Germany : the best country in the Western Europe? ; A perspective from an Indonesian

First of all, this is obviously only one opinion from an Indonesia guy. It wont affect any rank or any statistic regarding which country is the greatest,the most powerful,the richest or the best in The Western Europe. It was only my personal opinion toward this country : Germany. 

I stayed in Germany in the late Winter and Spring 2012. I worked as a Famulant ( German: junior doctor/clinical student) in Universitaetsklinikum Essen, North-Rhine Westfalen. I shared Wohnung ( German : flat/apartment) with a German doctor and a German student. I've visited not only the big cities like Berlin,Munchen,or Frankfurt, bu also suburban area and small cities like Aachen,Lübeck,ect. I was also very fortunate to be able to be invited by Native conservative German family to celebrate Easter ( their big holiday) during that time. Hence, I consider that I've already had some experiences and perspectives about the real Germany and how the people actually lives. I've already also traveled to and stayed in several countries in Europe ( France, Belgium, Netherland, United Kingdom and Austria) to be a comparison.

Dont get me wrong. I wrote this without any intention to make other countries less than Germany. I was raised with British pop cultures influences, Paris will always be my favourite city (till now), and I always ordain Salzburg,Austria as the most romantic city in Europe. And Clearly, it is only my opinion without referred to reliable sources. I do not know in statistics whether Germany's performance is better than any others country in Europe or not, but for me, Germany is my favourite country. Well,I guess, because their NAZI history ( Deutschland uber Alles!), they are inclined to not mentioning their achievements and proclaiming their country to be the best ( though I believe they noticed that their country is one of the most powerful in the world). But,there are several point that makes me pondering that Germany is one of ( If we can not say the most) the best countries in Europe (or particularly in Western region).

1. Public Transportation

Are you familiar with DB (Deutsche Bahn)? ICE or RE? U bahn or S bahn? Yes.and I was always amazed with Germany's national public transportation system.

So what is the differences? England already has National Express and Nationalrail or Britrail and they're quite good. France has TGV ( fastest train) and it is obviously excellent. Netherland has its Nederlandse Spoorwegen (NS). All of them are great. But What I was amazed from Germany in comparison to other countries is, the system is really and extremely integrated into one national system with same high standard with (almost) similar terms and conditions. There is only very slight distinction among 16 states (Germany is federal country), but overall it is similar whether you are in Kiel,Aachen,Frankfurt,Stuttgart,or Dresden. The choice is always ICE or RE ( city to city)? S bahn, U bahn,or bus (inter city) ? With same sign,same rules,same prices. Their train system unites Germany and connects every cities there. This integrated national system is notably very helpful for foreigner like me because it is easy to understand. You dont have to hire a guide, purchase a travel agent packages, if you want to travel in Germany. You dont have to confuse about choosing which modality or which kind of bus you take because it is similar in every part of Germany. You dont have to read many terms and conditions. The great thing about germany, is the goverment are clearly invested massively for public transportation and take lead. private sector were not really involved in this bussiness so there is no unnecessary competition and the price for public transportation is very affordable. Another great thing, The timetable for every public transportation in Germany are precisely very punctual and can be accessed on the internet. You can save alot of time.

I also love the concept of one-stop-services of "hauptbahnhof" (main central station) where every modalities transportation ( bus,train,taxi,subway) station are located into one spot (usually in city centre/touristic site and with so many shops/mall/hotel/parkinglot there).the hauptbahnhof are usually located in downtown, so it is quite easy to hang around. 

If you want to reduce your costs for transportation during traveling in Germany, you can always share ticket with Gruppen ticket, or traveling during weekend, or have experience of "Mitfahrengelenheit" (you rode in with stranger car but only pay for the shared cost of petrol)

2. People, Languange and Living Cost

"Was ist der typisch Deutsch? 1.Ordnung 2.Pünktlichkeit 3.Diszipliniert 4.Kalt 5.Unnahbar"

What's typical German? 1.Everything in order 2.punctuality 3.Discipline 4.Cold 5.unapproachable

Those are some stereotypes for German people. But like every other stereotypes, sometimes it's right, sometimes it's wrong. But from my experiences, German people are (more or less) is nice people.I particularly amazed with their attention with details. Just try to ask something (even just casual question like a direction to a street that you dont know) and they will give you every detail. They will draw you sketch and everything, and it is exquisite how crazy they are for detail.
About the Language. Ok, German is hard. Even when you already studied German in high school (like me), but when you speak with native German, you hardly understand what they actually talk. But the good news is most of them can speak English, and WILLING to speak English. They tend to accept that English is our lingua franca in this world ( because the history of British Empire) and wont force foreigner to speak German (though preferably if you could speak in German, it is a great plus). It is not like when I was in Paris, and there is a man who forced me to speak French "this is Paris, this is not London.Please speak French". But,still I Love Paris :D

Living cost.This is what I like from Germany, the living costs are ridiculously cheap in comparison with others developed country. You can buy Döner (Turkish-German hamburger) for 3-4 euros (3,5-4,5 dollars) and for Asian like me, the portion of one Döner is for two portion meals. During my night shift in hospital, I usually eat half Döner for dinner and eat another half for breakfast. For students, there is semester ticket which you can purchased for 200euros/terms and it is valid for almost every transportation in whole area of the state (you can imagine, like in Northrhine westfalen, you could travel from Aachen to Dusseldorf,from Essen to Münster). To be a comparison. DAAD (Deutsche Akademischer Austauch Dienst/ German Academic Exchange services) gives annual scholarship for scholars with 750euros/month. It is sufficiently enough for living cost in whole parts of Germany, But UKBA (United Kingdom Border Agency) will only issued UK Tier 4 visa (student visa) if the applicant showed there is a financial ability to support them 1.000 poundsterling/month (outside london) and 1200pounds/month for London. 750 euros compare with 1000poundsfor living cost, you see the difference,right?

One of my friends from Jakarta who studied Engineering in Essen Germany told me that his living cost in Essen were lower than his cost in Jakarta,Indonesia. gobsmacked? Yeah, I am.

3.Education

 Education is one of great points for Germany. They offer very high standard of education for FREE. There are several states in germany who charge a little tuition fee but still it is quite cheap. No matter you are native,local, foreigner, white,black,asian,atheist,muslim,christian, but as long as you want to learn and pass the exam, then you got education as high as you want and you can. This affordability would not reduce their standard, in fact their universities were still in highest rank in the best world university.

The affordability of German Education attracts so many students around the world including Indonesians. In Germany, it easy to find Indonesian students (another great point). Germany is different with some fellas in western europe who charged foreign student very greedy like " Ok, you are from third world country and want to study abroad,you must be INSANELY rich. Let's suck your money and bank deposit"

5. Cultures

France are very well known for French Food (and also...french kiss). British? Ok, Dont ask me about British cultures,because I am so infatuated with Brits! And when Britons speak with their accent as well. Germany Cultures are less popular than Germany BMW or German team soccer but they do have great culture!"pommes und currywurst" would not beat the popularity of "Boeuf bourguignon" and they will not ever beat English for their accent but Germany has another thing to explore.

I recalled when I visited Bayern (Bavaria) I see alot of native german cultures there. I was invited to Easter tradition celebration in Munchen with my friend (Native German) and it was very exciting! and then I realized, Germany is very rich for their cultures. And we should remember in the early days, English and Dutch are actually German inherited. With the Prussian Empire and Old Romanic Empire history in Germany, we could see, this nation has already went through hardship and another hardship before they achieved like these days.

And there are so many points why I love this country. From Germany, I could learn some lessons how to develop your country (remember, Germany starts from a scratch after World War II) and with their perseverance, they become one of the remarkable developed countries in the world. Such a great Job!And now, after I leave this country, there is always a piece of my heart that I already left in Germany. Ich hab mein Herz in Deutschland verlosen! And (if I could), I defenitely will come back someday to this country to make such a sweet-walk-to-remember!

Ich immer vermisse Deutschland!

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So long 2013 !

Praise the Lord for giving me -literally- the best year ever!

If we thought about every single moments which had already ensued during this year, Most of people in my class (Batch 2007/Class 2013) would profoundly agree : 2013 was remarkable. Reminiscing every great moments in 2013 :
- Year of graduation - Now,everyone officially calls you "Doc,...." -
- Year of vowing The Hippocratic Oath - The Oath that we hold until we demise, our ethical orders in every parts of our career -
- Year of passing Medical license's National Exam ( CBT and OSCE!)
- Year of starting the compulsory Internship(so-called-obligatory-community-services) year - a first milestone of our medical career, and this year is the first year that government raised our salary, isnt that great? -

For me, this year started with much hurdles. I lost my old rusty motorcycle. it is exquisitely old, so for some people who might get in the same shoes with me, perhaps they won't get bothered and simply just buy a new motorcycle or car. but for me, it has accompanied me during my hardest and finest time during my clerkship, so it brought so much memories. And also, since I took Elective in Germany last year, so I had tight schedule in order to catch up, hence I could graduate in similar time with most pupils in my class. well, dont ask me about my endeavour for that, I know I am not the brightest one,nor the luckiest, nor the most dilligent one, but I know the power of persistence and perseverance ;) . And modestly speaking, I learned that it is very necessary to plan every things accordingly and precisely. I consider : planning is part of making your dreams come true.

But this year also excruciatingly took me to another level of experience. Doing new and unexpected things would gladly gave so many perspectives. Bacpacking to Bali and Cirebon without any previous plan (decided 3 hours before flight) or any proper amount of clothes was crazy thing to do, but it was fun to travel spontaneously! Visiting so many places, not only common touristic places (London,Dubai,Oxford/Cambridge,or Scotland maybe?) but also the mundane places ( Bath, Stonehedge, Exeter,Devon or Truro,Cornwall), taught me about different culture and different people's way of life. Meeting new people from every parts of the world in The University of Oxford, Joining their eldest fraternity in medicine and academic, was a precious experience. And eventually, starting my internship year in Pariaman with great team and supervisor was such a blessing from Allah SWT

And I mulled every things above, and I decide,Ok...this year was splendid!

Well, there's still a dissapointment in my 2013 resolutions . I cancelled my Master (S-2) Application to Oxford this year. After pondering every possibilities and weighing on the pros and the cons very thoroughly, I decided it is better if I gave myself one year more to getting more working experiences and mulling everything again and again what I really want to do in my life. After all, the procrastination will not give me any further harm, beside,I am not in hurry,right?

But, I indoubtedly decide, 2013 is IMPECCABLE !

Thanks for everyone who already helped me to make it happen!

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Kriminalisasi Dokter

" Medicine is a science of uncertainty and an art of probability"

Begitulah pesan yang disampaikan oleh Sir William Osler - Dokter pendiri John Hopskin Medical School/Hospital,USA dan juga guru besar University of Oxford Medical School,UK - kepada para dokter seluruh dunia. Pesan itu bermakna bahwa ilmu kedokteran adalah sebuah ilmu dimana semua probabilitas dan kemungkinan bisa terjadi. Pesan ini mengingatkan kita bahwa Dokter bukan Tuhan, dan bahkan - walaupun sekarang - kita bisa membuat bayi tabung dan kloningan, memindahkan embrio ke rahim orang lain, dll, tapi masih banyak hal yang belum kita ketahui tentang tubuh manusia. Dan bahkan dengan pengobatan dan terapi secanggih apapun, atau menjalani guidelines yang paling precisely sekalipun, kematian pasien bisa sewaktu-waktu dokter hadapi. Seterampil dan seteliti apapun kita bekerja, adverse event sewaktu-waktu bisa datang.

Ada hal yang aneh ketika seorang dokter dituntut dengan tuduhan "malpraktek" ketika pasien meninggal walau sang dokter sudah mengobati pasien sesuai kapasitas dan kemampuannya yang paling maksimal. Baru-baru ini, dunia kedokteran dihebohkan oleh ditangkapnya dr.Ayu dkk di Manado atas tuduhan "malpraktik". dr Ayu ditangkap dengan tuduhan kelalaian sehingga menyebabkan seorang pasien ibu hamil yang baru dilakukan operasi, meninggal. Setelah dilihat, bahwa ternyata pasien itu mengalami emboli ketuban pasca operasi, yaitu suatu resiko setelah operasi yaitu terjadinya penggumpalan darah sehingga menyebabkan kematian pasien. Hal ini sangat jarang terjadi dan bahkan seorang ahli kedokteran yang paling mumpuni sekalipun tidak bisa memprediksi hal tersebut. Ini bisa terjadi kapan saja, dimana saja, di Manado, di Padang, di Jakarta, bahkan di luar negeri sekalipun.

Saya ingat saya pernah menyaksikan secara langsung kasus tersebut ketika saya menjalani night shift di Women Centre di John Radcliffe Hospital, Oxford,UK. Waktu itu pasien baru saja menjalani operasi Sectio Caesarian , dan tiba-tiba kondisi pasien memburuk. Waktu itu memang pasien memang berhasil diselamatkan ketika pasien langsung diperiksa CT pulmonary angiography (yang saya tidak yakin selalui available di Rumah sakit Umum di Indonesia) dan ditemukan embolus di paru nya. Tapi saya ingin saya tekankan, bahkan dengan standar pencegahan paling tinggi sekalipun ( Oxford University Hospital selalu melakukan deep vein thrombosis prevention dan sesuai WHO surgery check list), tetapi kasus ini tetap terjadi.

Para penuntut mengatakan bahwa Dr.Ayu seharusnya melakukan semua prosedur pemeriksaan sperti rontgen toraks, EKG, dll untuk pencegahan. Yang harus diingatkan bahwa kasus obstetri (kehamilan) adalah kasus emergensi dimana setiap detik berharga bagi keselamatan bayi dan ibu. Seorang dokter harus bertindak sangat cepat. dan saya ingatkan kembali, bahkan dengan pertimbangan, persiapan, dan pencegahan yang paling cermat sekalipun, kematian pasien bisa terjadi.

Terkadang dalam hati saya selalu berkata " Andaikan saja para "oknum" pengacara dan para wartawan yang suka menyudutkan para dokter, bisa merasakan SATU HARI SAJA menjadi dokter, maka akan mereka terdiam dan tidak sanggup untuk menuntut dokter". Bagaimana para dokter harus mengambil keputusan secepat kilat dalam suatu keadaan yang sangat darurat dan kemungkinan terburuk dari keputusan ini adalah hilangnya nyawa seorang manusia. Harusnya mereka merasakan "adrenaline rush" itu sehari saja, dan bisa lebih berEMPATI dengan para dokter, dan tidak hanya berusaha mencari-cari kesalahan dokter.

" Tidak ada satupun dokter yang berniat mematikan pasiennya". Untuk apa kami -para dokter- melalaikan tugas kami, jika ancaman dari kelalaian kami adalah kematian manusia. Seharusnya para petinggi hukum melihat Dokter bukan sebagai montir . Tidak seperti montir yang kita nilai adalah hasilnya (apakah mobil kita kembali baik apa tidak) , Dokter seharusnya dinilai berdasarkan prosesnya ( bagaimana proses tatalaksana pasien), bukan berdasarkan hasilnya (Mati atau tidak). Ingat ! ada campur tangan Tuhan dalam setiap kehidupan dan kematian manusia !

Lalu Kenapa kasus Dr. Ayu ini menjadi sesuatu yang krusial untuk kita ?

untuk para dokter - tentu saja - merupakan hal yang sangat krusial. Karena untuk pertama kalinya dalam sejarah dunia kedokteran Indonesia (dan dunia) , seorang dokter bisa DIPIDANAKAN (berarti masuk dalam ranah kriminal) karena kematian pasien. Hal ini bisa sangat fatal bagi kinerja kita ke depannya, karena apabila Mahkamah Agung (MA) menjatuhkan sanksi terhadap dr Ayu, maka ini akan menjadi yurisprudensi , yang menjadi dasar hukum sah kedepannya bagi sesorang untuk memenjarakan dokter jika pasien kita meninggal. Keputusan MA ini akan menjadi senjata ampuh bagi oknum untuk memeras dokter. Jika ini terjadi, jangan heran jika kedepannya, para polisi akan datang ke tempat praktek kita dan meringkus kita ke penjara.

Buat Masyarakat, hal ini juga tentu sangat krusial. Jika memang keputusan MA ini dijatuhkan. Maka akan terjadi defense mechanism besar-besaran oleh para dokter. Semua dokter akan menolak untuk melakukan tindakan emergensi karena takut untuk dipenjara apabila pasiennya meninggal (Siapa yang mau dipenjara untuk hal yang tidak bisa kita kendalikan seperti kematian manusia? ). dan pada akhirnya walau pasien itu bisa meyakinkan dokter setelah memohon-mohon, pasien itu harus menjalani semua pemeriksaan yang penting maupun tidak penting dalam keadaan emergensi, hanya karena sang dokter terlalu "paranoid", yang tentu akan menaikkan cost dari pengobatan tersebut. belum lagi hilangnya waktu berharga hanya untuk pemeriksaan yang tidak penting tersebut. Sebuah kerugian besar bagi masyarakat dan pemerintah

Kasus dr. Ayu bukan hanya masalah medis, ataupun hukum. tetapi ad
alah masalah kemanusiaan yang semua orang patut untuk memperhatikannya

* Tulisan ini adalah sebuah dukungan dari salah satu teman sejawat dari Sumatera Barat untuk dr.Ayu.dkk

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Oliver Twist

Baru baca novel Oliver Twist karya Charles Dickens

Novel klasik ini ditulis Charles Dickens pada abad ke-19 ketika masa2 revolusi Industri Inggris sedang berlangsung. Saat itu negara Inggris masih kalah maju dibanding Portugis dan Spanyol.

Di novel ini diceritakan bagaimana miskinnya rakyat Inggris di zaman dulu, dan bagaimana besarnya disparitas ekonomi antara bangsawan Inggris/politikus dibanding masyarakat Inggris kebanyakan

Dan kita ingat sekarang, Inggris merupakan negara adidaya di muka bumi, mungkin kita tidak menyangka bahwa zaman dahulu negara ini pernah menjadi negara miskin

Membaca novel ini,mengingatkan kita akan kondisi Indonesia zaman sekarang,terutama ketimpangan ekonomi.tpi entah kenapa, saya menjadi optimis, bahkan bangsa Inggris prnah menjalani kondisi segetir itu, bisa menjadi bangsa yang makmur. Kenapa Indonesia tidak?

GDP Indonesia saat ini sudah melewati GDP Belanda, bangsa penjajah kita dulu..

I once watched Bloomberg channel in Television and the expert told the outlook that , by 2035, Indonesia's GDP will surpass United Kingdom's GDP....

Di Alquran, dikatakan Allah berfirman bahwa Allah menggilirkan kesejahteraan pada bangsa2 di muka bumi ini...

Mungkin tahun2 berikutnya,kita lah yang menjadi negara adidaya..amin

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A Deathtrap for Doctors

We, Doctors, somehow made our own system nowadays become a "deathtrap" for us.

From the beginning of our medical course, We were always reminded by our predecessors and community that we are : the chosen one. the "GOD" or "GODDESS" - whatever its term - that implies we could do everything. We're genius. We're tough and strong. We're rich. We're professional.

We already passed the hardest exam only to get an opportunity to learn medicine. Either you are genuinely-omniscient or you are extremely prosperous from very-wealthy family (doctor's families, perhaps?) so you can get this highly privilege to get admitted to medical school. 

Then, we busied our self to learn "human". But most of us forgot to learn to become a "human". 

We considered our self as genius. so we considered us we know everything. so we are indeed humiliated to concede that there's something that we simply dont know. and as a human, it is pretty normal to not know something as long as we want to learn further, but No, we doctors. so we try to pretend and hence make or give wrong advice and considerations. and to make it worse, we laughed at those colleagues who admit that they didnt know. 

We considered our self as tough and strong person We made a system from the beginning, that no time for enjoying our own life. Did you remember, when we are in training being a junior doctor (dokter muda) or resident doctor, we forced our own body to work more than 100 hours/weeks and 32 hours-straight night shift twice or 3 times a week in hospital and the rest of hours outside hospital to study. and we forced more more further when we become a consultant, working day and night without thinking even one second that we wasted our precious time. we forgot to workout, to maintain our own body. we forgot to enjoy our once-time life.we buried our-self to make people become healthy, but we forgot to take care our health. and Why did we do that? We pursued of what? 

Perhaps it was due to considering our self as a wealthy people from well-off profession.Nonetheless, Doctors in our community is regarding as one of promising-gleaming-prosperous profession. We are simply rich. But no, in reality, in perspective of finance management, we are terribly poor. What the heck is it when our own medical council and medical school made a system so we have to pass an extremely expensive national exam called UKDI? What the heck is it if we want to re-new our medical license we must collect points (SKP), and in order to do that, we have to join many horrendously overpriced seminars and workshops where inclined mostly to be located in five stars hotel that boost the costs till millions bucks?? What the heck is it we should have ACLS/ATLS which costs almost 3 times our full monthly income as an intern doctor, to apply competitively whatever practical job in both public and private hospital ? What the heck is it we made a residency training as an unpaid job (and forgetting their services in hospital) and disparagingly weigh on that every doctors is rich, therefore 3-4 years without salary, would hardly raise an issue?Why we made those hurdles over us ? Why we make those system? and because everyone thought that we are rich, we bought fancy things ; a car (or some cars), luxurious clothes, ect only to declare we earned money that much. 

Practically, we made systems that suck our money and put us on a nearly poverty. 

Then because those system that I mentioned, we played dirty games with pharmacy (who mostly deliberately kiss our ass in the front, but stabbing our back) so we can afford that. and Man! we called it we are proffesional. 

We blamed Government over our situation nowadays, yes, it is utterly right that Government seems only put healthcare as political attraction rather than consider as an future investment. but deep down, we know, we partly also are responsible for making those system.

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Budaya Membaca

Dalam perjalanan pesawat dari Dubai ke Heathrow Airport,London, saya bersebelahan dengan seorang laki-laki berperawakan tinggi kekar, bertatto. Setelah pesawat take-off dia langsung memesan bir Heineken ke pramugari. Saya langsung berpikir "yah,..gua duduk sebelah preman nih..."

Tapi setelah itu dia mengambil alat elektronik sebesar tablet, dan membaca. Ternyata dia membaca sebuah buku dengan menggunakan pdf reader. Cukup aneh, karena kita tahu di Indonesia, jarang sekali orang bertampang preman membaca buku.

Perjalanan dari Dubai ke London yang memakan waktu 9 jam membuat saya bosan, sehingga saya memulai percakapan dengan penumpang sebelah. Ternyata dia sedang membaca buku "clash of civilization" Samuel Huntington. Sebuah buku yang menurut saya cukup berat untuk dibaca. Dan saya cukup terkesan dengan kemampuan membaca pria ini.

Tapi ternyata pria ini bukan lah satu-satunya orang yang gemar membaca.

Ketika saya naik kereta underground-tube (subway) di London, hampir semua orang di tube sedang membaca buku, apakah dengan pdf reader,atau buku,atau koran. Sangat sedikit saya lihat yang sedang mengobrol. Semuanya membaca. Bahkan sekali saya melihat pada saat bulan puasa,seorang bertampang arab memakai jas layaknya eksekutif muda, sedang membaca Al quran di dalam tube. Bisa kita bandingkan kalau kita naik KRL commuter line di Jakarta, rata-rata orang disana,kalau tidak tidur, pasti mengobrol.

Saya ingat waktu saya kuliah untuk program Elective di Oxford Medical School, hal yang sering didiskusikan oleh teman-teman saya adalah, "buku apa yang sedang kamu baca minggu ini?"

sangat jarang saya mendengar mereka bergosip, seringnya mereka malah saling mendiskusikan buku yang sedang mereka baca dan pendapat mereka tentang buku itu.

Budaya membaca ini mungkin yang membuat kita berbeda dengan negara maju

kadang, kita terlalu heboh bergosip atau eksis di social media mengupdate status sehingga kita lupa memperluas cakrawala dunia dengan membaca buku.

Budaya membaca mungkin akan menjadi kunci bagi kita untuk menjadi salah satu negara maju di dunia

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Next chapter of my life

Another chapter of my life will begin tomorrow....

Let me share this one-year-joyous-internship year with you...
My career as a doctor starts tomorrow..

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