Fur-ners, indeed

When I was telling people at my old office that we were going to be moving abroad, my friend April remarked in her joking emulation of a Tennessee accent, "Wow, Amy, you're going to be a 'fur-ner!'" As silly as it sounds, that was the beginning of my comprehension of the difference between the considerable amount of traveling I'd done previously and actually living abroad for an appreciable period of time. I started to realize that the expectations of my family and me would be significantly different than those of tourists. In the course of years of travel, I have grown comfortable with the discomforts of difference one encounters as a tourist in another country where one doesn't speak the language. I was used to the occasional smirks of the people behind coffee counters when I didn't order in impeccable Italian or Spanish or what have you. While I tend to be a little oversensitive about such things, I've managed to acquire enough humility and perspective (and a tiny bit of humor, tho' I'm still working on that) to get over it for the duration of the trip.

We're now, however, in a position where the trip's not ending for quite a little while. Moreover, we have to take care of the quotidian details -- carpet installation, bill payment, doctor's visits -- attendant to family life, and we're finding that our inability to get by in Dutch is finally proving problematic. Utrecht isn't known for its high concentration of expats, so we're something of a novelty in this area of a country struggling with issues of immigration. (This absolutely brilliant book should be mandatory reading for anyone emigrating to the Netherlands inasmuch as it seems very effectively to lay out the nature of the changing Dutch identity. I'm going to ruminate further on the book in another entry because its issues are all-pervasive here, and they're certainly relevant beyond these borders as well.)

The Netherlands do not have socialized medicine, but rather a hybrid of public and privatized medicine similar to what some have proposed for the States. Every citizen is mandated to have a basic level of health insurance that they must purchase at no small cost (it seems to run around €90 per adult per month). Anyone without insurance can be fined. Those fortunate enough to be able to afford it can opt to purchase better health insurance through their employers. Could this possibly mean that the government of the Netherlands has set up a system committed to least-common-denominator medical care to almost the same degree that managed care has encouraged in the U.S.? Today I set off to find out (although I left my Michael Moore cap at home).

I checked in with the receptionist, whose first question for me even before asking my name was, and I do quote, "Do you even live here?"

An aside: I cannot fathom coming to live in this country from somewhere like Japan where personal interactions are so delicately polite and couched in euphemism; I, the one from the brash frontier country, find that I am continually having to remind (or convince) myself that people are not trying deliberately to offend me.

We (I) got past that and I was ultimately permitted into the waiting room after displaying my insurance card and ID. So far, about what I'd expect an immigrant to encounter in the U.S.

When the appointment receptionist had heard that I was a new patient, she had kindly set up a double appointment for me. This meant that I would get a comparably generous 20-minute audience with the doctor rather than the 10 minutes afforded a typical visit. This did send up a little warning flare for me, but the Dutch do relish their ostensible efficiency, so I resolved to withhold judgment.

The doctor was reasonably prompt, calling me in only three minutes past my scheduled appointment time -- I wouldn't have expected anything less of this culture that expects my 8-year-old to have an appointment calendar at the ready. The doc was friendly enough, but the tenor of the conversation changed after she asked where I was from. This, too, I'm finding typical. There's an edge of something I can only interpret as defensiveness that creeps into a conversation after I have to make this admission. I was treated to a five-minute explanation of how Dutch medicine differs from American medicine -- only to learn that it does not differ. I was told that my huisarts, or primary care physician, would be my conduit to specialists. I remarked that this was exactly how our system functioned, and my doctor responded that she thought that all Americans saw multiple specialists rather than a primary care physician. Well, no, we have the same referral system.

Okay, five minutes elapsed.

Physical examination -- another five minutes.

Then I had a couple of questions about prescription meds for my asthma. We go back and forth to figure out what the equivalent is in Dutch medicine of my first of three meds, and figure it out. When I ask about the second medication, she interrupts me in mid-sentence to consult her clock and say, "If you have so many questions, you need to make a longer appointment." Twelve minutes have elapsed since I walked into her office, fifteen since my appointment time began. I remind her that I had a double appointment and she says, "Good, at least there won't be two or three people waiting," but this is clearly the effective end of the consult. I'm told that Americans are overmedicated and she will not prescribe any further medication for me, that this is what they do in this country. Right then. I am dismissed with two minutes left on the clock and two medications undiscussed, and am told to walk myself out.

Final analysis: Public/private insurance + Dutch bluntness = altogether unpleasant expat experience. I wonder if I'll find any difference if I start claiming to be from Moosejaw, Saskatchewan, Canada, the small town in which my husband's grandmother grew up. I think that might just be my new ad hoc hometown for the duration of my expatriation, or at least when I'm hospitalized with my first asthma attack. Can't wait to try it out.