Amid a nursing staff shortage, German hospitals have had to take matters into their own hands. When the coronavirus pandemic hit, a new arrival from Mexico proved very valuable at Berlin’s well-known Charite Hospital.
The story of German Health Minister Jens Spahn and Judith Heepe, the nursing director at Berlin’s Charite Hospital, is a little like the tale of the hare and the hedgehog. Heepe, like the wily hedgehog, is somehow always faster.
In September 2019, Spahn was in Mexico signing a contract to speed up the process for Mexican nursing staff to receive work permits in Germany. Heepe had already been there. A month before that, Spahn had sent his state secretary to the Philippines on a recruitment mission. Heepe had been there, too.
In the Brothers Grimm fairy tale, the hare thinks to itself: That’s not possible. Judith Heepe sees the funny side as she recounts her imaginary competition with Spahn. In the race to recruit nursing staff from overseas, you must be highly creative. And sometimes take matters into your own hands.
‘The international nursing staff have brought warmth and openness,’ says Judith Heepe
For more than five years, Heepe has led the nursing division at Charite, Berlin’s oldest hospital and Germany’s most famous. She is responsible for 4,600 staff members, and during the second wave of the pandemic they’ve been working under pressure every day, especially the intensive care nurses in the COVID-19 ward.
Struggle to recruit nurses in Germany
If the pandemic had broken out four years ago, Charite would probably have had to admit defeat. “At that time we were lacking 400 nurses. Every year we have plugged this gap by 100 workers and expanded our training capacities at the same time,” says Heepe.
That’s why she has not only flown to Mexico and the Philippines, but has also been to Albania and made approaches in South America. Soon, Charite also wants to bring Brazilian nurses to Germany. “The market in Germany has totally run dry,” she says. According to the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), the country lacks about 3,500 to 4,000 skilled workers in intensive care.
Politicians are constantly asking Heepe how the situation has come to this. “I can only tell them: this situation is our own fault. In recent years there have simply not been enough people trained and qualified. We now have what was a totally avoidable gap in the next four or five years,” she says. It’s an emergency that could cost Germany dearly in the next few weeks, with intensive care stations overcrowded due to the pandemic. “It also means that we must pay people better,” Heepe says.
Struggles with officials and bureaucracy
Heepe is someone who gets things done. Her motto: Don’t take no for an answer.
“At some point, I was more familiar with the State Office for Health and Social Affairs than I ever wanted to be,” she says with a laugh. She was always having to discuss the office’s requirements for foreign nurses to supply original documents. Her relationship with the Berlin health authorities has a history: It happened almost three years ago, half a world away in Mexico. And Heepe can still recall every detail.
“I was in a video conference with 15 Mexicans who were in complete despair because their recruitment company had gone bust,” she remembers. “And then I told them: ‘Who cares? We can do it! We’ll bring you here!'”
For Heepe, that marked the start of a nerve-wracking side job. She took on everything that the agencies would normally sort out, from visas and flights to dealing with officials, bank accounts and health insurance to organizing language courses. And sometimes, when the whole project looked at risk due to German bureaucracy, she took unconventional measures.
‘I tell my German colleagues: ‘You have everything here. You don’t need to emigrate,” says Mexican nurse Herbert Perez
A suitcase full of documents
In April 2018, Herbert Perez boarded a plane from Mexico City to Berlin with a suitcase and a backpack. Charite had paid for the flight. In the backpack were two pairs of trousers, three T-shirts and two shirts. In the suitcase: all the original paper documents for the 15 Mexican nurses who wanted to work in Germany. The young Indigenous nurse from the southern state of Oaxaca with the German first name became the vanguard; he had everything in his luggage that officials in Berlin were demanding.
“The scales at the airport showed exactly 22.5 kilograms,” Perez remembers. “At the very last second people were still coming to the airport to drop off documents.” The nurse can laugh now when he thinks back to his first trip to Germany, but at the time he was a nervous wreck.
“What would have happened if I had forgotten something amidst all the hustle and bustle, or if documents were lost in transit or if the airlines made a mistake and the suitcase went missing?” All these thoughts were running through his head. But everything worked out. Today, following a six-month program to certify his credentials, Perez is a valued colleague. He works on the coronavirus intensive care ward and helps day in, day out to bring Germany through the crisis.
Dramatic situations in intensive care wards
“The current situation is extremely critical, there are only a few intensive care beds,” Perez says. “At the moment we are reaching the limits of our capacities.” He has himself already tested his limits — like many nurses he contracted the coronavirus and was bedridden with fever for a week.
Perez wanted to be a nurse since he was a small child. He is the kind of person who needs to be told when to slow down. Even today, he’s surprised whenever his colleagues tell him he needs to relax, that he is entitled to a vacation or days off. “I didn’t know such things from Mexico, there you have fewer rights as a worker.”
Heepe is organizing everything so that Perez’s partner, a preschool teacher, can soon join him in Berlin and start work in Charite’s kindergarten.
An international success story, then, with only winners? Not quite. There is growing criticism that Germany is snapping up well-trained personnel from developing nations when they are also urgently needed in their own countries. A recent report in the German newspaper Frankfurter Rundschau spoke of “nursing imperialism.”
‘Germany needs to solve its nursing problem itself’
The German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) is familiar with these accusations. The experts agree: Germany’s nursing shortage is a problem of the country’s own making and in an emergency like the current coronavirus pandemic, other countries should not be further weakened.
“Bringing in qualified staff from abroad always sounds like the big answer to the problem. But the more you investigate it, the less of an answer it seems,” says Michael Isfort, deputy board chairman of the German Institute of Applied Nursing Research. The proportion of foreign nursing staff in the hospital sector is currently about 1%. “That is extremely small.”
Nurses like Herbert Perez go mainly to large cities like Berlin; according to Isfort 90 to 95% of the international staff are working in the big urban centers. “We’ve still not yet succeeded in getting care workers from abroad into rural areas,” he says.
According to experts, it’s clear that recruiting staff from abroad won’t be the long-term solution to Germany’s nursing emergency.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
