Elaine Custodio arrived in Bonn, Germany, in March 2018 with six years of nursing experience under her belt and a B1 intermediate German language certificate in her backpack.
Before leaving her native Philippines to start a nursing job at the University Hospital Bonn (UKB), Custodio studied German full-time to obtain the language skills necessary to work there.
But despite her best efforts, she struggled to speak and understand German — something that 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.
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. At 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 hospital in Bonn began recruiting qualified medical workers from the Philippines to offset Germany's labor shortage.
The hospital now has around 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.
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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.
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 eying a career in Germany ended up dropping out of their beginners' courses, said Steffen Zoller, founder of CWC (Care With Care) Recruitment.
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Many foreigners perceive Germans as being very 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.
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 more Filipino nurses have expressed an interest in migrating to Germany since it opened more routes to the migration of skilled workers.
Since 2017, UKB has recruited more foreign nurses not just from the Philippines, but also from Serbia, Bosnia and Herzegovina, Mexico and Argentina. They have around 1,000 more nursing positions to fill by 2027.
Zoller said that 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 Licay.
However, the jury is still out for Custodio.
Edited by: Keith Walker
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