A Tale of Three Cities - Report on my Experiences in Germany

This was my fifth year of medical school. But since I had earlier taken a year studying for a degree in anatomy, it was my fourth year in the medical curriculum. Year after year, I have felt more and more inclined towards a career that would see me not just in a hospital, but in a broader arena of addressing medical problems in the society. I was grappling with thoughts on how best to spend my elective term. I wanted a place where I would have clinical experience was well as experience with wider societal health issues. So when I learnt that I was going to attend an interview for such an opportunity, I felt like it was a calling. However, I was curious….nuclear war…I was not sure what to expect especially in a foreign country.

 In my country, few know anything about the intricacies of nuclear energy. In fact, for a developing country like mine, politicians have made promises of introducing nuclear energy alternatives in the near future. They say this to woo the masses and garner votes. No one seems to know of any major hazards associated with it. That is one of the reasons I like to refer to IPPNW more fondly as Physicians for Social Responsibility and Peace. But again not every person who treats patients in the capacity of a doctor is a physician. After several thoughts, I call it Doctors for Social Responsibility and Peace.
When I went to apply for my visa, I was a little demoralized by the treatment most applicants got at the German embassy. There was no privacy during the brief interviews that were conducted over the counter. As much as it was humiliating, I chose to look at the funny side of it. I particularly remember one story of an applicant who wanted to visit a friend she was dating online. For a moment I felt sorry for her, but then I thought, what a daredevil! Visiting someone she had never met and hoping to find a soul mate in a foreign country, miles away from home. There were many rumours in low tones at the embassy that Germany is not an easy destination. 

Until my visit to the embassy, I was uncertain of only what IPPNW was to offer in Germany. After visiting the embassy, I was more uncertain of what Germany as a country was going to offer me. It happened also that I had just sat my final fourth year examinations. I was awaiting the results. It was also a time when I needed to be with my family a lot and provide moral support in the hard financial times they were going through. I was also going to be away from my best friend, Sheila, who is also my girlfriend. For the about three years we had been dating, we had never been apart for two months. Then almost everyone I met implied it was going to be difficult in Germany without a good command of the language.

Berlin
It was on a Wednesday morning when I arrived in Berlin. I was met by host-to-be, a great man called Dieter. When we got out of the airport building, it was suddenly cold. It was then that I realized I was truly in a new country. Then I got into the car. I found myself on the driver’s side…I was no doubt in Germany now!
I had expected Berlin to be a big city with skyscrapers and everything else that defines a modern city. As we drove from the airport, I thought I must have been really far from the main part of the city. None of the buildings was any greater than about six floors.
A few minutes later we got to Dieter’s house.  There I met his wife, Sabine. We had a good breakfast together. The meal was full of variety. Cheese was in plenty, something that is not popular in Kenya. I liked it, except for the strong ones. All in all, I felt set for the country.
Berlin
After meeting Ulla and other IPPNW staff at the Berlin office, I set off to attend the World Health Summit and the European Students’ Congress (ESC). This was at the Charité. We do not hear much about the Charité here in Kenya, and I guess also in the rest of the world. May be what one hears about is once in a while the famous scientists who have discoveries named after them. This is quite a contrast to other institutions, such as American universities, where institutional names are heard louder. From a little background reading I knew that I was in the leading German medical school.
The World Health Summit was a big event. I only got to attend the sessions on public health presented by students. The conference had begun two days before. Nevertheless, I was in time for the ESC. I got registered and put on my badge. The queue at the registration desk was quite slow and poorly organised. I had never expected that. Participants for the year were not too many either. I later understood that there were not as many students as in previous years.
The presentations began the following day. They were remarkable presentations. Mine was two days later. It won the third place amongst poster presentations. Quite impressive and shocking as I had not rated it too highly myself.

Eberswalde           
I worked at the Martin Gropius Krankenhaus in Eberswalde. It was interesting moving from the Western part of Berlin, to the eastern part of Berlin and going further beyond Berlin to Eberswalde. One notes the amount of graffiti on the walls during the train rides. The mood of the people also changes. On the western part people look busy and engrossed in their activities. Whether it is reading books, working on the trains or just listening to music, they looked involved. It was the kind of look that tells you that there is too much to do, and that time is of essence. They were quiet, seemingly thinking about the next step; or more like juggling with what should be the next step out of so many.
On the eastern part, people were also quiet. It was a different kind of quietness though; a more reserved one, like one that would never end. This was not the quietness of being busy, perhaps more of just wanting not to talk. It was uninviting, though interesting to observe. A dark cloud of depression was not invisible on people’s faces. They were Easterners, suffering the long consequences of decades of cold war. I could feel some distant hope, one of a better future for the people of the old Eastern Germany. Things were swiftly changing. The younger ones even showed more enthusiasm. Except for a little difference on the way they dressed, and may be an iota of some ‘don’t care attitude’, they were positive. Oh!…I forgot to mention that they smoked a lot more.
At the hospital, there was a lot for me to learn. Coming from a developing country, the standards at Martin Gropius were impressive. I really liked the efficiency at the hospital. Patients were quickly and effectively attended to. The records were well kept. The documentation was tedious but I think that served the patients well. Most doctors complained that it was too tedious to do the paper work. In my mind I always thought that I have seen the effects of not having good documentation. If I was to take a vote I would vote for more documentation rather than less.
At the hospital I was under Herr Dr. med. Kruger, the chefarzt at the Neurology department. He was really friendly and always made sure that I was learning something. I also worked with other doctors in all levels of the hospital hierarchy. I got to meet Evelyn, the IPPNW link person at that hospital.
The system of medical education is quite different in Germany. I liked the fact that taking a specialization is not a very difficult affair. I am saying it is not difficult because it is so much more difficult in other countries. Kenya is not an exception. In Germany, one does not have to pay fees again to a university medical school and sit exams every so often. In Kenya, one has to pay high fees to a University teaching hospital and more so, the places are very limited. And I mean very limited, quite a paradox for a country that still needs very many doctors. I am talking about a country with about one doctor for every ten thousand people. The other thing I must mention regarding the medical system is the way doctors in specialization training are paid. Even though the payment is not as high as many would want, they are paid and they do not have to pay fees. Who is ever satisfied enough with money anyway? To cut the long story short, I really admired the medical education system.
The medical profession has been likened to the military in some aspects. Interestingly, the two do totally different things. Crudely speaking, while doctors save lives, the military eliminates it. I had experienced the protocol in Kenyan hospitals. I did not expect much of it in Germany. At Eberswalde however, it was quite marked, especially with the older generation of doctors. I particularly remember one case. We were at a doctors’ ward round one morning. I noticed that everyone was hesitant to walk out. So when I found myself closest to the door, I just opened it and led the others out. Well, that is how we do it in Kenyan hospitals. One of the junior doctors whispered to me, “the chief has to walk out first, and then the others follow in a hierarchical order.”
 
Hamburg, the harbour city    
My Hamburg experience was unique in every way.  As soon as I got out of the train at Altona, where I arrived, I had to take my umbrella out. I had hardly needed it before. Thereafter, I used the umbrella on a daily basis.
Here, I lived with students. I had gotten used to living within a family setting, and felt like one of the family. With the students it was a bit different. It felt more like we were just flat mates and friends. Like we were all there for mission, struggling for some defined purposes in life. It was very dynamic. Nothing was predictable. It was also fast. At one point we could be making dinner, and then while making the dinner, think of going out to party. It was spontaneous. And when we were all tired, we could draw back to our different ways of relaxation, until we felt like emerging back for common things.
I worked with Caritas International while in Hamburg. It is an organisation that takes care of homeless and paperless people in Germany. I got to know most of the people working in the Hamburg office. The head was a lady called Doris. She had a very friendly personality. Most of the other people were young, some doing voluntary service. They had taken this as an alternative to joining the army. That I think is the better option.
While at Caritas, I was involved in providing medical care to homeless and paperless people. This was both within the organisation premises and also on the streets, the Mobil Hilfe. I also joined dentists on the Zahn Mobil, a mobile dental service. In the streets, I had expected to find very arrogant and rowdy people. I did not expect them to show any appreciation. In the contrary, they really appreciated the little help we were able to give them. I say little because having been worked in German hospitals, there was a lot more we would have wanted to do for them. Our resources were however limited. Most were alcoholics or even taking some other types of drugs, judging from their behavior. I noted they really bad dental health. They always asked for toothpaste and toothbrushes from us as they could not afford it.
Gorleben
While in Hamburg, I got a chance to attend a rare event. Before I left Berlin, I had been told about the annual castor stoppage. I was aware that there was going to be a protest, but I did not know too well how exactly it goes.
Gorleben is about two and a half hours out of Hamburg. We left in the evening to get there about eleven in the night. There were camps all over. Even in the dark, it appeared to be a lovely countryside. We had dinner and slept, anxiously waiting for the weekend events to unfold. The very heavy presence of police was provoking. One would imagine that their presence makes one secure, I felt uneasy around them.
During the days of the protest, the sun was bright. It was a beautiful natural environment. I felt sorry for the inhabitants of this area. The curiosity of mankind to continue exploring nuclear energy for huge profits was tearing down a calm countryside. It was clear that no one was happy about it. Sad music and slogans of protests rented the air, all in one voice, “Atomkraft? Nein danke”.
I really admired the level of organisation at this protest. People had come from all corners of the country. Even though the castor made its way there, it was not a smooth ride. I left the place hoping that one day someone would heed to the call of the masses.

Frankfurt am Main
I should have titled this section “Gelnhausen”….but I decided to use the more popular title. Before I left Hamburg, I asked several people what Gelnhausen would be like. Most of them asked where Gelnhausen was. It is a small country town about forty minutes by train from Frankfurt. It is a town on a hill, with remarkable old German architecture.
I was glad it did not rain much in this town. I stayed with Dr. med. Judith Lindert. She had been to Kenya for a similar programme some years ago, so she fully understood what kind of hospital experience I needed.
She had arranged for me to work at Main Kinzig Clinikum. She knew some doctors at the Trauma and Orthopaedic surgery department as that is where she did her practical year. I was happy she knew that I would have wanted a place where I would require less knowledge of the German language to learn. This was in the operation theatre where I would not communicate with patients directly but would be more involved with the surgeons in operating.
The doctors there were a bit apprehensive at first. When I walked into theatre, I was issued with dozens of instructions on how to move around. I was not sure whether they did that routinely to visitors or whether it was just because I was from a less developed country. I think both applied. This is because while I was there, I got to see a new German student come in. They did not appear to give as much instructions.
I had learnt that in any new place one visits, there are various challenges one has to face. In my case, I knew it would take time for people I worked with to get confident with my knowledge and skills. I always tried to take it all positively, understanding different levels of exposure among people of the world. There are some who may never had a change to travel or work with people from other countries, so they remain tied up in prejudices.
A few days later, the surgeons really enjoyed my company. Well, there were other students with me at the hospital. To some of the surgeons, it was like they did not exist. I think it was partly because they showed up irregularly and were not too keen on getting up early enough to attend the operations at the department. None of them was interested in pursuing trauma and orthopaedic surgery. On the other hand, I felt as though the surgeons were being overly nice to me, given their initial reaction to my presence at the hospital; a kind of mechanism to pay for their ‘ills’ at the start. All in all, I totally understood why they had reacted the way they did. Indeed, I ended up enjoying their company a lot. I learnt many things and assisted in many operations. I was lucky that most of the operations they did are not that common in Kenya. So I got a rare opportunity to see most of these kinds of operations. I am talking about knee replacements, cruciate ligament repair and replacement, reverse shoulder prostheses and more.
While at Gelnhausen, I got to visit Frankfurt a few times. On the first occasion I stayed with Eva Schweiger who is an IPPNW student. She was on a break writing her thesis so she was able to show me around.
Frankfurt is a small big city. It is not vast like Berlin or Hamburg. Its characteristic skyscrapers give it a feel of seriousness and modernization. It houses many big banks and expensive shopping areas. It is a city where one has no business idling around. It is a working city by definition. It is a home of big businesses, the financial hub of Germany. Nonetheless, I liked the beautiful skyline, especially while taking a view from the Main.
At this point, I must say that something struck me about the three German cities I visited. They were all very important cities in the history of the country. Both had major impacts in the country. From the capital city, to the harbor city and finally to the financial city; their teeming differences were united by the presence of rivers right in the middle of them. The Spree in Berlin, the Elbe in Hamburg and the Main in Frankfurt; all added a magnificent beauty. Thousands of tourists in each of these cities confirmed that there was something attractive about them. Whether it was the history, lovely museums or just the nice feel of an organised city one always found something to enjoy.

Winding up
I got back to Berlin about four days before my departure from Germany. My return to Berlin was not a journey I enjoyed. I have always enjoyed travelling but this was an exception. I left Gelnhausen early in the morning. I was sad. Judith had been a really wonderful host. I was not too sure how to express my many thanks for what she and the staff at Main Kinzig Klinikum had done for me. I left a bottle of wine in her house so she would find it when she got back. It was a 2010 South African wine. I thought that would be a good appreciation. It was African wine made in the same year I visited Germany!
This return to Berlin was also marred by travel hitches, all thanks to the heavy snow. I had enjoyed the snow very much. Now I hated the delays it caused. I almost got into the wrong train at Fulda. All trains came late. There were two trains to Berlin all on platforms six and seven. One was through Leipzig and the other one was straight to Berlin, so it was to take about an hour less. It was the train I had paid for. In the hustle of catching the trains before they departed, most passengers got into the wrong trains. While inside, they closed the doors. We soon realized that we were on the wrong train. After asking whether we could change as it was not entirely our fault, there was hesitation. If this had happened in my first days, I would have thought Germans were too arrogant and mean. But then I had learnt that there is a way things work there. There are timetables and signs. One has to follow them and there is little room for error. One has to be perfect. It is not usual to open the train doors for confused passengers. Things function in a clock-work manner here.
Anyhow, the doors were soon opened and all passengers in the wrong trains were able to switch  to the right ones. I was relieved. I was worried about getting late for the Berlin meeting I was going to attend. Later, everything went smoothly and at exactly two o’clock, I arrived at Rathaus Schöneberg in Berlin. I was ready for the joint European meeting on Global Health and People’s Health Movement.
While in Frankfurt, I visited the Medico office. This is a German non-governmental organisation. While getting to know more about the organisation, I was told about the meeting in Berlin. This was a joint European meeting on Global Health and People’s Health Movement. I felt like there was no better way to start concluding the trip that to get a view on the status of global health in Europe.
The meeting involved experts from all over Europe. I got to learn a lot about the challenges of teaching and practicing global health in Europe. Even the concept of the discipline still remains a challenge to understand. I listened most of the time to the experiences of the experts, and I then I noticed that we all face the same problems, only at different levels and in different magnitudes.
As though drawing nearer to Kenya while still in Germany, I got to meet Christian, my exchange fellow to Kenya. We had met in Kenya but never in Germany. We exchanged lots of experiences. There was one thing we shared; we were not the same people as we were before the exchange. We were taking back with us experiences that we hope will shape us, our countries, our continents and the world, all in the hope for a better future.

Do I have recommendations for the future?
Such an experience is unique to every individual who goes through it. People are different, with different personalities and behaviours. They react totally different to the same situations.
However, there are a few common threads. An open mind is of utmost necessity. It is not easy to switch cultures in such a short time. Good timing of selection, perhaps earlier in the year would do a lot to contribute to this. A selection done by March would allow Kenyan students to have about six months to learn about IPPNW and Germany as a country and as a culture, perhaps even some German language. Given that German language lessons are readily available within and without the medical school; this would be an ample gap to get to know more about the country, its people and its culture.
A little spontaneity always adds flavour. When I look back, in a way it was good that I did not know much about the programme or country before hand. I got to face things as they came. I would have wished to learn a bit of the language before travelling… but now I can do that next time.
I have to commend the makers of my programme. The flexibility of accommodating my preferences and fitting them into the German context was a great success.
Thank you.

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