My journey from Broadway, 82nd Street, where I was staying, to Winthrop Street in central Brooklyn, where the New York State University hospital is located, took about ninety minutes. The hospital has a special health center, the STAR Clinic, for HIV positive and AIDS patients.

The streets in Brooklyn looked so different: lots of small, nondescript shops and street stands – a striking contrast to the lavish window displays I had been admiring only two hours before in Manhattan.

On the street corners, blue flags bearing the logo, "We believe in Brooklyn" were fluttering in the wind. The air was already hot and humid, and I was surprised by the strong, sweet smell, which became more and more intense as I went down the street. It took me a few more days before I realized that there was a rubbish incineration plant close to the clinic.

The directions on my slip of paper helped me to find the right street and a gigantic hospital quickly and with no trouble at all. Inside it looked so shabby and gloomy, and it took me while to realize that I'd got the right street, but the wrong clinic. 

I found myself in Kings County Hospital, just across the road from the Downstate Medical Center, the university hospital where I would be doing my clinical training. Anyone who isn't insured and doesn't have any money is given basic medical treatment, paid for by the state, at Kings County. The hospital has its own 'prison ward,' where imprisoned patients, their ankles chained to the bed, receive medical care. And, in fact, I had come across something that we don't have in Germany: a hospital for the poor. Countless homeless people live on the streets between the hospitals, and many of these people's faces would become familiar to me and greet me in a friendly manner each morning during the weeks to come.

For the time being, however, all I knew about Kings County was that there was definitely no STAR Clinic there. A week later I would spend three afternoons there and have an opportunity to get to know it much better. This experience would be worth a report of its own!

To return to my first morning: after this slight confusion was past, I finally became acquainted with the ward where I would be spending the next five weeks. It is divided into an inpatients' and an outpatients' department. The latter is also involved in a research project studying the transmission of HIV from mothers to children. Apart from receiving medical treatment, the patients are also cared for by social workers, a psychiatrist, a drugs and nutrition counselor.

When I arrived I was given a hearty welcome, people asked me about my journey and I was introduced to members of staff working in all fields. The senior physician took the trouble to briefly inform me about the various fields in which the individual staff members worked and to ask me what I was expecting and hoped to gain from my clinical training. I decided to take advantage of the opportunity to spend the first few days observing people working in all the fields, and attend the library in the afternoons to acquire the theoretical bases for my specific field: examining patients' intake of medicines and motivating patients to be compliant.

This gave me a chance to spend two days with the psychiatrist and form an initial impression of patients' strategies for dealing with their situation. Many of them suffered from depression and disturbed sleep, others from psychoses. Patients free from psychological disturbances also had routine psychiatric examinations.

The following day with the social workers was the most chaotic so far. Uninsured mothers turned up with their children, bringing with them unpaid bills. I rapidly lost track of what was going on in the ensuing battle against bureaucratic obstacles, quickly slipping into the role of babysitter. That afternoon my white coat was black from the children's dusty shoes and I was bathed in sweat, but happy.

I spent the last two days of my first week with the senior physician. I not only participated in an advanced training scheme for nurses and in consultant visits to a number of other wards, but also learned how the patients are given medical advice and care. The staff there is friendly but firm towards the patients. If patients are late for appointments, their appointments are cancelled and new ones have to be made. Rules must be obeyed. I was told that many of these patients need these structures, otherwise they simply wouldn't come or wouldn't take the treatment seriously. The first Friday ended with a talk with the senior physician on combination therapies, dosage intervals and the conditions for ingesting medicines. He decided to let me begin the compliance talks the following Monday.

I now had a week of impressions and experiences behind me, and before me my first weekend in New York. I traveled from Chinatown to Little Italy, from East Village back to upper West End Manhattan and walked aimlessly back and forth, wherever the mood took me, knocked out by all the hustle and bustle, the noises and the visual impressions I received.

The talks during my second week at work were a learning experience in themselves. There was one thing I wasn't prepared for, and that was the slang, the typical Brooklyn slang. It had very little in common with the English I had learned at school, and sometimes discussions would end up in laughter. I don't know how often I was asked where Germany was and whether I wouldn't like to stay in America. 

The greater part of the patients endeavored to be compliant, listened patiently while everything about medicine concentrations in their blood was explained to them, and promised to observe the time intervals for ingesting their medicines too. The rest of the patients were difficult to deal with for a number of reasons: they didn't take their medicine at all, or only very irregularly, or else they took the wrong concentrations in the wrong combinations at the wrong time of day. In these cases, I found my work meaningful and rewarding, because some patients really did understand and showed an interest in improving the therapy.

I enjoyed this work, but even so a few organizational problems arose during the course of the week. Some of the doctors forgot to send patients to me, and I often found I had no room to work in. 

Consequently, I took advantage of my free time to visit the ward doctor's treatment room as often as possible. There I heard some truly remarkable life histories and listened to the patients relating their problems and fears.

Dr. Burnley found time for all of them, explaining things, calming people down and consoling them. I was allowed to participate in the physical examinations and assisted in doing preventive gynecological examinations. 

Finally, it was decided that I should conduct talks with the patients twice a week. On these days there was a room spare. During the rest of the week I was to work with Dr. Burnley.

That was a good solution, and one that everyone was happy with.

I now remember my journey as series of colorful and lively experiences. And to conclude, I would like to extend my deepest gratitude to you--the IPPNW!
 
 

Am Montag begann meine Famulatur im Cambridge Hospital. Ich besorgte mir meinen Lichtbildausweis, mit dem ich in alle Räume des Krankenhauses kam. In der Frühbesprechung der Residents um sieben Uhr wurde ich allen vorgestellt und meinem Resident Jeffrey zugewiesen. Ich wurde Subintern auf der Inneren Station "fourth west" in einem Team, bestehend aus einem Resident, zwei Interns (Laura and Jasmin), zwei Pharmazeutinnen. Jeder Intern war für 8 PatientInnen zuständig. Der Tag für die Interns begann um 7 Uhr mit dem Durchsehen der Patientenbefunde. Um 8 Uhr war Übergabe, in dem die Nachtwache die eingelieferten Patienten im morning report vorstellte. Danach begann der eigentliche report, in dem die Interns dem Resident und einer Nurse über die Fortschritte ihrer Patienten berichteten. Das dauerte bis 10:30 Uhr, denn zwischendrin wurden einzelne Patienten in einer lockeren Visite besucht. Um 11:00 Uhr begann das teaching des besuchenden Arztes, das bis 12:00 Uhr dauerte und in dem man einzelne Patienten und Krankheitsbilder besprach. Jeder musste vorbereitet sein, denn man sollte etwas zu den einzelnen Krankheiten sagen können. Um 12:30 Uhr wurde in der Mittagskonferenz ein allgemeiner Vortrag zu einem medizinischen Thema gehalten. Am Nachmittag wurden Therapiepläne besprochen, andere Ärzte konsultiert und Neuaufnahmen im emergency room getätigt. Es gab eine kleine Bibliothek, in der ich gut einzelne Krankheiten nachlesen und mich vorbereiten konnte.

Die Mediziner hier waren richtige work-aholics, gönnten sich nie eine Pause, während sie aßen, schreiben sie noch oder nehmen an irgendeiner Konferenz teil. Oder alles drei zusammen. Bis jetzt ist das der eigentliche Unterschied, der mir auffällt. Ein bisschen praktischer am Bett, aber lange nicht so wie erwartet, und ansonsten vor allem groß darin zu organisieren, zu telefonieren, endlos und immer freundlich dabei zu bleiben. Nun, wenn das den Mediziner ausmacht... Ich auf jeden Fall möchte nicht in dieser Hektik leben. Laura Duncan, die Intern, mit der ich hier am meisten zu tun habe, ist sehr nett und interessant. Sie ist sehr fleissig und gleichzeitig schafft sie es, immer höflich zu bleiben, und nicht nur das, sie ist sogar zuvorkommend! Ich frage mich, wie sie das macht und woher sie die Kraft nimmt. Sie überlegt sogar noch, was ich machen könnte, obwohl ich eigentlich ganz zufrieden mit meinem Status bin. Zur Zeit ist sie a workaholic. Das ist so schlimm, dass man schon weiß, man braucht gar nicht zu fragen, ob man sich in der Freizeit sieht, weil de facto fast keine Freizeit vorhanden ist. - Auch das Team im Krankenhaus schweißte mehr und mehr zusammen, sie kamen sich näher und hatten mehr Spaß. Traurig machte mich nur eins: ich hatte das Gefühl, im Vergleich zu Amerika ist die Ausbildung in Deutschland beschissen. Und da ich ja nicht lange blieb, sondern meine eigentliche Ausbildung in Deutschland fortsetzte, konnte mir das ja nur Deutschland noch weiter vermiesen. Aber - soviel Erfahrung hatte ich ja auch noch nicht, und vielleicht war Deutschland ja auch gar nicht so schlimm. Woran liegt es, dass USA soviel besser ist? Ganz einfach: hier gab es Ärzte, die fast nur ins KHS kamen, um zu teachen. Das ist eigentlich das ganze Geheimnis. Da man das Gefühl hat, denen ist daran gelegen, einem etwas beizubringen, schwindet auch die Angst, überhaupt eine Frage zu stellen, weil man stört ja nur. Hier ist alles freundlich. Fast ein Paradies für Mediziner: Die Ärzte arbeiten in Teams, man hilft sich untereinander, kann jederzeit jeden fragen, die Schwestern sind supernett und alle sind freundlich und höflich zu einander. So sollte es sein! Endlich mal ein Positivbeispiel.

Mein Praktikum beim IPPNW Central Office war eine gelungene Zeit, in der ich für andere Medizinstudenten Texte und Material über IPPNW und Öffentlichkeitsarbeit zusammenstellte und Kontakte zu anderen Studenten in Indien, Südamerika, Ägypten und China suchte. Das Team ist sehr nett und es hat Freude gemacht, jeden Tag in der ruhigen Umgebung des Office zu arbeiten. George Bush war in der Stadt und dafür sind wir auf eine kleine feine Demo gegangen. Die, die da waren, waren richtig schön anti, radikal und fantasievoll. Mit Trompeten, Verkleidungen und Plakaten gegen Bush Politik, der zu einem Fundraising für einen political leader nach Boston gekommen war. Du zahlst 5000 Dollar Eintritt, schon kannst du am Mittagessen teilnehmen. Ich wundere mich immer wieder, wie viel leichter die Leute hier auf einen zukommen und mit einem ins Gespräch kommen wollen. Besonders mit Allison und Brian habe ich viel zusammengearbeitet und diskutiert. Mit einem warmen Gefühl erinnere ich die ganze staff von IPPNW: Allison und Brian, Michael, John, Lynn, Mehdi und Dough, und Anca.