By the river Nahe

Graham Wroe, 61 this month, is a general dentist or Zahnarzt in Sohren, a small town in the Hunsrück, Germany. Raised in Haslingden in Lancashire, Graham qualified from Sheffield in 1976 and worked in Sheffield and Derbyshire (mainly NHS) for nine years. He then emigrated to Cape Town, where he spent 22 years. He relocated to his wife Heidi's hometown in Germany in 2007. Graham has one daughter, Rachel; two step-children, Nadine and Derek; and two grandchildren, Enya and Timo.

When I work the early shift (7.30 am-2.30 pm), I rise at 6 am and make myself coffee and a light breakfast, usually scrambled eggs, at home in Bad Kreuznach, Rheinland Pfalz. Bad Kreuznach is a picturesque spa town situated on the river Nahe in the winelands.

I drive the 60 km to my practice, partly on the Autobahn, which takes 45 minutes to an hour. During busy periods I am fortunate to be always going against the main flow of traffic heading towards Mainz and Frankfurt. When I am tired my journey to or from work is a frustration but most of the time I relish the solitude.

On the late shift (2-9 pm), which I do on alternate weeks, I get up a little later in the morning. I usually have coffee and listen to the news on the radio, then go for a jog in parkland by the river or through the woods before a leisurely breakfast. The rest of the morning is reserved for errands, then a light lunch before I drive to the practice.

An international practice

We are a large practice and truly 'international'. The common language is of course German. The practice owner and two of my female dentist colleagues are Romanian; there is one German doctor and I am the sole 'Englander'. Our full-time orthodontist is of Polish origin and we have another part-time oral surgeon/orthodontist who flies in from Greece every month and stays throughout the working week. Finally, we have a visiting professor from Rome who comes frequently to give courses and perform implant surgery – a childhood friend of the owner.

The practice has an extensive support staff – about 30 women in total of various ethnicities, including a large contingent with a Russian background (the Hunsrück region has a large population of second and third generation Russian immigrants).

There is a formalised career structure in Germany with a day release programme for apprentices. A chairside assistant studies for three years before qualifying and then can go further to become what would be comparable to a hygienist.

Dealing with the health insurance system/cost estimates and submitting treatment plans generates an enormous amount of administration! Some of the office staff with young families work from home interfacing with the practice electronically over the Internet. We also have an in-house dental laboratory (which is headed by the boss's wife) generating paperwork too.

My workload consists mainly of routine check-ups and periodontal status reviews interspersed with routine cons, endo and extractions. Our team system means there will be overlapping crown and bridge/denture/implant cases in progress simultaneously that require my attention. There is a rapid flow of patients most days including emergency cases. We have a general anaesthetic session once a fortnight. A fair proportion of my time is spent explaining treatment options and costs by means of photos, radiographs and models. Often patients are given printed treatment options and their alternative costs to take home. A further appointment is then arranged to make a decision on the final treatment plan which will then be submitted to the medical insurance scheme.

Sign of the times

Unfortunately, I see too many, often young, patients with poor oral hygiene and advanced caries. It is quite a challenge to break the cycle of destruction with many teenagers who seem impervious to motivation. Depressing.

The 'obesity epidemic' is prevalent. This can pose problems for physical access, eg giving id blocks or working on molars. The often sequential medical consequences of type 2 diabetes and cardiovascular disease mean that many patients are on a cocktail of daily drugs. This can result in oral disease problems and general patient management complications.

Speaking the language

The vast majority of patients speak German with a few exceptions. These are a few Americans from the Cold War days who have stayed on and the staff from Ryanair (many whose first language is Portuguese but they speak English). Ryanair operate from Frankfurt Hahn airport which is close to Sohren – and nowhere near Frankfurt itself!

I am no linguist and German grammar is difficult to master. Plus there are regional dialects to encounter. One of my achievements, of which I am proud, is learning German in my advancing years. To think in a foreign language and to communicate is a source of immense satisfaction.

South Africa versus Germany

My South African practice was totally private and operated at a more sedate pace. The biggest difference here in Germany is that I do not have an assigned surgery to myself. We have eight treatment rooms which are assigned to patients and the treating staff navigate between rooms. The support staff do a lot more than in SA and the UK. For example, the nurses will take radiographs and impressions, make temporary crowns and so on. So for example, with a multiple crown case I will shape and build up the cores as needed and then leave an assistant (sometimes two) to do the impressions etc while I see other patients – only returning to deal with problems or to check the impressions and temporaries. The lab technician will also be involved to assess the patient, check any aesthetic wishes, check occlusal relationships and register tooth shades. Further scheduling is done via the computer in the surgery which frees up the reception staff. A team effort. When things go as planned the system works very well but when it's 'one of those days' then the waiting room resembles Paddington station!

UK dentistry

I am a BDA member and read the BDJ and BDA News. I won't comment on the furore surrounding the GDC that is gaining momentum. Here in Germany there are no such problems! You get what you pay for! For example there is no concept of a private scale and polish. The standard calculus removal for a normal insurance claim is just that and only applicable once a year. But there is a 'professional cleaning' which some of the insurance schemes pay towards that takes at least an hour and is much more extensive. We actively promote these treatments and the patients willingly pay: not a problem ethically or otherwise!

Lifestyle

Wherever one lives it pays to be streetwise and without wishing to sound dramatic, crime is a fact of life in Cape Town. I had activated burglar alarms both at home and in my practice there complete with panic buttons etc. Firearms are readily available. That said, the social life was very laid back and life was good.

Germany is more formal in its culture and more reserved. But, we are very fortunate. We live in the old pedestrianised, historic part of town where there is no traffic and all the shops, amenities and our favourite Italian restaurant are within a short walking distance. There is a castle on the hill and the soothing sound of the river outside our bedroom. Wonderful!

Family commitments motivated our move back to Europe. I do miss family and friends in SA, the ritual of the weekend braai (barbecue) and the Cape Town sunshine. I also miss the cricket – don't ever try to explain cricket to a German!

After almost 30 years abroad I can't say that I miss British life. I've been exposed to many cultures and I am very grateful for that experience. I do try to visit my stepmother in Haslingden at least once a year. She is well into her eighties but amazing for her years. I still get sentimental when I visit my hometown and I love to go for long walks on the moors.

Back home in Bad Kreuznach after the morning shift at my practice, I jog before it's time for dinner. I usually spend the evenings relaxing at home. Sometimes, after a hectic day, I spend the evening in the sauna: that's one of the advantages of living in a spa town.

After the evening session at work I don't usually get home until 10 pm or just after. I catch up on the day with Heidi and eat a light supper before retiring to bed.

Interview by Kate Quinlan