why internationals complain about emergency care

After two days of constant vomiting while not eating or drinking anything, Yeva Nikonenko was in despair. She thought she urgently needed help, so she went to the emergency room of the UMCG.

‘Before a nurse came to me, I had already thrown up about eight times. She emphasized that the hospital was only there for serious cases,” the second-year international law student recalls.

After she made it clear to the nurse that her constant spitting up was quite serious, she was admitted. She spent eight hours in bed with an IV in her arm, waiting for the test results. The final diagnosis: a serious form of gastritis, or inflammation of the stomach lining. The best thing she could do was take paracetamol and drink cola.

“I thought I was going crazy,” she says. ‘Of course I had already tried all those standard things. I came to the hospital because they weren’t working. There would have been no point in coming to the hospital. I might as well have stayed home for that advice.’

Yeva still has to throw up a few times a week, although it’s not as bad as before. ‘I’m still ill, but I’ll leave it alone now, because I don’t think I can get help in the Netherlands. I’ll wait until I go back to Georgia,” she says.

Gatekeeper

Ask around in Groningen and you will find a series of other examples of internationals like Yeva who go to the emergency room and feel not taken seriously, or feel that they are not receiving the right care. What’s going wrong?

According to Bas Bens, emergency physician at the UMCG, one of the problems is that international students come directly to the hospital when they should go to a general practitioner.

I don’t think I can get help in the Netherlands

He has noticed that more internationals have been coming to the emergency department (ED) in recent years. And although this is partly to be expected, since there are simply more internationals in Groningen, it also has to do with cultural differences, he thinks. “In many countries the GP does not have a gatekeeper function,” he says. “People are used to going to the hospital for a lot of things.”

Bens doesn’t blame them for doing the same here. ‘It can be difficult for internationals to understand how the Dutch healthcare system works.’

Despite this, many of them know roughly how things work here, he says, and they only go to the emergency room after they have already tried to find a doctor. ‘Nowadays they often have a waiting list and that makes it difficult even for Dutch people to gain access to primary care. If you don’t solve that as a country, it is not surprising that people come to the emergency room. They’ve tried everything and are quite desperate.’

Face full of sheets

That was certainly the case with Ilinca Padurariu, first-year international relations student, when the skin on her face became extremely irritated last October. After an email consultation, StudentArts wrote a prescription for antibiotics, but by the time she discovered it was a type she was allergic to, the weekend had begun.

Because it was exam time, she was extremely itchy and the sheets were now hanging from both her face and her neck, she decided that the hospital was her only option. At the time, she did not yet know how emergency care works in the Netherlands.

If people cannot find a GP, it is not surprising that they come to the ER

A doctor from the General Practitioner’s Emergency Department at the Martini Hospital spoke to her. ‘I told her I thought I had a staph infection and I could just tell from her attitude that she wasn’t taking me seriously. That could be possible, she said, but it could also be that I had scarlet fever. She advised me to go back to my own GP.’

At Ilinca’s insistence, she prescribed another antibiotic, but it turned out to be the wrong kind, because the staphylococcus bacteria – which was indeed the problem – is resistant to it. ‘By now my face was looking so bad that when I was at the library with a friend, a total stranger told her he would pray for me.’

Ultimately, StudentArts made the correct diagnosis, but that was only after she had been trying to find her way around the Dutch healthcare system for a month.

Conversation

There is no guarantee that students will receive the treatment they hoped for, says Bens, but what they can count on at the ER is a conversation, even if it is a minor problem. ‘We ask about their GP, whether it was difficult to find one or get an appointment and then we talk further. You can’t let them leave empty-handed,” he explains.

What makes it more difficult for internationals, he thinks, is that they lack a network of people who can help. ‘You’re alone and you’re worried. Many people then look up things on the internet and that usually doesn’t help.’

That is why he thinks it is important that everyone who comes to the hospital is seen, despite the pressure this places on the healthcare system. ‘What I consider an emergency and what you consider an emergency are probably not the same. In general, the public determines what emergency care is, whether we like it or not. Then they call or come by and we have to deal with it.’

But it can sometimes be difficult for internationals to explain what is wrong. ‘There is always a language barrier, which can cause subtle signals to be lost,’ says Bens. ‘It can be frustrating in such situations when you live abroad.’

Ambulance

‘Frustrating’ is putting it mildly, says international and European law student Raul Robert Nedelcu about his experience. Last September he received a call at night from a friend who was panicking. A mutual acquaintance had been drinking heavily and smoking a lot of weed and had lost consciousness in a shawarma place at the Vismarkt.

He was just another student who had consumed too much alcohol and drugs

‘When I arrived he was slumped over the table. His eyes were closed, he didn’t move or respond to my questions. Only his hand had a nervous twitch,” says Raul. So he did what seemed wisest and called 911, but the operator dismissed his concerns. “She said he was just another student who had done too much alcohol and drugs and that I should take him home.”

A Dutch passerby with a medical background came to his aid. She offered to call an ambulance herself and this time it came right away, Raul says. “They asked her to take his temperature and heart rate and they really gave her directions on what to do.”

Although it ended well for Raul’s friend – the ambulance arrived within ten minutes and he was treated on the spot – Raul has lost confidence in the Dutch healthcare system. ‘I don’t feel safe here anymore. “I don’t think I’ll be able to call an ambulance in an emergency,” he says.

Tips

Sometimes things can go wrong, says Bens, but he emphasizes that it is important that students seek help when they need it – initially from a GP and then at the emergency room. ‘We speak to everyone and we don’t just send anyone away.’

For those who see the healthcare system in the Netherlands as an impassable hurdle, he has a few tips. “Find a doctor as soon as you get here. If you are healthy you may think you don’t need one, but don’t wait until you do need one.’

And, he emphasizes: ‘If it is not an acute situation where it is a matter of life or death, then you go to the doctor. It is there to help you, and that system usually works well.’

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