Crise de Foie Article

In a region that has been in decline for generations most villages in the Languedoc in Southern France are quiet, sleepy places.  For most of the year you can see people sitting or standing around the village chatting.  In our village it is easy to spend a whole day in conversation with knots of people around the village enjoying the cool shade.  The occasional hiker passes through, but no other tourists, not even in high summer.
One of the delights of living in France is discovering a new ways of looking at familiar things. Every aspect of life is different, and even after many years here, there is still a fund of French ideas and practises that can surprise, horrify or delight. You might have thought that modern science would have brought a consensus to modern medicine, so that ideas and techniques would be much the same throughout the developed world. Not so. Even neighbours like France and Britain with similar populations, similar climates, similar economies, and access to the same scientific studies, can be very different. Some of these differences seem extremely odd. For example, French people are often debilitated by a crise de foie, not a crisis of faith, but a malady attributed to the liver. The English term liverish may be distantly related, but being liverish is nowhere near as serious as suffering a crise de foie. I've tried to find out what it is and what causes it, so far without success. Is it imaginary? Is it cultural? Is it peculiar to France? Apparently not, Italians suffer from it too. There again, no one else does. Again, women here still suffer from fits of the vapours, just as their British cousins did in Victorian times. Tight corsets fell out of fashion at around the same in the two countries, so why the difference? Was this complaint somehow cured by Anglo-Saxon feminism? It seems unlikely.
Sometimes the difference is not the illness itself, but the cure. Homeopathy is widely practised here, and is funded by the state alongside other forms of conventional medicine. Even our local vet uses homeopathy on his animal patients. No one here thinks this at all unusual. In other cases the difference lies in how a medicine is applied. In Britain suppositories are used infrequently: in France they are the medium of choice. It's unusual for any course of treatment not to include suppositories. This always seems to come as a surprise to visiting Brits who fall ill in France. Their embarrassed reaction is a source of endless amusement among the French. The same orifice is preferred for the taking of temperatures. French people are horrified at the idea of putting a thermometer in their mouths - they assume that all thermometers will previously have been inserted elsewhere. Another novelty is that it is normal here for unused medicines to be handed into the pharmacy. In this way they are safely taken out of circulation. Better still, they can still be useful. They are sorted and passed on to third-world countries. It is not obvious why British pharmacists don't operate a similar scheme. An American friend was clear about why it could never work in the US. He pointed out that someone would soon hit on the idea of donating poisoned medicines, leaving the innocent pharmacists open to legal action from the eventual victims. Autre pays, autre mores.
Everyone knows that the French public health system is better than the British one, and hugely better than the American one. It was after, all rated, number one in the world by the World Health Organisation in 2004. Surveys reveal a 66% satisfaction rating against 40% in the UK. Part of the explanation is that 9.3% of national income is spent on health care in France, against 6.8% in the UK. The consequences are clear to see. Home visits are still routine. GPs commonly spend half an hour with their patients. Patients can chose not only their own GP but also their specialists. There's no need for a GP to make a referral to a specialist here - anyone can just pick up the telephone and make an appointment for later in the week. 70% of the cost will be borne by the state, and the remaining 30% is generally covered by private health insurance. Waiting lists are negligible, often non-existent. For emergencies the whole cost is borne by the state. A couple of years ago, an English friend suffered a heart attack at our local swimming pool. A helicopter appeared within minutes to whisk him off to hospital. A doctor, trying to assure his wife, kept telling her not to worry because it was serious. She spent a long time trying to work out what he meant - that she should worry because it was serious, or that she shouldn't worry because it wasn't serious. The truth eventually emerged: his condition was not life-threatening, but a heart attack was classified as "serious" which meant that his treatment, including the helicopter rescue, was free of charge.
Every French household has a large medicine cabinet. Often each member of the family has his or her own. These cabinets seem to get bigger as people get older. By the age of forty you are expected to have one the size of a small sideboard. It is common to see even young people taking four or more types of medication with breakfast. That's counting the homeopathic remedies but not the suppositories. The French consume over three times as many pharmaceuticals per head as either the British or the Germans. If you don't take medication here, people think there's something odd about you - probably something seriously wrong - a terminal illness perhaps. Looking from the other side of the channel, this wholesale medicine taking smacks of hypochondria, a view that is reinforced by the empirical truth that the battery of medication prescribed for any illness is almost certain to include antibiotics, whether the illness is bacteriological or not. Another piece of evidence supporting this suspicion is that (against vocal opposition) the Minister of Health, Jean-François Mattei, plans to remove funding for some 900 pharmaceuticals which have little or no recognised medical effect.
Those official statistics do not include traditional remedies applied at home. Such remedies often supplement modern medical ones. If traditional remedies were counted in the statistics, it might well be found that the French consume four or five times as much medication as the British or the Germans. Some of these traditional remedies are excellent, even if they sound improbable. A solution of green clay works wonders for an upset stomach. Packets of powdered green clay are available in shops throughout France. Other cures are more local. For example the red earth in my area is used for making poultices. Herbal remedies are also common. Everyone in our village grows at least a dozen different medicinal herbs. I eat a leaf of feverfew each day to prevent migraines. More exotically, old women charm warts and claim to cure illnesses beyond the reach of modern medicine. In our tiny village at least two women still sing away serious illness. A 25 year old friend swears that their cures are effective. Their counterparts in Britain, wise-women and cunning-men, disappeared two or three generations ago. Living here is a bit like living in the past - a far cry from the brave new world where people cannot donate medicines to the third world for fear of litigation.

JdeSt-F © 2004,2005.
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