Thursday Bullets

• Halloween will probably go largely unnoticed here today except that I will try to make pumpkin soup for dinner. I had plans to buy a pumpkin and carve it together with Isolde but we never got around to it. She doesn't care yet though so it doesn't matter and besides, she already celebrated Halloween at school last week. This weekend we will probably visit a pumpkin patch (with the usual Halloween activities) though when we see friends in the UK. 
• Isolde has autumn holiday this week and has been home with Peter and Harald (and keeping her dad busy). They had planned to go to the Swedish church to check out their play groups but turns out it is also closed this week. So instead they've been frequenting playgrounds and met up with P & kid(s) a couple of times. 
• Early tomorrow morning we're heading to the UK by car. Hopefully the kids will sleep part of the 6-hour journey. I'm really grateful that we hadn't planned to go last weekend with the storm that we felt parts of also here in Belgium even though we were just on the periphery of it.
• We will be coming back from our weekend trip very late Sunday night so I've taken Monday off (tomorrow Friday is a Belgian and also Commission holiday, All Saints Day).  I'm looking forward to sleeping in a little and hanging with Peter and the kids. We may take the opportunity to go to Ikea for some supplies (candles for the approaching dark season) and we also really need to buy some plants for both indoors and the balconies. It gets very humid in the flat due to tight windows so I hope the plants will help a little. 
• Peter has bought tickets to go home to see friends in December when my mum visits. I'm happy that he decided to go, as he doesn't have as many opportunities to meet people as me at work and I don't want him to get bored. That weekend is also his office's Christmas party so a good time to go home. And of course it's also good timing, as my mum will be here anyway to keep me and the kids company. 
• Last weekend we had a really nice time when P, O & kids came over for dinner. We managed to eat a three-course dinner even though it took us a few hours :) We clearly need to have more friends with kids over so Isolde learns how to share her toys. At the moment she's in a very non-sharing mood also with her brother. But I guess it's a phase and probably also due to the fact that she isn't used to having friends over anymore since we moved here. 
• We have registered the family with a doctor (thanks P for the recommendation). It's a one-minute walk from  home so very convenient.  To continue on the medical theme, I took this year's flu shot (offered at work) yesterday. I have never had the flu but I don't want to risk anything so since a few years back I usually take it every year. 
• I finally put Harald on the waiting list for the Commission's crèche (childcare) and also started contacting a few alternatives where we live (the Commission one is near work but it would be more convenient to have one near Isolde's school). He won't start until next autumn (September 2014) but there are queues almost everywhere so it cannot wait. 

Almost 6 Months

Check-up for Harald today for the first time in over a month. He didn't mind being weighed and measured as usual but was not happy about the vaccination shots. Isolde used to only cry for a few seconds afterwards (and still has a high pain threshold) but Harald was upset for a couple of minutes and cried out again back in the waiting room. He's a little sensitive, our boy, but as we don't see him cry very often "mean mummy" thought it was kind of cute :)  When he got the first set of vaccinations at three months, he had a cold and was miserable overnight but I hope it won't be too bad this time.

It feels like we have a big boy, as he's much bigger than Isolde was at the same age, but he's not that much bigger than average for boys (but girls are generally smaller of course). He weighed 8,340gr and was 67cm today (Isolde was 6,990 and 64 cm at 6 months), which means he's grown taller lately and continues to weigh a little bit over average. The nurse thought his gums were a bit swollen, and it feels like he's been drooling and chewing (and biting when I'm nursing - not allowed!), so he may be teething, we'll see. Next visit is in just 10 days as we want to do the six-month examination with the doctor before we move. Last one was at two months and next one at 12 months (or we'll do it in Belgium), otherwise we just see the nurse for check-ups. 

Getting steadier and steadier

Just love those lashes!



Weight

 



Length

A Regular Tuesday?

Work. Dentist appointment (major filling but avoided a root canal, yay!). Electricity only in half the flat after Peter's fiddling (as an electrical engineer he's allowed but jury's still out whether he caused the problem or our contractors' electrician has messed up). A bath and some quality time with the husband instead of TV and computers is not that bad after all.

Update 22:50: Unpacked all our books instead and did some other post-renovation stuff instead of the bath but I enjoyed doing it! Fun chores exist!

Apothecary

All pharmacies should look like this one in Östermalm in Stockholm! Such a beautiful environment both for employees and (sick) shoppers (I'm not ill though, just admiring old genuine design through the window).



Via Anna's iPhone

4 Centimetres

...is what Isolde has grown since birth*. At our second visit to BVC on Monday she was 52 cm long and weighed 3,680 gr. The nurse didn't check that much else this time except did a general check that she looked healthy (skin colour, etc.) and was alert. Isolde spotted the mobile over the examining/changing table, which was hanging much higher than I thought she could see, so that was fun! Maybe she has inherited my fighter pilot vision! And she peed on the scale; that must be from Peter! ;) Next appointment is Thursday next week.

* Measuring babies are not an exact science though so give or take a centimetre.

First Pediatrician* Visit

We took Isolde for her first visit to the Children's Health Centre (Barnavårdscentralen, BVC) yesterday. As this was our first visit they asked if we parents (and members of the extended family) have now or have had any allergies, diseases or other issues such as vision or hearing problems, useful for Isolde's file. The nurse also measured and weighed Isolde - she's now 50 cm tall and weighs 3,470 grams (which is actually less than Friday's weighing but we're not worried as she's been eating well and 28 grams difference isn't much; she did grow 2 cm since birth and another explanation could be differently calibrated scales). The nurse also did a full check of Isolde's body (spine, skin, fontanelle, etc.) and told us about skincare (how and where to wash, which creams are good, etc.) and how to avoid friction injuries on the nails that I wrote about yesterday. She spotted that Isolde has a little blister in the middle of her upper lip - this was apparently a so-called breast-feeding blister and a sign that feeding is going really well. BVC also provides D vitamin that we will need to give Isolde daily starting in a couple of weeks' time. Our next visit will be on Monday - in the beginning we will go every week, which is good I think so that we know she's gaining weight and staying healthy.

First bath - six days old

I'm so cute when I'm sleeping!

* We didn't actually see the doctor, we'll only see him/her if necessary. Instead our main contact is a nurse specialised in child healthcare.

US Moves towards Universal Healthcare

Last night's vote in the US House of Representatives to approve Obama's healthcare reform bill was a major victory for the President but foremost for the American people. Most importantly, many uninsured will become insured, but almost as important, middle class Americans who have insurance but often not full coverage (and fall in the arbitrary hands of insurers*), will be much better off too. No more (or at least less of it) healthcare industry ripping off people* and driving up costs for the US economy (and taxpayers) (the US has by far the highest health care spending as percentage of GDP - 16% in 2006 compared to 9.1% for Sweden or 8.3% for UK).

Now Obama can concentrate on getting climate change legislation through Congress.

* This problem is not likely to be completely solved by this decision only, but hopefully it's a step in the right direction.

Keep Her Walking!

This woman walks around the world in the fight against breastcancer. Please send her on so that she can reach her destination and say a prayer for all those who are suffering from this horrible disease.

I found her over at Barbamorsan.

Connected

Donated blood this morning and it felt very special since my friend is still very sick and currently in the hospital with the doctors desperately trying to find out what is wrong with her (not life-threatening, thank God, but still very serious and will obviously become life-threatening if they don't cure her). She doesn't need blood, but the care she's receiving is part of a system and to contribute to some other patient somewhere else in that system feels very important to me right now. This is not the first time I have donated but it felt especially worth-while today.

New Career?

This morning I went for the annual health check* my employer pays for (well, I should say will pay for because it's a new benefit just introduced). It didn't start out well as I had waaaaaay too much wine to drink at a girls' dinner last night and as a consequence was not feeling my best this morning, a condition that wasn't helped by the fact that I wasn't allowed to eat anything before the check. Anyway, turns out that despite being hungover I have the eye sight of a fighter pilot!

* Very thorough examination including blood analysis, ECG, height and weight, vision and hearing, etc.

What's In a Name

I went to the doctor the other day and it was a different doctor than my regular one. Her name was Sicking! Doctor Sicking. How appropriate is that! Or not!

Mr President(ial Candidate), Sort Out the Healthcare System!

I've written on the issue of different healthcare systems before. I came across this article on the American health service in my saved items in my inbox and wanted to share it with you. It's a year old but it feels very topical.

America’s Lagging Health Care System (editorial in New York Times, November 2007)
Americans are increasingly frustrated about the subpar performance of this country’s fragmented health care system, and with good reason. A new survey of patients in seven industrialized nations underscores just how badly sick Americans fare compared with patients in other nations. One-third of the American respondents felt their system is so dysfunctional that it needs to be rebuilt completely — the highest rate in any country surveyed. The system was given poor scores both by low-income, uninsured patients and by many higher-income patients.

The survey, the latest in a series from the Commonwealth Fund, is being published today on the Web site of Health Affairs, a respected health policy journal. Researchers interviewed some 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States.

Given the large number of people uninsured or poorly insured in this country, it was no surprise that Americans were the most likely to go without care because of costs. Fully 37 percent of the American respondents said that they chose not to visit a doctor when sick, skipped a recommended test or treatment or failed to fill a prescription in the past year because of the cost — well above the rates in other countries.

Patients here were more likely to get appointments quickly for elective surgery than those in nearly all the other countries. But access to primary care doctors, the mainstay of medical practice, was often rocky. Only half of the American adults were able to see a doctor the same day that they became sick or the day after, a worse showing than in all the other countries except Canada. Getting care on nights and weekends was problematic. Often the care here was substandard. Americans reported the highest rate of lab test errors and the second-highest rate of medical or medication errors.

The findings underscore the need to ensure that all Americans have quick access to a primary care doctor and the need for universal health coverage — so that all patients can afford the care they need. That’s what all of the presidential candidates should be talking about.

Wello

A lot of people (read Swedes) complain about the Swedish healthcare system even though we're quite high up on the international comparisons of "best healthcare". It's a bit like in "Sicko" - if you've seen it - where the American healthcare industry (politicians, pharmas, etc. in mascopy with each other, according to Michael Moore's argument) tries to portray, or at least in the past has portrayed, Canada or France as countries with long hospital queues and waiting lists for operations and the US system as one of efficiency and high quality care. Of course some of their arguments about Europe are true; the waiting time for a hip operation can be several months, maybe up to a year in certain cases (usually due to scheduled operations being cancelled), but emergency care, including surgery, is of course immediate.

I won't go into all aspects of different healthcare systems in this post, but I just wanted to tell you about my most recent experience with Swedish healthcare, one which was overwhelmingly positive. I started feeling my predicament (won't go into any details but I suspected urinary tract infection*) in the middle of the night and this morning it got worse. We were at a friend's house for a crayfish party last night and had spent the night** there, but on our way back I told Peter that I probably needed to see a doctor. He remembered where one of the city närakuter was, a sort of on-call health centre for emergency issues that are not proper emergencies (for those people are supposed to go to the E.R. (A & E for my British readers) ) and took me there.

We got there at 13.45. I went up to reception and said "I haven't made an appointment but I was hoping you could help me" (usually they prefer if you call first and tell them you are coming in). The receptionist nurse said "Okay, it depends what your problem is and where you live and where you're regular health centre is". So I gave him the answers and he told me that I was fine (there are several of this on-call närakuter and they prefer if you go to the one you belong to geographically so-to-speak). He told me to provide a urine sample, pay the patient fee (140 SEK ~$20) and then come back at 15.30. So I did and 2 minutes after I had entered the place I was out of there.

We went home, relaxed, had a cup of tea and went back there an hour later. We were a bit early but so were they so 15.25 the doctor called me in and told me me that yes, I had suspected right (he also asked me to describe my symptoms just to double-check I assume) and that he was prescribing antibiotics. He added that the nearest pharmacy was closing at 4pm so I still had time to get my medicine without going too far (as it was a e-prescription the pharmacy has the prescription as soon as he clicked on enter).

15.30 I was out of the health centre and at 15.45 I could take my first antibiotic pill. If that's not efficiency I'm not sure what is. Even if I had had to wait for 1½ at the place I wouldn't have been too upset. It's Sunday after all.

To go back to "Sicko", what's also so great about Swedish healthcare is that it is universal and available to all, not just to the insured, and there's no one who gets turned away at the door or don't apply for a certain treatment.

* Haven't had one before but have heard enough from friends to recognise the symptoms
** Together with another 9 adults and 6 children, with access to only one toilet...

Healthcare or Sick Care?

Helena argues really well for more European healthcare co-operation! Some people think the EU should stay away from healthcare issues but like Helena, I think we can only benefit from more co-ordination and more patient influence.

Helena has a personal story to tell - you can read it here. In brief, she has moved back and forth between Stockholm, London and Brussels over the last five years, which has caused some difficulties for the Swedish health service, mainly as a result of the procedures in place for GP appointments, referrals for tests, waiting times, IT systems and ultimately, her living abroad. Even though she had a letter from her doctor in London stating that she needed to have a certain test taken, the Swedish health service could not set up an appointment unless she went through the normal routes within the Swedish healthcare system (details on her blog).

Her point with the post is to:

ask the question how the Swedish health service manages increased internationalisation? If they could not manage my needs, despite me being registered in Sweden, because I had taken a test in another country, how would they then meet the needs of persons who live in Sweden temporarily, persons who have just moved to Sweden, or person who do not speak Swedish?

The need of the patient must always be more important than the system. If something does not fit into the system there must exist a culture within the health service that encourages flexibility and initiative. But all too often governance through quantitative evaluation and budget goals makes it more profitable for divisions and units to stand on the side of the system when it collides with the needs of the patient.

Thus I cringe when I hear Swedish politicians saying that EU initiatives in the healthcare sector threatens the Swedish healthcare system. Defence of systems and models is seldom a very good political starting-point.

What I would add is that - which probably Helena would agree with as well - is not that we want the EU to start deciding the financing or the content of the healthcare provision, but to facilitate for patients in an increasingly global world.

What Kind of Healthcare System Will My Children Have?

Some of the initiatives in the healthcare sector in Sweden are making me a bit worried. The new Op-Ed Dagens Arena - independent, radical and progressive - has written on the topic.

The centre-right Alliance majority in Stockholm County Council has decided to go through with major privatisation in the Stockholm region. One of the places where they are starting is my hometown (where I grew up) Södertälje. According to the proposal on the table all healthare in Södertälje should be privatised, including the emergency hospital. In addition the responsibility for financing and commissioning of the care will be transferred to a private company.

I do not have a problem with private providers of care. What I do not like is when we start financing care through private insurances or handing over responsibility that should remain in public hands. What happens with the democratic governance of the health service and the principles about equality in care ?

The emergency hospital is put in the hands of private profit interests linked to the insurance companies and a monopoly is created consisting of a private company that develops healthcare fully on its own conditions. Simply a private county council in the county council.

As mentioned above, I do not mind diversity of providers in the care sector (or education for that matter), in fact I think it can be a good thing in many ways. But when the majority of these providers are being bought up by big companies or international venture capitalist my alarm bells are ringing.

The centre-right talk about diversity within healthcare, social care services and schools and that different ideas, providers and methods are needed. But sometimes, or really, they seem to be pretty keen on privatisation for the sake of privatisation. Why are private monopolies better than government ones?

As pointed out in Dagens Arena, Fredrik Reinfeldt said in the election campaign last year: "We don't want to sell emergency hospitals. We are not proposing that and I'm happy that you gave me the opportunity to announce that decision tonight." (10 Sep 2007)

But what is this proposal if not selling out the health service in Södertälje? And that is just the start.

A Bit of Sicko in the Swedish Healthcare System

Johanna Graf is always so spot on! I agree with her completely so I have translated her post:

"Unfortunately I have to throw up...
...because this is one of the most tasteless things I have heard. A private children's hospital is opening at Sophiahemmet in Stockholm [where] children of parents who have paid into a private child insurance can receive care. In a web survey carried out by [the tabloid] Aftonbladet it is admittedly a majority who thinks it is wrong with privately financed [through insurance] children's healthcare, but alarmingly many who still think it is a good idea. Maybe they have fallen for the insidious talk that is always brought out when private care is the topic; "But, if more people pay for their care themselves, the pressure on the public health service will be relieved and it can work better".

But think one step further! What do you think happens to the private caretakers' willingness to pay for care they no longer need, or need less and less often? What happens with the strength of a tax system where some, often those who are less willing to pay, do not think that the quality of the service that they are getting for their money is good enough, och therefore join another [health] insurance system?

In the particular case with private children's hospitals one can also quietly ask oneself what will happen with children who are born sick and in all likelihood have not yet been - or would never be - granted a private insurance?

This with private children's insurances is already today a chapter to itself. My middle son gave the wrong answer during a hearing test at the children's health centre and is still to this day, at age 16, not granted a full child insurance with our insurance company. And I have heard a lot worse stories. NO to such a society!

In the long term one could ask why all of us together must pay for their expensive medical training if many doctors only devote themselves to help those who pay the most for their services?

To be very clear, so that no one goes mad now: What I'm criticising is NOT private care, but private insurances. (It is the same thing with the education system: It is not the free-standing schools that is the problem, it is the financing system that moves tax money around in an eternal moving merry-go-around that is very financially unsound.)

It makes me happy that it is not only Social Democrats who criticise these systems. Also the Swedish Association of Health Professionals is a warning voice: "The risk is that the cleavages in society increase, that those who cannot afford to pay receive worse care and that the public health service cannot be financed at the same level as today."

Less that three years to the election, but there are unfortunately a lot that can be destroyed before then."