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“Wir schaffen das” – Health workforce integration: Notes from a small clinic in the light of global changes

By Daniel Gulati
on October 14, 2016

German chancellor Merkel’s slogan “Wir schaffen das” (we can do it) was first heard in 2015 after the onset of what has been called the greatest challenge of post-war Germany:  the migration of hundreds of thousands of forcibly displaced individuals (mostly from Syria, Iraq and Afghanistan) over the last year into the country. While this quote has stirred controversial political debate in the country and elsewhere, its simplicity inspired me to the following deliberations around integration. Or put differently, what does “Wir Schaffen das” imply for foreign health workers “in the (German) field”?

As a junior (European) global health professional I share the fate of many entering this field – we find ourselves eager to professionally engage, but quickly learn that jobs are scarce and competition is plentiful.  My background as a medical doctor grants an advantage I’ve come to increasingly appreciate after I graduated with a degree in global health and worked as a consultant for different research projects.  While looking for longer-term commitments I got to experience the global shortage in human resources for health first-hand, when working as a fee-based physician in a small, rural hospital an hour’s drive away from the city of Hamburg. My current employer regularly turns to agencies to find doctors for shifts left vacant due to lack of permanent staff. Corresponding to the chronic rural-urban divide in health worker distribution reflected throughout the world, this clinic too experiences frequent shortfalls in doctors, as medical graduates turn to larger, better equipped and more centrally located facilities, or directly opt for a better work-life balance and/or salaries abroad. Consequently, medics from different parts of the world are hired to fill the gaps.

My opportunity to bridge the time until I found a new job (in global health) by filling those gaps – that I arguably created myself by withdrawing from full-time clinical practice – might seem a bit cynical.  I have previously tackled the issue on health worker distribution academically as a consultant on Human Resources for Health projects, an issue which I now find myself experiencing first-hand (not without the analytic eye).

In any case, I now work as part of a diverse team of doctors from Indonesia, Libya, Syria, Azerbaijan, Egypt, Mexico, India, Macedonia and Hungary in a rural hospital in Germany. Many of us are quite young. This experience enabled me to observe the dynamics between senior German and junior doctors, as well as interactions with international doctors who are an integral part of our health workforce, particularly in rural areas. Our heterogeneous team presents certain challenges in the working environment, such as the dynamics between the more established, experienced medical professionals, and a young, often foreign workforce. For the latter, working in an environment such as one in a rural area in a different country requires them to not only acquaint themselves with a foreign and arguably more technocratic health care system at the macro level, but also distinct cultural dynamics at the micro level. In the case of a diverse international workforce, their role is vital towards addressing the gaps in the health workforce even in economically developed settings. While the contribution of migrant health workers is desperately needed, the willingness of senior [medical] professionals to embrace the diversity that enters their long-established facility falls short of the expectations they cultivate towards the new arrivals. Host countries often have guidelines on the integration of foreign, or emigrant medical staff into the workforce. These are typically bureaucratic processes and systems to ensure consistency and quality of medical training. Less emphasis is laid on cultural integration, particularly laying a degree of responsibility with the host countries/work settings. Social and cultural integration can play a role in overcoming the seemingly minor, but important aspects of professional and personal development. These could be on cultural perceptions of professional roles, and inter-personal interactions between colleagues – issues which go beyond the obvious barriers of language.

Little gestures can make a big difference, starting perhaps with making an effort to enunciate names of colleagues. The lack of effort, often of those in host countries to adopt such little gestures symbolizes to me the reluctance to accept the variation that global developments create in their personal surroundings and to take on personal responsibility within their immediate reach by respecting what is most basic.

And so there is a certain imperative for the medical professionals in host countries to acknowledge their role, and embrace the enriching diversity that an emigrant health workforce brings with it. The role that falls on everyone, voluntarily or involuntarily, in integration, is argued to mirror both individual and institutional conditions: the hospital as a resource-constrained environment, facing competition and economic pressure to create revenue by maximizing the number of treated cases leaves little space to acknowledge each of its employees’ backgrounds, which would in fact be most conducive to its own objective of tackling health worker shortages. An openness towards acknowledging the role of younger medical professionals – whether from the community or not – can help create a friendlier work environment. And yes, job-specific bridging courses may provide guidelines on professional or technical integration, but to truly offer a more conducive work environment and enable health workers to provide quality care, one must make an effort to bridge the social and cultural gaps as well. Only then “sollen wir das schaffen”, I’m afraid.

About Daniel Gulati

Daniel Gulati is a young global health professional who used to work as medical doctor in Germany, before undertaking work as a research consultant. Upon completion of his consultancy he will move on to a position with the Berlin Senate’s office for health and social issues.
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