Wednesday, 9 March 2022

Hollandse Hokjesgeest

I spent last night in bed crying because I had been dumped. No, not by my husband. Not even by a mysterious lover. I had been dumped by my rheumatologist. He said, in his very direct Dutch way, that though he acknowledges my problems are caused by the exact disease he specialises in, he cannot help me. He then spoke those memorable words that must be hammered so deep into every Dutch doctor it sometimes seems all they can say: go home and take a paracetamol.

He was my third rheumatologist since we moved here (I know, less than 2 years ago) and my frustration mounts with every time I encounter that what bothers me most about the Netherlands: hokjesgeest. How to translate hokjesgeest? Geest means spirit and a hokje is a small cage or cubicle - it suffices to say it embodies the exact opposite of thinking out of the box.

Hokjesgeest is what made us flee Dutch education, where at a very young age children are tested, labeled, and pigeonholed accordingly. It also reigns supreme in Dutch medicine, where doctors can’t help any patient without a proper label. A label you only get if you pass a stringent checklist. I spent a frustrated decade in the Dutch medical mill, until I moved to the UK and swiftly got diagnosed by a British rheumatologist that admitted my condition wasn’t ‘classic Ankylosing Spondylitis’ (AS) but who also said ‘auto immune diseases are very complex, and we don’t understand them completely. Your SI joints are inflamed at the moment which matches best with AS.’ The look of confusion on my Dutch doctors’ faces when the Brit uses the terms AS and RA (Rheumatoid Arthritis) alternately in his reports says it all.

The Dutch doctors with their checklists, procedures and labels make me long for the more lackadaisical British, as well as the pill pushers of Singapore. I have to admit that doctors in Asia have a tendency to overmedicate, but this quote from my Singapore doctor resonates with me still: ‘We like to also help less extreme cases with advanced medication. This will not only improve the patient’s quality of life, but also stops the disease from escalating until it is too late.’

Let me stress my Dutch doctors were not bad people. They were friendly, smart and knowledgeable people. Mostly. The first Dutch rheumatologist said my sicca symptoms (dry eyes, mouth and well, dry everything) were not a part of AS, though she admitted they were common with RA. But I did not have that, I had AS. Hence could not have sicca symptoms. When I disagreed, quoting medical research, she replied: ‘Everything you read online is not true.’ For the record, I had not been reading quacksunited.com, the website I consulted was from the national rheumatoid association.

The second Dutch doctor measured and confirmed the sicca symptoms, then uttered this confounding line: ‘If you look online you will find that in many countries, doctors would suggest you have Sjogren Syndrome, but in the Netherlands we have a stricter definition and I can’t diagnose you with it.’ He was a Sjogren specialist, and that was it for him.

The third one, an AS specialist, made me feel optimistic when he said that sicca symptoms were common in AS patients. But down the line, he ended up being the one dumping me.

When I asked him to prescribe the medication that helped me in the past, he told me no. I did not comply with the checklist for it, he would never get the paperwork approved. When I asked him, just to satisfy my curiosity, to put bureaucracy aside, and tell me if he personally felt the medication could help, he got very uncomfortable. He said he did not have enough experience to answer that question because ‘we don’t do that here in the Netherlands.’ This is one of those conversations where afterwards I had a lot of retorts. ‘But you gain experience only by doing!’ and ‘Don’t you read international journals or talk to fellow doctors abroad?’

At my last consult he said: ‘The rheumatoid diseases that we treat are like the tip of the iceberg. There is a whole lot of them under the sea that we don’t see.’ There was no room for me on his lifeboat. He sent me back to the GP to see if another doctor can figure out what can be done against the pain that he agrees is most likely caused by a disease he specialises in.

The one health care professional that I feel understands my body, that helps me, is my physiotherapist. He does not look at scans, nor blood tests. He looks at me. He feels. Unlike my last rheumatologist, who I only saw in person once (consults are done over the phone these days), he sees me every two weeks. He listens to me and his advice is always spot on.

Pondering my medical journey, I have one final fun quote for you. The medal for the most hilarious thing a Dutch doctor said to me goes to an interim huisarts (GP) I saw in the early onset of my disease, who spoke the unforgettable words: ‘Why don’t you come back when you feel better.’ I’ve never been more speechless. She did not even mention paracetamol.

Thursday, 20 January 2022

Indonesian soul food


January is a tough month in Northern Europe in the best of circumstances. Days are short, December festivities are over, and spring is not yet on the horizon. It is cold and dark. Dutch weather reports however remain unapologetically optimistic. It will be a beautiful sunny day tomorrow. Most of the country won’t get to see the sun, it will be veiled by thick fog, but some of you may get lucky!

We get our vitamin D from tablets and a sunshine lamp I purchased online. And to top off all the fun, we are in a lockdown. Blue Monday this year stretches into a long, blue month…

Unsurprisingly, the kids scream for soul food, to be precise: chicken soup. So I defy my resolution for a vegan January and succumb. What we need is Soto Ayam Indah!

The bright yellow turmeric used in this hot chicken soup should lift our hearts out of the blue. To my shock, I realised I never posted the recipe here. An omission that ought to be remedied fast, so you can all enjoy its super powers. Indah means beautiful in Indonesian, and that is what this soup is. It is also the name of the woman who worked for us in Singapore and whose cooking was famous amongst all our friends, the woman who spend many a night perfecting her recipes to get the flavours exactly right. We miss her just like we miss her soup and the sunshine.

Quantities are never specific in Indah's (or my) recipes. This is because spices vary in quantity and strength, so tasting as well as gut feeling is required. I prefer to err on the side of too much spice, feel free to adapt the recipe to your own taste.

Soto Ayam Indah

For the stock:

1 whole chicken, washed and roughly chopped in pieces

2 salam leafs

2 kaffir lime leaf

2 stalks serai (lemongrass)

3 cm lenguas root (galangal)

1 celery stalk

1 green onion stalk 



Coarsely chop the spices. Put all ingredients in a large stockpot and cover with water. Add salt to taste and bring to boil. Cover and let simmer for about an hour.

While the chicken stock boils, you can make the spice mixtures, the rempah and sambal, as well as prepare the other accompaniments thar are essential to this dish. Rempah and sambal are both spice pastes, the main difference being is that rempah is used in cooking where sambal is served on the table for everyone to add on the plate. 


For the rempah: 

6 kerimi nuts (candlenuts) 

2 cloves of garlic

handful small shallots

5 cm fresh turmeric

1 ts white pepper

1ts nutmeg

In Asia shallots are tiny and you can use a small handful. In Europe they tend to be bigger and 1-3 would suffice. Grind all the ingredients together (you can add some oil or water if your blender needs that) and fry the paste in a little oil until it smells fragrant, just a few minutes. Set it aside for adding to the soup later. If you want to go old school, use a grinding stone, some say it improves flavour.

For the sambal:

1-2 tomatoes

2-8 red chilis

5 shallots

2 cloves of garlic

Chop all coarsely and boil together for a few minutes until soft. You can vary the amount of chili and tomato based on how spicy you like your sambal. Then grind or blend everything together into a paste. Season with salt. Set aside in a bowl to serve on the side later for those liking some extra heat.

Soto

After the chicken has boiled, take it out of the stock. When it is cooled down a little, pull the meat off the bones. Here I tend to deviate a little from Indah’s recipe, as I like my stock strong-flavoured. I put the bones back in the pot and simmer them a few hours more, creating a fragrant bone broth. You don’t want to boil your chicken meat that long, as it would lose all its flavour. In the meanwhile, as your broth bubbles away, fry the chicken meat in a wok until crispy, let it cool a little, then pull it apart into small pieces and set aside in a bowl.


Indah always serves the soup it straight up, with floating herbs and all, but you can also choose to strain it. Either way, make sure to remove any chicken bones if they are there!


Now add the rempah to the stock, then bring it to the boil again. Add 2 tomatoes sliced into quarters, some stalks of green onion, and chopped local celery leaves. Don’t leave it to boil long now, just heat it thoroughly and serve hot!

Serve the stock with all the toppings, which I like to lay out on the table for everyone to help themselves: boiled beehoon noodles (you can also serve rice on the side instead), crispy fried shallots, boiled (quail) eggs, lime slices, quickly blanched tauge (bean sprouts), blanched Chinese cabbage, more shreddedcelery leave and green onion, the sambal, the shredded chicken, and some kechap manis (sweet Indonesian soy sauce).

Selamat Makan!