The Inner Working of Hospitals, plus a Safari: A Broken Foot Travels to Germany

The Inner Working of Hospitals, plus a Safari: A Broken Foot Travels to Germany

I wake up to the sound of birds chirping, the sun shining onto my cozy comforter in my cushy bed. The window is slightly ajar and I can smell the Namibian air.While I'm gazing onto the surrounding hills of Windhoek, I lazily wait for breakfast to be delivered. Fresh coffee from the French press, omelet and brown toast with butter, a side of stewed tomatoes, warm corn grits and marmalade. I could watch the TV that is fastened to the ceiling by the foot of the bed, using a headset if I want to be undisturbed. Or, I could request a pedicure, a manicure, a bedside shoulder massage. I also have to decide between various lunches that the culinary staff will enter into an iPad, sending my requests directly to the kitchen. Choices, choices.

An assistant arrives, the word “BUTLER” in caps printed just below the name on his tag. He is dressed in grey suit pants and vest, an impeccable white shirt, and a tie. Do I need anything before he takes me over to get the CT? Pain meds, more water? Another ice pack? A change of clothes into freshly pressed white linen?

“You were born in Germany?” he asks by way of making conversation. “I would love to go there some day, I am actually learning German in school. I also speak Afrikaans and my local language.” So educated, I think. I use the buttons on the side of the bed to put myself into the perfect free gravity position, back up 45 degrees, knees slightly raised. Just like United Polaris, only far more comfortable. We chat for a bit before he gently wheels my bed to the elevator…

Where am I exactly? You guessed it, although you might find it hard to fathom. Lady Pohamba, a private hospital in the capital of Namibia. Almost worth staying longer but at $500 per night I could rent a small castle around here. If there were private castles in Namibia, that is.

Also, my broken ankle needs plates and screws put in, and I have to decide where to get this done. I have to call my insurance (Horizon Blue Cross, Omnia Silver) to sort stuff out. I mention my plan because it does include international accident insurance. You just need to look for the blue suitcase on the front of your card. If you have that, you are covered while in far away places. I also have to change my flight, I have to decide when I should leave the hospital and where I should go next.

Lufthansa answers some of these questions for me: no flights for that day or the next, a Saturday change in itinerary is $4300, and Sunday is $250. My flight is to Frankfurt, Germany, where I can sort out next steps, i.e. do I fly back to the US, or do I get this fixed in Germany, rest up a few days for post op and then head home? Hospitals have only basic staff on weekends so Sunday will do fine for a flight to Germany. That leaves me with one day in the fancy hospital, and two days to have fun on crutches.

After a series of additional calls, I land on Progress Guest Farm, located just a short drive from the airport. At $110/night, it is much more reasonable than the hospital, even though it won’t have this fantastic bed. I won’t have a butler or a nursing staff of four, but I think that’s gonna be ok, lol. Breakfast to order and a three course dinner is included in the price, room service if needed since I am on crutches, the lodge is level and the Wi-Fi will just reach my room (rare in lodges). I can sit by the pool underneath palm trees, or I can enjoy the prairie view from the bed. They will take me to the airport, too. Sounds – and turns out to be – rather idyllic.

One of the nurses’ brothers works for a small family taxi company (I think it’s more like he just drove me for a price but whatever), and he takes me to the lodge upon my release. I am greeted by the host, Gerda Meyer. She and her husband run the lodge with a small staff. Gerda helps me to my room which had a view onto the open surrounding space. She accommodates me with a shower chair, additional water and snacks (one day they even makes me home-made pizza for lunch), and I spend the rest of the afternoon either by the pool or working on notes for the blog.

As you can imagine, I am not one to sit idle long, and I have one additional day that I can use for touristy things. My research yields another nearby farm, a non-profit Ecolodge and Wildlife Sanctuary by the name of Naankuse Lodge. Naankuse offers various excursions and daytrips, some of which don’t require walking – like, for old people. I pick an animal feeding tour of my favorite animals, wild cats. I am totally alone on the jeep (which my rock-climbing skills get me onto, even with only one working foot), chatting happily with the driver as he introduces me to the rescued wild cats: 2 lions, a leopard, several cheetahs and wild dogs, all coming to the fence as he arrived with the apportioned horse meat for their meal.

The cheetahs even rub themselves against the fence and purr (just like my Lucy!). But no petting, he says. You never know. Cheetahs have lost their fear of humans and we are not their preferred prey (too big), but a wild cat is a wild cat! Too bad, they look really snuggly.

I get back just in time for a three-course meal prepared by Gerda’s husband Niekie: a vegetable skewer, followed by breaded and fried game meat (a very standard meal around here), fresh vegetables, mashed potatoes and panna cotta with local fruit. Gerda walks me to my room so I can navigate the grass, pebbly path and terracotta dirt patch in the dark.

My flight on Sunday was with Discover Airlines, a former step child of Lufthansa, now it is its own company, though you use the LH portal to book. I say “step child” because everything on Discover is clearly a hand me down, including the plane itself. The business class section shows the older seating configuration without privacy, there is no storage, the remote on TV is substandard or not working, food is just passable. I don’t want to complain but a business class ticket isn’t cheap! For that price, United Polaris (my standard, if I fly business) is WAY better.

More interesting, however, is the notable absence of disability assistance. LH no longer has a number you can call in Germany (like, not a single number, just nothing!). A local ‘help desk’ number has a country code of South Africa, and that’s like calling from Northern Germany to Switzerland. It’s next door but not close. Nobody picked that up anyway. I do fill out an online form for disability services, which is supposed to be confirmed by email within 24 hrs but that email never turns up. The flight being delayed by 3 hours, Gerda drives me to the airport in the dark, something they don’t advise to tourists to do because there are no street lights on the dirt roads and lots of animals crossing at night, but she assures me they do this all the time. I figure that once there, service will be a non-issue as the ground personnel is run by the Namibian airport, not Lufthansa. And in any country that is not as wealthy as we are, there’s no lack of personnel. People don’t get unemployment or social security, their relatives cannot support them, so they will work, even for subsistence level pay, because they simply have no choice! Unemployment is extremely high and most people will take any kind of job if it pays for food and shelter. There are no soup kitchens either so for some people it’s either you work for pennies or you die. That is a reason why I always tip handsomely in places like this, even if it’s official staff (like a nurse or an airport service). I don’t want to seem like I’m showing off with my wealth, but I’ll take that as a criticism if it helps others.

As expected, wheelchair service is no issue and everything goes smoothly at the airport. I even get to go to the lounge for a while. The only adventurous part is getting onto the plane. Forklift or stairs, they ask me. Stairs, I say boldly. These prove tiring but the YouTube video I watched gave good advice. Hold on to the rail, use one crutch on the lower step, step up, repeat. 30 times later, I am on the plane. The flight attendants tell me they all watched from the window. Um, thanks.

On-board experience I will skip as uneventful, and pickup in Frankfurt goes ok as well, with the exception of the drop off outside arrivals. I am plopped at a café while my 83 year old dad wandered around looking for me (he doesn’t really use his cell). Once he locates me – 30 minutes later – he gets a luggage cart and I sit on the luggage while he wheeled me to the car.

Our next stop is the BGU, a specialty accident center in Frankfurt that my bestie Dagmar recommended, because most of what they do there is fix broken bones. CT and X-ray in hand we proceeded to their ER. Unlike what I have experienced in the US, this ER has a small and quiet waiting area with us being the only people there. But it is early in the morning and I am told it would fill up later. And it does, with a guy who twisted his knee skiing and a construction worker who fell off a ladder (no joke).

As soon as I report that I had just come back from being in a hospital in Namibia, things got exciting. The nurse dashes off within a split second to grab an N3 mask, pushing another one onto my face and my dad’s. Possible contamination, I am told. Apparently, a previous patient had ‘soiled’ an OR with an infection from a far away hospital and caused $30,000 in additional costs the hospital had to carry (the patient had to be isolated for 30 days). So in addition to being interviewed about my adventure, I am swabbed for germs in my nostrils, mouth, under the arms and my rear end. “Do you want to do that yourself?” the nurse asked. “Uh, no” no was my response. “You just go right ahead and do what you need to do. I don’t want anything to do with it!”

I am examined in an isolated room, door closed, by three different doctors (ER doc, surgeon and anesthesiologist for pre-op), each of them disappearing at the word “Namibia” and coming back fully masked.

Other than that, the docs assess my scans and the emergency room realigning of my ankle. They are quite satisfied with that, and that’s good because that is a very important step in my having full mobility and sensation back. The operation is scheduled for the following Monday.

In the meantime, it's hotel Papa, with a couple of days at my sister’s with her boyfriend and my 20 month old niece who ogled my crutches with great curiosity but who even at her age is observant enough not to run in between them. Thank you, Meira, you will make a great addition to my very practical and efficient family.

At my dad’s I get to learn how to get up and down the marble staircase into the basement where I sleep, and after fixing a broken wheel on my late mom’s fancy $500 rollator, I use that for food shopping and to get around the kitchen.

On Monday the 17th, I present early morning for my procedure, stomach growling. The contrast to Barnabas, where my late friend Sebaj was treated for his colon cancer, was educational to say the least. My belongings are locked away in a box and transported to the room that is already set up for me. The relay between the room where I changed and the pre-op for anesthesiology is seamless. German doctors are not used to explaining what they are doing to patients but my friendly banter opens them up. “Americans throw away everything,” one assistant says. Here we sterilize and re-use to be environmentally friendly. The anesthesiologist also explains that he would be using a local anesthetic so I would not be in pain as I wake up. That is a new thing to me. At Barnabas, everyone in recovery woke up crying in pain, nursing staff dashing around trying to get the orders for opioids filled – something I didn’t need because the local lasted for almost 2 days. Apparently the new hospital leadership at BGU instituted this policy two years ago. Good thinking! I do need Oxy twice, but that is only because they have to redo the cast the next day to angle my foot at 90 degrees instead of it being pointy and that is painful because the entire ankle is swollen from the toolkit that is now inside my ankle. “In the OR they sometimes have to rush the cast,” someone says. And I do get some IV painkillers, because I peacefully sleep through the entire rest of the day, opening my eyes only to eat two slices of bread with cheese for dinner (I’m very food driven), and then going back to sleep until 6 a.m. when I am woken up by shouting.

“Help me, help me.” I hear a woman’s voice next to me. Still woozy, I ask “what’s up?”. “I really have to pee, and I can’t find the help button, the remote fell off the bed.”

I have apparently slept through my roommates arrival in the middle of the night but I am pretty awake now. “I got it,” I say, and push the help button on mine. A voice answers as if it is a phone, not a call button (that’s because it is a phone, of course). At Barnabas, the button just turned the light on outside the room and then someone came, or as was so often the case, nobody came for minutes or sometimes an hour. “What do you need?” the voice asks. “My neighbor has to pee and she can’t find her bell. She has to pee like NOW.” Funny how such basic things can become a real problem. Apparently Mrs. O. already HAD peed because she needed to go for hours, but now the bed was wet and who wants to sleep in that.!

Mrs. O., an witty 82 year old with a dry sense of humor, has broken her arm during a family reunion when she didn’t use the rollator for like two steps. She was so annoyed with herself as she was also caring for her wheelchair bound husband. We become good friends in the days we spend together as I get us cake from the downstairs bakery every afternoon when I go for my practice walk.

Well, it is busy from then on. Breakfast at 7, blood work, vitals check, doctor for the floor examining the wound, then the chief of surgery who operated on me, then lymph drainage, lunch, a new cast, my dad visiting with a few things I’d forgotten, PT to make sure I could get up, coffee, cake, dinner, some sorting of my room mate's dilemmas (like not knowing how to use the wifi). I fall asleep at 8 p.m.

Someone told me that based on my experience with hospitals in three countries, I should write a Michelin guide to in-patient services, lol. Sadly, if I did so, Namibia would end up first and the US in last place. Germany is sort of in between. They don’t have dividing curtains for privacy, it’s unusual there, and the beds are not the greatest either. Care is good, though not amazing like Namibia. Just like in the US, staff shortages create problems in care. That said, the care we do receive and the speed with which we receive it certainly outpaces everything I have seen at Barnabas in the US. Wound care is better as well, food and food services, the idea of a head set for a TV is widespread everywhere except the US. Cost is another important factor. My operation, including 4 days of hospital stay with all of the care inclusive was $9100. Cost in the US can be estimated at three times that figure, with billings significantly higher.

My upgrade to the chief of surgery, for instance, was $800. And he was supposed to be the best, so even if that ends up being out of pocket, why should I care? My ankle is a lifetime investment.

The rest of my four day stay at BGU is fairly uneventful, with the exception of Mrs. O. announcing on Thursday that she wished to die because she was in too much pain and wasn’t feeling mobile. An officially announced death wish always gets everyone on high alert (because it has to be reported up the chain), so we had additional visitors: psychologist, psychiatrist, social worker, neurologist. Mrs. O.'s care is improved and so are her spirits, so I am able to leave on Friday with a good conscience knowing she was taken care of in the way she needed. Sometimes a loud cry for help is enough to get the job done and she did deserve better care. (Sometimes…).

I stay in Germany another four days just for a post op visit, but then it is really time to go back to my American home and my cat Lucy, and some human friends, too.

To those of you worried about traveling with a disability, I can say that everything went fairly smoothly, with the caveat that, as Germany is not a litigious society, this leads to substandard service, whereas in the US everyone overdoes it. At Fraport (Frankfurt airport’s melodic sounding name), I was offered a series of relay carts I had to hop on and off of, and I had to make my own way through passport control and security. It was a sluggish and cumbersome procedure, as a result of which I missed my stay in the lounge. I wouldn’t have cared but I did pay for it, so I wanted it. At Newark Airport I was not even allowed to get up from the wheelchair and someone was with me every split second, all the way into the cab.

In my next and final Namibia blog, I will tell you a bit more about the gemstone situation in Namibia and give you a sense of what you should expect if you ever travel there to buy. While I didn’t get to complete the trip, Jochen and Klaus did and they reported to me every step of the way. Until then, know that I have arrived home safely and am getting the needed aftercare until I can be fully mobile again in a few weeks. So everything ended (reasonably) well.