It’s my penultimate day in Leipzig and the fourth city I’ve visited so far on my Churchill Fellowship. It is a great place; it has a young population, thanks to the reasonable rents and relatively cheap cost of living, and a growing economy. There is a strong sense of history here (including the city’s links to Bach and, much more recently, the protests against the GDR in October 1989 which some say led to the fall of the Berlin wall), but it feels like the city is looking to the future with optimism.
Thanks to the support of Prof. Thomas Frese from Halle University (and a representative of the European General Practice Research Network) in accessing interviewees, this week I have met with GPs from across the city that have experience of working with refugees and asylum seekers. It is noteworthy, though, that none of the practices I visited had a remit to focus on these patient populations specifically, and most of their patients were born in Germany (in contrast to the Hjällbo Health Centre in Gothenburg, for example).
There is a lot for me to reflect on from my interviews but two key things have struck me. Firstly, the pragmatism that GPs have demonstrated in overcoming some of the challenges they face; most pertinently, the lack of interpreters for their consultations with refugees and asylum seekers. The GPs I have met have described a complete lack of interpreters, meaning that they rely on Google translate, the family and friends of patients, and sometimes other patients or contacts that offer informal help over the phone. This is unacceptable and I was surprised that, three years on from 2015’s influx of refugees, there isn’t better infrastructure here in Leipzig to enable GPs to treat asylum seekers and refugees effectively.
Secondly, I have been struck by the lack of oversight of the GP sector here in Germany. There is no formal regulation, so I’m told, and the body that administers practices’ funding and the State of Saxony take a hands-off approach. On the one hand, this affords GPs a degree of freedom (that no doubt many GPs in England would envy); but on the other, there seems to be a lack of any strategy or assistance for GPs, including in meeting the needs of refugees and asylum seekers. With the exception of only one GP I spoke to, nobody could cite any support they had received to enable them to best support the refugees and asylum seekers they treat. If I had more time here in Leipzig it would be great to hear from NGOs and voluntary groups that work with refugees and asylum seekers to hear their perspective on these groups’ access to primary care. With a week left to go of my trip, I’m already thinking of Skype calls I’d like to set up once I’m home…