Netherlands

In Holland I had my find my way off the tourist track to Nijmegen and the Canisius-Wilhelmina Ziekenhuis Hospital. A humbling experience; finding the right money (I must get glasses), dropping the money, apologising for being so slow, asking if I was on the right train, not really understanding the answer so having to move to the another part of the train to ask the question again of someone else. Getting on the right bus (thank God), showing the driver the address that I had jotted down the night before, he shook his head and then laughed. He knew the address I'd just written it wrong. Humiliating. Found the hospital, all the signs in Dutch. Had been directed to go to a particular door which didn't seem to exist. Arrived at the front desk - thank goodness there was a friendly open face ready and willing to speak to me. Even better she knew who I was before I even had to speak.

So there it is. What so many people who visit our hospital and hospitals throughout our country have to confront everyday. In Holland most people speak English. They know, from the moment you open your mouth, that you are an English speaker and so adjust their language accordingly. They take it for granted, it's a skill they've had to develop to manage the many langauges that pass their way, but I found it humbling. We have a cultural expectation in our country that people should speak English, it would be odd for us if someone used their own language to say good morning, or thank you, or see you later. In Holland (as with most of Europe I imagine), it's quite normal to not even try to speak the langauge of the country you are visiting (with the exception of France I believe or is that an urban myth?).

Language is of course a major barrier to health literacy - and yet it is probably a reasonable easy barrier to lift - compared to the more nuanced and complex nature of say culture. What I did notice about being in a Dutch hospital was the signage that was familiar to me - the toilets, emergency etc. The symbols that were used were effective, something about the way that the signs were placed made it clear where I had to be. Having said that, I'm sure my experience might have been different if I were say Japanese!

I met with the senior advisor on patient education and we found that we had much in common, which is somehow reassuring. Treasures in this hospital? A fantastic program of online patient communities. The patients, generally those who have chronic conditions, are advised to participate by their doctor and so instead of having numerous appointments with their doctor they regularly particiapte in and online community discussion. Resonates with the work going on at Women's College in Toronto and of course offers the doctor the opportunity to meet with lots of patients at once, is consistent with the notion of "teach-to-goal", which is essesntially a form of persistent nagging - health professional to patient, and is having results in the US.

This hospital also has a good relationship with a ROC, which, I believe (correct me if I'm wrong Dutch colleagues) is much like the Australian TAFE system, Offering an alternative to university study but also offers adult education. This org actually approached the hospital and offered to do an expo on health literacy and since then the hospital and the ROC have worked collaboratively. The ROC regularly sends adult learners to talk to doctors about how it feels to be an adult learners. Another great example of natural partners in health literacy.

More later