By Janneke Kruse and Marjolein te Winkel
Once upon a time, someone persuaded you to join Groningen. What made you say ‘yes’?
“The Netherlands is a paradise for a medical microbiologist. Virtually all the Dutch hospitals employ medical microbiologists and this is unique. Everybody in Europe knows this, so, it was a great honour to be invited by a Dutch hospital. At that time, I had set up cooperation projects in Münster with the Dutch neighbouring regions of Twente and Achterhoek to prevent the spread of MRSA. So, when I was asked to come to Groningen, I also thought: that’s not far from the German border, then I can still carry on with those cooperation projects. For me, this meant a huge step in my career. As Chef de Clinique in Münster I was in charge of 40 people, here I was made Head of Department, with 150 people. For me, that was very exciting.”
What do you remember of your early days at the UMCG?
“When I arrived here, the hospital was battling with a major flare-up of the VRE bacterium which had not yet been brought under control. As the new Head of the Department of Medical Microbiology and Infection Prevention, I had to prove my worth. In the end, I opted for an unorthodox method: to stop all measures, because there were too many. We went back to basics: hand hygiene and social environment surveys. Because workers can’t keep up with too many rules, and, as a result, nobody knows what is important anymore. And it worked, within 2 months the upsurge was under control.”
What is it that you are the most proud of having achieved at the UMCG?
“It’s the regional networks, the cooperative structures we set up. This started when we analysed a Klebsiella outbreak and noticed that this bacterium follows a whole route: from the UMCG to Beatrixoord to Emmen and back again to the UMCG. We only managed to discover this, because we were already able to use the most sophisticated sequencing technology. We then learned: without a regional network you cannot control any outbreak effectively. We started taking small steps and carried on developing regional cooperation. By now, this has resulted in a network which has been joined by some five hundred professionals in the four northern provinces.
“The Netherlands had chosen antibiotic resistance as its special research area and my pleas for networking appealed to then Minister Schippers of the Dutch Ministry of Health, Welfare and Sports. I was appointed Chairman of the Taskforce of the Dutch Society for Medical Microbiology and travelled throughout the country to speak about prevention through networking. Our region became a national role model, I am very proud of that. Regional networking structures also helped us enormously when the Corona pandemic broke out. We were able to share data instantly and get a grip on the Corona situation in the Northern Netherlands, because we had been cooperating effectively already for many years. By simply being in Groningen in 2020, your risk of dying of Corona was twenty times lower than in one of the southern Dutch provinces. This was a combination of good fortune, well-considered decisions, rapid response and effective cooperation.”
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What was your biggest surprise in the pandemic?
“That there was no Europe. Fifty years of working together in Europe suddenly came to nothing. It was ‘every man for himself’, all countries closed their borders. Having patients admitted across the border was difficult, tests and face masks were not shared. You have everything available on the continent and you share nothing. I was very upset about this, and I know why: because we had been saying for fifty years that healthcare and Europe are two separate things. If we had said, instead: care is Europe and Europe is care, it would have been different. Now we went back to being tiny little member states on our own little islands. We cannot continue like this, so I will be joining Ursula von der Leyen to focus on a European Health Union.”
What did you consider your main responsibility during this crisis?
“To protect our patients and our staff. We could only do so if everyone joined, in the whole region. Fortunately, the cooperative structures were already there. My appearances in the media were also intended to protect UMCG patients and staff and the residents of the Northern Netherlands. To prevent them from falling ill, you must be able to reach them and pass on your message. ‘Keep a safe distance, wash your hands, do not leave the region’. I deliberately sought out the regional media to reach the people in the north, because that is where our patients come from. I became so visible that people in the street recognised me as the expert of the UMCG. At some stage, it seemed that everyone knew me.”
Your visibility during the crisis also had its downside.
“In the latter half of 2020, I received several threats. The result of this in practice was that I sometimes did not walk or cycle home at night, but rather took my car, or a taxi. Just stop being so visible, Alex, then you don’t attract all that stuff, I thought to myself. But I had to continue informing people. Even if it meant that people got angry with me. Fortunately, I also received positive reactions. Hand-written letters with personal stories which people wanted to share with me. From people who had listened to our advice and felt safer as a result. And people who wanted to thank me and my team for our efforts. I am glad that my team’s efforts were also noticed. Of course, I was the visible one, but it in reality it was pure teamwork. A wide range of practical things had been put into place very effectively already before the pandemic broke out. For instance, by Bert Niesters, who had already made sure many years ago that all the equipment which is also used for scientific research would be instantly placed at the disposal of diagnostics as soon as it was necessary. I was able to cry ‘test, test, test’, because I knew that Bert had set this up.”
Is there anything you would have rather done differently, with hindsight?
“In a broadcast of the Dutch Nieuwsuur TV programme, I criticised the lack of transparency of the OMT. I should have dealt with that differently. It created a great deal of pressure on its responsibilities and that was not my intention. But it did result in the letters from the OMT becoming more transparent. However, I should have levelled my criticism at them directly, not through the media.”
What is your view on the large number of people who do not wish to be vaccinated?
“I understand that vaccination is different from other preventative measures, such as keeping a safe distance or wearing a face mask. Because those things are outside your body, that is different from getting a vaccine, fully aware that it may affect you adversely, no matter how small the risk of side-effects may be. In my view, people’s decisions have everything to do with their faith in the government and science. A high confidence factor will lead to more vaccinations and less confidence to fewer decisions in favour of vaccination. Based on the Dutch vaccination readiness, you can therefore say that seventy percent of the population trusts the government and science. But you don’t simply convince the other thirty percent by showing them even more data which they do not believe. You ought to wonder why they have this lack of trust and how you can restore this.
“Among the healthcare professionals, I think it has more to do with appreciation. The percentage of people vaccinated against corona in this sector is much higher than the national number, but the percentage of healthcare workers who take a flue jab has been very low for years. Any nurse is well aware what the benefits are of a vaccine, but will wonder: why should I sacrifice myself for an organisation or a system that actually does not appreciate me at all? And, on top of that, they argue about a better Collective Labour Agreement? I understand it if they say: ‘They don’t appreciate me, so I will think twice before I have my vaccination’. People will be more willing to take this small risk if they feel truly appreciated and recognised for their efforts. Show them this appreciation, and you will see that more people will decide to be vaccinated.”
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What will you take with you from Groningen to Munster?
“The way doctors are trained here in Groningen is unique in Europe. I have worked in Germany, in Greece, in Italy and in Portugal, and everywhere training doctors meant: ‘Just do as I do, then you will get it’. But in the Netherlands, and especially here in Groningen, they give real attention and have resources for training, people are given time for training. If you invest in training now, the effect will last 30 or 40 years. I hope I will be able to change the system in Münster along the same lines.”
What can we learn from Germany?
“That healthcare is not a cost object. Healthcare generates prosperity. The more you invest in healthcare, the better the economy will fare. I just hear a bit too often here: if we spend on healthcare, the rest of society gets nothing. But this is not true. If you spend on healthcare, society will flourish, because people will be able to resume work more quickly, the economy will benefit. Waiting lists are not a positive aspect, they should not be longer than two or three weeks, max. People want to get better and especially to get back to work.”
So now you will be taking up Board duties. And then?
“I will stay committed to cooperative structures, at our hospital, in our region and internationally. Munster is only just across the Dutch border, so we can continue to work together: Europe every day. And after that? In Europe, we do not have a Minister of Health yet, but Ursula von der Leyen will certainly appoint a real European Minister. That will be very interesting.”
In conclusion: what do you wish the UMCG and its staff for the future?
“That we pass the coming winter with good results and the pandemic becomes an ordinary infectious disease. And that the staff at the UMCG will get the time to find their feet back after this intense period and will then remember how unique Groningen is, and in particular the UMCG. Once you are here, you sometimes forget how fantastic this UMC is. And this is true – in certain respects, I will be taking a step down. I will be allowed to build something in Munster, but here at the UMCG we are already one step ahead. My aim for Munster is to achieve what the UMCG has already done. I have seen here, how amazing a hospital can be. Let us be role models for the Netherlands and Europe.”