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MOTHERHOOD IN THE FATHERLAND

HEALTH

Immunisations and anal pharmacists

Motherhood in the Fatherland follows mum Sabine Devins as she navigates the cultural quirks of having a baby in Germany. In the latest instalment, she tackles immunisations and baby pharmaceuticals.

Immunisations and anal pharmacists
Photo: DPA

This month, my daughter reaches an important milestone: it’s her last round of immunizations until school age. It will be a relief for me to see her chubby little thighs bandage-free until she’s marching off to school with an overloaded Schultüte.

Luisa and her counterparts in North America and the UK are lucky to count going to the doctor as a fact of life. When a baby is born in Germany, he gets presented with a Babypass. Like my Mutterpass, the little book is a transportable medical file that mothers can take from doctor to doctor with her medical history. It also tracks baby’s development.

All of the check-ups, or Untersuchungen, are abbreviated to U1, U2, U3, etc. Luisa’s appointments are labelled on the front of her Kinderpass with what dates they should fall between, going all the way to April 2016. Each Untersuchung has a page for the doctor to fill out. It also leaves me with a handy little guide to how much Luisa has grown over the last year (it’s a lot!).

Most of the exams so far have been simple physicals. Making sure Luisa is growing properly and all her little parts with it. At the U3, there is an ultrasound to look for hip dysplasia — something that I find Germans to be disproportionately concerned with. As there is some hip joint issues in Luisa’s family medical history, she received an ultrasound at her U2, then again three weeks later, then with a specialist, and then again at the U3. The conclusion: “Her hips are just fine, we just like to be very careful when it comes to hip dysplasia,” said our doctor.

According to the International Hip Dysplasia Institute, hips that require treatment only occur in two to three children per 1,000.

What I do like about Germany’s scheduled medical care for babies is that they do immunizations a little later than in the English-speaking world. While Luisa’s friends in the US, the UK, and Canada all had their first round of shots at two months, Luisa didn’t get her first Impfungen until she was nearly four months. The first round is done in conjunction with the U4 check up, when Luisa is between two and four months old. Since her appointment was booked closer to the end of the fourth, that was simply when she got her first round.

As for the immunizations themselves, they are very much the same as what children in North America and the UK are given. Right now, Luisa has fighting power against tetanus, diphtheria, pertussis or whooping cough, polio, pneumococcus and hepatitis B. On the advice of my paediatrician, I skipped the Rotavirus immunisation and many German parents also leave out the Hepatitis B. After her last round, Luisa will also be armed against measles, mumps, and rubella.

Overall, there isn’t much difference between the care Luisa would get here versus there. But what is different in Germany is the at-home care and what Mamas keep in their at-home medical kit.

I’ve written before on the various uses of breast milk to cure these things, but that does come to an end and now those ailments lead me to the medicine cabinet.

For stuffed noses, we have saline solution. It’s hated by our little one and therefore seldom used. As Germany is the birthplace of homoeopathy, I can find all sorts of natural remedies. My favourite is called Osanit and they’re little pearls I use for teething pain. It’s main medicinal ingredient is chamomile. Whenever those gums start causing problems, babes are dosed with a few little pearls that they can roll around in their mouth and it seems to work. Life goes on. American mom Laurie has a similar product in her cabinet called Dentinox-Gel N, which also contains chamomile but in a gel format.

For those fevers, we use paracetamol, but its application is what makes our stash “very German”. The favoured method of dosing your child by the Mamas is Zäpfchen, or suppositories.

I wasn’t sure what to make the first time I realised what my doctor had prescribed after Luisa’s first round of immunizations in case of fever. But she was hot and miserable and so it happened and it was awful for everyone, but it did make her feel better. The next day I went to the pharmacy and asked for liquid paracetamol to give her instead.

The pharmacist was confused by my request. “But with the suppositories, you know she’s getting the right amount. You don’t have to worry about getting her to swallow it and once it’s done, it’s done,” she said, very pragmatically.

With the next fever, I took out a spoon and tried to get Luisa to swallow her medicine. It didn’t work. Her mouth clamped shut, she shook her head and sticky, orange-flavoured syrup got all over the floor. The practical German in me took over and we went back to the Zäpfchen. I’m now a convert.

I’m not the only one. British mum Tori told me she thinks they’re brilliant. “I would have never used them if I were raising Max [in England], but my husband, who is a doctor, was the one who stocked up the medicine shelf and at first I wasn’t so sure, but now they’re all I use.”

But others aren’t convinced.

When Laurie’s son has a fever, she uses liquid ibuprofen, which her pharmacist told her not to use until he was six months old. Before that, she had infant’s Advil and Triminic sent from the US. She also keeps American-bought Neosporin on hand. She also wishes that children’s acetaminophen were more available in the Fatherland.

English mum Susannah won’t touch the Zäpfchen. “Sticking things up a baby’s bum is not an idea I’d ever considered until I became a parent here. I would have no idea how to go about it, and would worry I was hurting her.”

Instead, she stocked up on the beloved English cure-all Calpol on her last trip home. “It’s poured liberally down English children’s throats from a very young age, whereas Germany seems less into plying babies with drugs,” she explained. “By extension, the German equivalents seemed less trustworthy in my mind: Irrational but true.”

She also has Calpol saline nose spray, as an assistant at her local pharmacy “raised her voice and eyebrows at my request for — what she called — a brutal product. She pretty much accused me of wanting to shoot drugs into my innocent child’s brain tissue.” But Susannah felt the German saline drops weren’t working and was delighted when she read “Suitable from birth” emblazoned on the English saline spray.

These days, we more readily turn to Google than our mothers to answer the million times we need to know: “Is this normal?” However, when it comes to comforts and cures, we turn back to what we know from childhood, whether it’s Laurie who goes for Neosporin to treat her son’s scrapes or Susannah who trusts one name to cure it all. Even if similar products are available in the German Apotheke, it’s just not the same as what we know.

And just because I use the Zäpfchen, doesn’t mean I wouldn’t be grateful for your tips on getting your babes to swallow their medicine.

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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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