New Flophouse Address:

You will find all the posts, comments, and reading lists (old and some new ones I just published) here:
https://francoamericanflophouse.wordpress.com/

Tuesday, June 5, 2012

Go North, American Workers, Go North

A link to a very interesting article was posted in this thread over at Isaac Brock (hat tip to Badger):
Need job, can’t travel to Alberta:  Washington wants Ottawa to make it easier for U.S. workers to fill vacancies there.

In a nutshell, Canada needs workers, Americans need jobs.  As mentioned in a previous post, Canada's unemployment rate is well below that of the U.S. and in some Canadian provinces industries are screaming for skilled labor.  Well, some of the potential workers are sitting right there down south cooling their heels at home or in the unemployment lines.  Sounds like a fairly straightforward situation that two old friends ought to be able to work out over a cup of coffee and a donut.

It's not.  In fact, one Canadian HR manager said that of all the foreigners they are hiring right now (and they are hiring quite a few) Americans are the hardest to bring on board.  Canadian industry is complaining about government red tape and the difficulty of getting U.S. workers' skill and credentials recognized.  Canada has a system of "formal apprenticeship and certification system for many skilled trades" but the U.S. has no equivalent.

This surprised me because I had thought that such things were covered under NAFTA (the North American Free Trade Agreement).  Apparently not.  It seems to be easy enough for a manager (something the Quebec companies I was talking to recently assured me) but not for workers.

Both governments are making noises about rectifying this.  "Business leaders say Canadian and U.S. officials are looking for ways to enable Canadian companies to hire U.S. workers and recognize their trade skills so they can work legally in Canada."  But surely some sort of reciprocity will be on the table as well.  After all, if Canada makes it easier for Americans to work in Canada then one would expect the U.S. to do the same for Canadians.  These days Canada has more leverage in these talks.  The proverbial shoe is on the other foot with Canada being the prime destination nation sitting next to a potential sending country (the U.S.) with a pool of unemployed workers that can probably be had for a reasonable cost. Note as well that this is an election year in the U.S. and it would be helpful to the current administration to get those unemployment numbers down before November.

Of course this raises the usual debates in both countries.  Shouldn't Canada be training its own people to take these jobs instead of lowering its standards and bringing in Americans to "steal" them?  In the U.S. might some political parties make political hay over the fact that the U.S. is doing such a poor job of providing work for its own people that it has to start exporting them?  Not to mention that the U.S. tax code makes it very difficult for Americans to work abroad - it is designed to punish emigrants.  If some of these skilled U.S. workers do go north, they are in for a big and rather unpleasant surprise when tax time comes around in the U.S.

A situation worth watching.  If there are any Canadians reading this, I'd love to get your take on it.

Monday, June 4, 2012

Citizenship Renunciations: A Closer Look at the Numbers

Some days I just like to kick back and watch finer minds than mine tackle sticky questions.  Posts about the number of renunciations of American citizenship appeared recently in two blogs that I follow regularly, the Isaac Brock Society (I'm also a contributor) and Overseas Exile.   In their analyses is an important lesson about raw numbers and why it's important to dig deeper in order to understand what's really happening.  Context and a little critical thinking, mes amis, is everything.

Let's start with Overseas Exile.  Blogger Curtis Poe has been running a series about the data and politics concerning renunciations of U.S. citizenship.   Following Eduardo Saverin's  highly publicized departure, this number, 1,780 renunciations of U.S. citizenship in 2011, has been thrown out by the media and has been analyzed as high or low depending on your perspective.  Poe digs into that number and those of previous years to ask if these numbers are correct and has the U.S. done a proper job of compiling them for the official list?  The short answer is "no."  As Poe points out in this post :
Names are duplicated, some names are apparently missing, as we see updates posted later, and there's no way to cross-reference these names to anything reliable because there's just not enough information. Further, while my many years of work with raw data tells me that when data is bad it's usually consistently bad, that's for computer-managed data. But for this data, as far as I can tell, it's largely a manual process of handing this data from the various consulates, over to some central office of the State Department and then over to the IRS. It's also entirely possible that there have been political decisions involved in how this data is moved around and presented.
His suspicions are confirmed by accounts at Isaac Brock and elsewhere of Americans who did renounce and, to their surprise, never saw their names appear on the list.  Poe also took information about U.S. citizens naturalizing (taking on a new citizenship) in countries that do not allow dual citizenship - people who, in theory, would be required to renounce their American citizenship per their new countries citizenship requirements.  This is what he found:  "As you can see, aside from 2010, every year shows that more Americans obtained citizenship in countries which do not allow dual citizenship than Americans having reported as renounced. Heck, just for 2008 we have Germany reporting twice as many Americans acquiring German citizenship as there are reported renunciations."

And finally in this post, Poe looked at the only other year to date besides 2011 when renunciations of American citizenship were soaring:  1,812 in 1997.  Following a tip from Tim at Isaac Brock he found the answer in a U.S. government report:  1997 is high because the U.S. IRS combined the data from 1995-1997 into one year.  You read that correctly - the 1,812 renunciations of American citizenship on the IRS list for 1997 is really three years dumped into one.   Which means that "2011 does have the highest recorded number of renunciations in US history."

Conclusions?  The data on renunciations of American citizenship as reported by the American government is not to be trusted.  The numbers are higher, maybe much higher.  What I find interesting is that the media in the U.S. do not seem to be questioning them.  Where is the serious investigative reporting that U.S. journalists have been rightfully known for in the past?

Moving to the Isaac Brock Society, Eric took on an interesting task in this post, Comparing Renunciation Rates Around the World.  The U.S. numbers are one thing and taken in isolation you can argue that they are high or they are low or perhaps even that they are "just right" given the size of the U.S. homeland population. So Eric decided to see how the U.S. stacked up compared to other countries and their renunciation rates.  And instead of looking at the numbers of renunciations relative to the population, he   looked at the size of each countries' diaspora (those living abroad who are probably most likely to renounce) and calculated the number of renunciations per 100,000 people.  Just using some basic data on a few developed countries like Japan, Singapore and New Zealand and making some "back-of-the-envelope” calculations, he finds that the U.S. has a surprisingly high rate of renunciations.  Lower than countries like  Japan, Singapore, Taiwan and South Korea but higher than countries like New Zealand or Hong Kong.

Eric is very careful to say that his data was not necessarily reliable, especially for the U.S. which does not track its own diaspora (numbers range from 2 to 7 million) but his preliminary results were interesting enough that he continued his analysis here using renunciation data from Europe.  His conclusion? "Contrary to what the U.S. media would like us to think, 1,780 renunciants is a surprisingly large number for a first-world country, even one the size of the United States."  I invite you to have a look at his posts to date, the data and his analysis and decide for yourself.  But clearly he's onto something worth pursuing further.  It is simply not enough to assert that 1,781 U.S. citizenship renunciations in 2011 is "nothing and means nothing."  Rubbish.  Not only is this an emotional response devoid of any empirical evidence to back it up, but people's perceptions (especially those of politicians shaping policy) are influenced by these numbers when they are thrown out by the mainstream media without any context, questions or analysis.

Sometimes I look at my own country and the swill that passes for serious journalism there these days and I ask myself, "What are they thinking?"  Not critically, that's for sure.  What happened?  Perhaps one answer can be found in the growing numbers of American citizens living abroad.  What if the real damage is caused, not by people taking their money out the U.S., but by folks taking their brains elsewhere.  Curtis and Eric are two salutatory examples of people (from abroad, mind you) who are asking hard questions and actively looking for answers.  

Good work, guys.


Sunday, June 3, 2012

Student Strike In Québec

This morning I am turning over the blog to the elder Frenchling.  She is studying at Mcgill in Montreal, was at the heart of the action when the strikes started, and has been following the situation closely from the Flophouse here in Versailles.  She has some very strong opinions about the strikers and the rightness of their cause.  So I told her to get her thoughts in order and write it up and I would publish it here.  She did and here it is.  To say that she is not amused would be an understatement....

Students in Quebec on Strike!

It all started in march 2011, when Jean Charest, the Prime Minister, decided to not be a wuss and give universities in Québec what they really need: more money. Instead of taxing the entire population, he said that students should pay their fair share. Québec students pay the lowest tuition in North America, about 3000 dollars for a year. He proposed an increase in 1675 dollars in 5 years. It would bring tuition to maximum 4975 Canadian dollars a year, an increase of  75 %. Still much lower than the national average. And yet, students all around Québec had a meltdown. Understandable.  No one wants to pay more. 

The three leaders of the main associations étudiantes, CLASSE, FEUQ and FEQC immediately called for an unlimited general strike this year. The universities voted in their own general assemblies. The vote was hands up or down.  Does this remind you of anything? ("cough" communist regime "cough"). Any student voting against the strike was intimidated: people took pictures, shouted insults and shamed them. Thankfully, at McGill University (where I'm at), the strike was voted down. This was attributed to the large population of foreign students who simply do not care about local Québec politics. I like to think of the vote as common sense and a commitment to working and being productive as opposed to running down the streets with a red flag. 

Protests started to take place all around Quebec. They led to confrontations between the police and students. Students crying out, blaming police violence. Policemen complaining about students throwing projectiles and screaming "fuck the police". (I want to join the police later so I can't help but be sympathetic. If someday someone throws rocks at me, I'm going to arrest them.)

However, this did little to stop Charest. The students got angrier. You know how children get when you refuse them something?   They get nasty and throw food at you. After this, acts of vandalism started to become more common. Red squares were painted everywhere. Shops windows were shattered. The protesters started to wear masks. Charest called on the leaders of CLASSE, FEUQ and FEQC to condemn these acts of violence. They wouldn't. (What does that say about them?) Students started asking for free education. They turned it into a social conflict against capitalism and a "corrupt government". 

I might add that the minute the "strike vote" was passed in universities (reminder: the vote was not anonymous and anyone who tried to vote against it was shamed) people couldn't go to class anymore. Anyone who tried was thrown out and humiliated. Here is an example
On Wednesday, a masked enforcement squad swept through the campus at the Université du Québec à Montréal, hunting for students who had dared to show up for class. Wherever they found a class in session, they broke in and shouted “Scab!” in the students’ faces. The enforcement squad was defying a court injunction that ordered the university to open. They jumped on desks and tables and spray-painted slogans on the classroom walls. They grabbed two female students by the arm and told them to get out. The intimidated professors fled. Later, as law student Christina Macedo tried to explain to reporters what had happened, they drowned her out. “Scab! Scab! Scab!” they shrieked.
All the while they blocked exams, classes etc, they screamed "we're going this for YOU! So YOU can go to school!" Dichotomy between actions and words here - You just stopped hundreds of students from going to classes they wanted to attend and already paid for. They LOST time and money.  Proud now?

The strikers' reasoning?  "The strike was voted! It must be respected!" they whined. NO. You can't stop people from going to class. And I'm guessing the majority of students want to go back to class.  When asked why they don't have an anonymous vote, the strikers suddenly fall silent. What are they afraid of? 

A few brave students went to court and some universities were forced to open their doors, but the protestors always got their way through pure intimidation. As a result, the semester is now suspended due to Charest's "special law".   Essentially, protestors now need to make their itinerary known 8 hours in advance. They aren't allowed to wear masks. They aren't allowed to stop students from going to class. The semester is suspended until August. 

They had another meltdown. Claiming this new law gives too much power to the police, the leaders of the associations étudiantes just said they would not comply with this law, and they are asking students to do the same. And here is where I just lost it. Gabriel Nadeau-Dubois (leader of CLASSE) just told students to disobey the law. He says he doesn't care about fines. He says the government added fuel to the fire. And what would he call what he just did? Now Quebec is the scene of a huge riot. 300 protestors were arrested the other night. Fires were burning. Monuments were vandalized:  trash cans overturned, beer cans, condoms?! Sounds more like they're having a party than protesting for freedom and civil rights... 

I grew up in France. France, the land of strikes. French people love striking. It is kind of adorable sometimes, hugely annoying at other times. When I came to Quebec I thought I came to a place were people accepted that sometimes life can be tough and sometimes you have to pay for stuff. 

There are civilised ways to let the government know you're pissed off:  peaceful protests, petitions and elections. It's called democracy and the Québec student strikers really should give it a try.

(Here is a timeline of what's been happening)

Saturday, June 2, 2012

Education in France: Classer et éliminer

There is a lot to like about the French public school system.  From maternelle (preschool) to lycée (high school) it is well-funded.  The basic infrastructure is good:  schools are clean and orderly with no lack of books and other basic learning materials and the cafeteria food is well-balanced and tasty (especially at the maternelle and elementary school level).  For working parents the system has been expanded to include after-school care and there are camps available for the kids during vacations.  The level of teaching is high and all the teachers I've met were dedicated and serious ( I say this even about the ones I didn't like and there were a few).  In 2010 France spent nearly 135 billion Euros (about 7% of GDP) to serve over 12 million students in 65,173 educational establishments.  This spending is above the OECD average but I've heard few people complain about the cost.  I think this demonstrates the commitment that the French people and government have toward the public school system.  Education is serious business in the Hexagone and a source of much public debate which is rarely about the price tag.  Rather, the arguments tend to be about how the system is administered, how effective it is and how it could be improved.  It is constantly being "reformed."  Why?

Because, as my friends would say, "les résultats ne sont pas là"  a statement that is not entirely correct but just true enough to have people worried.  In spite of spending a great deal of money and exerting great effort, France does not have as high a rating in the OECD's PISA (Programme for International Student Assessment) as one might expect.  In 2009 PISA evaluated students in reading, math and science and French students were, well, average. Check out figure 1.2.15 on page 54,  France's reading score was 496 which is respectable but not outstanding and well behind other OECD countries like Finland, Canada, New Zealand and Japan.  Same for math scores (see figure 1.3.11) where France ranks well within the OECD average at 497 but is way behind countries like Finland, Switzerland, Canada and Belgium (not to mention Asian countries like Korea).  Again, these are respectable scores well within the OECD average. All this begs the question:  are we not simply generating "notre propre malheur"  (our own unhappiness) when we look at those numbers and get agitated?  No, because the world is getting more competitive, globalization is a fact of life, and we all want our children to have the best possible education in order to have as many options as possible.  Moreover, since globalization has a tendency to exacerbate existing inequalities (or create new ones), it's important to keep an eye on education and be sure that every child is getting a fair chance and isn't being held back because of factors beyond his control.  The French spend a lot of money on education  and they have the right to question how that money is spent and ask why, given better than average funding, the national numbers are not higher.

Some clues can be found in an excellent analysis called La machine à trier (The Sorting Machine) by Pierre Cahuc , Stéphane Carcillo, Olivier Galland and André Zylberberg (nice excerpt in this on-line article.)   What did these authors of this book find when they looked the French system?

For starters, inequality.  Yes, for the country of "liberté, égalité, fraternité"  the PISA results show incredible inequality.  Take the reading scores, for example.  France has an above average percentage of students in the good to great category but she also has an above average percentage of students in the below to way below average categories.  Lot of students "en difficulté" and having a very hard time reading at the most basic level.  They say that much of this inequality is rooted in the family - not so much money as cultural capital.  Students in families where professional level of the parents is high and have lots of books at home and the like, have more of what they need to succeed in the French system.  The closer the cultural capital of the family is to the system, the better the kids do with the most successful kids having parents who actually work for the educational system.  "En 2009, 89,4% des enfants d’enseignant accèdent à l’enseignement supérieur, alors qu’ils ne sont que 31,1% dans ce cas pour les enfants d’ouvriers non qualifiés." ( In 2009 89.4% of children whose parents are teachers went on to higher education, while only 31.1% of the children of basic workers did.)  This not a new phenomenon in France and I recall that Pierre Bourdieu was already talking about this years ago.  What is disquieting is that it seems to be getting worse, not better.  From 2000 to 2009 "la proportion des élèves de 15 ans les moins performants en compréhension de l’écrit est passée de 15% à 20%" (the proportion of 15-years old the least able to understand written texts went from 15% to 20%).

What in heaven's name is going on here?  This is a well-funded national education system backed by a public that I don't believe for one moment wants to see these kinds of numbers or is willing to throw up its collective hands and shout, "C'est la vie!"    The authors point to three characteristics of the French system that they think work against the goal of basic equality and opportunity for all:

Orientation:  This happens officially at the end of middle-school but in reality sorting starts much sooner than that.  Students are evaluated and orientated toward different schools and different areas of study depending on their results at that time.  I have lived the failure of this method.  When we returned from Japan it was late in the school year and the only places available at the local college were in what is referred to as the "classes poubelles" (the garbage classes).   As a result the elder Frenchling who was in her last year of middle-school was then oriented toward a very poor high school here in Versailles.  The public system gave us no other options though we could have gone private.  We were very fortunate that one teacher at that high school noticed during her first year, made a determination that a terrible casting error had been made, and recommended that she be transferred to a better high school where she succeeded brilliantly - well enough to get into a top university in Canada.

The system is, to say the very least, not terribly flexible.  Kids who are perceived to be poor students are systematically tracked away from programs that would allow them to get into high education later on.  It looks at past success or failure and does everything in its power to  make sure that kids continue to succeed or fail.  This does not take into account that some kids are late-bloomers or any other factor that might explain why there might have been a period of difficulty which would justify putting off judgement for a few years.  The authors of "La machine à trier" point out that countries with the very best PISA scores like Japan and Finland wait until much later to orient students.

Teaching methods:  There are a lot of jokes and criticisms of countries that place great emphasis on building students' self-esteem.  Some of that is fair but sometimes the French system feels like it's actively trying to destroy it.  The teaching methods can be very harsh and the power distance between students and teachers is very wide.  "Certaines écoles se caractérisent par un enseignement « vertical » où les professeurs délivrent des cours de type magistraux, les élèves prennent des notes, lisent des manuels et les enseignants posent des questions aux élèves." (Some schools can be characterized by a "vertical" style where the teachers deliver authoritative lectures, students take notes, read the literature and the teacher asks questions of the students.)  I am very glad that they qualified that statement since it is not true at every school and not every French teacher uses this very traditional method.  However, there is enough truth in it that the many private tutoring companies that exist to serve struggling students talk a lot about their ability to improve self-esteem as well as grades.  From Acadomia, "Notre philosophie : la confiance en soi comme étape fondatrice du succès." (Our philosophy:  self-confidence is the foundation of success.)

Competition:  The French system systematically judges and eliminates but how it judges is a bit particular.  Success is always relative and the only way to have "winners" is to create "losers."   A class where a high percentage of students succeed is simply not credible which leads to a rather vicious practice:  downgrading the class grades until there is a sufficient number of failures. "Si une évaluation n’est crédible que si elle affiche un certain pourcentage d’échec, de nombreux élèves, vont obtenir de « mauvais » résultats scolaires, quels que soient leur travail et leur bonne volonté." (If an evaluation is not credible unless it shows a a certain percentage of failures, than many students will simply get "bad" grades regardless of how hard they work or their motivation.)  This is exactly what happened in the younger Frenchling's high school math class.  The teacher noted (and delivered the news directly to the students) that too many students were doing too well on class tests and that she was obliged, as a result of their good scores, to lower everyone's grades.

Cahuc, Carcillo, Galland and Zylberberg argue instead for "une pédagogie de la réussite pour tous." (a teaching method oriented toward success for all.)   To those who would counter-argue that this would lead to inferior results for everyone, they simply point out in that other countries with better results than France the school systems not only perform better overall but manage to do so in a fairly equitable manner with a much smaller gap between the "worst" and the "best" students.

As a parent here, how do I feel about all this?  As someone whose children have been more or less on the winning side of this system, there is a very human desire to maintain it as is.  I suspect that many French parents in a similar situation feel this way.  Don't tinker with the machine lest allowing other people's children to win might mean that our children will do less well.  Once past that visceral reaction (which I will be the first to admit is petty, small-minded, and entirely based on vague unjustifiable fear) I think they are on to something.  If I dig a little deeper I find that I am appalled at  the notion that one child's success should be almost entirely based on another's failure.  Education should not be a zero-sum game and, where there is substantial evidence that the game is rigged, then there needs to be change especially in a country that has "égalité" as a founding principle.  I'm not sure how seriously their proposals are being taken by the Education nationale but here's one thing I am dead certain of:  the barriers to change do not really concern the financial realm - they are cultural and changing people's attitudes and deep beliefs (not to mention overcoming resistance to and fear of change) is a far greater task than any educational "réforme" devised by a French politician or bureaucrat thus far.

Friday, June 1, 2012

Recruiting for Canada

I neglected to mention that the elder Frenchling is back home in the Hexagone after a successful first year at university in Canada (she's at McGill in Montreal).  So nice to have her home and hear her stories about the Frozen North (not bad at all - just dress warmly and have sturdy boots).  She's been out and out about recently, re-connecting with her high school friends here in France who are at various French universities and she's spreading the word about Canada in general and McGill in particular.

As a visual aid she's been using this video which she showed me last night.  This was produced last winter by the kids in her dorm (Gardner Hall).  Set to various pop songs that I'm sure you'll recognize, this short piece gives you a tour of the facilities (including the skating rink set up just outside when it got cold enough) and shows the residents displaying their skills, talents and affiliations (yes, there is a French flag in there).

The elder Frenchling's French friends here are reported to be quite impressed.  I suspect their parents would be less so.  Lot of things in here that are hard to translate to another context:  the idea of "school pride,"  the jokes about drinking, the crazy skateboarders and the like.  How to explain that it's a goofy show of "solidarité" that is not incompatible with being "sérieux"?  

I loved it and am posting it here for your viewing pleasure. Mesdames et Messieurs, the denizens of Gardner Hall at McGill University (2011-2012):

Thursday, May 31, 2012

Healthcare Systems and International Mobility

I've had the pleasure of knowing three different healthcare systems in my time:  U.S., France and Japan.  All have been outstanding  I'm a skilled IT worker and I was legal resident of all three countries so I never had any problem with payment.  I was always covered under either private insurance through my employer or a national healthcare system.  Sounds simple and straightforward, right?  Not exactly.  For people who are highly mobile and move from one country to another there are some special challenges that are not necessarily taken into account by healthcare providers and networks in any country.   Here are a few thoughts about things I've noted over the years that sidesteps the question of which healthcare system is best and focusses instead on how well these systems work for highly mobile international migrants :

Relationships:  Once you get beyond the question of how it will be paid for and get inserted into whatever system exists in the host country, there is the important task of finding a doctor you like and building a relationship based on (one hopes) trust.  This doesn't happen overnight.  Leaving the country means leaving that relationship behind and having to build new ones in the new country.  I know that my own impressions of the different healthcare systems I've used are heavily colored by the doctors who treated me.  I still miss my ob/gyn in Seattle and have never found one as good or who I liked and trusted so much.  Same for my dentist in Tokyo.  I was very lucky to find a GP here in Versailles who is, for me, the very best I've found yet.  But building those relationships takes time and can involve a certain amount of trial and error.  I've talked to a number of migrants who rely for years on drop-in clinics and emergency services because they just haven't found someone they like and trust enough to become a regular patient.  This can translate into a situation where migrants don't get preventative care:  standard tests, immunizations and the like.

Continuity:  Having to rebuild relationships with healthcare practitioners means a lack of continuity in care.  All too often medical records  don't follow or have to be translated.  Immunization records, for example, have to be interpreted in the light of whatever the practice is in the host country.  There are similarities between the immunizations given to children in the U.S. and France but it's just different enough that the new doctor has to struggle to fit one system into another and determine what needs to happen next to comply with the host country's standard immunization schedules.  For adults the onus is on them to keep track of things and provide the new doctor with enough information about care received elsewhere so that he or she can pick up where the last doctor left off.  In the stress of moving and the adjustment to a new location, this is not usually a top priority, but can come back to haunt the migrant when he or she is asked by the new doctor, "So when was your last tetanus shot?"

Learning Curve:  The systems are very different from one country to another and a migrant has to spend some time learning how it all works in the destination country.  The processes are very different and you have to learn what forms to file, who to talk to or call, what to do in case of an emergency, what options are available and so on.  I know very few migrants who've actually researched the health systems of the new country or took the time to read all the terms and conditions for private insurance.  A lot of the information on-line, or provided through pamphlets and the like, all too often assumes some basic knowledge of how things generally work here which may be radically different from they worked over there.  It can be overwhelming for a new arrival and tends to be put off until he/she simply has no choice.  It comes down to "learning by doing" which can be very frustrating and very hard for someone who needs the access but isn't feeling that well and is not in an optimum frame of mind to assimilate new information.

Culture:  Aside from the basic protocols which are usually pretty similar between developed nations, the doctor/patient relationship varies radically according to the culture.  In some places doctors are remote paternalistic figures (gurus) and they don't like to be questioned by patients and would be very offended if a migrant sought a second opinion.  In other places, a migrant may be inundated with information by a doctor with a very informal familiar style.  This is not a statement about which is style is better, it's about the impact of that style on a migrant who is accustomed to something else and has different expectations and needs.  It can be very destabilizing and be an important barrier to building trust between the doctor and the patient when they are operating under two different cultural codes.  Adaptation is necessary and ideally should come from both sides.

Language:  On top of the cultural issues there is the issue of language.  To get and provide good care the doctor and patient have to be able to communicate.  Where the two don't share a common language this is a real problem.  One solution for the patient is to actively seek out a multi-lingual doctor.  This is easiest in big metropolitan areas and almost impossible in rural areas.  Sometimes the migrant actually waits until he/she has a basic command of the language before seeking any healthcare outside of an emergency.  It's simply too frustrating for both parties.  The cultural and language barriers can also be deadly.  I know one woman married to a Frenchman who was diagnosed with cancer after a few years here who became so frustrated and so depressed during her treatment that she ended up in the psychiatric ward.  Because of the communication problems the healthcare professionals simply didn't see the deterioration of her mental state until it was too late. Given how important morale is to successfully treating conditions like her, this was something that very much threatened her survival.

All of the above has a real impact on access to healthcare and the ability of any system to provide the kind of preventative care needed to avoid costly life-threatening situations.  The extent of the impact varies according to the migrant (socio-economic status, language ability, cultural knowledge and other variables) but anyone who is highly mobile will most likely encounter one or more of these difficulties. There is no one solution to all of them but I would like to propose that, instead of arguing about which system is "better," we might want to turn our attention for a few moments to the global arena and think about how we could make these systems work together to provide the best possible care for the mobile international migrant.

Wednesday, May 30, 2012

The Antithesis of a Fairy Tale

Remember how I was saying that not every migration story (even to an exotic locale like France) turns out to be a fairy tale?  I contend and will defend to the death my belief that my life in France is not better than the life I might have had had I stayed in the U.S., it's just different. In the cosmic crapshoot of life, stuff happens wherever you are and you don't always get to have things your way.

About two months ago I was diagnosed with cancer.  Since then I have been learning an awful lot, not only about a part of the French healthcare system I was kinda hoping I'd never need to use, but also about people here in my host country.  A new situation, new relationships, lots to learn.

Originally I was not going to post about this on the Flophouse.  In fact, I pre-programmed a week's worth of posts when I was in the hospital so that no one would know.  Since then I've changed my mind.  As I've been talking with people privately via the phone and email, I've found all kinds of people that I've known for years who have faced this and I never knew.  I've been given a lot of useful information about how to get through something like this from old friends and new ones.  I've spent many hours on Loic's blog, Carnets de Seattle, (he's a French expat in Seattle being treated for leukemia) and it's been a wonderful resource and a great comfort to me.  I'm also in touch with organizations here in France that have support groups and workshops.

I guess that I just came to the conclusion that keeping all that information to myself was both a form of delusional self-protection - yet another unhealthy manifestation of my own fears  - and a kind of selfishness.  Perhaps, just perhaps, there may be something in what I'm going through right now that just might be useful to someone else, somewhere on this planet.  Can't know for sure but then I'll never know if I don't try to connect through my experience.  It's what I've always tried to do with this blog and it would be contrary to my intent here to do otherwise.

It is not my desire to turn the Flophouse over to this topic alone.  My diagnosis and treatment is a part of my life but I don't want it to define my whole life. I love to write and do research about all kinds of topics (citizenship, FATCA, immigration and the like) and I am going to keep the focus there because I love to write, I love to share interesting things I've discovered, and because it makes me happy. But from time to time I'll talk about this too.

May it be of benefit.