Adventures in health “care”

Being a foreigner is not as dreamy as it might seem from the photo gallery of images I have shared over the past five years. Because social media can become a vortex for negativity, I try to be very positive with what I share. This can paint a false picture of what it is like being living in a foreign country.

Despite moving to a small farming community in northern France in the middle of a global pandemic,  have had many positive experiences and met incredibly kind, generous people and bovine.

The administrative side of being a foreigner is not all fresh bread and pastries and romantic dinners at French restaurants. For one, we started out in Belgium, living on my husband’s unfunded doctoral student budget so we only went out to eat on very rare, special occasions because the restaurants in Brussels, where we spent four years pre-pandemic, were so incredibly expensive. For two (I don’t know if you can actually write that, but I figured why not), since moving to France for a fifth year in Europe we only made it to one restaurant before a second and third lockdown closed them all.

I enjoy adventure and discovering new things. If I didn’t, I would not move as often as I do. It is character building. However, the past five years have seriously put my stamina to the test, and I think I have enough character to last me a good long while.

To live as a foreigner—or “expat” as the privileged non-refugee foreigners are known in this part of the world—you need patience and a very good sense of humor. I possess the latter in spades but am less well-versed in the former. Much of the time, I understand about ½ of what is going on, maybe more if I am lucky. This is because while I speak very good French I still miss a lot. And while I am no longer embarrassed to ask people to repeat or define words they are using that I do not understand, I sometimes let it go and chock it up to the experience of being lost without translation.

This has largely been my experience with regard to medical visits. Even in English in the United States, I often do not fully comprehend the medical speak being shared with me. In a foreign language, the experience is compounded even further. I try to ask questions and take notes. I use my Google Translate app. But in the end, I often find myself a bit at a loss and more than a bit frustrated.

I should add that also since moving to Belgium and then France, I have been experiencing an increasingly severe problem with my fingers, which have a propensity for becoming extremely swollen and itchy and covered with red lesions. Don’t worry, I will not post pictures. The condition is worse during the winter, which points toward possible chilblains, but it also occurs in the summer. All told, I have seen 10 different doctors, some of whom swear it is not chilblains and others who swear that it is. The doctors who swear that it is have literally taken one glance at my hands and pronounced their diagnosis in the tone of voice and facial expression that allows for no argument or discussion.

Don’t get me wrong, I enjoy being humiliated and demoralized by medical professionals as much as the next person, particularly when they are old, white men (and women). In fact, I come from a long line of Jews, and Jews are known are embracing suffering. During the holiday of Passover, we celebrate the exodus of Jewish slaves out of Egypt by focusing on the suffering part. We intentionally dip bitter herbs into a bowl of salt water to taste and remember the suffering of our ancestors.

My therapist believes that I have been suffering from transgenerational trauma in returning to the “mother country” where my ancestors fled for their lives or were killed before and during the Holocaust. Perhaps, my regular medical have become a way to ensure that I experience the most psychological suffering possible in order to honor the psychological suffering of my ancestors.

Side note: I have also seen some wonderfully kind, sensitive doctors and share my unending gratitude for my favorite GP at the university clinic in Brussels, who listened to my concerns and shared a genuine desire to help me figure out what was going on. Some doctors actually see me. For others, I am left wondering why they became doctors in the first place.

This morning, I went to the CHU Hôpital Suriez in Lille, France, hoping I would meet with a doctor who would see me. I was nervous to go to a medical facility during a global pandemic and with the milder weather my fingers were not bothering me as urgently as they had been when the appointment was scheduled. I was referred to the hospital in January, but there was a four month wait to get an appointment.

I went early, dropping my husband off at the university where he has been doing a postdoc since mid-September. He would spending the day doing a trial run for the conference he has been organizing through his one year position, all of which will be taking place online at the end of June. I don’t mind arriving early for a medical visit, even if it means waiting. I prefer to have plenty of time to navigate the unfamiliar terrain.

This experience was less confusing than others have been. The signage was relatively effective for both parking and the hospital itself. I found my way to entrance, which like most places had a Covid setup for entry and exit. Medical workers were standing to the right of the entrance line with masks pulled down to make smoking more accessible. I showed my appointment letter to the security and went into a large foyer with a high ceiling.

At European hospitals, at least those I have visited in Belgium and France, you check in multiple times at multiple information desks. This visit proved no exception. I asked on the ground floor where to go. I followed the directions and then checked in at an information desk, where I was instructed to validate my parking ticket and go down another hallway two doors down on the right to check in at an office.

I was asked for my ID and carte vitale (health card in French). The carte vitale is the way in for paying for all things health related in France.

For a long digression about French bureaucracy and the carte vitale, continue reading. To skip ahead, type “command F” and do a word search for the phrase “And now for an end to the long digression on French bureaucracy.”

We moved to France mid-September 2020 and still do not have one. It took four months just to get our titre de sejour ID cards. You cannot apply for the health card until you have the ID card. Once we finally got our ID cards, my husband submitted our application for the health card. This was in January 2021. Months went by with no response. He finally started calling after three months and made an appointment to go in to talk with someone at the Centre de Securité Sociale.

We walked in with spirits relatively high. My husband did a goofy walk along the red line on the floor we followed to get to the desk of the administrative worker. Once seated, the worked looked up our information and informed us that there were several documents missing from our application. I should explain that before we made the appointment, my husband had spoken with several other staff on the phone, all of whom had assured him that the application was complete and we should be receiving our temporary cards any day. When “any day” seemed long past was the moment he called to make an appointment to meet with a “real” person in person.

Not only were we missing several documents, which somehow no one else had thought to inform us, but we also had to submit an entirely separate application for my health card. My husband had been told that he could submit an application for both of us together since we were married.

It was at this point that my husband started to lose it. He took his hat off and brought his hands to his head, elbows on thighs, head bowed forward in exasperation.

I tried not to start laughing at the absurdity of the situation. In these inane administrative moments, there tends to be one of us who experiences a meltdown while the other finds humor in the futility of it all.

Do you all receive the same training and information? I asked the woman.

Yes, we do, she responded.

Because I don’t understand how we can receive such different information from so many different people.

We were given the list of documents and made an appointment to come in at the same time the following week to submit everything in person. This seemed the best way to go since we did not want to mail original documents for fear of never seeing them again.

Of the documents that were still required were the following:

Birth certificates translated into French

Marriage certificate (for some reason not required to be translated into French)

A RIB, which is a printed document showing that you have a bank account

Proof of residence

Other documents I no longer remember

The marriage certificate was not a problem. The RIB and proof of residence, however, were another story. For one, since my husband was offered a temporary, one-year position in France, we were not able find a formal rental. After many visits to many possible places to rent, all of which we were informed we had not made the cut, I finally asked someone and was told that French insurance companies will no insure property owners who rent to tenants with a temporary work contract. This is because renters are so well protected in France that they can literally stop paying rent and property owners can do very little about it.

Since we were not able to find a formal rental to live in, we finally found a vacation rental that we could rent through the end of my husband’s work contract. Because it was a vacation rental, however, we did not directly pay for utilities. Utility bills are generally the way you show proof of residence. So that has regularly put us at an administrative disadvantage. We had found workarounds by having the property owner write up a letter demonstrating that we are indeed living at his property.

We returned home and began securing all of the necessary documents. The translated birth certificates were the mostly costly at 118,00 euros.

We brought everything back the following week, making sure to have very low expectations that things would work out. We have found that if you go in expecting to fail then any success, however small, feels like an enormous achievement.

We met with a different person, who told us there was a problem with our RIB. The problem was that while we did have a European bank account, our account was with a Belgian bank and not a French bank. The horror!

The staff person went to ask a colleague and was gone a long time before coming back and telling us our Belgian bank had thankfully passed muster.

We were thrilled. She told us that our application was complete and she would put a rush on my application so that we should both receive our temporary health cards within a week to 10 days.

She also mentioned that we could have been going to an office much closer to us this entire time. The office in Hazebrouk was only a 20 minute drive as opposed to the 45 minutes it took to get to Dunkirk. Yet another piece of helpful information that her other colleagues either didn’t think to mention or just didn’t know.

French bureaucracy seems to me to be one of the great mysteries of the world.

We went home elated even though there were no bear claw (pattes d’ours) pastries at the bakery nearby that we had taken to frequenting on administrative errands in Dunkirk. When in France, you can drown your sorrows in incredible, fluffy pastries.

Upon returning home, my husband found he had received a voicemail from the person with whom we had just met, explaining that because of the type of work visa he had we needed to resubmit our entire application to an entirely different department, which was located in Paris.

After the requisite expletives were expressed, I dutifully got on the phone to try to call this new department to find out how we could get our documents to them since we did not want to drive all the way to Paris to bring them in person. Each time I called I was put on a long hold, and then something would happen to disconnect the call. The first time, I had accidentally muted my microphone so the person who responded kept asking if anyone was there while I assured them I was there and asked if they could me until they finally hung up on me and I discovered the mute symbol had been pressed. Every other time, the person would ask in which department we lived and then transfer me (no matter how many times I asked them not to) to the department in Dunkirk where we had just been. No one seemed to understand what I was talking about when I explained about my husband’s talent passport, which was apparently different than a traditional work visa.

After several hours and frustrated growling/screaming on my part, my husband got on his computer and found a number to call for the place in Paris where there were operators who spoke English!?!? He called, got through almost immediately, and did indeed speak with someone in English. Miracle of miracles. He then went online and uploaded our documents, something I did not think was possible in a country where seemingly everything bureaucratic is done by hand. Even to make an appointment to apply for a work visa through the French Embassy in Brussels had required sending an email to a person who would then check the calendar and send a response email with the date and time we could come in. We have decided that with the industrial revolution and modern farm equipment rendering it possible for there to be far fewer farmers, the rest of the population have since gone into the complicated labyrinth that is the French bureaucratic system for all things—visas, healthcare, social security, etc. Maintaining an antiquated system ensures job security, even if it makes foreigners heads explode.

And now for an end to the long digression on French bureaucracy:

Before my long digression, the administrative person at the hospital had just been asking if I could give her my carte vitale (health card). I was glad that my husband had suggested I bring the document (an “attestation” in French), which stated that at some future time my husband and I would be receiving the “carte vitale” health card.

The woman behind the plastic window took the attestation and my ID card. She also asked if I had a General Practitioner (médecin traitant in French) because without declaring one there would be a supplemental fee attached to my visit. I had just two days earlier gone to the doctor in my town who was an intermittent replacement for another doctor and had suggested I wait until my husband see the actual doctor and she would write a note that he could sign both of our papers for declaring the French equivalent of a GP.

Rather than explain this entire situation (which I would have to also do in French) I gave her the last name.

Is it a male or female doctor? she asked.

I was nonplussed, wondering why it mattered what their gender was, but I responded that I thought it was a man.

You think it is man? she asked, equally nonplussed.

Well, I attempted to explain, I have actually only seen the replacement doctor. The name is Rémi, I think this is a man’s name?

Yes, Rémi is a man’s name, she affirmed, inputting the name into the computer.

C’est compliqué, I said. (it is complicated)

Oui, c’est toujours compliqué les papiers francais. Très compliques. (Yes, it is always complicated, French paperwork. Very complicated)

I went to the waiting area and found a seat that was not immediately next to another person. Even with seats taped off, there was no way to be a meter and a half away from other patients.

The doctor came out and called for Madame Lewis.

C’est moi, I said.

On y va, he replied. He seemed jovial, and I hoped that this might be the doctor who would finally help me figure out what has been going on with my hands. This, it turned out, was having far too high of expectations.

He showed me to his office, invited me to sit down, and asked me to show him my hands. Before he even sat down at his desk had already pronounced his diagnosis: les engelures (chilblains). He then laughed, a guffaw, if you will.

This was exactly what happened with the vascular doctor I saw in Bailleul, who also laughed. It was the kind of laugh that seemed to communicate, Well of course it is chilblains. What else were you expecting? This is not a “real” problem. Buy some gloves. Why are even you bothering me with this in the first place?

It was almost like both of these doctors did not take me seriously and also wondered why I would ever question their authority. There was zero room with either doctor for any kind of discussion or the space for me to ask questions or express my concerns.

I am not a medical doctor, but I want to believe that people go into this profession to help alleviate their patients’ concerns. This has not been my experience in France. Chilblains do fit the bill, as they are common in cold, damp climate. However, my symptoms manifest throughout the year and the only medication that treats all of the symptoms is an oral steroid, which you cannot take more than once a year.

I explained these concerns and that I wanted to be sure there was no underlying condition that could exacerbate the symptoms. He shrugged his shoulders at the mention of symptoms persisting in the summer, saying that can happen. His response to the oral steroid was to tell me that I shouldn’t take this kind of medication. For treatment, he suggested avoiding the cold, wearing heavy gloves, and putting on more weight.

I sat there, staring at him and wondering why I risked my life to go to a hospital during a global pandemic for information that could have been provided by Google.

I don’t if it was my energy or the expression on my face, but he decided in the end to do an extensive “bilan” (bloodwork), most  likely as due diligence just in case he might have missed something with his 5 second assumptive diagnosis.

He then proceeded to share his notes from the visit by speaking into a recorder. The vascular doctor in January I saw in the town where I live did the same thing, explaining her diagnosis and stating that she was recommending a follow up visit at the CHU in Lille because the patient was not convinced of her diagnosis.

She did this while I sat there, listening to her. It was a special moment.

This doctor did the same thing, saying he believed it was chilblains as the previous doctor had. Again, I wondered why either of these people had gone into a profession to help people when there are plenty of other professions you can go into if you want to humiliate, demoralize, and patronize. Become a politician. Become a lawyer. Don’t become a doctor.

I almost (not quite, but almost) wanted the additional bloodwork to reveal something just so I can wipe that smug expression off of their faces and force them to see me as a real person with legitimate pain and concerns about my health and wellbeing. In my experience, attempting to communicate verbally is often insufficient. In the world of science, it is results that justify action and not the concerns of the patient.

The one positive from the entire experience was my delight at finding the nurse who took my blood had a tattoo of Totoro.

As I was leaving, I texted my husband, His solution was that I put on weight. Because it affects thin people more.

To which my husband responded, Ha! A very French response…put on weight…you just need to eat more French food! Oh la la.

Touché.

I validated my parking ticket at the hospital and thought this meant that I didn’t have to pay for parking. This is often the case in the United States, but this turned out not to be the case at the CHU Hôpital Suriez in Lille. When I put my ticket into the machine, expecting the barrier to rise up so I could exit the parking lot, there was a message requesting that I take my ticket back. I guessed that meant I had to pay, but by that time there were already two cars behind me, waiting to exit.

I rolled down my window and asked the person behind me to kindly “reculer” (move back) because my ticket wasn’t working. I speak French well, and I know she understood me, but she still refused for longer than was comfortable, stating there was a barrier. This made no sense to me, and I even got out of the car to look for this alleged barrier. Finally, she put her car in reverse so I could back up and drive back to the parking ticket machine.

Of course, the machine did not accept my new bank card, which the staff person at the bank had assured us would work. I had kept the old one in my wallet just in case because many places in France do not accept credit cards. Thank goodness the old one worked because I did not have exact change for 1,80 for the parking.

Back around a second time, and I made it out of the parking lot and headed home. Once home, I put all of my clothing in a burn pile, wiped down my phone, washed my bank card and ID, and got into the shower to wash away any physical trace of the experience. I have all kinds of fantastic neuroses, and anxiety over germs in public spaces is one of the less enjoyable ones. Over a year of global pandemic has not helped me alleviate this one.

I was proud of myself for managing successfully to avoid screaming or crying throughout the ordeal. My nerves were on edge spending time in a medical facility less than two months before having to test negative for the virus to then get on an airplane for an international flight. A tot of whiskey and the soothing effects of writing about the experience helped tremendously.

I have one more visit to a doctor in Brussels next week, and while I am going with the requisite low expectations I do hope that I will be seen.

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