Archive for the ‘Rieux’ Category

La Grippe

December 29, 2009

It’s a much better word for the flu, isn’t it? La grippe. Spooky. Dangerous. Exotic. Something that grabs you and holds you tight, maybe never lets you go. In this year of pandemic panic, we crazily took off with two small children for a year abroad. We left Vermont in October, just before the H1N1 “swine flu” vaccine became available in the U.S., just as the whole health care reform debate got into full swing, and traveled to that most dangerous of foreign lands: France. When Susan talked to the pediatrician before we left, he teased her, saying, “Oh, you’re not just afraid of germs; you’re afraid of International Germs!” France, according to the World Health Organization, has the best health care system in the world. Universal coverage. Great research facilities. Doctors who even make house-calls. As the U.S. Congress debates how to improve or fix the American health care system, we have had the opportunity to observe, first-hand, a different—and maybe better—way of taking care of the health of a nation. Our experience in the shadow of la grippe seems instructive, not only in the basics of so-called socialized medicine but also as an insight into the ways the French—and, by contrast, the Americans—see health and government and medicine in general.

Before we left the States, we did everything we could to be vaccinated against the H1N1 virus. We did get the regular seasonal flu shot, but the vaccine for H1N1 was not yet available before our departure date. Not only did we call our doctor but I went on the Internet as late as the day before we left Vermont to search for places to get the shots. James, our six-year-old son, often develops breathing difficulties at the end of a bout with the common cold or a flu, twice requiring Albuterol treatments. He’s prone to bronchitis and pneumonia. With all the reports we read about the H1N1 being especially hard on children like James, we thought that his risk factor was high. Alas, no vaccine was available. We decided we’d probably be able to find a way to get it in France. At that time, Europe had had only spotty outbreaks of the virus. Vaccinations weren’t really even a priority for most people.

We arrived in October to gorgeous, summer-like weather. Paris was blazing hot. Our friends there, who are doctors, met us at the airport with la bise—the traditional French greeting of kisses on both cheeks—all around. We asked them about the H1N1 pandemic. The government had not yet outlined the plan for vaccination, they said. In fact, they would attend a required meeting in Paris that night for general practitioners (les generalists). They acknowledged that doctors were concerned. But the vaccines were being made in France. It will be fine, they said. There will be plenty of vaccines. Not to worry. It’s not really here yet anyway, they assure us. And so we visit the Eiffel Tower, hand-sanitizing at every turn, and boarded the train south to Toulouse and Saint Araille.

After we settle into our long-term lodgings in the château, we ask our hosts, Pete and Rosie, who are preparing to go to Australia, if they have had any word about the H1N1 vaccine. They laugh. “Is that the swine flu?” they ask. I tell them about how serious it seems in the U.S., about the college freshman from Boston who went off to school and died within a couple of weeks. I explain that we are concerned about James’ lungs. Rosie says that with the regular vaccine one might get it at the pharmacy oneself and have a visiting nurse inject it, or even inject it oneself at home. She assumes it will be the same with the swine flu “jab.” But the pharmacist has no information. We ring Rosie and Pete’s (and soon to be our) doctor, Doctor T. He seems rather cranky about our questions. He explains that les generalistes will have nothing to do with the vaccines, that they will all be administered at newly created “vaccination centers.” We Google “H1N1 vaccine France” nearly every day for updates. The news reports that la bise is no longer recommended by the government, a hotly debated political topic, but everywhere we go, this is still the greeting. In early October, the government rolls out its vaccination plan: everyone will be able to get the shot from an official centre de vaccination in turns in order of risk. The French health care system, the Ministère de la Santé, will mail a letter—a bon—to every citizen in France with his or her place of vaccination and the date when he or she can receive the vaccine. No one will be required to get the vaccine, it is assured, but everyone in the whole country can be vaccinated before the end of January.

In France, everyone is covered by health care centralized in the government social security (Securite Sociale). The medical card each citizen carries is imbedded with a microchip that records all medical history centrally. Since the French decided that the H1N1 vaccine for children should be given in two doses, both of which should come from the same “batch,” this centralized system would not only assure that the vaccine was distributed according to relative risk (rather than to Wall Street bankers or professional hockey teams) but that both doses came from the same batch. General practitioners would be free to care for the sick rather than swamped with vaccination requests. The government revealed a complex, stratified plan that provided the vaccine to health care workers first, in October, and thereafter to pregnant women, children three and under, and to those with chronic conditions that placed them at a higher risk. School children and everyone else would be vaccinated after that. The government website opened, listing the vaccination centers—assigned by postal code—and their open hours. Everyone should bring their social security card and their bon when coming for the vaccine. The steps that would be carried out upon arrival at the vaccination center were detailed. Volunteers were signed up to administer the vaccines and process the paperwork. (Have I mentioned the French love of bureaucracy?) The plan was ready. The doors opened at the vaccination centers.

No one came.

The French are typically skeptical of their government, oddly not unlike the conservative right in the U.S. Conspiracy theories were trotted out. The vaccine had been developed too quickly. It wasn’t safe. Lawsuits were filed charging the government with an attempt at mass poisoning. The H1N1 was not, after all, much to worry about. Only a few French people were even sick. In the first week of November, a poll shows that only 20% of the citizenry plan to be vaccinated.

At the same time, I search the Internet every day, trying to discover how we—non-French citizens, non-holders of a social security card or a medical card, folks for whom a bon will not appear in the mailbox—might get the vaccine. We Americans—right next door to Mexico where the virus first appeared—are clearly more concerned than our French neighbors. Pete and Rosie depart for Australia without being vaccinated. We ask new friends with small children if they know where or how we might get the vaccine. They shrug. Not important. Clearly we are over-reacting. The American Embassy (in Paris) issues a statement that Americans who are part of the French social security system (working for French companies) will get their bon in the mail, and they list English-speaking doctors (in Paris) who might prescribe a bon that one can take to a vaccination center. Nothing for us. We find the vaccination center assigned to our postal code—Rieux-Volvestre, open only on Wednesdays from 3-7. Should we just show up and see what happens? We look up the French word for asthma (asthme). If he were French, James would be in one of the higher risk categories. We have our medical records. Should we call our pediatrician in Vermont and ask for a letter to support us? The news reports that several centers have had to throw out vaccine because no one—and these are the medical professionals who were first on the risk list—has shown up to be vaccinated. Our doctor friend in Paris emails to say not to worry; there will be plenty of vaccine for everyone who wants it. The government opens the vaccination centers to those in the next risk category: pregnant women, babies, and those with chronic diseases. Still no one goes to the centers to be vaccinated. A few schools near Paris close due to outbreaks of H1N1. A young woman dies in Toulouse. One of my Google searches reports the order in which people will be vaccinated with “homeless people and foreigners in their turn”; our turn, it implies, being at the end. Another Wednesday passes. And then two-dozen people in France die within a week from complications of H1N1.

Up in the tower, we all become sick with something that seems flu-like—the kids vomiting a few times, then each of us with sore throats and coughing. But none of us ever runs a fever over 100. The kids and I are well within a couple of days, though Susan’s symptoms seem worse and hang on longer. We aren’t sure whether we’ve had the swine flu or something else. James breaks out in a bizarre rash of welts, but by then he has no fever or other symptoms. And another Wednesday passes. By the end of November, 240 schools are closed around the country and nearly one-hundred people have died. Suddenly, the formerly deserted vaccination centers are jammed. In Lyon, they have to call out the riot police to control the crowds. When we cancel a birthday lunch with our friends with the baby because we are all still sick, they get in their car and drive to the vaccination center and stand in line for two hours. The government drafts all medical and nursing students. They call upon the military to assist in meeting the need. That Monday, in the children’s Cahier de Correspondance (the little book in which the teachers and parents communicate) a Xeroxed notice has been pasted in—school-aged children are the next group to be vaccinated, if the parents so wish; we are to go to our appointed vaccination center with the bon we should have received in the mail. We decide it’s time to just show up.

On Wednesday, December 2, at 3 in the afternoon, we drive to Rieux-Volvestre, about 25 minutes from Saint Araille. We bring our medical records, passports and visas and some cash, just in case. It’s a cool bright day. We arrive twenty minutes after the center opens, and the line already snakes through the parking lot. We have to park far down the street. I take the kids to the playground—one structure swarming with about thirty children (I have hand-sanitizer at the ready)—and Susan stakes our place in the line. We wait. Everyone waits. A lady hands out numbers like those at the deli counter; we’re number 162. It’s a cross-section of French society. The vaccination center is the only place to get the shot. Everyone in our area has to come here. There are well-dressed retirees, an Asian man, many young women with strollers, a whole extended family of farmers with mud on their shoes, some of James and Izzy’s classmates with their parents, and, as the afternoon drags into evening, office workers still in their suits arrive to join their families. Line cutting is rampant, people coming and going, but though people are disgruntled, no one is really angry or ugly. This is just the way things are done here. People chat with their line-neighbors. The parents of toddlers whip out snacks, but the rest of us are unprepared. We all look up to watch a distant hang-glider. As we creep closer to the front, the method becomes more clear. The rec center doors open and about twenty people are allowed in. One of the officials comes out and asks for pregnant women and mothers with babies, setting up a second queue for these special groups. Their line moves no faster than ours. I go to the car and gather all the library books and markers and activity books from the backseat. James sits on a curb and reads Garfield in French, a small throng of other children looking over his shoulder. Finally, after two hours, the sun beginning to set, we reach the door, still unsure if anyone will give us vaccinations at the end of this long wait.

Inside, we are crammed into a lobby and hallway, herded, eventually, into the bleachers in the gymnasium. The children clamor to the top row in a rowdy pack. Susan and I sit, clutching our number, with the other forty or so adults. One of the young mothers has to leave her infant with strangers again and again to chase down her toddler, who we deem “the escape artist.” We all pitch in to block his assent to the rafters. Every five minutes or so, a man calls out a few numbers, and those folks hurry down the bleachers, along the hallway and into a small room. After awhile, they come out and pass along the front of the basketball court (barricaded off—Aucunes chaussures de rue premises!—no street shoes allowed!) again to stand in line in another hallway under the bleachers to enter, finally, through a set of double doors. We wait in the gym for a half hour before our number is called.

In the small room, we are directed to stand in line at the first of three tables. There are perhaps twenty people crammed into the room, attempting to move from station to station. Susan steps forward for our little family. They ask for our health cards and our bon. Susan explains that we are Americans and do not have such things. What? No health card!? The volunteer is shocked. “Tell them James has asthma,” I say. Susan launches into James’s issues with asthme and the fact that we are living here for a year and the children are attending public schools here. The Frenchman in charge shrugs. The woman official with whom he’s consulting makes the same gesture. He says, well, in principal, we vaccinate “tous” (everyone), n’est-ce pas? Well, of course, they must be vaccinated. Papers shuffle. Susan hands over passports, visas, documentation of health records. The volunteers are unsure how to fill out the forms for us, the strangers, the foreigners. Meanwhile the escape artist and his mother and infant sibling are behind us, the infant fussing, the mother trying to talk to the officials at the table. I open one of the children’s library books and show the baby pictures. He smiles. He wriggles in his stroller straps. I show him another picture—Une girafe? I ask. And another. “Un chien?” The baby laughs. His brother, the escape artist, and a couple of other kids turn to watch the book. Susan gathers her documents, papers and forms—two for each of us. We’re to proceed to the next table to fill them out. Susan gives me one for James and one for myself. “Just copy everything I write on these,” she says. I can read enough of the French to fill in our names, dates of birth, address, phone number. I recognize the usual list of questions: allergies, cold symptoms, etc. We finish our paperwork and proceed to the third table, where we stand in line for a few moments before sitting down to discuss our answers with what I assume to be a medical student, a nice young woman. We are released to the next step.

Out of the small room, back through the gym, we join the line in the next hall. The children are very hungry, and tensions are rising among all of them—vaccination time is near. I open one of the children’s books from the library and try to figure out what it’s about, holding the book open and reading the French words, asking the kids questions about the pictures. “Prout de Pompier,” I read from the cover. “I wonder what that means?” The kids shrug, but they’re interested, distracted from the needle-moment at hand. The elderly couple beside me look over, eyebrows raised. I open the book and we look at pictures. “What do you think is happening here?” I ask, pointing to the bright illustration of a firefighter with a wisp coming from his pants. I read the French words aloud. The couple behind me smiles a little. I turn the page and read again. The double doors open and we all move through. Susan whispers to me over my shoulder, “You know that book is about farting, right?” I did not know. I’ve learned a new word in French: prout. Fart. The mother of the escape artist thanks me. This is enough.

At last, we enter a large room—a cafeteria in other times—set up with screens manned by nurses and medical personnel in white coats. But we—the foreigner family—are ushered through this room and into another small office, here to meet with a regular doctor. I have written on one of the forms that I am allergic to Thimerosol, a common adjutant in vaccinations, and Susan has confessed to cold symptoms. The doctor is very nice, very professional. The vaccine does not contain Thimerosol. Susan isn’t feverish. We are finally cleared for la piqûre (the puncture) and returned to the line in the other room. The children take their markers to a cafeteria table to draw. We all take off our coats in anticipation. We’ve been at the vaccination center for well over three hours. A kind man—a volunteer—comes in and dumps a bag of candy into a basket. The children, who are starving now, spot it right away. We’ve promised them anything, everything, in exchange for their cooperation with this ordeal, and they’ve been remarkably good, even though now, all around us, babies are screaming behind the little curtains. Everyone is exhausted. Even the kids seem relieved when it’s finally our turn. James and I go together, and Izzy and Susan go to another little curtained booth. The nurses are kind and efficient—though James’ nurse has to show mine, who is much younger, exactly where to give me the injection. As soon as we’re done, I grab a handful of bon bons and pass them to James. He deserves it. We all do.

Even after the vaccine, there is another line, everyone putting on their coats and the children eating unlimited sweets. At the final station, more forms are completed, stamped, and the children’s bons for their second injection three weeks hence (two days before Christmas) issued, along with paperwork detailing the shots we’ve just received. We leave the vaccination center well after dark, starving, exhausted and sore in the shoulders, but somehow elated. It’s as if we’ve passed some kind of test.

Does the French system work? Yes. We paid nothing for our vaccinations. We saw people of all classes in the line, everyone getting the same fair though tedious treatment. Was it efficient? Absolutely not. All those papers, all those stations. But the French seemed to take it in stride. Remember, the word “bureaucracy” originates in the French. And it wasn’t just a glitch caused by a last-minute unexpected rush; we go through almost exactly the same process when we return for the kids’ second vaccine three weeks later. The only things that have changed are that more people come prepared with blankets and food and entertainment, we have bons for les piqûres this time, and the vaccination volunteers provide sweets at almost every step rather than just at the end.

In our other encounters with the French medical system so far, Susan decided, finally, to get treatment for her lingering sinus infection. She went to Dr. T., our local generaliste, who will not prescribe antibiotics without an x-ray. The offices here have no staff to speak of—no receptionist, no phalanx of billing clerks trying to negotiate the myriad levels of insurance company rules and regulations. One person answers the phone and sets up appointments. You arrive and sit, and the doctor him- or herself comes out to fetch you at your time. That medical card with the imbedded chip is scanned and the information about the services you’ve received, your medical condition, and prescriptions are automatically recorded in the state database. If, like us, you are foreign, you pay a set fee for the visit—€22, about $30—and pay the pharmacist and radiologist in cash as well. The medicines are pricey, of course, but cheaper than they would be for the uninsured in the U.S. The x-ray of Susan’s sinuses costs €48, about $60; in the U.S., the same x-ray costs $120. We will attempt to get our U.S. health insurance provider to reimburse us, but we know it will be a nightmare of paperwork and negotiations.

The price of health care is lower here, and the anxiety we all feel in the U.S. when we are uninsured or if we become ill with some catastrophic illness that may or may not be covered by the insurance we do have is non-existent here. You need a vaccine; you get a vaccine. You’ll stand in line for awhile, but you’ll know that no wealthy person paid to jump ahead of you. You’ll know that you won’t be bankrupted should the doctor find a cancer when she grabs your arm for la piqûre.

From across the ocean, it’s hard to invest a lot of energy in trying to understand the various permutations of the health care bills being debated in Congress, but we try to keep up. The French system is also complex—not exactly a single-payer system, but close to one, funded both publically (by government) and privately (by employers). Citizens can choose their own doctors, go to as many specialists as they want, and pay out of pocket if they want to go to private hospitals where waits for surgeries may be shorter. But those out-of-pocket costs will be much lower than bills for the same procedures in the U.S. because the government caps prices. According to a (very good) report in Business Week, “France spends just 10.7% of its gross domestic product on health care, while the U.S. lays out 16%, more than any other nation.” Doctors earn less here, but all medical school is paid for by the state, malpractice insurance costs are negligible, and French doctors don’t pay the income tax themselves. The French system is also expensive, paid for by taxes at 20-40% of income, and most people buy supplemental insurance (about €200 a year for a family of four) to cover gaps between government reimbursement and costs (such as for glasses and dentistry), but the French are mostly satisfied with their health care, far more so than are Americans.

We strangers in the village are certainly satisfied. While on sabbatical, our family of four existing on a substantially reduced salary from the university in Europe with a decidedly unfavorable exchange rate, about $600 is deducted from my salary each month for our family’s (required) health insurance coverage in the U.S. We pay out of pocket for all our medical expenses here in France and must apply to our American health insurance company for reimbursement. Frankly, it’s probably not worth the effort; between our $500 deductible and the $20 co-pay for each visit, full price for doctor’s visits and medications in France are cheaper. And for the H1N1 vaccinations, there was never even any question that the benefit to the society of a fully protected citizenry far outweighs the price of the shot. Money never entered the discussion. After all our worry about la grippe, this new peace of mind about our health and its protection while in France is priceless.

Advertisements

Joyeux Noël

December 25, 2009

Our holidays began with about three inches of snow last Friday morning, resulting in cancelation of the last day of school before vacation… a child’s dream come true! We attempted sledding since we’re on top of a big hill, but, alas, not enough of the white stuff, which melted before midday anyway. We were disappointed that the children’s school holiday performance was also canceled, but we baked sugar cookies for the Loto benefit (Bingo) on Saturday night. Susan dropped them off to the teachers, who were in the back room cooking crepes to sell at intermission. She couldn’t stay, but they wished us all well for the holidays. “Joyeux Noël!”

On Sunday afternoon, we drove to Rieux-Volvestre, about 20 minutes east, singing Christmas carols in French in the car, to attend a free concert on a restored 17th century organ in the Cathedral Saint Marie. Some Bach, the Ave Maria, traditional Christmas songs, and selections from Occitan were on the program. We kept the kids still by plying them with sweets. Everyone in the small crowd—families with teenagers, grandparents with a toddler, a group of elderly women who sang along quietly, farmers with mud on their boots—sat happily in their coats and scarves the whole two hours. A clarinetist accompanied the organist for a few numbers, a wonderful mezzo soprano sang, and for the traditional Occitan songs, a man with a traditional instrument called a cornemuse, much like a bagpipe, played along. At the end of the standing ovation, the whole group joined in on an encore, which happened to be the same Christmas carols we had just learned in French in the car. At 4:30 on that clear, cool Sunday afternoon, we spilled out into the narrow streets—cobblestones, waddle and daub medieval houses close in—and wandered toward the center for the Marché Noël: donkey rides, a bounce house, handmade hats and soaps and Armagnac for sale in the covered market. Père Noël in his red velvet suit distributed sweets from a horse-drawn wagon, shouting it out: “Joyeux Noël!”

During the week we finished up shopping, got the kids’ second H1N1 vaccines, played soccer with the dogs, and made more ornaments for our little tree in the tower. On Christmas Eve the weather turned warm and gorgeous—around 60 F and clear. I went for my walk at about 3, and on my way home nearly everyone who passed was dressed up for the holiday evening out. A neighbor slowed and waved, rolling down his window to wish me, “Joyeux Noël!”

We too showered and dressed in our finery, got in the car and drove to Toulouse, stopping briefly at the supermarket to buy Susan black stockings. A supermarket on Christmas Eve is the same in France as in the states, save for the heaps of oysters in baskets in the aisles. And I’ve never seen such a mob of people buying black stockings at once! The check-out clerk smiled as I left: “Au revoir! Joyeux Noël!”

We had decided to splurge and attend the ballet in Toulouse–a first for James and Izzy–and cheap by American standards, €50 for our family of four. We arrived early enough to eat ham sandwiches in a café across the street, glasses of wine for us and lait chaud (big cups of warm steamed milk with sugar) for the kids. We chatted with the owners and other patrons, who admired Izzy, la Princesse in her crown and fancy dress, and James in his red bow tie who stole the crown for his moment. “Au revoir, Joyeux Noël!” we all said as we left.

The ballet was perfect—five short 19th century pieces, lots of tutus and satin, a fine troupe and good orchestra in the beautifully renovated Halle des Grains. At five minutes before the show was to start, the ushers appeared up in the cheap seats, got us all up and re-seated everyone in the empty seats down below. We ended up in the fifth row. The lights went down. The music came up. The dancers thumped onstage. James and Izzy sat forward in their seats, eyes wide, mouths open. I watched them watching the magic of their first ballet. On the far side, Susan too was watching the kids, her eyes shining. James turned to her and said, “I love this!” Izzy turned to me and whispered, “Mom, thank you!” Later, when she and Susan went to the restroom they met the prima ballerina–changed into jeans but still wearing her tiara, just like Izzy, in the hall. “Joyeux Noël!”

On our way out of the city, streets wet and shining, reflecting the blue strings of lights over the streets and the green and red-lit bridges over the River Garonne, we passed a phalanx of about fifty gendarmes around the Cathedral Saint Etienne, preparing for the mobs sure to appear in the next hour for the midnight mass. We drove home to the château through the countryside, farm houses and villages winking with holiday lights, little churches everywhere lit up for the traditional services. We would have gone, but the children were already asleep in the back seat. We arrived home just after 11. Izzy woke up enough to put out the cookies and milk for Santa, who brought scooters to coast down the driveway, and remote-control cars to torment the dogs, and kites to fly on the hill of Latour des Feuillants.

And another gorgeous day in the village.

James and Izzy Dressed Up for Christmas Eve at the Ballet

Joyeux Noël!