Elaine Custodio arrived in the midsized city of Bonn in Germany's west in March 2018. She had six years of nursing experience and a B1 intermediate German language certificate in her backpack.

Before leaving her native Philippines to take up a nursing job at the University Hospital Bonn (UKB), Custodio studied German full time to obtain the language proficiency required to work at the hospital.

Despite her certificate, she still struggled to speak and understand German, which proved to be a hurdle in the workplace.

German is one of the 10 most difficult languages to learn in the world, according to UNESCO. 

German is 'really hard'

The system for measuring language skill level starts at A1 for beginners, progressing to A2 for advanced beginners. B1 is intermediate, B2 is advanced intermediate. Learners at the C1 level are advanced and the C2 level is when someone speaks almost perfect German.  

"When I moved here, I felt safe on the streets, but I was scared of answering the phone at work," said Custodio, who hails from Quezon City in the Philippines. "The language was hard, really hard. During every shift, I would write down words I did not know and learn the meaning at home."

Custodio was among the third batch of nurses who arrived in Bonn when the UKB began recruiting qualified medical workers from the Philippines to offset Germany's labor shortage.

The hospital now employs some 740 foreign nurses, 300 of whom are from the Philippines. Like Custodio, many of these Filipino nurses at UKB struggle with speaking and understanding German.

Joel Licay, who also works as a nurse at UKB, said that he felt depressed two months into working in Germany because of the language barrier.

"Some patients told me that I'm stupid because I didn't know the language. Every day I was crying," he said, adding that he felt frustrated not being able to communicate with colleagues as well as patients and their loved ones.

Licay said when he first started working on one of the UKB wards five years ago, he needed to be accompanied by an advanced German speaker in order to effectively communicate with patients.

Even today he says he usually spends time honing his German skills when he comes home from work. His efforts have paid off and he is now on track for the C1 level.

Culture shock in Germany

The challenge of communicating in German is a "worldwide barrier," according to Maria Hesterberg, who heads recruitment for UKB, because it is not the easiest language to learn.

She and her colleagues noticed that their foreign nurses tended to struggle with the language.

And the language requirement to work as a nurse in Germany has been raised from B1 to B2, adding to the difficulties faced by them.

Many nurses in the Philippines who had been eyeing a career in Germany ended up dropping out of their beginners' courses, said Steffen Zoller, founder of CWC (Care With Care) Recruitment. 

Cultural differences can add to the language barrier. Many foreigners perceive Germans as being forthright in their communication, whereas people from other countries may not say things as directly.

"Germans communicate directly. We are very open, and it is not something that Filipinos are used to. We learned that in the beginning, it is very unusual in the Philippines to answer a question with 'no'," Hesterberg said.

She added that they had to discuss this in information events, explaining that saying 'no' is nothing personal. They have also encouraged nurses to ask questions proactively, no matter who they are communicating with.

Smoothing the path to Germany

Zoller added that CWC Recruitment — which has deployed around 700 Filipino nurses around Germany — also has an integration team to help prepare incoming health care workers for their big move to the country.

The Philippines is an important source of skilled workers for Germany, and remittances from Filipinos living abroad are a crucial source of income for their families back home.

Zoller said that an increasing number of Filipino nurses have expressed an interest in migrating to Germany since it opened more routes for skilled workers to migrate.

Since 2017, UKB has recruited more foreign nurses. They don't just come from the Philippines but also from Serbia, Bosnia and Herzegovina, Mexico and Argentina. The company has around 1,000 more nursing positions to fill by 2027.

Zoller said that, despite the language issues, Germany is often seen as a permanent destination for Filipino nurses who want to migrate, unlike in other countries.

"I see myself getting old here," said nurse Licay. As for his nursing colleague Custodio, she still isn't sure.

Edited by: Keith Walker

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