Thursday, May 31, 2007


Language, my friends, is a very interesting thing. One of the beautiful things about living in Asia, especially after some other Americans came to live in our same city, is the way that we fell into speaking an interesting mixture of English and Asianese. After a while, we would really get going and have a great time with this mixed "third" language. I think that we all just found that some words in Asianese expressed what we meant better than the English words.

A case in point is the word "mafan." Literally translated to mean "troublesome" or "hassle," the actual meaning is much more fluid. "Mafan" is when your shower head clogs and you buy three new ones that all break in succession. "Mafan" is when you are told by one authority to come back on Tuesday to renew your visa, and when you make the 45 minute drive back over there, the person you need to see is out of the office and you'll have to come back the next day. "Mafan" is when you are in another Asian city and have forgotten your passport and must travel back home to retrieve it since no respectable hotel will allow you to stay without your passport (this happened to us). "Mafan" is when you are out of the country, trying to apply for a visa to get back in, and the school where you study gave you the yellow sheet, not the white sheet, and so the visa officer will not accept your application (this also happened to us). And now, though I thought that America was always the land of convenience, ease and quick communication, I have found that "mafan" is dealing with health care in the US.

I hate to admit it, but a series of events over the last few weeks has led me to apply this word to the US health care system, as a very broad generalization, of course. The advantages in the US are many: excellent health care which is on the cutting edge of science, given by people who are knowledgeable and caring, specialists for unusual problems and even public health care for those who cannot afford it. But there are also some disadvantages: insurance nightmares, coverage issues, malpractice lawsuits which have forced every doctor and hospital to give disclaimers upon disclaimers in regards to care, and lots of red tape and "hoops" to jump through, even to get a basic procedure done.

Let me just share our story as an example. Before leaving Asia, all of our family was required to have our blood screened for heavy metals--lead, magnesium, chromium, arsenic, etc. Because of the pollution in the area we live, it was deemed necessary for us to have this (very expensive) test. We were tested, and Chloe actually turned out to have a slightly elevated arsenic level. We wondered how this could be since when we left Asia she was only eating a few simple vegetables and fruits in addition to nursing. But her age range is the most vulnerable for something like this, so though the rest of our family was in the normal range, our doctor wanted us to follow up with her. We thought it would be a simple matter of a repeat blood test, but unfortunately it wasn't quite that easy.

I called a pediatrician's office to schedule an appointment, hoping to cover this issue and a couple of others with one doctor's visit, like we would do in Asia. The doctor's assistant had many questions for me, and we were doing well until I explained what I needed. She then kindly informed me that they could not do a blood test for arsenic, but that I would have to go to a hospital lab for that. They also could not assist me with several immunizations that Chloe needed, since Japanese Encephalitis and Rabies (while common in Asia) are considered travel shots in the US and not at all standard. I would have to go to a Travel Clinic for those shots. And they also could not do a TB skin test, that is only given at one place in this entire city (it would seem) and I would have to make a separate appointment for that. So as it turned out, there was nothing that doctor could do for us! We didn't even make an appointment with her!

Oh dear. We then spent some more time with the Yellow Pages trying to contact these various agencies to get this medical work done. We found out where and when the TB tests were given and chose a date to go there and get that done. We called the outpatient lab of a local hospital and tried to determine what they would need in order to get the blood work done. We also researched online to find a different place to get the "travel" immunizations, since those immunizations are all a month long course of three separate injections, and we won't be in Louisville long enough anymore to accomplish this. In addition, the Louisville Travel Clinic wouldn't take any insurance, only cash. So we'll wait and do that when we're back with my parents in northwestern Iowa.

Then, this morning, the adventure began. We left our house shortly after 10 to go to the TB clinic, hoping to accomplish that fairly quickly, with a quick trip following to the hospital lab, and then home by lunchtime. Both Clara Anne and Chloe needed the TB test, according to our doctor, although they both also had the BCG at birth. The BCG is an immunization that is supposed to prevent TB, and since it is a live virus a child who has had it will (should) test positive for the next 5 years, though they do not have TB. Previously we had not given them the skin test, but then our doctor informed us that the BCG only "takes" in about half the cases so it was necessary for us to have them tested now. When we found our way to the clinic, however, we were told they only do the injection between noon and 3. We were also told that if the girls do show positive, they will have to have a chest x-ray to make sure they do not actually have TB. This is "mafan," exhibit A.

Then we made our way to the hospital to get Chloe's lab work done. However, unlike in Asia, the US labs cannot do anything without a doctor's order. You can't just show up to the lab and say you want to be tested for arsenic. So, en route we were in contact with our doctor (via cell phone) and he told us that he had not yet sent the order for Chloe's work to the hospital, and that it wouldn't be as simple as a blood test. Because of the way that arsenic settles into the body system, it isn't always present in the blood. So a urine test would be more effective, he thought. How are we going to get an 11 month old to give a urine sample? Mafan, exhibit B.

However, the good news is that the doctor was going to order a "spot" test which meant only one urine sample. His first inclination was for a 24 hour collection, but when he realized her age, he said that a 24 hour collection would have meant a hospitalization with a catheter. I certainly didn't want to have to put my little Chloe in the hospital, just for this test! That would have been extra-super-duper mafan! I was very thankful for the spot test option.

We took several wrong turns trying to find the hospital, and then several wrong turns trying to navigate the parking lot and find the main entrance. (This is mafan exhibit C of living in the US. At least when you ride in a taxi the driver usually knows where to go!) After the usual rigamarole of registering Chloe as a patient, (I think we have hospital cards from at least 5 hospitals around the world!), some more mafan of contacting our doctor again, giving him the lab's fax number, the assistants in our doctor's office not being able to find the diagnostic code (no surprise since probably your average American doesn't need to be tested for arsenic very often!), and then finally the fax coming through, we attempted to proceed.

Now the only trick was to get Chloe to pee. We stuck a little "collector bag" on her and I nursed her and then slowly gave her almost 10 ounces of apple juice. Her diaper, which had not been changed since 9 this morning, was dry, and so I figured it was going to have to come out sometime! But stubbornly she held it . . . and held it . . . and finally, an hour and a half later, I was about ready to give up when in a moment of fussiness she let go. Hallelujah! The bag leaked some, so I had a good-sized wet spot on my leg, but hopefully they got enough to do the test.

We thankfully left the hospital and then, since it was past one, headed back downtown for the TB tests. After only minor mafan there, which mostly involved parking and broken meters, both of the girls got pricked. We'll have to go back on Friday to have them read and see if we need the chest x-rays or not.

At this point it was 2:30, the girls had eaten every snack in my bag (raisins, goldfish crackers, a granola bar, and some cheerios), and we finally made our way home. I guess it's all about expectations: I thought that taking care of these things in the US would be much easier than in Asia, since there isn't the language barrier, etc. But despite the fact that there was some mafan, hopefully it will all turn out all right and the girls will both be given a clean bill of health, which we need before we can return to Asia.

To those of you who made it all the way to the end of this long post, Congratulations! Hope I didn't bore you with the endless details! Or, as we can say in Asianese, (apologetically) "Mafan ni le!" meaning, "I have caused you such trouble. Sorry about that!"


jc said...

it's just truth...the entire american health care system is mafan. it's a ridiculous joke that has spun out of control, like a plague that has no cure. that is one part that i despise about america, as do 99% of americans. i wonder if doctors think it's mafan when they have to be a part of the system.

Melody said...

Hey there, it was fun to catch up on the last few posts! Yes, healthcare system stuff can be a bugger, can't it? I did a rebuttal for Argumentative Research Writing in college on why socialized medicine was not a good thing...I was rebutting the use of socialized medicine. It was so interesting everything that I learned. I interviewed dr's and nurses who were part of socialized medicine in Canada and just read a lot of articles. In the end, I came to see that even though our system is messed up here in some ways, it is still a lot better than sitting and waiting for a week in a hospital emergency room lobby to have surgery and being told that you're too old to have a hip replacement and that the government doesn't want to pay for it. That would stink too...sorry you had you're issues though with having to go everywhere and contact so many people regarding all the shots and tests and all. That sounds frustrating! I hope the girls and you will all be okay. Oh, and I LOVE Blue Bell ice cream and used to eat it all the time in Texas!!! I haven't seen it up here in MN of course, as Blue Bunny & Kemps seem to rule the roost...but I sure miss Blue Bell. They just had so many neat flavors. My favorite one was birthday cake ice cream...LOVED it! I hope you have a great day. Love ya, Melody

Anonymous said...

Hey Rachel....

Corrie from Cross Pointe in SF, SD...may I reduce your level of Mafan when you come back to do your series of shots that you find a pediatrician now call and make appts....and discuss with them what you need...that way all is prepared for your return! I love reading your blog...very educational and is the running going?

Rachel said...

Hi Corrie,
Yes, we do have appointments at Sanford Health for those shots for Chloe during three different weeks in August--it seems like it should be fairly easy to accomplish it there! Thanks for the tip, though!

The running is going great! I am in the fourth week of the program and running much more than walking has been so gradual that I have really not yet been fatigued. We'll see if I can keep it up!