Belgium, Europe in a nutshell
Belgium is a small, highly developed and densely populated
country (11,730 square miles, 10,3 million inhabitants) at the crossroads
of Western Europe, with borders on the North Sea, France, Germany, Luxembourg
and the Netherlands.
Belgium is one of the founding members of the European
Community, and its capital, Brussels, is also the capital of the European
Union. The country became independent in 1830 and has a parliamentary
democracy under a constitutional monarch. It is a federal state, with
3 relatively autonomous regions: Flanders in the north, Wallonia in
the south and Brussels in the centre. The federal government retains
responsibility for foreign policy, defence, income tax and social security.
Sixty percent of Belgians speak Dutch (or Flemish), less
than 40 % speak French and a small minority speaks German. However,
most Belgians are multilingual. Belgium is Europe in a nutshell, multicultural
and multilingual. Belgium's history has always been linked to both commercial
and cultural exchange and much of its character is due to its role as
the meeting place of Western Europe. The country has retained its old-world
charm in the preservation of its ancient buildings and historical traditions.
The countryside is marked by flat coastal plains in the northwest (with
66 km of sandy –though often cold! -beaches), rolling hills in
the centre and rugged mountains and the Ardennes Forest in the south.
Tourists are said to only remember Belgium as “the
little country they passed through”. But once they take the time
to discover our rich cultural heritage of architecture, paintings, tapestries,
sculptures and our cuisine, they often declare it “the best kept
secret in Europe”. Visiting medieval cities, quaint little towns,
gothic cathedrals, rich museums, town halls, castles and carillons will
keep you busy for days. While there are obviously more places to visit
than Bruges and Brussels, these are the best two “first bites”
of Belgium. Brussels is one of Europe's great cities, well known for
its magnificent main square surrounded by gabled guild houses. Bruges
is a wonderfully preserved medieval town. But maybe you’ll decide
to spend most of your time in our pubs, where you can choose from a
selection of 400 different local beers, or our world famous chocolate
shops or our restaurants, with a reputation for gourmet food that makes
the French jealous!
According to international surveys, Belgium has one of
the highest quality of life standards in the world, as testified by
its excellent food, housing, health care, education and infrastructure;
and its high productivity, low poverty and the appreciation of foreigners
residing in Belgium. Life expectancy is 78.6 years (82 for females),
the birth rate is 10.5/1000 and the infant mortality rate is 4.7/1000.
The modern private enterprise economy in Belgium has
capitalized on its central geographic location, highly developed transport
network and diversified industrial and commercial base. Most Belgians
work in services (73%) or industry (25%) and only 2% are active in agriculture.
Industry is mainly concentrated in the populous Flemish area in the
north. A major and still growing problem is the high unemployment rate
of 12%. In addition there is intense pressure on the environment from
human activities due to urbanization, the dense transportation network,
industry and intensive animal breeding and crop cultivation.
Cystic Fibrosis in Belgium
There are about 900 known CF patients in Belgium. Nearly
50 % are 18 years and older¹.
There is no national neonatal screening programme yet, but several clinics
do IRT-tests on newborn babies. Still, the median age at diagnosis is
less than 8 months and 80 % of the patients are diagnosed before the
age of 3. The CF diagnosis is most commonly suggested by persistent
respiratory symptoms (37%), chronic diarrhoea & malabsorption (26%),
failure to thrive (24%), neonatal screening (15%) and meconium ileus
(14%)². The most frequent mutations in the Belgian CF population
are Δ F508
(71.4%), G542X (2.9%) and N1303K (2.5%).² In Belgium CF is known
as “mucoviscidose”.
High level CF care
The majority of patients are followed up in one of the
7 accredited CF centres. Since 1999, hospitals that can guarantee high
level of care, are able to obtain financial support from the National
Health Service for each CF patient registered in their clinic. High
standard of CF care is defined as one having optimal service provision
in terms of routine evaluation, monitoring and treatment necessary to
obtain the best possible outcomes for CF patients. To be accredited,
a CF centre has to offer frequent clinical evaluations (at least 4 visits
a year) and monitoring for complications by a specialised multidisciplinary
CF team consisting of CF specialist, nurse, physiotherapist, dietician/nutritionist,
social worker, psychologist and microbiology specialist. The minimal
CF population required for such a team is 50, but most CF centres follow
up more than 100 patients. All centres have some sort of segregation
policy to limit the risk of cross infection.
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Belgium
is one of the leading countries in CF physiotherapy
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Belgium is one of the leading countries in CF physiotherapy,
with a very active national CF Physiotherapy Group, headed by Jean
Chevaillier, who is well known for his development and refinement of
airway clearance techniques, such as the very efficient autogenic drainage
method. Most patients have access to a specialised CF
therapist in or nearby their hometown, with an average of 3 to 5 therapy
sessions a week.
Patients needing a more intensive treatment or education programme can
go to one of our two national CF rehabilitation centres. The Zeepreventorium
in De Haan at the Flemish coast welcomes patients from all over Europe.
A retrospective survey of all CF lung transplant recipients showed that
from 1988 up to 2004, 100 CF patients received a lung transplant in
Belgium. Actuarial survival data compare favourably to survival data
reported by the Registry of the International Society for Heart and
Lung Transplantation. Relevant lung function parameters in transplant
patients are excellent. Actuarial survival was 91, 82, 67, 59, 47 and
25 % at respectively 3 months, 1, 3, 5, 7 and 10 years. In January 2004,
fifty seven CF lung transplant recipients were alive after a median
of 36 months (range 1-150) following surgery. The mean forced vital
capacity is 83 (±SD 19) % predicted and the mean forced expiratory volume
in 1 second is 83 (± 23) % predicted.³
Although Belgium has one of the best social security systems
in the world, CF is still an expensive disease for patients and families.
The health system is quite complicated and not always adapted to complex
multi-organ diseases such as CF. To prevent over consumption of medical
care, a system of ‘break-money’ was introduced in Belgium.
This means that for the majority of treatments, patients have to pay
a small portion themselves. Since CF patients need a lot
of different treatments and medication, those ‘small portions‘
can add up to important sums. Some essential medication
is free for CF patients, such as enzymes, vitamins (only since the end
2004), certain antibiotics, e.g. Tobi, and DNase. A new nebuliser can
be obtained free of charge every 5 years, but patients have to pay for
spare parts and repair. For other treatments CF patients have to pay
‘break-money’, e.g. for tube feeding, physiotherapy, some
antibiotics, hospital and doctor’s visits. Other treatments have
to be paid for fully by the patient, such as high energy drinks and
physiotherapy equipment, e.g. flutter and PEP systems. Last year our
association spent 250.000 € to finance expensive treatments or
assist patients when the CF care weighs too heavily on the family budget.
The Belgian CF association helps CF patients and
families in all fields of life
In 2006 our association celebrates its 40th anniversary.
Our main goal is to improve the quality of life of all CF patients and
families in Belgium. More than 90% of the CF patients and their families
are member of our association. We work closely together with all the
CF centres, specialists, allied health care workers and of course, the
patients and families. This close collaboration is one of the main strengths
of our association.
Twelve staff members offer a wide array of services to the CF families,
such as information, psychological support, family meetings, free rental
of medical equipment, low cost home delivery of special nutrition products,
hospital visits, financial aid and legal and social support. We lobby
with public authorities to gain better reimbursement and access to optimal
care and social services. Our principle is that every CF patient in
Belgium should have access to optimal care and we help them to obtain
this by providing proper information, advocacy and if needed, practical
and financial assistance.
To enable patients and families to exchange experiences
and ideas without running the risk of cross infection, we created internet
groups for CF parents, kids and adults.
Besides supporting families and patients, raising awareness
is one of our main goals. Each year we organise a national CF day, to
inform the public about the disease, to raise awareness and solidarity
and dismantle all forms of discrimination. We try to obtain this by
organising a national event (with celebrities) and contacting national
and regional press, who bring life stories of CF patients and families.
On average, CF patients and our association are covered about 200 times
a year in one or other medium.
We offer financial support to CF centres to enable them
to provide optimal multidisciplinary and patient-friendly care and we
finance the participation of CF team members to scientific conferences.
We organise an annual national meeting of CF centres, with international
speakers and workshops, and regular platforms for all disciplines of
the CF team, where they have the opportunity to exchange experiences
and work towards a consensus.
Last but not least our association finances clinical research projects
and the Belgian CF registry.
We are very lucky to have a large group of people collecting
and donating money to our association to enable us to realise these
activities. Unfortunately we don’t receive any government funding.
We depend solely on private donations (via mailings), solidarity actions
(e.g. sport events, sponsored walks, concerts, school events), some
sponsoring from industry and the sale of Christmas cards and - Belgian
chocolates!
We would be very glad to share our experiences with other
countries. For further information please contact the Belgian
CF Association, karleen @ muco.be,
or our web page: www.muco.be
Did you know that…
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Brussels Market Square |
• Julius Caesar described
the Belgians as “the bravest of all the people inhabiting Gaul”
• The ‘most famous Belgian’
is “Manneken Pis”, a little boy… peeing (a sculpture
found near the Brussels market Square), besides other celebrities of
course, such as Mercator, Vesalius, Van Eyck, Bruegel, Rubens, Memling,
Ensor, Magritte, Horta, Father Damien, Hercule Poirot, Simenon (Maigret),
Adolphe Sax, Eddy Merckx and last but not least, Solvay
• In 2004, two Belgian tennis players, Justine Henin and
Kim Clijsters, were number 1 in the world ranking
• ‘French fries’ originate from Belgium and
Belgians dip their ‘frites’ in mayonnaise
• Belgium is one of the only places to be recognised from
the moon (besides the Chinese wall), because of its well-lit dense road
system
• Antwerp, one of the main Belgian cities is the capital
of the world diamond trade
• Belgium has the biggest “solar system” in
the world, on a scale of 1/40 million, called Space for CF. The Belgian
CF Association has placed 11 art works of the sun, the earth and the
planets all over Belgium to represent the different aspects of life
with CF; Mars for example, represents the fight against the disease,
Venus the love of people taking care of CF patients and Saturn, God
of agriculture, the nutrition problems.
¹ database Belgian CF Association, June 2005
² data from the Belgian CF Registry BMR-RBM, 2002
³ abstract 21.01.2004 ‘Encouraging results of lung transplantation
for CF in Belgium’, C. Knoop e.a.
Editors Note: For more information about Belgium,
please visit:
http://www.visitbelgium.com/
