In Germany, Asylum Seekers' Medical Needs Are Being Contained

Jun 13, 2016
Originally published on June 13, 2016 12:40 pm

Maher Murad recently had a bad sore throat and decided to go see a doctor. But the 19-year-old Iraqi asylum seeker doesn't speak German. And the German physician he went to see at the shelter where he lives, just outside Hamburg, didn't speak Arabic.

This kind of language barrier is common, as officials struggle to provide services like medical care to Murad and others. More than a million asylum seekers have poured into Germany over the past 18 months. The newcomers are from around the world and few speak English, let alone German.

But with the help of two German entrepreneurs, doctors at this refugee camp located in a former Hamburg building supplies market can now bridge the language gap with a few keystrokes and clicks of a mouse.

On the morning when Murad visited the clinic, his doctor, Martin Scherer, summoned a translator online. Moments later, one appeared on his computer screen via video-conference software. Through her, Scherer was able to ask Murad about his symptoms. She repeated the doctor's questions in Arabic and added a few of her own before translating the young Iraqi man's answers for Scherer, just to make sure the doctor got every detail he needed before making a diagnosis and prescribing treatment.

The access to online video translation services and the reconfigured, high-tech shipping container that houses the shelter's primary care clinic are the brainchild of Harald Neidhardt, the CEO of MLOVE, a Hamburg-based media and event company, and his friend, Mirko Bass, a business development manager at Cisco Systems, the multinational technology firm headquartered in San Jose, California.

The executives met in 2014, while introducing cutting-edge technology to Hamburg as part of its Smart City initiative. Like many Germans, they were moved by the plight of hundreds of thousands of desperate asylum seekers who arrived last year and overwhelmed local governments, including Hamburg's. The city took in 61,500 asylum seekers in 2015.

Neidhardt says the situation at the port city's main railway station, where many of the migrants first arrived, was appalling. He recalls there were "makeshift tents of the doctors' offices that don't have a floor, there's just a triage and some blue gloves here and some defibrillator on the left side, just to sort of pretend this was something that was medical."

The two worked as volunteers distributing clothes to asylum seekers, Bass says, but wanted to do more. So he urged his friend to come up with something innovative.

For the Smart City initiative, Neidhardt had already helped design a mini-village from shipping containers to house start-up businesses and event spaces. Now he proposed to create portable doctor's offices in refurbished, Wi-Fi-equipped shipping containers. These would be inexpensive and easy to set up at refugee intake centers.

Bass enhanced the idea by adding a network of partners, which include the German Red Cross, the University Medical Center of Hamburg-Eppendorf — for which Scherer works — and the long-distance translation services, which are provided by SAVD, a Vienna-based video interpretation firm.

"This is a little bit like Uber, you know," Bass says. "You press the button, the magic happens." In this case, a translator shows up.

Scherer says having round-the-clock access to SAVD's 750 translators, who speak 50 languages and are versed in medical terminology, has made it easier for all the doctors who treat refugees at the camp.

"This system helps us because they are trained and they can avoid misunderstandings," he explains. Having translators available online instead of bringing them into the primary care clinic has made for far less cramped quarters. If a patient wants privacy, the camera on the computer screen can be turned off.

Cisco funded the prototype, which Bass and Niedhardt say cost in the "high five digits."

It took six weeks to get the unit ready, Niedhardt says, but most of that time was spent waiting for the container to arrive. "Now, the waiting time is even two to three months, because containers for construction and housing are very much in demand," he says. The containers are sourced from various European suppliers.

By early November, the first Refugee First Response Center clinic was online. It has logged more than 4,500 patient visits, Niedhardt says. The video translation services cost half as much as the usual practice of hiring translators to be onsite.

The Hamburg-based Dorit and Alexander Otto Foundation, meanwhile, has donated $1 million to Hamburg officials to build 10 more such primary clinics for asylum seekers. The city has agreed to cover the operating costs. Care is free to patients.

The first of the new batch went online in late April and includes a 30-foot-long medical aid practice office — 10 feet longer than the prototype, to help patients and staff feel less cramped — and a 20-foot waiting room.

Neidhardt and Bass say they are determined to find more donors so they can build even more clinics, and not just in Hamburg or Germany.

"We see that the model works," Niehardt says. "Not only the language, but also just having a clean, amazing and functional doctor's office."

They also would like to expand the treatment options beyond primary care — which is something asylum seekers at the Hamburg shelter like Sonya Zargaran say they want, too.

The Afghan woman, who arrived here seven months ago, says she's still waiting for appointment with the specialist for her 11-year-old son, Ali, who was in a suicide attack at his Kabul school last year.

"The doctor here hasn't been able to do for him other than say he will refer my son," Zargaran says. "But nothing has happened yet and his hands are shaking so badly in class, he can't even hold a pencil to write."

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Here is one effect of the flow of refugees into Germany from the Middle East and elsewhere. Germany's health care system has more than 1 million more people to take care of. The trouble is not just the sheer numbers, but also an inability to communicate. Think about all the languages. Now two German entrepreneurs, moved by the plight of asylum seekers, have come up with a way of bridging the language gap in health care. NPR's Soraya Sarhaddi Nelson met with them and brings us this report.

SORAYA SARHADDI NELSON, BYLINE: Maher Murad has a bad sore throat and needs to see a doctor. But the 19-year-old Iraqi doesn't speak German. And the German physician he goes to see at his refugee shelter doesn't speak Arabic. The language barrier poses a serious problem until Dr. Martin Scherer turns on the computer in his exam room.


NELSON: A female translator appears on the screen, and thus begins a three-way quest in two languages to find what is ailing Murad.

MARTIN SCHERER: (Speaking in German).

NELSON: Scherer asks the young man about his symptoms.

UNIDENTIFIED TRANSLATOR: (Foreign language spoken).

NELSON: The woman online translates and follows up with more questions to make sure the doctor gets every detail he needs.

SCHERER: (Speaking in German).

NELSON: Scherer says having quick access to hundreds of translators speaking 50 languages and versed in medical terminology has made it a lot easier for him and other doctors to treat residents at this refugee shelter.

SCHERER: Lots of things in medicine are not objective. How is the complaint? How is the headache? How does it feel exactly? And therefore, this system helps us because they are trained and they can avoid misunderstandings. And in face-to-face translating, it also works. But our experience is the training and the professionalism is often not as good as the system.

NELSON: Not to mention, having multiple translators in a doctor's office would make it rather cramped. The doctor's online access to translation services as well as the reconfigured, high-tech container the exam room is located in, were dreamed up by Harald Neidhardt and Mirko Bass. The Hamburg entrepreneurs met while introducing cutting-edge technology to the port city in 2014. Like many Germans, the two men were moved by the arrival of hundreds of thousands of desperate asylum-seekers last year who overwhelmed local governments, including the one in Hamburg. Neidhardt recalls conditions at the city's main train station last summer.

HARALD NEIDHARDT: And you see the makeshift tents of the doctor's offices which don't have a floor. And there's just a triage and some blue gloves here and some defibrillator on the left side just to sort of pretend this is something that was medical.

NELSON: He came up with the idea of creating portable doctor's offices in refurbished shipping containers equipped with Wi-Fi. Neidhardt adds the goal was to make the clinics inexpensive and easy to set up at refugee intake centers. Bass proposed enhancing the initiative by adding a network of partners, including the long-distance translation services, which are provided by an Austrian firm.

MIRKO BASS: This is a little bit like Uber. Yeah, you know, you press the button. The magic happens - not the taxi arrives, the translator arrives.

NELSON: If a patient wants privacy, the camera on the computer screen can be turned off, Bass says. The tech company he works for funded the prototype, which he says costs in the high five digits. A million-dollar donation by a wealthy Hamburg family is allowing them to build 10 more of the portable primary care clinics, which the city will pay to operate. Soraya Sarhaddi Nelson, NPR News, Hamburg. Transcript provided by NPR, Copyright NPR.