drmanishbhattarai

Mid August, I was in Australia to visit my fiancé and was abruptly called to visit the German embassy here in Kathmandu. I booked tickets the next day and arrived but hey that’s another story.

Upon my arrival on the 29th of Sep 2018, a move that I had been working on for a couple of years owing to the fact that learning the German language was needed to tick the very first box of requirements to pursue a career in Medicine in Germany.

My very first move, a train ride from Dusseldorf to Osnabruck was a mishap, I boarded the wrong train, travelled on it for a good 2 hours before realising that I was moving in the wrong direction. --- -Phew.

My initial days were spent waiting for a work permit, during which I was not allowed to work and therefore not paid. During this time Hon. Prof. Dr. med. Dieter Lüttje, yes that’s what was written outside his door, head of the department had agreed to support me with 1000 Euros per month which was roughly what I needed to sustain myself.

Initially I felt a little amused, because I was free to visit anywhere and was given no work,
the only instructions I was handed out were, Ask Questions. Everyone smiled at me and life was good.
After a few days when the amusement sank in and reality crept in is when I started drawing parallels with the health system to which I was accustomed to and that’s where I wish to take you all.

After a few days I began to meander into deeper questions like how the system worked and there I stumbled across a few other questions.

As a junior doctor and just like other juniors, I, dreaded making diagnoses, firstly, because of the complexity of it and secondly this was Germany. A few days later I realised that everyone was already diagnosed when they were at the hospital(Krankenhaus).

Part of my job initially, was to take patient history and inside this file was a sheet with everything that I required, but mainly the diagnosis. I knew beforehand the condition the patient had. Led me to ask who the good samaritan was,who did this tidy work? Where do patients come from? Where is the OPD(outpatient dept). I later realised that each patient has a GP and it is this GP that was the first line of contact. The OPD- system is bypassed, so when people stop paying the doctors for OPD visits then the whole system is flipped on its head. Why don't we do that in Nepal was an obvious query.

I soon began to accompany the Prof. with his rounds and with each passing day I felt I gained a little more of his as well as my confidence.

My Prof. was a seasoned practitioner in 60’s and always carried a smile . He made it a point to have breakfast with the whole team in the mornings and bought breakfast. Most importantly, he was our first line of defence.*

Days passed by and I encountered patients, my german got better, slangs began to make sense.

Most inmates at the hospital were largely alone, No 'Kuruwas' (attendants), in fact the children only came to know when the hospital informed them about it.

Months passed by and things began to normalise, the daily calls back home and phone topics like what I ate and what I did at the hospital turned scarce.

One of the most striking features and contrary to what I was accustomed to was the way the hospital ran. All the work from feeding, washing, medication, was done by the hospital.

I was informed that to make it simpler, the whole system is same in all of Germany, in all the hospitals. The shape of the ward, where the mobile charger are placed, the bathrooms, the computer programmes, the app used to treat and dosage was uniform throughout the land. This made sense as unlike in Nepal, Germany had a system whereas anyone could come in and the level of care and the treatment would be the same. This lead me to another very important difference between how docs work in Deutschland(Germany) and here in Nepal.

Different World - Tho whole system is a light years away from what we have here, while we in Nepal are struggling for primary health, people in Germany are gifted with a GP each, the GP is the 1st point of contact and decides when and where people go for treatment.

Depth of Care: The system even caters to the daily needs of these elderly. You have people who can’t cook, wash or carry out regular hour chores and for such people there are specialized services whereby people ‘pflegedienst’(nurses) come in depending on the needs of the person,usualy elderly. Once, twice, thrice, four times a day everyday to cater to these people.
The ward even had a social worker who arranged these social errands for the needy. To such depth ran the system, that there was once a staff who taught the elderly, on how many pieces and what sized pieces to cut a ‘bratwurst’(sausage) so as to be the most energy efficient.

So in a way the govt. looks at the person from all angles. Diseased go the hospitals, the crippled to the rehabs, and those who can’t live alone go to the old age homes. Astounding, is the number of people who live in these old age “alter heim/pflegeheim” despite the fact that they are married have children or even wives for that matter who can care for them.

There are sad parts to this well drilled engine as well. Because of the fact that most of the people are independent and mostly decide how they want to live, they take work very seriously and are very good with time management. Even when someone is sick and in the hospital and have their daughters/ sons come visit them once a week for merely an hour, these patients are so happy and I have sometimes seen then dress up and put on make up to look pretty while they come. Chances are that, they only see their kids once a year or maybe haven’t seen them for years. I have sometimes during the early morning round seen first hand of how happy they are because someone is coming to visit them today or during the weekend.

Another strong difference and something that I really appreciated is how females choose to own their own identity , even words, nouns are variable eg. arzt-doctor, arztin -female doc, pflege- male nurse ,pflegerin- female nurse and the list is endless.

From short hair, jeans worn by most women/girls looks like they are built to be fast, efficient and may be better than their male counterparts.

They are very vocal and unusually loud, sit with a confident demeanour and you cannot difference between a male or a female.

Lastly, they are used to such high standards that I want to recall an event

-- It’s interesting how they say he(a 92 years old patient)was reanimated 2 months ago without a pause to acknowledge it, as if it's that easy to do that. reanimated means revive

I was stationed in the Geriatric ward. A few notes I wrote in the initial days.

: The amount of patients that receive dialysis and have end stage kidney disease is staggering.

: Fractures that may have something with sunlight vitamin D(prob due to low sun

light exposure)

: Doctors smoke openly, sisters, health care professionals , without an iota of shame, smoke openly under the hospital. What is comic is that sometimes even patients are seen about smoking, some come with intravenous (cannulas inserted inside your vien) drips hanging and some come with wheel chairs. Thank god I haven’t seen anyone with the whole bed asking to be taken to the smoking area

: The amount of respect patients have for doctors is enormous

:Coffee eatable water for tea or candy is readily available at the front desk coffee didn’t taste the best but its good.

: what also stands out is number of people of people the hospital has been able to retain. 60 year olds, 65 and they say they have been working here for the last 30 years. The dedication and ethic over the years has remained as strong as ever.

: The Deutschen(Germans) make it a point to greet each one with a guten tag(good-morning), hallo, morgen(morning), while walking through the corridor. This would /could be good in the morning but when you are tired towards the evening and then to greet every person at 4 pm could be quiet tiresome and sometimes irritating.

*for those who are not accustomed to the medical world, here everyone tries to bring you down, grossly evident during cross speciality meetings and seminars, which almost felt like war-zones, where it’s common to denigrate a fellow medico and to use this to climb a rung higher.