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Reflections on a Medical Elective in Berlin

The Charite

The Charite hospital was founded in 1727 when a redundant plague house was
converted into a teaching facility for military medics, and a hospital for the poor. It wasn’t long before the hospital was considered as a clinical education resource for the young medical students at the newly founded Humboldt University- but rejected on the grounds that the overwhelming number of patients would ‘confuse the beginner’! It wasn’t until 1810 that the medical school was established at the Charite, and it then flourished in the 19th century as household medical names, such as Robert Koch and Rudolf Virchow, emerged from one of Europe’s biggest medical research institutes. However, the Charite suffered greatly under National Socialism, and nearly 200 professors and teachers were fired on ideological grounds in the 1930s. Fighting was still taking place on the grounds of the Charite in the final days of the Second World War, and on May 2nd 1945, the Red Army occupied a hospital that had been nearly entirely destroyed in the bombing of Berlin. Rebuilding began swiftly thereafter, and for the next 45 years the Charite stood for achievement, self assurance, and independence in the DDR. Its buildings abutted the wall, and its walled-up west-facing windows symbolised the boundary. Today, 20 years after reunification, the Charite holds a strong international research reputation, and is one of Europe’s largest teaching hospitals.

The Clinical Placement

The doctors’ bicycles at the entrance ofthe Children’s Hospital where I worked
The two months I spent at the Charite were a great opportunity to challenge myself by
working within a foreign clinical setting where everything from the language to the staff hierarchy, the intravenous cannulas to the working hours, was different. Performing to one’s potential within a foreign environment is not always straight forward. This was especially true when working in Accident and Emergency, where staff are stressed and have little time for students, particularly those students who are unfamiliar with the computer systems and discharge processes that are essential if one is keen to see patients independently. I came to learn that to earn the doctors’ attention, and thus receive teaching, I had to make myself useful in any way possible.

I learnt much about communication, as I quickly came to realise how ones keen intentions can be complicated by a language barrier. My level of German is good, and I was often complimented with polite surprise on my ability with the language. But what the German hospital staff may not have realised is that the nuances of information delivery in the medical environment are such that if you are given instructions during a stressful situation, it only takes the misunderstanding of one of the words in the sentence to not be able to carry out the task appropriately. It is therefore essential in this circumstance that you are working with staff with whom you feel comfortable asking for clarification, without the fear that you will be slowing them down. A welcoming team makes a student feel confident and their ability to learn is increased ten-fold.

Although I had little trouble taking the history from a patient, I found that my
unfamiliarity with the small colloquialisms that are used with children to make them feel calm during procedures or build up a non-threatening rapport were what betrayed my foreign blood. The same was true when conveying medical knowledge in a foreign language; when trying to explain ideas or theories, such a high level of language is required to convey competence. When in the fast-moving, intellectual environment of a teaching hospital, trying to function in a foreign language can make you feel shy, under-confident, inarticulate and thick. However, I believe that having gone through the ardour of survival in that environment one can only come out the other side a clear and confident communicator who benefits any work environment, such as the NHS. I can also now appreciate how easily misunderstandings of both meaning and personality can come about with language, and I no doubt have more
patience and understanding for foreign language staff and patients in the U.K after my
experience abroad.

The intensive paediatric ward was a fantastic place to see a wide range of fascinating, and often rare, paediatric conditions that I had only glanced at when skimming through textbooks. It provided an insight into the sort of conditions that are managed by the most specialised of paediatricians. I learnt a huge amount by seeing a large volume of patients in A&E, and having to differentiate the sick from the well. I developed a more systematic approach to the paediatric examination and to determining the source of the most common presentation- fever. I increased my confidence in knowing when children can return to their homes with simple advice, rather that requiring observation in hospital. I was involved in some common paediatric emergencies such as Diabetic Ketoacidosis and Status Epilepticus. The more of these cases I saw, the more comfortable I became both with the essence of their management, and the clinical priorities in a patient who needs treatment quickly. I gained confidence in cannulating children, especially under difficult conditions, and in interpreting routine blood results.

The teaching from the professor was fantastic- his calm and systematic approach to
complex clinical cases betrayed his decades of experience. He would pop down onto the ward on Tuesday afternoons, and would take us to visit the most interesting cases in the hospital. He would stand by the child and ask them to reveal a limited amount of information from their history then point out the physical signs in a stepwise manner until we, as students, were able to bring them together with a diagnosis. His manner and rapport with children of all ages, and his clarity in explaining the science behind a clinical picture was admirable. His ability to distinguish the important from the unimportant is what made the diagnosis look easy, and it was this skill that was inspirational. I appreciated the professor’s care of me during my time in Berlin. He was keen that I learnt from the children on the wards, but also eager to pass on to me some of Berlin’s history. I think that such mentorship is vitally important in instilling enthusiasm and offering direction in any student, and that the importance of these mentors should be more widely recognised in university education. However, I think that my status as a visiting student, and the novelty this carries, may have aided my access to such time from the professor, and that such mentorship is actually lacking in Germany.

There were times in Germany when I felt that students, and the teaching of them during clinical duties, were a lower priority than here in the U.K. When I raised this with some of the junior doctors, they spoke about Germany’s lack of money and the consequent understaffing of hospitals, with the students’ education paying the price as service provision presides over education. It’s important not to generalise, but I asked myself whether we have a stronger culture of teaching within the medical profession here. From my limited experience of only one hospital in Germany, it would be unfair to judge this to be true or not. It did, however, lead me to reflect on the massive importance of teaching in the medical profession. I think it must be re-emphasised that, from a long way back in history; teaching is a central responsibility of a doctor.

When I am abroad, I often find it easier to reflect on the aspects of British culture of
which I am most proud, and a rare moment of patriotism creeps in. On this visit, I thought a lot about British education. In nearly every country I have visited, it is this it appears be to this feature of our society which other cultures, even within Europe, revere most. Within the medical profession in the U.K, we should not become complacent of this fact, but ensure that this proudly remains a central element to the NHS. The quality of our doctors will only remain high if the quality of the teaching remains high.

The experience also led me to reflect on the future of medical education within the shifting political axis towards ‘Europe’. I have always been a ‘Europhile’, as I have grown up within a linguistic family and have spent much time in France and Germany. I was immediately interested when I first heard of the Bologna Process to standardise medical courses across Europe, facilitating the movement of students and doctors between the nations of the EU. It is not that now having worked in Germany I am necessarily more cynical about this movement, but that I appreciate the importance of this personal experience in forming a more informed, critical view on how this change should be best managed.

There is some truth behind the UK’s snobbery about their position in the pile in terms
of research power and standards of education, and their subsequent reluctance to join what is already present in terms of European exchange programmes such as Erasmus. The concerns are not only about finding exchanges that offer an equivalent standard of education, but also that the standardisation of medical school courses would spell an end to the variety in teaching methods that is seen across the UK. A ‘European Medical Course’ would also pose questions of leadership in terms of educational research and power axes in curriculum setting. However, if an increasingly important EU is inevitable, then it is worth spending time to consider how our involvement in it will benefit us most.

The City

“Berlin ist eine Stadt, verdammt dazu, ewig zu werden, niemals zu sein”
“Berlin is a city condemned to be eternally becoming, never to be.”
Karl Scheffler, author of Berlin: Ein Stadtschicksal, 1910

The word I often hear used to describe Berlin is ‘modern’, and I ask myself what that
means. I have tried to associate this concept of modem with the images that come to people’s minds when they think of the city. Maybe the minimalist architecture that the Germans have used when renovating some of its government buildings and banks, giving an edgy coat to a metropolis flattened by bombs and shells. Or maybe it’s the infamous wall reminding us of the most modem of ideological divides. It’s probably a combination of many things, but what I think makes Berlin modem, more than anything else, is the city’s youth. My time spent living in East Berlin was too short to justly articulate what I mean by this, but a visitor can’t fail to notice that modem-day Berlin is all about young people.

I would enjoy hopping on my beige €15 bicycle and pedalling from my flat in Prenzlauer Berg, south through Friedrichshein, past the wall at East Side Gallery, over the Oberbaumbrticke and into the former western district of Kreuzberg. Sometimes impromptu tango dancing events would be held on the bridge, other times exhibitions from local artists. Every street in the city has a cycle path. On Sundays I would often walk down the road to Mauerpark- formerly the barren No Man’s Land between the wall; this space now plays host to busy markets, open air cinema events, street artists and basketball courts. The familycentred neighbourhoods in the east are full of square parks and city football pitches that are used and safe. The social progression, the optimism and energy are palpable, the idealismreal. Never has the garish neon architecture of 90s capitalism that lines West Berlin’s main street- the “Kurftirstendamm”- looked more out of place than in this city.

Berlin is far from perfect; unemployment is high, Germany’s financial powerhouses
have chosen Munich and Frankfurt for their homes, and some of the architecture has failed to hide the fact that the city was bombed to smithereens. However, it’s the best model for urban living that I have experienced and there is much we could learn from it. I did feel that in order to access a city so steeped in social history like Berlin I needed to have a purpose in my stay; without this, I feel that the impression I would take away from a short back-packing trip would be even more warped and inaccurate than the one I have provided above. My work in the hospital served as my access point and central focus. I also feel that in a city where so many go purely for fun and week-long parties, a daily routine is vital to avoid drifting along on the waves of hedonism.

I am massively grateful for my experience in one of Europe’s most historic hospitals. I
thoroughly enjoyed the challenge presented by the German language and feel that I will take the communication skills I learnt into many other challenges to come. I feel I have only just scratched the surface of one of the worlds most interesting and progressive cities. I will no doubt return.

I would like to thank Richard and the ISA charity for the financial help that made all this possible. Supporting young people in their exploration of the world, their building of skills and experiences is vitally important as our generation grows to follow from its predecessor. These experiences are incredibly effective catalysts in the generation of understanding, innovation and leadership. You have continued to support my working adventures and I would like to communicate my immense gratitude.

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Quotes

India has played a large part in my life over the last 18 months. Whether it is simply sharing a joke with my housemate about Indian postal service experiences, or admiring the country’s geographical and cultural diversity while looking over photos…. rarely will there be a day where its nagging, probing, and ultimately perplexing spirit doesn’t wheedle its way into my thoughts.

Robin Baddley, University of Sheffield, 2006

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