Musings from America 4 - Hospitals, Babies and health

Now going on holiday does not usually involve hospital visits, unless you are unlucky, or in my case due to my step daughter having her first child. It is sometime ago that I was last involved, over 30 years and whilst I can recall some things, especially the overwhelming feeling which I cannot really describe, when the baby emerges from the mother. This was a new experience.

I did not repeat that particular part as the proud Father and even prouder, if that was possible, Grandmother, were there at the birth along with a doctor two midwives, two pediatric nurses and two care assistants.  American health care is very good apparently.

This conclusion was reinforced when I went to visit the next day. The first impressions, maybe slightly unfair was the hospital approach where there was..........wait for it...... plenty of free parking ! UK readers will confirm that NHS hospitals make parking an income producing activity. 

We walked past A&E, I was later told that this was often empty waiting for people, I am sure the local inhabitants of Nottingham sitting waiting, if there any seats that is, for an hour or so, surrounded by managed chaos, as ambulances come in and more critical or serious patients take places at the front of the queue, would be surprised.

Entering the normal entrance you first see the Security Guard, directed to the lift, known as the elevator, we then had to buzz through to maternity unit. We needed to sign in, given a wrist band, and then the reception calls the patient's room and seeks her permission to let us in.

Of course every patient has their own room, ensuite naturally, TV. I saw two rooms, we got moved, and the simplest comparision is a good level hotel room with adjustable bed and oxygen !

My partner, the grandmother, or Gogo as it is called in Shona, is a nurse and her assessment of the stress load on the nursing staff vs NHS hospitals was very clearly USA low UK high.

I know the days when hospitals had strict visiting hours are mostly now relaxed, but all day seemed to be the norm, just as well as there was a succession of relatives, friends and work colleagues appearing throughout the day and Father slept on a sofa bed overnight.

Baby, Miles Judah, if anyone asks, is home and the great expedition that is child care starts. 

Of course all of this is covered by health insurance which is essential and indeed now mandatory for everyone, not much public funding here, but if you have the money or a good plan, from my limited experience USA medicine is good.

My other encounter with the system was getting an INR test done. Thus is something that I have to monitor and regulate my blood clotting by the use of warafin. Being away for several months the usual system did not apply. I was told to get tests done in USA and contact the UK hospital clinic to get the dosage altered.

This was actually quite simple, first I search goggle for testing clinics in Nashville. I find one and see the test costs $28 which is not to bad, but of course if I did need this every two weeks or so, the total cost would be more significant. Anyway I sign up on line, order a test online, pay via Paypal, get a receipt and form and the details of the clinic.

I drive to the clinic, no appointment needed, wait a short while, mainly because receptionist is AWOL, and get blood taken very competently, the computer file updated and I leave.

Two days later, I was tested on a Friday, I get an email with the results.

En passant, I reflect that the entire body of other people waiting, were there to get drug tests, I suspect court ordered or as part of some treatment regime. As a non drug user, I was in and out whilst the others still were waiting as I left.

Now came the less easy part, I thought why not email my test sheet to QMC hospital in Nottingham, they can run the calculations and email me back.............too simple, too obvious........Extensive searching revealed only one public email address for the entire Trust. I sent my results and an explanation to them, but was not convinced it would get to the right department. Remember I am on a 6 hour time difference, but on getting up at 9am here, 3pm UK, I am able to telephone before the clinic shuts at 4.

Fortunately the USA simcard I have includes free international calling to UK landlines, and I get quickly put through to a Nurse, I hear the handover, saying , "he is in America" and get my dosage instructions quickly and pleasantly. Now it needs repeating in a fortnight .........but the fact that a major Hospital Trust has not caught up with the use of email demonstrates the over conservative and bureaucratic approach of the NHS.......but solving the NHS crisis needs more time, so back to relaxing, shopping and eating, in between babies and this old man's medical issues.

Musings from America 3 - familiar but different

 

I expected things in the USA to be a bit different, language for example........trash = rubbish, gas = petrol, etc but I was taken by surprise by my experience at the gas station, ...........see what I did, speaking in the vernacular already !

The vehicle I have borrowed, (they say truck) is a 5.7 litre V8 ......... economical it is not, though I cannot yet calculate consumption ....suffice to say not a lot ...........but this is compensated by the price. Now Americans complain just as the British do but without a true reason. A simple calculation

Price, depending on grade, three kinds of unleaded petrol, take the midpoint $3.30 per gallon, this is therefore $0.66 per the litre we are now using, the dollar and the pound are about 1.5, thus 41p, compare to £1.35 where it was when I last filled up in UK ...........how the Brits would celebrate if the USA price applied there !

Anyway, back to the plot. My nearest dearest and family, had gone to Church, let me come back to USA and religion another time, so I had a run into Nashville City Centre. Not over impressed, nothing adverse, just "ordinary" though it was Sunday and not so many cars or people, apart from those queuing up to park for the Titans game, they being the local pro football team, the sat nav wanting me to join the street with the queue, which I respectfully declined. The nice American lady in the Ipad did not complain.

On the way back, I saw the gauge for gas reading low, time for a fill up. First thing was to check out where the filler is, I pulled into a car park for something, every business, out of the City proper anyway, has car spaces, and located and tried out the key to unlock ....... success ...... the satisfaction was to be short lived .......... a little further on I pulled into a gas station, a bit of U turning to get the filler next to the pump, no way the hose would reach over the Nissan, ........... digression pronounced Neesan here.

So to the pump, seemed a bit old, but had the usual nozzles, and credit card slot but the display was frosted over and difficult to read. Unclear as to which way the card went in, tried all 4 possibilities, not working, tried another card, same. In hindsight I should have given up then and gone to a more modern station but I really did not want to run out, as I had no spare can and no telephone number for my hosts who were at Church anyway, so I persevered.

There was a fading notice in small print that said to pay in cash go to office first. Clearly a trust issue, imagine that happening at a Tesco or Shell etc. So to the office, explaining that my cards did not seem to work, got no response, alas I seemed to have a man of few words, or at least few words of English, my Spanish is not good enough and whilst this may be a good guess, lots of Mexicans around in this area, I then tried 'can I pay by cash'. Well yes I could but how much would I pay he asks .............. well I realise I have no idea on how big the tank is on the Neesan, apparently big, I learn later. No help from the attendant, so I go for $50, I pay he gives me a receipt and thereafter takes no interest in me.

Back to the car, unlock the doors and petrol cap again, at least I had the sense not to leave either open during my absences, trying to explain my car has been stolen was not an experience I wanted........pick up pump, inset, press handle, zero, nadda, nothing, the display says $50, replaced pump handle try again.........starting to get a little peeved. Press some buttons pretty much at random.........no gas.

Lock up again and back to the office, Mr Talkative had disappeared, three new people at counter, one lady, two men, looks of puzzlement, as I seek instructions, one man, more talkative than the others, says I will show you, again accent uncertain, but gratefully follow him back to pump, unlock again, he presses buttons, without explanation, withdraws nozzle sticks in car filler, somehow locks on the flow and leaves it dispensing and returns to the office. Not much wiser but pleased to be receiving the "make the Neesan go juice" I wait, the handle clicks, ah I think, it has fulfilled its promise of $50 worth of gas, so I take the handle out, at which point it dispenses petrol over the forecourt, my shoes and hands.

Remaining suitably calm, on the surface only, I gave in to an overwhelming desire to leave. Replace cap, replace nozzle get in and go, I resist any inclination to go back into the office and explain, I get in drive off and open windows to evaporate smell........

I have some more petrol, but looking at gauge not a lot, I decline to try again today but mentally note that I want a newer station with shiny pumps next time.

Later when I recount the incident, I am advised that American cards operate on the magnetic strip on the back and do not have the chip that EU ones have, so my cards are probably not recognised and hence I cannot enter PIN, but that not all stations require cash up front ........ a better class area is also needed in my choice for finally filling up........tomorrow is another day, another unexpected experience, the discovery of everyday USA life to be continued.

Musings from America 2 - Stranger in a strange land

Over the next few days, I met a lot of people. First the Wedding Blessing, then the baby Shower and various visitors come to see the people from England.

One thing that struck me was the fact that I was the sole white person, its not often you get the feeling of what its like to be the minority. not that I was not made welcome, though I am not sure whether they came to see Tsisti or find out about this new person, probably both.

What we have here is a mixture of American black people, presumably descendants of the Salve Trade, but these are true Americans and do not have knowledge of Africa or its languages, together with more recent migrants, mainly from Zimbabwe and apparently all related to Tsitsi in some way.

Now I use the term 'related' with caution, as the Zims have a different use of relationships. If your Mother had you and her sister had a child, the children are not thought of as cousins as we, the Anglo Saxon do, but sisters. Throw in the inevitable situations of second wives/husbands and children of failed relationships then the complex interactions and connections are pretty incomprehensible. Most of the people I met were on the generation down stream so Tsitsi is mainly a Mama or a Gogo (Grandmother). The interesting twist is what I was called.........I guess there was some room for different attitudes to my status. Hence I have been called Malcolm, thats simple enough, Mr Malcolm which I think is a sign of respect for an older person, but I have also been Daddy, as the partner of the Mama, though the person saying this was not a direct daughter but as described above. I have also been Uncle which seems a catch all, for those who have some Aunt or Uncle type connection, apparently its means Big Uncle ................OK my head is hurting trying to sort this out, but finally the concept of in laws, father in law, step father etc seem to be totally missing.

This is not a complaint as everyone seemed pleased to see me, well at least I think so, there is always some uncertainty when the Africans start talking in Shona, a totally incomprehensible language, I looked at the grammar and gave up!

Of course the Americans are also excluded, as the Shona speakers switch seamlessly from English to Shona and back again, several times in a sentence, when there is a room full, there is never, I mean never, a pause, someone is always talking and often three or four at once.

The hospitality is tremendous and food is always being offered and the generosity of spirit is uplifting, One lady who is sister, on the loose definition, is lending me her car.........maybe I will eventually catch up, but in essence it does not matter, people are people some nice some not, guess you just live with it. 

There is a saying that the UK and USA are separated by a common language. I find that I am picking up expressions already, interstate not motorway, sidewalk not pavement, gas for petrol, diesel is more rare and most cars are petrol, I am driving this V8 Nissan SVU but the price at the pumps equates to about 40p at litre or liter ! and they complain about the price, they are astonished when I tell them we pay c £7 a gallon, and am astonished that we now accept this as normal. Anyway I digress, some more words, prawns are shrimps, no matter what size and the supermarkets contain things we do not see in the UK, giant bottles of egg whites or indeed whole eggs beaten ready for scrambling, no messy shells !

I am looking forward to more exploration of our differences, such as being able to go through some red lights if no one is there, overtaking on either side and I have yet to try American fast food, clearly I should not, but I need to be able to say I have been in a Taco Bell, Dunking Donuts and Macdonalds rivals like Wendy's.

I have also been buying stuff on line some before we left and delivery here in Tennessee, others since, I have got some good bargains but sometimes they don't like UK cards and if your delivery and billing address do not match, I seem to have overcome this by using Paypal and a preloaded Dollar debit card. I am now ok on amazon.com, maybe to be expected they will sell to anyone, anywhere, but have yet to try ebay. Specialist websites are also mainly OK and there is a huge range of products not available in the UK. Tsitsi prefers the mall and the huge range of physical shops, we went through a place called Madison and I do not exaggerate in saying that every kind of shop spread out in small areas  along the main road stretches for 4 miles, non stop apart from Car Dealerships, Banks, Doctors, Dentusts, vets et al. The USA is the place for shopping without a doubt. The prices are very attractive in general, ordered some boots for my son in law and he has saved £40.

Its only been a few days, but already I feel generally confident, yes I am unfamiliar with the geography but SatNav copes and I can navigate unfamiliar roads whilst driving on the right. The only problem is that there is so much to see that you can be distracted and keeping in the right lane for turns needs concentration.

All for now, but I confidently expect new stuff to emerge from the IPAD onto the blog, thanks for reading....

Musings from America 1 - the journey

Hello and welcome, I need to apologise to any remaining followers of Malcolm's Miscellaneous Musings, for the absence which sort of crept up on me. Don't worry dear reader, I will not try and catch up in a single blog, indeed I determined to start again but reference missing events that explain things as we go along.

One thing was the start of a new relationship, now approaching 24 months, and that sets the scene for the American theme, we went to the USA to visit my partner, Tsitsi's need to go for the birth of her daughter's first baby and hence the first grandchild. I suspect this might be worth a few words in due course. 

For now lets reflect on the planning and making the journey. Now I have become less and less keen on flying and on using airports, and being a big lad and with a bad knee, the thought of 9 hours in the meager space allocated was not attractive. The solution eventually was to go Business Class ....... not cheap when you pay for yourself, but having been on the outward leg Manchester to Atlanta, I will never travel in the cattle class again.

The seats, or rather the pods you get are superb, reclining seats which go all the way flat, the airline Delta, provided pillows and duvet, and you have ...... well a sort of TV but one each and you can select TV, Films, Music etc on a touch screen, saw one film, listened to some new to me music, through supplied headphones which provided high quality sound. The only downside was being interrupted by the cabin staff offering drinks, meals, snacks, hot towels. Excellent meals, high quality food ... I had fillet steak......in all 4 courses, real china and metal knives and forks. Maybe they believe that passengers in the back of the plane, Americans say 'coach', are more likely to hijack the plane if given real cutlery.

Constant supplies of bottled water and after the lunch, we had 'snacks' in the afternoon, three course snacks that is, prawns and salmon, pizza, ice cream if you really want to know.

So plane travel good, ....... airports less so, but we found a way to make that better. Now I have a heart flutter and a arthritic knee, which in combination means standing around in queues and walking through large airports, Atlanta is huge ! difficult. So following advice on the airlines web site, I sought assistance. This involved a wheelchair and pusher first from check in to complimentary business lounge, and then to the Boarding Dock and indeed right to the plane's entrance door, via security checks, I remained in chair, no taking off shoes or belts and fast lane through, highly recommended.

Atlanta was less so, again chair and handler awaiting, miles and I do not exaggerate through this very big facility, via baggage claim, to Customs and Immigration.

USA border police have no sense of humour and it pays to answer clearly and concisely, other passengers were diverted to another room ....... just like on those immigration programs on TV, we cleared after a little delay as the computer froze as he inputted Tsitsi's details. She believes God was watching over her, which was just as well, as her and my suitcases contained a number of items that might be difficult to explain, mainly African ingredients.......think freeze dried caterpillars and grain to make sudsa ..........

Perhaps to make up for our so far good progress, we ended up at arrivals front entrance to find the wheelchair and attendant could go no further and to get to the carhire pick up desks, meant a bus ride, but left us with 6 bags, some pretty big.........one feature of Business Class is allowance of two checked bags up to 32Kg each plus a take on bag each and my dearest made good use of it .........I guess we are away for two months so somewhat necessary .......... but getting that on and off a shuttle bus...."no way" as Americans say. So a taxi ride to somewhere on the extreme edge of the airport.

So picture the scene two old people surrounded by bags in a car park somewhere, no trollies.............leaving Tsitsi guarding the bags I ventured in to collect car, well actually I collected more paperwork and dispensed money produced my licence twice and then walked across a road bridge to the cars. Now I have hired in the UK and also Spain but this system was different. See office, no one in, stand around for a bit, see agent who asks what I want, says she will get the vehicle Jeep Grand Cherokee brought round .........Time passes, she returns and says take any of these pointing to a row of SVUs.

Not wanting to leave my lady with all the bags somewhere for too long, I checked out a few, brands and models with which I am unfamiliar, and choose one that seemed to have room for all the bags. I believe it was a Chevy.....

Now to drive back to where we were dropped, but now two double carriageways away, but only one missed circuit and eventually reunited, Tsitsi sat on bags on the grass, looking like a lost and abandoned soul.

Atlanta traffic notwithstanding, a reasonable journey to Nashville but second half in dark

Though I did not like the Chevy Something, very light and vague steering, seat belt at wrong height and missing the high power, bend round the bends, headlights on my left at home C6............in fact no citroens spotted then nor since.

Arrived at Nashville Navigon satnav US edition proved its worth, straight to the door.

Settled in and to bed, jet lag ok but a long day left nottingham at 6:30 now in Nashville at 22:00 local time ie four o'clock in the morning UK time.