Miller children's hospital

May 9th

After seeing so many differences between health care in the USA and the Netherlands, it's nice to see some similarities! Pediatric oncology care in the USA is rather comparable to the care in the Netherlands. Of course there are more patients in the USA, but the number of available beds are comparable, and the same accounts for the treatment and outcome.

Miller children's hospital is a wonderful building. Of course private money/ charity made it possible to build it.

Take a quick look at the poster above. Is it not strange that these kind of posters are actually necessary in a civilized country? Of course you treat every patient: you have sworn the oath of Hippocrates! By the way, hospitals are obliged to treat patients, but MD's aren't. Doctors can refuse to treat a patient if the think that they won't make enough money when treating him or her.

Take a closer look at the poster. You have the right to be stabilized.....

Mother's day

May 8th

It's mother's day and a present has been sent home....

San Diego

May 7th

We visited San Diego, a large city in the South of California. Our visit started with a tour on the USS Midway, a 1000 feet log aircraft carrier, built in the 40's. It was really impressive to see the size of this ship. It really is a city on its own!

Afterwards we visited the city of San Diego itself and we had lunch there. The afternoon was for shopping. We had to buy presents for our loved ones t home, otherwise we will probably no longer be welcome at home....

A day of sightseeing

May 6th

The rotary club of Laguna beach was the concierge club today and they wanted to show us everything. We were driven around in a Cadillac and a Rolls....We visited the art galleries in the town, learned about its history and we saw a lot of beaches.............

Health care

May 5th

Today I spoke with a MD working for Kaiser Permanente, which is a HMO. When you are insured by Kaiser, you will be treated in hospitals and by MD's working for Kaiser. Th e HMO is well known for its quality and is less expensive than other forms of insurance.
Problems that we encounter in medicine in the Netherlands, are often the same problems as in the USA: the increase in the number of patients that turn towards alternative healers and the externalisation of all kind of problems. The fact that malpractice lawsuits are so common, is possibly partly explained by the fact that it is believed that everything has a cause and could have been avoided if somebody had made a different choice....To give an example, if your child is diagnsoed with autism at the age of 6 years, many people believe that it is not fate, but more likely the fact that complications occurred during the delivery. As a consequence, the MD is sued. Could this be the reason for the high number of C-sections: to prevent complications during a vaginal delivery?

The medical health care system and why it doesn't work anymore

May 4th

Today I spoke to an adminstrator of one of the hospitals in California. He did a very good job in explaining me the history of the health care system in the USA.
In 1965 it was decided that the elderly (65 years and older) and the disabled would receive medical care by a system called Medicaid. This is a federal system, which has different names in different states. In California it is called Medicare. All employees pay a contribution to Medicare and when they turn 65 and need medical care, Medicare will pay. In 1965 a total number of 8 employees paid money to this system, to give health care to one elderly. Life expectancy was about 69 years. Nowadays, 70% of people who are 65+, eventually reach the age of 90. Moreover, the ratio employee/ elderly is nowadays 2-3:1. This means that the Medicare system will soon get broke. The state has lowered the amount of money that is paid for the diagnostic and therapeutic interventions in the hospitals. The amount of money paid is even lower than the actual costs. Because the hospitals need more money to survive, they charge patients with private insurance more money, to compensate for their losses. In return, the insurance companies will ask more money to their members. The fact that most insurance companies were taken over by private investors and the fact that only 85% of all the money in an insurance company has to be spent on medical care, aggravates the problems encountered. The fact that medical doctors get paid for eveything they do (CT-scans, bloodworks, etc.), makes that more tests are ordered. The fact that every medical doctor can be sued, even many years after he saw the patient, makes that most doctors practice a defensive kind of medicine in which even more tests are ordered, which will make health care even more expensive.
An 18-year-old girl who wants birth control, gets a breast examination, a mammogram and a PAP-smear, before she receives her receipe. All these diagnostics are performed, despite the fact that they are (in best) controversial all around the world.....

Dalai Lama

May 4th

Today we went to UC Irvine Bren Events Center, together with 6000 other people. We attended a lecture about Compassion and Leadership by the Dalai Lama. After a long period of waiting and after passing the security, we could enter the building. The Dalai Lama told us that he thinks that to many people are money-driven, probably because they think that money will make them happier. The most important message in my eyes: love your children and teach them to respect other people, who are 'different'. Our children can make a difference.

It was wonderful to see the Dalai Lama in person, hear him speak and experience his wisdom and humor.

A new week, a new host

May 3rd

This morning our new hosts picked us up from our hotel. My host is Dean, and his parents were born in Greece. He made me feel at home immediately. He had even bought tulips! In the morning we visited casa romantica (www.casaromantica.org) and learned everything about the history of San Clemente. It's wonderful to see that people are so proud of their history, even if the history is relatively young.

In the evening we had a dinner party at the house of Linda's host. We talked a bit about politics, but we especially talked about alchol abuse and binge-drinking. It turns out that there are several reasons why people abide the law in a more strict manner in the USA compared to the Netherlands. Of course the age limit for drinking is 21 years old, and bars have to pay large amounts of money if they do serve alcohol to adolescents. Not only the owner, but also the employee who sold the alcohol gets fined. Moreover, at home a lot of parents don't dare to serve alcohol, because of the chance of getting sued when something happens to a friend of their son or daughter when he has been drinking and gets an accident. Conclusion: I don't like the means, but I do like the outcome.....

Relaxing

May 2nd

Two weeks have passed since we landed on LAX. In these two weeks we met many people, with all different kind of religions, beliefs and opinions. One thing they shared: they were all US citizens. Slowly we are beginning to understand the people and their culture, and their problems.

This weekend we have a day off en stay in a hotel in San Clemente. We go to the beach, have a swim, go shopping and have dinner together. Tomorrow a new week will begin, a week with cultural visits, vocational activities and a visit to the Dalai Lama.

Sikh temple

May 1st

Today my host family took me to a Sikh service. I saw their temple and joined part of the service. It was very nice to get the opportunity to visit a Sikh temple and learn more about their religion.

When we prepared our study exchange, we said we would go to America and live with American host families. The last few weeks we have learned that there is no such thing. All states have different laws and all states have their own problems. The American does not exist: all different kind of ethnicities, religions and political beliefs have melted into one culture. However, each of these groups also has it's own culture. Conclusion: most Americans are bicultural, which creates diversity, but also creates tremendous problems.

District conference en hospitality night

April 29th

Today the district conference of the rotary was held. We were introduced by the districts governor during lunch and afterwards we presented ourselves. We wore our Dutch clothes and told the audience about the Netherlands.

In the evening we joined the hospitality night. All rotaryclubs served different kind of food. We (yes even I) danced all night!

A busy day

April 27th

How much can you do in one day? You can do a lot.

Today we visited Hoag hospital, the Tiger Woods learning center, a factory building special machines for companies like Abbott and we went to a project foccussing on abused children....

Hoag hospital is a very nice hospital, mostly (again) financed by private money. Rooms are large and have integrated computers for the medical staff. They said that the average occupancy of the rooms is 80%, comparable to the Netherlands. However, for a comparable number of deliveries, they have almost 1.5 times the capacity of beds (and personnel). Ay ll children are checked by a pediatrician and the average length of stay is 24-48 hours when it was an uncomplicated delivery....The number of Caesarian sections is incredibly high: 25-40%!

After Hoag we visited the Tiger Woods learning center. This center, again financed with private money, focusses on 5th grade students, and especially those with a B or C level. By means of experiments and interactive lessons, they try to interest this students in sciences like chemistry and physics. Unfortunately, again this is a project without outcome measurement.

The last few days I have seen that charity plays an important role in everyday life. Without donations, hospitals and educational facilities will go broke....The generous donors, however, most times expect something in return: when they are ill, they want to be treated like a priority patient. They don't have wait in the ER.....

The last event of the day was a visit to Olive Crest. Olive Crest is an organisation comparable with for example Elker in the Netherlands. When for example social securities needs a place for an abused child, who cannot stay at home, Olive Crest is visited. They had recently opened a beautiful facility for children who could no longer stay at home. When an abused child is treated at the ER, and needs no further medical care, then he is immediately transferred to one of the houses of Olive Crest. Here he can stay 90 days. In the meanwhile, social securities looks for a more definite solution. I wish we had such a facility in the Netherlands!

A new host family

April 26th

This morning we went out to get breakfast with Laura and her host. Afterwards we were dropped off and were taken to UC Irvine. After a lunch, we had a lecture about the California anti-bullying preventive. In the first week of our stay in the USA, it has become clear that the problems thta the US is facing, are nowhere comparable to the problems in the Netherlands. I had expected to attend a lecture about bullying, because of it's effects on children (bed wetting, stomach ache, depression). It turned out to be a program to prevent people to get involved in gang related crimes (as bullied people can get violent......). Again this was a program that was financed with private money. The state of California is almost broke and all kinds of initiaves in education and health care are financed with private money. The effect of most of these programs is never measured.

After the lecture I went to my new (Indian) host family. They were very nice and wanted to know everything about the Netherlands, social security and the health care system.

Orange Police

April 25th

This morning we went to Crystal cathedral again. This time the sun was shining and there was no service. Therefore we could make some pictures of the interior. It really is an impressive building. After a short GSE-meeting, during which we evaluated our first week in the USA, we got a burger at In N Out. The conclusion of the meeting: the first week could not have been better. Everybody is so nice and generous. We really feel at home. Tomorrow we will have to leave our hosts and go to the next host family, but we don't want to go....

This afternoon we visited the Orange Police and literally saw everything. Sergeant Mike gave us a tour, we watched the SWAT truck and we had a discussion about crime rates and crime prevention.

Easter is a family day

April 24th, 2 PM

This afternoon we went to Huntington beach to visit family. I finally saw Slater, Mike's and Jean's great grandson. He is a wonderful boy! We had a BBQ (despite the fact that we had just eaten a Vietnamese lunch....) and we really had a nice team. After our BBQ we went to the parc: we played egg toss (http://en.wikipedia.org/wiki/Egg_tossing) and really talked about everything. We talked about vaccinations, the use of vitamin K, politics and religion.

It is a fact that almost everyone in the US is concerned about the current problems regarding the economy and the health care system. Everyone I speak has different solutions, but nobody is sure that these solutions will work. Today someone told me: when you consider Europe as an , adult, the US are just a teenager....Changes take time, but they will come. At this moment both the US and Europe are facing great problems, and the solutions are difficult and not very popular.

Crystal cathedral

April 24th, 10.30 AM

Today it is Easter and it is raining.... After working on my blog, Michael takes me to Crystal Cathedral. It's a magnificent building! After looking around, we attend part of the service.

Crystal cathedral is a large building, but not so large as Saddleback church.....

Disneyland

April 23rd, 10 AM - 10 PM

We have been to Disneyland all day! And we all really enjoyed. We took all great rides en saw the most beautiful things.
The Fantasmic show was so nice to see. I know that my wife and son will be jealous! Annemieke en Hasse, I promise that I will take you to Mickey and his friends in Disneyland.

http://disneyland.disney.go.com/

Saddleback church

April 22nd, 5 PM

At Eastern it is almost impossible to go to church, it's so crowded. Therefore we went to church today. This week the Eastern service is hold 12 times (the same service). Saddleback church is huge: 3,000 people can be there together.... This day a miner from Chili, wo had been underground for 69 days (you will all remember the story), talked about his time underground.

The service was really impressive, but not my cup of tea I suppose. I really like our own small congregation in the Netherlands. However, in the Netherlands we are are talking whether or not to get a beamer and stuff like that which will cost us 4,000 dollars, but here they raise 43 million dollar when they want to built a new building for the teenagers.....

Lunch....

April 22nd, 1 PM

In the States you don't lunch with a cheese sandwich! You go out lunching! And when in Rome, do as the Romans do. So we had a wonderful Mexican lunch, it was enough for about a week, but we ate it all. The dessert was delicious: fried ice-cream (remember, it was just lunch....)

Same sex marriage

There would be a wedding in the Richard Nixon library, the day we visited it. Of course we began to talk with our hosts about marriage and about the fact that we have the same sex marriage in the Netherlands. We had to demonstrate that and Spud helped in performing the ceremony.

Richard Nixon Library

April 22nd, 9 PM

This morning we visited the Richard Nixon library, which is actually a museum regarding the life and work of Richard Nixon. We visited his birth house and entered his helicopter. We learned everything about his life and of course about watergate.

Angels- Red Sox 2-4

April 21st, 7 PM

The first baseball game we ever saw and we lost.....

Fortunately, we had a wonderful night and we really enjoyed ourselves in the stadium. So many people in red. We had Churros and Hotdogs and we talked about the game, unions, the helath care system and so many more.....

Mental Health Services

April, 21st

Together met Dr Michael and Linda, we went to St. Joseph Hospital. We spoke to the personel of the psychiatry unit and we got a tour. Linda showed some pictures and everyone was really impressed. Money seems to be a great problem in mental health care in US, as 'it is not a money maker'. A psychiatric patient shares a room with 3 other patients!

We talked to the manager (a liberal) and heard a very different opinion concerning the health care system in the US compared to what we had heard before. It's very nice to hear everyones opinion about both the Dutch and American health care system.

Chapman University

April 21st, 9 PM

This morning we went to Chapman University, a private university in California. Here we got a tour and we attended a lecture. In this lecture, a course about conflict and conflict management was presented. The information shared was comparable to the courses about tis subject in the Netherlands, however, the classes are much smaller and probably therefore, much more interactive.

A new morning

April, 21st

5 AM and already awake: this is what they call jetlag! After working on my computer for an hour or so, we had breakfast with melon and delicious toast....

At 8 AM we left for the city hall. At city hall all members of the GSE team were dropped of. This morning we will be heading for Chapman University.

A very warm welcome

April 20th, 6 PM

This evening we had a welcome party at the house of Johrita and Bruce. Of course all GSE members were there, and also around 50 Rotarians. We talked with a lot of people, explained our goals and told everyone about our lives in the Netherlands. A lot of US citizens told us they had been to the Netherlands!

The food was good, and so was the company. Around 9 PM we all went home and directly fell asleep.

The first vocational visit

April 20th

At 10.30 AM Dr Michael Abdalla picked me up from the Double Tree Inn. He and his wife Jean will be my hosts this week. They both are really lovely people!

After installing myself in my new bedroom, we left for the Children's Hospital of Orange County (CHOC).

We had a lecture about Ewing sarcoma and afterwards the chief resident, Kevin, gave us a tour.

CHOC is a children's hospital with more than 200 beds. Every subspecialism in pediatrics, oncology, neurosurgery, etc even has it's own ICU beds!

The rooms are big and very sophisticated. Money is never a problem as a lot of people donate money to children's hospitals in the United States.

Sweet dreams

April 19th: it's only 6 pm, but we are so tired! We take a quick swim and go to bed at 8 pm.

We are in California!

After an eleven our flight, we arrive at LAX airport. Four members of Rotary pick us up and give us a very warm welcome! The take our suitcases, drive us to the hotel and help us check in.

We buy sim-cards for our telephones, have a drink with Johrita, the district governor, and with Greg Owen, who will be next year's governor.

The beginning of a long journey

After months of informal and formal meetings, filling in forms and making powerpoint presentations, the time has come.

At 7.30 PM we take the train to Schiphol airport. The first night we stay at the van der Valk hotel at the airport, tomorrow we will fly to the USA!

Our son and my mother in law help carrying the suitcases....

Mijn laatste werkdag

Vandaag is dan toch echt mijn laatste dienst (en tegelijkertijd laatste werkdag) in de Isala Klinieken. De laatste brieven worden geschreven, de laatste foto's verstuurd en de medische dossiers bijgewerkt. Vanaf morgen ben ik vrij en zal ik mij volledig op de reis naar Amerika gaan richten. Eerst maar eens een lijstje maken met alles wat nog gedaan moet worden. Vandaag hebben we in ieder geval vanuit Amerika te horen gekregen dat we op bepaalde momenten toch echt met jasje en stropdas verwacht worden: samen met de andere heren in ons reisgezelschap zal er daarom in ieder geval nog een winkelsessie volgen. Maar welk jasje past er nu bij een zwarte blouse met Delfts blauwe (Delftware in English) accenten?

Districtconferentie Emmen

Vanochtend heeft het GSE-team zich gepresenteerd op de jaarlijkse districtsconferentie van district 1590. Na een korte inleiding door de teamleider, hebben de GSE-leden zich aan de rotarians voorgesteld en uitgelegd met welk doel wij naar California afreizen.

De gouverneur van distric 1590 (district Noord-Nederland), heeft reeds kennisgemaakt met de Rotary-leden in Orange County. Hij verzekerde ons dat wij meer dan welkom zijn in California. Vanuit Amerika had hij alvast een eerste geschenk meegekregen: Mickey en Minnie Mouse, versierd met een Rotary-speldje.

GSE 2011

Het Group Study Exchange programma (GSE) van de Rotary Foundation biedt jonge beroepsbeoefenaren (m/v) tussen 25 en 40 jaar een unieke mogelijkheid om aan het begin van hun loopbaan in het buitenland culturele en beroepsmatige kennis en vaardigheden uit te wisselen. Het GSE programma verzorgt reizen voor teams die een uitwisseling hebben met een bepaald district in het buitenland. Een GSE team bestaat uit vijf vooraf geselecteerde personen die geen lid zijn van Rotary en een Rotarylid dat als teamleider fungeert. De deelnemers verblijven vier tot zes weken in het gastland en zij bestuderen daar de gewoonten en de manier van werken op hun eigen vakgebied in dat land. Zij ontwikkelen daarbij persoonlijke en professionele relaties en wisselen ideeën uit. In 2011/2012 vindt de uitwisseling plaats tussen Orange county (California, USA) en Noord-Nederland. Het Nederlandse team reist in het voorjaar van 2011 af naar California.