Monday, 25 June 2018

Pediatric care

By Emily Prucha | Prague Daily Monitor |
29 October 2010

Finding a pediatrician was one of my top-priorities when Radek and I moved with our then nearly one-year-old daughter back to Prague. After registering us with Všeobecná zdravotní pojišťovna (VZP), the state insurance company, Radek began a diligent search to find a pediatrician. Although my baby books said I should prepare a list of questions and schedule appointments with a few different doctors to find one whose approach most clearly matched the needs of our family, in reality, the process boiled down to simple logistics. We needed to find a Czech doctor in our neighborhood who would accept our VZP insurance and had space for a new patient (each doctor has a quota of patients they can accept from different insurance carriers). At first, Radek got one or two rejections from doctors who said either they weren't accepting patients or that we didn't live in the right zone of the neighborhood to register with them. However, before long, we'd located a pediatrician a short walk from our apartment that was glad to register Anna Lee.

Being a first-time mom living in a different country, my worries about pediatric care were two-fold. Initially, I was nervous about how I would communicate my daughter's medical needs in Czech. Secondly, I was concerned how the socialized Czech health-care system would match up to the privatized US system we'd just left. I was particularly concerned whether the immunization schedules were the same, and if all the treatment options available in the US were also offered here. I didn't anticipate us being sick often, but I wanted to make sure we could get good care if we were.

Radek accompanied me to the first doctor's visit to make sure that the doctor and I could understand each other. After determining that between my limited Czech, elaborate hand gestures and the doctor's knowledge of Latin we could communicate adequately, Radek turned over the logistics of our daughter's health care to me. Although initially, I felt a bit overwhelmed with the responsibility of communicating Anna's health care needs in Czech, after a few visits, I realized that it was going to be all right. It took some time getting used to the code of conduct in the doctor's office, such as the need to bring two cloth diapers to each examination and never to push a stroller into the waiting room but leave it in the hall instead. Watching how other Czech mothers navigated through office visits helped me learn the ropes.

Since Anna wasn't sick very often, my biggest concern was getting the correct immunizations. I made a print-out of the standard US vaccinations to make sure Anna didn't miss a vaccination that was required in the US but optional in the Czech Republic. In most cases the two countries required the same.

However there were a few notable differences. The tuberculosis vaccination which is given mandatorily to all Czech infants before they are released from the hospital is not commonly given to children in the US, due to the low-risk of a wide-spread tuberculosis epidemic there. Therefore, as part of her Czech welcome package, Anna was given a tuberculosis vaccination shortly after her first birthday. About ten weeks after her shot, we were required to come for a check-up to make sure the site of the injection had reacted properly by turning into a raised, red bump. Although I was reluctant at first for Anna to have the vaccination because I'd long-observed the large scars many Czechs have on their upper arms as a result of their childhood-tuberculosis vaccinations, when I realized it was a standard vaccine, I went ahead with it. Luckily for her, Anna's shot reacted just enough without leaving a notable scar, although a few years later when our son Oliver was vaccinated his reaction was larger and left a scar. Now, looking at the bumps and bruises that cover my kids' bodies on a regular basis, it seems silly to have been so worked up about a little upper arm scar, but it symbolized a culture that seemed much more foreign to me at the time than it does now.

In contrast to the tuberculosis vaccine, the pneumococcal vaccine is part of the mandatory recommended immunization for American children, but an optional, costly (at the time) vaccine in the Czech Republic. Our pediatrician initially dismissed the vaccination as being too expensive, but when I told her that Anna Lee had already received two of the four doses, she agreed that she needed to complete the cycle. During the first year of our move, we still had insurance coverage in the US, so on our next trip back to Virginia, Anna received the last dose. By the time it was Oliver's turn to be vaccinated, our pediatrician herself stated that even though the vaccine was still expensive, Oliver should have it to be in accordance with the American guidelines. In order to obtain the vaccine, I was surprised when the doctor gave me a slip and instructed me to go to the nearest pharmacy to purchase it. I brought the refrigerated doses back to the doctor's office for one to be administered immediately and the rest to be kept for later. We paid for the majority of the doses and the insurance company covered the final payment. Nowadays, the vaccine is still optional, but I know more and more Czech friends who are choosing to vaccinate their children because their pediatrician has recommended it. At the time of Samuel's first round of immunization shots this September the vaccine had become free, which was a nice surprise.

In the case of polio, both countries vaccinated, yet I was surprised to be asked to bring our own spoon on the day of the vaccination so that the nurse could administer a live oral vaccination for Anna. At the time, the Czech Republic was the only country to still offer the live vaccine, our pediatrician told us proudly. When I asked her why, she indicated that Czech scientists believed it worked better. Anna Lee received two inactive doses during the first few months of her life in the US, followed by two active doses in the Czech Republic. Two years later when Oliver was vaccinated against polio the inactive version had replaced the active one in the Czech Republic.

By the time Oliver and later Samuel were born, the immunization schedules seemed to match up pretty evenly in both countries. Most of the optional vaccinations in the US were also offered for a fee in the Czech Republic. Yet the pediatricians that we've visited in the Czech Republic have steered me away from giving my children optional vaccines for one-time illnesses like chicken pox or a yearly influenza shot, believing that in most cases, it's better for the children to experience the illness. Although the swine flu stirred up quite a fuss last year and many of my friends here had their children vaccinated, our doctor said we'd be likely to do our children more harm giving them the shot than we would by just taking common sense precautions like hand washing and avoiding crowded shopping centers in hopes of escaping the epidemic.

In general, the pediatricians I've met here have seemed less eager to vaccinate or treat illnesses with antibiotics, than the doctors I remember from Anna's first year in the States. She is the only child who did get the chicken pox vaccine at our American pediatrician's request. Our current pediatrician is loathe to prescribed antibiotics, unless it's absolutely necessary to treat a bacterial infection like strep, and when the children come with a nasty cough or other symptom she always rules out serious infections first and then asks me if I don't mind waiting a few days to see if the infection will clear up with time and rest. And of course, it often does.

Just as medical standards and vaccination schedules have changed during the years I've been a mother in the Czech Republic, I'm certain they've changed in the US as well. Since we now only have traveler's insurance, we don't visit the doctor when we're back in the US unless it's absolutely essential. Still, from listening to my friends both here and there talk about their healthcare experiences, I think my children have been lucky to find Czech pediatricians who have accepted our children's bi-cultural heritage and have helped me make sure they get proper health treatment, whether it’s a vaccination, a prescription treatment for an illness, or even a referral to a specialist when necessary.

For foreigners who've recently moved to the Czech Republic or for foreign residents who are expecting a new baby, there is an upcoming seminar on the topic of the healthcare of children in the Czech Republic. The seminar is free of charge to non-EU foreigners and is offered by the Andílek family center in Prague 5, through a grant from the Ministry of Labour and Social Affairs.

Emily Prucha is a Life Section columnist for the Monitor. She likes writing about bilingual and multicultural families.
You can reach her at emily@praguemonitor.com. You can read more of her stories here.