HealthScare

The doctor’s face was beet red and not just because he was pissed off at my wife. We could hear the soap opera “Crying Maria” blaring in the room behind him, and he wasn’t at all pleased he’d been called out to examine Liina’s hand.

“What?” the doctor barked. This was Haapsalu, 2001, and Liina had been manhandled by some Russian thugs who jumped a queue to get aboard the Haapsalu ferry. Liina had boldly attempted to do the job of the ferry operators, who were too scared to even voice protest, and in exchange for her trouble the thugs held her arm and bent her fingers back over her hand. While Liina cried in pain in protective custody on the ferry’s bridge, the cops were called to arrest the queue-jumpers as they disembarked the ferry. Then we hopped in the car and raced to the hospital.

“What?” the doctor snapped again. Liina’s slow response time was getting in the way of his soap. “What do you want?”

Liina held up her swollen hand and explained.

“Move your hand like this!” the doctor demonstrated.

Liina moved it.

“It’s not broken.”

“Couldn’t we x-ray it?” Her fingers were as big as sausages. “I’d like to know for sure?”

The doctor reached out with surprising speed and seized her hand. He twisted it. Liina writhed in pain. “It’s not broken,” he repeated. “No x-ray is needed. Head aega.”

And that was that. The doctor returned to his television, and we drove on to a Tallinn emergency room where both a sober doctor and an x-ray machine were more easily available.


Say what you will about the Estonian healthcare system—and everyone has a horror story—I believe one thing is undeniable: it gets better every year. The days of drunken doctors (as well as Russian queue-jumping thugs) are mostly behind us thanks to EU standards, a more consumer-focused society, and the growing self-confidence of a citizenry who increasingly realize they’re not lower than grass on the great lawn of bureaucracy. Of course, there are some stubborn holdouts, who still think the business of society is transacted using brute force, favors from friends, and the occasional bottle of brandy, box of chocolates, or live chicken given as a bribe. These people are the Soviet residue, and they’re found mostly in the segments of government and business least touched by market forces. Which, sadly, is sometimes healthcare.

Last week, Liina accompanied her best friend Piret to the obstetrician at her family doctor’s practice. Piret is freshly pregnant and was quite excited to see her baby on the ultrasound machine in all its alien-like splendor. It’s her first child, and so she admits some of her questions may have appeared naïve to the doctor. Still, she didn’t feel she deserved the doctor’s repeated answer of: “That's of no interest to anyone in the developed world.”

When Piret could not spot her child on the ultrasound picture and asked if there was a chance she wasn’t pregnant, the doctor snapped, “Are you blind, woman? It’s right there in front of you.” To spare herself more humiliation, Piret falsely confessed that she could see her child.

“And how much do we owe you?” Liina asked, stepping in for Piret and ending the visit to the Soviet Doctor from Hell. The doctor demanded 995 kroons. When Piret took out her bankcard, the doctor demanded cash and told her to run to an ATM across the street. To spare them from seeing the doctor’s face twice, Liina produced the cash and the doctor snatched it from her hand as she shooed them out of the office. No respect. Not even a receipt.

When Liina recounted the story to me later that night I couldn’t help but recall our doctor from Haapsalu. “You think that doctor could have a sister in Tallinn?” I asked. Liina said she was afraid that doctor might have sisters in a lot of places.


Before returning to Estonia in 2000, Liina and I lived in the United States where I worked several years as an adjunct faculty member at a university. Adjunct faculty in America are the bottom feeders on the university food chain, and so the health insurance policy I was able to afford was little more than a guard against catastrophe—a 250-dollar monthly premium got me a five-thousand-dollar deductible policy to cover against major illness. Liina, who traveled frequently to Estonia, anyway, was able to use traveler’s insurance. This was quite cheap, but its downside was that it forced her to visit the American emergency room for any matter, large or small. The one time she did need a doctor—a shard of glass in her palm—we waited six hours to see the physician. The doctor was professional, though if he’d have allowed me access to the anesthetic, I could have done the job myself, and Liina would have been out the door in a mere fifteen minutes. And I might have been grateful enough to treat some of the other patients in the waiting room, many of them poverty cases, nutty hypochondriacs, or people suffering side effects of America’s greatest epidemic: obesity. With calisthenics I would have cured half and killed half, but the job would have been done, and the doctors would have been freed to treat people whose jelly-donut-eating lifestyles didn’t invite illness. But rules are rules, and while I might have been able to pass myself off as a doctor in Haapsalu, I wasn’t welcome to practice medicine in America.

Fortunately, Liina and I were both healthy and so were able to view the American healthcare disaster with detached amusement. We met plenty of the middle class who so staunchly defend their rotting system due to a hyped-up fear of socialism, a people so petrified of government at any level that not only were they unwilling to consider the single-payer system functioning so well a few miles north in Canada, but they were happy to entrust their system to insurance- and pharmaceutical companies and their lobbyists who clearly weren’t motivated to act in the patients’ best interest. At 100 billion USD per year, it's arguably the world's most expensive and least efficient system.

We also met the underclass, those who rely on the emergency room as their primary caregiver and to whom preventative care is at best a dream and at worst a foreign concept. Mostly, our American experience taught us this: America is not for the meek, and it’s no place to be poor.

For most medical treatments, give me Estonia. Yes, the Soviet-era hospitals in their constant state of decay are rather depressing, and the constant buzz of the fluorescent lighting is probably the cause of more depression than winter darkness. And true, I wouldn’t want to have an organ transplant here, and I wouldn’t want to trust an Estonian doctor to diagnose trypanosomiasis, buruli ulcers, or Cushing’s disease, and it’s a fact the American system is tops in the world when it comes to beating cancer. But if I’m able to keep myself fundamentally healthy and only garden-variety illnesses visit me, I’ll take Estonia any day.

And that goes double for emergency treatment. Last spring, during a routine do-it-yourself project, Liina dropped a shelf on my face and I had to visit the emergency room. Since I wasn’t dying (just bleeding from my forehead), I had the presence of mind to put a stopwatch on the visit. Forty-three minutes in and out. And very pleasant doctors and nurses.

I’ve since been once more to the emergency room (Keskhaigla) for my back, and I can’t praise enough the doctors and nurses there. They’ve got their problems, too—the emergency room is full of people who refuse to see their family doctors for one reason or another—but you don’t wait six hours to see a doctor and you’re spared the humiliating financial triage performed by a curt American administrator.

My Estonian family doctors have always been excellent, too, though I admit I have the advantage of some professor friends at Tartu University’s medical school who have recommended physicians to ensure I don’t end up in the hands of doctors like Piret’s. And so far, I’ve used only state doctors, stubbornly believing that I truly ought to get something in return for a thirty-something percent social tax.


I’m pleased to report that Piret found a new physician and she started over. Thanks to an obstetrician and a team of medical pros who seem to love their jobs, it was a wonderful experience for her, and she’s more excited than ever about having a baby. She had to pay six-hundred kroons to a private clinic for another initial visit, but she didn’t get yelled at, and the doctor helped her see her baby on the ultrasound screen. She even got a receipt.

In a country which so desperately needs babies, this isn’t only a victory for Piret. It’s a victory for us all.

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Read it in Postimees ("Tervishoid- ja õud") here.

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Dept. of Shameless Commerce: Give Vello's book for Christmas (in English) this year. (A refreshing alternative to the usual gifts of Kihnu Island sweaters or bottles of Vana Tallinn.) Available in English from Amazon.com here.


Inherit the Family: Marrying into Eastern Europe

Running

How far can a dog run into the woods? was a favorite question of the American marketing professor and beer industry consultant, Robert Weinberg. “Halfway!” Weinberg liked to shout when his students couldn’t come up with the answer fast enough to please him. “Because then the dog is running out of the woods.”

To Weinberg, the dog represented a brand and the running was to illustrate that overexposure to the public isn’t in the brand’s best interest. If the brand becomes too ubiquitous, argued Weinberg, the result is public resentment.

Lately, I’ve been feeling that way about the singer, Ines. Don’t misunderstand me: I’m her fan. I think she’s beautiful, sexy, talented, and she’s probably a great ambassador for Estonia. But lately I’ve tired of seeing her. I open any magazine, turn on any TV channel, and there’s Ines, telling me why she helps deaf kids, why she doesn’t ride a bicycle in the city, why she works out at My Fitness or uses Sensodyne toothpaste (though the last could have been another omnipresent Estonian celebrity). No offense intended, Ines. I love you. But you’re running out of the woods.

Which is one reason I stick to writing. So far, I’ve avoided broadcast media, even though some of the appearance invitations are tempting and come from legitimate Estonian Public Broadcasting programs. A few television appearances probably wouldn’t put me in danger of being asked to talk on camera to a yeti doctor about the importance of dental hygiene, but I’m not taking any chances. (Although in case they pay handsomely, I’ve memorized the lines: I consider regular dental checkups and brushing twice a day to be of critical importance…)

Another reason I’ve tried to steer clear of broadcast media is that being witty on the page doesn’t necessarily mean you can be witty on TV. “Oh, it’s not at all a problem,” said one show host in an attempt to reassure me, “you’re great on the phone. You’ll be great on the air.” But I wouldn’t be great. I’d sweat enough under my armpits and between my toes that at best the studio would flood, and at worst I’d get an offer to do advertising for an antiperspirant (I consider the use of antiperspirant to be of critical importance...).

What I’ve come to understand is that in a small country the need for celebrities is no less than in a big country. The difference is that in a small country, to feed the media machine it’s necessary to operate under the assumption that if you do one media you can do them all. To me, this is like the Estonian Olympic Committee asking tennis-wonder Kaia Kanepi to fill a slot on the Olympic Greco Roman wrestling team, just because she’s an athlete and happens to be in Beijing. For better or worse, I simply don’t have the talent to be a television personality. I talk through my nose, and my thoughts tend to wander and return home after long periods of time—not exactly a skill TV producers are lining up to get.

The issue of my questionable talent aside, I’ve never been comfortable with broadcast media, especially television. The makeup you have to wear gives me a rash, and there is also the inevitable presence of other guests. Should the other guests include Barney the Dinosaur and not Toomas Hendrik Ilves, this has obvious consequences for one’s self-esteem. I once watched an episode of Terevisioon where a guest was interviewed about Estonian national security while an actor in a purple animal suit danced and played in the background. “If I were that guest,” I told my wife Liina, “I’d run over there and beat the shit out of that animal.” Liina replied that that wasn’t the Estonian way. “Okay,” I said, “walk over there and beat the shit out of that animal.” Liina just sneered and said I had a lot of learning to do.

I’m also not the most photogenic guy around. I’m not ugly, but I’ve never suffered from too much beauty, either, and I don’t want to be one of those pain-in-the-ass prima donnas who goes on TV and demands to be lit from the left side or, like I’ve heard Michael Jackson used to demand, requires a bathtub filled with Evian water in his dressing room.

And my Estonian language, which isn’t great to begin with, gets noticeably worse on television. My already strange accent gets even stranger. The few times I’ve tried television and later watched myself, I thought I came off sounding like an idiot. Liina has suggested it has nothing to do with the language.

Finally, in a land of so few television channels, I admit I live in fear that accepting one offer would pave the way to becoming a cheap media whore, the kind of guy who’ll do anything to see his own face on television. “Oh, get Vello,” producers might come to say. “He’ll do anything.” No disrespect intended, but deep inside my DNA I don’t have that gene which pulls me to fame like a moth to the light or a Tarand family member to a gameshow.

Part of what I have against the media in general (print included) is that all of us who participate in it are, to some degree, guilty of feeding the bullshit machine. Even the biggest media with the biggest budgets are not exempt from this trap, and despite CNN’s efforts, they’ve been only somewhat more successful at filling time than even Estonia’s worst television station. Regardless of what anyone says, there is simply not enough real news to fill a 24-hour broadcast, and the CNN “professionals” end up filling the air with so much nonsense, idiots with uninformed opinions, and blatant self-promotion, that I refuse to have it in the home. When I travel, I challenge myself by turning it on in the hotel room to see how long I can endure. Seven minutes is my current record, except for September 11th, 2001, one of the few times in modern history when there simply was no substitute for television.

Writers have other advantages which television personalities don’t. Working on the page gives us time to think about what we want to say and how we say it. If I want to play with a sentence and restructure it a dozen times, I’m only wasting my own time, and no guests sit around quietly suffering. (The Pulitzer Prize-winning author Robert Olen Butler once tried a “watch me write” live internet broadcast, though most people I know who tuned in soon tuned out in complete disgust, and Butler was promptly awarded the nickname, Robert Olen Butthole.)

You may think I’m taking myself too seriously and perhaps you’d be right. Going on television would give me something new to write about and it would “extend the Vikerkaar brand” (as a friend in marketing tells me I should do), and it might bring opportunities to earn money beyond writing. I myself don’t use Sensodyne (I’m a Blend-a-med man), but I do use Gillette products, and I like Snickers candy bars, A. le Coq beer, and Lay’s potato chips. Might there be a hairy man in a white jacket out there to interview me about my grooming- or junk food habits?

But I doubt I’m in danger of running out of the woods anytime soon. According to Liina, I’ve had my nose up against the first tree I saw for quite some time, examining the bark in great detail and writing essays which speculate about why the ants I see move the way they do.

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Read this in Estonian in Postimees.