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MOTHERHOOD IN THE FATHERLAND

HEALTH

Immunisations and anal pharmacists

Motherhood in the Fatherland follows mum Sabine Devins as she navigates the cultural quirks of having a baby in Germany. In the latest instalment, she tackles immunisations and baby pharmaceuticals.

Immunisations and anal pharmacists
Photo: DPA

This month, my daughter reaches an important milestone: it’s her last round of immunizations until school age. It will be a relief for me to see her chubby little thighs bandage-free until she’s marching off to school with an overloaded Schultüte.

Luisa and her counterparts in North America and the UK are lucky to count going to the doctor as a fact of life. When a baby is born in Germany, he gets presented with a Babypass. Like my Mutterpass, the little book is a transportable medical file that mothers can take from doctor to doctor with her medical history. It also tracks baby’s development.

All of the check-ups, or Untersuchungen, are abbreviated to U1, U2, U3, etc. Luisa’s appointments are labelled on the front of her Kinderpass with what dates they should fall between, going all the way to April 2016. Each Untersuchung has a page for the doctor to fill out. It also leaves me with a handy little guide to how much Luisa has grown over the last year (it’s a lot!).

Most of the exams so far have been simple physicals. Making sure Luisa is growing properly and all her little parts with it. At the U3, there is an ultrasound to look for hip dysplasia — something that I find Germans to be disproportionately concerned with. As there is some hip joint issues in Luisa’s family medical history, she received an ultrasound at her U2, then again three weeks later, then with a specialist, and then again at the U3. The conclusion: “Her hips are just fine, we just like to be very careful when it comes to hip dysplasia,” said our doctor.

According to the International Hip Dysplasia Institute, hips that require treatment only occur in two to three children per 1,000.

What I do like about Germany’s scheduled medical care for babies is that they do immunizations a little later than in the English-speaking world. While Luisa’s friends in the US, the UK, and Canada all had their first round of shots at two months, Luisa didn’t get her first Impfungen until she was nearly four months. The first round is done in conjunction with the U4 check up, when Luisa is between two and four months old. Since her appointment was booked closer to the end of the fourth, that was simply when she got her first round.

As for the immunizations themselves, they are very much the same as what children in North America and the UK are given. Right now, Luisa has fighting power against tetanus, diphtheria, pertussis or whooping cough, polio, pneumococcus and hepatitis B. On the advice of my paediatrician, I skipped the Rotavirus immunisation and many German parents also leave out the Hepatitis B. After her last round, Luisa will also be armed against measles, mumps, and rubella.

Overall, there isn’t much difference between the care Luisa would get here versus there. But what is different in Germany is the at-home care and what Mamas keep in their at-home medical kit.

I’ve written before on the various uses of breast milk to cure these things, but that does come to an end and now those ailments lead me to the medicine cabinet.

For stuffed noses, we have saline solution. It’s hated by our little one and therefore seldom used. As Germany is the birthplace of homoeopathy, I can find all sorts of natural remedies. My favourite is called Osanit and they’re little pearls I use for teething pain. It’s main medicinal ingredient is chamomile. Whenever those gums start causing problems, babes are dosed with a few little pearls that they can roll around in their mouth and it seems to work. Life goes on. American mom Laurie has a similar product in her cabinet called Dentinox-Gel N, which also contains chamomile but in a gel format.

For those fevers, we use paracetamol, but its application is what makes our stash “very German”. The favoured method of dosing your child by the Mamas is Zäpfchen, or suppositories.

I wasn’t sure what to make the first time I realised what my doctor had prescribed after Luisa’s first round of immunizations in case of fever. But she was hot and miserable and so it happened and it was awful for everyone, but it did make her feel better. The next day I went to the pharmacy and asked for liquid paracetamol to give her instead.

The pharmacist was confused by my request. “But with the suppositories, you know she’s getting the right amount. You don’t have to worry about getting her to swallow it and once it’s done, it’s done,” she said, very pragmatically.

With the next fever, I took out a spoon and tried to get Luisa to swallow her medicine. It didn’t work. Her mouth clamped shut, she shook her head and sticky, orange-flavoured syrup got all over the floor. The practical German in me took over and we went back to the Zäpfchen. I’m now a convert.

I’m not the only one. British mum Tori told me she thinks they’re brilliant. “I would have never used them if I were raising Max [in England], but my husband, who is a doctor, was the one who stocked up the medicine shelf and at first I wasn’t so sure, but now they’re all I use.”

But others aren’t convinced.

When Laurie’s son has a fever, she uses liquid ibuprofen, which her pharmacist told her not to use until he was six months old. Before that, she had infant’s Advil and Triminic sent from the US. She also keeps American-bought Neosporin on hand. She also wishes that children’s acetaminophen were more available in the Fatherland.

English mum Susannah won’t touch the Zäpfchen. “Sticking things up a baby’s bum is not an idea I’d ever considered until I became a parent here. I would have no idea how to go about it, and would worry I was hurting her.”

Instead, she stocked up on the beloved English cure-all Calpol on her last trip home. “It’s poured liberally down English children’s throats from a very young age, whereas Germany seems less into plying babies with drugs,” she explained. “By extension, the German equivalents seemed less trustworthy in my mind: Irrational but true.”

She also has Calpol saline nose spray, as an assistant at her local pharmacy “raised her voice and eyebrows at my request for — what she called — a brutal product. She pretty much accused me of wanting to shoot drugs into my innocent child’s brain tissue.” But Susannah felt the German saline drops weren’t working and was delighted when she read “Suitable from birth” emblazoned on the English saline spray.

These days, we more readily turn to Google than our mothers to answer the million times we need to know: “Is this normal?” However, when it comes to comforts and cures, we turn back to what we know from childhood, whether it’s Laurie who goes for Neosporin to treat her son’s scrapes or Susannah who trusts one name to cure it all. Even if similar products are available in the German Apotheke, it’s just not the same as what we know.

And just because I use the Zäpfchen, doesn’t mean I wouldn’t be grateful for your tips on getting your babes to swallow their medicine.

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HEALTH

What you should know about Germany’s plans to roll out e-prescriptions

Germany is taking a big step towards a more digital-friendly health system, with plans to roll out e-prescriptions nationwide. Here's what you should know.

A person holds the e-Rezept app in a pharmacy in Oldenburg, Lower Saxony.
A person holds the e-Rezept app in a pharmacy in Oldenburg, Lower Saxony. Photo: picture alliance/dpa | Mohssen Assanimoghaddam

What’s happening?

From January 1st 2022, people in Germany will receive their prescriptions digitally (known in Germany as an ‘e-Rezept’) from healthcare providers.

Patients should be able to get their prescription from their doctor via a QR code sent to an app, which can then be transmitted to a pharmacy. The pharmacy can then let the patient know whether their medicine is in stock (or if they want to order it), and when it is ready for collection. 

This model is to be mandatory for people with statutory health insurance from the start of 2022, replacing the good old paper prescription.

However, the QR code can also be given to the patient by the doctor on a piece of paper if a patient does not have access to or doesn’t want to use a smartphone. 

READ ALSO: The changes around doctors notes in Germany you should know 

How exactly will it work?

In theory this is the plan – you’ll visit the doctor or have a video consultation. After the examination, the doctor will issue you with an electronic prescription for the medication that has been prescribed to you. 

A prescription code is automatically created for each ‘e-Rezept’, which you will need so you can get the medicine at the pharmacy. As we mentioned above, patients in Germany can either open this QR code in the free e-prescription app developed by Gematik and the Health Ministry, or receive it as a printout from the doctor. 

Next, you can take the prescription QR code (either in the app or as a printout) to your pharmacy of choice to get the medication needed.

One of the major differences and timesavers under the new system is that you can also select the pharmacy you want to get the prescription from digitally, order the medication (if needed) and you’ll be alerted when the prescription is ready. You can also arrange to have it delivered if needed. 

A doctor’s signature is not required, as e-prescriptions are digitally signed. 

The aim is that it will save on paperwork, time at the medical office and trips to the pharmacy. 

Some patients have already been receiving digital prescriptions. The ‘e-Rezept’ was tested out successfully in selected practices and pharmacies with a focus on the Berlin-Brandenburg region of Germany. The test phase started on July 1st this year.

Pharmacies and doctors’ offices nationwide have also been given the opportunity to test the new system from the start of December. 

“This will enable practice providers and pharmacy management systems to better prepare for the mandatory launch on January 2022 1st,” said aponet.de, the official health portal site for German pharmacies

The new e-prescription app.
The new e-prescription app. Photo: picture alliance/dpa | Mohssen Assanimoghaddam

READ ALSO: 10 rules to know if you get sick in Germany

There is some leeway though – if there are technical difficulties, paper prescriptions can still be issued in individual cases until the end of June next year.

The National Association of Statutory Health Insurance Physicians estimates that it could take until mid-2022 until all users are equipped with e-prescription applications nationwide.

The obligation does not apply to privately insured people from January next year. Private insurance companies can decide voluntarily to make the preparations for their customers to use the e-prescription.

What’s this about an app?

To be able to receive and redeem prescriptions electronically, people with statutory health insurance need the Gematik ‘das e-Rezept’ app. 

One issue is that the app appears to only be available at the moment in German app stores. We’ll try and find out if there are plans to change this and widen out the access, but it seems likely for that to happen. 

Germany’s Covid-Warn app, for example, was initially only open to German app stores but was gradually widened out to many others. 

As mentioned above though, those who don’t have access to an app will be able to use the paper with the code on it to access their prescriptions. 

READ ALSO: Everything you need to know about making a doctor’s appointment in Germany

Has it all gone smoothly?

As you might expect, there have been a few hiccups. 

Originally, the introduction nationwide was planned for October but was postponed due to many providers not having all the tech requirements set up. 

Now though, more than 90 percent of the practice management systems have been certified by the Association of Statutory Health Insurance Physicians – a prerequisite to issue the e-prescriptions.

The e-prescription is part of Germany’s far-reaching plans to digitise and streamline the health care system.

The head of Gematik GmbH, Markus Leyck Dieken, recently spoke of a “new era” that is “finally starting for doctors and patients” in Germany. 

Useful vocabulary:

Prescription – (das) Rezept

Doctor’s office/practice – (die) Arztpraxis

To order – bestellen 

Pharmacy – (die) Apotheke

Video consultation – (die) Videosprechstunde

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