Montag, 27. Oktober 2014

First month in Innsbruck


As some of you may already know, i moved to Innsbruck at the start of the month to enroll at MCI (Management Center Innsbruck) and start a Master's Programme called "International Health & Social Manament", which will extend over the course of the next 2 years. The combined working experiences i gathered at the outpatient clinic of Dr. Malus (5+ years, by far my longest-standing job to date) and for Bikram Yoga Schottenring in Vienna not only raised my interest in public health but also triggered the decision to get some further insight into healthcare and its socioeconomical implications. After overcoming initial doubts on behalf of my family and successfully navigating through the university's selection process, and with the highly valued support of my girlfriend Katrin i finally packed my bags at the beginning of the month and rode off into the Wild West (thanks Martin for providing your VW Touran - i'm so sorry you had to suffer a broken gearbox in the process)!

I chose MCI not only for its academic merits but also for its alpine setting - let's say it was an "added bonus". During my childhood we have spent many a winter skiing in Tyrol and - whether it were the multiple trips to Mutters' "Hotel Seppl" (with its indoor swimming pool) and Alpbach's "Kolberhof" (with its charismatic host Gerda Moser) or the fancy one-time-stay at Hotel Post in upscale St. Anton am Arlberg (where i had the honour of sharing the dining table with the late world-class skier Ingemarg Stenmark) - i only have the fondest memories of all those trips! Later, in my mid-twenties, i picked up rockclimbing and discovered that the attraction of the Alps was not just limited to the cold season and  it dawned on me that Innsbuck - being a university town - was something like the Shangri-La for Austrian students with a serious interest in mountain & outdoor activities. Therefore, naturally when the opportunity to study in the heart of the Alps presented itself, i jumped at it!














Not only do i owe a great deal of that inspiration to my father (whose passion for skiing not only rubbed off on us, but also financed all those wonderful skiing holidays) but my mother also played an important role in this. Her being Hungarian, and my upbringing in both an Austrian & Hungarian cultural setting, enabled me to move into the Hungarian Student Dormitory in Innsbruck, arguably the most beautiful student dorm in Innsbruck! Its building - meanwhile a protected landmark - at the corner of Richard-Wagner-Strasse and Kaiserjägerstrasse had been donated to Hungarians fleeing their country during the 1956 Revolution and seeking refuge in Innsbruck. It was used first as a means of accomodation, then a school, and since the mid-60's as a student dorm. Just prior to moving here, Katrin and i took a weekend trip to Budapest and visited the "Terror House", a museum dedicated entirely to the dark side of the Hungarian Nazi & Communist regimes, so moving in here bore even more significance and felt like connecting with a Hungarian history & ancenstry that i had previously only caught glimpses of!

Not only is the Ungarnheim a beautiful building located in the most beautiful district of Innsbruck (called "Saggen", which is lined with mansion-type buildings, and only a 12-minute stroll from my university), but i also happen to inhabit its most beautiful room for the first semester here, a lofty 50 (!) square meter beauty with wooden parquet floor, high ceilings and 3 huge ornamented windows looking out onto the immuaculate lawn of our equally immaculate garden (you can see my 3 windows directly above the green arch on the picture above). The dorm features 18 rooms for students and is inhabited by some really nice folks (mostly with Hungarian background like me) who i am already forging friendships and practising my Hungarian with, usually by striking up a conversation in the common kitchen where i regularly get to meet the others. This is another important benefit of the dorm and the reason why i was so keen on getting a room here: i've been growing up with the Hungarian language and - difficult as it may be - it comes naturally to my tongue & ear, but my vocabulary is limited and my grammar knowledge rudimentary at best. For example, until my recent trip to Budapest i wasn't even aware that the Hungarian language posesses only 3 tenses (which is why some say jokingly that Hungarians - when conversing in a foreign language - find it difficult to get to the point), yet i've been using the language quite confidently for years! Besides practising my Hungarian i am also taking Spanish classes once a week at the university (starting at A2 level) so at the end of these 2 years i hope to be able to say that i am fluent in 4 languages.

University has started off well, and i like the MCI's approach which focuses on applied rather than just presented knowledge. We have a diverse mix of staff & students (including a brash young Aussie, 2 young doctors from Egypt & India, and an old physiotherapist from Vienna - guess who that is), and the instructional language is English, another reason i chose the MCI over other health-management programmes in Austria. The first week was spent almost entirely on creative and/or teambuilding exercises, and culminated with the extra-curricular task of preparing "the perfect dinner" for our faculty, a task that we completed quite successfully as you can see on following pictures. 


 


We were assigned a budget of 400 Euros for that task, so it was also a playful test of our management skills (i was part of the decorating team and promptly drove to IKEA Innsbruck, where i have taken up a part-time Saturday job at the cashout, to get some napkins and candles; the only department that eventually went over budget was the beverage department, which ended up in a crate of beer being stored in the trunk of my car for future use). 

Since then, lectures have come in blocks at our study programme: the second week's core subject was "Fundamentals of Management" with Professor Ole Berg from the university of Oslo (resulting in my first assignment, a 6-page essay titled "I as a Leader"). In the third week Barrie Dowdeswell from the UK (who also doubles as a mentor for graduates) took over with "Governance in Healthcare Institutions", and week 3 and 4 (both short weeks with 3 days each) are filled with "Research Methods", our introduction on how to research & write academic papers. I particularly enjoyed the speed-reading exercise last week, where we had to skim through 5 pretty long scientific articles on healthcare-related subjects in 60 minutes while extracting the essential information. Our assignment consists of  writing an academic paper (in teams of 3) on any subject of our choice until November 9, so that'll keep me busy over Halloween, which in my case will become "Hallo-Wien": i'm gonna seize some of those days off to visit my family & girlfriend back home for the first time, as well as teach a couple of yoga classes at Bikram Yoga Schottenring and catch a few movies at the Viennale - Vienna's largest film festival has been a fixture for the past 4 years, and i would've hated to entirely miss out on it!

Meanwhile, the peaks of the "Nordkette" (the impressive mountain ridge that rises up on the other side of the Inn river) are already covered by the first snow of the season, and i got a taste of that last Friday when i tried to hike up to Höttinger Alm in the afternoon, a little inn up at about 1.500 m elevation - about halfway up, staggering through waist-deep snow, i had to admit that wearing gaiters had been a good idea, but taking my snowshoes with me would've been an even better one! 


Without them, the going got tough and since it was already getting late i decided to turn around and retreat, but was offered a nice view of Innsbruck in return. I'm already making plans for another trip up there in November, and i'll make sure to strap on my snowshoes next time because...

"Winter is coming"!


Mittwoch, 22. Oktober 2014

The Hungarian Health & Healthcare System

HUNGARY


Key Facts:

Size:  93.000 km² , Population: approx. 10.5 million
Capital:  Budapest (Population 1.7 million)
Public Expenditure on Health: 7.9 % of GDP (2013)

  • !      Roughly  5 million inhabitants living outside the country’s borders, having left after several waves of     emigration (WW I, WW II, Revolution of 1956) or because the live in areas that were Hungarian       territory before the 1920 Treaty of Trianon
  • !    Almost half of the country lives in communities of less than 20 000 inhabitants
  • !    At the last census (2001) 3.1 % of the population considered themselves to be members of a              minority. The Roma community has the biggest share, officially 190.000 in 2009, the real number is      estimated to be 500.000 or higher!


Governance:

-          19 Counties, recently divided into 7 larger „regions“ (each consisting of 2-3 counties)

-        
            After the communist regime fell, Hungary has had a stable political system with usually 4 parties in coalition. Since 2010 however,  2 parties (FIDESZ – Hungarian Civic Union & the Hungarian Democrat Party) have formed a 2/3 majority in parliament, and a radical right-wing party (JOBBIK) has also appeared.


Health Development in Hungary since WW II  -  4 Phases

Post-WW II to mid-60’s

Mátyás Rákosi
          („Stalin’s best disciple“)


       ·         major advances in socioeconomic improvements
       global immunization - > communicable diseases under control
       ·         the early public health efforts of the communist regime                    (including widespread immunization programmes) helped bring        communicable diseases under control
       ·         life expectancy at birth comparable to further developed, more        Western countries
Mid 60’s to Late 80‘s
The Kádár Regime a.k.a.
„Goulash Communism“

      ·         larger role of non-communicable diseases
      ·         whereas life expectancy continued to rise in Europe, it levelled         off (or, in the case of men) even decreased in Hungary
      ·          increasing health gap between Hungary and Western            
             Europe

Late 80’s to mid-90’s
Independence (1989)

      ·         Clear decline in health status, further widening the gap
      ·         Between  1890 - 1993, male life expectancy decreased by 1.5        yrs (unique phenomenon in central Europe)
      ·         Tougher transitional period than other formerly Communist              countries, such as Poland or the Czech Republic.

Mid 90’s to present
Prime Minister:
Viktor Orbán (FIDESZ)

·         Steady increase in life expectancy in men and women
·         Decrease in cardiovascular mortality
·         „A new era?“ (Jozán, 2009) – but the gap in life expectancy between Hungary and Austria (and other EU member states) has essentially remained unchanged


Health Status


 

2009
  • !      Hungary still ranks among the lowest in Europe in regard to life expectancy, trailing the EU average by 5.1 years, and lagging behind the EU27 and even EU12 for many health indicators
  • !      DALE (disability-adjusted life expectancy) 65.8 years (EU27: 71.7 years)
  • !      Ranked # 110 out of 156 in „World Happiness Report“ (only lower-ranked EU country: Bulgaria), Suicide rate still twice as high as the EU27 average
  • !      8.3 % of all males reported being heavy drinkers (2009), widespread consumption of illegally distilled alcohol may be an additional risk factor for liver zirrhosis
  • !       31.4 % of all population over 15 years of age were regular daily smokers
  • !      Persisting geographical & social inequalities, especially among the Roma Population

However…

Amendment of the Act on the Protection of Non-Smokers in effect since January 2012
The regulation bans smoking indoors with few exceptions, as well as in certain outdoor areas.

Opening of about 5.200 supervised tobacco stores, compared to more than 40.000 unsupervised retail outlets before, has made access to tobacco more difficult, which has already led to lower numbers of smokers aged 13-15. However, it is suspected that the tobacco business will increasingly move to the black market.

 


number of cigarettes smoked anually per capita: > 2000



Organization of the Hungarian Healthcare System:

·         Considerable departure from the centralized model in place during the communist era (where healthcare was state responsibility alone) and reinstallment of a Bismarck-type model in 1990
·         Single-Payer health insurance system with virtually universal coverage


Problems & Challenges in Hungarian Healthcare:

!      Lack of an overarching, evidence-based strategy for mobilizing resources for health. Without this, the health system reamains vulnerable to broader economic policy objectives.

!      HIF is responsible for recurrent health expenditure only, capital expenditure (both  maintenance & new investments) is the responsibility of the owners of healthcare facilities.  Poor general condition of hospital infrastructure & the legacy of an oversized hospital sector from the communist era, which resulted in downsizing. Still, the average hospital building is 50.5 years old and consists of 22 seperate buildings

!      Governance of the HIF has undergone several changes that have increased central control & reduced stakeholder participation, thus leading to less transparent and more unpredictable funding arrangements

!      Human resource crisis emerging due to the ageing of health care professionals, staff shortages and (due to poor salaries) increasing migration oft he healthcare workforce, especially among physicians.

!      As a result, physicians in Hungary are unevenly distributed both in geography and specialties. In contrast to the number of physicians, the number of dentists has increased by 56% between 2000 and 2008, because…

!      … Hungary is a target country in cross-border health care, mainly for dental care but also for rehabilitative services, such as medical spa treatment.

!      Difficulty in treating Roma population.





Mittwoch, 15. Oktober 2014

"A Feast for Crows" (Buchblogparade 10/12, Beitrag Oktober)


Nun ist es also soweit: Nachdem mich seine Buchreihe "A Song of Ice and Fire" seit Sommer 2013 begleitet und fasziniert, hat "der amerikanische Tolkien", George R.R. Martin, es nun auch in meine Buchblogparade geschafft. Dabei möchte ich gleich vorausschicken, dass ich noch nie ein Buch von Tolkien gelesen habe, und mich die "Herr der Ringe"-Trilogie im Kino relativ kaltgelassen hat. Das soll aber auch nicht heissen dass mir das Fantasy-Genre ganz fremd ist - "Die unendliche Geschichte" und später "Märchenmond" gehörten zu den Lieblingsbüchern meiner Jugend. Nur dachte ich eigentlich (und die "Herr der Ringe" Verfilmungen hatten mich darin bestätigt) dass ich für Fantasy mittlerweile zu alt bin. Science-Fiction, ja gerne, aber Ritter, Drachen, übernatürliche Kräfte? Nein danke, aus dem Alter bin ich heraussen. Das dachte ich jedenfalls... bis mir George R.R. Martin's "A Game of Thrones" in die Hände fiel.

Nun geschah das ja nicht ganz aus heiterem Himmel. Als ich mich 2011 im Rahmen einer Ausbildung mehrere Monate in den USA aufhielt, waren dort sämtliche Amerikaner ganz verrrückt nach der gleichnamigen Fernsehserie. Während ich am Sonntag die Freizeit nutzte um zum Baseball oder zum Sightseeing zu gehen, harrten meine Kollegen vor dem Fernsehgerät aus um die nächste Folge der wöchentlich auf HBO ausgestrahlten Serie nicht zu verpassen. Als ich einmal kurz hineinschaute, konnte ich den Hype überhaupt nicht verstehen. Ausser ein paar langhaarigen Männern, barbusigen Frauen & gestelzten Dialogen konnte ich da nichts Interessantes ausmachen.

Als der Game of Thrones Hype dann allmählich auf Europa überschwappte, beschloss ich der Serie dann doch eine zweite Chance zu geben - mehr aus Neugier und weil ich meinen ersten Eindruck wohl einfach bestätigt sehen wollte. Doch ich erkannte dass ich mich getäuscht hatte und die Serie durchaus ihren Reiz hat... dadurch wurde ich neugierig auf die Bücher, und dann wurde es plötzlich richtig interessant. Schon lange hatte mich kein Buch mehr so in den Bann gezogen wie die episch angelegte Story um konkurrierende Dynastien auf dem fiktiven Kontinenten Westeros! Irgendwo traf die Geschichte einen Nerv bei mir, weckte einerseits meine alte Jugendliebe zu Rittertum und Fantasy-Literatur, und bot gleichzeitig alles wonach ich heute in Romanen suche: komplexe Charaktere, einen unvorhersehbar mäandernden Plot, sowie einen geschliffenen Erzählstil. Alles das bietet George R.R. Martin, und noch einiges mehr. Alleine das Personenverzeichnis am Ende der Romane nimmt Dutzende Seiten ein, die Stammbäume der konkurrierenden Clans sind dermassen ausgefeilt dass ich mich immer wieder frage, wo er a) all diese Ideen hernimmt, und b) wie er bei sovielen Figuren noch den Überblick behalten kann!?

Falls jemand weder das Buch noch die Serie kennt, versuche ich einen ganz kurzen Überblick zu geben: der Großteil der Handlung spielt auf einem fiktiven Kontinent namens Westeros, der - am ehesten vergleichbar mit unserem Amerika - in einen "Norden" und einen "Süden" geteilt ist, welche sich klimatisch, aber auch ethnisch, religiös & kulturell deutlich voneinander unterscheiden. Es gibt auf Westeros zahlreiche Familiendynastien bzw. Clans die allesamt um Einfluß kämpfen und aus dem Grund unterschiedliche Allianzen bilden. Da wäre beispielsweise die Familie Stark aus dem kargen Norden, mit ihrem wortkargen aber geradlinigen & gutherzigen Vater Ned. Die steppen- bzw. wüstenhafte Region Dorne im Süden, regiert von der Familie Martell, ist dagegen für ihren kräftigen Rotwein und das feurige Temperament der "Dornishmen" bekannt. Regiert wird der Kontinent jedoch von der traditions- und einflußreichen Familie Lannister, die von der Hauptstadt ("King's Landing") aus die Fäden in der Hand hält. Im Norden von Westeros trennt eine gigantische Mauer die 7 Königreiche von einer unerforschten Gegend, und während auf Westeros ein Thronfolgekrieg entbrennt, braut sich im Norden ein ganz anderes Unwetter zusammen.

Es würde den Rahmen sprengen hier auf die vielen Subplots einzugehen, daher kann ich jedem nur raten das erste Buch zur Hand zu nehmen, und sich von George R.R. Martin und seiner Geschichte um den Finger wickeln zu lassen - vorzugsweise in Englisch. Was mich an den Büchern am meisten fasziniert sind die vielfältigen Charaktere, mit wieviel Phantasie Martin sie erschaffen hat, und wie er es schafft jeden Charakter einzigartig und anders auszugestalten. Und er schreckt auch nicht davor zurück selbst die beliebtesten Charaktere plötzlich sterben zu lassen, was den Leser ständig um seine Helden fürchten und bei der Geschichte mitfiebern lässt.

Hier die bisher erschienenen 5 Bücher - 2 weitere sind lt. George R.R. Martin nötig und auch bereits in Bearbeitung. Martin's Fans warten bereits sehnlichst auf die Veröffentlichung, und auch ich bin schon sehr gespannt wie er die Handlungsfäden zusammenführen wird.

  1. A Game of Thrones
  2. A Clash of Kings
  3. A Storm of Swords
  4. A Feast for Crows (hier bin ich mittlerweile angelangt)
  5. A Dance with Dragons