AN EXCERPT FROM
US and THEM
An American Family spends ten years
WITH FOREIGNERS
By Bill Meara
Chapter 6
Hospitals and Doctors
“So little fellow, where are you from?” asked the nurse during a home leave medical exam. My 9 year-old son furrowed his brow, thought for a few seconds, and replied (quite sincerely), “I don’t know.”
“The only real nation is humanity.” Paul Farmer M.D.
I came very close to being arrested in the emergency room of the Spiritu Santo Hospital in Ponta Delgada, in the Azores islands of Portugal. It was near the end of our time on the island. My wife Elisa had had a bad reaction to some dental anesthetic, and for several weeks she’d been in very bad shape, often hovering on the verge of passing out. We’d been in frequent phone contact with the nurse at the American Embassy in Lisbon, and finally it reached the point where I needed to take my wife to the emergency room.
We’d been on the island for almost three years. We knew a lot of people, and felt like we knew our way around. I’d been in and out of that emergency room several times over the years, usually looking in on American citizens who – usually through bizarre circumstances – had found themselves in need of emergency care in the middle of the Atlantic Ocean: One lady had been thrown off her cruise ship when she developed symptoms of heart trouble. There had been a nineteen year-old American sailor who’d taken a bad fall on the aircraft carrier George Washington, and had been flown to us for emergency surgery. In each case, “O Consul Americano” (me) had been given access to the emergency room. But on that day that I brought Elisa in, the staff suddenly decided to get very rigid about the rules.
We spoke to the triage nurse. She didn’t seem very concerned. She seemed to assign Elisa a low priority, and said that she’d have to stand-by in the waiting room. OK, no problem, but I said I wanted to wait with her. I explained that she was woozy, that she’d had allergic reactions that had almost closed her airway, and that her Portuguese wasn’t that strong. Could I please wait with her?
At this point, the Portuguese medical bureaucracy started to rigidly enforce the waiting room rules. A young doctor was called. No, he insisted, Elisa would have to wait alone. I tried to reason with him, emphasizing that Elisa might not be able to clearly explain her symptoms to them, and that she might just pass out (and pass away) unnoticed in the waiting room. He wouldn’t budge. Who knows? Maybe he didn’t like Americans. Maybe he just enjoyed exerting a little power over a family seen as being prominent. Whatever the reason for this silliness, I just couldn’t leave Elisa there alone, so I had to insist. I refused to leave. It got kind of ugly. The doctor threatened to call the police. I called the Consulate and asked them to brief the police chief (a good contact of ours) on my possibly imminent arrest.
The standoff continued for too long. Elisa was getting more upset. Finally, I told the doctor that perhaps he should start acting less like a lawyer and more like a physician. He shot back that if we were unhappy with him, we should ask for another doctor, which I promptly did. His replacement was more interested in medicine than rules and regulations. Soon Elisa was being cared for and admitted. And I didn’t have to go to jail.
There is a hackneyed old phrase about the best way to gain insights on a foreign culture. According to this old line, you should visit the whorehouses and the cemeteries. I don’t know about that – I don’t have ANY experience with the former, and only a few visits to the latter. But instead of whorehouses and cemeteries, I'd suggest that schools and the hospitals are the best places to get insights about foreign societies. Our two kids have been very healthy, but they had the normal share of sniffles, fevers, scraped knees, and bumped heads. My wife had some medical problems also, and I ended our decade abroad with the rather spectacular rupture of my Achilles tendon. So we got a good look at the hospitals and medical systems of Portugal, the UK, and Italy, and I think we did gain some insights. And of course we learned a few things about our own medical culture.
In the summer of 2000, we departed from the U.S. as very satisfied users of the U.S. medical system. Elisa had had a difficult first pregnancy. There was pre-term labor, Billy arrived about 6 weeks early, and Elisa’s blood pressure rose to dangerous levels right after she gave birth. Billy had an apnea episode, so for his first few months he was on a heart and breathing monitor. The second pregnancy was a bit easier, but by the time we left the Washington area, my Blue Cross/Blue shield card practically had the numbers worn off of it.
One of our first priorities in the Azores was finding a pediatrician. We’d heard there was a Spanish-speaking doctor on the island, so we went to him first (my wife’s first language is Spanish). Unfortunately he’d been in the Azores for so long that his Spanish had kind of merged with his Portuguese, severely limiting any communication advantage that working with him might afford. And somehow he and Elisa just didn’t click, so we went to see another pediatrician. I’ll call him Dr. Montes. In his office we found excellent care, but we also experienced a medical culture clash, and took a 50 year trip back in time in the area of doctor-patient relations.
The physical setting of Azorean medical offices was very different. Gone was the air of cool efficiency that marked our doctors’ offices back in Virginia. After a time in the waiting room (that part was just like home) we went in to see the doctor. The office was very small, and very warm. The Azoreans are not big on air conditioning, or even fresh air. (During one early meeting with the Consulate’s local staff, a sneeze from me caused one local employee to make a semi-panicked dive for nearby open window. You’d have thought he was a security agent trying to protect me from an incoming bullet. Azoreans believe that fresh air causes disease.) The windows in Dr. Montes’s office appeared to be painted shut. Sweat was running down my back as we discussed the children’s medical care. Well “discuss” is not really the right verb. What really happened was that Dr. Montes gave us a brief overview of how things would work: he would make all the decisions, and we would follow his instructions. Welcome to 1950!
Dr. Montes produced the Portuguese list of necessary childhood vaccinations. We immediately noticed that on the list was a tuberculosis vaccine. We told the doctor that the U.S. Embassy had recommended that our kids NOT get the TB vaccine. We explained that this vaccine is not given to American kids, and that if our kids received it, when they got back to the U.S. they would test positive for TB and might be placed in some sort of quarantine at the beginning of every school year. Dr. Montes reacted unhappily to our effort to get involved in medical decisions, and seemed totally undeterred by our TB-shot argument. He insisted that the kids would get the shot. Politely, we insisted they would not. He grew somewhat exasperated. In an effort to convince us, he said with some emotion: “Look, if Maria gets TB, will those people in the U.S. Embassy who you are quoting be taking care of her?” I think he expected us to relent, but the argument kind of ended when we quietly told him that, yes, in the event of a serious illness the State Department doctors would take charge, and would send us back to the USA.
We can’t be too hard on Dr. Montes. He is a great pediatrician and took wonderful care of our kids. And on the vaccination issue we later experienced the U.S. flip-side of this kind of medical cultural problem: We were back in Northern Virginia on home leave. Elisa wanted to take the kids in for check-ups with their American pediatricians. The American doctor looked through the kids’ files, and briefly focused on the vaccination records. She saw something that bothered her. At first I worried that we might have missed some important shot. But no. The problem was cultural: “Look at the way this Portuguese doctor has written the dates in the shot record,” she said, holding the familiar yellow multilingual World Health Organization card. “He wrote ALL the dates incorrectly. He put the day first, then the month! They are ALL wrong!” I thought she must have been kidding. Surely she must have known that this is the way Europeans write dates. “Come on doctor, 300 million Europeans can’t all be wrong!” I joked. She didn’t laugh. “No, he has written the dates incorrectly. When you get back to Portugal please tell him how the dates should be written and ask him to write them correctly in the future.” She was dead serious.
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By the time we got to the Azores, Elisa had been through an enormous amount of change in a very short period: In less than four years she had married, moved from her home country (the Dominican Republic) to the United States, learned English, had two children, and, while still nursing a baby and with a toddler in tow, had moved to an island in the North Atlantic where, at the age of 28 she was given the title “Consulesa” and thrust into the island's elderly-dominated Portuguese-speaking social elite. That's a lot of change.
In the Foreign Service we get instruction and reminders about the difficulties of culture shock and adaptation to new places, so when Elisa had a hard time adjusting to the Azores, I at first attributed it to culture shock. But it deepened and continued. She couldn't sleep and she lost a lot of weight. She didn’t like me playing the role of Consul. “Who is this Consul guy?” she’d ask, “I want my Bill back!” She hated being the Consulesa – early on, she found herself being approached by people who seemed to want to be her friends, but who really just wanted to be seen with the wife of the Consul. She wasn't herself. She seemed lost and sad. She was deeply hurt when, after throwing a baby shower for a friend, she overheard one of the local guests saying that the new Consul's wife had to learn a thing or two about how to properly entertain in Azorean high society – petty comments like that would send her into a downward spiral for weeks.
After a couple months of this, I called the medical office of our Embassy in Lisbon and asked to speak to the psychiatrist. I arranged for him to speak to Elisa on the phone. That seemed to help a bit, but not enough. I started to think that we would have to leave the Azores, that we would have to end our tour early. On a visit to Lisbon, I talked to my boss (the Deputy Chief of Mission) and warned her that we might have to curtail our assignment. There was a big risk in leaving early – it would take months for us to get out, and I feared that if I pulled the trigger and got orders to depart, by the time we'd be packing up, Elisa would have pulled out of culture shock and we'd all want to stay. There was also the matter of where we'd go, and where we'd live. I worried that the chaos and uprooting of another move would pile additional stress on Elisa. We decided to hang in there. I'm still not sure that was the right decision.
Neither of us knew much about depression. We were both wary of medication, in part because Elisa was still nursing Maria (Maria nursed until she was four years-old). With our lofty social position in the fish-bowl of Azorean society in mind we were foolishly reluctant to seek the help of a local doctor. I suppose we also had doubts about whether we could find qualified help out there on the island. (Later, we discovered that we shouldn't have been concerned about this – the Azoreans, it turned out, are remarkably open about seeking help for depression, and there were many doctors there who could have helped.)
Somehow, Elisa pulled through. Charity work at the hospital helped – there she met kids and families with problems much worse than hers. And it was there that she met Rocio, a young female pediatrician from Spain who had taken a job on our remote island and who was also struggling with the Portuguese-Spanish language transition. Rocio introduced Elisa to a wonderful group of expat Spaniards who couldn't have cared less about my job or our social position. This really helped Elisa. But it wasn't really a cure. The cure would come later, in London...
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In the UK our plan was to find a pediatrician, and then make use of our stateside medical insurance to pay for the care (essentially what we’d done in Portugal). Very quickly, however, we discovered that the vast majority of doctors were part of the National Health Service (NHS) and most of them were general practitioners. Appointments with non-NHS pediatricians were hard to come-by, but there was an NHS clinic right around the corner. When we enrolled at this clinic (called The Radcliffe Surgery), we tried to set things up so that our care would be billed to our U.S. insurance company. But the clinic personnel just shook their heads and explained that they couldn’t do this even if they wanted to – there was no billing office, no one to process the insurance paperwork. We found out that we were, in fact, eligible for NHS enrollment because Elisa was working at the kids’ school and paying British taxes. Oh well, we thought, welcome to socialized medicine! Welcome to the NHS!
Shocking as this may seem, we kind of liked it. To be fair, we were living in a very posh section of London – the NHS we experienced was probably quite a bit better than that of other areas. But we got the feeling that we were in a system that really was designed to do its best – within resource constraints – to take care of us. Blue Cross/Blue Shield never gave us that feeling – with them, it always seemed like their priority was finding excuses that would allow them to not take care of us.
Compared to the U.S. system, the NHS is a bit “no fills” and there is a whiff of big brother about it – you don’t get to pick your doctor. Even among the group of doctors at your local clinic, you don’t get to pick and choose – when you sign in at the front desk, you will be seen by the next available GP. You don’t get to go directly to a specialist – not even a pediatrician. It is the GP at your local clinic who will decide if you need a specialist. But on the other hand, if you called in and said you were too sick to come to the clinic, they’d offer to send someone to the house.
The British “stiff upper lip” and “musn’t grumble” attitudes were sometimes noticeable in our interaction with the NHS. The Brits (doctors and patients) seem a bit less pain-averse than their American counterparts. And – no doubt with cost constraints in mind – the doctors were reluctant to order up the kinds of expensive tests that U.S. doctors often ask for.
We also made occasional use of the local NHS hospital (Chelsea Westminster). We’d bring the kids to the emergency room for the normal cuts, bruises and fevers. They had a special, separate emergency room for children – this was great because it kept the kids away from the injured drunks in the main emergency room.
The NHS staff’s inability to take payment from us extended to visiting family members, but that did not prevent them from getting care. My mother-in-law was with us for most of our last year in London, helping out while Elisa studied. The contrast between the way she was treated by the U.S. and the UK systems was striking: The U.S. system refused to have anything to do with her. I could not use my family Blue Cross/Blue Shield policy to have her treated. And even the American Embassy medical clinic refused to do anything for her. Once, when we were worried that she’d been exposed to the flu, I told a doctor at the Embassy medical clinic about my concerns. He quickly wrote a prescription for an anti-viral medication, but before I could use it he called me – very concerned – and asked me to destroy the piece of paper – he wasn’t authorized to treat the parents or in-laws of Embassy personnel, even if they were (as my mother-in-law was) officially part of an Embassy family. I had to rip up the prescription and pay a private physician 50 pounds to write the same thing.
Contrast all this with the NHS approach. When Elisa’s mom developed a bad cough, we took her in to Chelsea Westminster Hospital. No questions asked, she was quickly seen by an excellent doctor, and handed her the medication she needed. Again, we offered to pay, but they wouldn’t hear of it. The Brits were far more human, far more humane in their treatment of my wife’s mother. When she walked into that hospital, they saw an older woman who was not feeling well, not an alien without the correct insurance card in her pocket.
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In London, the cure for Elisa's depression came to us via Billy's poor handwriting. Mothers of pre-mature babies often have a sense of guilt; even though there is nothing they could have done, they worry they should have done more to carry the baby to full term. Billy's early arrival also left Elisa hyper-sensitive to any signs that Billy might have some sort of medical or developmental problem. So when Billy's first grade teacher began to complain that his handwriting was a bit sloppy, Elisa was very concerned. Things got worse when, instead of just helping him to improve his handwriting, the teacher offered what sounded like a medical diagnosis. Billy, she said gravely, was suffering from “dysgraphia.” You know, kind of like dyslexia, but for handwriting.
I was skeptical. Elisa was very concerned. She started spending a lot of time in the dysgraphia blogosphere. The school recommended a course of “occupational therapy.” Elisa immediately signed Billy up, and soon every Thursday evening he and I would head off in the London subway to his therapy session.
My skepticism deepened as I watched what they were doing. There seemed to be quite a lot of stretching exercises, followed by long sessions in which Billy and a well-endowed young woman from South Africa would play catch with a medicine ball. (When I asked Billy what he thought of the whole thing, he said, “Well, I don't really know why, but I really like playing catch with that girl!” Indeed. ) I had real doubts about their usefulness, but Billy and I had a lot of fun going to and from these sessions. Billy was only six at this point, and, like most little boys, he very often needed to take a pee. I had learned that the time interval between his first warning (“I think I might have to pee!”) and the declaration of a full blown urinary emergency was quite short. This would usually happen as we were walking through the London night from the South Kensington tube station to our house. Billy and I came up with a special, semi-concealed place (on posh Cranley Gardens) where he could relieve himself. I'd stand guard and try to distract any passers-by. Billy was always mortified about having to pee in the bushes, but once the operation had successfully concluded, we'd laugh and take pride in our success at covert urination.
This was all great fun, but we wondered if the therapy was doing any good. More importantly, we wondered if it was really necessary. Did Billy really have a problem? I decided to consult with Embassy London's medical section. I'd heard that the psychiatrist there, Dr. Fred Summers, was a quite good on child development issues. We told him about Billy and, obviously with the intent of putting Elisa's mind at ease, Fred set up a full day of tests for Billy with a child psychologist. (As expected, the tests showed no problems of any kind; sadly for Billy, this put an end to the medicine ball sessions.)
Fred is a very perceptive doctor, and, while talking about Billy, he saw something in Elisa that caused him concern. He wanted to talk about how she was doing. She told him about the suffering she had endured in the Azores, and admitted that the symptoms weren't completely gone. Sometimes she had trouble sleeping. Sometimes she worried too much...
Dr. Summers concluded that Elisa was in fact still suffering from mild depression. He talked to her about treatment and prescribed medication. Elisa immediately felt much better. This was really life-changing treatment. Because of Dr. Summers’ care, Elisa's enthusiasm and energy returned and she very quickly got strong enough to go back to school, to the Inchbald School of Design.
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Because the U.S. Embassy in Rome had an excellent in-house medical clinic that took care of almost all our needs, our interaction with the Italian health care system was relatively infrequent. But when we did make use of it – mama mia! – it was always a real cultural experience.
There was a public hospital right on our piazza in Trastevere – Piazza di San Cosimato. Early in our time in Rome, Elisa developed a painful problem right at the start of a long weekend. The Embassy clinic was closed, but the duty nurse advised us to go to the hospital emergency room. We were amazed. The waiting room was nearly empty. The staff was efficient and courteous. Our foreign nationality didn’t bother them a bit – they explained that because we weren’t in their system, we’d have to pay a small fee – the equivalent of about $15 – after we were taken care of. Elisa’s problem was quickly diagnosed, medicine was prescribed and the doctor even gave us his personal cell phone number in case we needed to follow-up. Wow, we thought, the Italians have their act together! If this is socialized medicine, color us red!
On our way out, the receptionist gave us our bill and explained that we could pay in person at the administrative office around the corner. Off we went. The service had been so good that we actually looked forward to paying for it.
But then we got there. Opening the door (yes, it creaked!) we peered in on what looked like a scene from the medical-admin circle of Dante’s inferno. The room was dimly lit. Far too many people were stuffed in there, all of them in a hodgepodge of what at times looked like waiting lines but that frequently seemed to collapse into rugby scrums. A good portion of the people seemed to have hacking, tubercular-sounding coughs. If you weren’t sick when you went in there, you would be when you came out. We didn’t go in. Without even thinking about it, we both decided that this was no place for diplomats, and informally invoked our diplomatic immunity. I think I still owe them 15 bucks.
In Italy, as in many European countries, pharmacists have a somewhat larger role in the medical system than they do in the U.S. People will often turn to their local pharmacists for advice and even for simple diagnoses. In Italy, it was always “over-the-counter” advice and diagnosis, almost always within earshot of neighbors waiting in line for their turn. Just as the layout of Italy's apartment buildings allow people to hear all about their neighbors' marital problems, Italy's pharmacies seem designed for similar transparency on the medical front, and serve up daily reminders that there is no word in Italian for “privacy.” They'll often have a pathetically inadequate “privacy line” painted on the floor, but it is usually only a foot or so from the counter. And no one seems self-conscious enough to whisper. So days in Italian pharmacies are filled with a steady stream of almost public discussion of insomnia, pregnancy tests, incontinence, impotence, hot flashes, and birth control options. It is quite a show. Like they say, in Italy, life is a stage.
Over time, Elisa and I got fairly proficient at Italian but still, because of the baroque complexity of all things Italian, we seemed to need help when it came time to navigate the Italian medical system. That help came from Dr. Rosa Tavano and her staff at Embassy Rome’s excellent medical unit. For example, one afternoon during our first full summer in Rome, eight year-old Maria was playing in our living room. She bumped her elbow’s “funny bone” and ran to Elisa complaining of the pain. Then suddenly she turned pale, her eyes rolled upwards and she passed out. She was completely unconscious for around a minute before Elisa could get her to come around.
This, of course, scared the hell out of us. In a flash, Elisa was on the phone to the Embassy. Maria quickly regained consciousness, but clearly some tests were required, tests that would have to be done in Italian hospitals. Dr. Rosa and her staff made the appointments for us, and then served as kind of cell-phone guardian angels, monitoring from the Embassy each step of our progress. “Are you at the emergency room yet? Who are you talking to? Where are they sending you next? What test do they want to do? Let me talk to the doctor…” Dr. Rosa was amazingly supportive. She is completely bilingual, and completely bi-cultural. With us she was an American, but with the Italians she was an Italian (and as the U.S. Embassy’s doctor, an Italian with prestige and clout). Dr. Rosa could make things happen fast in a country not known for speed.
Sometimes this took a little finagling, the application of a bit of Italian furbizia. As we took Maria from test to test (at one point they were concerned about possible epilepsy), they decided that what was needed was a special electroencephalogram for children. This machine was not available at the hospital where Maria was being tested. If we tried to schedule the test at another hospital it might take weeks. But if the request for the test were to come from the other hospital’s emergency room, the test would be done immediately. We were getting ready to leave on a long vacation trip and wanted this resolved before we went. At this point about 24 hours had passed since Maria’s fainting spell. The advice on how to deal with this problem came via cell phone, almost in a whisper (I won’t say from whom). “Take her over to the Bambino Gesu Hospital emergency room and tell them she fainted this morning.”
Now, we don’t like to lie, especially in front of the kids. But sometimes, well, when in Rome… Pulling off this little scam was complicated by the presence of one of Billy's school pals, the son of a Norwegian diplomat, who was at our house that afternoon. Elisa had to take all the kids to the hospital with her. So the Norwegian kid had to be briefed on our little Italo-Dominican-American finagle – he seemed perplexed by the whole thing. But he kept his mouth shut and the tests were done immediately. We were relieved to learn that it wasn’t epilepsy. Maria just has a bit of low blood pressure. To be on the safe side, the staff of this public hospital insisted that Maria be admitted and that she spend at least one night under observation. I understand that that kind of thing is fairly unheard of in the U.S these days – the insurance companies usually won't permit it.
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The Achilles tendon injury that I mentioned earlier provided another example of the kind of differences in medical culture that you have to deal with while overseas: When they were getting ready to discharge me from the hospital after sewing my tendon back together, the surgeon’s assistant gave us instructions on the medications I’d have to take. I’d need some anti-coagulants, he explained, and he told me to take one injection every day. We knew that the Italians – like many other nationalities – were big on injections. In some countries patients don’t feel that they’ve gotten their medical money’s worth unless they are jabbed with something. We’d also heard that Italian medical culture includes a lot of self-injection instructions from the doctors, but we’d never actually faced the prospect of doing this ourselves.
When he told us about the injections, my first reaction was to tell the doctor that as an American, I just couldn’t possibly do this myself. “We don’t do that!” I argued pathetically. He didn’t accept this. I then asked if we could get the injections done at the local pharmacy. The assistant clearly saw this as crazy talk. It was, for him, as if I’d suggested that I get the pharmacist to help me swallow a pill. No, he said, I should do it myself. He gave us a little 30 second class and handed us the prescription.
I couldn’t do it! But Elisa saved the day and agreed to administer the shots, jabbing me in the abdomen once each morning. Even though I had wimped out, this little in-house injection incident somehow made us feel a bit closer to Italian culture.
The clash between the U.S. approach to medicine and the Italian/European approach was sometimes brought home to us during our visits to the American military bases. We’d often use the temporary housing facilities on these bases, and – perhaps because we had small kids – we’d sometimes find the need to use the medical clinics on these bases (there is an agreement between the State Department and the Defense Department that makes this possible).
Entering those clinics marked a return to U.S. medicine, with all its strengths and weaknesses. The first order of business was always money. Before we could talk to any medical people, we had to deal with administrative folks intent on confirming our eligibility, insurance coverage, etc. (this was quite a contrast with what happened in British and Italian hospitals).
One of our last trips in Italy was to Tuscany. There we stayed at a small Army Base near Pisa called Camp Darby. Elisa developed a headache early in the trip, and – wanting to avoid seven days of on-the-road suffering, we decided to go in to see the doctors at the base clinic. We thought it was a sinus infection and were hoping for some antibiotics.
After the usual administrative and insurance hassles, we went in to see the doctors. They checked Elisa out and seemed to conclude that there was nothing much wrong with her. But when she complained that her pain was severe (she is very sensitive to pain), the doctors seemed to shift into their very American “let’s order up some tests” mode. Let’s get a CT scan!
Of course, we were going to follow their advice, but we were dismayed to learn that the nearest CT scan machine was down in the Italian public hospital in Pisa – about 30 minutes from the base, and – because it was already after-hours, we’d have to start out in the emergency room. That gave us pause, but, with fond memories of our experience in the Trastevere emergency room in mind, we decided to give it a try.
Right away, we knew we were in a very different place. Pisa is in Northern Italy, which is supposed to be more modern and efficient than the central and southern parts of the country, but apparently the Pisa Hospital emergency room hadn’t gotten the word on this. It was jam-packed with hurting people. A good portion seemed to be homeless. There was also a large contingent of very old people, several of whom seemed to be on their final visit to the hospital. In the finest traditions of the Italian civil service, the hospital staff seemed to maintain an aloof distance from all of them.
As soon as we checked in, I began to doubt that we’d ever get a CT scan. The triage nurse seemed to be deliberately unimpressed by our being from the U.S. Embassy in Rome. Our referral from the medical clinic at the base seemed to deepen her antipathy. “They sent you here for a CT scan?” she asked. “For a headache? Mama mia! Signora you need a couple of aspirin, not a CT scan! We don’t order up CT scans for every woman with a headache!” (She was probably right.) She then told us that if we wanted to continue to push for the scan, we’d have to wait to talk to the doctor, warning that we’d be seen based on the priority that she had assigned to our case. From the look on her face, we realized that it would be a very long night. We opted to return to the base and to try a couple of aspirin.
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We came away from our exposure to the medical systems of Portugal, Britain, and Italy with the realization that there is nothing inherently superior about the American system of medicine, or indeed about American systems in general. We received wonderful care (albeit with some interesting cultural twists) from the doctors and nurses of all three countries. And it was nice to be in the hands of systems more focused on medicine than on profit, more concerned about the medical needs of their patients than about their nationalities or their immigration status or their health insurance coverage.
More importantly, we came away with a reinforced sense of our common humanity. After you (or your family members) have been sick or injured overseas, after you've been cared for by “foreign” doctors and nurses, well, it just serves as a reminder of what should be obvious – we're all human, we all have the same physical frailties, the same needs for care and treatment. Differences based on nationality are far less significant than the human frailties that we all share. Patriotism and nationalism often makes it difficult for us to see this common humanity.
When I was in the army, we'd sometimes go deep into the Honduran countryside. There we would find life-threatening poverty and severely malnourished children. The young American soldiers who were with me were often from tough inner-city backgrounds, but they had never seen poverty like this. Some of them were Spanish-speakers. In one village a young mother with two very sick little kids came running up to us seeking medical help. She thought we were doctors. We couldn't help her. The soldiers seemed to want me to dial 911 and call for an ambulance. They were angry and frustrated when I told them that what they were seeing was normal for southern Honduras, that this would not be seen by the Honduran authorities as an emergency. But I was heartened by their reactions: they saw a human being in distress and wanted to help. They didn't put on nationalist blinders, declare the victims to be foreigners and wash their hands of the whole problem.
During my first overseas tour in the Foreign Service, I was working with the Nicaraguan Contras along the Honduran border with Nicaragua. We had funding from the U.S. Congress to provide medical care to Nicaraguans who came across the border, but we weren’t supposed to treat Hondurans. One day our doctors were brought a tiny, almost skeletal infant. The little girl was in very bad shape, in danger of dying from dehydration. And she was Honduran. The doctors decided to break the rules. They decided to treat her. They put her on our helicopter and flew her to the Honduran capital. That little girl lived because those doctors were willing to overlook nationality, because those doctors were more focused on our common humanity.
In his book “Mountains Beyond Mountains” author Tracy Kidder described the long, arduous hikes that Dr. Paul Farmer makes to treat desperately poor Haitians in isolated villages: “He’s still going to make these hikes, he’ll insist, because if you say that seven hours is too long to walk for two families of patients, you’re saying that their lives matter less than some others’, and the idea that some lives matter less is the root of all that’s wrong with the world.”
CONTENTS
ACHILLES HEAL …………………………………………………1
US: SOME INTRODUCTIONS……………………………………...3
WHERE WE LIVED: HOUSES AND ‘HOODS …………………..13
INTERNATIONAL SCHOOL……………………………………...48
MILITARY MADNESS – WAR, BOMBS, AND BASES…………65
HOSPITALS AND DOCTORS…………………............................. 98
PLAYGROUNDS, PARKS, VACATIONS, PARTIES
(AND GOOD DEEDS)…………………………………………….111
DEATH CHEESE, AND CARS THAT CAN’T READ!
(LINGUISTIC ADVENTURES IN THE OLD WORLD)…………135
SCIENCE AND TECHNOLOGY………………………………….144
THEM: FOREIGN FRIENDS……………………………………..156
OTHER PEOPLES’ PATRIOTISMS……………………………….176
MOVING VAN BLUES – DIFFICULT DEPARTURES………….188
BACK IN THE USA………………………………………………. 193
CITIZENS OF THE WORLD………………………………………200
INDEX………………………………………………………………203
In print form the book is available from Amazon and from Lulu:
AMAZON: http://www.amazon.com/Us-Them-American-Family-Foreigners/dp/1499286287/ref=sr_1_2?s=books&ie=UTF8&qid=1403693380&sr=1-2&keywords=meara+us+and+them
LULU: http://www.lulu.com/shop/bill-meara/us-and-them-an-american-family/paperback/product-21687240.html
And it is available in e-book form from