Singapore has seen rising numbers of cases since easing restrictions. Photo: AFP / Roslan Rahman

JAKARTA – Let’s call him Jack. He is a retired engineer who lives with his wife in a rural town in Indonesia, where the big waves roll in from the Indian Ocean. He is kept alive by a US$36,000 coronary resynchronization unit (CSU) that can only be replaced in Singapore.

If he can get there, that is.

Three times now, the Singapore Health Ministry has deferred permission for him to travel to the city-state, despite a letter from his Singapore heart specialist attesting to the urgency of his case as the battery in the device winds down.

Warned by his Indonesian and Singaporean doctors that Covid-19 could easily kill him, the 69-year-old Australian has already been double-jabbed with the AstraZeneca vaccine.

Jack is one of hundreds of thousands of Indonesian citizens and foreign residents who spend hundreds of millions of dollars a year to get specialized – and expensive – medical treatment in Singapore that is often unavailable at home.

But come a health crisis and the door has closed, with officials claiming that the island’s much-touted health system is stretched to the limit by a surprisingly sharp surge in coronavirus cases.

The latest message from the Singapore Health Ministry is that waivers for overseas patients with serious health issues have been suspended until further notice – just when Singapore is allowing the first foreign tourists to enter.

Singapore’s Lee Hsien Loong. Photo: AFP / Sergey Guneev / Sputnik

In a half-hour speech to the nation on October 9, Prime Minister Lee Hsien Loong did not mention foreign patients, saying Singapore would continue opening up to ensure it remained connected to the global supply chain.

But in underlining the decision to drop Singapore’s zero-Covid policy and depend on its 85% vaccination record, he said the Delta-driven spike in infections could last for three to six months before it reaches the “new normal.”

It is anyone’s guess how many Indonesians are in the same emergency situation as Jack. Go to a Singapore hospital or doctor’s surgery during normal times and Indonesian is spoken everywhere.

“We can’t interfere because it’s at a higher level,” says one Singaporean general practitioner, who adds that his daily patients can often now be counted on one hand. “The only thing to do is to appeal through your foreign ministry.”

Health officials cite hospitals overflowing with Covid patients as the reason for the continuing deferments. The Singapore Medical Council did not respond to a request to explain why no exception is being made for urgent foreign cases.

Coronary resynchronization technology is a clinically proven treatment option for patients with heart failure, sending small electrical impulses to both lower chambers of the heart to help them beat in a synchronized pattern.

Because the battery is hermetically sealed inside the CTU when it comes out of the factory, Jack’s entire device must be replaced every four years. That comes in at a cool $36,000 to $50,000.

He needs only an overnight stay in hospital after an hour-long procedure to change out the device, which is now running in the “imminent replacement zone” – and has been for the past two months.

After that, he will have to stay in Singapore for another eight days to allow for any necessary recalibration and to give more time for the three-inch chest incision to heal.

Left unchanged, the device goes critical, sending out vibrations every hour until it eventually dies. That would leave Jack without any protection against a heart attack – the reason why CRU was installed in the first place.

A male passenger wearing a mask collects his bag after arriving at Singapore’s Changi International Airport from Germany on September 8, 2021. Photo: AFP / Suhaimi Abdullah / NurPhoto

Singapore authorities stipulate that Indonesians who get dispensation for medical reasons must have already received two vaccinations, undergone a PCR test and can produce a chest X-ray showing they don’t have pneumonia.

All this will be repeated on their arrival in Singapore, where they must go into two-week quarantine. In Jack’s case he will have to stay for another week after the procedure, and then enter eight-day quarantine on his return to Jakarta.

It will be an expensive exercise for an aging retiree, who has to pay for everything himself because the insurance premium for a man with his medical issues is beyond him.

“It is what it is,” he says, pointing to the $295,000 he has forked out since 2007 on Singaporean medical care. “If I get angry my blood pressure goes up. It will happen when it happens.” 

Paradoxically, Jack may be more at risk of getting the virus in Singapore than in Indonesia, where the official number of daily infections is now down to 1,300 from a peak level of more than 50,000 in mid-July.

Despite its impressive vaccination record, cases have risen from as few as 56 in mid-August to the current level of 3,500 a day. More than 1,500 patients are in hospital, 300 require oxygen and 40 are in intensive care.

Most of the seriously ill are people over 60, with Lee noting that 98% of recent cases have only minor symptoms. “It is no longer a dangerous disease for most of us,” he said. “We must not be paralyzed with fear.”

Earlier indications were that even vaccinated Covid patients and those with minor symptoms were being admitted to a hospital, but new screening facilities now allow doctors to determine who needs hospitalization and who doesn’t.

In mid-September, the government announced that home recovery has now been designated the default care management protocol for “more fully-vaccinated individuals.”

Singapore has so far recorded 117,000 cases and 142 deaths, but with the shift away from the zero-Covid policy, the 16-month ban on short-term foreign visitors is finally starting to lift.

The government has now opened up four “green lanes” for fully vaccinated travelers from Hong Kong, Macao, Brunei, Germany and, more recently, South Korea, none of whom have to spend time in quarantine.

Singapore medical tourism has taken a huge hit since the onset of the pandemic. According to one estimate, Indonesians spend about $600 million a year on treatment in Singapore, Thailand and Australia.

Much of that is in Singapore, which normally receives about 500,000 overseas patients a year, half of them coming from Indonesia alone, according to the Medical Tourism Association.

Cardiac surgeries at Singapore hospitals, including heart bypasses and valve replacements, range up to S$130,000 (US$95,800); cancer treatments such as chemotherapy, radiology and immunotherapy, can cost S$234,000 (US$172,600).

Market research indicates it may become increasingly difficult for Singapore to maintain its title as the region’s top medical tourism destination when Thailand and Malaysia are offering better value for money.

While Jack is a special case, perhaps the pandemic will also persuade the Indonesian elite to have more faith in their own doctors, instead of rushing off to Singapore for treatment of maladies that can easily and effectively be handled at home.