08 December 2008

My Introduction to the Slovak Healthcare System

Disclaimering: … just… consider yourself forewarned. And, I'm not making this up. And, despite my whining here, the people I dealt with were very professional and I would not be worried if, God forbid, something were to happen to me and I'd need to go to a hospital here.

Since I finally have my legal status here, the Slovak government needs to know that I am not bringing in anything like malaria, HIV, etc. Actually, HIV rates in Slovakia are exceptionally low, under 300 people in a country of 5 million. This is attributed to excellent education (proof that our MUN suggestions would probably work in real life), and last week my older (8th and 9th grade) students and I had good, open discussions about HIV and AIDS on the occasion of World AIDS Day. They were already excellently informed, which made me so happy, so we focused on the English conversation part of it, which is the point anyway. …and I’ve gotten off on a tangent.

For the Slovak government to find out I am healthy, I had to go to the Martinská fakultná nemocnica – the Martin Faculty Hospital. Martin is about an hour west of Ružomberok, and omgz is it a beautiful-looking city. Martin, Prešov and Košice were in the running for European Cultural Capital 2013, and Košice won, but I can see now why Martin was in the running – and unfortunately I saw pitifully little of it. It is also surrounded by the Velká Fatra and the Malá Fatra mountain ranges, which exponentially increase the overall excellence of the general atmosphere.

I got the bus around 6am, which meant I woke up much earlier than I normally do. Of course, the Sisters are already up for what seems like hours at that point, but it is normally my modus operandi to sleep as long as possible. The bus dropped me off right across the street from the hospital, as the sun was coming up. I found Pavilon 5 , my target building. The hospital is a rather huge campus, with a mix of late 19th century eclectic and socialist-Bauhausy-concrete buildings. There are three doors on the façade of Pavilon 5. Behind door number one, I found the tuberculosis ward. I was starting to get slightly freaked out, and honestly Mimi of La Bohème crossed my mind (“Silvestri, don’t end up like this, it would be tragic!”), but then I was relieved by the faint smell of bleach though I decided this was not where I was supposed to be. Door number two was some office where people were lined up to have blood taken, but the general theme was infectious diseases (fun!). I got in line, stood like a bureaucratic stooge for a while because I thought it was the right place, and when it was my turn, they told me to go back outside and into door number three!

Door number three led to an empty foyer covered in posters about malaria and Lyme disease, with menacing mosquito and tick pictures and maps showing high-risk areas. This made me feel about as comfortable as the tuberculosis ward. I rang the bell (lots of locked doors and bell ringing here) and a lady came out – funny thing is that doors two and three open onto the same interior hallway, and they of course could not just tell me to come in and show me down the hall.
I go into an examination room, the woman data-entries all of my relevant numbers into the computer and then has me sit down so she can take some blood. This was no different than giving blood, and she was really good at finding a vein on the first try – this is a good skill for someone in her line of work to possess. Interestingly, while she was taking my blood, she was not wearing gloves. I was a bit surprised.

Up until that point, we did not have any serious communication issues. Then she hands me what looks like a rather long q-tip and says something very fast in Slovak, while making a gesture with this thing at her ... posterior orifice. I hope the look on my face adequately communicated, “ARE YOU SERIOUS?” because that’s exactly what I was thinking. So I asked as formally as possible (Prosím Vás, etc.) “Could you explain that one more time?” So she makes the gesture again with this thing, and then tells me to go to the bathroom across the hall. Two quick statements about this: first, I really hope I understood her correctly; and secondly, happily, that is definitely not something I need to do everyday.

If that were not enough, she says to me the word in Slovak for ‘pregnant’ which I understood because after she read the confused look on my face, she made a motion over her belly and said “Baby!?” My response was something like, “Argh! Vôbec nie – absolutely not!” At which point she says, “ok, go to the röntgen, it’s across the street.” Röntgen is a word (of German origin) that took me ages to figure out what it meant, because it came up in discussion a few months ago, and no one could explain what it was, and then finally I figured out how to spell it and found it in a dictionary – it’s an x-ray lab. At the same time she handed me the prescription for the x-ray, she handed me a receipt that I needed to pay. This was a small problem due to the quite tidy sum.

But I went across the street to the x-ray lab, and waited while the rather arrogant staff got around to x-raying me. I was shoved into a ‘cabinet’ – a tiny room about 1 yard square with doors on opposite sides, and told to take off my top. This I also did not understand the first time around, and the woman was practically screaming at me. Two thoughts: first, this entire experience featured vocabulary I do not use every day, so I had trouble understanding it; and secondly, speaking louder when someone doesn’t understand does not help the situation.
So there I am, standing topless in front of a rather large x-ray machine with a little, useless lead apron covering my butt (they would put more lead over me at the dentist in America than they did in this case), and Pani X-Ray Technician must correctly position me in front of the machine in order to take said x-ray. It turns out, I was supposed to face it with my chin up and against the x-rayer – but that took a while and featured her saying pointing to my head and saying “To je hlava – this is the head” and me thinking “yah, I KNOW.” The actual x-ray took like a second of course, and then I went out and asked if that would be all. No, it wasn’t. At this point, I had forgotten that in Europe, the patient keeps the x-rays. I had to wait and get the x-ray and clean bill of health from the radiologist, and then take it back to the Foreign Diseases ambulancia myself. The frustrating thing about the röntgen (actually, most of everything) is that nobody was telling me what or WHY things were happening the way they did, they just assumed I knew, which I didn’t. So I didn’t know why I was waiting (frankly, I didn’t even know what the x-ray was for), though it turned out I was just waiting to get my x-ray, which didn’t take long. It is also possible that I was cranky by that point because I’d been up since 5am and had not yet had any coffee or anything to eat, due to my blood being taken. While I was waiting for the x-ray, I wolfed down a granola bar, which got some bad looks but by that point I didn’t care.

Back across the street, Foreign Diseases Ambulancia Woman takes the clean bill of health from the radiologist, and asks if I’ve gone to the cassa to pay yet. I knew I didn’t have the money required on me, and I also knew that my card doesn’t work in the Bancomats. So I left the hospital grounds, crossed the street and went to the bank to get a cash advance. This is a supremely great annoyance, as I have previously described. At that point, it was 8:45am, and I really wanted to be on the 9:45 bus back to Ružomberok, because there was a St. Nicholas Day Pageant at 11:30 and also I would have had to wait a long time for the next bus anyway. But I also know from experience that this cash advance process takes a while and I still had to pay and run back to the Foreign Diseases ambulancia. So I go to the bank across the street – the general dialogue follows -- it's the same every time:
Self: I have a card, I need cash and I know the Bancomat won’t work.
Greeter Woman: Are you sure the Bancomat won’t work? Here, try this one!
Self: Fine, but I know it won’t work.
[I go through Bancomat process. It doesn’t work.]
Greeter Woman: Ok, go to the line at the end of all of the other lines.
[I wait in line for a desk that looks the same in all VUB Banks. I say a quick prayer of thanksgiving for uniform corporate graphic identities.]
Grumpy Bank Woman: Next!
Self: I have a card, I need cash and I know the Bancomat won’t work.
Grumpy Bank Woman: I’m not telling you that we can’t do this, but are you sure the Bancomat won’t work?
Self: [with uncharacteristic bad attitude] Look, this isn’t convenient for me, either. Do you think I want to be here? NO THE BANCOMAT DOESN’T WORK.
Grumpy Bank Woman: Go wait at that other desk.
[Because this is the third desk I've been shuffled to, my mind flashes back, I’m not making this up, to Sicily, 1990. Picture it: A precocious 4-year old and her occasionally sparring parents are trying to dodge local Mafiosi and cash traveller’s cheques, still a recommended form of transporting currency before Al Gore invented the Internet and money became more of an idea rather than something to actually have in hand, just one of the many issues in the current global economic situation. The precocious 4-year old watches as her sinus-infected father navigates the treacherous waters between the potentially irrational Sicilians (“It’s after noon, we don’t cash traveller’s cheques in the afternoon, signore” – or something like that) and her mother.]
Helpful Bank Woman: What are you doing here [at my desk]?
Grumpy Bank Woman: She came here by herself, I didn’t tell her to come over here.
[Yes, she did.]
Self: I have a card, I need cash and I know the Bancomat won’t work.
Helpful Bank Woman: Have you tried the Bancomat?
Self: [Steam blows out of ear canals.]
Helpful Bank Woman: Please wait here, and then we will go to another desk.
[We go to another part of the bank, a beautiful, marble-veneered, Art Deco bank room flooded with natural light. Definitely the sort of architecture that creates the feeling of money, success, and power in an early 20th century American sort of way. The process happens, which takes two bank employees to accomplish, and I walk out of the bank with my money.]
[Dramatis personae exeunt.]
At which point I ran back across the street, paid at the cassa, and took the receipt back to the Foreign Diseases place. I left the hospital with my somewhat expensive (by somewhat expensive, I mean its cost when compared to my monthly salary, which is normally very adequate) souvenir of the Slovak healthcare system:

Happily, there was enough time for me to grab some coffee (classic Slovak Turkish coffee – crunchy! -- though I realized I'm just impatient when someone hands me a coffee and I should wait for the grounds to settle... Yet again, Slovakia teaches me zen-like patience) and a fresh buchta from a bufet across the street from the bus stop before getting the 9:45 bus. Somehow, though not suprisingly, I made it all the way back to Ružomberok with lekvar all over my face, ftw. Because the trips were not by the same bus operator, the trip to Martin cost 4SKK more than the return.

Overall, fascinating, and most importantly, I made it back to school in time for the Mikulaš presentation, which was my goal -- I would have felt horrible if I had missed it.

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