Mainly
Paediatric:
The association between the Paediatric departments of Leeds University and
the Karl Marx University in Leipzig – as part of the overall University
link – began in 1977. I was approached by the head of our department
in Leeds, Professor Smithells, at an early stage to ask if I would like
to be the first of what, I think, had been envisaged as one of a series
of such visitors from our department and, despite not speaking a word of
German, I gladly accepted. As it happened, apart from a few visits in the
company of the Professor himself, I remained the only representative from
Leeds, and I continued to make visits every two years or so until the reunification
of Germany when the programme stopped. My counterpart in Leipzig was Dr
(now Professor) Helmut Willgerodt. He, too, apart from an occasional visit
from the head of his department, Professor Wolfgang Braun, was their only
representative to come to Leeds, and that with rather less frequency than
my visits to Leipzig.
The driving force behind the visits was “collaboration” –
a useful euphemistic word! This was the research component of our time together.
In fact that was exclusively with Helmut who worked in the same paediatric
speciality field as I did, namely Endocrinology and Growth. The first visit
was around a conference entitled “Wachstum und Entwicklung”
– two words whose meaning I have not forgotten! Helmut and I spent
many happy hours together, ploughing through case notes of the patients
we had looked after in our respective hospitals, and either comparing the
outcome of our regimes of treatment or pooling the data for rare conditions
to get a series with larger patient numbers. Progress was, of course, slow,
as we only met about once a year, but it seemed worth while, and we were
proud to have had published a few articles, notably one in the English Paediatrics
Journal Archives of Disease in Childhood entitled “Growth in thyrotoxicosis”
– a relatively rare condition in children. The remainder of my time
was spent shadowing other consultants on their ward rounds or in their clinics,
notably those with Helmut, and attending the numerous department meetings
– little of which I understood.
As with any Centre, standards were variable, but my overall impression was
very favourable. The staff were knowledgeable and well read and conscientious
and hard working. The day was long, starting early about 8 am, though finishing
rather earlier than I was wont to in Leeds – about 4-5 pm. The atmosphere
was friendly and respectful, and the attitude of junior staff and nurses
and other ancillary services was impressive and reminiscent of the “good
old days” (may I be forgiven!) in England which, sadly, are gone for
ever. I was particularly impressed by the nursing charts on the wards which
were completed for every patient in the minutest and almost obsessional
detail and kept updated, and with observations that were frequent, reliable
and accurate. It was possible on referral to these to know with confidence
every detail of a child’s progress and treatment, and they were clear
and readable.
I have never come across such ideal monitoring anywhere else – and
so unlike much of our current paperwork which, though more bulky and impressive
looking, conveys little useful information and is difficult to interpret.
In Outpatients, too, in the Leipzig Kinderklinik, documentation
was excellent, though much of the basic observations and recording were
undertaken by the nurses. I got the impression that most of the staff were
of long standing and experience, and certainly did not change frequently.
They knew the quirks of the doctors with whom they had worked very closely
for many years. (I have known such quality of support in the past in England,
but not these days.) On the other hand, there were strange inconsistencies
and a sometimes questionable appropriateness of some undertakings. The children
with growth disorders had a medical photograph taken at almost every attendance,
they had frequent X-Rays which were unnecessary, and I was dubious whether
they were interpreted in the best way, and techniques of measurement, though
consistent, being taken by the same observer, left quite a lot to be desired.
Resources were clearly deficient and equipment archaic, yet within these
limitations the standards were outstanding. Helmut ran the chemical pathology
labs, and the methods were extremely outdated, lacking automation (which
has of course ultimately arrived with the West). I remember my astonishment
– throughout the time of my visits while still the DDR – that
blood samples for testing were taken by the consultant in clinic using a
needle directly into the vein and letting the blood drip out into a container.
There were no sterile syringes. Technically these doctors were highly expert!
Standards of treatment varied, depending on the quality of the medicaments
that were available. In my own field with the use of Growth Hormone, the
preparation they used was of poor quality and their results very inferior
to ours. This proved quite an embarrassment to me when we compared the outcome
of our regimes. Yet in some areas with simpler, cheaper forms of treatment
such as for thyroid disorders (of which they have a far higher incidence
than we do) the quality of outcome was excellent.
Parents and children were treated very politely but they were far less demanding
and far more accepting – and the concept of litigation just did not
exist: oh what joy! This was, however, associated with certain standards
that were accepted without question there, but which would be unacceptable
to us – such as restricted visiting and long waiting times. However,
the service they received when they saw the doctor seemed to make waiting
worthwhile. This was a referral centre so, though many patients were from
Leipzig, many also came from a considerable distance.
I like to think that our departments proved to have one of the most effective
collaborative associations of this kind – due to a large extent to
the extraordinarily cordial relationship that was built up with my counterpart
in Leipzig, Helmut Willgerodt (he is due to retire at 65 in 2001). Since
the Wall came down, our inter-university link has stopped, but I have been
back three times – once to the celebrations of the 100 years of the
Kinderklinik, once for Helmut’s 60th birthday celebrations
and, most recently, at my own instigation. There is no doubt that the key
to my enjoyment and the success of the collaboration has fundamentally depended
on the individual personalities whom I have known.
Mainly
personal:
On his visits to England Helmut was always obliged to travel by air, but
I was able to choose the overland route to the DDR by rail, which was
far more interesting and exciting – but rather frightening for an
inexperienced traveller who had never before been to Germany and never
behind the Iron Curtain. The experiences at the frontier were dramatic
indeed. The artificial ostentation of wealth and comfort displayed right
up to the border station on the West, where colours were bright, contrasted
with the grim greyness and discomfort of the East. With my ignorance of
German I developed various ploys to facilitate my entry to the East, such
as conspicuously studying my elementary German Grammar book and using
the phrase ‘auf Einladung’ which seemed to minimise
my cross-examination and, in particular, with regard to the finances!
I also learnt that to go from West to East at night by sleeper resulted
in a much quicker and gentler transition – and that was the way
I invariably chose after the initial visits, arriving in Leipzig at about
9am, tired but tolerably relaxed.
When I visited Leipzig with an invitation to contribute to conferences
or a symposium, I was accommodated in a hotel of high standard for the
DDR, but for the majority of the early visits I lived in the University
Guest house in Beethovenstraße, where I was looked after in a very
concerned and comfortable way by Frau Rust, and shared the building with
numerous visitors from other countries. I catered for myself in theory
and occasionally got my own breakfast, but in practice I had nearly all
meals during the day with Helmut in the hospital refectory (with filling,
but basic, unvarying food) and was taken out in the evenings – very
spoilt. In the later visits I stayed in a guest house behind a courtyard
near the Nicolaikirche in the Ritterstraße.
I cannot speak too highly of the way I was always looked after by my Paediatric
colleagues. They were friendly, interested and generous. A few spoke fluent
English, including Helmut, some none at all, but most a smattering –
and a far better smatter than mine! However, over the years I made a little
progress, and they always encouraged my efforts and we had some good laughs!
I was of course aware of the constraints under which they laboured through
the regime, and the great bonuses that accrued for those who were Party
Members. However, being naturally naïve, I did not realise that there
were those among their number who were informers, and I was saddened when
this came to light at the time of Reunification when these individuals
disappeared from the scene.
I was offered wonderful hospitality by the English-speakers, including
meals at their homes or in restaurants and being taken by car to many
places of historical and cultural interest, including Dresden (which I
found particularly harrowing from the effects of wartime devastation –
a reaction which persisted for me on a very recent re-visit), also Weimar,
Erfurt and East Berlin (I never got across to the West !) In view of the
obvious poverty overall in the nation, I was surprised by the relatively
high standard in which these doctors lived. The food was excellent, and
their accommodation adequate and comfortable, though small. This was possibly
due to the unrepresentative company that I kept, though doctors were not
affluent by our standards, but it was more likely due to the fact of the
cheapness (through subsidisation) of essentials such as the basic food
and drink requirements, rents and travel within the city and country by
public transport. Non-essentials were, of course, extremely expensive.
Helmut took me to visit his allotment which is about 30 miles outside
Leipzig and quite sizeable, with a building where he and his wife can
stay overnight. It is, however, too far for frequent visits, and he has,
of course, no garden in town.
The subsequent tragic changes since the Wall came down have been very
evident to me in recent years, in terms of unemployment, mistrust, crime,
drugs (though still only about one sixth of the incidence in the West)
and a great increase in the cost of essentials. On a recent visit I was
struck by the great variation in the quality of the buildings. Many have
been greatly improved with impressive restoration, and there are attractive
new buildings, yet alongside, and sometimes in remarkably close proximity,
there are decrepit, dirty, grey, unpainted, crumbling, boarded-up structures
– even worse than in the days of the DDR. I was informed that few
people now want to rent flats, and many are moving elsewhere due to lack
of jobs. And many who do have work prefer to live outside the city with
houses and gardens of their own. Prices of property have risen catastrophically
and, as a consequence, Helmut cannot afford to live in his previous flat
and has had to move to a smaller one. The population of Leipzig has fallen
from about 600 000 in 1945 to 490 000 now (about 10 000 per year since
Reunification). Before Reunification only old people could go to the West
– as I remember so well from my return train journeys from Leipzig.
Now it is the young ones who move out and the old ones are staying put.
The population mean age is becoming much higher, with a greater proportion
of pensioners, and the death-rate exceeds the birth-rate which has fallen.
This is bad economically for the city.
I felt sympathetic to the feelings of many of the doctors after Reunification,
when the attitude of Western doctors was to treat those from the DDR as
if they were ignorant and inefficient, whereas, in my opinion, that was
far from the truth. For example, I had been impressed by the establishment
of iodine supplementation to foods through the activity of the consultants
– as iodine deficiency was common in many areas of the DDR –
with pleasing reduction in goitre and hypothyroidism. This practice was
stopped with the arrival of the experts from the West, who presumably
thought they knew better.
Despite the friendliness of individuals to me, I was always conscious
of the restriction within their lifestyle and their fear of the regime.
Conversation in public was cautious and limited when it touched on anything
potentially with a political connotation. Things eased a little in the
safer surroundings of the home, depending on who was present. Helmut found
it extremely difficult to relax when he visited us in Leeds and could
not believe that he was not being watched – which he probably was,
even in Leeds. The Russian military presence was everywhere, and clearly
hated by the Germans, though they had to be careful how they expressed
it. Helmut had to present a comprehensive report to the authorities when
he visited abroad, and he learnt not to be too enthusiastic about his
time and research in the UK. By contrast, he had to eulogise and produce
a glowing impression of his “collaboration” on the visits
he made to Moscow which, he confided to me, were a waste of time, as the
Russian standards were abysmal. These visits were almost mandatory –
as, I think, were those he made to Czechoslovakia, though these latter
were of greater value. Russian was a compulsory second language in schools,
but it was clear that most people hated it and avoided its use whenever
possible. I was never sure whether the strict adherence to the law in
the DDR was merely a reflection of the Germanic culture, or the consequence
of subjection! Certainly I found it extremely difficult to wait at pedestrian
crossings till the lights went green even when there were no vehicles
anywhere in sight!
These
visits of mine to Leipzig were highlights in my experience, and a real
bonus for which I feel very honoured and privileged.
Der Gebrauch einer
Sprache führt zu Einsichten, die für Außenstehende fremdartig
und undurchschaubar bleiben. Nur dem Eingeweihten erschließen
sich Wortbedeutungen und sprachetymologische Zusammenhänge. Im
Schaufenster eines Leipziger Friseurs stand ein Schild mit der Aufschrift:
PRIMA
echtes Klettenöl !
DAS BESTE
zum Kletten der Haare !
from:
Leipzigs langes Leben (Leipzig, 1982)
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