Friday, 29 April 2016

On Being Sort Of Accidentally Tear-Gassed

Yesterday afternoon I was travelling across Paris, quietly minding my business as I changed from the RER  at Nation. As I stepped on the escalator up towards the metro, I suddenly became aware that there were a lot of people coming down the stairs next to me, covering their faces with their hands and scarves, and someone mentioned the word incendie. Unfortunately, turning around on the escalator wasn't an option, so I had to go all the way to the top, by which time my eyes were starting to sting and I there was a strong chemical smell in the air. This wasn't smoke - it was tear gas.

There were a couple of policemen at the bottom of the stairs who explained nonchalantly that some of the people at the demonstration on the Place de la Nation (contesting the loi El Khomri, which many perceive as an attack on workers' rights) had turned violent, hence the intervention of the CRS. When I asked for more information (such as, was it safe to leave the station), he said they hadn't had any contact with the police up above and didn't know any more. Nobody else seemed particularly bothered though, so in the end I just followed the crowd, took another exit and walked the rest of the way back.

The side of the square where I exited the station seemed pretty calm and I was actually able to make my way across the marching protestors to head in the right direction for home, but I read some news reports later in the evening saying that around 300 casseurs (hooligans) had disrupted the demonstration and 24 police officers were injured, including one who was seriously hurt when a paving stone was thrown at his head.

To put this into perspective, official estimates of the number of demonstrators range from 170 000 (according to the police) and 500 000 (according to the organisers), so 300 is a tiny proportion of the people who were involved, but sadly this is something that often happens in France: peaceful and legitimate political protest is hijacked by vandals who break windows, burn cars and have no scruples about seriously injuring either the police or anybody else who happens to get in their way. And for that reason, I have a lot of sympathy for the police, who are often criticised for their heavy-handed tactics, but are supposed to control this kind of behaviour.

On the other hand, it doesn't really present a good image to the public if hundreds of people in a metro station are exposed to tear gas and effectively given the choice between breathing it in or heading up to the surface and potentially being caught up in a riot. I was able to get myself out of the situation pretty quickly, but what about someone who had just got off the metro at the other end of that corridor? Or an old person who couldn't move very fast, or parents with small children?

It's a situation that reminds me a lot of football hooliganism a few years ago, where everyone's enjoyment was spoiled by a few people who were more interested in fights than the game and gave the sport a really bad reputation. Perhaps it's time for a similar crackdown on the casseurs.

UPDATE: watching footage of what happened on TV, it looks as if maybe what we were breathing in the station was tear gas which was thrown outside (because there was a LOT) and sucked down the air vents to the metro. So still not a great situation, but maybe less deliberate than it initially appeared!

Monday, 25 April 2016

Maternity Care In France

Medical care during pregnancy in France has a reputation for being excellent. As this is my first experience of maternity care anywhere, I can't really make any comparisons, but I'm prepared to believe it. However, like so many other things in this country, it takes a little time to figure out the system before you get to experience the excellence, so for what it's worth, I thought I'd share my experiences here.

As with other kinds of medical treatment, you have a lot of choices in France. The price of having choices is, of course, that you have to take responsibility for your own decisions, and there is also a fair amount of paperwork to be filled out (with accompanying deadlines), which for a rookie like me was a bit stressful, especially in my exhausted and somewhat emotional first-trimester state.

When I first found out I was pregnant, I actually already had an appointment lined up with a gynaecologist, so I phoned my GP to check if there was anything else I needed to do, and she gave me a prescription for the blood test which would confirm the pregnancy. Her secretary told me I would need this to send to the CAF and the sécurité sociale, which was to be done by the end of the first trimester.

From what I understand, the initial pregnancy consultations can be done by a gynaecologist, a midwife or your GP. If the gynaecologist is also an obstetrician, he or she can "follow" your pregnancy beyond the fourth month, as can a midwife. Midwives in France either practise at maternity hospitals and clinics, or as sage-femmes libérales, but hospital care, at least at my maternity unit, seems to start from the fourth month, so if you want to take the midwife option earlier, you have to find your own libérale one.

Most people I know have had their pregnancies followed by their gynaecologist, but my strange experiences with mine ended in me cancelling my 3-month appointment and stressing massively about what to do next. Understanding Frenchman sensibly suggested, after a week or so of being on the receiving end of my stressing, that I went to see my very nice GP to ask for advice, and that is what I did. One twenty-minute appointment later and I was feeling much more in control of the situation. The key things I learned from her were:

- although you can do the déclaration de grossesse as soon as you have the lab report showing that you're pregnant, it's fine to wait until after the 12 week scan, as you have up to week 14 to get it signed by a doctor and send it in.

- you don't have to travel all the way across town and pay a fortune to get a decent scan, as the weird gynaecologist had told me. My GP was able to recommend an excellent radiologist in our arrondissement and I got an appointment no problem.

- if you live in Paris DO NOT (as the weird gynaecologist advised me) WAIT UNTIL AFTER THE SCAN TO SIGN UP FOR THE MATERNITY CLINIC. It's more a case of peeing on the stick and contacting the hospital as soon as that magic line appears. (OK, I'm exaggerating, but not by much. We are lucky to have several good sector 1 units nearby and when I contacted them at around 10 weeks, two of the three were already full.)

Once I had a place at the maternity unit, I chose to have all my appointments there from 4 months onwards apart from the scans, as they do midwife consultations and also run ante-natal classes, but you can continue to see someone outside for a certain number of weeks, depending on what type of health professional they are. One option which doesn't seem to be widely used is seeing a GP - I asked mine a few pregnancy-related questions in the course of other appointments and she seemed a bit surprised. I have the impression that most women in Paris tend to see someone more specialist, and as a result, GPs are less used to dealing with pregnancies than a UK doctor or a French one in a more rural area might be.

I've been very happy with the midwife consultations I've had so far, as the midwives have all seemed both  professional and approachable, and I like the idea of getting to know the people who may be around for the actual birth. However, I can also see some advantages in seeing a gynaecologist (if you happen to have one who isn't weird!). One is that the hours for the midwife appointments are quite limited and have resulted in me having to take a few half-days off work. Although you are legally entitled to do this, given that my mutuelle would also cover the cost of a Sector 2 gynaecologist where I could get appointments after work, I felt a bit bad about missing all that time. Also, despite my weird experiences at the first two appointments, the gynaecologist had the equipment in her clinic to do a couple of very early scans, and it was nice to have some evidence that there was a baby in there and know that everything was OK at those early stages.

That's probably enough for now. More to follow as my experience progresses!

Thursday, 14 April 2016

That's Not My Name!

There has been a lot of paperwork in my world recently. Between medical information, organising maternity appointments and dealing with social security, I was only half-joking when I claimed that our baby required a full-time secretary before it was even the size of a plum. Now that we're also buying a flat (Did I mention that we're buying a flat? Well, we're buying a flat!), the mountain of documents has been growing ever more rapidly.

Mostly, it's fine. There's a lot to "read and approve", a lot to sign and a lot of appointments to fit in, but generally it's just a case of doing what needs to be done. One hiccup that I've encountered on quite a few occasions, though, is people calling me by the wrong name.

When we got married, I decided not to change my last name to Understanding Frenchman's. I had various reasons for this, including some feminist principles and the fact that his name is funny in English if you don't pronounce it the proper French way, but to be honest the biggest ones were that I like my last name, it goes well with my first name, I've had it all my life and it feels like part of my identity. On the other hand, I can see the attraction of having a "family" name that you share with your husband and children, so I wasn't completely against the idea of changing, and I understand why people do it. As a result, I'm fairly laid-back in everyday life if people decide to call me Mrs or Mme  Frenchman (as long as they don't also use his first name when addressing me - that really does offend my feminist principles!).

On official paperwork, however, it's another story. I'm amazed at the number of times that people or organisations have just assumed that I use his last name, and I'm dreading the day when I can't do something important because I don't have any identity documents with it on them.

The problem is that in France, you never actually change your name, you just (have the option to) adopt your husband/wife's name as a nom d'usage. (Eyelean has an interesting post about this where people have shared their experiences of the different options.) This means that somebody looking at my passport would see my actual name but not necessarily understand that this means I haven't taken my husband's name, since a woman who did use her husband's name would also have her maiden name on her ID card (with the option to add the nom d'usage as well). As a result, it's less obvious that I've decided not to change than it would be in the UK, where you either change your name everywhere or you don't.

And so I've written to the CAF, and I've phoned the lawyers, and I've had my blood group card reissued, and every time I wonder if the 25% of women in France who don't change their names after marriage are all doing the same thing, and if not, what I have to do to avoid the problem arising in the first place!

Monday, 11 April 2016

Are You Really What You Eat?

This week I read an interesting article about nutrition science, or perhaps more specifically, nutrition scientists. It explained how the theory that eating saturated fat, and therefore having a high-cholesterol diet, increases your risk of heart disease has never been proven through rigorous study. Because human biochemistry is much more complex than just, “what goes into your body remains in your body” there can even be an inverse correlation between cholesterol intake and blood cholesterol, as the body regulates the level to compensate for high or low consumption.

At the same time as the “saturated fat as the major dietary cause of heart disease” theory was emerging, another theory about the negative effects of sugar in our diets was also being explored, but the politics of science and the personalities of the scientists involved meant that this research was never widely publicised or included in nutrition guidelines. Instead, particularly in in the US and the UK, and following government advice, people attempted to reduce saturated fat in their diets, generally replacing it with simple carbohydrates. A few decades later, we have an obesity crisis.

Part of the research which “proved” that a high-fat diet caused heart disease was a study involving seven nations which showed that in countries where people had a high saturated fat consumption, like the US, people were having heart attacks right, left and centre, while in Japan, where intake is very low, so is the rate of heart disease. What the researchers omitted to include, however, were countries like France, where red meat, cheese and cream are very much on the menu, but the rate of heart disease remains relatively low.

With all of this information now coming to light, along with research into the effects of a high-sugar diet on our bodies' ability to regulate our weight and our appetite, governments are now trying to reduce people's sugar intake with measures such as tax on fizzy drinks.

However, while this is not a bad thing, I don't believe it's the solution to the problem either. Tax sugar, and manufacturers of processed foods will just replace it with something else which will probably be worse. (Remember how we all thought it was a good idea to replace the natural saturated fat in butter with liquid fats that had been artificially hardened into supposedly healthy “spreads” … until it turned out that it really wasn't?) And as long as we continue eating foods where natural flavours have been replaced by inferior substitutes which make the food “more-ish” because it seems to taste good but isn't quite as satisfying as the real thing, we will continue to get fat. Meanwhile, although my mother-in-law's jam, made with raspberries grown in her husband's garden and slowly ripened by the Breton sunshine, may contain a lot of sugar, the high quality of the product is undeniable.

If in doubt, this Facebook meme that has just appeared on my timeline may be good advice!

The French haven't retained a healthier diet than many other western nations by rigorously applying the results of scientific study to carefully produced ready meals. Rather, a combination of respect for local agriculture and a deeply-ingrained love food and the pleasure it can bring means that they have continued to eat genuinely high-quality food more consistently and for longer than some of the rest of us. It's not foolproof – Big Food in France does its best to pass off its products as local and artisanal, and people with full-time jobs and no time to do a weekday market shop do turn to Carrefour deliveries and Picard just like anywhere else. (And you only have to participate in an average apéritif here to realise that not everything here is deliciously natural and healthy.) But the timing here has been better than it has been in other countries, in the sense that France hasn't thrown away its traditions only, too late, to have their value backed up by scientific study. Let's hope that we can hang on to them, and ditch the Apéricubes instead.