In Sickness and In Health: Medical Journeys in Amsterdam
The unpredictable weather, the "laid-back" service in restaurants, the seeming inability of the Dutch to line up correctly: these are just a few of the topics that expats in Amsterdam like to bore each other kvetching about. Most of us also have a story or two to tell about our experience with the healthcare system here. In the U.S., folks generally wait until they are getting on in years before oversharing about their medical ailments and trips to a slew of doctors to seek to cure what ails them. Here, set adrift in a country with new rules, and new attitudes towards sickness and health, even young and spry expats can sound really old really quickly. I suppose my interest in doctors runs deep: as the daughter and sister of doctors, and granddaughter and great-niece of many, many dentists, I have always been interested in medicine. It's just that my tendency to feel faint at the sight of blood interfered with making it my life's work. Oh, and then there's the matter of taking Organic Chemistry...or any chemistry. I think writing about medicine suits me just fine.
My experience with all things medical in Amsterdam has been fairly typical. Our first year here, I basically had a cold that lasted all year. Like the good expat girl that I am, I found a doctor soon after we arrived. "Just in case", because "Vine's law", as we like to say in my family, dictates that if I didn't, I'd get sick. Many people rely on their U.S. doctors back at home, hoping their illnesses somehow correspond with their trips back across the ocean. I decided to jump right into the Dutch medical system. With some advice from another expat (of course) I picked a huisarts, or general practitioner, right in my hood. That doctor is the gatekeeper. You need to see her or him before you can go to any specialist, just like in the bad ole days in the U.S. when everything required a referral. At one point, after my cough had stretched into the third month, I went to see my huisarts. Expat friends with experience told me I should not expect an antibiotic. Getting a prescription for an antibiotic is as easy here as finding the holy grail. That proved to be case for me. My huisarts looked at me like a know-it-all teacher scowling at her timid student and reminded me that since this was my first year in the country, my body was just getting to know all the new germs.
Rather than doling out antibiotics like candy, like some doctors in the U.S., the huisartsen are known for being very stingy with it. Note that in an informational website for expats, the question, "Where can I get anitbiotics?" appears front and center in the FAQ section. The attitude towards antibiotics here is the medical equivalent of the old lady at Halloween who grudgingly gives you a tiny box of raisins when what you really want is a giant Hershey's with almonds. In this case, the tiny box of raisins is a suggestion to take some Paracetamol, which I think is just Tylenol but sounds distressingly like a parasite of some kind. On the other hand, if you are a dog, you have easy access to antibiotics. When Casey was bitten on the ear shortly after we moved here, he didn't have to beg for his prescription. Maybe I should start borrowing from him if I need something stronger than Dutch Tylenol. Most expats just stock up when they go back to the U.S. to visit, returning with their illegal meds stowed away in their luggage.
Other than Paracetamol, the most common "medicine" doctors recommend to expats seems to be Vitamin D. Because of the lack of sunshine during the long winter months, you need to get in the habit of taking Vitamin D religiously. I'm not sure if the locals take it. They do seem to enjoy their vitamins and health potions, and also their brightly colored fresh juices. However, I've noticed a few contradictions in the approach to good health: bike riders puffing away on cigarettes, an employee at the nearby "biological" grocery taking cigarette breaks next to the organic produce, tanning salons abounding, even at my gym. Perhaps the Dutch would find just as many contradictions lurking in the American approach to health if they lived in the U.S and blogged about it. Certainly, they don't seem to be dealing with an obesity crisis here. I'd chalk that up to the bikes and the cigarettes. On the other hand, my hair dresser - a fountain of information - tells me if you go out into the poorer sections of the city, you'll encounter both more fast food and more U.S.-style physiques. I hear what she is saying, but can also say that even in those areas, you just don't see the number of morbidly obese people you see in the U.S.
My closest encounter with the medical system here came when my teeth suddenly let me down this summer, after a lifetime of doing a good job of getting the job done with a minimum of drama. It turned out I would need a wortelkanaalbehandeling. Luckily, I had made a pitstop to visit my U.S. dentist the day I flew back here. His bad news, in English, didn't sound nearly as horrible, and was certainly less of a mouthful. I would need a root canal. He also gave me some good news: he was flying me back with an antibiotic in tow. Yes, I had scored! Once back in Amsterdam, I had a helluva time convincing the receptionist at my Amsterdam dentist office that my request for an appointment was an emergency, but she finally relented. In the few days leading up to the appointment, I was regaled with tales from other expats about their dental woes: crowns that didn't quite fit, wisdom teeth removed without novacaine, and of course root canals gone horribly wrong. Oh my!
The actual procedure went smoothly. I entered a swank office and an hour and a half later, had two of my canals cleaned, widened, and improved. That seemed quite fitting as I walked back to the tram, along one of the non-dental Amsterdam canals. I could have done without the running commentary from the endodontist, who insisted on telling me in detail (thankfully, in English) exactly what he was doing throughout the procedure. I noticed when the going got rough, he spoke in Dutch to his assistant. When I left, the receptionist seemed genuinely stunned that I needed to pay up front and then submit the bill for reimbursement. This return to the old days of insurance coverage is one part of the expat experience I do not enjoy. Then she actually apologized for the amount of the bill. I guess that means that Dutch insurance covers most dental procedures and she was unaccustomed to presenting patients with large bills.
Sadly, after two years here, I haven't been able to get a definitive answer to the question, "Do we need to buy Dutch health insurance?" (to supplement our expat coverage from the U.S.). You would think this is a straightforward question which would have a straightforward answer. Try asking ten expats that question, and you will get answers that range from, "Absolutely not! You just need some health insurance," to, "Definitely yes!" to, "It depends on what your company's HR department says." So we may actually be carted off to Dutch prison (where, you may recall from a previous blog post, there are many empty beds) or fined for not having Dutch insurance once we figure out what the real answer to the health insurance riddle is. I'll keep you posted.
[Just an aside: how do you feel about Bob Dylan getting the Nobel Prize for Literature? If they were going to give it to a singer/songwriter/poet, my vote would have gone to Joni Mitchell.]
What exactly is included in your Dutch healthcare package? For one thing, something called, "exercise therapy". And for another, "smoking cessation therapy". After the Michael Moore documentary, Where to Invade Next, folks in the U.S. were both stunned and jealous to learn that in Germany, if you are "stressed" by your job, your doctor can prescribe anywhere between one and three weeks of spa treatment. Sadly, in the Netherlands, "treatments at spa resorts are no longer reimbursed". A close reading of that revision tells me that at one time, they were. Nice. I arrived just a little too late.
Who better than Dr. John to tell us about being in the right place at the wrong time? Just an aside, but my 13-year-old self loved Dr. John's raspy voice, especially this song. And, after all, isn't he a doctor?
All kidding aside, the Dutch approach to healthcare has led to some amazing innovations. First, there is the "Dementia Village", De Hogeweyk, in the town of Weesp. The entire village is specifically designed for people with dementia. Then there's the nursing home in the town of Deventer that allows students to live rent-free, in exchange for interacting with the residents. At an education conference I attended last year, a 22-year-old student spoke about how most people applaud him for brightening the lives of the elderly people he lives with. He told us that instead, he feels he gets back much more than he gives, gaining a wider perspective on life than he would otherwise have. At the end of his talk, he introduced us to his friend, an elderly gentleman who sat at the end of my row. I wasn't alone in having tears in my eyes when we all stood up to give both friends a standing ovation. Bravo to the Dutch for not just having the idea, but putting it into practice. The idea which may have begun from a sense of thriftiness and practicality, but it has such deep and meaningful implications for society.
Some would say that the permissive Dutch laws on euthanasia should not be added to the list of healthcare innovations the U.S. could learn from. It's a difficult issue, and perhaps the Dutch have pushed the freedom to choose to an dangerous ledge. Allowing a 16-year-old to make this decision without parental consent? But allowing a person a person who is "suffering unbearably" to write an advanced directive without fear of a spouse or doctor being arrested? That's a different story entirely. Recently, the health and justice ministers have proposed allowing elderly people who feel their "life has been completed" to be able to choose to die. It certainly gives you something to think about.
Thankfully, I don't know anyone who has explored this aspect of the healthcare laws here. At the other end of the cycle of life, I do know several young women who have given birth here. Let's just say it's a very different experience than in the U.S. Many women here give birth at home. That's not really most American gals' cup of tea. It is not routine to give you drugs, although I'm told if you insist, you can get your epidural just like in the U.S. All new expat moms, however, love the system here of caring for the mom after she gives birth. A kraamzorg, sort of a Mary Poppins for a new mom, comes to your house for about a week after you give birth. One friend told me her kraamzorg made lunch every day, making sure to prepare her favorites. I wouldn't mind a kraamzorg of my very own.
Other than having babies, those near and dear to me have also experienced the following medical journeys: 1. screws taken out of a broken ankle (the screws presented as a parting gift after she was out of recovery); 2. a hernia repair (the cab ride to and from paid for by the hospital); 3. open-heart surgery (most scary by far, and luckily, a story with a very happy ending). All of these medical events took place in a ziekenhuis, my favorite Dutch word by far. It means hospital, but as with so many Dutch words, it literally means, "house for the sick". I love this literal language, even if it is so very difficult for me to master. Anyway, in each of the cases listed above, the experience was not what we are used to back in the U.S. When you're sick, you don't want different, however. All you want is to be in your own bed. It makes sense that when you are sick and in need of medical attention, you would most miss your roots back home. You are out of your comfort zone when you need it most. So while our American healthcare system is no paragon of perfection, it's what feels familiar. When you're under the weather, familiar is all you really want.
Although it's only very loosely connected to the theme of this post, I'll end with a tribute to my favorite teacher of all time. I promise I'll try to tie up that loose connection for you. If not, it will be a chance to introduce you to an important person who would have loved this blog, I think. Parry Jones was a feisty, brilliant Welshman who was my teacher in several high school history courses. More importantly, he taught me to love learning. His unorthodox style of teaching might not fly today in our world of helicopter-parenting and test-score mania. He growled at us when we offered up an incorrect answer, but also endeared himself to us by instructing us without warning to push aside the desks for an impromptu how-to on rugby. During other breaks in the action of studying history, he entertained us with tales of his many world travels, and taught us to sing a Welsh drinking song. I can still sing the song, in my best imitation of Mr. Jones. Too bad I can't remember more about the particulars of European history, or Asian history, two courses I was lucky enough to share with Mr. Jones. Here are the lyrics in case you want to sing along:
Here's a health to the King, and a lasting peace
May faction end and wealth increase.
Come, let us drink it while we have breath,
For there's no drinking after death.
And he that will this health deny,
Down among the dead men, down among the dead men,
Down, down, down, down;
Down among the dead men let him lie!
So what does Mr. Jones have to do wth the subject of Dutch healthcare? First off, I think the Dutch would certainly appreciate Mr. Jones' freestyle approach to teaching. Also, from what I have observed, the Dutch believe that a good beverage (be it a fresh juice, a crisp wine, or a genever - a kind of Dutch gin) can produce good health. Mr. Jones shared that philosophy. He once poured me a tiny glass of sherry during the school day because I was so distraught over losing my stack of notes written on index cards and essential for writing a soon-due term paper. The cards showed up within a few days, but that memory has stayed with me. I think the Dutch would raise a glass to Mr. Jones' approach to problem-solving. Thank you, Mr. Jones, for showing me that a good teacher can stay with you for life.