To understand my life over the past 3 years, you’ve got to understand a little bit about bacteria.
And not just any bacteria. I’m specifically thinking about the bacteria called Group A beta-hemolytic Streptococcus, the bacteria that causes the dreaded type of pharyngitis that Americans normally refer to as simply Strep throat.
Strep usually comes on quickly, but I’ve had all different flavors. The very first time I had it, I was unable to leave my bed for four consecutive days, and each day I believed that tomorrow would surely be better. Other times, I’ve had it without realizing it (which many would say is not possible). I’ve had it with and without a fever. I’ve recovered with and without antibiotics (again, very strange).
Now, I’m no doctor (let’s get that out of the way). But when it comes to a couple of things in the medical world — strep being one of them — experience has taught me a lot. I believe I know what I am talking abaout. Almost always, strep is one of those things that will necessitate a visit to the doctor and a course of antibiotics — it’s not one of those things you can mistake for a common cold.
My current battle in the war with strep began about a month ago, before my family made the trek to Budapest for the birth of our third child (another story entirely). I went to a private clinic, where the doctor saw me for about 10 minutes, gave me a prescription for an antibiotic, and a bill for $50. After I bought the medicine, I had spent $65.
While in Budapest, I passed the dreaded illness to my daughter. We took her to the doctor, and she got better quickly, but not before giving the dreaded step throat back to me. This time, circumstances did not allow me to go to the doctor immediately. But today, after several days of discomfort, I decided enough was enough. I had to try to go see someone and get the antibiotics I needed. However, this time I decided I would use the public medical system here in Mostar.
I started by looking up the local clinic online and calling them. There were about 50 phone numbers listed on the website. I called the number for the main nurse for Family Medicine. No answer. OK, I thought, I’ll try another number. Front Desk looked like a good alternative. No answer. Doctor’s office #1. No answer. Front Dest #2. No answer. No answer. No answer.
After going through about 6 of the numbers listed under Family Medicine, I decided to just call the Emergency Room dispatcher. Someone answered right away.
“Hi. This is not an emergency; I just don’t know who to call. I am a foreign citizen and I need to see a doctor. Is today a holiday?”
“I just called every number for Family Medicine and nobody answered.”
“Yes, well it’s break time. From 10 to 10:30 they don’t answer their phones.”
“Oh. I have a throat infection and I need to see a doctor. Which office should I go to?”
“Let me ask… I just asked the doctor, and he said you can go wherever you want.”
“Really? But I just have a throat infection.”
“If you just come to the main clinic, whichever office, someone will see you.”
This is how most of my dealings with public offices go. I have learned to call first. It doesn’t really make things better, but it makes me feel like I’ve at least done my homework. So I headed over to the main clinic. I found the office for Family Medicine, explained who I was, and took a seat, and waited. And waited.
After a little while, the nurse asked me if I’d like to just go to the Emergency Room. “But it’s not an emergency,” I replied. “But there you won’t have to wait.” Suspicious, I decided to just stay, rather than explain my case to yet another group of nurses and sit in another waiting area.
Then the doctor saw me. She looked at my throat, listened to my story, felt my lymph nodes, et cetera. Then she gave me a piece of paper.
“Here’s something you can take for your throat. You’ll have to go to the lab for a throat culture before I can prescribe any antibiotics.”
“But doesn’t that take a couple of days?”
“If you go now, you can make it by 12. They work from 8 to 12. If they do it today, it should be done by… Thursday.”
“Your throat isn’t really that swollen. I can’t prescribe anything unless a culture shows you have bacteria.”
So I begrudgingly went out to the laboratory, located by the hospital, across town (it’s a small town). I popped my head in the door and explained my case.
“It would be better if you came back tomorrow in the morning.”
“Have you eaten or drank anything today?”
“But all I need is a throat culture.”
“But you need to not eat anything before you do the culture.”
“What does that have to do with a throat culture? I’ve done this many times, and I’ve never had to fast for the culture.”
“OK, just come in.”
They ended up doing the culture for me. They were fairly nice, but only because I was insistent at the beginning.
“Come back Thursday from 12 to 3 to get your results,” they said.
This is the kind of thing that 5 years ago would have eaten up 2 or even 3 days. I have been through this before, before I was fluent in the local language, when I would go to the wrong clinic, arrive just after closing or break time, misunderstand the doctor, go to the wrong lab, etc. After 5 years, I managed to get that down to 2 hours.
I can say that the process is not actually much different from what it would be in the U.S. The main difference is that the doctor or nurse in the U.S. will do a culture on you at their office, and then send it to a lab themselves. Many doctors in the U.S. (and here) will prescribe something to you immediately, though, forgoing the 2 days it takes to grow bacteria in the lab, based on their opinion of the symptoms you are exhibiting. It is a guess, but a very educated guess.
The main difference I can see between the former-Yugoslavian system and the U.S. system is in the thought given to the comfort and overall experience of the patient. The patient experience in the U.S. is rather nice; in developing countries in Eastern Europe, any other experience would be preferable to go to the doctor. Facilities are old and dingy, and personnel are not overly nice. Rules and customs — such as the habit of an entire office taking a break at 10:00am — do not seem to make sense, and while personnel will even acknowledge that they seem nonsensical, no attempt is made to improve.
However, there are good people in the system, and very few people are mean or intentionally unhelpful. It just so happened that my visit to the doctor today might have been a waste of time. As it stands now, I feel much better — better enough that I can assume the illness will not reappear in the morning. So what incentive is there for me to go back to the lab for the results of my test? None.