On Medical Care....

Disclaimer- This post is really loooong and full of details that may be interesting to some, but definitely not to others.  I am certainly not offended if you decide to skip over this one!

After my last blog post I got quite a few questions through Facebook, the blog, emails, messages, etc. asking questions about the differences in medical care between the U.S. and here in Luxembourg.  While I am certainly no expert, and don't have tons of experience, I know a little.....

For starters, Luxembourg is a socialist country.  While I, of course, don't support socialism for the U.S., it is really fascinating to see how it works in a country that's already doing it.  The government programs are so different.  It seems as if we receive money from the government for so many things that I never would have expected, however we also pay sooooo much more in taxes here than we ever paid back in the U.S.  I also feel strongly that this form of government works for a country whose entire population is right at 500,000 people (crazy tiny, huh?)

So, the medical system is called CNS (Caisse National de la Santé).  Every resident is issued a card after all the paperwork is cleared that gives you a matricule number (basically, a social security number).  The number becomes your identity and you use your card when you go to the doctor.    

So, whenever one of us gets sick- or has another need to go to a doctor- I call to make an appointment.  That part is pretty much the same.  Unless, you have not yet "established" yourself at the doctor, of course.  In late October, our family all took turns having pink eye.  Miss H had it the worst by far, and it became pretty clear that it was not going to clear up on its own.  She needed antibiotics.  So, I called the pediatrician that a couple of my friends had recommended to try to make an appointment.  They were happy to see her until they found out that our family was not established at their office.  All of the kids needed to come in to be seen before they could have sick visits.  And we couldn't have our establishment appointments for almost a month- the last week of November.  So, I made my appointments, marked them clearly on the calendar, and made absolutely certain that nothing interfered with getting there on that date and time!  In the meantime, poor Miss H really  needed to be seen somewhere, so I ended up just having to walk in to the local children's hospital, Kanner Klinik (literally translated "Children's Clinic" in Luxembourgish), and be seen that way.  Not a big deal, really, just a little loophole that I didn't know about.  

Whenever you happen to have a need for a prescription medication (which is pretty much all medications), you get the prescription from the doctor, of course.  Doctors seem to love prescriptions.  K went to the doctor for a nasty cold a few weeks ago and came home with five prescriptions.  Then, you take the prescription to the pharmacy (still sounds the same, right?)  Pharmacies are a bit different.  There is seriously like one on every corner.  There are no medications, vitamins, or anything medically related in any regular stores.  There's no picking up some Tums at Target while you happen to be there grocery shopping.  All drugs have to be purchased at the pharmacy and they are all kept behind the counter.  Anything in front of the counter is not medicine- baby formula, beauty products, toothpaste- stuff like that.  That means, you have to ASK for anything that you need.  And of course, we don't know what any of the medications are called here.  

In the interest of full disclosure, here's my embarrassing story---- earlier on in this pregnancy, I was having tons of nausea, food aversions, ickiness, all the normal stuff.  As hard as I try, it's so hard to eat a perfectly balanced diet when you feel so nasty.  I noticed one day that my stomach was hurting particularly bad- more than normal.  And it wasn't sick, it was hurting.  Over the next couple days, it got worse and worse, until finally I decided that I thought I was dealing with constipation.  It's common in pregnancy, I know, but I had never dealt with it before.  Plus, the prenatal vitamin I've taken with my last three pregnancies has included a stool softener.  This time, it definitely does not.  I tried to handle it in the best way I could- eating more fiber, drinking more water, etc, but I was so uncomfortable that I thought if I could just get something to help move things along I would feel better.  You know, something with fiber, Metamucil, Fiber-One, something- anything.  So, finally, out of desperation, I went to the pharmacy, with my three little tag-a-longs, of course.  You have to understand that three kids is a pretty large brood by European standards.  There are a few families in our ward at church with more kids, but I have never seen any families at the school, at the store, in public anywhere with more than three.  Most have two, but there are a couple with three.  I went up to the counter and tried to explain to the lady what I was in need of.  I started with the nice, medical words, but I was definitely not getting through to her.  So, before I knew it, I was resorting to gestures and any way I could to communicate.  Finally, I blurt out, "I'm pregnant and I'm having trouble going to the bathroom."  Her eyes light up and she understands.  She tells me what I'm looking for and asks a few questions about which type of "help" I'd prefer.  Then, she makes the connection.  She stops and says, "Did you just say you're pregnant?"  Then she glances over at the three already I have, obviously thinking I must be a crazy woman.  When I responded, she shut down.  "I cannot give you anything, Madame.  If you are pregnant, I can give you nothing.  You must have prescription from the doctor."  And that was it, I walked out the door empty handed.  All that embarrassment for nothing....

So, on to the experience of going to the doctor.  We've had pretty good experiences, I'd say so far.  Different, but not bad.  I feel like walking into a doctor's room is like stepping back in time by about thirty years in the U.S.  I know the care we receive is fine, but it feels like a bit of a time warp.  They all look like old fashioned Dr.'s rooms in movies- with all the drugs lined up in a cabinet and all the medical instruments lined up on the counter.  There are old- fashioned looking scales and most things are recorded on paper.  My OB/GYN has a computer that she inputs information in at every appointment, but at the pediatrician, everything was done on paper.  Some of the "niceties" of going to the dr. like we have in the U.S. are just nonexistent here.  All of my kids had to strip down naked for their appointments.  I know that's not totally uncommon in the U.S., but Miss A, at age 6, was a bit weirded out by it.  Thankfully, the pediatrician speaks great English, and was very "sympathetic" to my situation of moving to a foreign country with three small children. 

At my prenatal appointments, there's no messing around.  This Dr. also speaks pretty decent English.  Not as good as the pediatrician, but not bad.  We've had a few mix-ups with vocabulary- such as a misunderstanding between the word "abortion" and "miscarriage".   The thing that amazes me though is that everyone speaks so many languages, so even just being decent in English is impressive.  At my first appointment, I walked in the door and she greeted me, "Bonjour, Madame." She continued by asking me which language I'd like her use when speaking to me, French, German, English, or Luxembourgish?  That's the part that just floors me.  Anyone who has grown up here, particularly anyone who is educated, speaks a minimum of four languages.  Sure does make me feel like a really dumb American when all I've got is English.  So, she began my appointment in English and before I knew it, she waved her hand and said, "Take away the bottoms!", which means take off your pants and go sit on that table over there.  There's no drape or cloth to cover up with.  And this happens at every single appointment.  The nice thing is I get to have an ultrasound at every appointment too, which has been amazing to see the progress the baby makes in just 2 to 3 weeks (which is how often she wants to see me).  Nine weeks gestation looks so drastically different from 12 weeks, and it's so cool to have pictures documenting the progression.  Definitely don't have that with any of my other kids.  This Dr. is all business, no small talk or jokes.  I believe that's partly her personality, but it's also definitely a cultural thing.  So, after having the ultrasound, still bare from the waist down, she always tells me to go hop on the scale and report my weight.  It's bad enough to have to see it, but there's just something wrong with having to announce it too.  The nice thing is that I get weighed in kilograms, so my weight is a much smaller number here than it would be in the U.S.  So, even though it means the same thing it sure does feel a lot nicer saying a number out loud that's less than half the number I'm thinking in my head.  

At the end of every appointment, we are handed a bill.  Typically, you go to the counter on the way out and pay your bill in full before you leave the office.  It's also acceptable though to take the bill with you and pay later with a bank transfer, or virement.  You absolutely must keep all these bills, including the stamp from the dr.'s office and your receipt.  All bills and receipts are then sent to CNS for reimbursement.  Or, if you have over 100 € of expenses, then you can just go to the CNS office, give them your receipts and they'll cut you a check on the spot.  I rounded up all our receipts two days ago and we're due over 400 € at this point.  I really need to do something about that.... CNS reimburses 80% of most medical expenses, though there are some things that are not covered at all, such as chiropractics.  We also opted to buy a private insurance plan though K's firm that allows us to submit the remaining 20% and be reimbursed even further.  The private plan also covers things not covered by CNS.  Anything purchased at the pharmacy is already subsidized by CNS, so it is already pretty cheap, and does not need to be submitted.

As far as the questions I got about having a baby here, I don't know all the answers yet because I haven't done it yet!  Someone asked about the possibility of having a water birth, and I believe that to be a yes.  I just learned that piece of information yesterday at my parent teacher conference with A's teacher because I found out at the conference that she is also pregnant  (due one day before me) and she was talking about her preference for a particular clinic because it's possible to have a water birth there.  I do feel very lost in the decision making process about labor and delivery.  There are two main hospitals that are close enough to use to consider.  One of them is nice and new, fancy and comfortable, with great food.  Everyone always gets this shiny look in their eye when they talk about this clinic.  However, from what I can gather, they are also very "clinical".  They have a fairly high C-section rate, and are pretty big on interventions.  It sounds like they have a hard time just leaving you alone and letting you labor.  The other hospital is usually described as being pretty old.  However, those that have been there describe a very different experience.  They describe being able to write their own birth plan, and being allowed to give birth the way they choose, with minimal intervention- this is more what I prefer.  I am surprised, honestly, at how reality on this issue is so much different than what I, as an American, had perceived before I got here.  In my mind, I thought of Europe as very  natural birth friendly, with most people using a midwife.  I'm not really finding that to be the case, at least not here in Luxembourg.  All the Luxembourgers I've talked to  don't really seem to care, while most of the Americans who have given birth here seem to be able to see my side of the issue more clearly.   I don't know what the end of our story will be yet, but I'm learning to be more assertive and ask more questions.  

As far as questions about family coming to visit in the Spring.... K's Mom has a ticket to arrive here on the 12th of May and she will stay for two weeks.  Then, my parents are planning to come on the 25th of May.  We are planning to bless the baby at church on May 26, while both of our parents are still here.  Then my parents will stay as long as they can- not sure how long that will be yet.  It seems like we're planning these things so far in advance, but when you're buying international plane tickets plans have to be made with time to spare, so that good deals can be found!

So, there you have it.  More than you probably really wanted to know, but I think everyone's questions have been answered.  Keep 'em coming!