access to healthcare.

The Hong Kong labour department states that employers should provide free healthcare and treatment to domestic helpers, regardless if the ailment is work-related or not and as long as she is in Hong Kong.

As such, many employers take out medical insurance for domestic helpers. This is a positive factor for healthcare seeking behaviour as insurance would cover most of the costs for any medical treatment.

A subtle nuance here is that the minimum requirement for insurance that employers should take out is the Employee Compensation Insurance, which only covers work-related injuries.

Given the blurry nature of what is considered “domestic work” though, this may cause some complexities with the insurance provider if an incident ever occurs.

Potential Challenges in Seeking Healthcare

The case of Baby Jane Allas

Baby Jane Allas was a domestic helper who was fired after being diagnosed with stage 3 cervical cancer.

Not only was this against disability discrimination ordinances, her dismissal also meant that her access to subsidised healthcare in Hong Kong has been revoked. As a result, she couldn’t receive the much needed radiotherapy and chemotherapy sessions without paying a staggering fee.

Learn more about her story here.

According to Hong Kong regulations, the validity of domestic helpers’ HKID cards are tied directly to their employment statuses.

This means that, if they are terminated, domestic helpers

• Lose access to affordable access to healthcare, and

• must leave Hong Kong within two weeks.

In other words,

1. Domestic helpers’ access to healthcare is entirely dependent on their employment status,

2. Employers are a huge factor that determines if domestic helpers receive healthcare, and

3. Fear of termination may also cause domestic helpers to withhold their medical conditions in fear of termination

These are all factors that may make seeking healthcare for domestic helpers in

Hong Kong more difficult.

Working Conditions as a Precursor to Bad Health

Taking a step back, the poor working conditions that many domestic helpers face may leave them more prone to health ailments in the first place.

According a report by Mission For Migrant Workers in 2021, amongst the domestic helpers in Hong Kong,

• 98% complained about long working hours,

  • 72% of which reported working hours up to 16 hours

• 35% reported poor accommodations a living environment

• 14% reported lack of food caused by insufficient food allowances

• 8% reported abuse and ill treatment

Beyond that, prolonged separation from family and friends cause many domestic helpers to feel lonely or even depressed.

These are all conditions that can ultimately lead to detrimental health conditions such as stroke, cardiovascular ailments and other diseases.

Infographic by Mission for Migrant Workers.

As working conditions are largely determined and vary by employers, there is no tangible way currently for the government to regulate and ensure the health and wellbeing of domestic helpers.

In light of this, the individual health and wellbeing of domestic helpers in Hong Kong boil down to their own experiences with their work and employers.

Supportive Social Networks and Healthcare

In a refreshing twist, here’s a way that domestic helpers gain agency over their health and wellbeing in Hong Kong.

A recent report explored how domestic helpers in Hong Kong extensively utilise their social networks (such as fellow domestic helpers, employers and domestic helper organisations) to effectively access healthcare and health information.

This usually takes the form of asking fellow domestic helpers for advice for health concerns, referring specific clinics for health check-ups, attending health-related seminars and more.

Employers sometimes play a supportive role for domestic helpers to seek healthcare by encouraging them to seek professional medical care, shouldering expenses and accessing medical resources on their behalf.

Domestic helpers communities also enhance health-seeking behaviours and overall well being by mutually affirming healthy lifestyle choices and encouraging proactive access to health services.

Read more about the research here!

Conclusion

Ultimately, domestic helpers do face a fair share of challenges in seeking healthcare.

Their access to healthcare is entirely dependent on their employment status, and their working conditions often leave them at risk of health ailments. These are issues that current policy mechanisms overlook.

However, labour regulations such as mandatory insurance and supportive social networks enable many domestic helpers to access affordable and insured healthcare in Hong Kong.

It is refreshing to know that, within a foreign environment, domestic helpers have agency to maintaining their own health and healthcare-seeking behaviours with the help of policy and community.

Reference: Helper Choice, SCMP, De La Salle University, Mission for Migrant Workers

Epilogue

As of the time I’m writing this, I’ve just returned home from my second visit and stay at the ER for mainly the same reasons at the first.

However, the information I had researched for this article enabled me to feel confident and not worry about my wait time, and I hope it did for you too!

If you ever find yourself in the ER in Hong Kong, I hope my article makes you feel at least a little bit better, and you will be assigned timely treatment!