Sickness and the other

Lately I’ve been quite sick. Not just sick as in suffering from a cold but crippling pain of the kind that keeps me up all night. As I type this, I am dizzy, nauseous and just pretty much unable to move. Also, I am exhausted because I get very little sleep at night. I have a strong suspicion my gall bladder needs to be surgically removed. Genetics from both sides (maternal and paternal) lead me to believe that I, too, have a pretty sick gall bladder. Either that, or I have something way more serious which I don’t even want to think about.

Still, even though I am dealing with this pain for a good month or so, I do not want to go to the doctor. I am, indeed, terrified of doing so. My past experiences have been so traumatic and dehumanizing that I am, at the moment, dealing with pain that in fact paralyzes me, rather than put myself through the grief of dealing with a health care professional. And I consider myself one of the lucky ones. My friend’s sister is dealing with what could very well be an extremely aggressive form of cancer and her experiences, which she is documenting in her blog in detail are heart breaking and illuminating. I cannot, in good faith compare anything I’ve gone through to her ordeal, because the severity of her sickness does not compare to anything I ever suffered since I live here. However, there are many themes that run across her accounts that are common not only to situations I’ve been in, but to those many other foreigners face on a daily basis when seeking treatments.

The Dutch healthcare system is very different than anything I’ve encountered before. Not worse, not better, just very different in approach. First of all, pain control medication is pretty much frowned upon. I suspect that this is part of the Calvinist heritage and an approach to “toughen it up” (i.e. “deal with it” or “endure it”). During delivery women are systematically discouraged from seeking pain relief (like epidurals) and pain endurance is more or less celebrated/ encouraged by health care professionals. I have no supporting data for this, but I would venture the theory that this is also driven by a desire to keep health care costs down (as medication is covered by health insurance and in the case of epidurals, an anesthesiologist would need to be present). In the past, when enduring some form of pain (say due to a twisted ankle), I have offered to pay for pain relief medication out of pocket and I was told that it was simply not possible. I had to toughen it up.

However, this is not the dehumanizing part of dealing with the healthcare system. The dehumanization comes from an assumption that I have had to deal with on way too many occasions: the presumption that I do not know what I speak about because I am a foreigner and, as such, I am ignorant. The worst of these situations happened around seven years ago during an endoscopy procedure. I had similar symptoms to what I am experiencing right now (strong abdominal pain after eating, usually lasting for many hours). At first they thought I had an ulcer and I was prescribed medication accordingly. When this medication did not have the desired effect, I was sent for an endoscopy study. This required that I do not eat for 12 hours. Needless to say, terrified by the prospect of the procedure, I complied. As the endoscopy took place, I ended up vomiting all over the place. I know this is probably very gross and I apologize for my graphic depictions but they are pretty instrumental to what followed. As I vomited all over myself and my surroundings, with a tube shoved down my throat, what came out was what looked like recently ingested food. Chunks of what I had had eaten 14 hours or so before. It looked as if I had just had a very hearty breakfast or a complete meal right before undergoing the endoscopy. The doctor in charge of the procedure started shouting abuse at me. Not just complaining or expressing annoyance. Just shouting plain abuse. The peak of the abuse came when he shouted ”You ignorant foreigners do not know how to follow instructions! You were clearly told you couldn’t eat for 12 hours”. As I sat there, with a tube shoved down my throat, covered in vomit, I had to hear that the reason for the indignity was not that I was sick and could not digest food. Clearly, the reason for my situation was that I was an “ignorant foreigner who could not follow instructions”. With tears streaming down my face, unable to respond (tube down my throat made it difficult to defend myself), I never felt more humiliated and belittled in my life. Being sick was not enough. I was obviously an ignorant foreigner who could not follow medical procedures. When he removed the tube, with my throat still sore and in excruciating pain, I tried to explain that I hadn’t eaten in 14 hours, that obviously, that vomit right there was proof that something was very wrong with my digestive system. He would have none of that. He refused to believe me. He wrote down that he could not perform the study due to my non compliance with the instructions. I was sent back home. To this day, I do not know what caused the pain. In fact, the symptoms disappeared once I stopped eating meat. That was until a month or so ago.

Now I am faced with the situation of enduring a system that constantly uses my condition as “the other” to mask its institutionalized bigotry. A couple of weeks ago, I learned that I am not alone in this perception. A group of healthcare professionals of Turkish heritage is opening the first clinic to target the immigrant population of Amsterdam. This is what the founder of the clinic had to say on the subject:

Genco said efforts to encourage general hospitals to take the different backgrounds of patients into account were sometimes rebuffed. For example, leaflets in Turkish about healthcare problems were returned to him with a note reading ‘we speak Dutch here’.

Even though I am not Turkish and have no affiliation to the Turkish community (at least not further than friendships and acquaintances), I wonder if I can wait until this new clinic is operating because, quite honestly, I don’t want to have to shout back with a tube shoved down my throat.

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