How would you describe the Serbian mentality?

Studying abroad: so close - so different

Anyone studying medicine in Germany knows that this is a privilege. So does Haissam Ragab. After completing his internship in Belgrade, the Hamburg student appreciates the German medical training all the more. 15th part: Serbia

Four weeks in the surgical department of the University Hospital Belgrade were enough to experience first hand and understand how different the medical world itself is within Europe. How much did the 25-year-old Haissam Ragab notice during his four-week flying visit to Serbia last September.

An example: In the outpatient clinic, where Ragab was mainly employed, traditional X-rays were regularly passed from hand to hand. Not between doctors, for example, but from patient to patient. Exclamations like “Please pass the picture on to the man over there” switch regularly through the station. Patients crowded there every day, sometimes accompanied by relatives and loaded with luggage. Because: The University Hospital in Belgrade is the contact point for numerous people. Not only the townspeople come here, but people from all over Serbia, most of them appear unannounced. Why is answered quickly: Belgrade has a reputation for delivering the best supplies in the country. In other parts of Serbia it can be difficult to receive adequate treatment.

In addition to the heavy rush and the resulting difficult hygienic conditions, the Germans were irritated by the conditions for those waiting. After the admission, the patients squatted for hours in a narrow space in the corridors and waited until it was their turn. “Everyone waited four to six hours,” says Ragab. And this in the stifling heat, because it can be very hot in Serbia in late summer. In 2015, the country even suffered from an unusual heat wave with temperatures sometimes over 40 degrees. "The heat surprised me very much. I only know temperatures like this from Egypt," says Ragab, who has Egyptian roots. Actually, an air conditioning system should provide cooling, but nothing was felt. "I would say it was defective, it was incredibly stuffy in the hallways."

Despite the difficult framework conditions, there was good togetherness in the outpatient department - not only when it came to passing on x-rays. “Doctors and nursing staff went to great lengths to take care of the waiting people. The nurses regularly distributed plastic cups with water to those waiting. ”When the patients could finally be treated after hours of waiting, there was always time for a personal word. “The doctors listened patiently to the people, took care of their situation.” The procedures in the outpatient department were otherwise similar to those in Germany: initial examination. Survey. Possibly imaging. Then the case was assessed and a decision was made on the urgency of the treatment. In acute cases, they were referred to the surgical ward.

Astonishing for Ragab: The patients endured the uncomfortable waiting with composure. The German even chooses the word “relaxed” to describe the patient's mood. For them, the condition in the ambulance was "nothing new". “The elderly in particular are very tough,” says Ragab. "But regardless of the conditions, the patients are in a good mood, joke with the doctors and laughed again and again." In the end, the most important thing for the patients was that they should be helped.

Haissam Ragab (25) spent four weeks at the Belgrade University Clinic, which is the contact point for people from all over Serbia. Photo: private

When it comes to health care, Serbia's citizens are used to grief. The health system has suffered greatly during the many years of armed conflict in the country, mass exodus and political and economic instability. There is a statutory health insurance, through which basic care is to be guaranteed, but money is scarce in all areas, making care in state institutions correspondingly difficult.

Those who can afford it prefer to go to private practices and clinics in the event of illness, especially if operations are imminent. The conditions there are much better. In conversations, Ragab heard clear words about the gap between public and private care. "Well-off people try to avoid state hospitals as much as possible," Belgraders told the German.

Even the equipment in Belgrade's university clinic was not as Ragab knows from Hamburg. But that didn't make it bad, he insists. “Everything was in the ambulance. CT MRI, X-ray machine. Just not up to date. ”The X-ray images, for example, were still good. The native of Bamberg did not notice a real lack of large medical equipment. However, here: Sutures were removed in the clinic with commercially available disposable razor blades. Ragab also lent a hand. “That was of course unusual, because a razor blade is certainly not a suitable means of pulling strings,” he admits.

When disinfecting instruments, the doctors also resorted to tried and tested household remedies: high-percentage alcohol, because there were hardly any expensive single-use products in the clinic. "A certain improvisation is certainly necessary in everyday medical practice," says Ragab. But the German also says very clearly: “The care of the patients was largely ensured. The doctors had their shop under control. "

There was another anomaly that stuck with Ragab: the assistant doctors are exclusively responsible for the outpatient department at the University Hospital Belgrade. Their reputation in the hospital hierarchy is low - and so is their salary. Nevertheless, Ragab says the young doctors were “very professional” at work. Similar to the patients, they too would take the sometimes difficult framework conditions fairly calmly.

This shows how clear the division of responsibility is in the clinic: Senior and chief physicians cannot be seen in the outpatient department with the newly arrived patients. Ragab had hardly any points of contact with other doctors than the assistant, because he was only rarely allowed to go to the surgical ward, and not at all.

In general, the German was more of an observer than an actor during the four weeks. He was hardly allowed to do anything himself. Pull a seam, change a bandage, hand a drug. More was not possible. This restriction did not only affect Ragab as a foreign guest, but also the local students. During the German's clinical traineeship, a Serbian student was with us in the outpatient department on some days. She was even further than the ninth semester Ragab, was in the middle of the PY. But she was not allowed to provide direct care to the patients either. “That was noticeable, because you're allowed to do a lot more with us in the PJ”, compares Ragab.

However, the clinical traineeship was not just mute running and observing. The Serbian interns were open to all questions, took a lot of time to explain, or talked about special patient cases with the students afterwards. Incidentally, English was spoken between the doctors from different nations. Information from the patients was willingly translated for the German by the Serbian doctors.

Apart from the clinic walls, there was a lot for Ragab to discover: Belgrade is a fascinating city for him, especially in the evening. When traffic, noise and heat gave way, the German came to life. He visited museums, restaurants and bars and marveled at the sometimes morbid architecture in the very old metropolis. The man from Hamburg found the atmosphere in the evening hours to be special: when the street lamps, which date back to the German imperial era, bathe the city in orange light, body and mind come to rest, he says. Back to the centrally located hostel, which was organized and paid for by the university clinic, Ragab was always full of impressions.

On excursions into the surrounding area, Ragab got to know the country even better, as intensively as is possible in four weeks. He drove out into the country and visited Sarajevo for a weekend in Serbia's neighboring country Bosnia and Herzegovina, which, like Serbia, once belonged to the former Yugoslavia. On the way there it went through beautiful nature and past ancient ruins. “The region has a lot to offer,” enthuses the German.

He can only say good things about the people he met. “In the evening you sit in the bar with total strangers and talk openly about everything.” The Belgrade people were very attentive to him, always very polite and hospitable. The mentality of the Serbs is basically a little more reserved than that of the Germans, judges Ragab. It was always noticeable: Germany enjoys a very good reputation in Serbia. Generally and in medicine. "The high technical level of German medicine is very much praised," he knows. He encountered the positive image of Germany not only on the part of the Serbs. In his hostel, Ragab met people "from all over the world". For almost all of them, revealing “I am German” led to the same positive reaction. Clearly: Germany enjoys a high reputation internationally.

This is not the only reason why Ragab feels that his decision has been confirmed: he may be drawn to another country for his practical year, but after completing his studies he will stay in Germany to practice here. ■

@ Appeared so far in this series:
USA, Scandinavia, Switzerland, Great Britain, Austria, Thailand, Spain, India, France, Cuba, Hungary, Italy, Poland, New Zealand, Turkey, Mexico under:
www.aerzteblatt.de/studieren/ausland