Too many doctors?

The finger is now cured – although I need to take care of it – and I don’t have to go back to the clinic on Friday. I was very impressed by the care and advice on offer over this small, but potentially serious, problem.

In the UK I am often wary of seeking help for small infections like this – even though they are quite frequent with all the immunosuppressive medication I take.

I guess this wariness is because I don’t want to be hanging around in waiting rooms, I don’t want to waste doctors’ time and I know I can look after and treat most infections myself and want to avoid antibiotics as much as I can.

Here in France I was treated very quickly and everyone understood the potential risks. The doctor also seemed almost thankful that he would have something interesting to do at 8.15am on Sunday after a night in the emergency department…

I was also relieved that I wasn’t just sent off with antibiotics. Of course, had I needed them I would have taken them – but they are no good for my bowel. Instead the doctors were prepared to assess my finger each morning for as long as it took.

This level of treatment is – I think – a direct consequence of having “too many” doctors in France. There are 207, 277 doctors in France according to the World Health Organisation’s 2008 figures, that’s 34 for every 10,000 people in France.

In Britain, the same studies give 133, 641 doctors – 23 for every 10,000 people. Not a huge difference on paper, but very noticeable in terms of the quality of patient care.

This ‘efficiency’ (if you are a patient or healthcare professional) or ‘inefficiency’ (if you are a budget holder or politician) has meant that I was able to get seen and assessed by a gastroenterologist within 24 hours of seeing a GP in July – possibly the most important step for someone with Crohn’s disease.

It means I get my Remicade infusion every 8 weeks (to the day) and that I am assessed by a doctor before each treatment and, on the first visit, by the consultant running the service.

Each time I’ve seen a doctor I have had as long as I need to be examined and assessed and for the doctor to arrange follow-up with their colleagues over the phone.

The wait for an out-of-hours doctor was about the same as the best I’ve experienced in the UK, but the time and attention given to me was better – there was no feeling of being rushed.

And the 30 minute wait (on a Saturday afternoon) in the emergency clinic was very civilised. All in all a good experience and one that helps me manage my long term health condition with more confidence – and therefore more effectively.

Steroids and septic fingers

The steroids have worked well and I am feeling a lot better – yesterday I managed my Saturday steak and chips for the first time in a month. I’ve seen a lot of the French health service in the past three weeks and that has been interesting.

Firstly, I needed to see my gastroenterologist to review the steroid treatment. We were able to phone and make an appointment time that fitted our plans and I went to the appointment on my own.

I got another thorough examination, a look through my blood results and a good chat. The gastroenterologist was confident that the attack was a result of more ‘mechanical’ narrowing in the bowel (from surgery and past scarring) rather than a severe inflammatory flare-up.

So after 25 minutes, I left with a reducing course of steroids and a request for me to be given a good look-over when I go for my next Remicade infusion at the bigger university hospital. And, of course, an open invitation to go to the clinic and ask to see the gastroenterologist “at any time” – all I need to say is I have Crohn’s and the staff will understand.

A few days later, I went to see my GP or généraliste to update my prescription – I needed to add the fortified weight-gain drinks I need after a flare-up. Again I got a good examination, except this time the généraliste was looking not just at my bowel but at my general health to make sure my body was not suffering too much from the results of the flare-up and the steroid treatment.

The next day I visited a local nurses’ office to have my regular Vitamin B12 injection (I no longer have the region of bowel that absorbs B12) and my ‘flu jab. It was strange having the nursing service totally separate from a GP surgery and the whole experience was unfamiliar and maybe a bit old-fashioned, but I’ll get used to it.

Unfortunately – and probably because of all the immunosuppressive drugs I am taking – one of my fingers went septic last week. Typically, I sort of ignored it to begin with and then used all my nursing skills to keep it clean and disinfected. But it didn’t get better.

So yesterday, I went to pharmacy and asked if they could suggest anything. Even before I mentioned the drugs I was on, they said “go and see a doctor today!”. I went straight to the emergency department at the local clinic, booked in with my Carte Vitale and was seen within 30 minutes.

The doctor and nurse had a good look at the finger (with much grimacing and muttering) and told me to bathe it every 3-4 hours in alcohol and made me an appointment at 8.15am Sunday morning to review progress.

I got the alcohol from the pharmacy, bathed the finger before and after last night’s football match and, this morning, it was much improved. So the doctor is getting his colleague to see me tomorrow at 9.15am at the clinic and – if everything is progressing well – I will go back on Friday for one last check.

Calling out SOS Médecins

Well, it was bound to happen soon enough – on Thursday night I had to test out the French emergency medical system during a rather nasty attack of my Crohn’s.

I’ve been having these attacks of extreme pain and vomiting since I was about 19 and they are not much less alarming after twenty-odd years. It is my body’s violent response to a blockage in my small bowel where food is stuck in a narrowing caused by inflammation.

Some women with Crohn’s have compared the pain to childbirth. I can’t possibly comment – but it is very painful. The huge waves of pain build up to me throwing up 3-4 times in a row followed by a brief pause and then the whole process starts again until there is nothing left in my bowel – and I don’t just mean my stomach.

On Thursday this went on for about 2 hours, but sometimes it has gone on much longer. Often in the past I have ended up admitted to hospital.

Over the past few years I have discovered ways of either stopping these attacks or making them less intense. When I feel an attack coming on I’ve used painkillers like tramadol and morphine together with relaxation and hypno-therapy techniques.

Sometimes these work, sometimes they don’t – and on Thursday they didn’t.

I knew we would need to call a doctor out and maybe go to hospital. This was really frightening – I had no idea what would happen. I’ve had bad experiences in the UK and, although all my contact with the French health system has been good so far, I was fearing the worst.

My partner phoned the local hospital around 8pm and, as I was unable to make my way to the hospital to see a doctor, they suggested calling out a doctor from the SOS Médecins service.

The wait was probably about the same as in the UK – about 90 minutes – but I would say that the doctor who came probably knew more about Crohn’s and about how the local health system works than a visiting doctor in the UK.

I received a thorough examination and we discussed my medical history and my current treatment. We decided that I would have a course of steroids and I would make an appointment to see my gastroenterologist within the following two weeks.

In the meantime I was to rest, keep myself hydrated and slowly and carefully start eating. This is the sort of treatment and advice that I would need to see a gastroenterologist for in the UK – perhaps a week after an attack.

So this was another positive experience of the French healthcare system, although one it would have been nice to have avoided.

Accueils des Villes Françaises

Finally my French has got to the level where I can spend time socialising with French people and start to understand more about the French way of life.

I have to say that the levels of concentration needed to follow conversation over a few hours is rather exhausting, but it is like a door has been opened to a whole new world.

My spoken French has improved a bit, but I am still a long way from being to express myself – which remains frustrating.

Although I have met some really interesting people through going to watch football, the main way we have met people is through an organisation called Accueils des Villes Françaises.

AVF is a network of local groups that help welcome people when they move to new towns in France and help integrate them into local life. The organisation is non-political, non-religious and run by volunteers.

Although we are not the only arrivals from overseas, most of the people we have met through AVF are French. It has been great to meet people around activities – such as day-trips, cooking groups and over coffee – and be able to ask for tips about living in France and get answers to some of the questions that have been bugging us for ages.

Mainly, though, it is a very good opportunity for me to practice listening to and speaking French with people who have chosen to be interested in ‘new arrivals’ and are generally very patient with my poor grasp of their language.

Earlier this week we went out to see a film with a small group of others from AVF. We saw Faubourg 36 which is the hit French film of the autumn and it was the first French language film I have watched without any form of subtitles.

Thanks to it being an excellent film, I was able to understand the story and what the director was saying, despite struggling to make an exact translation of all the dialogue.

I am a big fan of cinema and French cinema in particular. So, for the first time I watched the full screen of a foreign-language film, rather than mainly focussing on the subtitles. In many ways, this is probably the most exciting aspect I have discovered of my improving French.

Le Foot

One thing I was keen to do – health permitting – was to watch the local football team. When I was younger and lived in London I went along to every Arsenal home game and the occasional away game too.

Top-flight football in England has been out of my price range for at least 15 years and my health problems haven’t made it easy for me to travel to London. So I’ve had to survive on a trip or two to Highbury every season or so.

Living in Caen is great for football. Tickets start at around €11 a match and it is easy to get a bus to and from the stadium. In fact the stadium is an easy walk, if I feel like it.

The team itself plays fast attacking football with a bit of an English flavour – the coach, Frank Dumas, is a great admirer of English football and played briefly for Newcastle.

The home games are lively on the pitch, with far more goals than the average French first division game delivers. Their home form is less impressive – I went to one local derby and their performance was appalling, as usual.

The terraces are lively too. Each football club has at least one supporters group who make banners and flags and organise the chanting – creating a far better atmosphere in the ground than at most English matches.

It has been quite easy to get to know people at the football. I got in contact with the supporters group and they were surprised and intrigued that an English football fan wanted to come and support SM Caen.

I have been welcomed and introduced to people and through an appalling mixture of bad English and even worse French, we communicate. I’ve found out more about France, French life and Norman customs than I would have done any other way.

Away from the football I have found that people don’t want to speak bad English to me and don’t particularly want to hear my bad French. This makes communication short and shallow.

However, with football fans we have something in common – football – and a need to talk about it and so my linguistic failings are forgiven, at least partially. Each time I am reminded to work hard on speaking better.

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.