Czech Healthcare Adventure! Part I
Today I experienced the Czech medical system as an uninsured foreigner! And it's fucking awesome! When I say uninsured, I mean that I am not yet on the Czech public health insurance that is offered to me as an American expat, the same insurance offered to Czech citizens. I currently have travelers insurance that I paid for upfront for the next four months while I'm waiting for my visa to be processed. This insurance protects me in case of an emergency and extends outside the Czech Republic, whereas the state insurance is only effective within the country itself. After my visa is approved, I'll be able to get on that sweet, sweet state system and reap a multitude of benefits as a diabetic woman with depression and anxiety and a reproductive system.
The one issue/non-issue with the travelers insurance is that hardly anyone takes it. I've scoured the internet for endocrinologists, gynecologists, general practitioners, and therapists who take my insurance, Ergo, with little to zero success. Then I searched for English speaking doctors who are accepting new patients. Google's reviews sent me to the guy I went to today and I've been smiling like an idiot the whole afternoon. Not to mention booking an appointment with him was incredibly easy. I chose a time slot on his website and I showed up.
I should note that depending on your affliction, you'll need to see certain doctors for certain things. For instance, I can't get my birth control from a GP, so I'll need to make an appointment with a gynecologist. I was unsure what the case would be for both my Wellbutrin and Cymbalta, a cocktail of which keeps my neurotic and anxious tendencies at bay. Who would I need to see for this? An actual psychiatrist? If today's guy couldn't do it, then I'd be able to get a referral. Just one more extra step.
Living in Královo Pole means I'm in this nexus of Brno tram lines and busses that can take me pretty much anywhere within two stops, and this morning I only needed to take one. I also stopped at the ATM to withdraw cash for my appointment since I'd have to pay out of pocket in case my insurance wasn't accepted, which it wasn't. I stammered a bit trying to figure out how much to withdraw. $100? $3,000?
I realized I got caught up in my "Americanness" because I was assuming a doctor appointment was going to put me into debt or at least reinforce a ramen-style eating habit until further notice. Americans are so used to sacrificing shit just to pay for their healthcare. If I lost my insurance while living in Seattle, my life would have become unsustainable and I'd be working just to afford all of my medications I can't go without. The numbers were staggering after looking at them. It was scary and it lit a pseudo political fire under my ass to protect myself. So here we are.
Dr. Otsar is located in an intricate webbing of tram lines near some of the universities. Lots of young people were milling about in their white sneakers while drinking Red Bull and snickering at what I assumed was me. I found the building and went up to the third floor. The waiting room had six Poang chairs from IKEA so I parked myself and hoped that someone would attend to me based on the absence of windows to the actual clinic. A robust redheaded woman came out of a very white closed door and barked Sit, you wait at me. So I sat and waited. Other patients were coming to and from the waiting room and were seen before I was, but I figured this was because I was new. One thing I did notice was that whenever someone entered the room, they were greeted.
Dobrý den!
It was like entering a room with a surprise AA meeting on the other side. I followed suit and did the same for whoever showed up. Normally in an American waiting room, you're sizing up the other patients wondering what's wrong with them and you feel fine after a minute or two but then you hear a loud sputtering wet cough that everyone will leave with by the end of business today so a really great experience overall.
Dobrý den!
The redheaded Czech Trunchbull came back out and asked me for my ID and my insurance card. I gave her my passport and showed her a picture of my travelers health insurance card on my phone. She waved her hand dismissively at me and said No Ergo. You need pay cash. 300 crowns. Through a thick furrowed brow, she looked saddened or disappointed to tell me this.
300 crowns? What is 300 crowns?
Czechs have a monetary system based in the hundreds or thousands for the average transaction, so even though the written numerals printed on the banknotes should have a comma in them, this was business as usual.
300 crowns = $13.63
Am I actually seeing a doctor for less than what most airport sandwiches cost? Not to mention that, but this is WITHOUT insurance? How is this possible?
I waited around for about an hour or so and when I was called back, I discovered the English speaking doctor who was praised on Google for speaking English spoke very rudimentary English. Armed with paper prescriptions and medical records, I entered what looked like what used to be an old Eastern European classroom with an exam table. Dr. Otsar was wearing a VERY tight and white v-neck sweater and equally tight white pants because I guess he wanted to give off a vibe that while sterile, he still has style. He took my height and weight in centimeters and kilograms and spoke slowly with me. He asked me
So what is your problem?
I lethargically explained I had just moved to Brno and was looking to establish care. I told him I have Type 1 diabetes and he looked amazed at me for a moment.
Inzulin dependenti, yes he said to me. I'm not sure if it's because he didn't expect me to live this long as an American with the shitty health insurance I had or what it was, but it was though I appeared to him as a miracle of modern science in this office with very thin windows and very fluorescent lights. I gave him my handwritten US prescriptions for my diabetes supplies as well as two bottles of Cymbalta and Wellbutrin. He explained that I need to see a diabetologist, a term I hadn't heard of prior to researching the Czech healthcare system, and he wrote me a referral to someone who he thinks might speak English. That'll do.
He then checked the time on his hilariously huge digital watch and turned his attention to my prescriptions for depression and anxiety. On the tram ride down, I imagined the questions I'd be asked involved my history with these disorders, how long I've been on the medication, who prescribed them to me in the United States, you know, typical doctor questions. Instead, he didn't ask me a single question. None. He pulled up his catalog of medications in some kind of a Czech formulary and gave me prescriptions for two months in less than five minutes. I think having the medications themselves with me helped the process along and I didn't have to explain, and very slowly, that without these scientific creations, I am not a functioning member of society no matter which country I'm located. His last order of business was ordering blood work for me on a sheet of paper much like what I'm used to seeing back home. He checked different boxes for which labs were needed and handed it over to me. Okay, 300 crowns. I pulled out a two-thousand dollar bill which sounds fucking ridiculous but that's what it is. He gave me change, thanked me for coming in, and told me to come back after I had been fasting for 12 or more hours to complete my blood work. This CAN'T be this easy. Can it? WITHOUT insurance? With zero insurance. $13 and I'm out the door? With a prescription for two months?
I stopped at a cafe near my flat for a quick...bread with cheese and egg and salami and pickle on it before heading to the pharmacy. There are pharmacies everywhere noted by their big neon green crosses, like a beacon of a good healthcare system! The only other time I had been in a European pharmacy was when I got bedbugs in Vienna. I went into an apotheke near my hostel and mimed to a pharmacist using my fingers as pinchers that I had been bit and needed something to make me less itchy. He gave me a German ointment to slather around my wrists, ankles, and stomach and even though I was completely miserable, the experience was noteworthy for future reference.
I entered a pharmacy chain called Dr. Max, which is very clean and green and pristine. Three pharmacists had their own workstations with a computer and a phone. There was no singular pharmacist up high, towering over everyone with malaise and discomfort underneath. It felt like walking into a mobile phone store. They each greeted me.
Am I on a game show?
I gravitated to the pharmacist closest to me.
We greeted each other with Dobrýden! and I slid the prescription across the counter like I was withholding something sinister when really I'm just a foreigner who doesn't speak much Czech trying to access prescription drugs. He did a few quick motions with the computer and turned back to me disappointed, much like the Czech Trunchbull had earlier. He spoke a bit in Czech and while doing so he realized I didn't understand, so I asked him
Mluvíte anglicky?
In English, he said he was sorry to tell me that I would need to come back tomorrow for my prescriptions as they weren't in stock at the moment. The look on this guy's face was usually saved for parents who needed to tell their kids that beloved Freckles or Froofles "went to visit the happy little farm" while they were in school that day, or an American finding out that their health insurance costs were going cause them to go bankrupt. I almost was 180 degrees turned to leave when he told me that the costs were going to be 600 crowns. Fucking WHAT. So if we double our math from earlier, two months of two different prescriptions will cost around $27, which brings today's costs to about $40. Without insurance. In the US, today alone would have put me roughly a thousand dollars in the hole.
It's been a few hours since my first healthcare adventure in the Czech Republic and I'm still blown away at the amenities and services available to me as a foreigner who has yet to access public health insurance. The language barrier is proving to be a bit jumbled but with the right terminology and speed at which words are spoken, it should solve itself as it did today. I was scared going into this morning. I needed to make an appointment and see someone about my prescriptions before they ran out, and even though I'm still unaware of when my visa will be processed or when my public health insurance will go into effect, I was still able to accomplish my business and more.
I will still need to navigate through the thickets of endocrinology (or diabetology?) and the gynecological bureaucratic systems, but considering I've only been here for a little more than two weeks, I've made significant progress. Right now I'm working on this post and kitty is curled up in my blanket I was using for a pillow. I lit a couple candles and I'm going to make garlic broccoli for dinner. I'm not beating myself up about high blood sugars; I've had a few meals where I've been over 300 but I'm chalking it up to the fact that I'm underestimating the carbiness or sacharidy of the fucking squishiest bread loaves in the world. Yeah, I'm insulin dependent. I'm insulin dependent as fuck.
I'll keep updating the further I navigate. But as an introduction into the Czech healthcare system today, I'm incredibly happy that I can be healthy here.