Our French Christmas

We’re in the middle of our French Christmas and New Year and, despite being laid up by colds, are enjoying the experience.

Our colds started at the end of the university term and just as we were about to go to Paris for the weekend before Christmas. We did get there, stayed in a nice 3-star hotel and the two days we managed to venture out were spectacular.

We walked up the Champs-Élysées with its illuminations and Christmas market. There were thousands of people there and it was all very festive.

Earlier we had visited Le Bon Marché – the oldest department store in Paris – and watched people buy very stylish Christmas presents and some amazing delicacies in the food hall.

Food is always in important in France, but during this holiday time it does become spectacular. Today the queues were long at local patisseries as people bought their festive specialities like Bûche de Noël, chocolates, macaroons and Galettes de Roi, plus brioches for the foie gras, of course.

We’ve really enjoyed the food, which has been served small and often, rather than the huge ‘pig-out’ on Christmas day that is traditional in the UK.

Christmas day is very much a family day in France, with time to see friends during the following week. Sadly we had to turn down a number of invitations this week in order to nurse our colds and to keep our germs to ourselves.

Spending time at home, we’ve noticed that French Christmas TV is much less of a big deal than it is in the UK, although, as always, there are some excellent dramas and TV films to watch.

The big Christmas day film was Robin Hood Prince of Thieves – which is an excellent film to choose, but there would be outrage in the UK if BBC1 or ITV decided to show such an old film.

So, now we have finished 2008 – the year we came to France – and at midnight enter 2009 – the year we return to the UK.

We still have many more months here, but it is a definite landmark in our year – and perhaps time to make some New Years resolutions, which is a tradition here too.

The health benefits of Calvados

Many of the conversations I had with people before I left Brighton were about how wonderful French food was - and I have to say that I am not disappointed.

Food is a very important subject for those of us with IBD. We all react differently to our experiences of severe bowel symptoms - some of us can become scared of what we eat.

It is true that I run a mile at the sight of sweet corn, but I do generally love
my food and really enjoy cooking, so France is a great place to be.

The first thing about France is the abundance of high-quality food. In the UK, it seems to me that there is a choice between cheap and tasteless or tasty but expensive food.

Here, I can buy fresh produce - fruit, vegetables, bread, fish, seafood and meat - in daily markets, local small shops or in supermarkets.

The variety and quality on offer here means I have a lot more choice of things that are good for my gut, easy on the pocket and taste sensational.

Although my health has been patchy (my Crohn’s wasn’t exactly going to stay back in the UK was it?) I do think the diet here has been kinder on me.

I’d forgotten how tasty fresh seasonal vegetables can be. Soups are perfect for my gut and I’ve included a simple recipe below for you to try after you’ve been to the local farmers’ market.

The other benefit of living in France is how we eat. Lunch is not a sandwich gulped down at your desk - it is a two-hour institution.

Taking time over a meal, having several small courses, plenty to drink (an apéritif then water or wine) is perfect for the IBD bowel.

And so too, I’m beginning to think, is finishing the evening meal with a small digestif - Calvados (apple brandy) in this part of France.

I’m happy to keep trying it - for purely medicinal purposes of course!


Recipe: pumpkin soup

Ingredients - serves 4

1kg unpeeled pumpkin or squash

25g unsalted butter

1 medium onion, chopped

2 cloves of garlic, crushed

1/2 tspn ground cinnamon

1 litre vegetable stock

100ml crème fraîche

salt & freshly ground black pepper


Method

1. Cut the pumpkin into wedges and scoop away all the fibres and seeds. Cut away the peel and cut the remaining flesh into small-ish chunks.

2. Melt the butter in a large pan. Add the onion and cook over a gentle heat for about five minutes. Add the pumpkin flesh, garlic and cinnamon. Cook gently for another 5 minutes.

3. Add the stock, cover and simmer gently for 25 minutes.

4. Take off the heat and liquidise until smooth. Stir in the crème fraîche and season to taste with salt and freshly ground black pepper.

5. Serve with fresh bread and, if you like, a handful of grated Gruyère cheese gently stirred into the soup.

Coming off steroids

I am suffering a bit having finished my course of steroids at the weekend. I have big aches and pains – particularly in my joints – and I am ridiculously tired all the time. The good news is that my guts seem to be behaving themselves.

Fortunately, I managed to squeeze in a trip back to the UK before the steroids stopped. It was really nice to see family and friends, but otherwise there was nothing much I was missing (apart from curry) and I felt like I was ‘coming home’ when I arrived back in Caen.

I have struggled a little bit getting back into listening to and speaking French – but I haven’t forgotten it. Speaking English for a week was a luxury and brought home to me how much work it is to live in a country were you don’t speak the language.

The first thing I had to do after returning to Caen was to have a blood test prior to tomorrow’s Remicade© infusion. The last couple of blood tests have been stressful as I haven’t really understood what was being said to me and I felt really stupid afterwards.

What threw me last time was being asked my weight by the receptionist. Because so much of my comprehension is based on the context rather than understanding all the words, I was simply not ready for this question. No-one has every asked this before a blood test in the UK.

I might as well have been asked the cube root of 27 or who was the second president of the USA. I know the answers to both*, but would not expect to be asked such questions prior to a blood test so my brain would never think that those were the words being spoken to me.

Anyway, these weren’t good experiences, so I decided to try another laboratoire this time. Everything went well and I understood what was going on. I was asked my weight, but I was asked very clearly by the phlebotomist (rather than the receptionist) and with a nod to a set of scales. And I was anticipating the question this time.

I got the results through the post this morning and everything looks okay (and better than last time). Even my haemoglobin levels are up – must be all the steak and red wine.

*3 and John Adams if you wondering

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.