Why living abroad makes you appreciate the NHS so much more

While living abroad, it is difficult not to make comparisons with your home country. I have discovered this both now living in Chile and also two years ago when I studied abroad in Wisconsin for a year. This is often a completely useless and unhelpful thing to do. Every country has different histories, values, traditions and customs, and therefore it is impossible and futile to compare them. However, this ideal does not always translate to reality and I constantly find myself subconsciously comparing Chile with England in many aspects.

Take the weather for example (an English person’s all-time favourite topic of conversation). Winter in Chile is nothing like a good old English winter, where it is perpetually grey and drizzling and the temperature hovers between 5-10 degrees for around five months. There have been a handful of grey and rainy days during the winter months- but only a handful. While the mornings and nights are cold (granted), more often than not the temperature will climb to 20 degrees by 3’o clock. I am currently writing this in a side-street café outside, enjoying the sunshine in what is technically slap bang in the middle of winter. Unthinkable in England.

From foods to families, metro etiquette (which is terrible here) to coffees, it is almost impossible not to compare aspects of the two countries.

Another observation which deserves a mention is the way Chileans interact in lifts. Whilst in England it is common practice to look down at your feet when someone enters the lift and do your best to pretend they are not there, here it is perfectly normal to strike up conversation with your fellow passengers. And when someone exits the lift there is a chorus of ‘ciao’, which is repeated until the last passenger. The first time I exited the lift to this I was extremely flattered, until I found out I was not special in getting this goodbye- it is just considered polite lift etiquette. I am going to have to make a conscious effort not to repeat this automatically when I return to England.

But, while I am embracing these differences with an open mind and enjoying getting to know a totally new culture, living abroad does make you appreciate many things about your own country that you take for granted.

The most significant of these for me is without a shadow of a doubt our health service. Both times that I have lived abroad, my appreciation of the NHS has increased rapidly.

In America, access to public health services has been reduced due to Trump’s attempts to dismantle Obamacare. But even when I was there in 2015/2016, my experience of the American health system was largely negative. When I took myself to the doctors after diagnosing myself online with a serious heart problem (which turned out to be very minor heart burn, treated with one dose of Nurofen), the first thing I had to do was register my insurance details.  The care I actually received was good- but the fact that I had to search for my insurance details before I was treated left an extremely sour taste in my mouth. On top of that, I was billed $200 for a four hour stay (insurance only covered 90% of the service, which gives some indication of just how expensive American healthcare is), which included the premium services of an X-ray, blood test and TV which played SpongeBob Squarepants on loop. For any Americans reading this, this may seem like the most normal thing in the world. But having to ‘pay’ for healthcare is such an alien concept for most British people that for me, it felt very strange indeed and instantly gave me a newfound gratitude for the NHS.

The general rule of thumb in Chile seems to be that public resources are available- but they are all a bit shit. One of my students today summed it up pretty well when he said: ‘Chile has excellent facilities and institutions…if you can pay for it.’ In such a privatized country, access to good healthcare is limited to those who can afford it. I have heard horror stories about the waiting times and quality of care in the public healthcare system.

Instantly, I could not help but compare this seemingly inadequate public system to our own NHS. Of course, the NHS is by no means free from problems, of which everyone is aware. Last winter for example has been cited by many as being the worst on record, with thousands of cancelled operations, overflowing wards, major internal incidents declared, and waiting times frequently exceeding the 4- hour target in A&E.

But, despite all these problems, for the majority when we need its services, it is there to deliver world class care regardless of income, class, or race. These fundamental principles are the backbone of the NHS, now and when it was created by Aneurin Bevan, the Labour Minister of Health 70 years ago.

Bevan, the son of a Welsh miner had a strong sense of social injustice and believed that poverty was not the result of the individual, but of inadequate governmental distribution of resources. His ardent belief that healthcare should be available for all, combined with his opposition to Churchill earned him many enemies in the Post-War period. Surprisingly, despite his creation of one of the most treasured British institutions that has transformed the lives of millions, he features relatively low on the list of Great Britons (behind David Beckham and Robert Baden Powell, the founder of the Scouts movement). Not to say that Beckham and Baden-Powell, football and scouts have not been influential British staples; but more so than the NHS?

The first NHS leaflet released in 1948 featured the headline: ‘It will relieve your money worries in time of illness.’ This fundamental principle of the NHS of ‘free healthcare on point of entry’, so embedded in the minds of most British people, has baffled my students here. I recently gave a lesson on the NHS soon after its 70th birthday, and many, including doctors and nurses reacted with incredulity when I explained how the system works.

‘Free? And what about the quality of care?’

I myself have had excellent experiences of the NHS service, and like many others have witnessed the first-hand care and world class pioneering research that it conducts. And all without an invoice at the end. This certainly would not have been available in most other countries without paying a huge amount of money, which in many cases would financially cripple a family.

Nigel Lawson (a former Tory MP under Thatcher, almost at the opposite end of the political spectrum to Bevan) once stated that the NHS is the closest thing Britain has to a religion. Indeed, when Donald Trump criticized it last February, calling it ‘broke and not working’ (with the excellent grammar that is so reminiscent of his Twitter), he sparked a flurry of anger from politicians and the people alike. Yes, we are well aware that the system is nowhere near as good as it should be. But to take criticism from the President of a country with the highest medical costs in the world, leaving millions without access to healthcare was a little too much to handle.

Clearly, the future of the NHS and how to ‘fix it’ so to speak divides the country. But, the sanctity of the NHS as an institution is one of the only things that people across the political spectrum in Britain can agree on. ‘Privatisation’ is often seen as a form of blasphemy when spoken about in the NHS context. And from experiencing and witnessing health care systems in other countries, it is clear to see why.




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