„You have to start over“

Two years have passed since Kabalan submitted his nostrification application to MedUni Vienna. In between: months of poring over books, taking exams, attending courses and continuing education, as well as lectures he held himself. Now he is on the verge of being recognized again in his old role, namely as a surgeon. The 36-year-old recently completed the nostrification process at the Sozialmedizinisches Zentrum Ost - Donauspital in Vienna.

medinlive: In a month, your training will also be officially recognized in Austria. What was your journey like up until then?

Kabalan: I came to Austria four and a half years ago. I was originally born and raised in the Syrian city As-Suwaida. It is about 100 kilometers from Damascus. I completed my residency in general surgery in Damascus, in Syria's largest hospital.

medinlive: What qualifications do aspiring doctors in Syria need to be accepted to medical studies?

Kabalan: You have to score a certain number of points in your school-leaving exam. If you get 97 percent or more, you are allowed to study medicine. But the score varies depending on the number of applicants. I got 99 percent, which put me in first place in our city. Afterwards, there is a six-year study program. From the third year, you can do an internship in the hospital. Depending on how many points you have gained during the six years, you can do a specialty training. You need a certain number of points for the respective specialist training and the further training then takes between four and six years. After that, you take an oral, a written and a practical specialist exam.

medinlive: How did your professional life continue?

Kabalan: I worked for about six months as a specialist in a hospital and a clinic in Damascus. At that time, the civil war had already started there. Because my position was anti-government, the situation was very risky for me. We had patients who were members of the opposition. After they had been shot and detained, we treated and operated on them in our hospital. Many times they were then further abused by soldiers, which I could not endure. Finally, I fled to Yemen where I worked as a specialist for six months.

medinlive: What was the situation like in Yemen?

Kabalan: In Yemen, the situation was similarly dangerous, except that as Syrian doctors we earned quite well compared to Yemeni doctors. But being the only surgeon in the hospital, I took all the responsibility. The situation there was very bad overall. While I was working there, Al Qaeda blew up a car near my apartment. So it was very dangerous, and as a foreigner you are also always in the focus. After that, I fled to Austria and immediately started learning German.

medinlive: How did you do with that?

Kabalan: It wasn't that difficult up to the B2 language level, but starting with C1, I realized that only at this level you can speak enough German to be able to communicate in the hospital. I therefore think it's good that the level was raised to C1 in the sampling test. Because many doctors have problems communicating with patients. They have too little contact with Austrians and have only learned German in language courses, which is not sufficient. In German courses, you learn maybe 20 percent of the language. Because courses are not necessarily given by language experts, sometimes it can be students, for example. From the B2 level, it was just experts. I also learned through Tandem (language learning method where two people with different mother tongues teach each other the foreign language, ed.). That helped me a lot and I also made Austrian friends.

After I finished C1, I had the idea to hold my own language course with Latin terms for physicians. The course was intended for doctors from Syria, Russia or even Serbia or Romania. The course was a preparation for the language exam at Österreichische Akademie der Ärzte.

medinlive: Besides the language, what was one of the biggest challenges you faced when you came to Austria?

Kabalan: I had to start from zero. I was a medical specialist in Syria, had an office and performed many operations on my own. Here in the hospital, you are no longer a specialist, you have to start all over again. In addition, you are alone. Your family is not here and you are always worried about them. It was not easy. The work situation was unfamiliar at first. In internal medicine, you are responsible for several stations all by yourself and you only have a few breaks.

medinlive: What was the situation like in Syria?

Kabalan: Even worse (laughs). In the last two years, during the war, I had 15 night duties per month and there was no rest day between the duties. And sometimes I had to fill in for colleagues who had quit. Sometimes I had to do three shifts in a row.

medinlive: How did you do in the random test?

Kabalan: I passed nine out of ten subjects and had to take five oral exams. Psychiatry, for example, I had to take orally. Pharmacology was difficult. For that, I studied ten hours every day for a month. It took a total of five months to complete the exams.

medinlive: How did the crediting of your residency training proceed?

Kabalan: I was credited for four years of general surgery residency, I had to complete two years of counterpart subjects that I completed at Donauspital, which were: Internal Medicine, Trauma Surgery, Pathology, Anesthesiology and Pediatric Surgery.

medinlive: What suggestions do you have for improvement with regard to the nostrification procedure?

medinlive: How can the nostrification process be improved?
Kabalan: I think it is important to be provided with precise information, concrete documents that describe what is irrelevant for the exams. You can't read thousands of books, but if certain books were recommended, that would be very helpful. Organizations like "Check In Plus" (a center for migrants financed by the AMS, editor's note) were helpful concerning organizational questions.

medinlive: Can you describe the first weeks in the hospital?

Kabalan: The first two weeks in internal medicine were very difficult because the patients only spoke dialect. In the beginning, it was challenging to understand the system and the procedures, to know who is the right one to contact for what. But after two weeks, it worked well. In Syria, everything was documented by hand, even assignments were written by hand. We also didn't write electrocardiograms, that's what I learned here in Austria.

medinlive: Are there differences regarding surgical methods between Austria and Syria?

Kabalan: In Syria, we performed many operations openly, especially gunshot wounds and a lot of laparotomies because of tumors. We rarely performed laparoscopic surgeries because of a lack of time. Only gallbladder removals were done laparoscopically. Also, as surgeons, we did not do gastroscopy or colonoscopy surgery, these were only done by internists. That is why I attended two courses in Germany: Hernia Surgery (TAPP/TEP) in Berlin and Laparoscopic Cholecystectomy and Appendectomy in Tuttlingen. In addition, I attended a course on endoscopy in Vienna. I paid for all these courses myself.

medinlive: Have you experienced situations in which you felt discriminated in your work at the hospital in Austria?

Kabalan: No, some colleagues were maybe more strict, but I didn't actually experience any discrimination. It is important to know the language. And discrimination exists everywhere. When I worked in the hospital in Damascus, doctors from Darʿā came to our hospital. Darʿā is about 100 kilometers from Damascus and was the starting point of the first protests against the government. Some of my pro-government colleagues were discriminating the colleagues from this region.

medinlive: Did you also think about starting the nostrification process in Germany?

Kabalan: No, I never thought about that. I also think that in Germany the system has been changed and it is more difficult now that so many Syrian doctors have come to Germany.

medinlive: In October of last year, work training was offered for refugee physicians through the Kaiser Franz Josef Hospital in Vienna. What do you think of such offers?

Kabalan: I know someone who participated in it. He was able to improve his language skills and communication with patients and doctors, but when it came to medical work, he was only allowed to watch and could not show what he was capable of. In some internships, doctors are even forbidden to talk to patients. I myself worked for two months as an intern at the St. Josef Hospital in Vienna. That helped me a lot to get to know the system and the surgical instruments. I was in the operating room almost every day. If you want to work as a doctor in Austria and start the practice, it is better to do advanced training outside of Vienna and also to work in smaller hospitals, because you can learn there in a more relaxed environment.