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Discrimination against ‘foreign’ doctors widespread in Sweden

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“When I was working in psychiatry, a patient cancelled his appointment with me three times because he didn’t want to be treated by a ‘foreign doctor’,” 30-year-old practitioner Navid Ghan told AFP.

“In the end he didn’t have any choice, I was the only doctor available.

During the appointment, even though he saw that I spoke Swedish without an accent, he told me ‘you foreigners, you don’t understand anything’,” Ghan said.

Ghan, whose name has been changed at his request to protect his identity, is not even a ‘foreigner’: he was raised and earned his medical degree in Sweden.

“Now my colleagues and I joke about it in the lunch room. The nurses arrive and say ‘they cancelled again when they saw your name’.”

Since 2010, as part of a broader reform to Sweden’s universal healthcare system that opened up primary healthcare to private actors, patients have been allowed to choose their own doctor and clinic.

Prior to the reform, Swedes were assigned a clinic based on where they lived.

But as tensions smoulder over rising immigration in traditionally homogeneous Sweden, the reform has made it possible for patients to refuse to be treated by non-ethnic Swedes.

Sweden has seen its immigrant population double in the past two decades, statistics show, and support for the far-right Sweden Democrats has surged to 20 percent to make it the third-biggest party.

‘Fair-skinned’
Lars Arrhenius is the head of Sweden’s Equality Ombudsman, a government agency that promotes equal rights and combats discrimination.

He said that choosing a doctor based on ethnicity is a “worrying development”.

At the end of March, 1,011 doctors and medical students signed an appeal in daily newspaper Expressen calling on “the responsible authorities to act against racism” in their field.

In July, the country’s largest broadsheet Dagens Nyheter published an investigative series exposing the scope of the problem.

Journalists posing as patients who had recently moved to a new city or town called 120 healthcare clinics and asked that their new doctor be an ethnic Swede.

READ ALSO: Opinion: The Swedish discrimination that dares not speak its name

A total of 51 clinics agreed to the request, 40 refused. Only a handful explicitly said the request was unacceptable.

“We have Maria, Sanna and Elsa. Three fair-skinned women,” one medical secretary told a journalist.

Gender Equality Minister Marta Stenevi, whose brief includes the fight against discrimination, told AFP the practice was “totally unacceptable”, after meeting various actors in the healthcare sector to address the issue.

The head of the Swedish Junior Doctors’ Association, Madeleine Liljegren, said clinics often consented to the requests because of “competition between healthcare clinics over patients.”

The more patients a clinic has, the more state funding it gets.

Lack of support
“The nurses likely think ‘I’ll agree to their request’ — as shocking and horrible as it is — just to keep the patient,” said Liljegren, noting that some clinics do not have enough patients to stay afloat financially.

Makih Fatelahi, a hospital doctor in the southern Swedish county of Kronoberg whose name has also been changed, says some patients are concerned about communication issues.

“The problem is that they only see your name when the appointment is made.

You don’t get a chance to establish an in-person contact before you get rejected,” the 28-year-old tells told AFP.

The number of cases of discrimination against doctors of foreign origin is not known.

In 2020, more than 3,500 general discrimination complaints were filed to the Equality Ombudsman, 1,146 of which concerned “ethnicity”.

Sweden’s health care system relies heavily on immigrant workers, who are often employed as nursing assistants. In 2020, 2,401 doctors received medical licences in Sweden, almost half of whom earned their degrees abroad.

Navid Ghan said he doe not feel supported by his superiors, even though they have seen the discrimination he has faced.

Many doctors with foreign names complain about a lack of internal procedures at their workplaces for how to respond in such situations. 

“You end up not paying any attention to (the discrimination). I use an algorithm to not let my emotions get the better of me: Does this patient really need my help? If yes, I take care of the patient and ignore the comments. If not, I ask a colleague to take my place,” Ghan said.



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Drop in cancer diagnoses as high as 14 per cent during pandemic, early data shows

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The drop in the number of cancers detected during the Covid-19 pandemic could be as high as 14 per cent, preliminary data has suggested.

A report from the National Cancer Registry said it was still too early to provide “definitive answers” on whether pandemic hospital restrictions last year led to a reduction in the number of cancers diagnosed.

The registry’s annual report said an estimated decrease of 14 per cent in detections pointed to the “potential scale” of Covid-19’s impact on other healthcare.

A separate analysis of data on microscopically verified cancers diagnosed last year showed a reduction of between 10 and 13 per cent, the report said.

The drop in confirmed cancer cases, when compared with previous years, could be partly accounted for by “incomplete registration of cases already diagnosed”, it said.

Prof Deirdre Murray, director of the National Cancer Registry, said there were “clear signals that, as expected in Ireland, the number of cancer diagnoses in 2020 will be lower than in previous years”.

‘Very worried’

Averil Power, chief executive of the Irish Cancer Society, said the organisation was “very worried” over the significant drop in cancers diagnosed last year.

The shortfall in cancers being diagnosed would present a “major challenge” in the coming years, with lengthy waiting lists and disruptions to screening services “all too commonplace” already, she said.

Ms Power said it was frightening to think of the people who were living with cancer but did not know it yet. She added that existing cancer patients were “terrified” of having treatments delayed due to the recent rise in Covid-19 cases.

The registry’s report said there were about 44,000 tumours identified each year between 2017 and 2019.

Not counting non-melanoma skin cancer, the most common cancer diagnoses were for breast and prostate cancer, which made up almost a third of invasive cancers found in women and men respectively.

For men this was followed by bowel and lung cancer, and melanoma of the skin. Lung cancer was the second most common cancer for women, followed by colorectal cancer and melanoma of skin.

Nearly a third of deaths in 2018 were attributed to cancer, with lung cancer the leading cause of death from cancer, the report said.

The second, third and fourth most common cancers to die from in men were bowel, prostate and oesophagus cancer. For women breast, bowel and ovarian cancers were the most common fatal cancers.

The report said there were almost 200,000 cancer survivors in Ireland at the end of 2019, with breast cancer patients making up more than a fifth of the total.

Mortality rates

The research found cancer rates among men had dropped between 2010 and 2019, with mortality rates decreasing or remaining the same across nearly every type of cancer. Rates of cancer detected among women had increased between 2008 and 2019, with mortality rates for most cancers decreasing.

The report said the five-year survival rate from cancer had increased to 65 per cent for the period 2014 to 2018, compared with 42 per cent two decades previous.

There had been “major improvement” in survival rates for most major cancers, however, the research noted the chances of survival varied significantly depending on the type of cancer.

Prostate, melanoma of the skin and testis cancer had survival rates of more than 90 per cent, followed closely by breast and thyroid cancer, and Hodgkin lymphoma. Pancreas, liver, oesophagus and lung cancers had much lower five-year survival rates on average, the report said.

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How Germany has made it easier to cancel broadband and phone contracts

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What’s going on?

On December 1st, new amendments to the Telecommunications Act came into force in Germany. The updates bring with them wide-ranging changes to consumer rights laws for people who’ve signed – or will sign – new mobile, landline and internet contracts.

The headline change relates to the amount of time contracts are allowed to run for after they renew. If a customer signs up to a 24-month mobile contract and doesn’t cancel before it renews, telecommunications companies will no longer be allowed to sign that customer up for another one or two years without their permission.

Instead, people who don’t cancel in time will be put onto a one-month rolling contract that essentially allows them to terminate at any point with just one month’s notice.

It’s an end to a tax on the disorganised that has seen people stuck paying for contracts they no longer want or need for up to 24 months longer – often at higher prices than they agreed when they first signed the contract.

Does that mean all contracts will be rolling contracts?

Not exactly. As before, most new contracts will run for a minimum 24-month term – so expect to be locked in for at least this long, unless you specifically look for a more flexible contract. 

The change affects what happens after this initial term is up, meaning if you do sign up for a yearly contract, one year won’t automatically turn into two if you don’t remember to cancel it in time. 

READ ALSO: Everything that changes in Germany in December 2021

What else is new?

Alongside the key changes to contract durations, there are also changes to the way in which contracts are agreed and tougher standards for internet providers.

In future, if you agree a contract over the phone, you have to receive a summary of the terms of the contract and confirm it in writing before the agreement is legally valid. 

This summary must include the service provider’s contact details, a description of agreed services, details of any activation fees, the duration of the contract and any conditions for renewal and termination. Without written approval, the contract has no legal standing and the provider has no claims against the customer – even if they switched to the new services immediately after the telephone call.

A young man on the phone in Hannover
A young man takes a phone call on a tram in Hannover. Under the new changes, contracts agreed over the phone will not be valid until they are confirmed in writing. Photo: picture alliance/dpa | Hauke-Christian Dittrich

If a provider makes a change to a contract after it’s up and running, customers now have the right to terminate without notice.

In future, providers must inform customers if there are more favourable offers available and a change to a new contract would be possible.  This must happen once a year, and once again, providers aren’t allowed to do this solely over the phone. 

For broadband customers, there’s more good news: internet providers will in future face issues if they don’t provide the bandwidth stated in the contract. 

That means that if your internet is slower than promised, you should have the right to pay a reduced price or terminate the contract. 

READ ALSO: Moving house in Germany: 7 things you need to know about setting up utility contracts

I signed a new contract a while ago. Do the new rules still apply? 

Yes, they do. Regardless of when you signed your new contract, the amendments to the Telecommunications Act will apply. 

That means that once your initial contract period is up, you should be able to cancel freely and only pay for the month’s notice. You should also be informed of any changes to your contract or better offers and be eligible for compensation if your internet goes below the promised bandwidth. 

If you’ve already been locked in to a 12- or 24-month contract through an auto-renewal, the situation is a bit less clear – but it may be worth contacting your provider and asking them if the terms of your contract have changed in light of the new law. 

READ ALSO: Has it just got easier to end credit agreements in Germany?

What are people saying?

The Telecommunications and Value-Added Services Association, which represents the industry, said it was important than the initial 24-month contracts were allowed to continue. The subsequent new notice periods are a good compromise, VATM Managing Director Jürgen Grützner told Tagesschau

“On the one hand, this means better financial forecasting for expanding providers’ networks and, on the other hand, the best of both worlds for consumers,” he added. 

Campaign for faster internet
“We need fast internet!” is scrawled in huge letters across a street in Weetzen, Lower Saxony. Photo: picture alliance/dpa | Ole Spata

However, Grützner believes the new rules on bandwidth could cause difficulties for providers who struggle to offer the same quality of internet across all regions. 

Meanwhile, consumer rights advocates have welcomed the improvements to contract law. 

In particular, the Federal Consumer Advice Centre “expects competition to improve as a result of the new regulation, including the price-performance ratio,” Susanne Blohm from the organisation’s Digital and Media Division told Tagesschau.

In an initial sign of the regulation’s positive impact, the provider Telefonica has announced that it will abolish surcharges for contracts that don’t have a minimum cancellation period. 

Vocabulary

amendments – (die) Novelle

bandwidth – (die) Bandbreite 

minimum contract term – (die) Mindestlaufzeit 

provider – (der) Anbieter

We’re aiming to help our readers improve their German by translating vocabulary from some of our news stories. Did you find this article useful? Let us know.



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Can my child really be refused entry to school for not wearing a face mask?

Voice Of EU

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What are the new rules on wearing face masks at primary school?
Pupils in third class upwards are required to wear face masks, apart from those with exemptions. These rules apply for children aged nine-plus using public transport and in other public, indoor settings.

Can my child really be refused entry to school for not wearing a mask?
Department of Education guidelines state that unmasked pupils in third class upwards will be refused entry to school if they do not have a medical certificate to show they are exempt from the rules.

Schools, however, are being advised by the Government to take a “flexible” and “practical” approach to the new rules over the coming days.

Are these rules underpinned by law?
The guidelines are not statutory but, like existing rules on face masks for secondary students, schools are required to implement them.

When asked if school principals will be legally protected when implementing the wearing of face masks, Taoiseach Micheál Martin said where they apply public health policy they will be “protected definitely”.

On what grounds can a child be exempt from wearing a mask?
There three main grounds under which children may be exempt from wearing a mask:





Confirmed cases in hospital Confirmed cases in ICU


579


122

(1) Any pupil with difficulty breathing or other relevant medical conditions
(2) Any pupil who is unable to remove the cloth face-covering or visor without assistance
(3) Any pupil who has special needs and who may feel upset or very uncomfortable wearing the cloth face covering or visor, for example pupils with intellectual or developmental disabilities, mental health conditions, sensory concerns or tactile sensitivity

Do children require a medical certificate to prove they are exempt?
Most children will not require a medical certificate on the basis that schools are best placed to identify children whose needs are such that the wearing of face covering may not be possible for them.

In other circumstances, a medical certificate – from a GP, typically – must be provided to the school.

What happens with mask wearing at break time or during PE?
A “common sense” approach is being advised. As it the case at second level, students may take off masks briefly for eating and drinking indoors.

Schools are being advised that masks can also be taken off when in the yard and for PE lessons outdoors.

If sporting activity takes place indoors, masks do not need to be worn if the space is well ventilated and subject to CO2 monitoring.

Masks may also be taken off for music, but consideration should be given to social distancing and ventilation.

What happens if my child forgets or loses their face mask?
Schools should have a sufficient supply of masks for this purpose.

My child is in a mixed class with second and third class pupils. What rules apply?
Where there are mixed classes in a single classroom, only children in third class and above are required to wear face masks.

When will the rules be reviewed?
The Department of Education says it has been advised that this measure is being introduced on a temporary basis and is subject to review in mid-February 2022.


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