My Carte Vitale

I am now the proud owner of a Carte Vitale – a little green plastic card with my picture on it that gives me free health care in France.

Since I went to the social security office in July I have had a piece of paper with a temporary social security number, but this now the real deal.

All French people have a Carte Vitale and – when plugged into a card reader at a hospital, pharmacy or clinic – it gives information about how much the card holder has to pay towards their care.

For most people the Carte Vitale pays 70% of health care costs with the additional 30% paid by a mutuelle – an insurance policy usually paid by the person’s employer.

However, for people with long-term health conditions (affections de longue durée), the Carte Vitale pays 100% of all health care, apart from a few pharmacy items – a list that the government here is trying to lengthen.

I managed to get a Carte Vitale with 100% cover because I was able to get a form E121 from the Pensions Service in the UK. This isn’t always an easy process, but I knew that I needed it in order to be able to live in France for a year.

The European Health Insurance Card (EHIC) scheme may have been sufficient if my Crohn’s was much more stable and I didn’t need regular hospital admissions for my Infliximab treatment.

Although, having said that, my partner Becky is having some problems getting the correct EHIC card – there is one for holidays and one for longer stays.

So far, my health has been quite stable. Even so, I have been to see a médecin généraliste (GP) twice, a gastroenterologist once and I have had one trip to the university hospital for Infliximab and one blood test.

This week I need to have a Vitamin B12 injection, plus another blood test and then have another Infliximab infusion in two weeks’ time. And I am having ongoing treatment for a dental infection at the dentists (paid for by the Carte Vitale).

To be able to hand over my Carte Vitale each time does make life much easier and cheaper than having to pay and then claim back 70% of costs via the EHIC office in the UK. It will be interesting to see how this works if Becky needs to use her EHIC card while we are here.

Slowing down time

It is a strange thing how time can appear to go very slowly and then, suddenly, the weeks speed by. That is exactly how the last month has been for us.

To begin with, each day was a real challenge - finding our way around the town, struggling with speaking French and trying to understand how everything works here. Time went slowly and every day was memorable.

At some point we must have reached a level of proficiency and confidence where most aspects of everyday life were not a struggle. Then days merge into others, with special trips or events the highlights that shine out from the humdrum.

In some ways it is quite nice that each day is no longer a struggle, but I would like to slow time down a little, otherwise our year will be over too soon.

We have had two nice trips in the past month - to the American Film Festival in Deauville and to Bayeux - and we've had some nice visits from family and friends.

We have also both had a nasty cold that has lingered for a week or two and has caused the postponement of another couple of trips out.

With Becky starting her university course next week, we will be settling into more of a routine. This will be good for getting things done, but does threaten to speed up time. Once we have Becky's timetable, we can spot times for day trips, evenings out and times to meet up with new friends.

Regular half terms are definitely being reserved for trips away - Paris and possibly a trip to the south at the end of October.

After our 12 weeks of 'acclimatisation' our adventure is really about to start now, so we need to use what we've learned so far to make sure the experience doesn't fly past too quickly.

Keep on speaking French

The days and weeks are really racing by at the moment. France has returned from its summer break and we are now seeing the country as it is for 11 months of the year. It is busier, noisier and the shops are all open.

It took me a while to recover from coming off the antibiotics I was taking for a tooth infection. I was fine while I was taking them, but as soon as I stopped I felt rough for a week and didn’t get out much.

Back in the UK having to stay tucked up for a week is not unusual and I take it in my stride. Here in France it was more difficult. Partly this is because our flat is a little small, but I think the main reason I went a bit ‘stir-crazy’ was that I wanted to be out and about speaking French and learning about my new town.

I learned that it is very easy to feel isolated. My French is progressing well, but I am very aware that I do struggle to have a conversation. Every time I am out I have to work hard and be prepared for constant linguistic challenges.

It will need a lot of commitment from me to progress with my French to the level I want to achieve. Lying in bed feeling poorly, this all seemed rather impossible and pointless. I really did end up feeling sorry for myself!

Once my body was back on an even keel I had an afternoon out with my partner. We went to the library, picked some CDs to listen to and filled our bags with all the brochures and leaflets for the new season of local arts events and then went to a local bar to read them.

There is so much going on in town between now and next summer – it was reassuring to know that I won’t have any excuse to be bored and I will have plenty of opportunities to practice my French.

A trip to the dentist

We’ve had our first visitors over the past week, first our mothers and then my sister, her husband and my niece – who’s nearly three. It was great to spend time with our relatives and a relief that they all think we live in a nice apartment in a beautiful town.

The visits also coincided with my first health emergency – a infected tooth – and a bit of a step forward with me speaking French.

The tooth was unfortunate. I generally have good teeth, but this tooth has been a problem for two or three years. I have had root canal work done twice and a number of broken fillings and temporary crowns. It has cost me an arm and a leg in dental bills.

The latest episode of the saga started with some pain last Tuesday and a lump of tooth falling off that evening. The next day I felt ghastly and suspected I had an infection. Because of the immunosuppressant medication I am taking for my Crohn’s, I needed to get it looked at.

After consulting with the local pharmacy and the emergency department at the local clinic, I understood that it would be best to see a généraliste. So I went to my doctor to make an appointment for that afternoon.

I saw another doctor in the practice (my doctor was on holiday) and he was very helpful. He listened to my slow and painful French and even had a look in my mouth before accepting that he wasn’t a dentist. I left with a prescription for antibiotics and the telephone number of his dentist.

My partner kindly phoned the dentist at 8.30 on Thursday morning and explained my situation. My French is not good enough to manage phone calls yet. He was happy I was on antibiotics and arranged an appointment for Monday.

The antibiotics quickly kicked in and, after 4 doses, I was feeling a little better by the time my sister’s family arrived on Thursday evening. I’d also been prescribed dispersible tablets which seemed a lot more gentle on my digestive system, so I was able to enjoy the weekend.

Forty-five minutes after waving goodbye to our visitors on Monday afternoon, I was at the dentists, trying to explain the history of my tooth and trying to understand what the dentist was saying to me. It was hard work but ultimately successful.

So, I have a chronic infection at the end of the root. This didn’t surprise either of us because of my immunosuppressive treatment. The dentist said he didn’t want to do anything and wanted to wait to see what happened in the next 3-4 weeks.

I left with another appointment next month, an instruction to phone for an emergency appointment if things deteriorate and I paid nothing. Dentistry in France seems to be part of the health care system.

Interestingly, at the end of a week when I spoke lots of English to people other than my partner, my French has improved quite a bit. I’ve done no study this week and when I felt poorly the last thing I wanted to do was to speak French.

I remembered on Tuesday night and through Wednesday that it is quite scary being ill in another country, but I got the treatment I needed and am now feeling better. I had to make myself understood in French and I did. It is good to know that my survival instinct is in good working order.

The morning after infliximab (Remicade®)

I am always quite tired after my infliximab (Remicade®) infusions, but I am particularly wiped out this time. I don’t think it’s anything to do with the drug – although the extra steroid and anti-histamine might have done something – I think it was going to a different hospital and having to cope with a language I don’t speak very well.

All in all I think I did rather well. I was really nervous beforehand, but the day itself went smoothly. And I now know how it all works and I know that every 8 weeks my French will have improved.

It’s one of those things – if only I had the level of French I will have at the end of the trip now, so I can sort out all these difficult tasks with my healthcare. I would probably cope quite well at the end of the year – when I know how everything works – with the level of French I have now.

I had wondered how different the actual procedure would be compared with the UK. There were some big differences like having my own room, having the anti-allergy cocktail beforehand and actually being seen by doctors.

There were smaller things like getter fed - a particular bug-bear for a fellow infliximab patient I know in the UK - and having a decent cannula in my arm - my bug-bear, if you hadn’t noticed.

In the UK I have got to know the unit staff and, even though I sometimes feel like an extra in M*A*S*H, I have a good experience and feel safe, despite the chaos and $0.01 cannulas made by prison labour in China.

My experience yesterday was on a different level. It was what you’d hope for and, I guess, what I am becoming to expect from the French health system – efficient care where the patient’s health is the only consideration.

My first Remicade® in France

I’ve just got back from my first infliximab infusion in France. Infliximab (or Remicade®) is the regular treatment for my Crohn’s disease. I’ve been taking it for just over two years in an attempt to avoid further surgery. It has worked quite well and I have an intravenous infusion every 8 weeks in hospital.

The high cost of the Remicade® and the trip to hospital every 8 weeks was the reason I needed to get my health care well and truly sorted out as soon as possible after arriving in France.

My appointment was for 8.30am and I got there on the tram in plenty of time, in case I got lost (which I did) or I failed to explain who I was and why I was there (which was no problem).

I was shown to my room, which had amazing views over Caen from the seventeenth floor of the hospital block (not good for my vertigo though). I was offered breakfast and tucked into French bread and a bowl of black coffee.

The nurse looking after me weighed me, looked at my blood results (which I remembered to bring) and explained clearly in French what was going to happen and that I would be there until about 3.30 or 4 o’clock.

The consultant in charge of the unit came and introduced herself to me and asked – in English – a few questions she had for me after reading the letter from my gastroenterologist in Caen and my consultant in the UK.

A junior doctor then came to see me, looked at my blood results, my weight, asked me, in French, if I was allergic to anything and if my general health was okay and then wrote up my Remicade® prescription.

The nurse put a cannula in my arm just before 10am. She was a bit worried that my veins were small and then, when needle was in, she was amazed how the vein she picked suddenly changed direction. I reassured her that they were always like this and it seemed to help her calm down a bit.

The cannula looked very sturdy and 21^st century – I don’t think the first priority here is finding the cheapest cannula available on the world market. Immediately after the cannula was in I was hooked up to a litre bag of saline which was run in slowly at 125ml per hour.

I was then given a small dose of steroid and of anti-histamine. This is a precaution against allergic reactions to the Remicade® and is not uncommon, but I hadn’t had this before in the UK. This was run in intravenously over 10 minutes and then I was left on the normal saline until 11.30am.

At 11.30am the Remicade® was set up and run over two hours. I had a hot lunch – egg salad, beef stew and potatoes and bread and cheese (no wine though) – and settled down to finish the book that I’d started earlier.

I was told that I needed to remain in bed, lying down, while I had the infusion and to rest for two hours afterwards. Throughout the infusion and for the rest period an automatic blood-pressure machine took my blood pressure and pulse every 15 minutes and a nurse popped in 3 or 4 times an hour.

The IV wasn’t hooked up to a pump, it just ran into my vein, in the old-fashioned way. So the infusion ran a little longer than the two hours. But that was fine and I finished my book – ‘J-Pod’ by Douglas Coupland, which was a good read.

Everything was finished just before 4pm. I was given a wallet full of documents to take to the ground floor, got my next appointment time for 8 weeks, said my goodbyes and I was off.

I wasn’t entirely sure what I had to do will my wallet of stuff or where on the ground floor I had to go – it’s one of those things that people just expect you to know and then are utterly bemused when you try to explain there is no such paperwork in the NHS.

Anyway, the woman on reception directed my to where I needed to go and the clerk in the discharge office spoke a little English and took the wallet from me and copied my social security certificate and the letter for my next appointment. I checked that I didn’t have to do anything else or send any forms anywhere (I didn’t) and I was finally off home on the tram.

An introduction to French football

I went along to my first French football match on Sunday afternoon, a Normandy derby match between the Caen reserve team and Rouen in the amateur CFA league.

The match itself wasn’t great. A nicely worked goal from Caen and some great goalkeeping meant a 1-0 victory, despite the Caen captain being sent off with 25 minutes to go.

I did enjoy the afternoon. It was a lively crowd and I heard a lot of the banter and chanting that will be a feature of the first-team games, but the crowd will be ten times bigger. So it was a gentle introduction and gives me the opportunity to go away and learn some more vocabulary and a few things to say.

On Sunday I was utterly cowardly when it came to striking up a conversation. I could have done, but I didn’t. I don’t think it will be long until I do pluck up courage to start talking to people. Talking about the football with other fans is an easy place to start.

Yesterday I queued up for tickets for next Saturday’s Ligue 1 game against Valenciennes. It is the first home match of the season and after last Saturday’s 2-1 defeat away at Bordeaux, it is an important game to win.

Over the next couple of days I need to write down a few conversation pieces to use while I’m having my infliximab infusion on Thursday – it could be a four hour stay, so I do need some conversation…

One topic to prepare could be about football, I can then refine it and use it again on Saturday. This practice, together with my daily study and online BBC ‘Ma France’ lessons will quickly get my confidence up. I’ve already noticed how much my comprehension has improved, particularly reading the sports news.