All the stuff you never knew you needed to know about life in rural France.....and all the stuff the books and magazines won't tell you.

Wednesday, 24 November 2010

Calendar time again

French iconImage by pedrosimoes7 via Flickr
About this time of year, if you live in rural France, you lay in stocks of aperitif biscuits and booze and keep a store of twenty euro notes at hand.
It is calendar time, when every organisation from the football club to the fire brigade presents you with their offering, varying from what resembles a group of wild-eyed psycho killers...the football heroic figures dealing in masterful fashion with the Towering Inferno...the fire brigade.
It is tactful to press some of the folding stuff into the hands of their representatives as they take their leave as one devoutly wishes to be spared a visit from the psycho killers and not to be ignored in one's hour of need by the fire brigade.

I was thinking of this when the fishmonger handed me a calendar of stupendous proportions to add to those from the agricultural co-operative, the local supermarket, the garage and the Red Cross, who handle all the ambulance work in Costa Rica...and a great deal more besides..

The first time my husband was taken ill in France, many years ago, the doctor called up an ambulance but as it was lunchtime on a Sunday, it took two hours before it arrived and there was no provision for  a stretcher.
The driver drove and his assistant held on to my husband, by now entering a coma, while they drove for one hour to the local hospital.

I was not allowed to accompany them, and had to follow behind.

At the local hospital, I did manage to see the emergency room doctor and explain the situation.

The hospital did not have the appropriate facilities to treat him.

Another ambulance was summoned.....but there was a delay as the ambulances available did not have oxygen on another hour was lost.

Once again, I could not travel in the ambulance.

Finally he reached a major hospital which could treat him but, in large part down to the delays in waiting for ambulances to arrive, he had suffered major damage and had to spend over a month in hospital.

I was not impressed.

Another moan about public services?
Not at all.
These were the private ambulance services which at that time had a complete monopoly on the  transport of patients, except in the case of road accidents.

They usually double as taxi companies....and each company holds the monopoly on service for its area, so if you think 'Taxis Merdiques' offers a rotten service..... too bad. 'Taxis Merdiques' is what you're stuck with.

Sit in any French hospital waiting room and you will see as many white coated ambulance/taxi drivers as patients, as in many cases the cost of transport to hospital by ambulance/taxi can be claimed back under the health insurance scheme, so one day you are sitting alongside Madame d'Enculade and her taxi driver in the orthopaedic department and the next day she is cutting you out of a parking space at Leclerc...driving herself.

The ambulance theme continued when I returned from shopping to find an e mail from Guy with all the local gossip.

Apparently, the ambulance companies regional confederation had held its annual meeting at which the owners of these companies let rip in no uncertain manner.

They claimed that the fire brigade, in order to cover up for lack of activity in fighting fires and rescuing people generally, were poaching on the preserves of the ambulance companies by taking people to hospital!

Shock horror! What is the world coming to when a monopoly is not respected!

The whole thing is a nonsense.

For a start, most of the fire brigade personnel in rural parts are volunteers, who give up a great deal of their time to train and practice for the task of helping people in danger.
There is no way that these men and women want to take time off from running their businesses in order to poach clients from Taxis Merdiques.

And as far as I can see, there is the usual rate of arson, gas explosions and accidents, so hardly a lack of activity for the fire brigade to need to cover up.

The fire brigade are, not surprisingly, livid.

Their point of view is that if they are called by the SAMU...the medical co ordinating transfer someone to hospital, it is because there is no one else available to do it....Taxis Merdiques being otherwise engaged in running children to and from school under their contract with surrounding communes.
In those circumstances, the fire brigade is carrying out its legal duty to come to the assistance of the population and far from trying to take custom away, the fire brigade, snowed under as it is, would be only too delighted if Taxis Merdiques could get their act together and carry out the business in which they hold a monopoly.

So what is all this about?

I think it may all stem from the increasing problem of health cover in rural areas.
Doctors don't want to live out in the sticks any more and as their numbers decrease those that are left either don't have the time or don't have the inclination to make house calls.

The rural population is elderly...though it seems that young people are starting to return to rural areas as the nature of work changes.....and reluctant to go to the doctor's surgery, having been brought up in the age where the doctor came to them.

A doctor on a house call would automatically call Taxis Merdiques to take his patient to hospital but nowadays the patient - doctorless - is likely to call the SAMU who, if they decide that hospitalisation is called for will not wait around if all Taxis Merdiques' drivers are otherwise engaged but will summon up the fire brigade.
They have targets to meet and ensuring the profitability of Taxis Merdiques is not one of them.

You can see why the ambulance companies are uptight, though.
The ambulances cost money.
The staff need a high standard of training.
Given French employment law, they try to keep staff to a minimum, so urgent calls can conflict with their contract jobs.
And everyone carted away by the fire brigade is a payment missed.

It is the usual way things happen in system super-imposed on another with no thought for the contradictions.

And, as usual in France, no one dares root and branch reform because of the many vested interests involved. Just look at the pensions fiasco if you need proof of that.

All I can suggest is that when the fire brigade come calling with their Christmas calendars the ambulance companies make a very generous donation......they might need a fireman some day.
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  1. You really should run for office...

    Any word on a house sale?

  2. I wonder if the systems will work quite the same in Costa Rica? Here's hoping it doesn't!

  3. e...not a dicky bird...
    If I ran for office I think I'd be assassinated as soon as I published my programme..

    Another Day of Crazy.... accounts vary as to the effectiveness of the Red Cross ambulance service, so I'm planning to do exactly what I did in France...get into the car and drive straight to the hospital I need.
    For some reason, the treatment that only major hospitals could do in France is available in local ones in Costa Rica and the nearest is only ten minutes away...

  4. I can only say that I have had immediate help from my Dr on the two occasions that I have needed help quickly.
    I have to admit to not needing an ambulance, but my friends down the road have twice in the past year had the ambulance in the middle of the night. Both times was quick and very efficient.
    Last year when I had double pneumonia, and I talked my Dr out of putting me into hospital, he made a house call daily, or phoned on my mobile to make sure I was OK. No extra charge. My neighbours, (all French) made sure that I eat, had fluids and did any shopping for me. They popped in several times during the day to check up on me. The door was just left unlocked.
    I could go on about my other urgent trip but I will not bore you with what I considered to be French efficiency where health is concerned.

  5. I seem to remember there was a crack down on reimbursing these taxis as it was becoming a primary source of Secu abuse with able people taking a medical taxi to a routine appointment.

    As they cost a lot more than ordinary taxis, it was a considerable drain on the Secu.

    You now have to have a signature from the doc you are visiting declaring the medical taxi is a medical necessity and the Secu just love checking up and finding abuse. It gets plastered all over the news. :)

    By the way, I found your Costa Rica blog so I'll be along!

  6. Good grief. There is something horribly 17th century about all this. I thought the French health service was supposed to be better than ours (the UK's)? At least we can rely on the ambulances to turn up and transport you to a hospital without slugging it out with firemen and taxi drivers for the privilege!

  7. That ambulance musical chairs must have been an awful time. Your tales of the dreadful inefficiency at state level of France always leave me speechless, really. Tin pot doesn't even come close. It's curious that developing countries, taking Europe or the States as their model, often have much better services where they have any at all.

  8. Diane, I'm glad it worked well for you...
    Over the years we have had a number of different doctors...some good like yours, and...others.
    Pot luck, like anywhere.
    And good neighbours are beyond price.

    Sarah, yes, you now need a bon de transport from the doctor you are seeing...and some spray them round like confetti while others are more conscientious.
    I had a ex maire...who went to six different dermatologists until she got the opinion she w3anted....taxis every time! Luckily they seem to have cracked down on that little game too.

    Steve, now that the SAMU are co ordinating things I think it is better...
    The French health service is very much the curate's egg. Good for elective stuff and routine stuff...not always so good otherwise.
    But everyone has their own experience.

    Pueblo girl, everyone here in Costa Rica moans about their NHS, the Caja.
    It only prescribes generic medicine, so people moan about that...waiting lists for elective surgery can be long, so people moan about that but our experience so far has been good.
    Haven't tried the ambulance services and don't intend to.

    Perhaps when setting up services developing countries don't take on board all the old wood that 'old' countries assemble as part of the history of medical provision.

  9. We're very very lucky here as one of our oldest friends lives across the road and runs the ambulance! Saved my FIL's life twice so far. About 8 minutes for someone to show up.

  10. Zuleme, I'm once bitten twice the first sign of trouble it's into the car and away...too many things go wrong if I rely on other people.
    And that will go for Costa Rica, too.

  11. If you have no use for that calendar with the wild-eyed psycho killers I'll take it. 2011 would be quite interesting with some crazy French football players to ogle every month.

  12. Clippy Mat, you know not what you ask....

  13. Fly, I've never had to use our local equivalent of Taxi Merdique, when I was rushed to hospital in the middle of the night it was the Pompiers who took me... well I say took me, they took me to the departmental border, then I was offloaded in the middle of the night, in the pouring rain, dressed only in my PJ bottoms, onto another ambulance that had authority to transport me the rest of the way. How ridiculous is that? My husband wasn't allowed to come and in fact they didn't even tell him where they were taking me. He had to phone round all the local hospitals to try and track me down.

    When I set fire to the kitchen the pompiers took nearly half an hour to arrive from the next village, 5 kms away. I always wondered if it was because they thought my donation for their calendar was insufficient! Fortunately, as a former air stewardess, and owner of two fire extinguishers, I was able to fight it myself so by the time they arrived they were faced with a smoke-damaged English woman and a no-longer burning kitchen.

    Our village produced a 'nude' calendar one year, and sorrier specimens of manhood, complete with marks round their ankles and farmer's arms, would be hard to find. Quite put me off my croissant!

    The French health service is pretty good, it's also pretty much bankrupt too, not to mention costly.

  14. P(V)LiF, I always thought it best to be generous to the sapeurs pompiers....
    If Clippy Mat reads your post she will know why I say she knows not what she asks....I think one of the things people should be told is that they should not live near a departmental and...worse a regional...border

  15. Fly, sage advice indeed. I managed to live near both a departmental and regional border and the administrative nightmare that produced was beyond belief. I would defy anyone to remain sane when they live in one departement and their children go to the nearest school, which is the next departement as well as a different region. Aaaaargggghhh!

  16. Having only ever lived in Lyon in all the time I've been in France, I can see that I am going to be in for a royal treat when I move to the country.

    We have the calendars around here but it's more a question of a quick knock on the door, asking outright for a contribution, no exchange or apero and off they go to the next door.

    My only ambulance experience have been with the firemen which sounds fortunate for me, although having read your post I think I will be tempted to jump in the car and drive to wherever I need to go.

  17. I think firemen universally are sweeties...
    But..whatever you do, heed advice above and choose a house well within one not live on the edges!

  18. Fly.. it's too late now...we are living on the edge...\!/

  19. Lesley, it would make a wonderful title for a blog...

  20. And if you don't give lots of money for the Harmonie calendar, we'll come and play in your garden!!

  21. Mark in Mayenne,you can do anything with threats like that!

    Oddly enough, we had always wanted to provide a music venue..the site was superb... but no one in the powers that be was interested.

  22. Yes there is a feeling here too that anything music-related *should* be done in conjunction with the music school or the Harmonie. Initiative is discouraged.

    But I have found that most people recognise a good thing (or a free concert) when they see it, so drumming up an audience for anything I organise is not a problem.

  23. Loving reading your blog. Just discovered it.

  24. Mark, 'initiative is discouraged' would make a wonderful motto for living in France...

    bigwords is...nice to hear from you.