Monday, November 12, 2018

Pregnancy in Switzerland

Today I am 36 weeks pregnant. Which is absolutely mind boggling to me. Also today, I officially start my maternity leave. With 4 weeks to go (maybe less, hopefully not more), a job that requires me to be on my feet quite a bit (therefore giving me contractions), and a country and employer that take care of their pregnant women, I decided it was time to rest and take care of me, and savor the last few weeks of childless life.

I'm bringing this blog back from the dead today because I thought, since most of my friends are parents and/or labor and delivery nurses, you might find it interesting to hear what its like to have a baby in another country. 
After living in France and Switzerland for a little while Adam and I decided that we wanted to have at least our first baby in Europe because 1) the benefits offered here are better than we could get in the US (the only developed country without countrywide, legal paid maternity leave) and 2) Lots of reports coming out that the US has by far the highest maternal mortality rate of any other developed country, for many reasons, and Europe's maternal mortality rate is less than half of that of the US. 

So here's a list all the things Switzerland provides to pregnant women and new moms  and some of the differences in insurance and care. (i'm sure some of this is the same as the US, but I don't know as I've never been pregnant in the US)

1. First a little overview of the Swiss health insurance situation. There are 2 types of insurance, basic public (which is required for all citizens and residents) and private. They both include the same prenatal care benefits but the difference is that people who pay the high price for a private insurance plan can be delivered by the OBGYN who has followed them their entire pregnancy and they can deliver in a fancy private clinique, which is essentially a small hospital with 5 star hotel amenities. (I work at one of these). The people with basic public insurance must deliver at a public hospital and at the end of pregnancy, their medical records are transferred to this hospital and the last few prenatal visits are done by the midwives there, and then you are delivered by a midwife there, whoever is on shift at the time. (there are also residents and an attending physician for complications and c-sections). Labor and Delivery nurses don't exist here, midwives do all levels and stages of maternity care.  Private cliniques ensure a private post-partum room where the dad is allowed to stay overnight, the public hospital has double post-partum rooms, dads are not allowed overnight. Anyone with public insurance can pay to deliver at a fancy, private clinique, for the small price of $5500-9000. Private insurance allows moms to stay in the hospital for 5-7 days or more after delivery. Public I believe is 3 or 4 but I'm not entirely sure. 

I do not have a private health insurance plan, therefore I will deliver at the large public hospital in Lausanne. Early on, I signed up for and paid $800 for the possibility of a private room at the public hospital, if available. They do a little over 3000 deliveries a year and I am told they have the highest quality NICU and maternal-fetal medicine care in the country, at least in this region. Even if I had private insurance, I would choose to deliver here for this reason. Private cliniques can only handle full term, non-complicated deliveries.

The only downside of delivering at this hospital is that with over 3000 deliveries a year, they only have 6 labor and delivery rooms, are always full to the gills, and therefore only accept you into the actual L&D room when you are in full blown, active labor. Before this you are allowed to stay at home, and if hospitalized, early labor is done in a pre-labor unit and you're not allowed an epidural on this unit. And I've heard that their midwives are crazy busy and have little time to dedicate to you during the early labor stage and in the post-partum unit. So from everyone I've talked to who has either worked there or delivered there, I have heard mixed reviews. Some had great experiences, others not. I'm just hoping that my knowledge and experience as an L&D nurse, and my many L&D/midwife/OB friends will help me if I encounter any issues with this. 

2. No matter what insurance plan you have, the rest of the care and benefits are the same. Maternity leave officially starts the day you give birth and is 14 weeks long and paid at 100% that entire time. What I am doing right now until delivery is considered a regular sick leave, but is also paid at 100%. For the last 6 weeks, I was only working part time, but was getting paid my full time salary (nurses here are salaried, not hourly). After the 14 weeks paid maternity leave, if for some reason I want more time off, I can easily get it, but it won't be paid. Time off before or after delivery is easily granted by doctors and employers and most people take advantage of that. In fact, I must be the only nurse at my hospital to have worked so far into her pregnancy because starting at 5 months I have gotten daily comments and questions about when I'm going to stop working. Most of my co-workers are from France, and there maternity leave starts at 34 weeks. So the last couple weeks I got a lot of "What the heck are you still doing here?!?!" 

3. While you are pregnant and working, there are some restrictions. The big one is that starting at 16 weeks you cannot legally work more than 9 hours in one day. And starting at 20 or 24 weeks, half of your shift must be sitting, half must be standing (which is difficult to regulate when you're a nurse). Since night shifts are all only 12 hours long at my hospital, I was taken off night shift at 16 weeks (yay!), and I was working four 9-hr shifts per week. My 6th month of pregnancy I had a lot of braxton-hicks contractions so my doctor put me at part time, so two 9-hr shifts per week, that I started at 30 weeks.  

While I was at work, everyone was very careful about what I did. I couldn't push a patient bed or wheelchair. If I went to get a patient out of bed for the first time after surgery or delivery I had to do it with another person. Sometimes they wouldn't let me carry the patient's dinner tray to them. On slow days they usually told me to stay sitting when call bells went off. And on extra slow days, or if i was contracting, they let me go lay down in an empty room. My managers knew I wasn't sleeping well and usually let me start my shift at 11 so I could get extra sleep in the morning. 

4. During pregnancy, a lot of things are covered by insurance, or at least partly reimbursed. Plus I have a complimentary insurance plan for alternative therapies, so I took advantage of it all. Physical therapy, massage, osteopathy (a really cool alternative therapy that is hugely popular in Switzerland), sophrology (breathing and relaxation techniques), accupuncture, a psychologist, and more that I can't think of, are usually all covered at 75% during pregnancy. Although you need to go to someone who is recognized by your insurance company or else it won't be covered. I was burned a few times by this.
Everyone also gets $150 towards prenatal classes of any kind. We did not take any childbirth classes but I did take a prenatal aquagym pool class for 5 weeks.  
Also, 2 pair of full thigh-high pregnancy compression stockings are also fully covered. My legs aren't swelling but I went and got one pair anyways because, why not.

5. One thing I didn't know until it was too late was that insurance covers the cost of prenatal vitamins. I bought 8 months worth of expensive prenatal vitamins in the US and brought them back here and then found out this information. But I was also prescribed to take a magnesium supplement so that is paid for every time I fill the prescription.

6. 100% of all my prenatal visits have been covered and I get an ultrasound at every appointment. We have pictures on our fridge from 7, 11, 16 and 22 weeks. The ultrasounds I got at 27 and 32 weeks were quick and I didn't get pictures, although I probably could have asked. But it was cool to get to see the baby every month.

I don't know if this has changed in the US, so please tell me, but my doctor wasn't concerned at all with weight gain, or in my case, lack of weight gain. Apparently now there is no minimum requirement for weight gain, as long as both mom and baby are healthy and baby is growing like normal. Pregnancy did not slow my lightning fast metabolism and I've only gained 15 pounds. But the baby measures smack dab in the middle of the growth curve every time so all is good.

7. After delivery everyone gets a home midwife of your choosing. You are allowed 16 home visits from her in the first 2 months after delivery. Then 3 more any time after that. The early visits are great for establishing breast feeding and making sure the baby is gaining weight. Especially since after leaving the hospital the first pediatrician visit isn't until 1 month of age. The extra 3 later on are usually used for help weaning off the breast.

8. Every little neighborhood in the city has a community center and once a week they have a midwife there for anyone to go and ask questions and weigh your baby. You can also go there any morning to meet other moms over coffee and let your kid play.

9. Another standard post-partum benefit is you get perineal physical therapy sessions. This is great if you don't want to pee every time you sneeze or get an operation when you're 60 to lift back up everything down there.

10. The city gives every new parent a certain amount of free garbage bags to account for the extra trash all those diapers require. In Switzerland, to promote recycling, non-recycled trash has to go in a specially marked trash bag that costs more than regular ones. (you're fined if you're caught using any other bag). For a mini trash-can sized bag, its $1 per bag, each size up is an extra $1 per bag. So this is why the trash bag allowance exists. In our city, the allowance is $160 worth of trash bags.

11. My particular health insurance company gives us a gift of $100 for the birth of our baby. And since we registered him/her with the same company, the baby will get a complimentary upgrade to private insurance status for the first year of its life. I'm not entirely sure what this means for a baby but its still cool anyways I guess. 

12. In Switzerland I can choose at what percentage I want to work at after I come back from maternity leave. 100% is 42 hours a week here, for nurses it is averaged over the month since 42 hrs/week is impossible with 12 hr shifts. My contract states that I work 80% with a potential to also work the extra 20%, which I always did before announcing my pregnancy. I have requested to come back to work at 60%, which equals about two 12-hr shifts per week. I could have also requested to not come back at all, and this would not have affected my paid maternity leave at all, which I am entitled to as an employee. These requests are usually always granted but I still haven't gotten mine accepted yet.

13. Daycare. Daycare is just as difficult to find and expensive as in the US. Again there is public and private. For public, you turn in a general request form once you are 16 weeks pregnant, with the days and hours you are requesting, and you are put on the waiting list for a few daycare centers within a certain radius of your home address. There is a daycare that prioritizes employees of my hospital and is right next door to it so there's the most chance I'll get into that one. You have to resubmit this request form every 4-6 months, until you are accepted to a daycare center. I just submitted my second request form last week.
The cost is based on your income, so everyone pays a different amount, and if you make less, you pay less, and vice versa. Based on our combined salaries, for the 3 days a week I requested, we would pay approximately $1000-1500 per month. I've heard you can wait up to a year before getting accepted to one. and if you need to go back to work before a spot opens up then you get involved in the very complicated game of nannies and the babysitter black market. 
Once your kid is accepted into a public daycare, then they are automatically accepted into the after school programs when they are older. So most people want public.

Private daycare is more expensive, $140 per day for a full day and doesn't ensure this after school program thing, but its also easier to get into for new babies since most people then switch to public once they are accepted. So I also put myself on the waiting list for 1 private daycare. 

So that's my experience so far. Obviously I don't know how the labor will go and since I'm not allowed to work in the delivery room here, I don't know if there are any differences in labor care than what I'm used to but I will soon find out. If its anything extremely interesting or different I'll attempt to write about it if I have time. But just like I learned being a travel nurse for 4 years, all hospitals have slightly different ways of doing things but the goal is always a healthy mom and health baby. 

So now I'm going to take a nap. Because since about 27 weeks, I've been sleeping like crap, whether its heartburn, back pain, my overactive brain, or this baby that really enjoys 4am kickboxing. 

Wednesday, October 25, 2017

African Safari Honeymoon

When it came to planning our honeymoon we knew it had to be something really big because we've already done some pretty amazing vacations. Since we've seen most of Europe our sights have been set on Africa for a while now. There were countless tour options and countries to see but I'm very happy with the choice we made.

It was a 2 week long tour, starting and ending in Johannesburg, making several stops in Botswana and Zimbabwe, and finishing with the famous Kruger National Park in northeast South Africa. We spent 1 full day in Jo-burg on each end of the trip. The first and last night were spent in a hotel but every night in between we camped in a tent in camp sites that had bathroom facilities that were usually pretty good, and sometimes there was even a bar and a pool. It was rainy and chilly in Jo-burg but every other day was clear sky with a very strong sun at 95 F (36 C), luckily the nights cooled down quite a bit, between 60-70 F (15-20 C). Super dry climate, it just turned spring down there so it wasn't very green yet. 

There were 24 people, including 2 awesome tour guides. about half of us did the whole 2 weeks, the rest of the group changed between the first and 2nd week. We had a blast with everyone and got really close with a few. One of the best things about traveling is who you meet. I think we've got some new friends for life.

We went on multiple game drives in search of animals. The "Big 5" which are elephant, lion, rhino, buffalo, and leopard. There is also the "Small 5" (which includes elephant shrew and leopard tortoise) and the "ugly 5" (which includes hyena, warthog and wildebeest). Sometimes even just driving from one town to the next was a game drive in itself as we frequently stopped for giraffes, zebras and elephants on the side of the highway. 

On the first night, we arrived at our campsite and our tour guide was about show us how to put up our tent when a guy from the campsite next to ours ran over and said "hey there's a black rhino at our site so you might want to put your food away." So naturally we all ran over to the other site and there he was, the rhino, just standing there. The other campers were banging a pot to get him to leave, that did nothing. Eventually one guy threw an apple past the rhino, hoping he would follow, then the rhino started to charge the guy. Me and 2 other girls instantly ran as fast as we could in the other direction. Everyone else stayed and watched, the rhino only took a few charging steps at the guy and then stopped. According to our guide, this rhino had become used to humans in the camps and so was not as dangerous as he could have been. But how's that to start a safari adventure!

One night we spent in the Okavanga River Delta in Botswana. We had to take a tiny canoe called a Mokoro into and out of there. This night was truly being in the bush, no facilities, toilet was a hole in the ground. The locals and our guides cooked a traditional meal on the campfire. It was one of everyone's favorite days. We just relaxed, got to know the other group members, swam in the delta, took a nap, and went on a game walk and walked next to zebras and elephants. We were told that if we needed to use the toilet at night to listen and shine a flashlight to look for reflection of eyes. Sometimes hippos and elephants will show up unannounced. In fact, many nights we were told to look out for animals, one campsite had rhinos roaming around, another we were warned of leopards, another site we couldn't leave anything outside the tent or baboons might steal it. 

During the Makoro ride through the delta we sat and relaxed while a local guide, called a poler because they pushed the canoe with a long pole/stick, guided us through tall grasses and reeds. At one point the grasses opened up onto what was called Hippo Lagoon, for obvious reasons. A couple hundred feet away were about 8 hippos, their heads occasionally surfacing for air. As the 15 or so Makoros floated up, 2 of these hippos started inching closer. (2nd most dangerous animal in Africa we're talking about) Eventually one of them got to maybe 20 feet away, max. It was making a grunting noise and made kind of a jump in the water. At this point the polers pushed us hard and fast back into the reeds. I was terrified. Our guide was laughing, he's been doing this all his life. The guide in the Makoro next to ours, however, was patting her chest and said "wow that was a close one." After my heart stopped racing, I fell asleep for the rest of the ride, it was very relaxing.

We spent 2 days in Victoria Falls as the halfway point of our trip. Luxury campsite, very clean, really nice bar, restaurant and pool, with a spa that I took advantage of and got a cheap, much needed massage. The falls are beautiful, it is low water season so they're not even as amazing as they can be. The hotel staff briefed us on the available activities and I saw something called a tandem swing that caught my attention. It was on sale for 50% off. It didn't seem to be as bad as bungee jumping and me and Adam could be strapped together for it. Sounded fun so we signed up. Honeymoon splurge, we said. Then we got to the bridge and I watched people jumping off for the swing and the bungee and I realized they're not that different after all. I instantly went into a strange mode and stopped thinking as to not psyche myself out, as some people were. In the video you hear the guy ask if I'm nervous and I said "I don't really feel anything right now" which was true, I had totally blocked any emotion in order to jump. But the look on my face in the beginning tells all apparently, and its so hilarious I just had to buy the video. So we jumped. 4 seconds of free falling. Worse than any theme park ride. I was supposed to keep my legs straight but the initial shock of the fall made me want to curl into a fetal position into Adam, but I instantly remembered to straighten out when I felt my foot almost get caught in the ropes. When free falling turned into swinging my neck snapped back and I heard a crunch. This can also be seen in the video. My neck was sore for days. Immediately afterwards I expected one of those adrenaline highs, to be like "that was awesome!" but that didn't happen. As we swung I kept saying "ok.... ok.... ok..." and I still can't fully figure out my feelings towards it. 

Day 2 in Vic Falls we went white water rafting, we had signed up for this months ago when we booked the trip. Low water season means high level rapids, class 3-5. The intro meeting in the morning scared the shit out of me. They explained how to get rescued when (not if, when) you fall out and that there may be crocodiles. I've rafted class 3-4 before, but 5 means getting thrown out and capsizing and I wanted none of that. Adam told the guide that I was thinking of backing out and he said "don't worry, if you're in my raft I'll take care of her, but she will be in that water" It didn't make me feel much better but I went along anyways. The rapids were intense, scary at times. Our group took up 3 rafts. Mine became known as the safe raft, the other 2 capsized through several of the 19 rapids, sometimes on purpose because people asked for it. Ours didn't capsize at all, and only once did people get thrown out. I managed to stay in but Adam wasn't as lucky and he got rescued by one of the kayakers who followed us the whole time. This time, at the end of the day I was saying "that was awesome!"

We had 3 border crossings to conquer during the 2 week period. We were told these can be tricky, and take a long time, depending on the mood of border controllers. The first 2 into Botswana and Zimbabwe were surprisingly easy and quick. That's how it seemed getting back into South Africa too. Half of our group had gotten through when the computer systems shut down and the electricity went out. It was the middle of the day, 95 degrees. Adam and I were part of the first half of the group that were finished. We waited in the bus but there was no air conditioning. We found a small grocery store with a/c and stood in there for an hour, until their electricity went out too. After about 3 or 4 hours, they got a generator installed and the computer systems came back on and the rest of the group passed through customs. But then the bus wouldn't start. The battery had died. We waited another hour or so for the tour guides to arrange taxis to take us to the camp site which was an hour away. In all we spent 6 hours at the South African border that day. The taxis stopped at a mall and we picked up 15 pizzas, we got to our campsite around 9 pm and there was a big warm hot spring pool that we all relaxed in and ate pizza. That day gave meaning to the phrase "this is Africa"

During this trip we talked a lot with our tour guides and other local guides and asked questions about history and culture. We learned a lot, I love learning about other cultures. Our rafting guide was shocked to hear that Americans don't learn about African history in school. I told him that this really is a shame and that it is unfortunately up to us to learn about most of the world on our own time, and this is one of the reasons we came to Africa. 

We spent a day with a conservationist in Matopo national park in Zimbabwe and what he told us was fascinating. I wanted to spend all week with him just picking his brain. He was a white, englishman who was born and raised in rural Zimbabwe. He had studied the bushman, the last remaining culture of hunter-gatherers left in the world. There's only 3000 left. Most have been forced from their original lands and killed by modern farming societies. We saw some cave paintings that were around 13,000 years old, in a region thought to be inhabited for 500,000 years. 

We also learned a lot about the wildlife. The habits of the animals, how they live and act. He also explained that with the current and very insufficient ways we are combating poaching right now, there will zero rhinos left in 2 years! Not in the wild or in zoos. He knows what to do to slow this down (its worked for lions) but the superpowers in the world don't listen.

On our last day in Johannesburg we went to the Apartheid Museum. I didn't realize how little I knew about South Africa and Apartheid and I felt ashamed. I'm so glad to have learned all I did, and I want to keep going back to Africa to learn more. 

All of the details of what I learn about history and culture when I travel I write in a travel journal so I don't forget. The Africa section is many pages long. We have a double entry visa for Zimbabwe valid for 6 months. We have already started checking cheap flight sites for another trip. Whether it be the same region or a new country altogether. We fell in love with Africa!

Thursday, July 6, 2017

redo summer post

This is my redo from my last post, which wasn't very interesting. I wasn't in the mood to write a blog, so I don't know why I even did. Because I just complained about the heat. So I'm writing a more interesting one today that is like my usual posts. I'm starting to run out of things to write about. My cultural observations are always there but its starting to get too difficult to explain them all the time. Plus, lately there haven't been too many interesting things to write about. But here's what I've compiled over the last couple months.
Its summer in Europe and that means vacation time. With 5 weeks vacation during the year, its a big deal. Its all everyone is talking about at the hospital. Asking each other where they are going on vacation this summer. People usually take 2 weeks in the summer time, at least. I've been asked several times what my summer vacation plans are and I have none and people are so shocked. I explain that I'm going to San Francisco in September for a wedding and that we are taking a 2 week honeymoon in October after my internship is over. But they are like "but you need a vacation in the summer!" Then I explain that I want to get this internship over with and that I don't work weekends so we take mini trips every weekend into the mountains. And they're like "oh ok well I guess that's pretty good then" 

(side note. To my SF, LPCH friends: I will be in the Bay Area Labor day weekend, I want to see you all!)

My floor hosts a lot of students and interns for short periods of time. This week we have this 18 year old kid who just finished high school and wants to be a doctor, so he's observing for a week. He said something to me yesterday, jokingly, sarcastically, but I just smiled and answered yes or no (i forget exactly what he said) because I didn't have the right come-back in french. He said "you know I was just joking" I said "yeah I know" he said "people my age joke a lot." I was like, does this kid think I'm 80 years old or something?! Do I look that old?! I said "yeah I know I joke a lot too, its just hard for me to do it in French, I'm much funnier in English" 

This is my least favorite part of speaking a 2nd language, you can't always express yourself the way you want to or be 100% your normal funny self because you just can't always communicate it right. And french people aren't going to understand when I quote American movies, yesterday I had the best Bueller moment but nobody got it. A few weeks ago I had a great Christmas Vacation quotable moment but no one to tell it to. This goes the other way too, a doctor told a joke yesterday and everyone busted out laughing and I just sat there and said "will someone please explain this to me" I got it after that but the joke was already over. 
So I just have to deal with people thinking I'm kind of boring or quiet.

You know you live in Switzerland when the only choices at the hospital cafeteria one day are fish (I hate fish) and chicken liver or veal cheek (I don't eat veal) and then you have to load up on salad and sides.

When we went to Lake Como, which is just across the swiss border, on the train we were wondering when we would finally cross the border into Italy... You know you've crossed the border from Switzerland into Italy when the train stations are spotless and modern with clean shiny signs and then all the sudden you're in a train station with faded signs and it looks like it hasn't been renovated since WWII. Oh yeah, now we're definitely in Italy. (Lake Como is beautiful though) (and they have started modernizing parts of that station)

But I guess to fully appreciate this observation/joke you need a little understanding of the basic stereotypes that European countries have of each other. This illustrates 2 of them.

I said to myself when I moved here a year ago (crazy it's already been a year) that as soon as I considered myself more or less fluent in french, I'd start learning German, because it would really come in handy in the German speaking region, which is 75% of the country. So according to my Duolingo app, I am now 6% fluent in German. Which I think is kinda funny and pathetic that it even tells me that. 

I really miss working in Labor and Delivery. I'm dying to get back to pregnant women and babies. I was near the OR one day and saw a baby being rolled out in an incubator and wanted to just grab it. I went to drop off a culture specimen one day and I saw a mini-fridge labeled "Placentas" and I got so excited and sad at the same time. I told this to Adam and in typical Adam fashion his first response was "..... you know what rhymes with placenta? ..... polenta!" 

Friday, June 23, 2017

Summer heat

We are currently on a train to St. Moritz. It's a fancy ski resort town in eastern Switzerland and we've heard lots of good things about the region. It's about 5 hours away. 

I'm calling this blog summer heat because I'm so sick of being hot and sweaty and sticky 24/7. I live in the richest country in the world and they don't seem to like air conditioning. At times I feel like when we were in India in July. There is very minimal a/c around here. And where there is central a/c installed, it's kept at a minimum. This was the same in France.

At the hospital, my floor is the only floor with air conditioning. It's only in the patient rooms and the nurses station, which is a closed off room. The hallways are hot, the kitchenette room is hot, the locker room is hot. I've started taking the bus instead of walking uphill 15 mins because I would just be so hot without any releif when I got to the hospital.

 But because a/c is so minimal here, people aren't used to it and don't particularly like it. My patients would rather just open the windows (yes the windows open in the patient rooms) and sweat than turn on the a/c. They say it causes bloody noses, coughs, and sore throats. I've been telling them it's the fact that they were intubated during surgery that their throat is sore, not the a/c. 

The other place that doesn't like a/c.... The gym! They have it, but it's on so low you can barely feel it. I'm sweating before I even start my class. And the classroom at the gym is awful. It's disgustingly hot in there. They have a big box fan in the corner, and if I don't get a spot next to it I have to stop in the middle of the work out because I get dizzy and lightheaded. It makes me not want to even go. Everyone is soaked in sweat and complaining about the heat yet nobody does anything about increasing the a/c.

Our apartment doesn't have it, which isn't a big deal because I've lived in old apts in the US without it. We only have a small fan and at night we sweat and I have trouble sleeping. Now, each night, I put a cold wet towel across my body to fall asleep, it helps. When we cook it's even worse because of the heat of the stove. I don't think window units exist here because windows are different than in the US. They open like a door. I saw one place with one of those giant floor units that's like 4 ft tall with a tube that you hang out the window and you have to put water in it. I've never once in 2.5 years in Europe seen a ceiling fan. At work everyone talks about those fancy Dyson fans but they're $300 so that's not gonna happen.

I will say one thing. I do not want American style, freeze your butt off, super intense air conditioning. It's a waste of energy and money, and I hate that I have to bring a jacket everywhere in the summer because everywhere is so freezing inside. I'm assuming the energy thing is why Europeans don't use too much a/c, they are very conscious of energy usage and such. But a little more would be nice.

But Americans are known for their love of a/c because at work once, when it started getting warmer outside, I said I was hot and they said "go turn on the a/c." I said "where is it? I don't know how to turn it on" they said "an American doesn't know how to work the a/c?!"

Enough complaining. Here's a funny story to finish.
The people I work with enjoy teaching me different slang and cuss words. There are so much more ways to cuss in French than in English, by the way. But I reciprocate this and teach them the equivalents in English, if there is one. Recently I taught one of my nurse friends FUPA. (If you don't know what this stands for, look it up or ask someone) it is now his most favorite word ever. There is no equivalent to this in French. He writes it on the white board in the nurses station, he drew out a picture of the anatomy of a FUPA, my new nickname is FUPA. once, during report, from across the room he slowly but deliberately scratched his face, making me look up at him, and he had written FUPA on his hand, causing me to burst out laughing but then pretending to cough so I wouldn't interrupt report. 

It's things like that that get me through working med/surg

Friday, April 14, 2017

Being a Swiss nurse

Its 8am. We are currently on a train headed to Lake Como, Italy. Which is 5 1/2 hrs away, just on the other side of the border of switzerland. We'll be spending our 4 day easter weekend there. Switzerland has public holidays the Friday and Monday of Easter. Therefore all of Switzerland is heading out for a vacation and at every stop the train fills up more and more.

Right now I'm very tired and not in a good mood because Adam's daily alarm went off at 6:30, 45 minutes before we needed to wake up to catch the train. I'm normally not a very nice person to be around when my sleep gets interrupted but after these last 2 weeks I need as much sleep as I can get. 

For 2 weeks I've been working every day 7am-4pm. Re-learning all the medical/surgical nursing I've forgotten over the years. Learning about heart surgeries and heart problems that I've never taken care of before. Learning various medications that have completely different names than in the US. Learning the organisation and rythym of the unit. Learning how to chart. Oh and did I mention that I'm doing all of this in another language! 

My brain is fried. I'm mentally drained. To make matters worse, for my first week, right after working 9 hours and speaking french 9 hours, I had one last full week of french lessons. Then I'd go take a class at the gym (can't take a break now, wedding is less than a month away, need muscles) On Friday of my first week they let me go home 2 hours early because it was so obvious how utterly exhausted I was, I couldn't even think straight. I was like a zombie. I went home and promptly took a 90 min nap. And napped Saturday as well.

The hardest thing is by far the language. Nurses, remember in nursing school we had to learn medical shorthand and abbreviations. Abbreviations for diseases, shorthand and symbols for the little words you get too lazy to write in your charting or in prescriptions. Now try doing it in another language. I bring a little notebook with me everyday to write in that has pages full of just that. To all my nurse friends who are not native English speakers, I don't know how you did it! Everyone reading this right now needs to go hug a foreign doctor or nurse, there's tons in the US so you have plenty of opportunities. I feel so ignorant for never thinking about how hard it must have been for them. Americans can be like that

My first 2 weeks I mainly observed and learned how to do basic things that I'd forgotten like dressing changes and EKGs, helping patients with their bath (luckily most are pretty independant). Next week I think I'm going to start getting assigned simple patients to take care of. 

It's mainly a post-op floor for mostly cardiac surgery patients after they have stabilized in the ICU. There are other surgeries as well, like thyroidectomies, back surgeries and GYN stuff. 

Charting is all on paper. Nothing is on the computer. And french/swiss people have weird handwriting that I have a hard time deciphering. They have totally different ways of writing certain letters and numbers. The number 1 is like an A without the line through the middle (because in Arabic, where our numbers came from, it was based on angles, and that shape has 1 angle, and they still write it like that). A 4 sometimes looks like a sloppy 6 to me. A capital M looks like a large lowercase n because they don't make that little downward angle in the middle. And a few other letters aren't like Americans typically write them. And it's a half-cursive, half-normal print mix. I'm always having to ask what is written on the chart. I'm getting used to it though. But reading doctors handwriting... impossible.

As far as nursing duties goes, it's not that different. Some materials are different but most are the same or similar. They use plastic bottles for IV drips instead of plastic bags. And unless it's a dangerous drug like a blood thinner, they don't use IV pumps. There is no medication machine like a pyxis guarding all the drugs. It's just a wall of drawers, alphabetized, unlocked. Except for opoids and such, obviously locked up. 

The patients are much more patient than Americans. Which is a huge plus. If you tell them "no" they accept it and don't ask questions. 

There's less documentation than in the US. Also huge plus. They worry of being sued for everything you do just doesn't exist here. It's a very American thing. Over charting, over treating, over intervening. Over-CYA (cover your ass). One thing I've realized being out of America is everything there is just over done. It's a culture of excess. I like being away from that. 

Some of the values for labs are different because they use different units of measurement. For example a normal blood sugar value here is between 3.3-6. In the US it's 60-100.

The only thing I don't quite like is that the locker room for students and interns is unisex. It's a tiny room without anywhere to hide. So I wear my undershirt to work so I don't have to take off my shirt. And I change my pants as soon as I walk in as fast as I can if there's no guys in there yet, or wait till they leave. It's only 1 or 2 guys, and in europe it's not a huge deal, but as an American it's kind of awkward. Even though, technically, my underwear covers just as much as my bikini does. So I guess it's not a big deal so I'll get used to it. 

Oh yeah the other huge adjustment that I still don't like... taking care of men. For a week and a half I successfully avoided having to go near man's private parts but I knew that would eventually have to end. Pre-op cardiac patients have to be 100% shaved on the front side of their body before surgery. I just have to keep in mind that Europeans are more open than Americans about that sort of thing and it's more awkward for me than for them. Which was the other way around when I worked in Labor and Delivery. The patients were all shy about having their hoo-ha's looked at by everyone that walked in the room, while us nurses never thought twice about it. 

The staff is incredibly nice and welcoming and supportive and understanding of the learning curve I'm suffering. They help me with all the words and abbreviations and medication names I don't understand. And if they're all joking around and laughing and I'm just sitting there blank faced they say "you didn't get that did you?" and they will then explain the joke to me. Which includes teaching me interesting slang expressions and cuss words. Which there are so many more of in french than english. 
They're always making fun of American accents but they mean no harm, it's like how Americans like to randomly break out in a British accent. I like to make them try to pronounce my name in english, and they just don't get it. (I've had to frenchify the pronunciation of my name these last 2 years, here my name is "laurenne" with emphasis on the "renne" and the impossible, back-of-the-throat french R sound)

Almost all of them are from France. The conditions and salary for nurses in france are just terrible so a lot of them come to switzerland where they get paid double. Plus the Swiss just have a hard time recruiting their people to be nurses. Years ago they recruited tons of nurses from Quebec, then from Portugal. Now the Swiss have their panties in a bunch and only want to hire swiss nurses. There was recently a report on the radio about how to make the medical field more appealing to young Swiss people, because there's just so few. 

On my first day, as we were sitting down to chart our morning rounds, the nurse I was following stopped mid sentence and said "oh, before we start, I have to show you something very important" she turned around to the wall of drawers of medications and opened the largest one, which is unmarked, inside it was full of chocolate! I said "yeah this is obviously a Swiss hospital"

Tuesday, March 28, 2017

I got a job!!!!

Starting Monday, April 3rd, I am no longer unemployed! It will be almost exactly 1 year to the day that I had my last day at Stanford and worked as a nurse. It took much longer than we expected but hey, that's life abroad. 

Quick sidenote, I will be working but not getting paid. (so much for the 2nd income we were looking forward to) Its technically an internship. Those aren't paid. But its OK because I won't be sitting on my butt all day with nothing to do. The process of getting this internship was quite difficult and that's what I'm going to explain in this blog today.

So I got that letter from the Red Cross at the very end of January telling me I did not meet all the requirements to have my diploma recognized and that I needed to do a 6 month internship in med/surg to make up for it. For 2 straight weeks I called countless hospitals with no luck. Finally, mid February, a hospital said they'd hire me and brought me in for an interview. This was a public hospital. They explained that by law, any internship over 3 weeks long had to be paid. But they couldn't afford to pay me for 6 months so they said I needed to apply for unemployment so that I could be paid in some way, shape or form. I took all the steps with the unemployment office only to get to my interview and they tell me I don't qualify for unemployment because you need to have worked for 12 months in Switzerland to qualify. I knew this but I said this wasn't because I was technically unemployed, its because this hospital required me to have unemployment benefits so that somebody could pay me for my internship. Even with this special case, I still didn't qualify, so the hospital said they could not give me an internship.

Back to the drawing board. I reached out to 2 private hospitals (I'll refer to them as #1 and #2). These are the 2 hospitals I had interviews with last summer. Private institutions are not regulated by the government so they can get away with not paying me. I've mentioned before that the private hospitals are for people who pay big bucks for the highest tier insurance and its like a luxury hotel hospital and you treat the patients like royalty. Not my cup of tea but whatever. 

Hospital #1 replied immediately with an offer for an internship, its a hospital 1 hour away by train. Hospital #2 is a 10 minute walk from my apartment, my american nurse friend works there and they have a maternity unit for me to make potential connections with. Obviously the better choice. But #2 took forever to get back to me, and even when they did, took forever to get the ball rolling on an offer. So I accepted #1 and was set to start 2 weeks later. Right before I was supposed to start, hospital #2 finally got their act together and gave me an offer (after I emailed them saying I had to accept at another hospital because they were taking too long). I struggled with what to do. I was told it might not be the best idea to cancel an offer I've already accepted. I didn't really want to burn any bridges but #2 is just obviously better for me, so I accepted it. I felt really shitty about having to cancel the internship with hospital #1, my french teacher helped me write a very professional email to them. 

So, nurse friends, get ready for all my future posts about what its like to be a med/surg nurse in Switzerland. 

Also, this is why I love Europe and where America needs to take notes and learn. Seriously. At my meeting with the nurse manager of hospital #2 she asked me if I needed any days off. I said I needed a week in May for my wedding. The response I got: "oh, you're wedding! pff! take off 2 weeks if you need it!" Then I said there were 2 weekends in September I probably would need off. Her response: "well you should think about taking a week or 2 during the summer. May to September is a long time without a vacation" Boy, do I love that European mentality. That would never happen in the US.

In other news, I have 2 funny stories.

- Adam and I seem to have not the smartest French teachers, or, it seems like they don't get out much. After going to Finland, Adam was telling his teacher about the northern lights. She had no idea what he was talking about. He explained what they were, still she didn't know what he was talking about. Thinking he was just speaking really terrible french, he showed her a picture of the northern lights, her response: "oh! you mean fog!" .... no! what fog is green?! Turns out, she has never ever heard of the phenomenon of the northern lights... seriously? I don't get it. 
     The only person I will pardon for not knowing this was a friend in Madagascar, she is Malagasy, it made perfect sense to me when she commented on my photo asking what that was. 

-When I told my teacher about Finland, she had no idea what a snow mobile was. I had to explain that to her. She lives in a country full of mountains, even has a chalet in said mountains, and has no idea what a snowmobile is...smh

-Then, I was explaining to my teacher how Adam and I find all of our cheap flights to the US. I said that if you fly in the summer time though, it will always be expensive no matter what. She said, "well unless its winter in the US" I gave her a confused look. She said "like in June or July when its winter in part of the US" I stared back at her with the most confused look ever and she said "isn't the United States divided into both hemispheres?" I said "um... no... not at all. Its all quite far north of the equator. The equator is in South America" She didn't know this. Basic geography people! 

Further in our conversation about air travel I also had to explain to her that you are actually allowed to bring food on a plane. And if you buy any food or drink after security then its allowed on. And that these days it usually costs to check a bag (that one she just did not believe) I think its been a loooong time since she's been outside of Switzerland. She is even shocked when I tell her how much cheaper things are in France. 

-2nd funny story, its a little vulgar, I'll try to tone it down. But I have to tell it. One day I was listening to the Swiss morning radio on my computer. I clicked on a story they had done called "Fist F**king." I clicked on it because I figured it had to be a metaphor for something and I wondered what it was. Nope! Not a metaphor! Not at all! They actually had a sex therapist on discussing this particular sexual act. She said the idea came to her to talk about it on the radio when she saw her teenage son watching porn and they were doing this and he didn't think it was physically possible. She discusses why people like it, who likes it, how its done, the risks, the pleasures, the social connotation. All discussed in very professional, matter of fact way, as if they were talking about the weather report. I couldn't believe my ears. But I forget, this is Europe. Sex is not a taboo subject. Americans are prudes. 

Friday, February 24, 2017


It's Thursday morning and I'm currently on the train on my way to the mountains for a snowboarding lesson. Skiing gave me horrible pain in my knees, so much so that I got really nervous about injuring them. I took a lesson to try to fix my bad form but that only slightly helped the pain. So now I'm a snowboarder. Snowboarding is not very common in Europe, maybe only 5% of people do it. I still like skiing better but I have no more knee pain so I'm sticking with snowboarding. It's just much harder to learn with harder falls. I wear butt pads, knee pads, wrist guards and a helmet. I'm too old for an injury. And in the last 2 weeks, with the kinds of falls I've taken, I'm certain I've prevented 1 concussion and a few petallar and tailbone fractures
Its funny, when I was little and would go rollerblading my mom wanted me to wear all the padding but I refused, totally uncool to be seen with all that when you're 10. But now I want all the padding available!

 I don't know how it is in the States, if you're a skier then tell me. But here, and France too, people cut you in line like crazy to get on the ski lifts. Very obvious, blatant line cutting. Whole families, encouraging their kids to push ahead. It drives me crazy. Last week I finally turned around and said something to a little girl who kept kicking at my board with her skis, saying she wanted the snowboard out of her way. Her dad was right there and didn't stop her. I told her I wasn't gonna go anywhere if she kept kicking me like that, she stopped. And why do parents never apologize when their stupid kid skis into me, while I'm struggling on my board just to stay up, causing me to fall and their kid keeps on skiing past. As if it's my fault because I'm the adult. Friends: don't be that parent, be aware if your kid is a jerk

    the bane of my existence here in Switzerland. Ugh! I started the process of getting my nursing license recognized here in January 2016. The paperwork I had to compile, it was just so ridiculous. Finally in October I sent off my file for the final step and had to wait 3 months for what I thought would be my Swiss nursing license. Adam and I were making plans as if I'd have a real job in February. Well 3 months came and went and in late January I got a letter from the Swiss Red Cross telling me that I did NOT meet the requirements to get my diploma recognized. I am short 1200 university credit hours in hospital clinicals (Thank you Xavier!) And also, 1 year of working in med/surg is not enough. Never mind that I worked 6 years in high risk labor and delivery units, L&D nurses don't exist here so they don't care about all that. 
     So they are requiring me to do a 6 month internship in med/surg, which is most likely unpaid, before they will allow me to have a Swiss nursing license. 
     I almost had a temper tantrum when I read that letter. For the next 2 weeks I called all sorts of hospitals and agencies asking about this internship and got "no we don't do that" or "we don't have any internship positions available" from everyone I contacted. Both healthcare agencies I contacted told me they don't assist with internships, the Red Cross said they don't help either, it's my responsibility. 
     But luckily I have a few connections here and through the grapevine I was able to get an interview for an internship on a pulmonary floor. That's for Monday the 27th. The thought of working med/surg again makes me cringe. And pulmonary too, I hate phlegm, and I better not have to take care of anyone on a vent or I'll walk right out that door. 
     But it might be a blessing in disguise that I get to be hand held for 6 months before venturing out on my own. But I'm dreading it so much I've considered finding a job as an Au Pair, and you know how much I dislike kids. But I'd rather take care of kids all day than med/surg patients, and that's saying something. So we'll see what even happens at this interview. It's probably best to continue with nursing after all the effort I've put in, anyways. So that's to be continued....

So mostly I'm bored a lot but I do keep busy. I go grocery shopping across the lake in France, that takes up half a day. I meet up with Adam when his business trips are close to home. I met in the middle to see my friend who lives in Germany. I take classes at the gym almost every day. I also have almost daily french lessons. Adam's company is offering each of us 50 hours of private lessons. I'm working on expressions and idioms to make me sound more fluent. French has a ton of them, more than English. It's hard to remember them. I also got a book called French for Nurses and I learn names of all the hospital supplies, how to describe a bedsore, and all the various ways of asking the patient about their bodily functions.

     I remember in the Cross-Cultural Training class we took the lady told us the 6 month mark is the hardest. Well she was spot on with that! At the 6 month mark we went to the US, to Florida, did a lot of wedding stuff, stayed with my parents, Adam's parents came to see us. It was only 6 days and very busy. Not long enough to fully enjoy. For the first time in 2 years I really didn't want to come back to Europe, I did not want to get on that plane. And when I got home, I did not want to be here. It lasted a week. I was really down in the dumps. Adam left immediately on a 4 day business trip. I was super bored. No job. No interest in speaking French. Then that Red Cross letter came right as I was pulling out of my funk and it pulled me right back down.
    That article I posted the other day about trailing spouses being miserable... well I'm not miserable and I'm not depressed, but jeez its hard. I LOVE my job in the US but I've never missed it. Well now I miss it. When my friend here went into labor in January and was texting me about it, I wanted so bad to go to the hospital and play nurse for her. I LOVE my friends in the US but I never felt sad about missing them because I'm used to living far from them, but now I really miss them. At least in Grenoble we had activities and friends and a social life but we're having a hard time finding that here. I have 2 American girlfriends here and they're great, so that really helps because they understand my expat blues. I'm lucky to have them. And of course Adam, my very best friend, our relationship grows stronger every day. 

I think the problem for me, specifically, is that since 2012 when I started travel nursing I've been chronically unsettled. This didn't bother me at first, I was having a blast with travel nursing. Then I arrived in San Francsico in 2014 and, just like when you meet "the one," I knew I wanted to stay there forever. But of course "the one" became my boyfriend that same year and then I went to France and that was just gonna be temporary. Then Switzerland happened rather unexpectedly and that's also supposed to be temporary, but we don't know how temporary or when we'll leave. I'm so sick of living life in 3 month intervals. Now its less, its like week by week. 

But probably in 10 years when I'm bogged down with kids and work I'll look back on these unsettled, childless days when I sleep 9 hours every night and miss them. So I don't think about it, I just keep swimming and keep a positive attitude and look forward to our next cool vacation. Which is Arctic Finland. 

I found out something totally awesome that will come in handy when I'm having a bad day. We have a wellness/natural therapy thing we added to our health insurance. So, for example, I got $200 towards my gym membership. But the best is massages! It covers massages! I can get a 1 hour massage and only have to pay $20! I can get about 10 massages per year with this, I've used one and can't wait to get more!

    when working at the restaurant in December I got really stressed and behind on a very busy friday lunch rush. I forgot to give a table their salads. Heaven forbid. They didn't tell me I forgot, as any normal person would do when their waitress forgets something. Instead they told the head server as they walked out the door to leave. I got in trouble. I asked her why the hell didn't they just tell me during their meal that I'd forgotten and I'd have gone and gotten them their salad (which in Switzerland is a measly plate of just lettuce for $5). It was so busy. I had 10 tables. Easy mistake that's easily fixed. She said the Swiss will never say something like that, either they will tell you at the end, or say nothing and give the restaurant a bad review on TripAdvisor, which is all restaurant owners here care about. 
     Since there's no tipping standard here, you can't just take your anger out on a forgetful server by not tipping them, your anger gets directed at the whole restaurant. So TripAdvisor reviews are everything. (I, personally, was the reason for their most recent 5 star review)
     Then I explained that 2 servers for 20 tables and 50 customers is just insane and how could I be expected to not get behind in those conditions. In the US that restaurant would have at least 3 servers, maybe 4. She said here, there is server school, which she took to be a career waitress, and you are expected to take care of 40 customers by yourself, and that's just how it is. Restaurants are typically small, personally owned, wait staff is expensive (I got paid $20/hr) so it's got to be like that.

     So we took an awesome 11 day road trip around Southern Spain: Andalusia. Starting in Barcelona and visiting Montserrat, an old monastery in a very cool looking mountain. Then on to Valencia for 3 days, where we stayed in a hostel and spent Christmas eve and made some friends and went on a pub crawl that I very much regretted the next morning. Christmas day we drove 6 hours to Sevilla, and from there took day trips to Cordoba, Granada, and Ronda. We had a great time. Spain is so different from the rest of Europe and I love it. The history is so interesting, 700 years of Islamic rule, Spanish Inquisition, and now a fun, social, laid back culture with great food. 
     Because Spain should technically, geographically be in a time zone behind the rest of Europe, but it's not, everything there happens later. You can't even eat dinner until 8pm because that's when restaurants open. Our tour guide in Sevilla referred to 12 noon as the morning, and 7pm as the afternoon. 
     They don't do much celebrating on dec 24th or 25th in Spain. The gift giving day is January 6th. So the week between xmas and new years is huge sales and people flocking to the stores to buy stuff. They also don't have Santa in Spain. Gifts come from family, not a fat guy with a beard and reindeer. 
     New Years Eve we were supposed to fly back to Geneva, with a layover in Lisbon, Portugal. We would have probably been on the train home from the Geneva airport when the clock struck midnight. We don't really care about NYE, its too overrated, so we didn't care.
     But our first flight to Lisbon was delayed and we realized it would cause us to miss our connection to Geneva. We spoke to the airlines and they said they realized this and it would be taken care of when we got to Lisbon. We landed in Lisbon and staff were waiting to take those people missing connections to a bus. The bus took us to a 4 star Marriott where we were served a free buffet meal. We took a sardine-packed subway downtown to where I read there'd be stuff going on. Got there at 11:45 and ended up having a great view for some awesome fireworks. We paid not one single dollar from the time we landed till we left the next morning. Great way to start 2017!

I met up with one of my best friends in Belgium one weekend and spend a saturday with her and her bf in Bruges. Adorable town, by the way. Sunday we met up with one of Adam's friends who lives in Antwerp, Belgium and he took us to the Red Star Line Museum. This is the opposite of Ellis Island, it was one of the main ports where everyone immigrating to the US at the turn of the 1900s left from. Soooo cool! So interesting. Especially since my entire family came to the US during this time. I stood there reading every little thing in every exhibit and eventually was so behind I couldn't find Adam. At the end was a room all about anti-immigrant sentiments in the US at the time, against the thousands of Germans, Poles, Russians, Italians etc, that were coming over. There were political cartoons that you could literally put into a newspaper today and not know they were 100 years old. It was exactly the same issues. It was very interesting and insightful to see. History repeats itself, we should learn from it. In the words of Forrest Gump, and that's all I have to say about that....

Adam's friend also told us a funny story about Belgian/Dutch last names. When Napoleon ruled there, people didn't have last names, didn't need them. so Napoleon made a law forcing everyone to have a last name. Most people gave themselves last names that were practical, if they lived on a hill, their last name was Hill (in dutch of course). If they were nice people, their last name was "good neighbor". His friend's wife's last name is "dogs" maybe her family were dog lovers. Some people with a sense of humor didn't take this law seriously and thought it was just a temporary thing, and for generations their family's last name has been "amazing orgasm." Luckily, Belgian government allows people with ridiculous names like this the ability to change them. 

I also learned at a bar in Bruges that you shouldn't serve a beer unless it has a matching glass for it. If not, the bartender will apologize. I've noticed in France in Switzerland too, when I order a beer, its always in the same name glass. 

I've only eaten at McDonald's (or as the french say: MacDoh) twice in my 2 years out here but I've noticed some interesting differences when walking by. Only a McDonald's in Switzerland would serve cheese fries with venison meat. (all swiss restaurants serve deer... and wild boar) And only a McDonald's in France would serve a raclette burger. Once they featured a "Chicago BBQ burger".. Adam and I found this a little strange because I'm quite certain BBQ does not come from Chicago. But the French would never know this, all they see are 2 American words and instantly think its cool. It's funny how they change their menu for the culture they are in. In India, McDonald's only had chicken and veggie burgers, of course with curry and all sorts of flavors. McDonald's here are also very nice, clean, and have a separate cafe with coffee and pastries. McDonald's in Switzerland is crazy expensive. Dollar menu? yeah right! A big mac is $11. A happy meal is $7. 

so my french teacher also teaches me a lot about swiss culture and other things about how to live in Switzerland. She told me that the mountains are full of bunkers for emergency situations if the entire population needed to hide out in some crazy nuclear war situation or something. Her husband went to one during his military service. They have ones with food, supplies, makeshift hospitals, everything you could need. It reminds me of District 13 in the Hunger Games
I've also heard the borders are lined with explosives to shut the country off from said crazy situation, but I'm not so sure that's true, nobody has been able to confirm that one.

Switzerland may be neutral but they have a very strong, very wealthy military. A military that, I've heard, you don't want to mess with. And every Swiss man has to do a certain amount of required military service. 

Switzerland is a very rich country today but this wasn't always so. Switzerland was a little country of mountains, cows, and farmers. Then came WWI and WWII. They were neutral. While the rest of Europe was spending money on their military and then afterwards spending money on rebuilding their country that had been bombed to smithereens (like France and Germany) Switzerland never spent a dime doing those things. The Swiss are known as good watch makers, thus good at making precise tools that the military could use. They sold military devices and machinery to both sides during WW2 and made a fortune. And voila! Now you have a country where a big mac costs $11

But I do like it here....