Hiccup! and Medical Services in Greece

 Sifnos public medical center

 Sifnos medical center reception and waiting room

Rooftops as seen from Argo Anita Hotel, Pireaus

A figurative hiccup! that is.  We’ve broken stride.  The hiccup! in our routine was triggered by Karoline’s 101.4 F / 38.4 C fever accompanied by chills and abdominal sensitivity.  Her symptoms triggered our first foray into Greek health services, along with challenges gaining control over our stateside insurance coverage.  Based on this very limited experience I have the sense that health services in Greece would be of high quality if not for bureaucracy and economic reality. Meanwhile, we are confronted with the issue that, for U.S. institutions, the uniqueness of a Leave of Absence, coupled with overseas travel, stresses and challenges the rigidity of U.S. healthcare systems.

We pinch ourselves to realize that, in the many visits to the island since 1994, we have never been in need of medical service….until now.  We found the (only) public medical center on the island.  That alone was an accomplishment!    Once inside we experienced a Doc Martin scene, (if you don’t know what I mean rent the BBC series from Neftlix.  Hilarious.)  It is not possible to make appointments, one simply shows up.  There is no administrator or numbering system to manage the queue.  Rather, queuing is on the honor system.  Given that we don’t understand the system and can’t speak enough Greek to figure out where we fit in line, or which doctor to see, we found ourselves hours later left in the waiting room as the last patient.  The over-worked, much stressed, yet kindly young pediatrician examines Karoline.  Turns out he was born in the same town in Germany where we used to live.  Because he studied medicine in Germany, his German is better than his English so that becomes our language of communication.  The doctor runs a number of tests over the course of three days to eliminate the probability of other common illnesses and ultimately agrees with my initial suspicion that her symptoms could be from malaria.  Given that we have recently returned from Tanzania where malaria is a known problem, he insists that we run tests to confirm or deny the suspicion.  The expertise to complete the malaria tests does not exist on Sifnos.  There is a quandary:  should we wait to do the tests until we see if Karoline has a subsequent fever attack -- a clearer sign that malaria is the culprit?  If so, then, we might run into medical response timing problems because the ferries do not run daily in low season, and windstorms are brewing, which might mean that ferries will not run at all.  

Gerhard and Karoline traveled on the first possible boat to Athens the following day, where blood smears were tested at Ana Sophia, Europe’s largest childrens hospital.  On the ferry they were alerted to a new general strike beginning the following day which meant that no taxis, buses or metro operated in Athens.  Gerhard smartly calls the hotel to request assistance with commandeering an emergency taxi, (one of two in Athens), for the next morning’s transfer to the hospital.  With great luck and persistence the hotel manager is successful.  Nevertheless, all roads were jammed with higher than usual private car traffic.  What normally would have been a 30 minute door-to-door metro commute became an hour and a half.  Upon arriving at the hospital complex Gerhard and Karoline were challenged to find the right department since signs, in Greek alphabet, could not be deciphered and no one could speak English, German or Chinese.  After a chaotic and time draining general registration process, to include Gerhard’s perfunctory and unwitting signed agreement that Karoline would stay the night for Euros 74, they were taken to the proper department.  Here three doctors, (one knows not why), examined Karoline with great curiosity.  Only one could speak a common language, (English).  The blood smear was taken and Karoline was led—to Gerhard and Karoline’s surprise—to her bed for the night.  Since the hospital was over-crowded, she was expected to sleep on a cot in the hallway along with 20 other children.  No way, Jose!  This triggered a series of mobile phone calls…to me…to the pediatrician on Sifnos…to Greek friends who know the system. 

While Gerhard and Karoline were suffering their logistics ordeal, I was manning the phone on Sifnos, becoming impressed by the warm-hearted concern of local friends calling with well wishes for Karoline.  One such friend leveraged her connections to reach Greece’s pediatric specialist in malaria and TB at Athens University. 

By coincidence, the malaria specialist Nikos Spyridis is also on staff to Ana Sophia hospital and was on site during Karoline’s visit.  He met Karoline and Gerhard at the appropriate department, analyzed the test results as negative, fought the verbal battle with the staff to immediately release Karoline from the hospital.  He relayed, (via phone to me), the advice to our local pediatrician that we are not to be alarmed, unless, within the following 5 days, Karoline should have another fever.  It took another two hours to gain release from the hospital, most of which—Gerhard realized later—was consumed by the doctor trying to find someone who could translate the release letter to English for Gerhard’s signature. 

Yet the ordeal was not over.  How to return to the hotel during a general strike?  Despite offers from friends to meet them at the hospital and drive them by private car to the hotel, in the end result the most practical solution was for Gerhard and Karoline to walk the three hours from hospital to hotel.  They walked through Syntagma Square where they witnessed the security brigade surrounding the Prime Minister’s car cavalcade, as well as the forming group of noisy protesters.  They continued on through a depressing industrial section of Athens under a beating sun before arriving at the hotel in the port of Piraeus.  After another over night and a bit of shopping for things we can’t get on the island they caught the next ferry to Sifnos. 

Looking back on the experience we can better understand the challenges confronting Greece as a country:  systematic inefficiencies, lack of sensitivity to economic factors, and lack of desire to make the—shall we call it-- “capitalistic improvements”.  I am catching on that if the *system* was more effective, then the tradition of need to call on a friend’s favor, (to help overcome the system) – with the expected eventual reciprocation – would be unnecessary.  This tradition is a significant impediment to the kinds of change that the EU and IMF is expecting in return for the recent bail-outs.

That is the Greek side of this story.  There is another side as well; that of the American health care coverage while we are abroad for a year.   We found that between IBM and Kaiser Permanente our health care coverage was all screwed up.  Basically, both institutions operate processes and systems designed for the lowest common denominator.  An employee and her family on Leave of Absence is about as far from the design norm as it gets.  Unexpectedly, upon checking, Karoline was not covered.  This despite having spent weeks earlier resolving to a coverage plan via endless Skype calls, e-mails and faxes, (to include Amy and Gerry’s help from distant Virginia—thank you!).  For a while I had visions that the issues would never be resolved before I return to the IBM desk in a year’s time.  However, thanks to a competent, persistent and kind administrator at Kaiser, we are covered, and retroactively to our earlier understanding.

Sum total of the experience:  Three days of missed local Greek school, (Karo brought her U.S. school work to Athens), two nights in a hotel, one 20 Euro taxi ride, a 5 Euros registration fee at the public hospital, a 13 euro CRP blood test at the Sifnos private lab, and no fever within the next 5 days – all confirmed that Karoline is free of malaria.  There is always a silver lining in such situations.  For us, this was the opportunity to become familiar with the medical system and to be more resourceful should we confront another health challenge.  Further, we made acquaintance and became impressed by the skill of Pedro,our local pediatrician.  We launched new friendships with Billie, the nurse, and Gordon, the Sifnos medical lab director.  Our current friends showed us a side of Greek kindness and compassion that is heart warming, endearing us further to the enchantment that is the island of Sifnos.