It's not Good or Bad, It's Just Different

At 37 weeks pregnant, I am often asked how I feel about giving birth abroad. Am I nervous? Do I wish I was back home for my delivery? Am I ready for a Dutch birth? What occurred to me is that many of us have a misconception that anything other than what we are accustomed to must be bad or inferior. This goes beyond birthing a baby abroad to many aspects of life.

Living abroad the past year has allowed me to dispel many of these misconceptions and biases, though in some cases it has reaffirmed stereotypes. Ever heard the phrase "Going Dutch?" Well it really makes sense to me in light of the Dutch, umm, frugality that Ben and I regularly experience. While I've embraced it as a "cultural difference", I still can't quite understand the lack of ceiling fans, garbage disposals or why M&Ms don't taste the same (lack of delicious chemicals, I suppose).

I can only hope that I am not a walking American stereotype in my  daily interactions. We're not all gun toting, Big Mac eating, culturally insensitive folk.  But do I have a penchant for shopping, sales, and snap your fingers convenience? Absolutely! Oh Amazon Prime and Target, how I miss thee!

There are a few Dutch and American differences that stuck out recently. During a heat wave that topped 99 degrees, we found ourselves struggling to cope without air conditioning.  It's an uncommon amenity in a country that typically sees 70 - 75 degree summers. I played the hot, angry pregnant woman card so we ended up staying in a hotel for a few days to escape the insufferable heat. At least the heatwave gave us the excuse to overindulge in lots of ijsje (ice cream).

As soon as I found out Baby #2 was on the way, I was anxious to learn about the Dutch labor and delivery process. My belief that all Dutch women birth at home with no pain support or epidurals has since been debunked. Although this is the most common route, it is thankfully not the only one available. During the maternity tour at the local hospital, I learned that epidurals are available 24/7 (Phew!) in a labor and delivery room that resembles that of any hospital in the States. While I don't have a dedicated OB, my experience with a midwife has been mostly the same with the exception that I am not stuck in the waiting room for 20-30 minutes for each appointment.

However, the Dutch pregnancy protocol is far different than that of the States in that many of the tests that   are required in the US are optional in the Netherlands. I had to inquire about the dreaded glucose (orange drink) and Group B Strep tests only to find that it is only given to "at risk" patients. Being a Type A  "educated patient", I at least had little push back in getting these tests as long as I was willing to cover the additional costs.  

So once baby arrives, most moms stay in the hospital for 2-4 hours after the birth. Yes, you read that right. If mom and baby are healthy then it's back home in a matter of a few hours.  Here is why:  You go home directly to your Kraamzorg, an at home baby nurse dedicated to assist you from the minute you get home and for the following 8-10 days post delivery. All of this is covered by insurance. Makes sense, right? Might as well be sleeping in your own bed and using your own baby items with professional help to take care of you, baby and the rest of your family. I must admit I'm the most curious about this aspect of Dutch maternity care. Given the Kraamzorg's responsibilities include preparing meals, caring for baby, and giving mom time for herself, I couldn't be more excited! To sum up my pregnancy experience thus far, the Dutch maternity/pregnancy approach is incredibly practical while cost effective. USA take note! Now don't even get me started on Dutch vs. U.S. maternity leave...

If there is one thing I've learned over the past year it is that the Dutch directness is a necessity for getting (and at times demanding) what you want. Sitting back expecting someone else to take initiative isn't going to get you far in the Netherlands. I've embraced the Dutch directness and will continue to be transparent as we embark on our next adventure as a soon to be family of five (Brie, new baby, Maddie, Ben, and I). As the Dutch say, Success! (Good Luck!)

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Dutch Workplace 101

Seven months into our journey abroad, and I can finally say that I'm employed! Not speaking Dutch was an unexpected, HUGE hurdle in my job search - just because everyone here knows English doesn't mean that's what they want to speak in the workplace. Not to mention, Dutch and American healthcare systems are very different so my experience wasn't exactly transferable. Well, I've been fortunate to find Tired of Cancer, a Dutch healthcare start-up that has not only embraced my native English, but actually appreciates my knowledge of the U.S. healthcare system. For those interested, check out www.untire.me (shameless plug of our new app for patients fighting and recovering from cancer). Okay, now I wanted share my experience of what work life really looks like here:

Vacation!!!

There were immediately a few items that I couldn't help but highlight as I was reviewing the contents of my job offer. The standard Dutch vacation allotment is set at 20 days with most companies allowing 25 days a year. Yes - you read that right - and that is not counting government holidays. That is the LAW for everyone regardless of position. Sure beats the 14 days that I've had the past 8 years. There was also something else that caught my eye: the 'Vacation Fund'. Wha? Not only do you get 25 days a year to be out of the office but you get one month's pay to support said vacation days. Italy, here we come!

Now, there is a reason vacation is highly regarded here. There is a strong work ethic with a work hard, play hard mentality. From my experience thus far, the work place is a very focused atmosphere. By that I mean there aren't 15 minute office break chit chat sessions or long lunches. The time in the office is focused and efficient, which has been an adjustment yet a welcome change.

Trial Periods and Contracts:

The Netherlands has strong protections for employees, which means lots of red tape and headaches for employers. It isn't easy to fire someone so employers must tread carefully when hiring. Think of it like a Union.  The first 30 days is seen as a test period for both the employee and the employer to ensure a good fit. If it's not, either party can part exit the contract without issue. After that, your tenure with the company is dictated by your contract, which is normally 6-12 months. From there, your employer can decide to renew…or not.

Dutch Lunch

The standard lunch fare here is well, very Dutch. Simple, inexpensive, filling. Bread is the centerpiece with lots of dips, spreads and other condiments to create a decently healthy lunch. Given the simplicity, there isn't the need for an office microwave or freezer. Our office provides lunch, making life a little easier every morning as it's one less thing I have to worry about. I am already juggling enough between getting myself ready while convincing a toddler to eat breakfast, get dressed, and get in her stroller so we can get out the door.

Lunch is a no-fuss event where we pull out the lunch fixings, dishware and other necessities and sit down within a matter of minutes. We fuel up, chat about the latest news (often whatever crazy tweet storm is happening back in the U.S.) then back to work. I know many in the U.S. often opt for takeout, frozen dinners or leftovers at their desks, but the Dutch approach is refreshing yet efficient! Now, I have to admit I do miss the occasional Jimmy John's sandwich (California Veggie) or Publix market run during the lunch hour, but I can definitely get used to this.

On the topic of food, I had mention some popular (and delicious) Dutch dietary staples:

Hagelslag:  Now most kids would delight in the excuse to eat chocolate sprinkles at breakfast or lunch. Here, it is just what you eat as part of a balanced diet. Really, no joke. Now, keep in mind the standard American cereal, donut or pop tart probably has as much sugar but sprinkles for breakfast just sounds like a diet buster. 

 Applestroop: This sweet, molasses like substance is often used in combination with old cheese. A bit too sweet to be eaten alone (although I am sure there are plenty of kids that do) it always appears on Dutch cheese plates where you would normally find accouterments like honey or marmalade.  You'd be surprised to find that an Applestroop and Old Cheese sandwich is a more common combination than the beloved PB&J. 

Pindakaas (peanut butter) Now on the topic of PB, I had to bring up that the Dutch have the BEST peanut butter brand you can find on the supermarket shelf. Anyone work at Unilever? I need to understand why this brand is available here in NL but not in the USA. Move over, Jiff. This is 10x better than any U.S. peanut butter I've had. The texture and taste are in perfect balance. Our 2 year old peanut butter connoisseur now refuses to eat anything else. Any chance we can get Costco to carry it in jumbo jars? https://www.calve.nl/pindakaas/

Momma Knows Best

We knew it was just a matter of time before we'd be experiencing the Dutch healthcare system firsthand. This last episode even included a bonus trip to the ER. Might as well go big, right? It all started last week with Brie running a high temperature between 103-104F. Knowing the Dutch approach is to wait and see, I bided my time with plenty of Children's Motrin and Tylenol horded from our last trip back to The States. Sure enough, even after three days, I was told "give it a few more days" and call me on Monday.

Before I go further, I have to mention a few pros and cons about healthcare in the Netherlands:

 It's not bad, it's just different: Pediatricians are only seen for routine checkups and vaccinations through the government's children bureau. Kids go to the GP for all immediate issues just like an adult. This can be frustrating as the GP does not see kids often enough to cater to their common illnesses. Case in point, getting a flu shot here for a kid (or adult) is a rarity especially if they are deemed healthy. We went through a bit of red tape to get it but things were made worse by the fact that the nurse administering the vaccines had little experience with children. First, she asked ME where it should go. Then poor Brie was stuck with the needle not once but TWICE since the nurse pulled it out for fear of hurting her.  

Efficiency, Cost, and Control: You can't just go to any doctor. The location (our postcode/zip code) dictates what doctor(s) are available within a certain radius of home.  I can't complain about a 5 minute walk to see the doc. The costs appear to be lower since an out-of-pocket visit is $30 (without insurance) compared to a $75 copay for our doc back in Nashville. However, lower cost comes at a price. The GP is the gatekeeper and it is up to them to refer you to a specialist or the ER. Without their approval you can't pass GO and forget about collecting any medications.  

Finding someone who cares: For the Dutch, customer service is not a priority. From dining out to healthcare, there is little incentive to provide extraordinary service. In trying to get an appointment for the GP, the office receptionist mom-shammed me for debating to bring her in since the only appointment time conflicted with a job interview. To make matters worse, she told me they would reject my ER request (the only urgent care option) since an appointment was available. When asked if I could be placed on a wait-list in case of a cancellation, I was told there would be no cancellations that day. Ugh! Talk about making life difficult.

On Saturday morning, after four days of high fever with a kid not eating, sleeping, and generally miserable, we headed to the ER. Upon pulling up, we were greeted with an empty parking lot and a single person in the waiting room. Further proof that GP gatekeeper/approval system seems to work. 

Our ER doc experience mirrored the GP visit with the same "wait and see" diagnosis. I dug in my heels as I couldn't bear another day without a solution. We suspected it could be a UTI (yes, kids get these) with the help of Google and WebMD. The three hour ER ordeal was worth it when the results came back positive-ish. The doc believed the sample had been contaminated and was only 80% confident. He suggested that we catheterize Brie to get another urine sample and test again. What? It was tough enough getting a toddler to pee in a cup! With my feverish toddler nestled in my arms, I tried not blurt out "Are you crazy? No way in hell is this happening just to be 100% sure she needs amoxicillin." Ben, seeing the look on my face, quickly asked if it was necessary and if we could get the antibiotics without it. This should be no surprise as Dutch doctors are notorious for a selective prescribing habit. The Netherlands has the lowest prescription rate of antibiotics compared to all other EU countries. 

There is something to be said for the Dutch approach as the Netherlands doesn't have an opioid epidemic or antibiotic resistance issue. It's also worth mentioning that the Dutch Healthcare System has consistently outranked the U.S. in terms of healthcare quality. 

While I respect the system that is in place, healthcare is personal. Trusting your intuition is sometimes the best prescription you can give yourself and your family.  Stay well!

Going Dutch

Happy 2018! Hard to believe we're already a total of five months into our life abroad. We're still working on learning the language, navigating the nuances of daily life, and embracing the Dutchie culture. As we reflect on the past few months, I wanted to share a bit more about the activities occupying our time.

Food and Fitness

We live two blocks from a cozy bakery subjecting us to the temptation of croissants each morning. I've had to incorporate plenty of exercise into my daily routine to work off the Dutch dietary staples of croissants, bread and cheese.  My workout here is a bit different from my YMCA bootcamp class or Cyclebar spin in Nashville. I average 5 miles of walking per day in addition to the gym. 
My gym, The BBB Boutique, is known for it's heated cabin workout. It is basically a Pilates reformer in a heated pod of 120 degrees (F). Having not done much Pilates (or yoga for that matter) I was a bit skeptical that this was going to provide me the same workout as bootcamp or spinning. Turns out, I love it. It's an intense workout in a quick 30 minute class.  Who wants to open a U.S. franchise?

New Neighbors 

Establishing a network is one of the key pillars to succeed in a new city (at home or abroad). I've found it especially important now that we have a kiddo. We've been fortunate to land the neighborhood jackpot again even though its doesn’t quite compare to our close knit Richland-West End community. Our neighbors have been a tremendous asset in helping us navigate our new surroundings. From finding doctors to learning the dutch secrets on avoiding parking tickets, the insight has proven invaluable. We'd estimate about 75% of the street has kids based on the number of kid bikes, chalk drawings and toys that line the sidewalks. Ben and I knew we were in a special place as soon as we were invited to a regular post-bed time wine night. We all live next to (or above) one another as is typical in traditional row homes so our baby monitors still stay connected at each other's property. Nothing like being able to grab a bottle of wine and enjoy adult conversation without the hassle of a babysitter. Cheers to that!

Dutch Language

Majority of the Dutch population knows English so it makes communicating in every day life easy. However, you rarely hear spoken English on the street.  Living with a language barrier has made me see things in a different dimension as the words spoken are no longer the focus compared to the interpersonal aspects of communication. The expressions, tones, and gestures speak volumes as I know my own expressions do as well. I am lucky that many individuals can effortlessly switch to English as soon as I give a puzzled look along with my Spreek je Engles?  To truly embrace life abroad, Ben and I started weekly language lessons. With only a month of lessons under our belts, we already recognize more around us but still have a long ways to go. My first lesson oddly enough took place in a former prison now called De Vrije Wolf (The Free Wolf).  Not kidding! It was in operation for over 160 years and only recently was transformed into a hipster work and event space. I have to admit it was kind of fun albeit a bit distracting as each cell still retained the original format complete with toilet and basin.  Overall, I am enjoying the challenge of learning a new language while trying to incorporate it more in daily life. Tot Ziens!