Zooming thru the year

A friend of mine reminded me that I'm falling behind on my posts and that my fans are dying to hear what's going on in my life.  Okay okay, fans is a bit dramatic but I'm sure a few of you are curious how things have been going since my last post back in January!

At this moment, I've been living in Utrecht for nearly 8 months! This fact blows my mind.  It just doesn't totally feel like that long even though it's been a great experience so far.  I've gotten to know my city pretty well and I have favorite places to shop, eat, drink coffee and go out for a beer or cocktail.  I've got pretty decent command of riding a bike although admittedly when you've had a few drinks it's a wee bit more challenging... I have a running bucket list with biking that includes riding with no hands and carrying someone on the back of my bike.  I've got a solid group of friends and housemates who are supportive of me when things can get tough (which they have occasionally).  Overall, I've carved out a happy little nook for myself.

Me and my bike!

My street in Utrecht (F.C. Dondersstraat)

Utrecht and the dom tower on a sunny day

This is the oudegracht (old canal) in Utrecht

So what is there to report on?  Since January I've been going to my 9-month internship at the University of Amsterdam which means I've been doing the commuting thing.  It's been fun, actually.  My commute door to door is about 45 minutes.  I bike to the train then train to Amstel station and then take a bus to the science park.  The downside is the expense.  For that, I resent dutch students.  At the moment, they can elect to travel for free on the weekdays or the weekends.  Obviously, if they are commuting for school, they chose the free week travel.  Lucky for me, I have my scholarship to help cushion the costs although I see the money disappear much more quickly now.

I've met some new people at my internship and at first it was hard.  Most of the group is dutch and they're aren't fabulous at switching to English all the time despite their mostly excellent command of the language.  Granted, all professional meetings and work that internationals are involved in are conducted in english but it was more of struggle during lunch or social breaks.  I've found in, at least our group, that there is more resistance to switching languages than there was in Utrecht which is interesting considering I hear much more english spoken around the UvA campus than the Utrecht campus.  Luckily, I work with two awesome internationals and a few dutchies who are really great about switching to english with us.  They really lighten the stress and frustrations of the internship.  I'm so happy to have met them.

Over the past couple months, I've decided that I probably want to do my PhD back in the states.  As great as it is being here, I've realized it's hard being far from home, friends and familiarity.  I used to be proud of my ability to move and feel comfortable in a new place rather quickly and surround myself with great people.  I still have that skill but I've realized that it doesn't translate into the ability to be a constant nomad and live anywhere in the world.  It's also been a realization that language separates you from normal experiences when you're immersed in your native tongue. I think it's important to make a small caveat, here.  I have not learned much, if any, dutch in my time living here. In some ways I regret this but in others I don't.  By not learning dutch I miss out on eavesdropping, at least partial, conversations.  By not learning dutch I don't have to struggle with difficult pronunciations etc when in reality I can pretty easily converse with any dutch person in english.  And frankly, unless I chose to live here more permanently, dutch isn't the most functional of languages since it's a small country and dutch isn't a commonly shared language.  Back to the main topic, I miss out on things without knowing the language and I miss that.  Those of you who know me, know how social I am.  When I'm at a party, it's extremely typical for me to hop all over the party in and out of many different conversations.  But when I'm at a party that's predominantly in another language, it's much more challenging to do that and silly as it sounds, it sucks having that taken away from me.  In the end, I have another year and few months living here in Europe and who knows what is really in store for me.  Maybe I'll fall in love with a new place and decide I want to stay forever.  In the meantime, I'll just take it day by day!

For those of you with an appreciation of the hilarious typicalness that accompanies my life, I have a good story.

On Valentines day, I went out clubbing with a few of my coworkers.  Alcohol was consumed, dinner was missed and I found myself a little drunker than I should have.  Long story short, I tripped and fell as we were leaving and my face, specifically one front tooth, caught my fall.  I also sliced under my chin pretty nicely.  In the end, I should've gone to the hospital but I just didn't want to deal with it at the time and didn't think they could do much either.  I went to the dentist the next day, got a root canal that following morning because I managed to expose one of my nerves in the break.  Then we had to figure out my insurance, which took way longer than it should've, but luckily the insurance covered the entire costs of the root canal and the crown.  It's still a bit a continuing story (yes, I realize it's almost 2.5 months later) because the crown glued on crooked and got a chip in it (not by my own fault).  I'll be replacing it soon.

Looking good

At the end of March, one of my best friends from New Paltz, where I did my bachelors, was able to visit me here in the Netherlands.  I know that part of the trip worked out because she tacked it onto another she was taking with her mom to Spain but regardless, I was so thrilled to share my current life with a friend.  Even though we had only 4 days of excitement, we got lots of sightseeing and shopping squeezed in.  I got to be a tourist in Amsterdam, which admittedly I hadn't really done yet.  We went on a canal boat tour, walked the red light district, ate dutch pancakes and took lots of pictures.  Conveniently, I had bought tickets for Mumford and Sons that weekend AND I'd bought two extra tickets for no reason.  Now I know I bought them for Emily and her mom without knowing it.  It was awesome sharing a concert in another country for a band that we both really love.  Such an unexpected treat.  I hope she's not the only visitor other than my parents but even if she is, it means something that one more person got to take a little peek into my life here.

Em and I outside the pancake house in Amsterdam

Mumford and Sons at Ziggo Dome

So that's a nice little sum it up post about what I've been up to lately.  I'm sure I've missed some things but I'll probably just make another post if I did!

Guest Post: Healthcare in NL

So I've decided to get ambitious and possibly lazy and asked my friends if they would like to join in and write up their experiences moving abroad.  All of us do somewhat different things and come from different countries and perspectives and I thought it would be cool to share that with all of my readers.

First up is Teresa!

        Teresa is in my neuroscience masters and works with Green Fluorescent Protein tagged neurons so (nerds that we are) she's a GFP tagged person :)

Hoi!

My name is Teresa and I’m happy to follow Brenna’s invitation to write a guest entry to her blog. I am an Austrian who has lived abroad in the US, Denmark and now the Netherlands, and I am especially interested in intra-European differences.

I had a lot of ideas, ranging from gel-indulging Dutch male hair styles to their blindsiding honesty. But (un)fortunate coincidence has brought to me a topic about which I can now talk about from personal experience: Gezondheidszorg, the Dutch health care system.

It started with a moderate sore throat that I didn’t worry about too much. When it didn’t go away after a week, I went to the local drugstore for advice. Technically not a pharmacy, they mainly sell body care products and a wide selection of relatively high dosed pain medication, many of which wouldn’t be available over-the-counter or outside pharmacies in other European countries.

A bit to my surprise they didn’t try to sell my anything, not even symptomatic relief, which they definitively would have done in Austria.  But simply said that it will go away on its own. ”Maybe get these honey liquorice drops for a euro on sale”, which, a bit faithlessy, I did.

As the symptoms worsened and I felt too sick to work, I decided to go to find a GP. Finding one, making an appointment and bridging the language gap went smooth, she saw me the same day. Again to my surprise, she discouraged me of taking any antibiotics but recommended strong pain relievers and faith in my immune system. With a background in molecular biology, I do generally have the latter, and I understand the fear of creating multi-resistances, so I decided to wait the weekend and see.

At that point, Brenna was the first one to mention to me that the Dutch have the tendency not to give medication when not absolutely necessary. I didn’t think about it too much, since in my experience the US American environment was more inclined to give out medication than my Austrian one.

Without giving too many details, it wasn’t a good idea to wait and I acquired some unpleasant stuff. I don’t consider myself a hypochondriac, and I was feeling a certain degree of urgency, so I was quite sure that when I went back to the GP the Monday after, that she would give me antibiotics. But still, no. She wasn’t sure what the effect would be. I should see a specialist first, meaning possibly waiting for one to two weeks for an appointment. In the meantime, she could give me stronger pain medication. 

Which I was quite sure wouldn’t close my ulcer.

This spurred my interest in this, in my eyes, bewildering system. What is the philosophy behind it? How is it organized?

One of the first things I read was a guideline¹ for expats to the health care system. Some excerpts:

"In general, there is a natural, non-interventionist approach to medical and maternity care in The Netherlands, reflected in the reluctance of doctors to prescribe drugs unless absolutely necessary, the general practice of giving birth without any pain relief and the high proportion of home births. Additionally, doctors tend to volunteer much less information to their patients about their conditions than is normal practice elsewhere, and there is far less preventative health screening than in many other western countries; it is not, for example, usual for women to have annual pap smears. Some non-Dutch nationals living in The Netherlands reportedly find this approach to healthcare a source of concern.“

"Alternative treatments, such as homeopathy and acupuncture, are very popular in The 
Netherlands and the cost of these are sometimes covered by health insurance." (Skeptics – where are you?)

The guide states that 55% of Dutch births take place at home, apparently the highest rate in the Western world (a short search in academic literature² suggests lower rates, 25-35%). The U.S. Department of Health and Human Services estimates the US American share of home births to be around 0.70%, similar to the rates I could find for other European countries.

I find it difficult to embed this non-interventionalist fact, with some homeopathic hagelslag³ mixed in, into my general picture of Dutch culture. It especially seems to collide with their tradition and general high esteem of science.

Why give somebody pain medication, when there is a remedy that might have the same amount or even less side effects – taking into account that the natural course can take considerably longer? Do they value “fighting” something through on your own? Do you get a medal?

-(The popular blog ”Stuff Dutch People like” offers another explanation: Home births are just more gezellig - cozy, intimate, sociable.)

Another aspect that I find intriguing: If there is a tendency to “let nature take its course”, which I read from child birth without pain relief and generally less medication given – how does this fit with the Dutch liberal attitude towards euthanasia? Is suffering just a part of it at some, but not other stages of life?

Maybe I expect too much philosophy behind this. The reasons might be merely economical. Give less medication unless necessarily needed, save costs. But what about the longer time courses of disease? The missed days of work?

As a simplification, let’s look at some statistics: According to the OECD report  ”Health at a Glance 2011”⁴ the Netherlands has the second highest health expenditure in relation to GDP (following the US) of OECD member countries, which is roughly synonymous with the Western World. When looking at expenditure on pharmaceuticals per capita as a share of GDP, it scores a lot lower, 17th place out of 32 OECD member countries. While generally giving less than average medication, the Netherlands is the country of the Western world distributing the least amount of antibiotics, half of average. There seems to be a commission just dedicated to the decrease of usage, which in general seems legitimate – as long as people don’t start hesitating to use them when there really is a need for them.

So apparently, there is a difference in allocation of health care spending in the Netherlands compared to other countries, with less spent on medication. Then what do they spend it on? They score average for all measures I could find, such as doctors consultations per capita and length of stay in hospitals.⁵

Final outcomes: In life expectancy at age 65, it only scores 19th, and 10th (out of 32 countries each) in population aged 65 years and over reporting to be in good health, according to the same report.

OECD’s ”Society at a glance”⁶ from 2006 places the Netherlands slightly above average for work days lost to sickness and disability.

Thus, there seems to be a lot of spending with moderately satisfying outcomes. And some frustrated expats!

References

¹ „Dutch Health Care System“ by Bronovo Hospital, Den Haag. (http://www.bronovo.nl/NR/rdonlyres/9C846A53-22AD-40BB-9B92-E9242A123053/0/dutch_health_care_apr2011.pdf)

² Maternity Care in the Netherlands: The Changing Home Birth Rate. Wiegers et al, 1998. BIRTH 25:3.

³ http://stuffdutchpeoplelike.com/2011/03/06/hagelslag/

⁴ OECD: Health at a glance

http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2011_health_glance-2011-en

⁵ Interesting detail: The report also states that approx. 66% of adult females are screened for cervical cancer (pap test), so I guess the person of the guide mentioned above prided the Netherlands a bit too much on non-interventionalism.

⁶ OECD. Society at a glance

http://www.oecd-ilibrary.org/social-issues-migration-health/society-at-a-glance-2006_soc_glance-2006-en

Notable Differences

Originally I thought I wouldn't write a post while I'm abroad but since I've returned, I started seeing and noticing things that are different from when I'm living in Holland so I think I'll keep a list.  Some of these difference seem like "duh" moments but I think it's important to think about when you're used to one thing (the US) then acclimate to another place (Holland) and then return to the original place (the US) those differences stick out even more!  I think at some point this list will become less specific so bear with me :)

What I've noticed:

-I used to say that I miss overhearing peoples conversations when I'm out and about on the bus/train/shops etc.  In Holland I barely know dutch so I really don't hear many conversations around me and thus I just tune them out.  When I got back I thought I would like hearing my language but it turns out that most people talk about dumb and uninteresting things...and now I have to "hear" them because it's in english. Although I still miss hearing little kiddos talking about funny things and the occasion overheard awkward conversations.

-Customer service.  Okay okay I know that it's known that American's are super nice and always checking in on you and in Europe they make it their business to serve you and then leave you be.  On one hand I like the european way since you're not overly harassed but also I miss the american way because sometimes it's difficult to get the waiters attention if you need something and it's a nice feeling to connect with a person who's entirely in control of the food that goes into your mouth.  But MAN when I first arrived back we ate dinner at the airport mexican restaurant while we waited for my sister to arrive and the waitress was driving me absolutely insane! It may be partially attributed to the fact that I was extremely sleep deprived but at that moment, I missed the european way.  After 3 weeks, I overall miss the european style leave them alone idea.  I was rushed out of a restaurant the other day and did not like that.

-I have to remember to tip again while I'm in the US...although I like good service, it's nice not having to consider tip as much while I'm abroad.

-In Holland the bathroom stalls usually have a door that you can shut like a regular bathroom.  I'm guessing they enjoy their privacy.  I've gotten used to it and I also like that privacy.  Now that I'm back in the US I have to get used to having shitty stall doors that have a foot open below and inches on each side. Just different hah.

-This might sound a little silly and hopefully not rude to my international friends but I realized that sometimes I have a hard time finding my own words in english.  In a way my english is degrading just slightly.  That's a weird feeling.  I also noticed that it was a little hard to get used to the speed of conversation with a bunch of natives again.  It's not like everyone speaks really slowly in Utrecht but when you speak in your native tongue with other natives inherently the conversation speed increases.

-I miss riding my bike.  The other day I, literally, spent 10 minutes driving my car around one of our local parking lots trying (with difficulty) to find a parking spot! It was insanity.  It made me miss just parking your bike wherever you like.  Don't get me wrong, I still enjoy driving and the freedom to go to distant places on my own timetable but I do miss the loveliness of riding my bike everywhere.

-I don't miss using euros instead of dollars. Every time I use euros I see my money slipping away (poor exchange rates).  I love that, generally speaking, shopping is cheaper here.  I also admittedly like that I can shop more quickly because I'm familiar with all of the stores and products.  It's also quite nice that everything is in english :P

-I went down to Santa Fe to do a little shopping before xmas and it was really amusing to me that even here in the US I don't just hear people speaking in english.  In fact, the majority of passing conversations I heard were in spanish.  Reminded me a bit of being back in Utrecht.  In fact, I've been noticing that many signs are written in both english and spanish.  Maybe it's always been like that and I've never minded but I found myself looking at the secondary provided text because typically english is the secondary text when I'm in NL.

-I really really really missed eating new mexican food.  It's just something that I won't be able to find in the Netherlands and it does bum me out.  I'm planning to bring much more back with me if I can manage it (i.e. green and red chile)!

-If there is anything that becomes repeatedly clear to me, it's that I am and always will be a mountain girl. I grew up in the mountains and I just love them.  There is something so majestic about them that I can't always find when I'm at the beach or in the wide open fields.  No offense NL but you just don't have that.

-Grocery stores.  America does it big.  This is definitely a cliche that we live up to.  The single grocery store in my hometown is about 5-7 times bigger than any of the grocery stores I've walked into while living in the NL.  On one hand, it's really nice because you have tons of options and you can find more unusual items that I typically haven't a clue where to look for them in NL.  The opposing thought is that I get on just find if not better in a smaller store.

• Caveat: I've noticed that you learn about what a culture/group likes to eat a lot of by examining what they provide tons of options for.  It's a wee bit more difficult to determine in the US but the dutch most definitely show it in the grocery stores. 
• Bread. Not only are there many options but nearly all of it is always gone by 6pm daily. It's insanity how much bread they eat on a daily basis.
• Dairy products.  There's so much and I don't even know what half of it is.  It's all kinds of drinks that are yogurts, yogurts that are drinks, buttermilk beverages, milks etc. Dessert style yogurt etc.  It's a lot!
• Mayonnaise. I pretty much loathe the stuff although there is something different about the type they have in NL.  But they have a hilarious selection of different types.  It's only laughable because that's normal in the US for allllll the condiments but really it's only focused in on mayo.
• Frying oil. Piggy backing on the mayo--fries combo, they love fried food.  I think every dutch party I've been to have served fried food as munchies and all of it was actually fried in their own personal frier.  That makes me smile. (*but how are you all still skinny?! bikes I guess)
• Sweets.  This can apply to both US and NL but I still remark on it because the sweets are different to what I see on our shelves.  I can't quite tell you what makes them different but they are. Frankly I'm not a huge sweets fan so I haven't dabbled to find out.

-One final note.  Going back home has made it just a little harder to come back here.  Don't get me wrong, I love living in Utrecht and I've met great people but it gave me this uncomfortable feeling of not knowing where I belong.  The chapter of my life in Los Alamos has closed although I still have many valuable friends there and the chapter of my life in Utrecht has only just begun.  Sometimes it's hard to find a place still.  I know it will come with time and I look forward to that certainty but in a way this break may have been poorly timed with my adjustment to life here in Utrecht.  BUT oh well!! I had a great time with friends and family in Los and I plan to continue having a great time in Utrecht.  Take it as it comes.