27 May, 2011

Three Years and Counting...

Yesterday marked my three year anniversary living in the Netherlands.  I can't believe how the time has flown by!  I didn’t have the time to blog about it yesterday as I was far too busy getting my hair done and then drinking pink bubbles.  Not a bad way to celebrate, eh?  Now I have a few moments to squeeze out a post before I race off to the Amsterdam Comedy Festival to see some fantastic acts such as Brendon Burns and and our ‘own’ Greg Shapiro, so I’ll be brief.

How does it feel to have reached it to this point?  Initially I was only planning to be in the Netherlands for a year, 18 months max.  I had plans in Australia.  I was moving to Perth and going to tour the west coast.  But, somehow life managed to derail my plans.  Maarten found a job that he loves and we bought a house and married, so we are locked in for another three and a half years.

Will I make it to 2014?  I can’t honestly say.  I have good days and bad days living here.  If the weather is good I can manage the bad days, but winter is a real struggle (note to self:  find a career that means I can spend summer in NL and summer in Aust).  I do have very serious problems with the people.  I’m endlessly frustrated by the lack of awareness of other people and just today I came to a revelation:  Dutch people live like they drive.  On the freeway drivers react, they don’t anticipate.  So, instead of looking at the driver ahead in the right lane and noticing that they are going to change lanes and compensating, the driver will maintain his or her speed until the other car pushes in then they hit the brakes (braking on the freeway unnecessarily is a pet hate of mine).  Walking around town it is exactly the same.  People walk around, but don’t assess what’s coming towards them so will maintain their line until they bump into another person.  Then, because there is a general refusal to accept that there is anybody else in the world, neither person will acknowledge the other and just keep walking.  Or, they will mutter and curse because they were crashed into when they could have easily avoided the incident themselves if they had been more aware.  Some Dutch people will argue until they are blue in the face that this is a ‘Ranstad’ problem, but I’ve been to every province and I see no difference.

Ahem.  Sorry, that became a bit ranty and that’s not what this post is supposed to be about!

What do I love about living here?  Well mostly I love that the Netherlands is almost the centre of the universe.  Within an hour (or so) I can be in Germany or Belgium.  I live next to one of the most vibrant cities in Europe, I can visit any number of art galleries filled with masterpieces, beer is cheap and I can cycle absolutely everywhere.  Not being many hills, this is especially good!  I love the food (aside from the icky fish that I talked about here), especially the winter stews and I love that since I’ve lived here I have seen some of the biggest bands on the planet.  I’m off to see Neil Diamond in a couple of weeks and they don’t cost the earth.  We just bought tickets to the ultimate Nanna Heartthrob AndrĂ© Rieu for less than half price.  Living in Alice Springs the extent musical entertainment includes local cover bands, a really bad DJ at Melankas (thank goodness they finally tore that hell hole down!) and the pub juke box.

What’s next for me?  I have a couple goals in the pipeline to keep me busy in the next twelve months.  As I have been living here as Maarten’s partner for three uninterrupted years, I am now eligible to apply for dual nationality.  I just have to find the cash to pay the €700+ fee.  I’m also hoping to get my driver’s license.  Sadly I’m unable to exchange my Australian license for a Dutch one so I have to sit the theory exam and take endless driving lessons to start over.  The bonus is that I can take the test in English and I can find a condensed one day course to do it.  I plan to blog (rant?) about both as they happen, so stay tuned!

06 May, 2011

Take Paracetamol and Come Back in a Week...

...Is the way the story goes when it comes to primary health care here in the Netherlands.  It’s generally accepted that when you go to the doctor he or she will roll his or her eyes, take a certain condescending tone and then send you off with instructions to take paracetamol as there is nothing else that can be done.  If you don’t get better in a week or so, you are allowed to make another appointment.

Now, generally speaking, I am a very healthy person.  I have been admitted to hospital once, on Christmas Eve when I was five, for a broken elbow.  I’d been to sit on Santa’s knee and was given a cup ice cream then thought I should play on the monkey bars.  Like any five year old I was covered in ice cream, so I slipped.  If you knew me as a child (or even now as an adult), you will know that being quiet is not my strong suit.  So the entire town knew that I had hurt myself.  My parents had to rush me to the hospital for x-rays and then proceeded to leave me there overnight.  by myself.  On Christmas Eve.  Did I mention that it was Christmas Eve and I was left by myself?

Wow, this was more than twenty five years ago, you’d think I would have let it go by now!  Just imagine what my parents had to live with...

But my point is, I’ve never been really sick.  Sure, I’ve had colds and the flu and endless bouts of tonsillitis when I was a teenager, but never so sick that I couldn’t get out of bed for months at a time, had to have major surgery, or even had a cool cast for a broken limb (my broken elbow only earned me a sling - ripped off!).

I am, however a very big fan of preventative health care and being pro-active about my own health.  Heart disease is rampant in my family and my dad takes blood pressure tablets each day (although I may have something to do with the elevated levels there!).  As a consequence I like to be on top of what is going on with my body and have regular health check ups.  Well, I did until I came to the Netherlands.

Initially I was very daunted by the system.  My lack of Dutch acted as a bit of a barrier.  I was ashamed to live here but not able to conduct myself at a high level in Dutch.  Plus I had read some of the many complaints and horror stories about health care in the Netherlands by other Expats.  You can see what I mean here and here.  Not to mention the discussion with friends where we would all just joke about travelling home to our respective countries when the time came for some actual health care.  Never minding the extortionate compulsory health insurance premiums we all have to pay living in the Netherlands!

But late last year I had a problem.  I had a sore toe.  I know, I know I'm a whinger, but it really hurt.  Actually, after several days the pain increased to the level where I couldn’t sleep and couldn’t really walk either.  So off to the Doctor I limped.  You’ll never guess what the treatment was.  Yep.  Take paracetamol and if it doesn’t improve in a week, come back in.  Really.  My toe was bright red and twice its normal size and almost visibly throbbing, but paracetamol would do the trick.  Oh, and a washing powder bath.  I actually laughed in the doctor’s face at that.  But, what can you do?  You go to see the doctor putting all of your faith in them that they will be able to help.  At the very least help with the pain, but I was in with the doctor for no longer than five minutes and then ushered out the door.  Now, this was a Friday so of course there’s no option to get health care over the weekend unless you’re in serious problems.  On the Saturday I  had to go to Rotterdam and couldn’t even put my own shoe on, so had to wear one of Maarten’s.  Cue Ronald McDonald impersonations and sad clown faces.

I was back in the Doctor’s office first thing Monday morning (different doctor this time as I refused to see the same one) and it was confirmed:  I had an infected toe.  No shit Sherlock.  From then on I had a completely different experience.  Once we agreed that something was wrong treatment proceeded at a lightning speed.  I was back that afternoon for a follow up, given antibiotics and painkillers, then I was in again every day until they could slice it open and get rid of the infection.  The difference was like night and day.  I was immensely happy with the care, and confident that if something happened to me again, I would be taken care of.

Thank Goodness, because this brings me to my next experience.  A routine PAP test.  I was due for one as it had been three years since my last check.  According to Dutch standards I was still two years early, but by Australian guidelines I was already a year late.  Plus we’ve been discussing the possibility of having children (well, a child - let’s not get ahead of ourselves!) and I wanted to make sure all the Go Gear was in good working order first and not in need of any serious maintenance.

Oh, how wrong could I have been!  The doctor (the good one, not the paracetamol freak) ran the check and told me to call back in two weeks when the results would be in.  No worries.  Ten days later the phone rings.  It’s the doctor.  Can I come in for the results.  It’s not good news.  So, I dropped everything and made a mad dash to the doctor, on the phone wailing to my wonderful mum the entire time (on my mobile.  To Australia.  Not looking forward to that bill!).  Maarten, bless his heart also dropped everything and almost beat me to the doctor, and he had to drive 30km!

We took a deep breath and went in to find out what the results were, and it wasn’t pretty.  I had either cancerous or pre-cancerous cells.  My result was PAP 4 in the scale from 1 to 5 and the GP had booked me into a gynaecologist the next day!  So, there were a lot of worried faces in my family that day.  We weren’t sure if I had cancer and my doctor told me I should prepare for the worst possible outcome.  As an eternal pessimist, you can imagine what the worst possible outcome was in my mind.  And because I have to have contingencies for contingencies, inside my head was not a great place to be.  However, the worst case scenario would be a hysterectomy.  This was a less than ideal scenario, but far better than the alternative that was flying around inside my head!

The rest of the day passed me by in a haze.  I couldn’t tell you what I did or who I spoke to.  I was completely consumed with worry.  What if I’m sick?  What if I’m going to die?  What will Maarten do?  What about the house?  Why me? By the time I arrived at the gynaecologist, I was barely keeping myself together.

The gynaecologist.  What a marvel of a man.  He was happy to speak to me in English and he might possibly have been The Fonz in a past life.  He managed to allay my fears in about two sentences.  I kid you not.  He said (and I’m paraphrasing here), “This is the problem.  It could be cancer, but I seriously doubt it.  This is the result I expect and good job for having your regular checkup because it’s nasty and would definitely become cancer years down the line if untreated.”  

He also said something that shocked me to the core.  This was most likely caused by the Human Papillomavirus, which is what you and I know as warts and the reason behind the creation of a controversial vaccination now given to girls with their MMR shot.  There are up to 40 different strands that affect people and of course I wasn’t so lucky as to just get the warts strain.  He actually laughed at me when I gasped about having an STI.  I was more prepared to be told I had cancer!  He rattled off some extraordinary statistics re infection rates.  According to him, around 80% of women in the Netherlands carry the virus at one point and using condoms is not a great guarantee against the virus.  As a rule 90% of cases are cleared up within two years, but a very small percentage of women can go on to develop pre-cancerous lesions and cervical cancer.  Lucky me.  I never seem to find myself in the majority, ever!  It should also be noted that while cervical cancer rates in the Netherlands is very low (around 500 cases per year), it is the biggest woman killing cancer in developing countries.

Then the time came to address the elephant in the room.  The stirrups.  Attached to a big screen.  This was going to make for entertaining viewing.  Up I climbed and then before I knew it, there was my magnified cervix being displayed for all to see.  Did I mention Maarten came along for moral support?  Poor guy.  After a bit of poking and prodding it was time for me to cough while he took the biopsies.  It went something like this:  
Dr: “Okay, cough.”
Me: “Cough”
Dr: *chunk* goes the biopsy forceps
Me: “Fark! Oh sorry, I said Fuck”
Dr:  “That’s okay, fuck’s fine.  Cough again?”

After three coughs we had enough tissue and I was allowed to put my knickers back on.

He explained that he expected I would have a CIN grade 3 result, which is defined as severe dysplaysia and that I would at least have to have the LLETZ procedure to remove the cells.  Once this is done I will then have follow up PAP tests at six monthly intervals for two years (or for as long as necessary).

I was back in the gynae’s office a week later for my results, and yep, all of the above predictions came true.  I have a CIN 3 result and will need the LLETZ.  I’ve opted for the procedure under a general anaesthetic rather than a local as there is some cauterisation and it’s something I don’t want imprinted on my memory for all time.  This will all happen some time in June.

But, what actually made me sit down and write about this experience was my own GP.  Last week, while I was waiting for the biopsy results, she called me out of the blue to see how I was doing, that I should stay positive and to let me know she was thinking of me.  Because there is so much ranting and vitriol against the primary health care system in the Netherlands I wanted to stand up and say that I had a good experience and that I couldn’t have been happier with the care and support that I’ve been given by my GP and by my Gynaecologist.

I know it can be frustrating when it seems like your doctor is not taking you seriously and I can’t stress enough, if you’re not happy with the outcome from one doctor, you should insist on seeing somebody else.  One doctor may insist that Penicillin is the work of the devil (Dutch doctors are notorious for refusing any form of antibiotic prescription, not just penicillin), but another will understand and see its worth and understand that preaching bed rest and paracetamol is not always the appropriate treatment.

I could have waited for Cervical Awareness Month, but that was way back in January and this is just too important to wait until next year.  If you’re due for a screen, please don’t put it off.  If you’re embarrassed for your own doctor to do the test this week when you’ll be back in next week with a child and an ear infection, make the appointment with another doctor.  Besides, your doctor (or nurse depending on where you live) has done the test so many times in the past and have better things to think about than what your hoo hoo looks like!

Stop making excuses and do it.

I'm a Random Nomad!

If you haven't seen it already, let me bring a wonderful site to your attention, called The Displaced Nation. 

The guys over there have been kind enough to add me as part of their Random Nomad series and I couldn't be more excited about it.

 From the site:

The Displaced Nation is a country for those who have traveled for so long and crossed so many cultures that they no longer belong anywhere in particular.

We welcome international travelers of any variety — be they backpackers, globetrotters, expats, rex-pats, repats, or armchair dreamers. The only thing you need have in common with us is 1) a nomadic ability to fit in everywhere and nowhere; and 2) a compulsion to observe life’s rich tapestry on a global scale.

TDN discuss all manners of exciting topics, from deadly dishes around the world to The Royal Wedding to classic displaced writers in a way that is sometimes serious, often tongue in cheek and laugh out loud funny.

Go over and take a look around.  You’ll find that before you know it you will have lost a day, and you’ll emerge with a smile on your face.

While you're at it, don't forget to follow The Displaced Nation on Twitter.

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