Frankfurt / DPA
Afram Shamoun, who for decades practiced medicine in Damascus, is now lying on a
doctor’s couch in Frankfurt pretending to be a
patient with knee problems.
The 59-year-old is taking part in a course that prepares doctors qualified in other countries to take the exam to be able to practise in Germany. Today they’re going over the “bed test”: one person plays the patient while the other tries to diagnose their problem as a lecturer looks on and gives comment.
Twenty-seven doctors are taking part in the current course, which is organized by Berami, a Frankfurt-based association which helps migrants with retraining and professional integration. The doctors began the course in April, with almost 2,000 teaching units to get through. Now they’re almost finished and some time this year they’ll take the examination at the nearest test centre in the town of Marburg.
“Contusion, pressure pain, function test,” Bernd Lohmann writes on the blackboard.
He’s leading today’s course, “Verification case, knee injury.”
Before he retired, Lohmann was a surgeon, but the 69-year-old has been working as a lecturer for two days a week since September. He says the doctors have a “very good” chance of success in Germany. “There’s a huge lack of doctors.” In terms of qualifications he can’t complain, “they’re all trained doctors,” he says. The only problem is the language.
Lila Ghali, a 38-year-old Syrian gynaecologist, remembers her first German internship in a hospital in Wiesbaden very well.
“They thought I had no experience,” she says in her now fluent German. “I didn’t understand anything and couldn’t say anything.”
But even though her every-day German is now excellent, it’s not enough to get her through the exam. Knowledge of specialist terms is also required.
“The participants actually have to learn two languages,” says Atilla Vurgun, the course’s medical director.
When talking with patients, it’s a “kneecap,” when they talk among themselves and in official letters, it’s the “patella.”
What makes it more difficult is that in the Middle East, Arabic is used for specialist terms rather than Latin, as is common in Europe.
“I’m afraid of the exam,” says Ammar Haeidar. The 33-year-old already has a certificate allowing him to work under supervision and for a limited time in a Frankfurt hospital.
Haeidar comes from Syria but studied medicine in Iran and worked as an emergency doctor there. The pressure he’s under is written on his face, and what he finds more stressful than the job, the course and the exam is Germany’s infamous bureaucracy.
What language certificate do you need, what’s in the exam, when are you even supposed to take it? Some people get a date within weeks while others have to wait six months.
“If just registering is this complicated, what’s the exam going to be like?” he says.
Raif Nahhas finds the bureaucracy equally baffling. The 32-year-old Syrian lives in the city of Mainz, 40 kilometres from Frankfurt, and works as a “scientific assistant” at the university clinic there.
He’s been trying for some time to find out whether the certificate in technical language he gained in Frankfurt is valid in Mainz, which is in a different state. The doctors exam preparation course costs 10,000 euros if students want to take all the modules, and it lasts for eleven months – eight hours a day, five days a week.
The fees are paid for by the job centre or the local employment agency but demand is bigger than capacity. Berami needs more lecturers and rooms, and recently introduced selection interviews.
“We certainly need more doctors for patient care,” according to the state medical association of Hesse, of which Frankfurt is part. But the most important consideration is patients’ wellbeing. “So we can’t accept any reduction in quality,” it adds.
Last year around 300 people applied for a licence to practise medicine (Approbation), which recognizes that a foreign qualification is equal to that of a German, and 114 applied for a work permit, which allows the holder to practise for a limited time, under supervision and at a specific work place, according to the Hesse state body which regulates licences. But there are no official figures on how many foreign doctors are allowed to practise in Germany.
“Until two years ago most were coming from Greece,” says the state body in Hesse. “Now it’s Afghanistan, Syria and Turkey.”
Even when foreign doctors have decades of experience, they have to start from scratch in Germany. Both of the gynaecologists, who wear headscarves in today’s seminar, have to study dermatology, pulmonary medicine and orthopaedics again.
And once they have their licence to practise general medicine they have to study their specialism again. “We’re wasting resources there,” says Berami’s Vergun.
“Many have humiliating experiences in clinics,” adds Lohmann, who previously worked as a head of department. “They’re treated as trainees. Nobody gets anything out of that.”
Ghali knows the feeling. She loves to help out more when she sees how overworked her colleagues are, but she’s not yet allowed to.
“The doctors suffer because they’ve got so much to do and we suffer because we have to sit at home.”