I know there is an historic election going on.  And I have voted, that is I have authorised my mother to forge my signature on a postal vote.  And I do care who wins.  But I also believe that the US will survive either way, because we have a constitution that has sustained probably the most liberal (in the old fashioned sense of the word) society in the history of the world, and I think it will keep on doing its job.

Only right now instead of feeling historic I am feeling anxious about my daughter, who is working for the VSO (the British equivalent of the American Peace Corps) in Southwestern Uganda, right on the border of the DRC and Rwanda.  She keeps telling me she is okay, and I know there is no fighting where she is, but there are constant reports in the middle of the night on the World Service about conflicts and mass movements in that area.  

In her world it probably means nothing more than a refugee camp opening up.  But if it opens up I am afraid she will go in to assess the children there, and then I am afraid she will catch something.

This kind of fear for your children has nothing to do with right or wrong or what you have raised them to do.  My daughter has been in Uganda for more than a year because there are people there who need her help.  I am proud of her for that, but I am also counting the weeks (not so many now) until she is home again.  And hoping this new conflict doesn’t mean she puts herself at risk before she comes safely back to me.

I’ve been pretty lucky with my children (touch wood, because I am also superstitious), but this kind of anxiety inevitably reminds me of old anxieties.  You never stop worrying about your kids.  When the Uganda daughter was about 3, and was meant to be taking a nap, instead she got into the flouride tablets that I (wrongly) was giving her to compensate for what wasn’t being added to our water.

I found her with the pills everywhere around her, a few smeared on her mouth.  I had no idea how toxic an overdose might be.  I took her to the emergency room and not long afterwards her father arrived to join me.

The medics all seemed, as I suspected, completely casual about the potential flouride overdose, but a doctor came in and examined her and lingered in a way that surprised me.

When she left I said to my husband, do you think that doctor seemed unusually interested in listening to her heart?

He assured me I was imagining things and we waited.  Nurses brought ipecac and the poor child vomited what turned out to be 3 flouride tablets.  Still we weren’t discharged.

After a while the doctor came back and looked very sober and said,  “Has anyone mentioned that your daughter has a heart murmur?”

I noted, without any satisfaction, that my mother’s instinct wasn’t wrong. The doctor said they weren’t worried at all about the flouride, but they needed to x ray my daughter’s heart. Suddenly we were there for an entirely different reason.  

We waited another hour or two and then the x rays were available.  My husband, who had quit smoking, took it up again in the mean time.  

Finally the doctor said the x rays showed her heart was not enlarged.  That meant there was no immediate danger.  She would be put on a waiting list to see a heart specialist.

We waited three months.  Further tests revealed that the heart murmur was “harmless” and that was the end of that drama.

I’m waiting again now.

Meanwhile the rest of you guys are probably thinking about trivial stuff like who might be the next President of the United States.

I had a mammogram today.  

I’m three and a half months short of my 55th birthday and this is my second mammogram.  In England you don’t ordinarily get on the National Health Service list to have one until after your 50th birthday and then you get one every 3 years.  You are not allowed to “top up” by paying for intervening years.  (It’s the same with cervical smears which also are only available every 3 years.)

Once you hit 50 you will be invited to attend (as they say) the next time the breast screening unit comes to your area.  In my case that didn’t happen until I was 51 and a bit because I live in the middle of nowhere. I got a letter telling me that an appointment had been made for me at the mobile unit which would be parked outside my local GP’s office.  (My GP is practice is determined by where I live.) 

I telephoned and asked if I could please have my appointment at the main hospital instead, in the city where I work, so I didn’t have to take almost half a day off to drive the 45 minutes back home in the middle of the afternoon.  Or perhaps I could have an appointment first thing in the morning or last thing in the afternoon?  None of that was possible, it seems. Breast screening is linked to GPs and GPs are linked to where you live.  (I’m not allowed to have a doctor in the city, because that is too far away.)

Last month, almost three and a half years after my first mammogram, because that was when they got around to me, I got a second letter.  This time I did have to change the appointment because I wasn’t even in the UK, but I took the only alternative they offered me.  I knew it was no good actually trying to find a time or place that was convenient.

You do not see a doctor when you have a mammogram.  A technician takes the films.  As before, the technician — not the same person I saw last time — explained to me that the films could not be read on the spot, so I might be recalled if the pictures were bad and I shouldn’t be alarmed if that were the case.  I do not know who actually reads the films.  I think it is a specialist technician, but not a doctor.

The receptionist checked to see if I was planning to go away in the next few weeks because the results will come by post in about a fortnight, and they wouldn’t want me to miss such an important letter.  I am not sure what would have happened if I had said, yes, I’m planning to be away.

In case you think women are discriminated against I can tell you that my ex husband (who is 60) does not get offered a regular PSA test for prostate cancer and neither of us has ever had a colonoscopy. (Some of you may be applying for visas right now.)  Only one of my four children ever saw a paediatrician throughout their childhood — why she was so singled out is probably the topic for another post — and no child in the UK gets a routine check up after the age of five.  There was never a doctor, let alone an obstetrician, present at the birth of any of my children.  My blood pressure has only been checked twice in the last 7 years and I have never had a cholesterol test.

Our system in England is certainly fairer.  No family goes bankrupt because of a sick child they are desperately trying to save.  If my mammogram shows I have cancer I will be treated without worrying about paying for that treatment.  It is true that I will have almost no choice about who treats me, nor will I necessarily have access to drugs that are routinely prescribed in the US or even in continental Europe, but I will get what care works for most people and is statistically most effective.  

No one in this country has to fight cancer, or any other disease, and the insurance company at the same time, the way Obama’s mother did.  If you are not a typical case, though, like anywhere else in the world you might have to fight bureaucracy.  

It is possible that it is statistically true, as they tell us, that mammograms and cervical smears are really only required once every three years and that PSA tests are pretty unnecessary.  The government is beginning to accept that colonoscopies might be a good plan (cancel that visa application) and there has lately been some movement towards more preventative medicine, but none of this is patient led.

My family and I get care that an uninsured family in the US could only dream about.

My family and I get care that an insured family in the US would consider completely unacceptable.

And just so we’re clear, I pay a lot more taxes than you do (if you are an American).

I don’t know the answer.  I am guessing that to spread decent care to all, some of you are going to have to accept less than you are used to.