We all get sick. It comes with the contract for being a human on the planet earth. It would seem that illness would be a constant that doesn’t vary from one culture to another. To some extent, that is indeed the case as viruses and bacteria don’t really care what we think. However, from one culture to another the definition of an illness and the cause of that illness is far from universal truth. My parents both work in medicine and I remember my Dad telling me, as if he was letting me in on a forbidden secret, that for as much as we know, there’s also quite a lot that we just don’t know about our bodies, medicine, and the world in general. Not knowing all the answers is can be disconcerting, especially for Americans.
My last trips to Amsterdam have been a bit stressful because we ended up in the hospital twice with little Sean who has been having some respiratory problems. He may have asthma, or maybe not. For right now his body reacts to regular viruses (like ones that kids get from exchanging snot and eating already-chewed play-dough that they find on the floor) by tensing his airways to his lungs. Now we have medicine, and we’ll hopefully be able to prevent future trips to the hospital.
Aside from the negative aspects of being in the hospital with our two-year-old son, the OLVG hospital in Amsterdam was an interesting cultural experience. Despite having lived in Italy for a while, I still react to illness as an American. My wife reacts as an Italian, which is very different. We both had some interesting observations in Amsterdam.
First though, what is the difference between an American point of view and an Italian one when it comes to getting sick and hospitals? I’d say that one American characteristic is how we react to getting sick. We immediately seek to define the illness and subsequently administer the correct medicine/s. Italians rest more and tend and eat light foods. Another is that we often don’t even define a regular cold as “being sick”. Stuffy nose? Cough? Sore throat? Just take some medicine and get back to work. I differ from most of my colleagues and Italian friends in this sense but upon some reflection it’s interesting to think about something like Nyquil, a drug that can help you essentially ignore being sick, is illegal in Italy.
I’m not going to delve too far into hospitals in the US or the American healthcare system. I’ll just say that having now thoroughly experienced two European systems, we’re not doing it right. Our doctors are great in the US, there’s absolutely no doubt about that, but what we pay to insurance companies and then still pay out-of-pocket is insane. Paying for healthcare in Europe means a healthy cut from taxes, but having a baby or taking an ambulance never put anyone in debt in Europe. Guess how much the patient gets billed for an Ambulance ride in Italy. Nothing. I’ll leave it at that.
Despite my reverence for the Italian ideal to provide healthcare for everyone no matter what, I do differ with most Italians on what I define as sickness and also on the causes of sickness. Most Italians believe that colds, fevers, and many other ailments are a direct result of skin being in contact with “cold” air. Being from Colorado, I have very different definition of “cold”. Here are few common reactions, even from doctors, upon hearing that someone has come down with a cold or a viral infection:
– “Ah, yeah, it was pretty windy yesterday, so it makes sense that you’re sick today.”
– “Well, you didn’t blowdry your hair before leaving your house.”
– “You weren’t wearing a scarf, and your exposed neck is the reason that you have a fever now.”
– “Walking around barefoot = a shortcut to pneumonia.”
I remember that at first it was hard for me to take Italians seriously, and thinking that maybe they were joking. This reaction is common among our students too, yet there might be a bit of wisdom to their ways. I have to admit that at times I find myself thinking like them yet I never blowdry my hair and I am generally barefoot whenever at home. Interestingly, I have no explanation for why I can walk around in the rain in Denver or Portland and be fine, yet in Siena the same scenario ends in a week-long cold.
When Italians get sick, they are a bit more respectful of the time it takes to get better. Americans just take medicine and get on with life. Italians tend to let the illness run its course and there is a much larger emphasis on the importance of rest and diet. This is probably a healthier approach.
There is one Italian belief that I can’t get used to. It’s called la congestione. The vast majority of Italians, many of them very intelligent people, believe that if one eats food at the beach and then goes for a swim without waiting for a full 3 hours, that person might die. Yes, death. If this were proven somehow to be true, it would mean that I have haplessly flirted mortal doom thousands of times.
The Dutch aren’t very concerned with wind or rain probably because at least one of those two things, if not both, is always happening. They face getting sick with a staunch aversion to medicine. It’s as if submitting to medicine is somehow a failure. Of course, more serious illnesses require medicine but the common ailments just get tea, rest, and maybe an extra sweater. Earlier this year Marianna had an ear infection. Her doctor waited about a month to finally prescribe antibiotics (by which time the right side of Marianna’s head had become swollen). Maybe she’s stronger now?
Another Dutch practice that surprised me is childbirth at home. Not that pregnancy is an illness, but I think that Marianna (IT) and I (USA) would both agree that the hospital seems the logical place to deliver babies. Not in The Netherlands! They still prefer to do things at home, arguing that it’s more comfortable for the whole family. That seems all well and good until there are complications and you have to be dangerously rushed to the hospital.
Both of our hospital experiences in Amsterdam were positive. Not only were the doctors and nurses great with children, but they also took a lot of time to make sure that Mom was ok too (Dad… well, Dad counts less in these situations in any culture). The pediatric ward is full of toys and nice rooms that can accommodate parents as well. I think that the greatest testament to the success of the OLVG Amsterdam pediatrics department was that Sean did not cry whenever the doctors visited him. He had blood drawn from his finger twice and the first time he was asleep and woke up startled, the second time, he might as well have been eating ice cream for as happy as he seemed. The most traumatic experience through a total of 6 days in the hospital was when some volunteers dressed as clowns came into our room to spread some “cheer”. Sean was pretty distraught.
I mentioned earlier that my Dad always spoke about how we don’t actually have all of the answers. The Dutch approach to the doctor/patient relationship seemed at times to fully acknowledge humanity’s insecurity. They never fully committed to diagnosing Sean with anything. Maybe pneumonia, but maybe not. Maybe asthma, but it’s hard to tell. His bronchial tubes react by closing, but it’s difficult to say what’s making them do that. Will this medicine work? Maybe. Multiple times when the doctors or nurses came to speak with us about Sean they didn’t offer any information, they just asked us how he was doing. They even asked us if we thought he was better. Maybe it’s just a cultural norm that we don’t recognise yet, but both Marianna and I are used to the doctor telling us if our Son is getting better. This is not to say that they were at all incompetent. They just seemed to embrace the ambiguity of illness.
Personally, I like all of these differences. It’s like having a free, built-in second and third opinion with regards to any illness. At this point though, we’re mostly interested in the opinion that keeps us out of the hospital for a while. We’ll probably end up with a mix of the best medicine from everywhere.