Friday, December 4, 2009

Going veggie

I’ve wanted to eat more vegetarian meals and have tried to cook vegetarian, but my efforts have been half-hearted. Then a couple months ago Clara announced that she wanted to go vegetarian (except chicken – she wasn’t ready to give that up yet). This was good incentive to really make an effort and I’ve been working quite hard to make meals vegetarian as often as possible and trying to learn new ways to cook.

But Richard and Iris are resisting, and tonight there was a major meltdown. I made spaghetti with meat sauce but used white beans instead of hamburger. It was actually pretty good, but a little bland. (Much of my veggie cooking is bland when I substitute something else for the meat. I have to work on this and get new ideas for seasonings.) But Iris was SOOOOOO disappointed! She screamed and hollered that spaghetti with meat sauce was one of her favorite meals and that I “ruined everything!” She had so been looking forward to her favorite meal! I could make two versions of the sauce – one with meat and one without, but it’s a lot of work to make two versions of everything. This is not a restaurant!

My niece recommended a book to me: How to Cook Everything Vegetarian by Mark Bittman. I have some other veggie cookbooks but I haven’t used them much yet.

When Richard cooks, he always uses meat or fish!

Friday, October 9, 2009

Award-winning performance? Unfortunately, not yet

So Barack Obama has won a Nobel Peace Prize. I should be pleased but I’m not.

I’ve always believed the Noble Peace Prize should be awarded to someone who has done inspirational things. The choice of Obama for the prize this year feels very political – a gesture of approval to the American public for electing someone whose politics are more in line with those of Europe. And while that may be a good thing, it’s an award to Obama for his approach not an accomplishment. (Okay, maybe a Democrat winning the presidency is an accomplishment these days!)

I’m also saddened to see the prize awarded to a politician, unless it’s one who has taken an extraordinary position or is fighting an extraordinary cause, the obvious example being Daw Aung San Su Kyi. In Obama’s case, making overtures around the world, viewing policies from a global as well as an American perspective, and generally acting as a statesman for one of the world's premier democracies is part of his job as president. I expect nothing less. Has the quality of American presidents declined so much that someone who is thoughtful in manner deserves an award?

Before I had even heard today’s announcement, I was actually thinking back this morning about my decision to support Obama during the democratic primary in 2008. One of my concerns was whether or not Obama would be “tough enough.” Would he be able to withstand the right-wing juggernaut, and fire back? Would he vigorously defend core liberal values (something Bill Clinton with his great need to be loved failed to do)? I had some doubts, but decided to give him a chance.

But as I look at Obama’s progress on a number of issues – health care, homosexuals in the military, Israeli settlements, and others – I’m feeling very worried indeed. As head of the U.S. Democratic Party, I’m still waiting for his leadership on issues close to this Democrat’s heart.

He hasn’t done anything prize-worthy on the American, let alone the world stage…yet.

I'm almost embarrassed for the guy!

Thursday, September 17, 2009

Are Ole and Lena jokes kosher?

I was in touch yesterday with a Chicago native (or at least a long-time Chicago resident) who had never heard of Ole and Lena jokes. I couldn’t believe my Midwestern ears! I guess Scandinavian-bashing stops east of the Mississippi.

(If you don’t know about Ole and Lena jokes, just google “Ole and Lena” and you’ll see some. Or visit Ole and Lena for more information.)

Even my Swedish husband enjoys Ole and Lena jokes although he raises an interesting issue: He points out that ethnic jokes, for the most part, are socially unacceptable in the U.S. Yet people accept Ole and Lena jokes. (Generally Ole and Lena – and their friend Sven – are portrayed as dumb as doorknobs.) He wonders why this is, and if it’s changing – that in a few years even Ole and Lena jokes will be considered vicious.

He may have a point. A few years ago I was at an optometrist in Minneapolis wearing a T-shirt purchased in Minneapolis that said “Pray for me! I’m married to a Swede!” The woman who was assisting gave me a funny look then said, “What’s wrong with Swedes? My husband is Swedish (i.e. Swedish-American).” She was mildly offended. I then double trumped her, explaining that my mother is “100% Swedish” by American standards and that I’m married to the real McCoy, which is why I bought the shirt! But I wear it only in the U.S., never in Sweden.

What do you think? Is it time to outlaw Ole and Lena jokes?

Friday, September 11, 2009

He still sounds like a man

Yesterday I downloaded the transcript of a conversation between two well-known freelance writers. As I was skimming through it, one section in particular caught my eye. One of the speakers in describing his typical day said he often has two hours free in the middle of the day. That’s when he goes running or to the gym. I noticed he didn’t say that’s when “I go to the dry cleaners, take the kids for haircuts, do the laundry, clean the bathroom, go grocery shopping, etc.” He went on to say how lucky he is to have a wife who “loves to cook dinner,” and the other speaker chirped in that his “life would be over” without his wife.

I didn’t read this conversation looking for justification about why life is tough for women who work full-time outside the home. But when I stumble on stuff like this, it’s just so glaring.

Someone may have the best, most helpful, most liberated husband in the world, who does and shares the obvious household tasks, but I’ll swear until my dying day there is an invisible line in the sand for heterosexual couples that no man will cross. Men consciously or subconsciously leave the “extra” work for their wives because they know, at some level, the wives are there and will pick up the slack. It’s not necessarily intentional or mean-spirited. It just happens. (Maybe it’s because they were conditioned by their mothers. But even here in equality-driven Sweden where most children have been in daycare with full-time working moms for at least two generations, study after study shows that women still do the vast majority of housework, and not by choice.)

Unless the wife is physically out of the picture, men often don’t know, realize, or think about all that the wife does. I know of a situation (in the U.S.) where the wife died and a few months after her death when he had sole responsibility for the household and the kids, the husband admitted he never realized how much his wife did around the house (granted, she was a full-time homemaker). Of course husbands can be asked to do more, beyond the obvious, but who enjoys being a nag?

I wonder if the speakers’ wives work outside the home. And what the first speaker’s wife thinks about his comment, “I’m very lucky I have a spouse who loves to make dinner.” (And clean, and run errands, and patch the siding, and fix the toilet, etc. – all the small stuff I doubt he thinks of.)

There's a difference between telling and showing someone that you appreciate them. You need a little of both.

I don’t know him personally; he may be a good guy.

But he still sounds like a man!

Monday, August 17, 2009

It's time to march in favor of REAL health care reform!

I saw in the news today that it looks like Obama is backing away from a public provider option for health care reform. I find this very distressing! For many reasons, meaningful health care reform is not possible without a public option (sorry – health care cooperatives just don’t cut it!)

It’s time for a March On Washington by anyone who has ever been denied coverage (either health or disability), been denied service by an insurer, has a pre-existing condition, or simply can't afford health care insurance. (That makes about 100% of the American public, doesn’t it?) If the Democratic outliers in Congress won't do the right thing and support a public option for fear of political fallout, it's time to give them political cover by visibly demonstrating that MEANINGFUL reform is what most Americans want! Obama's election made that mandate clear.

I’m sick of the wingnuts dictating the terms of the health care debate. It’s time for a March On Washington in favor of real reform. Push your friends, neighbors and any activists you know to support a March On Washington in favor of MEANINGFUL health care reform! The time for universal, cost-effective health care is now!

American health care today is an international embarrassment and a disgrace.

Friday, July 31, 2009

The mammogram chronicles - part 9: All's well that ends well?

(I never finished my mammogram story because I'm so disgusted with the entire episode I’m too disillusioned even to complain. But for the record, here's a rundown of my final visit.)

I showed up on time for my ten o’clock appointment on May 25. I took a queue number and sat down. After ten minutes, I was able to sign in and take care of the SEK 300 (USD 40) co-payment. I had hit the co-payment limit (SEK 900 per year) so I qualified for free health care for one year. The receptionist made me a validation card and I sat down to wait again.

At 10:25, I reminded the receptionist I was waiting. She said she would check on it. At 10:35, I went back to the receptionist and asked what the delay was and said I had been waiting for 35 minutes. She said I was mistaken about the time – my appointment was for 10:30. (She tells me now?) I showed her my appointment confirmation sheet that clearly said 10:00. As we were discussing the matter, a nurse came out and called my name.

But now I was very annoyed and decided to make trouble. I pointed out that if patients have to wait more than 20 minutes for an appointment they are entitled to free care (i.e. no co-payment) even though this meant I would lose my “free care for a year” card. Now she had to invalidate my card and reprocess me while both the nurse and I waited. The nurse was getting impatient and I was maliciously gleeful about causing extra delay.

As the nurse and I walked back into the examination area – it was now 10:40 – I told her about the mix-up in appointment times. She said tersely, "We are responsible for appointment times, not the front desk," and acknowledged they were running late. As an afterthought she offered a brief apology, but no explanation, for the delay.

I waited five minutes in the examination room. A frazzled-looking doctor walked in. She reported that the mammogram was normal. I sat and she looked at both breasts. She quickly ran her hand along the side of one and said everything was fine. I asked about the cause of the pain. She said no one knows why women get breast pain (not a word about fibroid tissue), that it was nothing to be concerned about, and if I had a lot of pain she could prescribe something. I declined. Visit over. Five minutes.

And that concludes "specialist" breast care in Västmanland!

Friday, July 17, 2009

Please be "seated"

What do Italians have against toilet seats?

In fairness to Italians, I first encountered the seatless toilet in Greece 30 years ago. I haven’t been to Greece since then, but I have been to Italy several times and I see that the tradition lives on.

So what gives?

About three years ago, we were in Rome and my then eight-year old daughter needed to use the toilet at The Forum. We entered the public restroom and my daughter looked at me in dismay, “What do I do, Mom?” It was a bare, seatless toilet bowl with a thin, uncomfortable, dirty rim. “You balance, honey,” I answered.

Having grown up in the United States where toilets are designed for comfort, I know a good toilet seat when I see one. I am not unfamiliar with hole-in-the-floor toilets either. But a seatless toilet is the worst of all worlds. Either seated comfortably or squatting low is much easier than a precarious half-balance on one’s haunches when “taking care of business” (not to mention the danger of mid-air spray; women do not pee in a thin, tidy stream).

And it isn’t just public restrooms. Our hotel room in Rome had been retroactively equipped with a roundish seat that didn’t quite fit the squarish bowl. And just two weeks ago, our hotel room in Pisa had an ill-fitting seat that was also broken. You had to bear right as you sat to avoid slipping and sliding and ending up on the rim.

A friend theorizes that Italians don’t want to bother cleaning toilet seats. Perhaps she’s right. But that doesn’t explain why the seats on toilets that have them fit so badly. It’s a nuisance, not to mention sexist, to provide toilets without seats or ill-fitting ones.

So why do Italian women and apparently those of other southern European cultures put up with this? Is there a secret or a way to use seatless toilets that I’m missing?

Ironically, in Roman times, public toilets were a place for leisurely socializing. They were often built with ten or more "holes" for group communing!

Tuesday, July 14, 2009

This bird doesn't "tweet"

I’m not sold on the concept. I think it’s a fad that will fade as soon as the hype settles down – we’ll see.

I “get” Facebook, Linked In, etc. The concepts make sense to me. Aside from the social aspect of Facebook, they’re just huge “yellow pages” or business directories for people with the added benefit of references, i.e. friends of friends who can facilitate introductions.

I’m not a techy person so I’m always resistant to new technology – just one more necessary evil I have to master.

But Twitter seems simply like high-speed marketing or promo-hype. I can see how it benefits movie stars and public figures who constantly need to be in the limelight. And I understand it can be a method for spreading the word quickly about a new product or program or seminar, people for whom having the newest and trendiest is an important part of their profile.

But as a medium for spreading the word about “basic” or “thoughtful” products and services, I don’t really get it. Those just take time to build a following and there are better methods for doing that. I wouldn’t buy or do something just because someone hyped it on Twitter. I’d still need to investigate it before I put my money down. Perhaps I’m just old-fashioned!

It’s true that I may not have heard of the product if it hadn’t been pushed on Twitter, but this would suggest the danger of Twitter overload or Twitter spam where everyone is hyping everything and valuable messages get lost in the noise. It’s kind of like the specialty groups on Linked In. There’s good information there, but you also have to wade through a lot of junk.

I also don’t get the concept of “ghost” bloggers. I realize there have been ghost writers for people who want to get their message out but are not good writers. But a “ghost” blogger seems a contradiction in terms. As I understand it, blogs are the musings of their authors. But famous people or companies who hire ghost bloggers – that’s just another form of advertising. It’s no longer the voice of the author. It’s more a forum on a particular subject and not really a blog. To call it a blog is false advertising in my book.

What do you think?

Sunday, July 12, 2009

Surströmming - a wedding guest I'd rather forget!

(A friend recently asked me about surströmming. She had encountered it at my wedding 16 years ago. Here’s the story.)

My Swedish husband and I decided to get married in the U.S. I had heard about surströmming (literal translation - sour herring) and thought it would be fun to bring a couple cans of it to the U.S. as a joke to eat during at a post-wedding picnic at my sister's house. It's actually fermented herring.

Although my husband and I had never eaten it, he thought it was a bad idea to bring it to a wedding(!), but since it was an informal, outdoor picnic, I wasn't too concerned. I bought two cans to bring with us. Since I had heard that the cans can "explode," I put them in a plastic bag just in case they leaked. I took them with us on the plane. Luckily, no problems.

When we got to the U.S., we were curious if you could buy surströmming there and went to the Swedish specialty store in Minneapolis and asked if they sold it. They said they were not allowed to either import and or sell it because it was classified by the U.S. government as "rotten" food, and it's against the law to import rotten food.

Since we had heard that the cans can explode, no one wanted to open it at the picnic. A friend was brave enough to try. When he punctured the can, a small stream of juice shot out, nothing too amazing, but, oh, the smell.....!!! If those cans had leaked on the airplane, I swear the other passengers would have thrown me off in mid-air, and what a demand there would have been for sick bags!

(A few years later, I was working at a high school in Sweden. It was mid-August, prime surströmming season, and the students hadn’t returned yet. We were temporarily located in an old school building while the regular building was being remodeled. One day, I smelled a very foul odor in the halls. I thought there must be sewer problems. I later found out that someone had been eating surströmming! The odor is that foul and that strong!)

Surströmming is supposed to be eaten with onions and potatoes. Only a couple people at the wedding dared taste it. It's slimy going down and best swallowed quickly! My husband and I both tried it. Hours later, you could still feel the sensation of it in your throat and the aftertaste, kind of a continual mild burping. It is truly revolting stuff.

My sister took what was left of the surströmming and threw it in the trash can in her hot, mid-July garage. She said when she went out the next day, the garage reeked and there were flies buzzing everywhere. She said it was awful. So she retrieved the surströmming and buried it in her backyard!

I have had nothing to do with surströmming ever since!

Tuesday, May 5, 2009

The mammogram chronicles – part 8: Backward care at the Västerås breast unit

The phone rang a few minutes ago. It was the breast unit from the central health clinic (Centrallasarettet) in Västerås. They called to report that the mammogram I got yesterday was “normal.” (They also told me this after yesterday’s test.)

“I see you’ve had soreness in your left breast and under under your arm since January. Do you still have it?” (The technician who did yesterday’s mammogram asked me the same question. Yes, I do.) “Then you should probably get a physical (breast) exam, too.” She then offered me FOUR different days at a VARIETY of times with a CHOICE of doctors THIS month.

“Why couldn’t you have taken care of this yesterday when I was there?” I asked. She seemed surprised by the question and mumbled something about availability or scheduling. To be honest, I don’t remember exactly what she said except that it was a bureaucratic non-answer. “Since your mammogram was normal, we wouldn’t normally do a physical exam. But you say you still have pain.”

Faithful reader, if you have been following this chronicle, it’s quiz time. Question number one: Why did I call the breast clinic in January?

The moral of this story: Don’t fall out of the system. If you’re not in the computer, you don’t exist. And if for some reason you pop up, the droids who keep the system going have no idea what to do with you.

Something is very wrong with administration of the breast clinic at Centrallasarettet, and the women of Västmanland are literally paying for it (another visit, another co-payment), also in wasted time and anxiety.

Västerås, stop playing the odds with women's health.

I’m sure my sister would agree.

Thursday, April 30, 2009

The mammogram chronicles - part 7: It can happen to anyone

I’m feeling quite distressed today. I just found out that my oldest sister has breast cancer. It was discovered during a routine mammogram so it came as a shock to her.

The “good” news is that they caught it early; so there are treatment options besides a mastectomy.

Suddenly my fight to get a mammogram has taken on new urgency.

I’m very sad today.

Sunday, April 26, 2009

Mid-week Bangladesh

My daughter returned from Bangladesh this morning.

A couple days ago, I texted her with two questions.

1) Was she tired of Bangladesh or would she stay longer if she could?
“Both. I’ve been sick most of the week [with a cold] and I’m sick of the food and the ants everywhere, but otherwise I want to stay – I’m totally in love with Bangladesh.”

2) What would she like for dinner when she returned?
“Like tacos, waffles, HARDCORE kebab – as long as it doesn’t contain rice, weird vegetables, fish, chicken or goat. And ice cream for dessert!”

We had told her that ice cream, if she saw it, was strictly off limits unless it was industrially manufactured. But she told me this morning that during the last 24 hours she has developed an “upset stomach.” So I guess that precaution didn’t help much. An "upset stomach" is just part of the “experience” to places like these!

(Yes, she had all the necessary shots/vaccinations before she left. She has been on my mind all week. I'm glad she is home.)

Monday, April 20, 2009

"We're having a blast!"

A few months ago, my 14-year old daughter and her classmate told us they wanted to go to Bangladesh. Their school is part of a project (Teachers Without Borders) that builds and supports schools in rural Bangladesh. I was little skeptical but said okay, especially since they needed to raise about SEK 25,000 – mostly for airfare – and I had my doubts they would be able to do it. But through some money-raising projects and grants from companies and the Swedish church, they succeeded. They left Friday evening with a teacher from their school and the teacher’s 18-year old daughter.

Before my daughter left, I talked a lot about what to expect, even though I’ve never been in that part of the world. We mainly talked about cultural differences, extreme poverty, and heart-wrenching things they might see or experience. (Her younger sister has been worried that she will come back "changed.") I didn’t want to sound too negative so I also told her about a news story I’d seen (or read) recently about someone who had explored a slum in one of India’s large cities (I forgot which one) and reported that, despite everything, things “work” and people survive. Everyone has a place, and there is a vibrant sub-culture that thrives. (No, I have not seen Slum Dog Millionaire.) Of course things should be better, but for the people who live there it’s home, and at that level at least should be respected. Or so was my open-minded, liberal lesson to my daughter before she left. Of course there is a difference between rural Bangladesh and a city slum in India. But I imagined the impact of the experience would be just as overwhelming and profound.

So imagine my surprise when I got a text message yesterday that said “We’re having a blast!” Not exactly the reaction I would have expected after a couple days in one of the poorest, most crowded countries on earth. I’m completely blown away. The exuberance and resilience of youth should never by underestimated, especially by "worldly" parents.

Saturday, April 11, 2009

The mammogram chronicles - part 6: I'm stumped!

A couple days ago I received a letter in the mail. I've been assigned a time the first of week of May for a mammogram!

What I don't get is how they "magically" found a time so quickly (and that coincidentally allows them to keep treatment money within the district). Three months is supposed to be the maximum not the minimum waiting period for care. Yet this is the second time I've waited for specialist care that was scheduled just before expiration of the three month waiting period. And in this case, an appointment was scheduled within a week of the deadline.

If I can get an appointment so quickly after the scheduling deadline, why have they made me wait three months for it? Yes, I have no "urgent" symptoms, but the point of a mammogram is to confirm that there are no problems. And just because the symptoms aren't urgent doesn't mean there isn't a problem. (Otherwise, why bother with the mammogram?)

I don't like my health care district gambling with my health and playing the odds when, as far as I know, there is no reason for it.

I also don't understand why I was told me a couple weeks ago that I wouldn't be able to get an appointment within three months and that I was welcome to try and find a place that could take me.

I'm fed up with conflicting and non-information from the breast clinic at Centrallasarettet in Västerås!

I'm convinced no one knows what's going on and what the policy is for scheduling mammograms in Västmanland.

Wednesday, April 1, 2009

The mammogram chronicles – part 5: You’re not our problem

I called the neighboring health care district (Eskilstuna) this morning to see if it was possible to get a mammogram there. I had to wait in the telephone queue (they apparently have no callback system), but it was only a 5-minute wait so that wasn’t too bad.

I explained that I was calling from Västerås (my health care district), that the Västerås mammography unit was backlogged, and that if I could get an appointment in Eskilstuna the Västerås district would pay for it. The nurse, receptionist or whoever it was who answered the phone said Eskilstuna also had a backlog (only a month!) and seemed unwilling to take me.

She asked if this was a routine health check. I told her yes and no - that it had been five or six years since I had had a mammogram, that I had some pain, and that I thought it was time to get another. She asked me my age and pointed out that I should be getting called in regularly for mammograms (the law says about every two years, I believe) in my own health care district.

(Long story here. I wanted reminders for mammograms to be sent to me, but I did not want them to automatically schedule a time, which is standard procedure. If you don’t show up for a scheduled appointment, you’re billed for the cost unless you cancel or reschedule it, which at that time required you to play the “telephone time” game, which I can’t stand. I’d rather call at my own convenience and schedule it myself. I asked if they could just send me a notice without assigning me a time. No, that was not possible. “The computer” was not set up to do that (even though appointments for these kinds of things are often hand-written in the reminders). So in a fit of pique I told them not to send reminders and they obliged. I wonder if they are now “punishing” me for not doing it their way. After all, if a middle-aged woman who is supposed to have mammograms regularly hasn’t had one for five to six years, don’t you think she’d be given some priority?)

She implied that they couldn’t help me since this was a routine health check. I said that it doesn’t really matter whether it is or isn’t since the law says I’m entitled to an appointment within three months of the request, and Västerås has told me they can't honor the 3-month limit. She said I needed a referral if they were to take me. I asked why I needed a statement from a doctor (which I would have to pay for) to confirm that my breasts are lumpy and that they hurt. I already know that. But if I had a slip of paper from a doctor saying what I already know they would take me? I said I didn’t need a referral for a mammogram.

She said that the rules vary from district to district and that women in her district need a referral for a mammogram (since they get mammograms regularly). So, I asked, if I live in Eskilstuna and a year has passed since my last mammogram but I suspect I need another I must have a referral from a doctor? She did not answer the question but said if I had a lump (that magic word again!) they would see me, but that pain is not a symptom.

She iterated that I should be getting the check-up in my own district and I repeated it’s impossible since they can’t meet the 3-month scheduling deadline. I said she could book an appointment with me now or wait a month and deal with my health care district directly when they come calling themselves next month. She took my contact information and said she would check with her supervisor and Västerås, and that she would call me back.

Why, you wonder, didn’t I just tell her I felt a lump? Because it’s too late. They all know me now, and I’ll soon be on everyone’s shit list. And, I must also admit, I'm curious to find out how dysfunctional the system is.

Update: As I was finishing this chronicle, Eskilstuna called me back. The nurse had spoken with Västerås and if I want a mammogram in Eskilstuna, I must get a referral from Västerås. I asked what “referral” means – a promise that Västerås would pay or a referral from a doctor saying I needed a mammogram, or both? She didn’t really know – a referral is a referral. But to me it matters. If I need a promise of payment, I have to nag the breast clinic to provide one. If I need a doctor’s statement, then I have to visit a doctor (or get my own physician to write one for me). Out of curiosity, I asked again if women in Eskilstuna need a referral for a mammogram. She reiterated that women in her district get regular check-ups so, in principle, there is no need. But if a year after getting a mammogram a woman wants another, she needs a doctor’s referral unless she has obvious symptoms such as a lump or discharge from a nipple. She suggested I contact my own district again. (Back to square one).

“I don’t understand why Västerås can’t manage to schedule a routine check-up,” she said. (The million dollar question!) I can. It’s personal – they hate me. But don’t ask me to see a psychiatrist about paranoia – the wait is too long.

Saturday, March 28, 2009

The mammogram chronicles – part 4: Gaming the system

As I was writing my latest post for The mammogram chronicles, I began to wonder if maybe I should have accepted the doctor appointment. If the breast clinic’s own doctor recommended that I get one, perhaps I could get a mammogram a little quicker. I called the breast clinic back on Friday (apparently they do take calls on Friday) to find out.

The clinic opens at 7 am. I called at 7:10 and was scheduled for a callback at 8:30. Miraculously, someone did call back at about that time. I said I had been offered a doctor appointment but that I had declined. I then asked if I had accepted the appointment and the doctor recommended a mammogram would that improve my standing in the queue and I could get one quicker? The nurse confirmed my understanding – no.

I then said it was a pretty sad state of affairs if you had dire symptoms and really needed a mammogram you had to wait so long to get one. She then said if you have very suspicious symptoms, like a lump, they get you in faster. But general soreness (including my sore shoulder), she said, is usually due to hormones, and although it’s good to get a mammogram, soreness is not considered serious so you have to wait (and wait, and wait).

A friend of mine was going through a tough divorce and wanted to talk to a therapist or counselor. The last I heard, the wait for mental health care for an adult can be a year or more. (By the way, pills are the preferred Swedish solution to mental health problems. Counseling and therapy are considered too messy and too expensive.) There is an emergency number you can call to get a couple emergency sessions with a mental health specialist. “I called the emergency number and told them I was suicidal,” my friend said. “I’m really not, but I knew it was the only way I’d get in to see someone.”

When I was showering this morning, I think I felt a lump.

Thursday, March 26, 2009

The mammogram chronicles – part 3: Learning the rules

I’ve had unexplained soreness in my shoulder the past couple days along with a sore breast so I’m getting a little anxious about scheduling this mammogram. After having waited two months already, I figured I would not be getting an appointment before the end of the three-month scheduling period (the magic date is April 28), so I called the breast clinic today (the callback was scheduled for 1 pm. They called at 1:25) to find out the procedure for scheduling a mammogram in another health care district so I would know what to do come April 28.

Apparently there are two care options: Free Choice and Guaranteed Care. The Free Choice option means if I find a clinic that will take me before April 28, my district will pay for the mammogram but not transportation. The Guaranteed Care option, which kicks in after April 28, requires my district to schedule a mammogram for me somewhere in Sweden (I don’t know if it covers Europe), presumably within 3 months after April 28. They also pay for transportation. So it looks like I should get a mammogram somewhere in Sweden no later than July 28.

I was a little confused. I thought I couldn’t arrange a mammogram on my own before April 28 unless I paid for it. The nurse said because there was a “stopp” in the queue and since I had already waited so long I could use the Free Choice option. (In Swedish, “stopp” can mean anything from a blockage, to a bottleneck, to, in this case, closing the queue completely. She didn’t explain what she meant and I didn’t ask.) Why hadn’t some one told me this two months ago? They are so eager to keep health care money within their district they will jeopardize patient health to do it!

She then offered me an appointment with a doctor next Tuesday and explained that the doctor visit usually followed the mammogram, but since I had been waiting so long, I could see a doctor next week. I asked what the doctor could do for me and she explained if there was anything suspicious the doctor could look into it (a biopsy, I suppose). But isn’t a mammogram usually the next step if the doctor detects anything suspicious? Yes, she conceded. So this visit is actually backwards? Yes, she said.

Well, I know my breasts are sore and lumpy and that my shoulder hurts. So not a lot to be gained from a doctor visit, which would also cost $37. I declined.

I said I would try and call the neighboring city to see if I could schedule a mammogram there. She mentioned that that city also has a queue, but I decided to try my luck anyway. I called the central health care referral number and asked for the locations and phone numbers of mammography clinics in the city. The receptionist referred me to the central hospital and gave me the number to the x-ray department. Of course, it was the wrong – mammography is its own unit – but the person in x-ray was kind enough to give me the correct number. When I dialed, I got a message: telephone hours are Monday –Thursday 8-10, and Monday and Tuesday afternoons 1-3.

Guess what I’ll be doing Monday morning at 8:00 am!

Sunday, March 15, 2009

How DARE they!

On Friday there was an article in the newspaper about the rescindment of proposed bonuses for Volvo’s top managers, and that SEB, one of Sweden’s largest banks, had backed away from a bonus proposal for its top management.

My question is how dare they? How DARE they?! These businesses are not exactly robust, and these proposals shouldn’t even be on the table!

I’m shocked how socially and politically tone deaf these boards of directors and top managers are, and I’m truly surprised that unions and ordinary people aren’t protesting in the streets about such outrageous behavior.

Who are these people?! And how did they get so out of touch with reality?

Wednesday, March 4, 2009

The mammogram chronicles – part 2: Is it worth it?

On February 2, I tried to schedule a mammogram. I’m still waiting to get an appointment.

A few days ago, a reporter interviewed a woman who is a part of my health care region on the radio. About a year ago, they closed the health care facility in her area and she now has to go to the main central clinic for a mammogram (the same one where I’m still waiting for an appointment).

She lives about 80 kilometers from the clinic. She was saying if you’re dependent on public transportation, it basically takes all day to get to and from the clinic, not to mention the cost of train and bus tickets. She said that she and several women she knows have decided to skip mammograms in the future (and take their chances).

I know how she feels.

Sunday, February 8, 2009


[If you enjoyed my post below "It's not just health care", you might be interested in this essay written in March 2005. For the record, my local clinic abolished telephone time in January 2008. (You can now call any time of day to make an appointment.) According to staff, the atmosphere in the waiting room occasionally got ugly as doctors got backlogged and the room filled up with patients who had dropped in during the two-hour "open clinic" each morning (no appointment necessary) thereby avoiding telephone time. The clinic has also abolished its open clinic hours.]

I was explaining a fine point of English grammar to two of my adult students when one of them suddenly jumped up and ran out the door. Stunned, I turned to her colleague to see if she knew what was going on. “She has to call her doctor,” she explained. “It’s telephone time.” "Oh," I nodded, and resumed the lesson.

You can’t claim to know anything about Sweden until you’ve experienced telephone time. It is the one (and only) hour of the day when you’re allowed to call and schedule a doctor’s appointment at your local health care center. Telephone time is usually in the morning (at my clinic, between 8 and 9 a.m.), about the time you’re leaving for work. On the given hour, with a deep sigh, you grab your phone and frantically dial your doctor’s number (they schedule their own appointments) as fast (and often) as you can to try and get into your doctor’s answering queue.

If you’re lucky (and your doctor is at the office on time), you’ll get into the queue on your first try. If you’re very lucky, your call will be answered within a couple minutes. If you’re unlucky, you could be on hold for twenty or thirty minutes, or more. And if you’re really unlucky, you could get stuck in a queue for ages only to learn from an answering machine that your doctor is on vacation (yes, this happened to me), and that you’ll have to start the whole process again after scrambling to find the name and number of another doctor with only ten minutes left until the end of telephone time. For mobility’s sake, I’ve learned to call my doctor on my cordless phone if I’m calling from home or on my cell phone if I'm in transit. (“Hello, Doctor?” I holler above the traffic as I push through crowds on my way to the office. “I have a terrible yeast infection!”)

If you think your problem doesn’t need a doctor, you can take your chances and try the district nurse (same procedure), who will promptly ask for your naitonal identity number upon taking the call. (Patients in Sweden do not have names, only national identity numbers.) With a little pleading and a lot of lying (my district nurse is appointment aversive), you can get an appointment; but more often than not, you’ll be asked to come during "open clinic" (9-11 a.m. at my clinic) and spend your morning waiting in a room filled with white-haired retirees.

If you don’t know your assigned doctor’s name and telephone number, or the clinic’s designated telephone time, you’ll have to waste a day getting that information. (Because you usually find it out after telephone time.)

Scheduling a doctor’s appointment can take days.

But at least the health care system makes no bones about its disdain for patients (aka taxpayers) unlike SJ (svenska järnverket), the administrative arm of the Swedish state railway, which is running a poster campaign harrumphing its on-time service. The poster caught my eye because the train from which I read it was late. (I commute twice a week between Mälardalen, one of Sweden’s fastest growing regions, and Stockholm.) In fact, my morning train was cancelled or delayed three times in February and two times in March. As was last night’s train, which was delayed then cancelled due to brake trouble. As I waited last night, I decided to have a chat with the conductor.

Why, I asked, have I been having so much trouble with trains lately? I thought SJ had fixed the problems with its Regina trains, a batch of trains purchased three or four years ago that had not been designed for cold weather. The fiasco led to massive delays such as the January evening three years ago when my husband’s train stalled in the middle of nowhere. A new train was called to rescue the stranded passengers, but even this train had technical problems and could travel no faster than 40 km per hour. In the end, the passengers waited in dark, chilly carriages (the train’s reserve battery eventually ran out) for the next scheduled train, which arrived an hour later.

(My favorite SJ story is the time a Regina train stalled and the passengers got out and PUSHED THE TRAIN to help it regain power. There was a photo of the incident, taken by one of the passengers with a cell phone, on the front page of our local newspaper Västmanlands läns tidning. But I digress...)

They’ve fixed them, she reassured me, but now there’s a shortage of carriages and drivers. Oh, yes. I’d read about that in the paper. SJ has ordered some new, nifty double-decker trains that are so overdue – more than a year – that SJ has stopped promising when they’ll arrive. In the meantime, SJ has refurbished and put back in action some old, rundown carriages (apparently with none to spare for unexpected problems) to make up the shortfall until the new trains arrive. [Author's update: Once they arrived, there were chronic mechanical problems with the double-deckers, which caused major delays and cancellations.]

Hmmmm, I mused. But why is there a shortage of drivers? (There has been some very nasty flu going round…) The drivers, she explained, are off getting training for the new double-deckers, and there aren’t enough other drivers to cover for them.

The Social Democratic party, which has been in power for all but nine of the last 73 years, is gearing up for elections a year from this fall. On cue, Prime Minister Göran Persson is talking about raising taxes to meet future demand for public services such as health care and rail transport. (Only in Sweden can you win an election by raising taxes.) But surprisingly enough, support for Persson (and the Social Democrats) is slipping. Call me a skeptic, but I think the Social Democrats are missing the big picture.

Monday, February 2, 2009

It's not just health care (Also: The mammogram chronicles - part 1: Moscow School of Customer Care)

It’s about time for a mammogram. Not remembering what to do, I called my local clinic and asked how to get one. “I don’t think you need a referral [She doesn't know?],” answered the nurse? clerk?. (I've never been sure of the medical qualifications of the person who answers the phone.) Pleasantly surprised, I asked if she had the number for the main breast clinic where I needed to go. “No,” she said. (Why, of course, would she?) I had to look it up.

After rummaging around for the health care catalog, I found it, and the number for the breast clinic. But to my horror, listed under breast clinic was the dreaded “telephone time.” I could only call between 8 and 9:30 am on Monday-Friday and between 3 and 4 pm on Monday-Thursday to make an appointment. It was now 10:25 am. I’d probably have to wait until tomorrow. But not completely discouraged, I called the number anyway and got some kind of automated call system. The voice said there was a callback time today at 3:20 pm. If I left my phone number, someone would call me back. Okay, I thought, I’ll bite.

At 3:30 pm the breast clinic called. “I want to schedule a mammogram,” I said. “Do you have any symptoms? Would you like a consultation?” a voice asked. Tricky question. If I said no, I'd be put at the end of the queue. Hmmm…I haven’t had a mammogram for several years or a breast exam in more than ten. Better to say yes, and I described thickening tissue under my arm and soreness. (I have lumpy breasts and these symptoms are chronic but the voice didn’t need to know that.) “I’ll talk to the doctor and call you back,” said the voice, which also noted that it was late in the day.

I kept my ears open for a phone call all the next day. No call. So the day after that, Friday, I decided to call, skip the consultation and just schedule a mammogram. But alas, I missed telephone time again. (I called around 10:00 am.) I also got a message that there were no callback times available. End of recording. I started wondering about this callback system. Does it work on a day-by-day basis only? Or can I call on a Monday and schedule a callback for Tuesday or Wednesday? Only the breast clinic knows for sure, and they're not telling.

So this morning, Monday, I made sure to call during telephone time. I got a recorded message saying there was a callback time available at 9:25. (It was now 9:30.) I took it and thought if they don’t call, at least I can call again later in the morning.

About five minutes later the phone rang. “I want to schedule a mammogram,” I said. “Do you have any symptoms?” asked the voice. Oh, no, I thought! I’m not getting trapped into this again! But I couldn't resist completely. “Yes,” I answered, “but it’s not worth discussing since I talked to someone last week who promised to call back, but never did. I just want to schedule a mammogram.” “Just a minute,” said the voice, which could figure out who I was through my national identification number, which I had to provide when I scheduled the callback. Pause. “I see it here. You’re ‘wait.’ You need a referral.”

REFFERAL?! My heart started pounding! “My clinic said I didn’t need a referral and that I could call you direct!” “Yes,” the voice explained, “but you need a referral from one of our doctors here before we can schedule a time.” “But all I want is a mammogram,” I said. “Can’t I just schedule a time for that?” “No,” said the voice. Feeling my blood pressure rising and afraid that I had outsmarted myself, I took a deep breath and said, “Let’s pretend that I’m calling you for the first time and that I just want a mammogram. Can’t I schedule one?” “No. All mammograms require referrals.” (I still want to know how a doctor who has never seen me can make an informed referral. But never mind; some things are beyond the comprehension of mere mortals.)

Realizing it was hopeless, I asked how long the wait would be. “I don’t know,” said the voice. “Just give me an idea,” I pressed. “I don’t know,” the voice repeated. “Weeks?... Months?...A year?” I prompted. (Notice that I didn’t say days. THAT much I know.) The voice snorted softly when I said a year, as if the idea was preposterous. “Just give me SOME idea,” I insisted. The voice hesitated…“Maybe four weeks. Perhaps six. I don’t know.” (Mind you, this is six weeks until I’m notified of an appointment. The appointment itself can be any time up to three months AFTER notification. It’s possible I won’t get the mammogram until mid-June. And Swedish health care rules being what they are, I can’t go anywhere else for the mammogram unless I pay for it myself.) “By the way,” I added, “You shouldn’t promise to call someone back if you’re not going to do it.” Silence. We ended the call.

So, you may say, what a great argument against national health care! Not so. In all fairness, my county was rated dead last (or was it second to last?) in a recent national survey on health care quality. (Incidentally, even though it's only February 2, my health care catalog dated 2009 is already out of date. Apparently there is no “telephone time” anymore for the breast clinic.)

I’m convinced it’s how you design and administer the system, not who pays for it. There's no reason why a universal or national system has to be rigid or impersonal. That's simply a reflection of the person you're dealing with. A few years ago I received emergency obstetrical care in Canada. The service was reasonably prompt, and very friendly and courteous, with better equipment that I had experienced in Sweden.

There’s been a lot of talk about revamping health care here. But you would first have to redesign Swedish mentality. Sweden is not a service-minded culture; institutional services and many private businesses are designed for administrative ease, not customer convenience. (I’ve had endless discussions with friends and family about why.) You see it over and over again in many public services and private enterprises. It’s not just health care. (My other favorite example is the Swedish railway – a textbook example in every respect of how NOT to run a business.)

I don’t know what it will take for a paradigm shift here, but for starters, I’d stop sending employees to The Moscow School of Customer Care.

Saturday, January 31, 2009

Entrepreneurship: Swedish and American style

(“Kvick” thoughts, huh? Guess they haven’t been too “kvick” lately!)

My daughter and her classmate want to go to Bangladesh. Their school has a project where it’s helping to start and support a couple schools in Bangladesh for six years. My daughter, age 14, and her friend want to go with one of their teachers on a field trip there. The cost for my daughter and her classmate is SEK 30,000 (about USD 3,600).

Aside from hesitation about whether or not I want my daughter “alone” in Bangladesh for a week, my first thought was money. If my daughter and her friend were going to do this, they’d have to raise the money themselves. I threw out some ideas beyond the usual bake sales, car washes, etc. that might result in serious cash (such as an on-line auction rummage sale) and offered to help if they wanted to do it. They were lukewarm about the idea, so I dropped it. Instead, they’ve been contacting businesses, foundations, etc. to see if they’d be willing to make a donation.

Not a bad way to go. But I was struck by the difference between their way of thinking and mine. My first thought was how to raise the money. Their main thought was who could they ask. I suggested if they try and do at least some “serious” fund-raising, potential donors might be more willing to give; but the girls didn’t bite. (OK, I know they’re only 14.) Interestingly, none of the potential donors, as far as I know, have offered to make a matching grant.

But I think something more fundamental is at work. Having grown up in the U.S., I had always seen and been told that if I wanted something I had to earn it. In Sweden, teen-agers rarely rake leaves, shovel snow, etc. for pocket money. Since the wages adults pay for “neighbor kid” help are much lower than the professional market-rate for such services, it’s considered vaguely exploitative to ask a neighbor kid to do it. Consequently, the market for “pick-up” jobs among teens is virtually nonexistent. And when you do find a teen willing to help, they expect to be paid quite well!

Of course, I’m not in favor of exploiting people, and believe people should be paid decently for their work. But as a culture, Sweden neither encourages nor cultivates entrepreneurial thinking. I’m reminded of something I read in the newspaper not long ago. A Swedish family living in New York talked about an incident at the playground. A five-year-old wanted to go down a big slide but was afraid. If it was Sweden, said the couple, the child’s parent would probably have said, “Are you afraid? You don’t have to go down if you don’t want to.” In the U.S., they said, the American parent stood at the bottom of the slide and said, “You can do it! I’m here - I’ll catch you if you fall!”

There’s been a lot of discussion in Sweden recently about how to increase the number of business entrepreneurs. I say, get ’em while they’re young!