Next chapter in my health history

I’ve been steeling myself for the next medical episode: a second shoulder replacement. This was scheduled for 2015 but was overtaken by the cancer drama.

I first saw the surgeon, Mme Bertrand, back in June, and we agreed to wait to take further action until the Autumn.  My physio, Joceline, has been pressing me, saying that it is doing the tendons no good delaying further, and when I discussed with my GP, Maelle, which part of my rubbishy body should be the next candidate for repair, she replied ‘the shoulder’ – you need your shoulders to walk with crutches!  She was probably thinking aloud and not realising what a scary thing that was to say!

Anyhow, I contacted Mme Bertrand a little while ago to set the ball rolling for a November operation.  This week has suddenly become action-packed with medical events.  On Monday I saw my lovely GP, Maelle.  Yesterday I drove to Montpellier to see Mme Bertrand (as usually, dressed in style in a shiny black number with incredibly high heels – I still find the absence of white coats startling).

She has fixed 7 November as the provisional date for the operation with the réeducation either in Clinique Maguelone or the Clinique Fontfroide.

I was in Fontfroide 15 years ago after my right hip replacement and have reasonable memories, but it has apparently not aged well.  Maguelone is new to me, but looks very swish.  Given I will probably spend two-three months in réeducation everyday life – the room, the staff, the food – are as important as the physio.  The Centre Ster, where I went after my first shoulder was good for physio, but the premises were dingy and the food awful.  Its saving grace was its setting on the edge of the garrigue, where I went for some lovely walks.

Mme Bertrand and I discussed the continuing intermittent pain in my left hip and buttock – probably the sciatic nerve she said, but we needed to know whether it was the scar tissue of the hip replacement or the arthritis in the back causing the problem before deciding definitively whether to go ahead with the shoulder now.

So, today, I was back in Montpellier today for a scan of the left side.  I will need to wait for Mme Bertrand to explain the report, which is in technical jargon, but the radiologist who gave it to me seemed to be saying that there were no major causes for concern – just an awful lot of arthritis in the spine!

I go back for a second scan – this time the shoulder – next Tuesday, followed by another meeting with Mme Bertrand. (Apparently one cannot have two scans on the same day – hence the need to go twice to Montpellier.   I suspect the reason is some convoluted administrative/financial rather than medical one.)

An awful lot of meetings and quite a few kilometres covered (a return trip to Clinique St Roch is about 150 km). And quite difficult to prepare for the forthcoming visits this weekend by Graeme and Clare Mitchison  followed by a fortnight by Peter, my brother in law. (Tomorrow morning: yet another medical visit, this time for Poppy.  She is scratching furiously, but the vet has already ruled out fleas, so perhaps an allergy?)

Addresses in rural France

Given the absence of house numbers and street names, not to mention inaccurate GPS maps, it is sometimes a miracle that people find my house. Two events have forced me to take some action.

A week ago I got a letter from the national office that deals with postal addresses, reporting anomalies in the addresses of letters and parcels sent to me and warning mail will be delayed or returned to sender if I don’t give the proper address to everybody. Here are the ‘incorrect’ and ‘correct’ addresses.  As it turns out (see below) neither is correct!

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At the same time I have been struggling to get a parcel delivered by UPS.  Like many people in the country I do much of my shopping on the internet and UPS is normally one of the most reliable delivery companies.  Not this time.  What have they done to the taciturn but extremely efficient guy with a straggly ginger beard who knows exactly where I live I wonder?  The first delivery date passed because apparently my address was incorrect.  I phoned to make corrections and to ensure they had my mobile number on record. The second delivery date came and went – with two more phone calls. I have tried giving them Couloustrine, Pied Méjean, then Pied Méjean, Couloustrine, and then just Pied Méjean. I have now been given a third delivery date of Monday.  Perhaps…

This prompted me to decide to find out once and for all what was my proper address.  Down to La Poste in le Vigan on Friday – only to discover that it is closed for two weeks for renovations!  The nearest post office is now 25 km away in Ganges (and in another départment – Hérault).

So my next port of call was my neighbour, Yves Martin, who as well as coming from an old local family, is deputy mayor. His visit this afternoon was very fruitful.  In the old commune maps are marked various lieux-dits: places with somewhat vague boundaries and some vague local history provenance.  I had always thought my house was part of Couloustrine, but it turns out that this only applies to our original house, down on the road leading to Serres.  Up here I am part of the lieu-dit Pied Méjean (the old, pre-motor route up to the village of Salagosse at the head of the valley).  So in fact in the post office form (above) the only field that should have anything in it is the fourth – the lieu-dit.

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Given the whole hillside is Pied Méjean, with several roads, I now share my address Pied Méjean with at least a dozen neighbours – although to complicate things even further, my road is the communal boundary, so the houses on the other side are in the commune of Mars not Bréau.

I had been aware of the current legislation which only requires communes of over 2000 inhabitants to have street names and house numbers – and also that there has been a recommendation that smaller communes should adopt this practise.  Yves told me that they had already started with the village of Bréau, but it would be quite some time before they got round to Pied Méjean.

He did however respond very positively to my request that there be a signpost at the start of Pied Méjean, and said that this plus ones for Couloustrine and, further down, Pont de Mars had disappeared (stolen?).  He will get the council to take this up with the DDE, as it is departmental roads which are affected.  This would certainly help me when giving directions.

Meanwhile I said that I would contact TomTom, which has a chunk of the road above my house actually missing!

Ah, the dramas of rural life.

The sanctity of mushroom hunting

I’ve just been talking to a neighbour who looked at the unstable clouds to the west and instantly cheered up, and said: “Good mushroom weather”.

Locals regard the cèpes as the desirable delicacy.  Come this time of year, as soon as there is some rain, men disappear into the local woods – somewhat secretively, not  wishing others to know where their favourite spot is for finding this delicacy. It’s about the only time I see some of these men set off on a walk!

The rain has come just in time: this is the weekend of “Les journées mycologiques” in le Vigan – two days devoted to the mysteries and pleasures of the mushroom.  There is always a splendid exhibition of mushrooms, with experts on hand to identify specimens brought in by the public.

Tomorrow evening a university mushroom expert will give a talk on the sex life of the truffle! (I don’t know how else to translate “Tout savoir sur la sexualité des truffes”.) And on Sunday another university mushroom expert will lead a walk near le Vigan in search of different varieties of mushrooms.

I’m not particularly keen on cèpes, but if somebody were selling chanterelles in the market tomorrow, I would be there like a shot.  I remember years back in Scotland, Chris used to buy lovely fresh chanterelles from a local shop, supplied by one little old lady doing the rounds of the woods near Ediburgh.

Exchange rates play havoc

I got a nasty surprise yesterday: I found I was badly overdrawn on the account I use to pay taxes and routine bills like utilities and insurance.

I had taken my eye off the ball since June, traumatised I think by the aftermath of Brexit, and had not looked at bank statements over the summer.  I knew I was not spending more than usual, but I had not thought to check the effect of sterling to euro exchange rates.

The first graph may not seem so bad, but a change from over 1.40 to under 1.20 has an impact on my daily financial circumstances.  My income (transferred from the UK) was 1200 € less in the August-September period this year than the same period last year – enough to have tipped my account over the edge.

The second graph shows a somewhat different problem I have.  Last year’s exchange rates were healthily over the 1.30 mark, so my monthly revenue rose very nicely.  Of course, sensible people would have made allowances for this … …  but not me.  In 2016 I pay income tax on last year’s income, so just when my income is going down, the tax bill each month has shot up. Curiously I don’t know any other British people here who pay French taxes on British income to discuss this (well, I do know one couple, but they are in a totally different and more comfortable place, so I don’t ask them!).

By local standards I’m quite comfortably off, and I admire all those who manage on much less.  I’ll just have to make more of an effort to make ends meet, starting by considering whether to cancel this autumn’s project, installing a more efficient shower tray and waste system in my bathroom.

postscript Friday evening at 5.30pm.  I transferred cash from the UK on Wednesday and it has still not arrived – and my French bank says it can do nothing before the weekend.  The last time I had a similar problem was in the early 90s when we transferred money to buy the house – coinciding with a run on sterling – and it took a month to arrive.  (Somebody in RBS speculating with our cash?)  Let’s hope I will be solvent by Monday morning this time!

The weather breaks

At last the weather has broken. As usual in the Cévennes we pass from one extreme to the other: we have just had 12 hours of storms and torrential rain. It has eased off but I can hear the river down below – the first time for months.

The footbath kept beside the jacuzzi records that we have had at least 14 cm of rain since early morning. And below, the bassin looks as if it is on the point of overflowing (despite its overflow mechanism). What a contrast to the water yesterday – the photo shows it to be pristine clean and inviting.

Public-private health services

I’ve great reason to be very grateful for the French health services and – cross fingers – will continue to benefit (until such a time as Brexit might take away my rights to use the system!). But although it justifiably has a high reputation internationally, there are worrying signs of cracks in the system, especially in rural areas.

There are not enough GPs and supporting services such as physiotherapists for what is an ageing population.  The local hospital in le Vigan  appears to have a secure future, but more as a place of first instance for mainly elderly patients and as a rather poor substitute for a hospice. I have heard that the ‘réeducation’ services from which I benefited in 2015 (nearly three months recuperating from a hip replacement and graft in 2015) are more at risk, with the tendency to send people to bigger centres in the big towns.

More alarming is last winter’s news (which I have only just learnt of) that the Clinic in Ganges and Les Chataigniers, the small local convalescent home, have been bought by a private health group called Cap Santé.

I still struggle to understand the complex structure of the French health system, but basically there are state run hospitals (‘hopitaux’) and privately run clinics (cliniques) which mainly work for the national health service. Most of the costs of a stay in hospital are covered by the state health system, but part of the cost of board and lodging are charged to the patient – who in turn gets all or most of it back from their complementary health insurance scheme (depending on what contract they have made). The clinic board and lodging charges can be higher than those of the hospitals and it depends on your mutuelle how much is covered. (I have quite a good insurance and have spent months in cliniques without paying anything – apart from the monthly insurance payments.)

But what I am learning is that there are cliniques and cliniques.  The Clinique at Ganges is a small but good hospital serving a huge population in the rural hinterland (I had my 2001 hip op there and the 2015 biopsy op to establish I did indeed have cancer, and have made frequent use of the radiography and outpatient services).

Until this recent take-over, this was a clinique mutualiste: that is, a clinique owned and run by one or several mutuelles (the complementary health insurance associations).  Unlike private cliniques these are non-profit making. For example, the surgeons in the mutualiste clinique in Montpellier where I was operated on last year were salaried and were not permitted to demand a fee higher than that which is covered by the national health system. This is in contrast to the two private cliniques where I had my shoulder and hip replacements.  The shoulder surgeon in particular extracted a somewhat gross supplementary fee (dépassement des heures supplémentaires) – he worked at the Clinique St Jean, which is in the group which has just taken over the Ganges clinic.

So what does it mean for the Clinique de Ganges to pass from mutualiste to private?  The Cap Santé has said that it is going to put considerable sums into the clinique, both to improve the existing establishment and to eventually built a new hospital in another location.  How can it do this and deal with the debts which the current clinique currently has?  The group claims that it aims to retain the mutualiste values… I fear there will be ‘efficiency’ savings and I cannot see how charges will not go up or services be cut back.

The group has also bought Les Chataigniers whose role as a convalescence centre for patients from Ganges is seen as complementary.  It claims it is going to invest 2m euros in modernising  les Chataigniers.  The only good thing I have read is that the improvements include building an on-site kitchen. Meals are currently delivered from Montpellier and I can vouch that they are disgusting!

I am of course by  political inclination uneasy about public-private partnerships.  The head of Cap Santé has said: “Je considère que les cliniques sont des entreprises comme les autres mais avec une grande responsabilité qui implique une véritable éthique et une vraie morale vis-à-vis des patients dont nous avons la responsabilité”.  That is, clinics are businesses but with an ethical and moral responsibility to patients.  He has also said there will be no redundancies. Huh, we will see.

 

 

Drought and heatwave

Here we are, well into September, and still the sun blazes and – despite some heavy afternoons – the rain refuses to come.

It has not rained for nearly a month, and only twice since July, and the sun is even hotter than in August. Afternoon temperatures are in the thirties, so I am more than glad that I can refresh myself in my pool. But the countryside shows signs of suffering from this prolonged summer, as you can see from these photos taken yesterday evening from my bedroom window:

My hazelnut and walnut trees are losing their leaves and even the oleanders, known for resistance to Mediterranean extremes, are wilting.  This is of course much more serious for farmers and winegrowers (who already took a battering from a sudden localised hailstorm last month).

The ever expanding population of wild boars is also obviously seeking sustenance and refreshment, sometimes in unorthodox ways, as captured in this snap of a female and young family sharing the seaside with holiday makers at Banyuls sur Mer.

sangliers-plage

Rain is now forecast for Wednesday with a drop in temperatures. Everybody is crossing fingers.

Insects

On the whole I am not phased out by insects.

We have few mosquitoes here, thank goodness, though a local variant, more like an irritating midge, continues to persecute visitors (I think it has got bore by my blood, though it ruined many evenings for me when we camped).

There have been a lot of scorpions this year, but again, they are pretty innocuous ones and I know few people who have been stung by them. You just learn to keep an eye out in the bathroom and bedroom and when putting on sandals.

Curiously I have always disliked ants a lot.  I hate the way they crawl over your skin and nip.  Since installing my new kitchen I have had fewer there, but obvously they are everywhere outside. Yesterday I found myself observing the antics of a tiny ant, determinedly dragging a leaf three times its size.  Why? Where?

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Quite my favourite insects are the dragonflies that fly endlessly in circles over the pool.  They are as magical as the water lilies in the plant pool.  I have tried repeatedly to capture them in flight, without success, and have had to settle for photos from rather far away as a dragonfly took a rare rest.

Roy Carr-Hill

I have seen Roy and his wife Lyn several times over this summer.2016-08-14_IMG_3740

Roy and Chris were at Nuffield College in the Sixties.  Since then, Roy – a statistician – has worked in diverse fields like Health Economics, Education in Developing countries and Medical Sociology, often holding chairs in different disciplines at the same time.

It was through Roy, at that time married to a French doctor, Sylvaine, that I first came to the Cévennes and subsequently Chris and I and the girls camped for many years at the site set up by his friend, Yves Colomb (fellow ‘soixante-huitard’).

Roy is now based at York University (though much of his work is for international organisations like Unesco) but he has retained a home in the Cévennes – a small house perched on the outskirts of Valleraugue. He married Lyn, a Mexican, last year.  All his friends are delighted and hope this will last!

A few days ago I went to a small lunch to celebrate Roy’s and Lyn’s birthdays and their wedding anniversary.  Two fellow guests were Jankees Duvekot, a Dutch lawye with a house hereand a relatively new acquaintance, and Guy Boissière, an old friend.  Guy built the house extension to our original house, and is another Cévenol radical much involved over the years in various movements, mainly ecological.

 

Sanglier – wild boar

I have mixed feelings about sangliers.

I really don’t like them being hunted.  Early this morning I lay in bed listening to the hunters emitting their weird calls, the hunting dogs barking, their bells jangling, and then, boom boom – very loud shots.  (I get the impression the guns are more powerful this year).

This is the start of the hunting season. This year it started early because we are being overrun by sangliers.  The hunters belong to teams, it’s very clannish, almost like freemasons.  In our valley there are two teams, one led by the former mayor’s family, the other by Eric Combernoux, ‘roi’ de la vallée.  But as I’m on the crest of a hill I also hear the hunters from the next valley, on the slopes of Mars.

There are rules about when they can hunt (Wednesday, Saturday and Sunday) and where (in theory, set distances from habitations).  Such are the accoustics of the valley, that this morning I felt the dogs and hunters were on my land, but they were in fact on the hillside opposite.

Mixed feelings?  Well, to start with, I’ve just eaten sanglier, given to me by the plumber two houses away, who hunts with Eric.  It’s curious, I don’t like or eat pork (dates back to being ill as a child in the run-up to appendicitis), but somehow, sanglier is gamier and therefore a bit more acceptable.

I also have to accept that we do now have a serious problem of sangliers wreaking damage everywhere.  It was dramatic seeing how one giant male was able to turn over the soil on a many of my terraces in the winter.  At least I no longer have a vegetable garden to protect.  More serious are the problems for farmers and wine-growers.  One told me that all his grapes of a particular variety were eaten by the sangliers this year, so his yield is going to be very limited.

Two nights ago I spent a pretty sleepless night.  I could here noises down in the woods below my pool.  Then Poppy heard them too and at intervals rushed out onto the terrace and barked ferociously – at a safe distance from the intruder.  Finally I saw him: a young adult male (not as big as the winter giant) happily munching away at my compost heap.  This time he was not doing much damage, but I felt justified at making noises (at a distance…) to chase him away. My Belgian friends up the road have enclosed their land with electrified cables, but I think it would be too costly and unsightly for me to do the same thing.