Healthcare

It's amazing how quickly one can become familiar with something new. I now take it for granted that every time I go to the doctors with one or other of the children, I will introduce myself to the receptionist ("Hi. How are you?...") and then produce my insurance card and allow them to swipe my credit card. I'm buying a service, right? It's not all that different from shoe-shopping.

We regularly attend four different clinics (I sometimes feel as though my life is being lived out in waiting rooms). The Boston Children's Hospital is huge - an industry in itself. The entrance foyer is filled with sculptures and art work. There are several different cafes and food outlets to choose from. There are car parking valets, rows of wheelchairs of all shapes and sizes (think about the banks of shopping trolleys that you see at the supermarket - it's not that different).

We are registered as patients of the Harvard Vanguard practice. To understand the practice, one would need to imagine something midway between a hospital and a GP's surgery. The girls have a nurse who regularly phones us for a chat to see how they are both getting along. The accounts manager now knows me very well (although that might relate more closely to the amount of bills we have recently generated rather than as a principle of the practice). Our general doctors are located at the local Harvard Vanguard practice; Iola's ear and nose specialist is at a larger Harvard Vanguard practice in Boston. The practice has it's own pharmacy who will telephone me when Maya's inhalers need updating. They have cafes and smart waiting areas. They employ all kinds of doctors from general practitioners thru oncologists, orthopaedic specialists, midwives, behavioral therapists and acupuncturists.

And, last but not least, we attend twice-weekly appointments at a physical therapists (where I continue to confuse the receptionist by talking about physio). Again, the practice is glossy and comfortable. Maya has worked closely with a physical therapist who is 'awesome' and she's now walking without crutches, to the amazement of her surgeon. They have equipment which would not look out of place in a top-of-the-range gym and they have a swimming pool.

There are themes to these experiences which contrast to our experiences in the UK, and most of them relate to money.

Money buys time. The old adage that 'time is money' is turned upside down when you look at health care. These practices are not being subjected to huge cost cutting, which means that they have more time than one can imagine within a UK context. When we attend an appointment with our general practitioner, we can expect the appointment to last at least half an hour.  A nurse will weigh the girls, measure their growth, take their temperature, chat to us about any general concerns and then escort us to a room where the doctor will see us. There is no sense that we have 6 minutes (or however long a UK GP would have for a standard appointment). We are given as much time as we need. It's nice for us, it must be wonderful for the doctor to have fewer patients to that they can spend more time considering their case.

Money buys stuff - lots of stuff. There is no shortage of equipment, medicines or technology. This is the 'all-singing, all-dancing' end of the health system. When Maya was in hospital in Albuquerque, she had a bed which vibrated and moved to ensure that she did not get bed sores; she had an inflating cuff on her non-broken leg to reduce the chance of clotting in that leg; she had a choice of 6 different menus at every meal; she had a television with hundreds of channels; her own en-suite; an arts specialist; three physical therapist; a nurse who was allocated to only 3 patients...

Money makes stuff work. The computers in the hospitals talk to one another because there has been the money to pay the technical experts who can make this happen. I don't know if the computer strategy for the NHS has been resolved, but when we left the UK it had been a very expensive failure.

Money buys space. These hospitals and health centers are vast. They are surrounded by acres of car-parking (free in Albuquerque, affordable in Boston). The corridors are crammed with art work and sculptures (Iola and I spent over an hour trying to look at all of the art work in the Children's Hospital in Albuquerque).

Money buys good manners - it shouldn't, but it probably does. When you get lost, people stop to help you - lots of people - nurses, volunteers, doctors, surgeons. Because they don't have to treat as many patients, they probably have more time to stop and help people... they probably have more time to be human. When Iola went through her endless weeks in oxygen tents in Lancaster hospital, we saw different doctors. We didn't have a choice, it was just that whichever doctor was allocated to our ward would appear. Some of them were very good, but they didn't all say the same thing. It's confusing and terrifying as a parent to meet different people and to hear their different opinions about how your child should be treated. Maya has had two doctors for her broken leg - Taylor Jobe in Albuquerqe, who looks and talks like a surf dude and still telephones us to see how she is getting on, and Dr Kasser in Boston who, despite being one of the world experts in pediatric orthopedics, has the time to be polite and gracious and to listen to what Maya has to say (which often takes quite a lot of time).

Money makes things ridiculous. I was charged $100 for a bottle of ear drops; our helicopter ride to hospital cost $48,000, the hospital bills continue to land on our doorstep. However, when I talked to a friend whose father visited from England, without insurance, and had a heart attack, she told me that when you explain that you have no insurance the bills tend to be instantly halved. There is little logic to the numbers of dollars written onto the bills that you are given. We have insurance and savings and we would pay (and are paying) whatever we could to mend Maya's leg and to ensure that both girls are healthy. Not everyone has that choice and that's the ongoing debate in Senate at the moment. There are philanthropists everywhere - no-one would be turned away from either the Boston Children's Hospital or the Children's Hospital in Albuquerque because they couldn't pay their bills - and that is highly commendable. But, at the opposite end of the spectrum, there are also whole industries growing rich, really rich, out of the amount of money which is pumped into the medical care system in this country. Coming from a country with the NHS, I struggle with the ethics of people making sizeable profits from healthcare when there are so many people who struggle to pay their medical insurance each month and have to pay the excess of their copay with credit cards.

But, when I attend our appointments (about 3 a week at the moment), I obediently open my wallet and take out that credit card. The time and place for ethical dilemmas is elsewhere. We've been told that Maya can start running on July 1st.

Maya and Iola's school

The girls have picked up various Americanisms and a current favourite is the word ‘awesome!’ Lots of things are awesome: chocolate cookies, the Museum of Science, the new ‘jump-kick’ that Iola has mastered at taekwon-do, a really good thunder storm. It’s not an adjective that Nathan and I use as frequently – the word feels slightly overblown on our tongues. We are, however, all in agreement that the girls’ current school is awesome.

The girls go to school in the South-East corner of Cambridge. Their school is within walking distance to the MIT, Google’s offices, and various bio-tech companies. This is an area of huge industrial development: new drugs companies and computer software firms move in almost daily. People with disposable incomes commute into this area to work: you see them at lunchtime queuing outside designer sandwich bars and coffee shops. In terms of housing, however, it is the poor corner of Cambridge. Properties around here are almost affordable and the streets around the school house a diverse mix of long-term Cambridge residents and new communities, particularly from the Azores and Haiti.

The girls’ school is housed in an ugly brick and concrete building. From the outside and the inside, the school looks poor. It was built in the 1970s and, visually, it has not aged well: the metal-framed windows look shabby; the breezeblock interior walls are cracked in places; the floors are not particularly clean; the toilet blocks stink. But, on the positive side, students’ work is everywhere: art displays cover every notice board, and there are bits of paper and notices that children have made sellotaped onto nearly every surface. Wherever you look there is a chaos of felt-tipped paper. There is no litter anywhere.

The building’s strengths were probably envisaged in relation to its functionality rather than its appearance. There are three floors of classrooms. The school has an auditorium which has theatre-style seating for 500. The gymnasium is large. There is a purpose-built canteen. The school library is larger than our local library. There are several art rooms, including one with a pottery kiln. There are science labs and music rooms and playgrounds and a basketball court and city garden spaces where students grow fruit and vegetables. From an English perspective, it’s just really really big. And it currently only houses around 400 students between the ages of 4-14. 

Iola’s kindergarten class (which now has only 15 students) has a classroom which is larger than the entire downstairs floor space of our flat. Within the classroom there is a reading area, an art area, a work area where desks are arranged, a large cloakroom and a small toilet block. The school has two kindergarten classes. Each employs two full-time teaching staff and both have similar numbers of students. The kindergarten classes also have separate specialist teachers for Italian, art, physical education, and music. There is no national curriculum here in the United States, although Massachusetts has developed some curriculum guidelines. Iola’s learning this year has contrasted with her experience in England last year where there was much greater focus upon literacy and numeracy. The focus here is upon learning through creativity. For example, the students ‘worked’ as researchers on the rain forest for several months. Each child became an expert upon an animal of their choice. Iola can now talk extensively about bush-master snakes (not particularly nice animals, but our familiarity with them makes us feel quite fond of the poisonous little critters). Iola has made a pottery snake, made observational drawings, written poetry, produced a research report on bush-masters which has been published as a virtual book on the school ipads, and prepared and given a presentation on the snakes which was recorded and is now stored as an audio-book on another part of the school’s software. I have had periods when I have worried that she doesn’t bring home a book each evening, but she has become a confident reader over the past few months and her number work is excellent. In music, the class focus upon a ‘composer of the month’. These composers have included Mozart, Louis Armstrong, and Stevie Wonder. Iola is learning to read music, discuss musical form, and work out dance routines.

Maya’s learning is closer to the English model. She has daily homework in maths and English. Her class of fourteen students have one full-time teacher but also receive lessons from specialists in Spanish, information technology, physical education, art and music. Every child is required to learn a musical instrument. Each student has access to a Macbook and the class also work in the computer suite which is crammed with Macs, provided as part of a research project by Lesley University. Each student has an on-line mentor (a ‘keypal’) based at MIT. The children have written stories and published these online. They have had science lessons based around the CSI television program, using new forensic technologies facilitated by local drugs companies. They have been judges for the Massachusetts Children’s Book Award.

And this school is widely seen to be the poor relation in the Cambridge Public Schools system!

This September the school system for Cambridge is changing. Rather than the elementary schools catering for 4-14 year olds, a new system of middle schools is being introduced for grades 5-8 (students aged 11-14). I have been fascinated by the way that this policy has been developed. I don’t know how typically American this process has been. The chief superintendent of schools is extremely laid back with a ready smile to any question and an absolute commitment to deferring any answer. His staff are a diverse mix who like to spend meetings publicly congratulating one another, which means that every meeting is a very upbeat experience although sometimes light on actual content. 

The 11-14 year olds from nine elementary schools will move into three newly-formed middle schools. A new curriculum is being developed for these schools and new buildings will be built to house these new schools. It takes at least three years to build a new school around here so, in the meantime, the new middle schools will be squeezed into the elementary schools which the children already attend.  

There is much about the new curriculum which is exciting. The English Language Arts curriculum includes journalism, on-line publishing, and the negotiation of a range of different literacy demands as well as creative writing and analysis of more traditional literature. The Mathematics curriculum is extensive and covers areas of mathematics upon which I am unable to comment (too many squiggles and apparently random numbers). Maya’s grade will study Spanish, French and Mandarin and then elect the language in which they would like to specialize for grades 7 and 8. Large amounts of the timetable are given over to drama and music, with the potential for every student to elect to take individual music lessons and to play in a school orchestra and marching band. Awesome.

But with all of this innovation, some areas of traditional schooling have had to be compromised. The curriculum is based around 6 day curriculum blocks, so the second Tuesday is the new Monday and the following Wednesday will be day 1 of week 3. Confused? Try organizing forty-odd eleven year olds. And students will only be offered two 45 minute periods of physical education over each 6 day period. The physical education department are completely disenfranchised by this (I spoke with them on Wednesday evening and ended up feeling quite depressed myself) and have decided to maximize the time for activities by abandoning the requirement for students to shower and change. Really? Imagine teaching an afternoon class of ‘aromatic’ thirteen year old boys and girls who have been running around the gymnasium that morning. And it seems as though history and geography have been amalgamated into a social sciences department which is trying to serve so many different masters that it’s not quite sure what to include and what to leave out.

Maya’s new principal is young, ambitious, and optimistic. He talks a good talk with his speech peppered with words such as ‘possibility’ and ‘opportunity’. I asked him what the weekly timetable would actually look like, but he couldn’t say exactly as there are ‘various possibilities’ being developed. I asked what the new school’s mission statement might be, but he wants to develop this with the students in September (and I think that this is highly commendable). I asked where the classrooms would be and he said that there were lots of ‘exciting opportunities’ that they were currently working through and showed me a heavily annotated sketch which had been worked out on a scrap of paper. I asked how large his staff would be and he explained that they are still in the process of finalizing the recruitment process. 

Teaching staff are not contracted to work the summer vacation period, which stretches from June 15^th through to the first week in September. That gives the new principal a fortnight to finalize things. I’m not sure if my anxiety about this timing is a throwback to my Englishness, but I am very glad that I’m not in his shoes. I’m sure that Iola’s music teacher would tell us that ‘it’ll be alright on the night’, but if the principal manages to pull this one off I think that that will be truly ‘awesome’.