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MOTHERHOOD IN THE FATHERLAND

HEALTH

Morning sickness? There’s a tea for that

Giving birth while living abroad can be a daunting prospect. The second instalment of the Local's series Motherhood in the Fatherland follows expectant mum Sabine Devins as she negotiates the cultural quirks of having a baby in Germany.

Morning sickness? There's a tea for that
Photo: Josh Devins

At 18 weeks, I feel like I’ve already run the gamut of pregnancy side-effects. The queasy mornings and aching breasts of the first trimester have morphed into back aches and a host of digestive woes — and I haven’t even hit the halfway point.

If I were back home in Canada, I’d probably walk into a pharmacy and purchase a suitable medication thought safe for pregnant women. But in Germany doctors and chemists encourage a more natural remedy. Yes, to cure what ails during pregnancy, there’s a tea for that.

“It’s a tea-drinking culture here,” the pharmacist at my local Apotheke explained. “It’s very old, dating back to when monasteries were also healing places for the sick, and now it’s practically a tradition to turn to tea first.”

As someone used to finding a pill to cure my little complaints, I’ve actually been happy to dose myself with tea. Being pregnant means I’m extra careful about what I put into my body, and having natural alternatives that actually work is a great comfort.

“Every pill package here comes with a warning saying that the product is not tested on pregnant women. I would hate for someone to come into my pharmacy and say ‘you recommended that I take this to treat my cold and now my child has a birth defect’,” my pharmacist said.

In my first trimester, I was fortunate enough to have a fairly easy time with morning sickness – most of it went away when I ate breakfast – but peppermint tea also would have helped, I was told.

After discussing digestive issues with my obstetrician-gynaecologist, she wrote me a prescription, but told me to try fennel tea, or Fencheltee, first. I have yet to fill the prescription and will probably stick to the tea.

Against the leg cramps that I’m waiting to start any day now, I’m to drink chamomile tea, or Kamillentee. To combat the increased mucous my body produces (“A totally normal thing,” says my doctor), I drink the occasional cup of thyme tea, or Thymiantee.

There is even an herbal tea mixed specifically for pregnant women, appropriately called Schwangerschaftstee, or “pregnancy tea.” I got my leafy mixture at my local Apotheke, where the pharmacist explained that the particular brand, mixed by Bahnhof Apotheke, came highly recommended by Ingeborg Stadelmann, midwife and author of a well-known German guide to pregnancy. You can also find the tea at organic grocery shops and local drug stores.

The blend varies and most pharmacies work with midwives to make their mix, but almost all agree they should have Alchemella or Lady’s Mantle (Frauenmantel), lemon balm (Zitronen Melisse), nettle (Brennnesseln) and raspberry plant leaves (Himbeerblätter). The first two ingredients are meant to calm and relax while stabilising the influx of hormones in the body. Nettles help the body build up the extra 30 percent blood flow it needs to support the work of growing a baby. The raspberry leaves are the most important. They contain vitamin C, important for boosting my weakened immune system, and calcium and iron to boost the baby’s growing bones.

But as wholesome as it sounds, the tea isn’t the tastiest and I have a hard time swallowing the recommended two to three cups a day.

But progressing through my pregnancy and beyond, I can look forward to many other infusions. The pharmacist told me to stop by before my final month of pregnancy to get a blend with more raspberry plant leaves. This is meant to prepare me for birth by relaxing the cervix, which I learned from her has the cringe-worthy name of Muttermund, or “mother mouth.”

After Baby Devins makes its entry into the world, I’ll have to stop drinking peppermint tea, as midwives say it hinders milk production, and switch to a blend of breastfeeding tea (Stilltee), made of fennel, caraway, anise and fenugreek. According to my experienced mom friends, it’s delicious.

The same midwives who put together the Schwangerschaftstee also blend teas for the postnatal recovery time, called Wochenbett, which will help my body deal with another roller coaster of hormones as it goes back to its new normal.

If I were an expat in the North America, I wouldn’t have as many natural options. The US Food and Drug Administration says more than two-thirds of pregnant women there take some sort of prescription drug during their pregnancy. The same organization cautions against drinking too much herbal tea, claiming it is unknown how some herbs affect the foetus – not something German health experts seem too worried about.

In Canada I would also struggle to find German-style herbal tea blends to help calm my hormones or clear my sinuses. Former Berliner Susanne Wengenmeier told me that after moving to Vancouver she misses the tea remedies she found so readily available and effective during her time in the city.

“I was in the drug store and went to their ‘natural’ section to find the teas that cure everything and there was nothing! I was so disappointed,” she said. “I then felt really German.”

But if there is one complaint I have about steeping away my ailments, there is one persistent pregnancy problem that the teas definitely do not help – my ever-shrinking bladder.

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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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