I've just ended an epic battle with a two-week long cold. Typically, this wouldn't be a thing of note, however, I have a storied history with strep throat and my condition was such that I was prime for infection. Under ordinary circumstances strep throat wouldn't be a thing of note, however, I am currently living in France where healthcare works a little differently than in the United States.
Strep throat and I are old pals, and in the past it hasn't been unusual for us to reconnect every six months or so. Generally it occurs after a cold, after a week of little sleep, or after any other set of circumstances that leave my immune system in a general state of disrepair. The pain in my throat will linger long past all other symptoms: no redness, no swelling, no fever, spots, or bumps. More than once, dubious doctors have been proved wrong in 15 minutes by a positive Rapid Strep Test (backed up by a standard two-day culture). Antibiotics are ultimately prescribed and a week later I'm back on track. It's a simple process I know well and take seriously because although no one wants to be living with strep throat, I also have guttate psoriasis. Guttate psoriasis is a skin disease (the trendiest of skin diseases!) where small pink, scaly lesions appear on the skin, and outbreaks of which are primarily triggered by a streptococcal infection, among other things such as stress and skin injury. The anxiety caused by the possibility of an outbreak alone is enough to trigger an outbreak. So last week I had my French host mother book me an appointment with the local doctor as soon as my sore throat failed to subside.
Speaking a melange of French and English I tried to ask the doctor for the RST. "Le test? L'examen pour les streptocoques?" My inquiry was met with confusion. He asked me what I usually do when I have les streptocoques and I told him I take antibiotics. He vehemently denied me the antibiotics I wasn't even asking for, then told me my throat wasn't red and shooed me out of his office with a prescription for Ibuprofen. Later in the car with my French host mother I explained the RST in English and learned that such a simple and routine procedure does not exist in France. What is this tomfoolery?
As cultural differences is a favorite topic of mine, two days later I relayed my ordeal to a French friend. He astutely pointed out that while I may think it's insane that such a basic healthcare practice doesn't exist here, he thinks it's insane that the infection is such a ubiquitous issue in the United States that the practice is a necessity. An outbreak of strep throat is so rare in France it's practically newsworthy he said to me. My initial incredulous reaction began to change shape-- perhaps my irritation with this foreign health system that can't cater to my medical needs should be redirected home to Antiseptic America.
Growing up I would often hear my nurse mother complain of the parents who bring their sniffling children to the doctors and the doctors who then dole out antibiotics to shut up the sniveling parents. Overuse of antibiotics in America is no myth and the "hygiene hypothesis," which proposes that increased cleanliness and hygiene has decreased our exposure to infectious microbes and parasites and thus suppresses the natural development of our immune systems, is not a new theory. I can't help but wonder if the HH is less theory and more fact. Americans have a reputation for over-washing, over-sanitizing, and over-prescribing and although it's possible my personal experience with sickness in a foreign country is a result of my own weak immune system and not that of an underlying cultural issue, evidence suggests otherwise. Scientifically speaking of course, I, and many of my American cohorts, seem to get sick a lot abroad. And my French dishwasher's capabilities are questionable. But I'm not pointing any fingers.
One can't be sure of the origins of the American notion of "dirty Europeans" but maybe a little dirt isn't such a bad thing if it makes one less susceptible to bad things. I still don't know if I had strep throat or not but I did what any American would do: doctor shopped and got a prescription for antibiotics.