The Dutch Attitude Toward Infection

Dutch medical care is reknown for its comparatively low cost and accessibility to people of all incomes. Some services would seem to be unique to the Netherlands, including Kramzorgt, the postnatal care in which a trained woman will come to your house for about a week after a baby is born to help care for you and your family. That being said, there are several differences between healthcare in the Netherlands and elsewhere that deserve consideration. The Dutch attitude toward infection actually defies current scientific understanding of the spread of disease.  While critical of a perceived overuse of antibiotics or dependence on medicine, the Dutch perspective on infection is that it’s just part of life, and it probably won’t kill you, ignoring the emergence of antibiotic-resistant strains of pathogens. The Dutch do not seem to consider that living nearer to farm animals and farm byproducts makes it possible to encounter animal-vectored diseases more easily.  Gastrointestinal illnesses are almost always dismissed out of hand without even a stool test because the patient probably won’t die.  Odd rashes go undiagnosed.  Likewise, a generous medical leave system allows people to go out of work for weeks instead of being cured and sent on their merry way.  Therefore, the Dutch really don’t track their own frequency of potentially grave-but-rarely-deadly illnesses.  The good news is that when the Dutch recognize an obvious threat, they will react.  A small, but deadly outbreak of meningococcal C in the early 2000’s resulted in a country-wide program to vaccinate every child in the Netherlands.

So, though the Dutch may keep immaculate houses and clean their restrooms often, you will find that when you visit a restroom at a restaurant there is only one sad strip of cloth on which to wipe your hands.  Restaurant workers rarely wear gloves. Dentists and orthodontists do not necessarily wear gloves.  In addition, handwashing as a precautionary measure is not emphasized with children at school.  So, in short, don’t be surprised to find that your family with young children may be more ill than you remember being in the U.S., and it won’t just be because your family was never exposed to the germs of the Netherlands; the Dutch get sick as well.

The Dutch Attitude Toward Pain

The Dutch attitude toward pain is very much in line with "Pain is good for the body." Dutch women are increasingly asserting their rights to painfree childbirth in a country where, as recently as five years ago, offering such was considered aberrant. It can be challenging to obtain the same level of pain medication you might have received in England or the U.S. for chronic backpain, kidney stones or other such conditions. "Paracetemol," a Tylenol substitute, is the favorite drug of choice prescribed by physicians for pain.

Medical Care

We’ve learned a lot about the Dutch medical system since coming here, and we want to pass along advice to you so that you can make educated decisions.  Note that many of the wealthy Dutch, owing to their own issues with the Dutch medical system, receive medical services in other countries such as Belgium and Germany.

The gatekeeper for the Dutch medical system will be your huisarts or local family doctor, whom you select when you first arrive in town.  The huisarts has normal doctor’s hours, usually setting aside a small fraction for walk-in, about 3/8 for appointments and 5/8 for housecalls.  Your huisarts will also go on vacation, in which case his patients will also be covered by another doctor in your neighborhood.  After hours and on weekends, you must go to the Centrale Huisarts Post, whose number you will receive from your huisarts.  To go to the CHP, you first call the CHP (don’t go there unless you are dying!).  Get an appointment time.  Then, go to the Diaconesset Hospital (now also referred to as Maxima Medische Centrum) on the northwest side of Eindhoven just off the ring.  Each of the three major hospitals in Eindhoven also has an Emergency Room (eerstehulp), which you go to under emergency conditions.

Traditionally, a single apotheek in Eindhoven was dedicated to being open after hours, but the responsibility rotated amongst drug stores.  So, once you had had your feverish child seen at 11:00 p.m, there was still the drive to one open apotheek in an obscure section of Eindhoven.  We had an experience where they would not let us pay for medicine in the middle of the night with a pin card because the pharmacist was behind security glass, and to enter the pin card, they would have had to let us into their “secure” area.  We believe that the CHP has now put an apotheek in next to them, but, just to be sure of a smooth transaction, have a map and cash on hand when you go to the CHP.

The trouble really arrives when you want greater medical service than the Dutch system is prepared to provide.  The Dutch medical system does not provide for regular papsmears and mammograms before the age of 50 (and even then, it’s about every 3 years for mammograms).  Unfortunately, this could contribute to the fact that the Dutch have a lower survival rate for breast cancer. Your huisarts runs gynecological exams. 

Actual treatment of readily diagnosable illnesses is probably on a par with that of other first-world countries, but many patients receive treatment too late.  If you have a severe medical problem or a chronic, unusual illness, you will need to get in line.  Cancer patients are told they will have to wait for treatment.  Open sores in young children can require months to get treatment, even after repeated bacterial infections.  And that’s for people who speak fluent Dutch.  Although Eindhoven has three inter-related hospitals, the nearest university-affiliated, research medical center is in Maastricht.

On some positive notes, children under a certain age receive regular, well-child checkups at a center in Eindhoven.  If you are registered properly with your local city government, called a “Gemeente,” you will receive a “summons” to bring your child at some point. The nurses seem to be above average in terms of professionalism and caring. 

In short, if you have a family member with a significant, medical health problem, do not come to Eindhoven.  If you do come to Eindhoven, bring some books that will help you diagnose your family’s illnesses yourself, so that you will be half way to getting your answers before you begin working the system.

Mental Health

To the best of our knowledge there are no native English speaking therapists working in the Eindhoven area.  This is in part due to the dearth of native English speakers in the area, and also due somewhat to the Dutch attitude toward therapy.  Most mental health services for expats are available in Amsterdam, the Hague, and Utrecht.  Utrecht, being nearest, is one hour away from Eindhoven by train.  You can get a referral to these through the Access Foundation, the information for which can be found at http://www.euronet.nl/users/access or by calling 070-346-2525.

Dentristy/Orthodontia

Dentisty in the Netherlands focuses more on treatment than prevention. The prices for dentistry services are mandated by the government, and therefore, dentists are not incented to provide “fancier” or cosmetic services.  In addition, the standard of care is uneven, and gum and tooth problems can escalate without your receiving the type of attention you would in the U.S. It really would be best to have regular dental checkups in the states.  In general, German dentistry is considered by the Dutch to be superior to Dutch dentistry. 

There can be long waiting lists to get in to see good Dutch orthodontists (when we called, it was two years); therefore, if you will be coming over with a child who needs orthodontia, get on the waiting list before you move.