The two things tourists rarely see

What healthcare and education have to say about the souls of nations

Chemotherapy, French-style

When planning a holiday abroad, you might research where to find the perfect singani sour, the hottest art exhibit, or the most scenic hiking trails. But few travelers, I’m guessing, sit around researching the healthcare and education systems of their destination countries.

Yet few things contain as much information about a country as these two systems. In fact, it could be said that healthcare and education systems reflect the soul of a nation.

They are also what differentiate tourists from people who spend years or the better part of a lifetime living in other countries. Living in other countries means figuring out how to pay bills there (learning how to pay my electricity bill in Yemen took an entire day’s tutorial from a Yemeni friend). It also means figuring out where and how to get medical treatment, how to talk with doctors, and for parents, how to navigate school systems you struggle to comprehend because you never went to school there.

I didn’t give much thought to these differences before I left the US. I only had experience with one country’s healthcare and educational systems. What I knew about France was that the bread was crusty enough to cut the roof of my mouth open, the wine improved my French, and the museums were a great place to pick up boys (in younger, single days!). What I didn’t know about France was that one day the French school system would try to ruin my daughter’s life. (Okay, an exaggeration, but those are her words).

I didn’t know much more about England, except that healthcare was free. This is a pretty big deal, but Americans like to tell each other horror stories about people who die on operating tables there. Because how could anything free be any good?

Let’s take healthcare first. Perhaps because I have had an unusually disastrous last decade and a half, healthcare systems have played an outsized role in my life. I’m going to focus on France and England, as those are the places in which I have unfortunately vast experience. I have plenty to say about my experiences with healthcare in Yemen, Bolivia, and Uzbekistan, but those stories will have to wait.

While I studied theatre in London when I was sixteen and again when I was twenty, I wasn’t on intimate terms with the National Healthcare System (NHS) there until I got pregnant at forty. My husband and I were living in Yemen, but the Foreign Office flew us back to London for healthcare and our daughter’s birth. All of my pregnancy care, including scans, appointments, midwives, doctors, endocrinologists, and vaccines, was free. The fifty-six hours I struggled to birth my daughter in a sparkling new hospital wing were free. My eventual cesarean was free.

Three days after I left the hospital, a visiting nurse came to our rented house to check on me and the baby. This is routine. When she saw Theadora was failing to thrive due to my lack of milk, she sent us straight back to the hospital. Again, all free. I am willing to pay any amount of taxes to support a system like this. (Which I realize means it isn’t strictly “free,” but given how heavily I use it, it’s pretty close). Plus, no paperwork. I get hours of my life back that in the US were spent filing insurance claims, finding and losing receipts, looking through my approved list of doctors for anyone good, etc.

Tim, Theadora, and I moved to London as a family in 2010 (after getting evacuated from Yemen and spending four months in Jordan). We found doctors we liked, walking distance from our flat. We could almost always get same-day appointments. We never had to open a checkbook or pull out a debit card. We had no co-pays. Babies and children received all of their vaccines and dental work for free. It blew my fucking mind. Nothing in my life has been as revolutionary as gaining access to universal healthcare.

But was the care any good? I hear you cry. Yes, for the most part. Not all the time—most significantly, several doctors failed to test me for ovarian cancer when I had all the symptoms. This happens, I know from online support groups and charity message boards, in every country. Women my age are generally considered disposable and our symptoms not taken as seriously as men’s (reference: Invisible Women by Caroline Creando Perez:

https://bookshop.org/p/books/invisible-women-data-bias-in-a-world-designed-for-men-caroline-criado-perez/15136602?ean=9781419735219

). You can read more about my diagnosis and experience of a London surgical ward in my essay “Eviscerations” in the Kenyon Review: https://kenyonreview.org/piece/eviscerations/

Overall, however, the care I have received in the UK over the past couple of decades is neither better nor worse than that I received in the US.

I have been a terrible burden to the NHS, but it has not complained. I have seen orthopedists, physical therapists, neurologists, gynecologists, podiatrists, therapists, and gastroenterologists. And of course, for the last couple of years, I have seen a great deal of my oncologists, phlebotomists, and chemo nurses.

I would recommend UK cancer-care to anyone. I have had kind, professional, and experienced oncologists, including the head of ovarian cancer research for the entire trust. I have had a chemo nurse who stayed on the phone with me when I was crying and held my hand during tough appointments. I have received all the drugs I needed for free. I had access to four clinical nurse practitioners whom I could ring any time I wanted for advice, test results, contact with my oncologists, or just to chat.

Is it perfect? No. I often had to wait three hours for my chemo drugs to get from the pharmacy to the chemo ward because the pharmacy was chronically short-staffed. I sometimes spent hours in waiting rooms for other appointments. (At least time in waiting rooms, for me, is never wasted. I have a book, a notebook, and a crossword puzzle with me at all times. So you could say that my time in waiting rooms was good for my continuing literary education). But these are prices I am more than willing to pay. These are prices I can afford.

I shudder to think what my cancer care would cost me—and how much paperwork and bureaucracy it would involve—if I were diagnosed in the United States. We’d be bankrupt. We couldn’t even afford the insurance. Well-meaning Americans have sent me information on allegedly “cheap” insurance plans—but $1,200 per month is not cheap. Or even possible.

Shifting my cancer care to France, where we now live, made me nervous. I knew how everything worked in the UK. I had all the routines down, where and when to get blood tests, which hospital I needed, how the chemo nurses operated. Changing everything, even to a health service I instinctively trusted, scared me.

My first discovery was the charity Cancer Support France, which offers help to Anglophone patients. The head of the organization came to my house to explain how they worked. She assigned me a buddy who can accompany me to all appointments, translate if necessary, and listen to me when I need an ear. My buddy, Joanna, helped me find an oncologist specializing in ovarian cancer, came with me to the first appointment (when Tim was still in Uzbekistan) and checks up on me weekly.

My oncologist surprised me by insisting on speaking English. I was prepared to speak French; I am accustomed to talking with doctors in French. “I need practice,” she said. “I studied in the US.” It turns out that my oncologist, Dr. Véronique D’Hondt, studied medicine at Columbia University in New York the same exact year that I was studying there for my MS in journalism. In fact, she lived in a dormitory for international students with many of my classmates. We probably walked by each other on campus. So from the start, I felt we were destined for each other.

I am still struggling to find my way around the sprawling complex that is Institut de Cancerologie Montpellier. I have learned now that once I find the proper wing, I need to take a number like at a deli. While this at first struck me as impersonal, it does seem to ensure efficiency. I very rarely have to wait to see anyone, even in the chemo wing (called the Hôpital du Jour, which always makes me feel I am getting the special of the day).

Once I check in, I’m seen briefly by a nurse, who weighs and bracelets me. She passes me to a doctor, who examines my blood test results, explains what they’ll be giving me, writes prescriptions, and answers questions. In the UK, I saw the head chemo nurse rather than a doctor, but in truth they play similar roles.

In France, the doctor I usually see is a Moroccan woman who speaks many languages and has my ideal hair: thick, curly, and black (no doubt arousing envy in her chemo patients, including me). I know I’m not supposed to notice or comment on a doctor’s appearance, but Dr. Dakir is stunning. She’s also bright, compassionate, and willing to talk with us for as long as we want.

Here’s the big difference: For treatment, I get my own private room. With an ensuite bathroom. At first I thought there had been a mistake. I’m not special, I reminded them. You can put me in a room with all the other chemo patients.

But it turns out they do this for all of their patients with lengthy treatments. Not only that, at lunchtime they brought me a fillet of fish with a tomato confit, purée of celeriac, endive salad, a wedge of Camembert, bread, chocolate mousse, and coffee. The French, it will surprise no one, value food.

I feel ambivalent about the private room. In London, I was always in a room with about fifty other chemo patients, all of us lined up side by side. I appreciated the solidarity, the kindness of my fellow patients. I am a chatter, I have always been a chatter. I like making friends. A private room keeps me from befriending my fellow patients. However, I do get to doze off on an actual bed, Tim quietly reading by my side.

Blood transfusion protocol also varies. Whereas in London I was once again in a large room with others, in France I have a private room. When my French nurse comes in to hook me up to the blood, he does an additional test, pricking my finger to ensure that my blood matches the blood in the bag. No such additional tests are done in the UK, although they still seem to have given me the correct blood.

In London, my chemo nurses were run off their feet, sprinting from one patient to another with no time to chat, but my French nurses stroll in as if they have just emerged from a yoga class, with endless time to answer my questions.

Cancer care in France is free. Additionally, cancer patients are entitled to free prescriptions and free taxis to and from the hospital, or reimbursement for petrol. Social workers call me to suggest benefits programs for which I might qualify.

What does all this tell me about the values of the UK and France, versus the values of the US? That British people see healthcare as a right, not a privilege. No one ought to be deprived.

The French have similar values. Although not all healthcare is free, it is remarkably inexpensive compared with US healthcare. They also seem aware that cancer patients may not be able to work and generate income.

And the US, my beloved homeland? It believes the wealthy are entitled to better care than the poor. The more money you have, the better the healthcare you can access. You can pay for private rooms, special doctors, extra treatments. And no one, ever, gets anything for free. The country where allegedly all men are created equal treats them as anything but.

If I had no other reason for living where we do, I would live here for the healthcare alone—and for the values universal care represents.

Next week we’ll be talking about education and why the French system fills my daughter with angoisse.

Housekeeping notes:

This column was inspired by a friend who wanted to hear about the differences among educational systems in different countries (and I’m always fielding questions about healthcare). If there is a particular aspect of international life, writing life, diplomatic life, or living with cancer, please let me know! You are my people and I want to make you happy.

Our first group Zoom chat for founding members will be on March 3. Zoom links will be sent to you! This is a chance for members to ask me anything they want about writing, cancer, living between things, and all else.

An exclusive column with some art-inspired writing exercises for paying members is also in the works.