Those Are The Rules

By Madeleine Kando

When I first came to America many many decades ago, I was appalled at the "live or let die" attitude of American society. I felt that free education and free health care were a citizen's birthrights. And I have always felt that America could learn from the Dutch approach to taking care of its' citizens' health.

I am again visiting my 96 year old mother in beautiful Holland. How clean and civilized it is here. Such a contrast with our dirty, pothole-studded streets in Boston. I am glad we 'parked' our mother here. Of all the places in the world this is paradise for the elderly. Or so I thought until my most recent experience with the Dutch Healthcare system.

I will not bore you with the details of my mother's medical condition other than to say that her eye specialist recommended a series of injections for her macular degeneration. Very encouraging news, I thought to myself. We caught the evil monster in time before it wreaks havock with my mom's vision. Don't wait too long, the doctor said. Next month at the latest.

So we go to the front desk to make an appointment. Yes, time is of the essence here. 'Oh, but you have to wait until the secretary is back from vacation to make an appointment' says one of the assistants. I am astounded. My mother is gradually turning blind and we have to wait for a secretary sitting somewhere on a beach getting a tan!? I hear my own voice escalate to a new level of irritation: 'Hold on here' I say in my rusty Dutch. 'We were just told by your boss not to wait too long with this treatment.' 'Miss Tan is the only one who sets up appointments of this kind, those are the rules. She will call you when she gets back.' 'When will that be, prey tell?' 'Next week.. sometime.'

I must have been a terrier in my previous life, because situations like this make me dig in my heels and really go for whatever I am after. Next day I call and ask to speak to the specialist. 'No, you cannot speak to him.' 'Why?' 'Those are the rules.' 'Can YOU ask him why we have to wait when he recommended not to wait.' 'No, I cannot do that.' 'Why?' 'Those are the rules.The tanning lady will call you back when she returns from her beach in Spain. But don't hope too much: there is a waiting list you know.'

A reality check with Dutch friends reveals that this is fairly customary here. Waiting lists are everywhere. I discover the hard way, that the words: 'don't wait too long' are meaningless. It is like the fuse of a dynamite stick. It fizzles out when it reaches the morass of the bureaucratic process.

In order not to commit murder and blow off some steam I go to the local swimming pool for a swim. I see a whole stack of swimming fins and ask the attendant if I can borrow a pair. 'No, we don't lend out swimming fins. Those are the rules.' I am tempted to ask her how many years hard labor she would get if she broke the rules, but resign myself to do without.

Refreshed I call the hospital for a third time and ask if my mom can go to another hospital where secretaries are not getting a tan while the patients are slowly turning blind. 'You can go anywhere you like, Miss.' Good! So I call another eye center. I go through my rusty, lengthy explanation and the lady on the phone is very patient. She explains to me that my mom has to be screened and has to come in for an initial evaluation. 'Why cannot the patient's records be faxed over from one hospital to another?' 'Oh no. We cannot do that. Those are the rules.'

There seems to be a general agreement amongst everyone that health care in this country is bare bones. That people are put on waiting lists, even when it is urgent. Unless it is life threatening people are left to deteriorate. Somehow the Dutch health care system is rated as one of the best in the world. But I don't think it applies to 96 year old women who suffer from multiple ailments. The 'egalitarian' mantra of the Dutch system has created more inequality than anything else. The old and the really sick are sent home packing and are told to live with it and not come back. Because those are the rules.leave comment here