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Multi Lingual Internet Mail Magazine
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★ jp-Swiss-journal ━ Vol. 91 – November 11, 2007 (Swiss Time)
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http://www.swissjapanwatcher.ch/
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【 目次 /
INDEX / INHALTSVERZEICHNIS 】
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【J】
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スイスの経験的医療事情 外科編
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明子 ヒューリマン
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【E】
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Personal
Experience with
Swiss Medical
System, Surgery Edition
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Akiko Hürlimann
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□━━━━━━━━━━━━━━━【日本語 】━━━━━━━━━━━━━━□
スイスの経験的医療事情
外科編
明子 ヒューリマン
日本旅行最後の山歩きの途中、濡れた木道で滑って転んでしたたかに右足首を打った。居合わせたスキーインストラクターだという人が「腫れが引くまで冷湿布をして安静にしていれば1週間ほどで直りますよ」とアドヴァイスしてくれた。旅は続けられると一先ず安心して、旅程を変えず杖をつきながら5日後にスイスに戻ってきた。大した痛みは無かったし、初日に腫上がった足も日を追う毎に収まってきていた。念の為翌朝ホームドクターに連絡すると、デリケートな箇所なので連絡しておくから直ぐに州立病院*1)に行ってレントゲンを撮ってもらうよう言われる。この程度で急患に行くと迷惑がられるのではと案じながら受付をすませる。先ず確認されるのは契約している健康保険会社と保険の種類、それにホームドクター。退院後のケアはホームドクターが引き受けてくれるシステムになっている。急患待合室には、十数カ国語で待たせる理由と忍耐を要請する冊子が備えてあった。更にしばらくして、「あなたの事は忘れていませんよ!」と、言ってくれた。待つ事１時間。丁度土曜日だったが、通された診察室には患者が入れ替わり立ち代り運ばれてきて、４〜５人ベットで待機させられていた。
先ずアシスタント・ドクターが怪我をした時の状況を聞き取り、診察。その後レントゲンを撮った後で主任医師と相談後結果を伝えてくれた。「残念ながら骨が折れています。」と言われて青天の霹靂の思い！「ぎりぎりのところでくっついているので、金属ネジと金属板で骨を固定する手術をすれば6週間で杖無しで歩けるようになります。手術をしなければギブスを6週間嵌めなければなりません。手術をするなら来週はスケジュールが詰まっているけど、今日の午後なら出来るのでどうしますか？」と決断を迫られた。ギブスにはとても耐えられないと思い手術をお願いした。以前身内が骨折した時、石膏のギブスによる圧迫痛と皮膚炎に悩まされていたのを思い出したからだ。麻酔は全身麻酔か部分麻酔にするかと聞かれ、思い切って部分麻酔を希望した。全身麻酔は体への負担が大きいと聞いていたからだが、「薬の量が若干異なるだけですよ。」と軽い答えが返ってきた。
手術室に運ばれると電動ベルトコンベアでベットから手術台に移された。これは医療スタッフにも患者にも負担が少ない方法だ。ここで執刀医と初めてまみえ挨拶をする。見ると彼以外の６〜7人のスタッフはほぼ全員がうら若き女性達。軽快な音楽が流れる中、患者にも声をかけながら、執刀医を中心に互いに冗談や軽いおしゃべりを交わしながらリラックスムードの中テキパキと準備が進められた。手術が終わるまでこのリラックスムードが変わらなかったのには驚いたが、お陰で手術に対する不安は随分和らいだ。この種の手術は日に２〜3回は普通で、多い時はもっとこなすというだけあってのこの雰囲気のようだ。手術中何か音楽を聴くかと聞かれたのでお願いすると、ヘッドフォンを着けてくれ、所望した音楽が流れてきた。出来れば足にネジを差し込まれる音や衝撃音は聞きたくなかったから。事前に手術時間は1時間程度だと聞いたが、正に予想通りに終了した。
5時半の夕食1時間前には病室に移されたので、無事に夕食にありつけた。朝食を食べたきりで、かなり空腹だったので安堵する。三食の食事は毎日看護師が翌日の希望を聞きに来る。普通食、半ヴェジテリアン、ヴェジテリアンの3種類のメニューから選ぶ事が出来、半分の量でも注文出来る。ワインリストも用意されていると聞いた。この食事が野菜たっぷりで大変美味しくて驚いた。病院の案内パンフレットには、健康に留意した低カロリー食を注意深く用意していると書かれていただけのことはある。ナイトテーブルには歯磨きセットの入ったポシェットも置かれてあって、急な入院でも困らないようになっている。大中小の白いタオルも備えてあってホテル並み。お茶は朝ポットに入れて毎日届けてくれるし、おやつの果物と新聞も届けてくれる。因みに看護婦(Krankenschwester)は看護士 (Pflegefachpersonal)
と呼ぶようになっていた。看護士の資格にも段階があって、国家資格を得るには６〜7年はかかるそうだ。中に外国人看護士も1人見かけたが、スイスのディプロマを持っていないので、医療看護ではなく補助的な範囲の仕事をしていた。
術後2日間はベットから下ろしてもらえなかったが、3日目から早速担当の理学療法士が来て、ギブスに代わる器具の扱い方を説明してくれた後、杖を突いて歩く練習を30分ほどしてくれる。階段の昇降にもそれなりの方法があって、間違った動き方は危険を伴う事を知った。日に１〜2回は散歩をして練習するよう言われる。4日目からは付き添い無しでトイレに行く許可を貰ったが、自力でトイレに行く喜びがこれ程大きい事を改めて実感。5日目からはビニール袋で足を包んでシャワーもOK。足の関節が固まらないよう、こまめに足首を動かす。いずれにしても現在ではギブスと言えども患部を石膏で固める方法は採らなくなったと聞かされた。その代わり、ナイロンファスナーで着脱出来るムーンブーツ（Moon
boots）の様な形の布製の履物の中に、更に砂状の詰め物を入れてある袋を挿入して空気を入れると、石膏のようにしっかりした状態になる。この上に合成樹脂で出来た保護枠（Schiene）を嵌めてた上で、杖をついて動き回る。サイボーグみたいないでたちだが、この方法は患者にとって大いなる福音だ。着脱出来るので皮膚炎に悩まされる事も無く、回復も格段に早くなる事は明らかだ。
退院時、担当のアシスタント・ドクターが書類を調えてくれる。手術の概要と今後の治療方針を記したホームドクター宛の手紙、理学療法の処方箋、そして毎日自分で注射しなければならない血栓予防の為の皮下注射を持たせてくれた。5週間後に又レントゲン撮影をして経過を診てみてもらうことになっている。以後週2回合計9回理学療法に通うのだが、施設は選べる。入院中同室の人から薦めてもらった地元の施設に通う事にした。オランダ人の理学療法士が運営している施設だ*2)。担当の理学療法士によると、オランダはこの分野の教育が進んでいることから、スイスでの開業が許可されたそうだ。オランダ語はドイツ語に近いので言葉の問題は無いと言う。一方手術で使用されたネジは高価なレアメタルのチタンで出来ており、こうした医療器具分野でスイスは主要輸出国だそうだ。幸い今回の手術で使われたネジは2本で金属板は使わなかったと聞いて安堵した。病院から連絡を受けた保険会社からは事故状況の詳しい説明を求める書類が届いた。若し保険でカバーして貰えないとなれば高額の医療費負担になる。危険な行動で起きた事故の場合、保険会社は費用を負担してくれないので気懸かりだが、返事を出した後連絡が無いのでどうやら大丈夫そうだ。
理学療法に通う為に「ティクシー（TIXI）」 が利用出来る。これは地域のヴォランティアによって支えられている身障者運搬事業*3)。スイス国内の主要都市にはこの組織があるようだ。会員になると専用の車で自宅と医療機関の間を送迎してもらえる。代金は基本が1回3スイスフランで、2〜3日前までに予約を済ませておく。運転してくれるのは、登録されているヴォランティアと兵役代替勤務を希望した人々*4)の他、失業対策事業にもなっている。現在ヴォランティアの数は男女200名ほどだそうで、半日単位で勤務している。多くは定年退職後社会貢献を志している人々が主体になっているようだ。彼らは年に1度食事会をして互いの親睦も深めているそうだ。どの運転手人も様々な人に出会えて興味深いと話している。
このようにスイスでは不安の無い治療が受けられるのは大変有難い。スイスでは医師の数が足りていて、国民すべてが医療を受けられる状態だという報道があった。とは言うものの、ドイツ人医師の進出で間に合っているのが現状で、将来的には高齢者の増加に伴い医師不足は必死の情勢になることから、今後大量の医師の養成が求められているそうだ。今回成田空港の診療所で、「内科だけなので外科の診療はしません」と先ず断られて驚いた。湿布をして帰ったらレントゲンを撮ってもらうようアドヴァイスはしてもらったものの、日本最大の国際空港で怪我を診てもらえないのか？と不安になった。是
非とも改善してもらいたいものだ。ご参考までに、ツューリッヒ空港内のエアポート・メディカル・センターは、高級リゾート地サンモリッツにある診療所が進出している。*5) 空の玄関に著名な診療所を誘致して自国の医療水準を示すことも、スイス一流のビジネスモデルと見た。空港は戦略的な企業活動の場でもある。
【参考】
*1) Zuger Kantonsspital:
http://www.zgks.ch/
*2) Physio Aktiv
GmbH: www.physio-aktiv.ch
*3) TIXI: www.tixizug.ch
*4) Zivildienst:
http://www.zivi.admin.ch/themen/00499/index.html?lang=de
*5) Airport Medical Center:
http://www.klinik-gut.ch/english/s_airport_e.htm
jSj Vol. 58 July 22, 2004 [ J/E/D/F ] スイスの経験的医療事情
【編集後記】
長い休暇になってしまった。余り長く発行しないと配信サイトから抹消されてしまうので、一先ず発行に漕ぎつけることが出来て一安心。今後山歩きの際は、かさばっても必ず杖を持参することにする。
□━━━━━━━━━━━━━━【 English 】━━━━━━━━━━━━━━□
Personal Experience with Swiss Medical
System
Surgery Edition
Akiko Huerlimann
During mountain walking on the
last part of a Japan travel journey, I slipped up on a wet wooden trail and
strongly hit my right ankle zone. A ski instructor happened to be close-by
giving me the advice "Put a cold compress on until swelling is reduced
and keep quiet, it'll recover one week later". I felt at ease for
carrying on the travel; we didn't change our travel plan coming back to Switzerland with a stick 5 days later. The pain wasn't very strong, and
the swollen leg of the first day became less day-by-day thanks to the
decongestant patches. Just to be safe, my husband called our home doctor up
next morning. The doctor said that the affected zone of the ankle was a
rather crucial part; he went to make reservation at the prefecture hospital
*1) for me, I had go there immediately for taking an X-ray. We were a bit
worried whether we might be complaint for coming to the emergency ward with
such injury level. Anyway, I could finish check-in at the emergency
reception. The first things to be asked were my health insurance company,
type of insurance, and my home doctor. Home doctors do take care of
patients after a hospital stay. In the waiting room of the emergency ward,
there was a leaflet, which explained why they let patients wait and it
requested to be patient. Furthermore, after some time, a staff said to me,
"We haven't forgotten you!" After having waited about an hour, I was guided
to the examination room, where patients were carried one after another, and
several patients laid on bed even on a Saturday.
At first, an assistant doctor
asked me how it happened, and examined the leg. After taking X-ray, she
told me the result having discussed the case with the chief doctor. When I
was told, "Unfortunately, your leg is fractured", I couldn't
believe it! "The cracked bone was tightly together (not split). If it
was fixed with metal screws and plate by surgery, you'll be able to walk
without sticks in six weeks. Otherwise, you must wear a cast for six
weeks." Next week, the operating rooms (OP) are fully booked, but this
afternoon there is space for your operation. What would you like to do?"
I was pressed for a prompt answer. I thought I wouldn't stand to have my
leg in a cast and agreed to an immediate surgery. I remembered when a family
member broke a bone; she suffered from tightening pain and eczema. I was
also asked either full anesthesia or partial anesthesia. I dared to wish a
partial anesthesia. I heard that full anesthesia gives more physical burden,
however, the answer wasn't serious, and "It's just a little difference
regarding to the portion of drugs".
I was transported to the
operating room (OP) and moved to the operating table by electric
belt-conveyor. That system gives less physical burden to both patient and
medical staff. At that stage, I saw my surgeon and greeted. When I looked
around, almost all staff, about six to seven except the doctor were young
women. Rhythmical background music was played. They explained to the
patient what they were doing, and they exchanged jokes or chattered centering
around the doctor. Despite that relaxing atmosphere they worked nimbly. I
was astonished that the relaxed mood wasn't changed till the end of the
surgery; thanks to that, my anxiety about the surgery was fairly eased off.
I learned that this type of surgery was normally done two to three times a
day, but sometimes even more surgeries are done, that's why they seemed to
be able to create that atmosphere. I was asked whether I would like to
listen to music during surgery. I said "Please". Then, I was put
a headphone on, and I could hear the wished music. If it was possible, I
didn't want to listen to the sound of inserting screws into my leg or percussive
noises. I heard in advance the surgery time should be about one hour, and it
was punctually finished.
I was transported to the
patients' room an hour before dinner at 5.30 p.m., so I got an evening meal. I had only breakfast that day and I
was very hungry, then I was happy. Every day, a nurse came to take order
for the three meals of the next day. We could choose menus such as normal
meal, half vegetarian, and full vegetarian, and a half portion meal was
also available. I heard that they even had a wine list too. I was surprised
the meals were very delicious with lots of vegetable. It's written in the
hospital brochure that low calories meals are carefully prepared for the
patients' health. A pochette with a tooth
brushing set was also ready on my night table, so in case of an emergency,
hospital stay should be no problem. Three sizes of white towels were also
ready, so it's just like a hotel. Every morning, staff delivered us a pot
of tea, even fruit and newspapers. By the way, nowadays, care staff is
called "Pflegefachpersonal" (licensed
care staff) instead of "Krankenschwester"
(hospital nurse). I heard that care staff have different qualifications,
and it takes them six to seven years to acquire the official qualification.
I saw a foreign nurse. As she didn't have a Swiss qualification, she did
subordinate work instead of medical care.
After the surgery, I wasn't
allowed to get out from bed for two days. As from the third day, a
physiotherapist visited me. First, she explained me how to use a kind of
ankle brace, and then she instructed me how to walk with sticks for about
30 minutes. There is the right way to walk up and down a staircase. I
learned if I took steps the wrong way, it could carry risks. I was
instructed to practice on my own once or twice a day. As from the fourth
day, I was allowed to go to toilet unattended, I confirmed the great joy of
going to toilet on my own. As from the fifth day, I could take a shower by
packing my leg with a plastic bag. In order not to become inflexible on my
leg, I moved my ankle as often as possible. Anyway, I learned that
nowadays, gypsum doesn't mean to cover the affected area of the body with
gypsum (plaster). Instead of that, looking similar to moon boots made of
fabric, which can be slipped on, there insert a plastic bag stuffed arenaceous material. For making it solid, pump air into it. On that
boots, I had to wear a protection splint made of plastic, and walking
around with sticks. It looked like a cyborg, but
this method is an absolute gospel for the patient. As this is removable,
patient are not annoyed by eczema; therefore, recovery must be quicker.
Before leaving hospital, the
assistant doctor in charge provided documents. Surgery
summary to my home doctor and to myself, prescription of physiotherapy,
and hypodermic syringes against thrombosis prophylaxis. It's planned an
X-ray control and consultation by the surgeon in five weeks time on the
document. Before that I have to go to rehabilitation training twice a week
totally nine times, but I could choose the facility upon my convenience.
I decided to go to a place, which my roommate at the hospital had
recommended. The facility is managed by Dutch *2). According to my physiotherapist
there, the education system in that field is advanced in the
Netherlands, therefore, they were granted admission to open their training
center in Switzerland. On the other hand, the screw that was used for my
surgery is made of costly titanium, a rare metal. Switzerland is a leading
country in the field of such medical instruments and plays a role as major export
country. Fortunately, I learned that the surgeon used only two screws and
no metal plate for my surgery; I was relieved. My health insurance
company was contacted by the hospital and sent me a letter asking about my
accident how it happened. If the cost was not covered by the insurance,
that'll be a big financial burden for me. Insurance companies do not cover
cost of accidents occurred by dangerous activities; I was afraid of it. So
far, I haven't received a reply to my answer yet, so it should be OK.
For ambulatory rehabilitation,
I asked for the TIXI service. TIXI is a transport business for disabled *3)
supported by local volunteers. The organization seems to be established in
major Swiss cities. If you become a member, you can receive their
transport service between home and medical institutions by their car. Basic fare
costs SFr. 3. -- per each time, and reservation should be made two to three
days in advance. Drivers are such as registered volunteers, alternative
civilian service members*4), and an unemployment relieve project is
cooperating as well. At the moment, around 200 men and women registered as
volunteers and work on a half-day basis. The majority are retired people who
have their sights on social contribution. They have dinner once a year and promote
friendship too. Every person said that it is a very interesting work and that
they can meet many kind of people.
As I reported, it is very good
to be offered secure medical services in Switzerland. Recently, it was reported
that there are enough medical doctors in Switzerland, and everybody can get
medical treatment. Nevertheless, the present situation is that many German
doctors work in Swiss hospitals. Because of demographic aging, a lack of
doctor will be inevitable in the future; building up a big number of
doctors is requested. At a medical clinic at Narita airport, I was very
surprised to be told first, "As we have internal medicine only, we don't offer
surgical care." They gave me the advice to apply a cool compress and go
to see a doctor for X-ray at home. I felt unease that the biggest
international airport in Japan doesn't care injured people! I very much hope the
airport to improve medical services. Just for your information, the Airport
medical center at Zurich airport is managed by a clinic in St. Moritz that
is well known as an exclusive resort. *5) I understand that showing the high
level of the national medical care system by attracting a recognized
clinic to their air gateway could be also a special Swiss business model. That
means airports are strategic business locations.
【 Reference 】
*1) Zuger
Kantonsspital: http://www.zgks.ch/
*2) Physio
Aktiv GmbH: www.physio-aktiv.ch
*3) TIXI: www.tixizug.ch
*4) Zivildienst:
http://www.zivi.admin.ch/themen/00499/index.html?lang=de
*5) Airport Medical Center
http://www.klinik-gut.ch/english/s_airport_e.htm
jSj Vol. 58 July 22, 2004
[ J/E/D/F ] Personal Experience with Swiss Medical
System
【 Editor's comment 】
I took a long holiday. I'm very
glad to be able to issue this magazine. If we don't issue too long, the
delivery system will cancel our magazine. I decided to bring sticks for mountain
walking in the future even it's troublesome to bring.
□━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━□
We are intending to offer you
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スイスと日本を基点にグローバルな視点で、ニュース性に重点を置きながら、適宜日英独仏語の多言語でお届けします。不定期発行: 発行案内はWeekly Swiss News Headlines からも随時お知らせしますので、両誌共にご愛読お願い致します。 後日修正が加えられる場合があります。
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