Saturday, October 2, 2010

Six Days with Socialized Medicine

I had fully intended to spend this weekend on a soul-searching adventure in the woods somewhere. I made this decision while reading The Tao of Pooh on a long train ride home last weekend. I wasn't going to plan where I was going, though I would equip myself with a map. Maybe I'd get a compass. I'd plan An Expedition, but not Where To. I would find Who I Am again, as autumn tends to make the picture clearer for me. I would write poetic prose or prosaic poetry about this self-discovery.

But instead, I spent the week learning A Bit About Czech Healthcare. Let's turn this Rather Unfortunate Week into a learning experience and a treatise on the importance of affordable, accessible healthcare (and try to ignore how quality fits in).

On Sunday, I was chopping vegetables for tea (best to call it that, as it was too late for lunch and too early for dinner). I was given a soft-skinned pumpkin from my girlfriend's garden, which was the basis for a tea of roasted autumnal vegetables. Instead of cutting it, gutting it, and baking it as I usually do with winter squash, I learned that since the skin was so soft, I could peel it. And then I peeled off a bit of the tip of my pinky. Only some skin and nail, but it wasn't pretty. I had no idea what to do. I walked around my flat looking for something to wrap it in, trying to figure out some remotely sterile plan. After forty minutes of profuse bleeding, I decided it was a Medical Situation. I googled "hospital Kolín" and found that there was a hospital about a fifteen minute walk away, right where I walked to school. After bundling against the cold and rain, I arrived at what was not a hospital in the American sense. More of a clinic. Open on weekdays. I called my boss who tried to direct me to the real hospital, but that didn't help. I walked to the square and found the town map, then walked to the hospital. At this point, I had been bleeding for over two hours. I got to where the hospital should be, but found it under reconstruction with no clear signs. I had taken two breaks already and was about to sit down for another, possibly the break that would involve finally passing out, when I spotted an assistant teacher from my school! What luck!
She happened to know how to get to the ER, despite the lack of signage even in Czech. She walked me in and took me to the reception desk, where I paid 90 crowns (about $5) for a ticket to the emergency room. It was like going to the movies. I waited in the hall, and when I was called in, a nurse without gloves removed my bandana and poked at my finger, while I continued to bleed everywhere. It felt more like an office than an emergency room. There were two desks, a few chairs, and a table with metal boxes and tongs full of mostly unwrapped first aid materials. The peroxide was in an old jam jar with a piece of masking tape as a label. They couldn't give me stitches as there was nothing to sew, so they put some weird loosely woven, sticky gauze on the tip, then another few layers of gauze, then they wrapped it all up. They seemed only to use rubbing alcohol to clean it. They didn't even wash the blood off the rest of my finger before they covered it. They, still un-gloved, took my bloody ER ticket and sent me away with a care sheet instructing me to rest and take the bandage off in three days.

That's it. The rest was all inference. "I'm pretty sure I shouldn't get this wet" was the most important one. American medical care may be harder to come by, but at least when you leave, you've probably been told by three different people exactly what to do. Also, after bleeding for a few hours, I decided I could still walk home, which in retrospect was probably a terrible idea and something that American ERs certainly would have discouraged. But I made it.
Three days later, I removed the bandage to find that, unsurprisingly, the piece of sticky gauze used instead of sutures was stuck. I could not for the life of me remove it. So, back I went. I got the exact same treatment and exact same instructions. In removing this piece of gauze, they completely re-opened the wound. I'm not sure how it's ever going to heal if the process continues like this. Something tells me that tomorrow, I'll probably be visiting the ER for the third time this week.

It's not been so bad. I quickly decided that as far as these things go, I was quite lucky. It's the pinky on my left hand, could there be a less useful finger? It's out of the way enough that now that the second bandage isn't so dense and doesn't give me a claw, I can sometimes even use my left hand. Also, couldn't get luckier than running into my assistant! And we had a holiday on Tuesday, so I had one less day to be the Amazing One-Handed Preschool Teacher, able to change diapers with a single hand (no joke)! Both times, I was in and out of the hospital in under half an hour. Accessible and affordable, hurrah!

But on Wednesday as I was staring down another three days of annoyance with this bandage, I started to notice what I thought was just post-pub-visit congestion in my chest was getting pretty bad. By last night, I couldn't sleep because it felt like someone was crushing my lungs. This morning, I got up early and headed to the doctor. I've been to this doctor before for a cold. I learned that you don't need an appointment, and in a clinic-like fashion, you just get there early and wait until you can go in. I waited about an hour for my turn, but it turns out that my doctor was on holiday. My intermediate-at-best "English-speaking" doctor was on holiday. My symptoms were taken by the medical assistant in her helpful, if broken, English and via google translate. I was asked if I had "the snuffles" and how bad my coffee was. Her broken English was encouraged as I replied that I had "only small snuffles and a big big cough."
I went into the doctor's office, which really is more of an office than an exam room (again), but the counter is covered in phials of blood that are just lying out, not even in any kind of holder. This still unsettles me. The white, cold, sterility of American medical places is actually really comforting.
The doctor examined me and asked me the basics as well. Checked my throat "iz good." Checked my lymph nodes "iz mmm." Checked my lungs. Checked my lungs. Checked my lungs "iz... okay." Iz okay? Iz not dead but iz not good iz okay? That was my diagnosis, "iz okay" said in a very hesitant manner. He told me to sleep in bed (couches are out?), drink hot tea, and take medicine every 12 hours. He didn't tell me what the medicine was but I assumed it was an expectorant. I paid my 30 crowns ($1.67) and went to the pharmacy where I expected to receive my expectorant. Just get this stuff outta' my chest! The pharmacist spoke to me in rapid Czech and I understood one pill every 12 hours, yeah, got that. Then I understood "antibiotika" and asked her if she spoke English. She told me it was a prescription for antibiotics for my chest infection. Huh. That sounds... not "okay." So I went to school and the other teachers looked at my pills and read my papers. Yep. Chest infection (not exactly sure what that means, to be honest, but it still sounds bad). And then I decided that maybe that whole "sleep in bed" thing wasn't a bad idea.
Now, I'm not sure how I'm going to get to the hospital to have my dressing changed if I am too wheezy to walk to the kitchen, but I guess I'll figure that out tomorrow. All and all, three visits for under $20 ain't bad. I am skeptical about the quality of my medical care, though it was certainly fast. Also, what if I didn't have 30 crowns for my doctor or 90 for the emergency room? I needed to pay before I even got treatment. I assume they can't refuse treatment if you can't pay, but I do find the pay-before thing troubling. Is this a system that works better than America? As far as I can tell, yes. Does it have its own problems? Certainly. But there is no way to properly describe the feeling of comfort in knowing that if I get sick, I can get treated without worrying about accruing hundreds of dollars of debt for every hour spent getting care. This peace of mind is priceless.


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  2. i have such a love/hate relationship with socialized medicine. i love that medical care is available to all, but i've never had a good experience with it, unfortunately. i mean what is the point of cheap care if it's not helping (i.e. re-opening your wound, etc). i think socialized medicine has the potential to be brilliant, as you said, 3 visits for $20 is a win! :)
    Most importantly... FEEL BETTER!!! x

  3. Hello, I am your friend on Ravelry! I just read your account of Czech health care. Funny! My husband is Czech and we live in PRG since August 2010. He tells me that the up-front charge at the ER is to discourage people from abusing the free system, wasting the hospital's time with nothing. I also imagine they want to regulate the homeless people and other "unwanteds" that might otherwise camp out there.

    anyway--i enjoyed your blog and hope we can meet sometime! I am stusek on ravelry. Hezke den!