Young, Cancer, Abroad
November 13, 2013 11:49 AM   Subscribe

Asking for a friend: my good friend has just been diagnosed with endometrial cancer. She is in Europe and not returning home for treatment, and I'm trying to help her figure out her funding options and provide emotional support. Tips wanted/needed please.

My good friend has another, very close, friend, let’s call her Mary, who is an au pair in Europe. She was recently diagnosed with endometrial cancer, and will not be returning home (the US) for treatment. Instead, she’ll stay in Germany. She is 21.

To me, this seems like it could be a mistake. I’m worried about a language barrier, and also that she’s going to be alone in Germany. I also don’t know what to say to her. I’m trying to get together the money to go visit her (from the United States).

She’s said that her options are a hysterectomy or radiation therapy, and after that hormone therapy, and if that doesn’t work, chemo. I don’t think she has enough money to freeze her eggs.

These are my questions:
1.) if you were in this situation, would you have wanted a close friend to come visit you? She isn’t completely alone in Germany, but she has no family with her (and doesn’t want to have family with her).
2.) could someone explain some additional funding options for her? I don’t think she has insurance. If she did though, don’t they sometimes cover egg freezing in these situations? If she doesn’t, could someone explain how she would get covered now, under the new healthcare laws?
3.) if you were in this situation, what would you want to have said to you? What sort of care packages would you have wanted?

I think the funding options question is the most important, but any tips—from other people’s experiences, to what to say, etc—would be great. I’ll check back periodically to make sure no one has any additional questions/needs any additional answers, but other than that I’ll try not to threadsit too much.
posted by obviousresistance to Health & Fitness (11 answers total)
Is your friend going to spend her own money for treatment.

Germany's health system is similar to our Obamacare in that all people must participate by signing up with a provider.

If she's in the country, working illegally, then she may not have a choice, she may have to return home for treatment.

Are you asking her questions, or are you asking YOURS?

Here is the information regarding funding for healthcare in Germany.
posted by Ruthless Bunny at 11:58 AM on November 13, 2013 [1 favorite]

Response by poster: From the friend:

"Thanks for the link. These are a combination of her questions [Mary's] (the funding) and mine [the friend of obviousresistance] (the funding and the emotional support). I don't know if she has signed up for a provider yet. Mary is in the country, and working, legally. I'm not super sure what you mean by "her own money." She will not be using her parents money or anything from an HSA if that is what you mean."

If there are any other really important things we forgot to put in this I'll throw it in, otherwise stepping away now.
posted by obviousresistance at 12:07 PM on November 13, 2013

What stage is the cancer? NCI lists more options for treatment than your friend mentions. If she does have surgery there, someone should be with her, as recovery takes some time and can be emotional, especially if uterus and/or ovaries are removed--big hormonal change.
posted by Riverine at 12:08 PM on November 13, 2013

Her own money as in "I have a private trust fund".

If she's in the country working leagally, she should be signed up for healthcare under the Germany system, and she should know if she did that. In which case she can speak to her insurance company to understand what's covered.

Or, she can go to a provider and sign up now.

What have her doctors told her about down time? What is her employer willing to do for her to accomodate leave?

There are a lot of questions that need to be answered before your friend decides how to handle this.

The best solution may be to return to the US and apply for SSI care and benefits. What kind of visa is she on in Germany? Some of those Au Pair deals are pretty gray market.
posted by Ruthless Bunny at 12:13 PM on November 13, 2013 [1 favorite]

Best answer: She should definitely check out the forums at Toytown Germany if she is interested in meeting other English speakers in her area (if feeling lonely) or just getting Germany-related info from other expats. There are several threads regarding cancer treatment (use the search function in the top right).

Assuming her employment situation is legal/on the books, she is probably way better off financially to stay in Germany rather than return to the US. If she is working for a German family as an official au pair, they are generally required to fund her health insurance (there is a health insurance mandate for all residents of Germany). If for some reason she is both (a) legally in the country and (b) somehow exempt from the health insurance mandate, the out of pocket costs will still be cheaper than uninsured costs in the US. Whether her insurnace, if she has it, will cover the cost of freezing eggs will depend on the company she's with (there are public and private companies and many different policies). However, German policies (esp. from public krankenkasse) tend to be much more inclusive than the US health insurance policies we're used to.

This is the au pair page from the federal employment agency (use google translate).

She should speak to her host family and her agency ASAP. Her treatment may make her unable to work for a period of time and I'm not sure how that effects her contract (or if there is some kind of disability provision).
posted by melissasaurus at 12:14 PM on November 13, 2013 [1 favorite]

Best answer: Health insurance is an immigration requirement in Germany, your friend won't have passed through the immigration paperwork process without it. Personally, I found signing up for health insurance to be such a painless process that I kind of can't believe it all worked properly, and I can totally see it getting lost or forgotten amongst all the other paperwork that moving to Germany requires. As an AuPair her host family should be paying for it so they're the first people to talk to. Then when she knows which company and policy type etc, contact them to find out what's covered. The big companies at least have English speaking professionals you can talk to so she should look into that. Health insurance in Germany is very good, think of it more as a comprehensive health care system than insurance like you get in the US, so she shouldn't be left worrying about paying for anything, That's one of the main benefits to moving to Germany in the first place.

And if somehow she managed to get this far without health insurance then she should just sign up with TK by filling in this form and emailing it back to them. Mine was processed in less than a week. Then look at her immigration paperwork to make sure she really is legal because that's not supposed to happen.

There are lots of English speaking doctors in Germany and the oncology care is as good as anywhere else in the Western world. Standard of care isn't something she needs to worry about (any more than the US anyway). I'm a non-clinical oncology researcher in Germany and we do everything in English in the lab, and often at meetings etc too which clinicians attend. If she does have trouble understanding things then maybe reaching out to an oncology research department working in English would be a way to find someone to translate, given they'll be used to speaking English in a relevant scientific setting. I wouldn't be surprised if hospitals have a similar service available.

Being away from family and in another culture in general is a different problem and I don't know how much that will affect her. Having a friend visit for even some of the process is probably a good thing.
posted by shelleycat at 1:01 PM on November 13, 2013 [3 favorites]

If she has health insurance in Germany she'd be out of her mind to come home. Please don't encourage her to do that because of your fears, it would be a huge mistake. Having cancer in the US and no insurance is a terrible, bad no good situation.

Your friend is going to lose her fertility and possibly her life, she needs moral support, cheering up and a shoulder to cry on. Probably visitors. If she needs financial or other advice it should be unbiased. Offer her that and try to hide your own fears and wants here.
posted by fshgrl at 2:08 PM on November 13, 2013

Absolutely, if she's insured in Germany, then she needs to stay and get treatment there. No question.

My concerns were if she was NOT currently insured, or in the country illegally.

There are a lot of American Bases in Germany, so check out Ex-Pat or US military support groups.

I suppose she must have insurance, or else how would she have received this diagnosis in the first place?

I'm sending good thoughts across the atlantic.
posted by Ruthless Bunny at 2:11 PM on November 13, 2013

Response by poster: Update from friend:

"Thank you so much! I've forwarded her this thread. I'm glad to know she's made the right choice to stay in Germany, since she is there completely legally. I'm trying to figure out how to visit her right now.

It's still stage 1 cancer, and she's very optimistic. Again, thank you!"
posted by obviousresistance at 5:06 PM on November 13, 2013

3.) Don't tell her she can adopt, don't try to find silver linings, just listen. Listening, and not trying to come up with "solutions," is the best thing you can do.

As far as care packages: nice tea, hand lotion, candles, a soft blanket, magazines, nail polish, relaxing music...
posted by baltimoregirl at 7:07 PM on November 14, 2013

If you can, go see her. I am currently going through chemo in the city where I live, which is not the city where my family is. Although my best friend lives here too and I have a strong and devoted community helping me through this, I have felt my best when my siblings and parents have come to see me. There is something about access to the people you don't see all the time that is immensely comforting, even if you are just napping on the couch a lot and waking up to see them sitting there, smiling at you.

This would be especially important if she doesn't have a strong community where she is right now - not sure how much time she has had to develop a support network in Germany, but cancer treatment is a tough and lonely road to travel alone. Also, she should make sure to include a therapist in her treatment team. It's the part of cancer treatment that sometimes gets pushed under the rug, but makes the most difference, in my experience.

Regarding the treatment plan she laid out, has she had a second opinion? Not sure if German insurance will cover that but if it does, it's always a good idea.

Care packages are always great. I set up an Amazon wish list at my friends' insistence and it's been a lovely way for out-of-towners to feel connected to and take care of me during this time, but you can just send her random gifts and cards - anything to remind her that you're out there thinking about her.

Good juju to her and all of you who care about her.
posted by deliciae at 4:46 PM on December 5, 2013

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