This July I had the amazing opportunity to spend 3 weeks in Kumasi, Ghana, living in a volunteer house with other young adults from all over the world and shadowing doctors at the local government hospital. Tafo government hospital is a relatively small hospital that mainly deals with routine and simple cases from the community, referring more difficult cases to the bigger university hospital. It has a labour, paediatrics, ObGyn, mental health, surgical department, emergency room and wards.
I spent most my time there on the wards (paediatrics, male and NICU) and mainly joined for rounds (discussion of the patients‘ treatment for the next 24h every morning) and new admissions.
In the first week Noa, a first-year medical student from Wales, and I, shadowed a paediatric doctor. We learned about the most common diseases treated on the paediatric ward including malaria which is responsible for the admission of more than half the patients on the ward at any point. As there is currently no Malaria vaccine and the disease is transmitted by mosquitoes found all over Ghana, most children get infected a few times in their childhood before developing immunity. Other common diseases were dehydration and malnutrition, sepsis, pneumonia and gastroenteritis. It was here that we first came into contact with the severe poverty in Ghana. Doctors would not always prescribe the most effective medication but the cheaper, less effective version as there is no centralised insurance, and this financial burden could make a family unable to pay for food.
We spent the second week in the NICU (neonatal intensive care unit) and the paediatric ward. The babies in the NICU often spend a week or more being treated there, so there were far fewer different patients than in the paediatric ward. During this time, we treated babies with hypoglycaemia (low blood sugar) due to a diabetic mother and a baby with a congenial heart condition where the chambers of the heart are connected due to a hole in the separating wall. Here again, the issue of poverty came up. The patient needed open heart surgery which was too expensive. Due to this, they will have to be on medications for the rest of their life. In paediatrics this week, we learned some more hands on skills such as how to take and present a history and perform a chest and abdominal exam; both of which we got to practice on patients. Additionally, we were trusted with writing up the notes, prescriptions and discharges that were discussed during rounds.
The third week was mostly spent on the male ward. A big issue that was highlighted this week is the huge stigma around HIV/ AIDS after a HIV positive man that had not been taking his medication presented to the male ward with severe AIDS symptoms. We tried to educate him on the importance of medication compliance. He was so afraid of losing his social status if someone found out and in denial that he refused to be properly educated. This issue is so big that staff in the hospital don’t talk about HIV/ AIDS but retro virus in order to protect their patients from the consequences of this stigma. We also witnessed a case of GI obstruction (an obstruction of the GI track that inhibits the normal flow of food and other substances through the GI system) and a GI bleed which are fatal if left untreated.
On our last day we had the opportunity to observe an emergency C Section due to the ambilical chord being wrapped around the babies head. This was definitely one of the highlights of my time at the hospital as it is just so interesting to see surgery and such a special moment to see a new life being brought into this world.
Overall, I really enjoyed my time at the hospital, I learned a lot and got several practical experiences, far more than when I previously shadowed doctors in an English hospital. It is however important to mention how bad of a condition the hospital was in compared to western standards. Everything was quite unhygienic as there was no disinfectant on the wards that was used between touching different patients. The wards were a tiny, not very well-ventilated room with 5 patients in beds next to one another. The toilets were completely unhygienic due to a water outage that lasted a few days. In addition to that the hospital was not very well equipped. People got send home with open wounds after car accidents as there were no bandages left in the emergency room. Despite this it has to be said that the doctors were aware of these issues and actively tried to battle them, striving for a better developed health care system.
This poverty could also be seen outside of the hospital. Already, on the 6h bus ride from Accra airport to Kumasi the streets were filled with potholes and many streets especially in the cities were only dirt roads. Living conditions in cities consisted of a lot of either very simple huts or unfinished, half abandoned buildings. In Kumasi, the running water and power for the whole neighbourhood would go of at least twice a day and not come back for up to 5 days. Conditions were even more deprived when we visited a community further north in a rural area that was still living in clay huts and therefore didn’t have any access to running water, electricity or proper health care.
Another significant cultural difference to Germany was the openness and welcoming nature of everyone around us. Everywhere we went we were warmly greeted and welcomed into the community. The native people living in the volunteer house with us instantly treated us like a part of the family and Ebenezer, a PA student from Kumasi we had met at the hospital promptly invited us to join him in the children’s church he runs for a service the next Sunday. This service was about 2 hours long which is quite short by Ghanaian standards where services can last between 4 and 5 hours. This is due to the huge influence of religion in everyday life. Ghana is mostly Christian and Moslem. On every other corner there was someone preaching the bible and a lot of cars and buildings have religious quotes on them.
Another (quite negative) difference is the corruption that exists especially within the police force. When we were going on the interstate roads during weekend trips to Mole National Park and Cape Coast, we would get stopped about once per hour at a police checkpoints to pay them off to be let through. These were some of the only moments in Ghana where I felt genuinely unsafe and scared. All in all, though, everyone felt safe most of the time especially in our neighbourhood in Kumasi.
To summarise, I’ve had an amazing time in Ghana. Not only was my experience at the hospital really eye opening and thought provoking and has massively reinforced my decision to go to medical school massively, but the people in Ghana have created such a welcoming and open community for everyone. Additionally, I got to meet a lot of awesome young adults from all over the world that were living with me in the volunteer house and who were also in Ghana to learn about the culture and help out in the community. I feel extremely privileged to have been able to go on this trip and get a view into a completely different culture and community of people that are a lot less privileged than almost all of us but still try their best to improve the situation in the country to the best of their ability and create a warm and welcoming environment for everyone, even foreigners.
I want to especially thank Dr Richmond Adjei Awuah, a (mainly) paediatrics doctor, for making the time every day to teach us so much and just going out of his way for us for the entire 3 weeks. My stay would not have been as good without him. Thank you.
Carla Hinterding
Recommendations + Tips
I would dearly recommend going to Ghana for your Auslandspraktikum. This have been some of the best weeks of my life. You get to meet some amazing people and get to know a completely different country and culture. At the hospital, you will definitely get to do more hands on than in Germany or other developed countries, though due to cultural differences and the condition of the hospital, you might spend a lot less time overall in the hospital (I was there from 8:30 until 12/2 o’clock). Also, there are other options than medicine such as teaching and childcare which might further your academic education, it will most certainly further your cultural and social one.
The company I did it with is PMGY, though there are many different ones. I think you just have to find the one that fits for you. About PMGY: They were definitely trust worthy and helped me out a ton beforehand for things like the visa (which can be especially tricky for underage people) and what to pack ect. Most things went very smoothly in the volunteer house and I definitely felt safe and taken care of. The one thing I would criticize is that there was not a lot to do in the hospital and Noa and me definitely got lucky for finding Dr Richmond. Others in the hospital had a very different experience and didn’t enjoy their placement as much.
All in all, if you want to go to Ghana for a hospital placement, I am more than happy for Herr Laupitz to give out my number and talk to you in more detail, but I would definitely recommend.
In July 2022, I had the amazing opportunity to do a four-week internship in Accra, Ghana. I lived in a student house with other Germans who were working in Ghana, as well as locals who were helping us with everything. My internship took place in Ridge Hospital.
Ridge Hospital, also called Greater Accra Regional Hospital, is a major hospital located in Osu Accra, Ghana. It has a capacity of 420 beds and a staff of 654. The hospital comprises eight departments: gynaecology, labour ward, emergency room, surgery, paediatrics, psychology, intensive care unit and neonatal intensive care unit.
The location is quite far from the student house I lived in. My colleagues and I either took a Trotro or a Bolt. The latter is a cheap taxi company which is unlikely to fleece you. Trotros, in comparison, are privately owned minibuses that travel fixed routes. They are the most popular means of public transportation in Ghana. While there are Trotro stations indicated by a group of people standing next to the road, these vehicles can be boarded anywhere along the route. My first time taking a Trotro was very confusing due to the fact that the conductor isn’t shouting out the destination clearly. Therefore, it took some time to get used to the system and know which one to take.
During my time at the hospital, I saw and learned a lot. I was assigned to different departments and spent one week each in paediatrics, gynaecology, emergency as well as the neonatal intensive care unit. This way I got an insight into in numerous different departments and gained a considerable amount of medical experience.
I began my internship in the paediatric ward where my trainee doctor took his time and explained every patiently to me. I was allowed to accompany the doctors from the respective ward on their daily medical round where they visit every patient and discuss their case. Here, I learned a lot about illnesses such as stroke and malaria and also learned how to identify trisomy 18 by the looks of a new-born child. In addition, I found out about malnutrition and the symptoms coming with it.
In my second week, I had the chance to visit the gynaecological ward. The first day started off great as I got the chance to witness two c-sections. It was my first time in the operating room. Therefore, seeing all the procedures was really interesting. However, the most special and at the same time scariest moment was the time between a child being born and their first cry. This is due to the fact that this first cry shows whether or not the child’s lungs are healthy.
On my second day I was allowed to be present at a natural childbirth. When we first started our shift in the morning, we were determined to watch a natural childbirth. Unfortunately, we had to wait for several hours, which was worth while. The experience was so emotional for me that I had tears in my eyes by the time the child was born.
I spent my third week in the emergency room. The first half of the week, I was at the ward where patients stay for up to 72 hours. I was able accompany the nurse handing out the medication. She showed me how to change infusions, calculate the number of pills to give and measure blood sugar levels. Another task of mine was checking vital signs like blood pressure, temperature, oxygen saturation and pulse. For the other half of the week, I was at the triage where patients are only staying for up to 24 hours. Here, I wasn’t allowed to do as much as in the ward, but I got to see some highly interesting cases. I learned a lot about illnesses such as diabetes and withdrawal syndrome.
In my final week, I visited the neonatal intensive care unit. This unit provides extra care for premature babies or sick new-borns. The illness the majority of the children suffered from was new-born jaundice. This illness can be identified by a yellow discoloration of their skin or eyes. It can be left untreated in most cases, however if the discoloration isn’t disappearing, the child should be treated with phototherapy. This therapy took place in the neonatal intensive care unit where I had the chance to observe it. Additionally, I followed the doctors for their rounds and saw nurses feed the children or lay a feeding tube.
During my internship, I came in contact with the many problems the Ghanaian health system still has to cope with, one being that there is no general health insurance. Therefore, patients need to pay for almost everything themselves, for example drugs, food, water and surgery. This results in doctors paying more attention to the costs of the treatment. For instance, doctors are sending patients home when there is a sign of improvement in their health. They are paying particular notice to their diet and try to avoid unnecessary testing. Another problem I perceived was the lag of sterility. Even though the Ghanaian doctors and nurses did as much as they can, I still had the feeling that generally, awareness for sterility was missing. Therefore, the Ghanaian standards in that regard were not the same as German standards.
This is just one difference of many between Germany and Ghana. Another one that really stood out to me was that people in Ghana in most cases were very welcoming, friendly and always willing to help. One time I was lost at a bus station and didn’t know which bus was the right one to take. Immediately people came up to me and helped me to find the right bus. I also felt very save in Ghana and never found myself in a situation where I was concerned about my safety. To be fair, I didn’t risk anything and was never out alone at night. For me, this proved the people wrong who told me that Africa was scary and dangerous.
In contrast to these warnings, my internship showed me the beauty of Ghana. After work we were able to explore the city Accra. We visited markets or the beach. At the weekends we went on trips to see more of the country. I visited the Wli waterfalls and did a hike with a local guide who explained everything about the jungle, the animals and the nature there. During this hike I ate the best pineapple of my life, straight from the bush and even walked on the ground of the neighbouring country Togo. I spent my last weekend in Ada Foah, a small village located at the beach. We did boat tours, went swimming in the sea and slept with the sound of the waves. Ada truly felt like paradise. Overall, I had a wonderful time in Ghana. I am unbelievable grateful for the time I was able to spend there and the things I learned, not only about medicine but also about the Ghanaian culture. This internship definitely changed me and put my views and values into perspective.
I arrived in Chicago on 3rd July and was picked up by my aunt for a two-hour drive to Milwaukee. The Medical College of Wisconsin is located in Milwaukee and this was the location where I would be doing my international internship as a part of the TUMKolleg. My aunt has been working in the Bioengineering Department of the college for several years and gave me the great opportunity to work with this Department for three weeks. I got the chance to be part of the Team in the NRF (Neurosciences Research Facilities) that is responsible for conducting crash tests with dummies and PMHS (short for postmortem human specimens, essentially bodies that have been donated to science for experiments like crash tests). During my three weeks, I was part of three different research projects.
CMM
The first project I was involved in used a sled that could be accelerated to 50 km/h within 0.2 seconds to simulate a car crash into a wall with up to 30G. This project has been issued with the background of autonomous driving, where passengers are believed to be positioned more horizontally for added comfort. That position raised the question if current seat belt standards could still meet the required safety level, or if an effect called “submarining” would occur. Submarining essentially means the passenger sliding under the seat belt during the event of a frontal crash, thus resulting in a more dangerous position. For this test, a PMHS had to be fitted with tilt sensors which were directly mounted onto the spine and other bones of the body. I had the chance to watch the body being prepared with the sensors and to assist the team with setting up the sled. After learning about the functionalities of the motion-capturing system they were using, I got the chance to apply this knowledge while preparing the system together with the team. The acquired data, together with the tilt sensors, could be used to calculate the movement and rotation of the spine and other body parts during the crash. High-speed cameras also allowed a slow-motion replay. Additionally, a CMM (coordinates-measurement machine) was used to perform a 3D scan of the body before the test.
The second and longest project of my stay at the Medical College also involved the crash sled, but this time a dummy was used instead of a PMHS. Since we performed multiple test runs in this project, it was easier to use a dummy throughout all the tests than to set up a new body all over again. This meant that we had to dismount the previous test setup and put the dummy set up together. This took a few days of dismantling, cleaning and assembling until we could start with setting up and calibrating everything for a series of tests. This project was issued by a company producing test dummies. Last year, they handed our team their THOR dummy to test how changing the setup of a dummy with different sensors or body parts would alter the response of the dummy during crash tests. This year, a modification of the previously used dummy was given to the Bioengineering Department, which had all cables from the acceleration sensors routed internally. This led to the question of whether the internal routing would affect the response of the dummy compared to the old one. During this project, I got to realize how much effort it takes to run these bigger research projects. Calibrating, documenting and making sure that everything is working correctly and safely, while also meeting required scientific standards took a lot of time and effort. A case in point was the positioning of the body on the test sled. The dummy had built-in tilt sensors, which could tell us at what angle different body parts like the pelvis are positioned. Since the results had to be comparable with other similarly performed tests, we could not just put the dummy on the sled but had to meet the exact required angles. This part alone took us a long time. Apart from setting up slow motion cameras, pressure sensors for the seatbelts and the VICON motion capturing system my part was also to document the test with pre- and post-pictures and create a 3D scan of the dummy.
But I didn’t spend all my time helping the team of the Medical College, and since I had already arrived on 3rd July, I got the chance to celebrate the American Independence Day on the 4th July. After a nice afternoon at a nearby lake, my relatives and I celebrated this day together with some friends, while having a great dinner and watching the fireworks.
Another highlight was the kayak tour through the canals in downtown Milwaukee followed by a boat ride on Lake Michigan, which is the fifth-biggest lake in the world and roughly a thousand times larger than Lake Starnberg. There we also witnessed preparations for an air show performed by the US Air Force. Sadly, we were not able to watch the complete Air Show that was set to take place a few days after my flight back to Munich. It was still interesting to see the difference between the US and Germany, since in Germany you rarely see any military planes or air shows, while in the United States they are pretty common. The close distance to Chicago also allowed us to do some sightseeing there. We visited the popular landmark “The Bean” and Navy Pier while also walking along the beautiful Lakefront with the Skyline of Chicago behind us. I also experienced my first ever Korean Barbecue, where we grilled Korean-style meat on a barbecue built into the table.
The popular motorcycle brand Harley-Davidson was founded in Milwaukee and created a Museum displaying the history of the company. We had a great time visiting this museum and walking through all the different generations of Harley-Davidson motorcycles, as well as learning a lot about their racing history.
On the last Friday before my flight back to Munich, the whole Bioengineering Department went to the Milwaukee baseball stadium for a barbecue in the parking lot. Afterwards, we had a fantastic time watching the Milwaukee Brewers team play against the Colorado Rockies.
Thanks to the Medical College of Wisconsin, the great team I worked with as well as my relatives for these interesting and amazing three weeks!
Appendix: Plan your trip early enough so if you encounter any inconveniences or problems you have time to solve them without any pressure. When staying in Milwaukee a boat tour on Lake Michigan and a visit to Chicago are worth it. Watching a game of the popular Milwaukee Baseball and Basketball teams (Brewers and Bucks) is also pretty exciting.
Just like many former students of the “TUMKolleg”, I took the opportunity to visit an American university with other fellow students for my summer internship.
Brigham Young University (BYU), located in Provo, Utah, is a religious university from the “Church of Jesus Christ of Latter-day Saints” (a.k.a. Mormons). It is named after the influential church leader and first governor of Utah Brigham Young. BYU is just like any secular American university where students commence their undergraduate studies, though with a few exceptions since it requires very modest behavior, and students must follow a rather conservative dress code.
The university has proven its academic success multiple times by several other nominations and was even ranked the “number one university in the West for student engagement“ by the Wall Street Journal[1]. , BYU offers a broad range of courses to their students, but we only got to see the physics department because Justin Peatross, who organized the whole trip for us, is a physics professor. He is engaged in optics and his specialty lies in high-intensity laser physics.
On our first day at BYU, Professor Peatross had courses to teach that were too advanced for us, so we joined a class for first year college students taught by a senior student. We were doing experiments with magnets and coils, but we had already seen most of the experiments in school before.it was interesting to try everything out by myself nevertheless. After that college class we went to lunch where I was impressed by the number of restaurants in just one cafeteria. Then Professor Peatross took us to a different lab where he gave us two assignments. The first one was to measure the speed of light mechanically without using electronic devices for our measurements. After running some calculations, we were happy to get to the correct speed. In the second experiment we measured the intensity of polarized light that is reflected by glass. The goal was to findBrewster’s angle and make our data match the corresponding Fresnel coefficients. After some time and plotting the data, we saw how our data matched the values predicted by the theory, which was quite satisfying.
Over the next few days at BYU we worked on electronics with Arya, a teaching senior student. She showed us breadboards and an Arduino chip that was programmable which was not new to everybody in our group, but it was for me. After running through some basic tutorials to get to know the board, we started a bigger project. With the breadboard, several capacitors and a car body, we tried to build a car. The challenge, though, was to optimize for energy efficiency and speed at the same time. We built on the car for several hours and in the end, it could drive the test track with a decent evaluation score. I personally learnt the most while working on the car because I had never dealt with electronics before and I found out how difficult but at the same time satisfying it can be.
On our last day at BYU we joined an optics class. After working with lenses and prisms to manipulate light behavior for a bit, we tried to optically measure the distance between the bits on a CD with a laser. We finished our day with a tour through the universe in the university’s planetarium. The show was amazing, and we got to see incredible images of our galaxy, going from our night sky into the depths of other star systems. I am grateful that I could be a guest at BYU and learn so much about electronics and advanced physical topics in in practice which was an unforgettable learning experience.
American people & culture
As much as I enjoyed the educational part of our stay, the best part of our internship was getting to know Utah and its people. Thanks to our awesome host families we got to see many parts of Utah. I was astonished to see a very rich and diverse nature. The nature we explored was just incredible. It was fascinating to see the Arches National Park, the long canyons in Zion National Park, the bizarre-looking Goblin Valley and so many other fabulous things that would just take too long to list. All our adventurous hiking tours were filled with fun and joyful moments. Sometimes we found ourselves in remote regions with no soul around apart from us. I enjoyed that experience since it is not easy to find such remote spots with only nature around in Europe.
Aside from nature, we also got to in touch with American culture in all its greatness. Generally, European or German culture is quite similar to the American one, but differences are still visible. When we arrived in Utah, the first thing I noticed was the big size of everything: The size of the roads, cars, buildings and even portion sizes of meals were much bigger than I was used to. I did enjoy the food there, but preferred eating at home with my host family. They were growing their own vegetables in their backyard and even had chickens for eggs. Restaurant meals, in comparison, were often too fat- and sugar-rich for my taste.
I was glad to meet incredibly nice and very open-minded people in Utah. It was good to be surrounded by all these kind people on our activities together. I noticed how open everybody was to strangers. People would just have a little chat with strangers they met on a hike. This would be a rather rare occurence in Germany where people are often more reserved. The best talks, though, were with my host family; we could truly get to know each other and talk about all sorts of topics ranging from the Marvel universe to politics. We talked about our cultural differences a few times and found that the most fundamental parts of our cultures were pretty much the same.
I believe this general openness mentioned earlier is deeply integrated in American culture, but in Utah it also stems from their religion. Most people in Utah are members of the „Church of Jesus Christ of latter-day Saints“ (a.k.a. Mormons). They are Christians and mostly differ from other Christian religions through the “Book of Mormon” which could be considered a “third testament”. We went to church with our host families on every Sunday and I saw that the service was not much different from a Protestant one. However, after church service we had Sunday school where we learnt about the Bible, the Book of Mormon or other elements of their belief. I enjoyed being there because everybody was really welcoming and we could have a good time.
Still, Mormonism is not a faith that is very easy to practice: According to their rules members should pray before eating, have daily scripture time and not consume alcohol or high-caffeine drinks like coffee. It might sound very strict, however, I felt that all their good traits such as openness were affirmed by their belief, and it may even be the reason for their kindness. I will always remember our hosts and everybody there I got to meet as very warm, humble and welcoming people, and I am very thankful that they took us into their houses and made our time in Utah incredibly fulfilling.
Advice for future interns
You will be traveling with a tourist Visa (ESTA), so don’t mention your internship in the Visa application or when questioned
Bring a traditional gift from Germany for your host family
Be prepared that you must stay abstinent from alcohol and should not drink coffee or black tea (Coke is okay, though)
You will probably go hiking and camping, so bring proper clothes and shoes with a good profile
Bring modest clothes in accordance with the university’s dress code
In church, boys should wear a tie and girls may wear a dress
If you want to use your phone there a lot, you should consider buying a prepaid SIM card in the U.S which is very easy to do.
Im Sommer 2021 absolvierte ich mein dreiwöchiges Berufspraktikum bei der selbstständigen Hebamme Christin Graba aus Starnberg. Sie war die betreuende Hebamme bei den Hausgeburten meiner Mutter, also auch bei meiner eigenen Geburt.
Frau Graba ist seit 1977 als staatlich examinierte Hebamme tätig. Zunächst arbeitete sie 14 Jahre lang in verschiedenen Kliniken, um dann im Jahr 1990 ihren Tätigkeitsbereich in die außerklinische Geburtshilfe zu verlegen. In den bisher 43 Jahren ihrer Berufstätigkeit hat sie über 5000 klinische und 2000 außerklinische Geburten begleitet und dabei einen reichen Erfahrungsschatz gesammelt. Ihre Tätigkeit umfasst das gesamte Spektrum von Schwangerschaft, Geburt und Wochenbett im häuslichen Bereich der Schwangeren. Der Aktionsradius beträgt dabei bis zu 120 km. Teilweise waren wir mehrere Stunden am Tag zu den verschiedenen Wohnorten der betreuten Familien unterwegs.
Bis 2019 unterhielt Frau Graba zudem eine eigene geburtshilfliche Praxis, in der die Frauen zur Geburt erschienen, die sich in ihrem eigenen häuslichen Umfeld gestört fühlten. Hier fanden auch Geburtsvorbereitungskurse und Rückbildungskurse statt.
Quelle: Tutzing 2017, Süddeutsche ZeitungHebamme Christin Graba (rechts) mit Mutter und Neugeborenem
Die Grundlagen der geburtshilflichen Arbeit sind im Hebammengesetz festgelegt. Die ärztliche, gynäkologische und die hebammengeleitete Betreuung stehen gleichberechtigt nebeneinander. Keine Geburt darf ohne die Anwesenheit einer Hebamme stattfinden. Sollte eine Geburt im unvorhergesehenen Fall doch ohne sie stattfinden, sind die ärztlichen bzw. helfenden Personen verpflichtet, Mutter und Kind innerhalb von drei Stunden in die Betreuung einer Hebamme zu übergeben.
Mit Ausnahme der Geburtsbegleitung durfte ich bei allen Arbeiten von Frau Graba anwesend sein und ihr zur Hand gehen. Es war eine unglaublich abwechslungsreiche Zeit. Da wir mitten in die familiäre Umgebung der werdenden oder frischgebackenen Mütter und Väter gingen, wobei auch Erstgespräche und Problemberatungen stattfanden, fühlte ich mich zunächst wie ein Eindringling. Doch ich wurde überall sehr freundlich und offen aufgenommen und gewöhnte mich bald an die besondere Situation. Was mich sehr überraschte, war das breitgefächerte medizinische Wissen einer Hebamme: Auf Wunsch der Eltern können alle Vorsorgeuntersuchungen in der Schwangerschaft und die Geburtsbetreuung durch die Hebamme durchgeführt werden. All diese Leistungen werden von den Krankenkassen übernommen.
Nach der Geburt unterstützt Frau Graba im Rahmen der sogenannten Wochen-bettbetreuung die Eltern bei allen Fragen und Problemen bei der Versorgung und der Pflege des Neugeborenen. Dabei führt sie auch folgende Untersuchungen durch:
Erste ausgiebige Vorsorgeuntersuchung des Neugeborenen
Pulsoxymetrie innerhalb von 48 Stunden nach der Geburt zum Ausschluss eines eventuellen Herzfehlers
Nabelschnurblutentnahme zur Laborbestimmung der Bilirubin-Werte (Ausschluss von Neugeborenen-Gelbsucht), des C-reaktiven Proteins (Entzündungswerte), einer Blutgruppen- und Rhesusfaktoranalyse, eines direkten Coombs-Tests (unspezifischer Test auf Infektionserkrankungen) und des Vitamin D3 Status.
„Neonatal Screening“ (am 3. Tag): Dem Neugeborenen wird Fersenblut entnommen und in ein Speziallabor geschickt. Diese Untersuchung dient dem Nachweis von verschiedenen Stoffwechselstörungen, die, wenn sie unerkannt bleiben, zur körperlichen bis hin zur geistigen Beeinträchtigung des Kindes führen können.
Frau Graba sendet die entnommenen Proben einmal täglich an ein Münchner Labor, das die entsprechenden Analysen durchführt.
Ein weiterer Aufmerksamkeitsschwerpunkt in der Nachsorge-Betreuung liegt auf der Stilltätigkeit der Mutter. Ziel ist es, den Frauen nach der Geburt einen möglichst guten Einstieg in die Muttermilchversorgung des Kindes zu ermöglichen.
So sind neben der handwerklichen Tätigkeit und dem medizinischen Wissen einer Hebamme auch gute psychologische Kenntnisse erforderlich, z.B. um den Betroffenen Stress und Angst zu nehmen. Denn Stresshormone stehen nicht nur dem gesunden Verlauf einer Geburt entgegen. Sie können auch der Beziehung zwischen Mutter und Kind schaden und z.B. zu Stillschwierigkeiten oder Gedeihstörungen des Kindes führen. Für Erst-Gebärende ist es häufig eine herausfordernde Aufgabe, die Zeichen ihres Babys richtig zu interpretieren und seine Bedürfnisse zu erkennen. Es ist die Aufgabe der Hebamme, diesen Lernprozess sensibel und geduldig zu begleiten. Die Integration des Vaters steht gleichberechtigt in allen Betreuungsabschnitten neben den Bedürfnissen der Frau und des Kindes. Das Elternpaar hat ein Recht auf Hebammenbetreuung bis zum Ende der Stillzeit. Innerhalb dieser Phase bleibt die Hebamme die konstante Bezugsperson für alle themenbezogenen Anliegen.
Speziell geschulte Hebammen helfen Eltern mit Migrationshintergrund, sich in dem für sie ungewohnten Umfeld zurecht zu finden. Hierbei müssen die kulturellen Besonderheiten berücksichtigt werden.
Bei speziellen Problemen haben alle Eltern einen Anspruch auf die Betreuung durch eine Familienhebamme, die u.a. dabei hilft, geeignete Fachleute und Unterstützungsangebote zu finden. In der Zeit meines Praktikums wurden drei Kinder geboren. Es war für mich ein besonderes Erlebnis, im Rahmen der Nachsorge ihre ersten Tage zu begleiten.
Da ich mir meine berufliche Zukunft im medizinischen Bereich vorstellen kann, war dieses Praktikum für mich eine tolle Gelegenheit zum Sammeln von wertvollen Erfahrungen und Eindrücken.
Kurz vor den Sommerferien habe ich im Klinikum rechts der Isar ein Praktikum in der Unfallchirugie gemacht und hierbei viele spannende Einblicke bekommen, die sonst nicht so einfach möglich wären.
Die Gründung des Klinikums erfolgte im Jahr 1834, seit 1967 ist es als Universitätsklinikum Teil der Technischen Universität München. Es dreht sich also nicht nur um die Behandlung von Patienten, sondern auch um Lehre und Forschung. Heute gibt es ca. 6.600 Mitarbeiter und 30 Kliniken. Die Klinik und Poliklinik für Unfallchirurgie beschäftigt sich natürlich sehr viel mit Knochenbrüchen, aber auch mit Weichteilverletzungen und Gelenkerkrankungen, die im Zusammenhang mit einem Unfall stehen.
Der Tag im Klinikum begann immer gleich, mit der Frühbesprechung um 7:30 Uhr.
Dort wurden unter anderem die Fälle der neuen Patienten gezeigt, vergangene OPs anhand von Computer-Tomographie-Bildern oder Röntgenbildern besprochen, der OP-Plan des Tages vorgestellt und wichtige Ankündigungen gemacht. Das hört sich jetzt nach sehr viel an, hat aber meistens um die halbe Stunde gedauert.
Quelle: Leonie Trojahn
Anschließend fand die Morgenvisite auf der Station statt. Hierbei gehen die Oberärzte, Stationsärzte, Assistenzärzte, PJ-ler (Studenten im Praktischen Jahr des Studiums), Krankenpfleger, Physiotherapeuten und Praktikanten wie ich zu den einzelnen Patienten. So können die Operations- und Heilungsverläufe, das Wohlbefinden, weiteres Vorgehen und allgemein Fragen geklärt werden. Bei der Menge an verschiedenen Person wurde es in den Räumen hin und wieder doch recht voll.
Danach gab es drei verschiedene Möglichkeiten den Tag zu nutzen.
Zum einen die Station: Wichtig nach der Visite waren die verschiedenen Blutabnahmen. Blut wird normalerweise mit Hilfe von Butterflies abgenommen, das sind feine Kanülen mit Kunststoffflügeln, die das Abnehmen erleichtern. Die richtige Handhabung, zum Beispiel der Einstichwinkel, habe ich bei einer Art Trockenübungen, erprobt. Aber was auch oft vorkommt und ich häufig gesehen habe ist, dass es nicht bei jedem Menschen leicht ist, Blut abzunehmen. Besonders bei älteren Patienten oder Patienten, denen schon oft Blut abgenommen wurde. Geübt habe ich auch, den Unterschied zwischen einer Vene und einem Nerv zu fühlen, eine Verwechslung ist sehr schmerzhaft. Sehr beeindruckend war das Sehen einer arteriellen Blutabnahme, also wirklich Blut direkt aus der Arterie, für eine Blutgasanalyse. Dabei pulsierte das Blut im Röhrchen, dass direkt mit der Nadel verbunden war.
Ich habe viel vom Stationsalltag gesehen, zum Beispiel Eintragen oder Ändern von Medikamenten in das digitale System oder das Schreiben der zahlreichen Arztbriefe. Anderseits auch was passiert, wenn ein Patient nicht mehr ansprechbar ist/sichtbar verschlechterten Zustand hat und schnellstmöglich die Ursachen und Behandlungsmöglichkeiten gefunden werden müssen.
Neben der Station habe ich einen Tag in der Notaufnahme verbracht, die mit zur Unfallchirurgie gehört. Ich habe Ärzte und Krankenpfleger begleitet, wobei ich viele verschiedene Fälle gesehen habe, von der allergischen Reaktion zu Fahrradunfällen bis zu abgeschnittenen Fingerkuppen. Das sind alles vom Schwierigkeitsgrad her sehr unterschiedliche Fälle. Da nicht geplant werden kann wann, wie viele Patienten kommen, ist es sehr wichtig, eine sinnvolle Behandlungspriorisierung zu haben. Hierfür wird das Manchester Triage System verwendet. Wichtiger Bestandteil der Notaufnahme sind auch die Schockräume, spezielle Behandlungsräume, in denen die Erstversorgung von polytraumatisierten, also schwerverletzten, Patienten durch Mediziner verschiedener Fachrichtungen vorgenommen wird. Ich bin durch die Schockräume geführt worden, war aber bei keinem Fall dabei.
Die dritte Möglichkeit war der OP. Natürlich habe ich dort die normale Kleidung gegen OP-Kleidung, -kopfbedeckung und -masken getauscht. So konnte mehrere verschiedene Operationen sehen. Einerseits eher kleinere Eingriffe, wie beispielsweise das Richten einer distalen Radiusfraktur. Das sind Brüche der Speiche, die nah am Handgelenk sind. Allerdings tritt diese Fraktur häufig auf, da sie bei dem Versuch brechen, den Körper, bei einem Sturz mit den Händen abzufangen. Der Eingriff besteht aus einem ca. 10 cm langen Hautschnitt, durch den der Bruch mit Hilfe einer Platte stabilisiert wird.
Ein größerer Eingriff war das Entfernen eines Infekts nach einer Femurfraktur und das anschließende Setzen eines externen Ringfixateurs. Bei diesem Oberschenkelbruch musste zunächst das infizierte Gewebe und tatsächlich auch Teile des ebenfalls infizierten Knochens entfernt werden, um anschließend den eigentlichen Bruch mit Hilfe des Fixateurs zu stabilisieren.
Egal wo ich war, ob im OP, auf der Station oder der Notaufnahme, jeder hat mir immer etwas erklärt und jede Frage beantwortet. Ich hatte die Möglichkeit, die Nicht-Patientenseite eines Krankenhauses hautnah zu erleben und es hat mir dadurch auch den Beruf des Arztes näher gebracht. Es gab vieles, was für mich faszinierend neu war, für das Krankenhauspersonal hingegen natürlich Alltag. Ich habe in dieser Zeit sehr viel gelernt, mehr als ich hier aufschreiben könnte. Ich kann nur abschließend sagen, dass es ein tolles Praktikum war und es mir sehr viel Spaß gemacht hat!
