Latest / Dam Parenting / Who do i call when my child is sick in the Netherlands | A Youth Doctor explains the system

Transcript

Who do i call when my child is sick in the Netherlands | A Youth Doctor explains the system · Dam Parenting

• 0:00
  OK, before we get into it, I want to say something quickly
• 0:02
  and from the heart. This episode is a big deal to
• 0:05
  me. Like genuinely not in a dramatic
• 0:08
  way, just in a quiet. I've been working on this for
• 0:11
  over 2 years now and I really hope it makes a difference for
• 0:15
  some of you out there navigating this system with your kids.
• 0:18
  So here's the ask. You can make a difference too to
• 0:22
  this podcast. If damn parenting has ever
• 0:25
  helped you figure something out, it saved you from a panic Google
• 0:28
  at midnight or just made you feel a little less alone in this
• 0:32
  very particular experience of raising our kids here in the
• 0:36
  Netherlands. The single best thing you can do
• 0:39
  is to subscribe. And if you've already done that
• 0:42
  or if you're feeling extra generous, leave a review or
• 0:46
  share it, forward it to a parent in the WhatsApp group, the
• 0:49
  Facebook group, wherever, just anyone who might be asking
• 0:53
  questions. Just tell someone it costs
• 0:56
  nothing and it means everything. And it helps more families find
• 1:00
  this. OK, that's it.
• 1:03
  Now let's get to the good stuff. Welcome back to another episode
• 1:09
  of Down Parenting. I am your host, Eva.
• 1:11
  And I'm going to start today's episode a little differently.
• 1:14
  There's this phrase, Mama bear. Everyone's probably heard it.
• 1:17
  Maybe you even use it. I kind of half understood it.
• 1:20
  Like, yeah, of course everyone protects their kids.
• 1:22
  Of course you do. But then I actually lived it and
• 1:26
  I'm not going to get into the details.
• 1:27
  It's not that kind of an episode, but there was a period
• 1:30
  where my instincts were telling me that something was not right
• 1:32
  with my daughter and I would sit up night after night.
• 1:36
  And this is from back when she was one.
• 1:38
  So we're talking over 4 years ago.
• 1:41
  It happened multiple times over multiple months over these
• 1:44
  multiple years. And basically I was put in my
• 1:48
  own sleep and my own needs somewhere at the very bottom of
• 1:51
  any lists because there and then the only thing that mattered to
• 1:55
  me was her. And I had to learn to advocate
• 1:57
  in a way that was completely new to me and in a system I did not
• 2:01
  understand and in the language that was not my own.
• 2:04
  And somewhere in the middle of all of that, this is what Mama
• 2:09
  Bear actually really meant. You're going to fight for your
• 2:12
  child. You're going to find those words
• 2:14
  even when you do not have those words, and you're going to push
• 2:17
  even when you feel like you're being too much.
• 2:21
  So since then, I've actually met a lot of parents in our
• 2:23
  community whose children are navigating everything from food
• 2:27
  allergies and asthma to things that are more internal, more
• 2:30
  psychological, harder to name. And every single one of them has
• 2:34
  had to figure out a healthcare system that is not the one that
• 2:37
  they grew up in. A system with different rules,
• 2:39
  different language, different philosophy, and sometimes a
• 2:42
  different way of listening. Which is why from the very
• 2:46
  beginning of Down Parenting, I've been trying to get the
• 2:48
  right people on this podcast. Not just general advice, actual
• 2:52
  practitioners, the people inside the system who can help us
• 2:56
  understand it. So when we walk in to an
• 2:59
  appointment, to a consultation or any conversation, we're not
• 3:02
  starting from zero. We're starting from somewhere.
• 3:06
  So for over 2 years now I've tried.
• 3:09
  I've sent emails and DMS, I physically shut up events, and I
• 3:12
  was told more than once that expats are not the priority
• 3:15
  right now. And every single time I tried to
• 3:17
  carefully explain it's not just expats, it's US immigrants.
• 3:23
  It is anyone who did not grow up here who does not have the Dutch
• 3:26
  parent to call and who does not have the cultural shorthand that
• 3:30
  tells you which door to knock on and what to say when it opens.
• 3:35
  And then last November, well, something shifted thanks to the
• 3:39
  wonderful April from Healthy Hair done on El, a space that
• 3:42
  exists specifically to support our community in the
• 3:45
  Netherlands, to help us find and understand the systems around
• 3:48
  us. I was introduced to someone from
• 3:50
  the Hey Hey day and they put me in touch with the doctor from
• 3:54
  the children's unit. And I've been sitting on this
• 3:57
  episode now, well, for the last month between sickness and
• 4:01
  whatever. Well, basically, I'm afraid I
• 4:05
  just wouldn't do it justice. And the nerves got the better of
• 4:08
  me and well, the nerves are just, well, the nerves are
• 4:12
  nerving is all I can say. I'm still nervous, if I'm
• 4:16
  honest, even saying this out loud.
• 4:17
  But here we are today. I'm done parenting.
• 4:21
  Dr. Marana van Hegel Buddha is a youth healthcare Doctor Who's
• 4:26
  going to join us to shine some light on the system that so many
• 4:30
  of us are trying to figure out. Her team works under the
• 4:33
  different names depending on where you live in the
• 4:34
  Netherlands, the Okate in Amsterdam, the Say JZ, the JGZ.
• 4:41
  We're going to get into all of that.
• 4:43
  I hope there's something in this episode that you can take away
• 4:46
  and hold onto because something that makes you feel a little bit
• 4:50
  more confident the next time you go sitting in the waiting room
• 4:53
  or you picking up the phone or you're just trying to figure out
• 4:56
  which door to knock on. That's all I've ever wanted this
• 4:59
  podcast to do. Let's welcome Marana van Hengel
• 5:03
  Buddha. Thank you so much for joining us
• 5:04
  on Dam Parenting. Good morning, I'm happy to join.
• 5:07
  It took a while to finally get someone from the Fey Fey Day to
• 5:10
  join us, so I'm sincerely thankful for you willing to come
• 5:13
  on and shed light on the system. So we hear a lot from
• 5:17
  international parents that sometimes they can arrive into
• 5:20
  the system and sometimes they are pregnant in the system.
• 5:23
  And at the end of the day, the system is very foreign, not just
• 5:26
  language, but the whole structure.
• 5:28
  Can you tell us what do you think catches people off guard
• 5:32
  the most? Yes.
• 5:32
  So the region I work, I work with a lot of people from
• 5:36
  different regions, a lot of expats.
• 5:39
  And I think what's quite complex to comprehend is that in many
• 5:43
  countries, Healthcare is organized in a different way.
• 5:47
  You have different systems to enter the healthcare system.
• 5:50
  You have different ways of contacting the healthcare when
• 5:56
  you will have an emergency or when you need your child to be
• 5:59
  seen or anything. So they're used to the way
• 6:03
  healthcare systems works in their country and then they have
• 6:06
  to adapt to our system. It's probably part of the
• 6:10
  difficulties is the language. And then we can, I think zoom in
• 6:14
  on different healthcare professionals that might be a
• 6:18
  bit specific for the Netherlands, for example, like a
• 6:21
  GP and the midwife. So we have a lot of first line
• 6:26
  care here that's maybe uncommon for people in the country where
• 6:30
  they came from. And I think there's always a
• 6:32
  kind of question is, is it just us or do Dutch people also find
• 6:37
  the system a little confusing? Or is it only just from us
• 6:40
  coming from a different system? I think it could be both ways.
• 6:43
  So if you're grown up here, you're educated with the system,
• 6:47
  I think it's quite clear. But yeah, if you're not used or
• 6:52
  don't use healthcare a lot, it might be difficult also for
• 6:54
  Dutch people. Good to know it's not just us
• 6:57
  and the cultural layer is real, I guess, because it's not just
• 7:01
  that the system works differently.
• 7:02
  There is a different philosophy behind this depending on where
• 7:05
  you're from as well, the relationship between patient and
• 7:08
  doctor and the decisions that also get made.
• 7:10
  Can you speak a little bit about that?
• 7:12
  You know about things like the paracetamol and the antibiotics
• 7:16
  and the referrals and everything else.
• 7:17
  Yes. So I think talking about that
• 7:20
  maybe indeed it's seen as a bit of a Dutch routine.
• 7:24
  And I think we get to the point there that we explain a little
• 7:28
  bit about the hazards. So it's called the GP and we
• 7:32
  have a lot of hazards in the Netherlands and the hazard is a
• 7:36
  very important person. The hazard is actually the key
• 7:40
  person to go to regarding any physical and or mental health
• 7:44
  issues. They offer medical generalistic
• 7:47
  care, they can prescribe medication and they also refer
• 7:51
  to specialists if needed. But they they are very well
• 7:55
  educated. They've done a very severe
• 7:58
  educational program and they help out with a lot of things,
• 8:02
  as I say, regarding physical and or mental health issues.
• 8:06
  To get back to your question regarding paracetamol and
• 8:10
  antibiotics, I think the Netherlands are maybe seen as a
• 8:13
  bit of a defensive country regarding prescription of
• 8:16
  medication. I think this is partly because
• 8:20
  we are educated and raised in this way and this is the system,
• 8:24
  how we've organized it and how it works.
• 8:27
  Regarding, for example, the antibiotics.
• 8:29
  It's also quite important for us to prevent the resistance for
• 8:34
  antibiotics. Whereas in different countries I
• 8:37
  am aware that they often prescribe antibiotics for maybe
• 8:41
  airway infections or cough and colds.
• 8:45
  Whereas here in the Netherlands we generally do not do that.
• 8:48
  And that's also an important reason because mainly these
• 8:52
  airway infections are caused by viruses, and antibiotics
• 8:56
  generally do not help and work against viruses.
• 9:00
  They're mainly working for an bacterial infection.
• 9:04
  Yeah. And of course, there is also,
• 9:05
  yeah, medical policy, how we indeed organize the country, how
• 9:09
  we organize the healthcare that has influence on these
• 9:11
  decisions. I think it's good to emphasize
• 9:14
  that, at least for us as Dutch people, the fact that AGP will
• 9:19
  not prescribe any specific medication is not the same as
• 9:23
  not taking good care of the client or the patients.
• 9:27
  And it's maybe, as you say, our philosophy.
• 9:29
  And sometimes for foreigners it's seen as not taking good
• 9:33
  care of us or not doing anything, just prescribing
• 9:36
  paracetamol. But I think we see it in a
• 9:38
  different way. And that frustration can also be
• 9:41
  real for the families who basically arrive here having had
• 9:44
  completely different experiences.
• 9:46
  Some come from systems where you just walk into a specialist,
• 9:50
  some systems where the GP would have done a lot more antibiotic
• 9:54
  prescription giving or listening to what you need and basically
• 9:57
  adhering and saying, OK, let's give you what you're thinking
• 10:00
  might work for you. There's no one other type of
• 10:03
  system, I guess. So this Dutch system is
• 10:06
  genuinely unique and therefore every other system is also
• 10:10
  unique in their own ways. How do you handle that in the
• 10:12
  practice with your international patients?
• 10:15
  So I think from my point of view, so we work in the youth
• 10:19
  healthcare system. So we're a preventive healthcare
• 10:22
  organization. And I think explaining and
• 10:26
  giving some time as we meet new people, we always plan a home
• 10:30
  visit. We try to explain the system, we
• 10:32
  try to explain how things work, how things run, who you can
• 10:37
  contact for certain different needs or questions.
• 10:42
  So I think it's always good as a community to be open to people
• 10:47
  from other countries and to make time to explain how things work,
• 10:51
  and also to have respect for the fact that they are used to such
• 10:55
  a different system. So it's not easy for them to
• 10:58
  adapt and to understand. And if we pay attention to that,
• 11:02
  I think that's a good attitude to try to help them and be
• 11:07
  available to answer the questions.
• 11:09
  OK, well with that, let's try and answer some questions.
• 11:12
  I guess let's lay out the map as it would, because I think the
• 11:15
  first thing international parents need is just names and
• 11:19
  what they do. So can we start with you, for
• 11:21
  example, in simple terms, I guess, who is the house arts and
• 11:25
  what do they actually do? Yes.
• 11:27
  So in the Netherlands, after your medical degree of about six
• 11:31
  years at university, you're registered as a basic doctor.
• 11:36
  From that point of view, you can go into specialization.
• 11:40
  So you can specialize into GP hazards, which is another three
• 11:45
  years. You can also specialize in any
• 11:48
  other specialty like surgeon, gynecologist, for example,
• 11:51
  pediatrician, and you can work in the preventive healthcare
• 11:55
  sections like youth healthcare. And regarding the GP, So they've
• 11:59
  done a thorough education with a lot of practical experience.
• 12:04
  They're trained to handle emergencies, they're trained to
• 12:08
  prescribe medication. They're trained to deal with a
• 12:11
  lot of General Healthcare issues.
• 12:14
  It could be anything. Yeah, it's wounds, it's problems
• 12:18
  from your internal organs. You can have problems with your
• 12:23
  mental health, they can always see you GP, it's generally free
• 12:28
  of charge and they can decide whether they can treat you, they
• 12:31
  can guide you or they can refer you to a specialist or to
• 12:36
  another type of professional. So I think they're a good sort
• 12:39
  of first person to contact to discuss your questions and
• 12:44
  complaints. And I think there's going to be
• 12:46
  some families out there or some listeners out there that's,
• 12:49
  well, when we find out we're pregnant, we automatically ring
• 12:52
  the house arts. But well, all we get is
• 12:55
  congratulations, now go call your Velos Kondeka.
• 12:57
  And sometimes we don't really know what that means.
• 13:00
  Can you explain to us a little bit about why we're seen by the
• 13:03
  Velos Kondeka? And we have a whole episode on
• 13:06
  the Velos Kondeka back in Season 1.
• 13:08
  So people can go and listen to that, which goes into the whole
• 13:10
  training. But can you just explain just a
• 13:12
  little bit why we're seen by them and not by you?
• 13:15
  So in the Netherlands, the midwives play a central and
• 13:18
  independent role in maternity care, unlike in many other
• 13:21
  countries where obstetricians or gynecologists are the primary
• 13:25
  providers. The Dutch midwives are
• 13:28
  responsible for the first line primary care for pregnant women
• 13:33
  with low risk pregnancies. So I think that's good to
• 13:37
  emphasize. So the midwives, they're
• 13:39
  trained, they see you throughout the whole pregnancy.
• 13:43
  They make ultrasounds, they monitor your blood pressure,
• 13:46
  they do the lab applications and results and they guide you.
• 13:50
  As soon as you do have, for whatever reason, a bit of a
• 13:54
  complicated or higher risk pregnancy, then they have also
• 13:58
  these guidelines that they need to refer you to the specialist,
• 14:02
  which will be the obstetrician gynecologist in the hospital.
• 14:06
  And then from that moment on, you'll be guided by them.
• 14:10
  And if that's the case, you will also give labor in the hospital.
• 14:15
  I think that's maybe also good to emphasize it's quite
• 14:18
  different from other countries maybe in the world that the
• 14:20
  midwives do guide the labor either at home if patients want
• 14:24
  it, or they can guide the labor in the hospital, but under their
• 14:29
  care if it's a low risk pregnancy.
• 14:31
  And as I said, if you're into gynecology and you're guided by
• 14:36
  the obstetrician, then you'll always give labour under their
• 14:39
  care in the hospital. OK, so for new and expectant
• 14:42
  parents listening, registering with the Velos Kantoha is your
• 14:45
  first step in pregnancy. Your household is still
• 14:48
  important, but they do hand that care over.
• 14:50
  So that's good to know. Now let's get into the well,
• 14:53
  where you work, the yay Hey Z in English, that's JGZ and I want
• 14:58
  to spend some time here because this is where the naming can get
• 15:01
  confusing. So depending where you live in
• 15:03
  the Netherlands, this service might be called something
• 15:06
  different. So can you actually explain to
• 15:08
  the listeners what it actually is and why listeners might know
• 15:12
  it by different names? Yes.
• 15:14
  So in the Netherlands, youth healthcare, we call it Yoked, is
• 15:19
  organized by the national government.
• 15:22
  We have a budget for the healthcare system and it's part
• 15:26
  of the public health system. Every municipality has youth
• 15:30
  healthcare. In most locations in the
• 15:33
  Netherlands, it's called the Hey day.
• 15:35
  So youth Healthcare is part of the hey day.
• 15:38
  In some other municipalities it's called the Say Hey.
• 15:42
  So this is the center youth and has in so the Center for Youth
• 15:47
  and Families. But we're actually, we're
• 15:49
  offering the same care. And I think what's good to
• 15:52
  emphasize is that to explain a little bit who work for the, so
• 15:57
  it's me, it's the youth health care doctor.
• 16:00
  We have a lot of youth health care nurses that work with us.
• 16:03
  We do have also a screen team. So they do the home visits after
• 16:08
  the babies are born. They screen for congenital
• 16:10
  diseases. They perform a hearing test in
• 16:13
  the first week after delivery. And of course, we have a lot of
• 16:16
  other staff that works with us. We're always divided in
• 16:20
  different centers, municipality. As you are living in Amsterdam
• 16:26
  and maybe a lot of listeners will be in the big city, I think
• 16:29
  it's good to emphasize that of course, Amsterdam is a very big
• 16:34
  city with many different youth healthcare centers.
• 16:38
  In Amsterdam, they're part of the Okate.
• 16:41
  So this means the Outer and KINT team, and that's also how you
• 16:45
  can find them. I work in Radio Amstelvane, so
• 16:48
  this is Amstelon region. We do not work with Okate
• 16:52
  structure, but we, we work in a little bit in a different way,
• 16:55
  but I think we can maybe get back to that later on if needed.
• 16:59
  And what do we do as the youth healthcare?
• 17:01
  So we're involved with all the families from baby onwards to 19
• 17:07
  years old. We also actually do provide care
• 17:10
  already for pregnant women. So we say actually we work from
• 17:13
  -9 months from the conception to 19 years.
• 17:18
  We monitor growth, we monitor well-being, we monitor our
• 17:21
  behavior development, we monitor motor skills, we perform the
• 17:26
  national vaccination program and we give a lot of support to
• 17:30
  families regarding questions about how to raise the children.
• 17:33
  But it can also be a bit of broader questions to do with
• 17:37
  housing, to do with financial things.
• 17:39
  We can advise them where they can seek help.
• 17:42
  I think our aim is to have as many happy and healthy children
• 17:47
  growing up in the Netherlands as possible.
• 17:49
  We're free of charge and it's also good to say where it's
• 17:53
  voluntary so you do not have to use our care.
• 17:57
  Though in the Netherlands about 95 to 99% of the families do
• 18:03
  visit the a face it and mainly between the age of 0 to 4 this
• 18:08
  percentage does visit. Well, that's great to hear.
• 18:11
  And this service, whatever can be called wherever you are in
• 18:14
  the Netherlands, it's free, it's proactive, and they also will
• 18:18
  reach out to you, so you don't necessarily have to find it.
• 18:21
  Can you explain a little bit to the is about the two different
• 18:23
  approaches if you're pregnant here or if you arrive here?
• 18:26
  If you are registered in the country, so you do have an
• 18:29
  address and you are a citizen, then when you do have or get a
• 18:35
  child, automatically the municipality gets a notification
• 18:40
  that there is a new client, there's a new patient, and
• 18:43
  automatically the AKZ will be informed of the arrival of the
• 18:48
  newborn. If you're known in the system,
• 18:50
  if you might have an older child, we do have already your
• 18:53
  contact details. So yeah, KZ will reach out to
• 18:57
  schedule the first home visit to meet the family and to meet the
• 19:01
  newborn. If you come from abroad and
• 19:04
  you're new here, as soon as you do give labor and get a child,
• 19:08
  then also what will happen is that the AKZ will get a
• 19:13
  notification of a new newborn arriving.
• 19:17
  If we at that time do not know the family yet, what we'll do
• 19:22
  send you a letter to the home address because that's the
• 19:26
  contact details that we are offered because of registration
• 19:29
  in the municipality. We'll send you a letter and
• 19:31
  we'll introduce ourselves and we say please provide us your
• 19:35
  contact details, meaning your e-mail address and your phone
• 19:39
  number so we can reach out to you and then we can be in touch
• 19:43
  to schedule appointments. And just to be completely clear,
• 19:46
  for anyone listening out there who might be attempted to call
• 19:48
  the Okate or the yay Z or the Hey hey day at 11:00 tonight
• 19:52
  with a sick child, that's not what this service is for, right?
• 19:56
  Correct. 11:00 It's not generally our working hours, so
• 20:00
  that's good to emphasize. So we work weekdays Monday to
• 20:03
  Friday 8 till let's say 5 fish and as.
• 20:07
  I try to explain a little bit. So we do monitor growth,
• 20:10
  well-being healthcare, we're preventive healthcare.
• 20:14
  So regarding your question about my child is sick, I do have an
• 20:18
  emergency or I do have an urgent question without office hours,
• 20:22
  then indeed you can rely on the GP or as we maybe come to it the
• 20:28
  hazards and posts because they cover the out of office hours
• 20:33
  for emergency care. So you just mentioned there when
• 20:36
  we have the baby here in the Netherlands, we go and register
• 20:38
  it and we get the contact details.
• 20:40
  What about the families who are arriving here with older kids?
• 20:42
  What happens there? Yeah.
• 20:44
  So if we talk about the youth health care, actually the same
• 20:47
  thing happens. So if people arrive here with
• 20:50
  older kids, it's the same procedure.
• 20:52
  You register at the municipality, we got a
• 20:54
  notification there are new people arriving.
• 20:56
  We sent a letter to contact the family and we await their reply
• 21:02
  for the contact details to set up appointments.
• 21:05
  So regarding the youth health system, all the children and
• 21:09
  babies zero to 19, they will be automatically pop up in our
• 21:14
  system. Whereas with the GP this is a
• 21:17
  different registration as families arrive.
• 21:20
  You do have to seek a GP yourself, so you have to look on
• 21:25
  the Internet. Where can I find a General
• 21:28
  practitioner and can I contact the the practice to register as
• 21:34
  a family or as a person? So this is an active process
• 21:37
  that the client, the patient, him or herself should follow.
• 21:41
  So the command to registration is generally a trigger for all
• 21:44
  of this. It's actually not just an admin
• 21:46
  box that you take. For the youth health care
• 21:48
  registration, yes. That's good to hear, and here's
• 21:52
  something that I think is actually generally useful and
• 21:54
  it's not widely known when the Hehe de does contact with the
• 21:58
  family after you register at the Hementa.
• 22:00
  There's something specific you can do that can make a real
• 22:03
  difference. Can you give us a little bit
• 22:05
  more information that parents should be aware about when they
• 22:08
  get that letter when you arrive in the country?
• 22:10
  Yeah. So I can imagine if you come
• 22:12
  from abroad, there is a lot of new things happening.
• 22:15
  You, you live in a new country, there's a new language.
• 22:17
  So you might get a bit lost in the system, but indeed us the
• 22:21
  day the so we're the same organization.
• 22:25
  We will reach out to all the children and families that
• 22:30
  Register here. And it's very important to
• 22:33
  indeed open the letter to see the invite and to get back to us
• 22:38
  to give us your contact details so we can set up appointments.
• 22:42
  And then I think that would also be helpful if we pay a home
• 22:46
  visit or we speak to you on the phone, we can explain a little
• 22:50
  bit about the healthcare system because if we normally pay a
• 22:54
  home visit, we always explain about the whole system.
• 22:57
  This Is Us. This is the yay face that it's
• 23:00
  important to seek a house or to yourself to register at a GP.
• 23:04
  We do have the hospitals. Normally you use hospital care
• 23:07
  either in emergency settings or if you are referred to the
• 23:11
  hospital specialist, either through US, yes is it or through
• 23:15
  the GP? In general in the Netherlands,
• 23:18
  specialist and hospital appointments are not available
• 23:23
  or accessible without a referral has so you cannot pop up at a
• 23:27
  hospital to ask for an appointment.
• 23:29
  That's not the way the system works, but we're happy to
• 23:32
  provide the information and to help people to get around and
• 23:37
  organize themselves here. So the tip is when the hehe de
• 23:41
  gets in touch, make sure you respond, give them your details,
• 23:43
  tell them your language preference.
• 23:45
  Also, that one small action gets your children properly embedded
• 23:49
  in this system. So make sure you write that
• 23:51
  down. In fact, go ahead and tattoo
• 23:52
  that on your arm. OK.
• 23:53
  Next, the kinder arts or the pediatrician.
• 23:57
  When do children in the Netherlands actually get to see
• 23:59
  one? Because this is very common in
• 24:01
  other cultures that that's where your child is seen.
• 24:03
  Tell us what the medical system is here though in the
• 24:05
  Netherlands. Yes, good question.
• 24:07
  So there is different scenarios, let's put it that way.
• 24:12
  So when you are a healthy child, you're under youth healthcare as
• 24:18
  we provide. And for example, if you're have
• 24:21
  a cough or a cold or you're sick, you see your GP.
• 24:24
  If you have a more complex issue, you might have a
• 24:29
  abnormality, you might have a disease that needs to be
• 24:34
  controlled with the pediatrician, then you are
• 24:37
  referred to the pediatrician either by us, yeah, he said
• 24:41
  doctors or by the GP. So for example, you can think of
• 24:45
  groups like if you suffer from asthma, if you have a congenital
• 24:49
  disease that needs monitoring or you need medication prescription
• 24:54
  for a long term because of a disease that you have.
• 24:57
  If you have intestinal or bowel diseases, you could have
• 25:01
  something like arthritis or anything.
• 25:03
  Hey if suffer or are known with diseases then they will be
• 25:07
  referred to the pediatrician. Another big group is premature
• 25:11
  babies. So depending on your pregnancy
• 25:15
  and whether it's a low risk pregnancy with normal delivery
• 25:19
  and a healthy baby or you might have a preterm labor.
• 25:23
  So generally preterm laborers will always be in the hospital
• 25:28
  and depending on how premature the baby is at its arrival, the
• 25:32
  pediatrician will ultimately be involved from the first moment
• 25:37
  after birth. So to make it a little bit more
• 25:40
  in detail, so a general pregnancy is for about 40 weeks.
• 25:45
  If it's under 32 weeks, when you give labor for the first few
• 25:50
  years, you'll always be monitored by the pediatrician
• 25:54
  automatically because you're more at risk.
• 25:56
  If it's a 32 to 40 week delivery, it will depend on the
• 26:00
  condition. There's a lot of factors that I
• 26:03
  think it's too much details to zoom into.
• 26:06
  But generally you'll be seen by the pediatrician.
• 26:08
  But if things go well they will hand over the care again to the
• 26:13
  euphrezontite. Sure, and the GP.
• 26:16
  So last question on this element I guess would be the 2 after
• 26:20
  hours and emergency options because this is where families
• 26:23
  really can panic. What is the House, Arts and Post
• 26:27
  and how is it different from the SCH?
• 26:29
  Yes, very good question. We hear this same as us, the
• 26:34
  hazards, the General practitioner, they work weekdays
• 26:38
  from 8 to 5 fish at their practices from 5:00 PM to 8:00
• 26:45
  AM. There is the hazards of posts.
• 26:47
  It's called the Hub, the HAP, and this is a out of office hour
• 26:54
  hazards and posts where if you have a sick child, if you're
• 26:58
  sick yourself, it applies for parents, it applies for
• 27:01
  children, it applies actually for everyone.
• 27:03
  So you contact the hazard. Suppose that's actually the
• 27:07
  first thing to do and then you're speaking on the phone to
• 27:10
  someone who'll ask what the complaints are and they will
• 27:14
  judge what is needed. Do you have to come?
• 27:17
  Do you have to pay a visit? And you'll be instructed over
• 27:20
  the phone and then they'll make a plan.
• 27:22
  The hazard supposed is not the location to contact when it is
• 27:27
  an emergency. So if there is a life
• 27:30
  threatening situation, you always call 112 and then you'll
• 27:35
  automatically be referred to the hospital and the essay ha as she
• 27:40
  mentioned. So this is the part of the
• 27:43
  hospital that is occupied by the medical staff, by the
• 27:47
  professionals. The hazard supposed is occupied
• 27:50
  by GPS, but they work very closely together.
• 27:54
  They're always in the same center.
• 27:56
  So when you, for example, enter the hazard supposed, it turns
• 27:59
  out you need to be admitted or you need to be seen by the
• 28:02
  specialist. They will send you through to
• 28:04
  the other division, the essay ha.
• 28:06
  But I think the hazard supposed it's a bit of like a first step
• 28:10
  judgment. Is it severe?
• 28:12
  Is it urgent? I think that's the aim.
• 28:15
  Okay, and now I'm just going to do a quick fire round of real
• 28:18
  scenarios. So this is practical and
• 28:21
  hopefully you'll be able to give us a quick answer on each one of
• 28:24
  these. Scenario one, it's 7:00.
• 28:26
  My 2 year old has a fever of 38.5.
• 28:29
  There's no other symptoms. Who do I contact?
• 28:31
  The House, right? Supposed.
• 28:32
  Correct scenario two. My child's 18 months are not
• 28:35
  walking. Who do I call?
• 28:36
  This is a very good question to ask to the hey, hey, you contact
• 28:40
  your youth healthcare center and you ask for an appointment and
• 28:43
  then we can zoom in on your questions, your worries, and
• 28:46
  then we can see if we need to do something or what we need to do.
• 28:50
  OK, scenario three. My child has a rash.
• 28:52
  It's red, spotty. It's not painful, but it is
• 28:55
  spreading and it's Saturday afternoon.
• 28:57
  Who am I to call? Depends on your worries but
• 28:59
  generally again the hazard supposed and you ask for care
• 29:03
  and and what is needed. They might say if you're not
• 29:06
  worried, if your child is not sick, you can call your own GP
• 29:10
  on Monday morning 8:00 AM. But if needed, you're always
• 29:13
  welcome to visit. OK it's now scenario 4.
• 29:17
  My child has fallen and hit in their head.
• 29:19
  They're crying but they're seeming fine but I'm now
• 29:21
  terrified. What should I do?
• 29:23
  Sorry, which day is it? Well, I don't know any day, but
• 29:27
  when a child hits their head, obviously we're a lot more
• 29:30
  triggered of. Course.
• 29:31
  So I think with children it's always important to seek medical
• 29:34
  care, especially when you're worried or there is like this,
• 29:38
  there has been a trauma, there is a injury.
• 29:41
  So you call the hazards or you call the hazard supposed
• 29:44
  depending whether it's a weekend, an evening or a day.
• 29:47
  And I think it's always good to contact a doctor to discuss the
• 29:51
  complaints and see which care is needed.
• 29:53
  And finally a bit of a Gray area.
• 29:55
  It's just I just feel worried kind of parent moment here, my
• 29:58
  guts telling me that there's something wrong.
• 30:00
  I can't really describe what it is.
• 30:02
  What should a parent do? I think there is multiple
• 30:04
  answers possible to this question, so I'm always happy to
• 30:08
  see these people. I, I think it's very good to
• 30:12
  contact your youth healthcare center to request a visit and
• 30:17
  see the youth doctor and discuss your gut feeling.
• 30:21
  They can have an assessment, they can see the child, they can
• 30:23
  see how it grows. We can zoom in on the complaints
• 30:26
  and together we can discuss what, yeah, what would help the
• 30:30
  parent, what actually is the question, What is the worry,
• 30:33
  What is the concern? Of course, you're also happy to
• 30:36
  contact. The other option to contact your
• 30:38
  GPA GP is also the perfect person to discuss this matter
• 30:42
  with. So I think both answers are
• 30:45
  great. In general, it depends a little
• 30:47
  bit is my experience that some GPS, they have a lot of
• 30:51
  experience with young children, so they're very happy and
• 30:55
  skilled to work with you. There's also GPS that in their
• 30:58
  practice or in their municipality do not see so many
• 31:02
  infants or young children. So they might refer you to the
• 31:06
  because they say these people work with young children all day
• 31:10
  long. They're so skilled, they're so
• 31:12
  they have a lot of experience. Please ask them to see you.
• 31:15
  So maybe not every GP would respond the same, depending on
• 31:20
  their population and their experience.
• 31:22
  OK. I'm moving on very quickly.
• 31:24
  Let's just quickly go over the insurance company because this
• 31:28
  is very complicated and we're not going to get fully into it,
• 31:31
  but just very quickly. Children in the Netherlands, are
• 31:34
  they automatically covered under the National Health insurance?
• 31:37
  Yes. So in the Netherlands, health
• 31:39
  insurance is mandatory for almost everyone.
• 31:42
  This is the Dutch Health Insurance Act.
• 31:45
  So everyone who lives and works in the Netherlands needs to have
• 31:49
  a basic health insurance. Children must be insured, but
• 31:53
  they are covered for free under their parents policy.
• 31:56
  So parents must register themselves with an insurer
• 32:00
  within four months after birth. And then regarding the migrants
• 32:05
  or the expats, if you live or work in the Netherlands, then
• 32:09
  usually you must take a Dutch health insurance.
• 32:12
  Same with a newborn, you must arrange it within four months
• 32:17
  after registration with your municipality or after you start
• 32:20
  working. Regarding expats, if you work
• 32:23
  for a Dutch employer, yes, you must have a Dutch health
• 32:27
  insurance. If you're temporarily posted by
• 32:29
  a foreign employer, then sometimes you can stay insured
• 32:32
  in your home country. But many experts initially use
• 32:36
  international insurance, but they must switch to the Dutch if
• 32:40
  they become a subject of the Dutch law.
• 32:42
  So children in general are insured under the parents
• 32:46
  policy. And what's covered?
• 32:49
  Everything for children zero to 19.
• 32:54
  Youth Healthcare is covered. Factionation program is covered.
• 32:58
  General practitioner care is covered.
• 32:59
  Medication is covered, refer to the specialist and being treated
• 33:04
  in the hospital by a specialist is covered.
• 33:07
  Tapping into what you just said, the referral for the specialist,
• 33:10
  can you walk us through how does that actually work?
• 33:13
  Yes. So as I mentioned, when you have
• 33:16
  a condition that requires, for example, pediatric care, then
• 33:21
  either because of prematurity or because of something that pops
• 33:25
  up after your delivery, you'll be automatically enrolled in
• 33:29
  this system. Or you are seen by the GP and
• 33:34
  they think that special specific pediatric care is needed.
• 33:38
  So the GP refers you to the hospital and then you're seen by
• 33:42
  the pediatrician. The youth doctors can also refer
• 33:45
  to the pediatricians. I think the most to outline that
• 33:51
  reasons that I refer it could be questions regarding with
• 33:55
  intolerance of dairy or intolerance of food.
• 33:59
  It can be a growth problem. So either children don't grow
• 34:03
  that well a little bit failure to thrive, or they might grow a
• 34:07
  bit too fast and it might be a risk factor for the future.
• 34:11
  Other reasons that if I have the suspicion of a medical condition
• 34:16
  that needs further follow up, I can refer.
• 34:19
  Yeah, and we're going to do another quick fire round.
• 34:21
  I'm going to read you a statement and you just tell me
• 34:24
  myth or facts so we can go straight to a pediatrician
• 34:28
  anytime we want. Myth.
• 34:29
  OK, our newborn needs their own Dutch health insurance.
• 34:32
  Uh, myth. The Eeyore is always the fastest
• 34:36
  way to get help. Oh.
• 34:37
  Difficult one. It's quite fast, so yes, but
• 34:42
  it's not the route to take. OK and the GP decides everything
• 34:46
  and they have the final say on all care.
• 34:48
  Myth. It's always the negotiation and
• 34:51
  it's always the patients Has also a lot to say in this.
• 34:55
  OK, this is being quite intense. Didn't expect it to keep going
• 34:58
  on so long, but there are so many more questions that so many
• 35:01
  people will have for this. So this is just the first
• 35:04
  conversation starter we're having here with Doctor Marian
• 35:06
  Van Hengel Buddha. But hopefully we're going to be
• 35:09
  getting her back to answer a few more of the main topics that our
• 35:12
  international families have here in the Netherlands.
• 35:15
  I would love to say thank you so much for joining me.
• 35:18
  This has been two years of trying to get someone to come on
• 35:21
  to just give us an explanation because it can feel so confusing
• 35:26
  here in the Dutch system. So Doctor Marian Van Hengel
• 35:29
  Buddha, thank you so much for joining us here on Dan Parenting
• 35:31
  Podcast. Yes, thank you.
• 35:33
  Thank you. It was very nice to be here.
• 35:35
  And I agree that it's been very briefly, there's so much more to
• 35:39
  say. So I'm very happy to zoom in on
• 35:42
  more details and maybe we can see which topics we need to
• 35:47
  emphasize more or which topics we might need to speak about in
• 35:51
  detail. Super.
• 35:52
  Thank you so much. Thanks for inviting me.
• 35:56
  And there you have it, over 2 years in the making.
• 35:58
  One conversation and we've barely scratched the surface,
• 36:00
  Which, well, it tells you everything you need to know
• 36:03
  about how much there's still to talk about.
• 36:05
  What I hope you're walking away with today is a foundation, a
• 36:08
  map, the basic shape of the system that can feel incredibly
• 36:11
  opaque when you first arrive, where to go, who does what, why
• 36:15
  a Dutch GP suggesting paracetamol and sending you home
• 36:18
  is not the same as not caring about you, even when it feels
• 36:22
  like it might be. And why the door you knock on
• 36:24
  first really does matter. And I want to say this really
• 36:28
  clearly because I believe it with everything going, always
• 36:32
  trust your instincts when it comes to your child.
• 36:34
  You know your child better than any system does.
• 36:37
  The system is there to support you and understanding it better
• 36:41
  means you can use it better. But that instinct, well, that's
• 36:44
  yours, so keep it. And the good news I'm genuinely
• 36:49
  excited about this is that Doctor Mariana has agreed to
• 36:52
  come back and we've got more episodes in the pipeline.
• 36:55
  Vaccinations, development behaviour, mental health
• 36:58
  emergencies. I mean, I don't know what,
• 37:00
  there's just so much to cover. And I really believe that having
• 37:03
  a returning guest who actually works inside the system, who
• 37:06
  actually understands both sides of this conversation, it's
• 37:09
  actually going to be something you will not just want to come
• 37:12
  back for. It's something you're going to
• 37:14
  want to share. And honestly, this is a huge
• 37:16
  moment for me personally. And I know I'm not a journalist.
• 37:20
  I know this podcast is held together basically with a lot of
• 37:23
  love and very little sleep. But I figure every one of these
• 37:27
  episodes is a conversation starter.
• 37:29
  At least we know a little bit more than we did before, and
• 37:32
  sometimes that gets us somewhere.
• 37:36
  I want to say a giant thank you again to April from Healthy Hair
• 37:38
  done on Elle. If you don't know April's work,
• 37:41
  go and check her out. She's doing something really
• 37:43
  important for the community, building the bridge between
• 37:46
  international families and the systems around us.
• 37:49
  I hope she's organising many more events and creating many
• 37:52
  more connections because today's episode would not exist without
• 37:55
  her. And to you listener for
• 37:58
  listening, Thank you genuinely. Now, if anything in today's
• 38:02
  episode sparked a question, something you would like Doctor
• 38:06
  Marana to answer in the future episodes, I want to hear it.
• 38:10
  You can drop me a message directly through Spotify.
• 38:12
  You can DM me on Instagram. You can just send me an e-mail
• 38:15
  on damparentingpodcast@gmail.com.
• 38:18
  All of it gets read and all of it will shape what comes next.
• 38:22
  I'm your host, Eva. This is dam parenting.
• 38:25
  Take care of yourselves and your little ones and I'll see you
• 38:28
  next week.