{"id":36373,"date":"2014-07-24T09:33:30","date_gmt":"2014-07-24T13:33:30","guid":{"rendered":"http:\/\/asweetlife.org\/?post_type=feature&p=36373"},"modified":"2016-01-11T03:54:44","modified_gmt":"2016-01-11T08:54:44","slug":"not-quite-so-brave-living-with-diabetes-in-three-countries","status":"publish","type":"post","link":"https:\/\/asweetlife.org\/?p=36373","title":{"rendered":"Not Quite So Brave: Living with Diabetes in Three Countries"},"content":{"rendered":"

\n

\u201cYou have diabetes and you went to all those different countries?\u201d the woman exclaimed. \u201cThat\u2019s so brave!\u201d<\/p>\n

She and I were talking at a party. (We had noticed each other\u2019s diabetes kits and the inevitable bonding session had ensued.) I had just mentioned that I spent the last three years in three different countries: Estonia, the United Kingdom, and Germany.<\/p>\n

When I mention my travels many people act surprised, and I\u2019m never sure how to respond. To me, being \u201cbrave\u201d means being afraid of something and doing it anyway. I\u2019m a cautious person who avoids taking risks. The prospect of dealing with diabetes abroad didn\u2019t seem particularly scary to me\u2014if it had, I\u2019m not sure I would have done it.<\/p>\n

But this conversation with a fellow diabetic made me think back on my decision. Should diabetics necessarily view traveling to a different country as a frightening experience? Or can it be a beneficial and informative one?<\/p>\n

There were many factors that alleviated potential causes of worry for me. Rather than hopping from one locale to another, I led a settled life in three different places. In Estonia, I was doing research on a Fulbright scholarship, in England I was enrolled in an MA program, and in Germany I was volunteering with the organization Action Reconciliation Service for Peace. In each different city I had an endocrinologist and knew exactly where I could buy medical supplies. Nothing was left up to chance that wasn\u2019t up to chance in the U.S.<\/p>\n

I was most nervous before I left for Estonia. It was the first time I\u2019d be out of the country for an extended period of time and I had no idea what to expect. Would my diabetes supplies be available? \u201cAnd what about an endocrinologist?\u201d my parents asked me. \u201cAre you sure there\u2019s one nearby who can speak English?\u201d<\/p>\n

This was a fair point. I didn\u2019t speak a single word of Estonian. I emailed the Fulbright coordinator, who emailed the Fulbright contact at the American embassy in Estonia. She gave me\u2014to my great relief\u2014the name of an English-speaking endocrinologist in Tartu, the city where I would be living.<\/p>\n

Once I had bought an Estonian cell phone at Kaubamaja, an Estonian department store, I called the endocrinologist\u2019s office and set up an appointment. The receptionist was as chatty and cheerful in person as she had been on the phone, but the doctor was quiet and didn\u2019t crack a smile. Although she offered to do \u201ctests and things\u201d in addition to giving me prescriptions, she seemed relieved when I declined (as I was planning to see my American endocrinologist when I went home for Christmas).<\/p>\n

I got into the habit of buying my insulin and other supplies at the Raekoja Apteek, the pharmacy in the pink-and-red town hall. The only change I needed to make in Estonia was to switch to insulin pens instead of the vials and syringes I had been using until that point. This wasn\u2019t a problem; once I got used to the pens, I liked them more anyway.<\/p>\n

Diabetes care in the UK was even better. In fact, thanks to the National Health Services, it was the best I\u2019ve ever experienced. If you watched the opening ceremony of the 2012 summer Olympics in London you might remember a sequence that involved nurses dancing around huge hospital beds. To the uninitiated this paean to the National Health Services might have seemed bizarre. However, as someone who had directly benefited from the British system of healthcare, I watched the whole thing mentally cheering Yay, NHS!!<\/em> (even if the dance was a bit strange).<\/p>\n

\"Brunch<\/a><\/p>\n

Since I was a legal resident of the UK, all of my doctor\u2019s appointments and supplies were completely free. My university\u2019s medical center and pharmacy were only a five-minute walk from my dorm, and I received a note in my university pigeonhole advising me to make an appointment when the podiatrist and ophthalmologist would be visiting campus. Diabetes care couldn\u2019t have been easier.<\/p>\n

In fact, my biggest difficulty with diabetes control in Estonia and England wasn\u2019t a lack of supplies, facilities, or doctors. It was my own mentality. I entered the experience of living abroad as if I were going on a very long vacation. It\u2019s okay if I mess up every now and then because I\u2019m away from home\u2014I\u2019ll just deal with everything again once I get back.<\/em> This approach might work if you\u2019re away for two weeks, but not if you\u2019re away for two years. I knew that my diabetes control was slipping. I couldn\u2019t even remember the last time I\u2019d had my A1C tested.<\/p>\n

My mentality changed\u2014was forced to change\u2014once I got to Germany.<\/p>\n

I went to Germany to do a year of volunteer service at the Neuengamme Concentration Camp Memorial in Hamburg. For the first month I attended a language class in the city center every morning. One day my classmates and I were commiserating about the amount of bureaucracy we had to deal with as foreigners; even the smallest of privileges had a string of formalities attached. One girl from Romania joked that she\u2019d decided to marry a German man just so she\u2019d be eligible for a decent cell phone plan.<\/p>\n

\u00a0\"\"<\/a><\/p>\n

Then a man from India spoke up. \u201cActually, I don\u2019t mind the bureaucracy. Where I come from, things are completely corrupt. There are many ways of getting something, but they all depend on how much money you have. In Germany, there is only one way. But if you do everything correctly, than you can be sure you will succeed. It\u2019s fair.\u201d<\/p>\n

It was my experience with diabetes in Germany that made the truth of this sentiment sink in.<\/p>\n

I found my endocrinologist in Germany by printing out the Google results of a search for\u00a0 \u201cendocrinologist\u201d and \u201cHamburg\u201d and then calling each office on the list in turn, asking if the doctor was willing to take on new patients and whether she or he spoke English. The first doctor who met both criteria was located an hour and a half away from the memorial by public transportation.<\/p>\n

I made an appointment in the afternoon and left work after lunch. When I arrived at the doctor\u2019s office I signed in with the receptionist and gave her my ID and insurance card.<\/p>\n

\u201cHmm.\u201d She flipped my card over and frowned at it. \u201cPrivate insurance? We will have to check this to make sure it\u2019s good.\u201d<\/p>\n

\u201cOh.\u201d I was taken aback. Was there something suspicious about my insurance\u2014or me? \u201cOkay, sure\u2026\u201d<\/p>\n

Later one of my coworkers explained that most people in Germany have Gesetzliche Krankenversicherung<\/em>, state-sponsored health insurance. My volunteer organization had opted to give me private insurance instead. In many ways, this worked out to my advantage: I could visit a specialist without a referral, and I received full reimbursement for all prescription-based medicines or medical supplies. But, my coworker explained, German doctors are often extra-cautious with private insurance because they, too, want to be sure they will receive reimbursement.<\/p>\n

After I sat in the waiting room for an hour, the receptionist returned, shaking her head. \u201cI\u2019m sorry, it\u2019s too late today. The woman who deals with these things has already gone home. I tried to fax the insurance company, and they aren\u2019t answering, either. Can you come back tomorrow?\u201d<\/p>\n

Tomorrow<\/em>? I thought. This wasn\u2019t going to look very good to my boss. I had just missed half a day of work already. But of course there was no way around it. Rules are rules, and my endocrinologist wasn\u2019t going to do anything unless she was sure she had proper authorization.<\/p>\n

Soon I realized that even though there are annoying things about German bureaucracy, there were also benefits for me. Every three months I had to go in for tests or else I couldn\u2019t get any more prescriptions. This forced me to get the regular blood work that I had put off in Estonia and England. My A1C, which had been high when I first arrived in Germany, steadily dropped.<\/p>\n

My doctor\u2019s thoroughness paid off for me in an unexpected way, too. A week after I had my third batch of tests, I got a call on my cell phone from my endocrinologist\u2019s office. A doctor\u2014not my normal doctor\u2014was on the other end. He seemed quite upset. I didn\u2019t understand what he was talking about, but whatever it was, it sounded serious.<\/p>\n

\u201cOne moment, please?\u201d I thrust my cell phone towards my coworker, who had been looking at me in concern. \u201cCan you talk to the doctor for me?\u201d I whispered.<\/p>\n

She took the phone and began to chatter away in German. It turned that the doctor was saying that my blood work had shown that I had severe anemia. He wanted me to visit a GP as soon as possible.<\/p>\n

I told my mom about this as we skyped that evening. She asked what I\u2019d been eating. \u201cWell, that sounds fine,\u201d she said. \u201cMaybe you\u2019re not absorbing enough nutrients. When you go to the GP, you should ask him to test you for celiac disease, too. Honestly, you should probably just go on a gluten-free diet\u2014I\u2019ve been saying that forever!\u201d<\/p>\n

My younger brother was diagnosed with celiac disease when he was 13. I was tested a few years later and the results were inconclusive. Since I didn\u2019t get any symptoms when I ate gluten, I interpreted \u201cinconclusive\u201d to mean \u201cignorable,\u201d and continued to follow a diet that can best be described as gluten-rich. The summer before I left for Estonia, I asked my doctor about the results again. Her answer still left me some wiggle room: \u201cYeah, it\u2019s probably better if you avoid gluten. At least usually. I mean, say someone has just baked rolls and they smell great and you really want one, then it\u2019s okay, once in a while\u2026\u201d<\/p>\n

My German GP, on the other hand, didn\u2019t know English well enough to mince his words. \u201cYes,\u201d he said, after doing a blood test, \u201cyou have celiac disease.\u201d<\/p>\n

This, I thought, was finally a situation that required me to be \u201cbrave.\u201d Or at least, I would have felt brave if I had decided to go to another country knowing that I had celiac disease and not knowing what gluten-free products were available. Now that I was already in Germany, I didn\u2019t have much of a choice.<\/p>\n

Luckily eating gluten-free in Germany didn\u2019t prove to be as difficult as I\u2019d feared. I emailed a German friend whose boyfriend also has a wheat sensitivity. She called me with a whole list of suggestions. Thanks to that and a process of trial and error, I quickly became as familiar with the pros and cons of different German gluten-free brands as my brother is with American ones. While eating gluten-free can still be frustrating at times, it\u2019s become second nature to me.<\/p>\n

When I think back on my experiences with diabetes abroad, I realize that Is it brave to go abroad having diabetes?<\/em> isn\u2019t really the best question to ask. A better one might be: how will diabetes impact the experience you have? Having a health condition like diabetes will force you to have unexpected interactions, which in turn can give you unexpected insights.<\/p>\n

In Estonia there were times when I would ask for a box of pen needles only to be told, \u201cWe don\u2019t have a full box.\u201d The pharmacist would pull out a box of needles, count how many were left, and charge me for that number. When I asked why this was, the pharmacist shrugged. \u201cWell, some people only need to give themselves a shot once a day, so they don\u2019t like to buy so many at once.\u201d<\/p>\n

In Germany I had another run-in with bureaucracy. After my year of volunteer service, I began a new job at a publishing company. I was late to the first staff meeting because my blood sugar was low and I had to scarf down some glucose tablets at my desk.<\/p>\n

Afterwards I apologized to my boss and explained what had happened. She reassured me that it wasn\u2019t a problem. \u201cAnd you know,\u201d she added, \u201cthere are three people in this company who are especially trained in first aid. If you like, I can set up a meeting with them so that they know what to do if there\u2019s an emergency.\u201d<\/p>\n

All three of my coworkers were friendly and interested as I gave an overview of diabetes and explained about taking insulin. Then I explained that if I fainted, they would need to inject me with glucagon.<\/p>\n

\u201cYeah,\u201d one of them said. \u201cI don\u2019t think we\u2019d be allowed to do that, legally.\u201d<\/p>\n

I looked at their apologetic smiles and felt unsettled.<\/p>\n

Other interactions were positive and touching. My boss at Neuengamme let me miss work for my endocrinologist appointments without taking vacation days. My Neuengamme coworkers couldn\u2019t have been more helpful. Knowing that I was nervous about speaking German on the phone, they offered to call the doctor for me and made detailed notes of the doctor\u2019s instructions. Once I went out to dinner and couldn\u2019t find my diabetes kit when I came home. I realized that it must have fallen out of my bag at the restaurant. I had an extra kit, so it wasn\u2019t a too big of a deal for me, but when I went back to the restaurant the next day and asked for the original kit I was greeted with an exclamation of relief from the manager. \u201cOh, we were so worried! I stayed here until one in the morning, hoping you would come back!\u201d<\/p>\n

It turned out that the woman I met at the party knew a thing or two about bravery and diabetes. She had been diagnosed in the 1970s, when good control meant \u201cnot ending up in the hospital.\u201d Even so, she had studied abroad in France a few years after this diagnosis. I\u2019m sure having diabetes affected her experiences abroad. I hope I meet her again so I can ask her how.<\/p>\n","protected":false},"excerpt":{"rendered":"

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