ABSTRACT
This study investigates beyond the bifurcated myth of the medical migration of Korean women to Germany in the 1970s, which is known as the “German dispatchment” myth from the Korean perspective and the “development aid” discourse from that of the Germans, by focusing on the newly-released documents from the German Hospital Federation (Deutsche Krankenhausgesellschaft, DKG). The migration was essentially a transfer of labor from a weak to a strong state, and the disparity of state strength characterized the nature of the recruitment mechanism. Both Korea and Germany have romanticized the labor transfer and appropriated the collective experiences of migrants for their own political purposes. In this transnational business, the Korean Overseas Development Corporation (KODCO) and the DKG maintained exclusivity in the labor migration channel and were faithful to their own interests. The DKG, as a representative of the German healthcare industry, was concerned about being criticized for destroying the healthcare system of developing countries by stealing their skilled workforce. They, therefore, tried to influence publicity in Korea and Germany to persuade the people that the recruitment benefited both countries. However, the DKG was aware of the deceitfulness of its “development aid” discourse. The Korean government, which advanced the labor export for the sake of obtaining foreign currency, romanticized it as patriotism and used the term “German dispatchment.” However, the incapacity and corruption of KODCO as an agency from the Korean perspective resulted in criticism regarding its recruitment program. The DKG complained that the selection of incapable personnel coupled with corruption was causing unforeseen financial damage to its member hospitals. Nevertheless, it officially defended its partner for the sake of its own interests, such as avoiding bad publicity and securing the sustainability of the recruitment program. The conflicts regarding nursing tasks and working conditions between Korean nurses and their German colleagues and employers captured in the documents of the DKG trace the origin of the issues in relation to cultural misunderstanding and pervasive racism. The disparity of state strength between the two countries resulted in the subaltern position of Korean female healthcare workers in the global labor market, and they tried to bring forth the best possible outcome while working in a foreign country in unfamiliar circumstances. However, the difficulties with female guest workers from Asia were generally credited to their inability to adhere to the German working style. This study contributes to the existing scholarship on this topic by filling the gaps. Historical research on the medical migration of Korean nurses and nurse-aides to West Germany has relied on limited historical sources. In 2013, the National Archives of Korea transferred official documents regarding these workers that were produced and archived by the DKG, which represented the interests of German healthcare institutions. Its documents on Korean nursing personnel provide supplementary information and display findings in different perspectives. They do not bring forth completely new findings that have never been researched before but are still valuable for delivering concrete evidence on the circumstances of that time, which were previously merely inferred.
Subject(s)
Female , Humans , Asia , Commerce , Delivery of Health Care , Developing Countries , Emigration and Immigration , Fellowships and Scholarships , Germany , Health Care Sector , Korea , Nursing , Racism , Theft , Transients and MigrantsABSTRACT
BACKGROUND/AIMS: To evaluate the prevalence, relationship between symptoms and esophageal motility disorders, and the factors that could affect in esophageal motility, we performed a manometric study and analyzed the results in a large number of patients with esophageal symptoms. METHODS: Records from 1746 patients referred to our manometric laboratory for evaluation of esophageal symptoms between September 1994 and September 2002 were enrolled. We used low compliance pneumohydraulic capillary infusion system to perform esophageal manometry. RESULTS: Among patients with abnormal esophageal motility, 390 cases of nonspecific esophageal motility disorder, 20 cases of nutcracker esophagus, 11 cases of achalasia, 4 cases of hypertensive lower esophageal sphincter, and 4 cases of diffuse esophageal spasm were present. The symptoms of 1746 patients were oropharyngeal dysphagia, esophageal dysphagia, non-cardiac chest pain or chest discomfort, substernal soreness or heartburn, regurgitation, and lump sensation. In multivariate analysis, age (OR=1.95; p=0.007) was an independent factor affecting esophageal motility. CONCLUSIONS: There are esophageal motility disorders in 24.6% of patients with esophageal symptoms, and various symptoms are present in them. The factor associated with the abnormal findings of esophageal manometry is age.
Subject(s)
Humans , Capillaries , Chest Pain , Compliance , Deglutition Disorders , Esophageal Achalasia , Esophageal Motility Disorders , Esophageal Spasm, Diffuse , Esophageal Sphincter, Lower , Heartburn , Manometry , Multivariate Analysis , Prevalence , Sensation , ThoraxABSTRACT
PURPOSE: Acute renal allograft rejection is known to be an important prognostic factor of long-term graft survival. The purpose of this study was to make a treatment discipline in acute renal allograft rejection by finding any relationship between Banff classification of acute rejection and response to treatment and long term graft survival. MATERIALS AND METHODS: Thirty-eight cases histopathologically diagnosed as acute rejection were included in this study. The grade of acute rejection was classified according to Banff criteria (1997). Response to treatment was classified into three groups; complete (>75% reduction in serum creatinine increment), partial (25-75% reduction), and no response (>25% reduction). RESULT: Mean age of the patients at the time of biopsy was 32.3 years and male to female ratio was 25:13. The mean interval between renal transplantation and rejection episode was 4.9 months. Mild, moderate and severe rejection according to Banff classification was 15, 15 and 8 cases respectively. Antirejection therapy with steroid pulse was initiated in all cases, antilymphocyte globulins (ALG or OKT3) in 19 cases and tacrolimus rescue therapy in one. All patients except for two (93%) with mild or moderate rejection showed complete or partial response, whereas responsiveness was noted only in three cases (38%) with severe rejection (p>0.01). 66.7% of cases with mild rejection showed complete response to steroid pulse therapy; 40% with moderate rejection; 0% with severe rejection (p=0.01). Patients with severe rejection had much poorer long term graft survival than with mild or moderate rejection (p=0.01). CONCLUSION: These results suggest that Banff classification of renal allograft rejection could be used as an indicator of treatment responsiveness and graft prognosis. They also suggest that a more intensive anti-rejection therapy should be recommended in high grade rejections.
Subject(s)
Female , Humans , Male , Allografts , Antilymphocyte Serum , Biopsy , Classification , Creatinine , Graft Survival , Immunosuppression Therapy , Kidney Transplantation , Prognosis , Tacrolimus , TransplantsABSTRACT
Extra-anatomic bypass(EAB) is defined as bypass grafts that pass through a significantly different anatomic pathway than the natural blood vessles they replace. The two categorical reasons for doing this in aortoiliac occlusive disease are to avoid "hostile" intra-abdominal pathologic features and to avoid the high risk of transabdominal reconstruction in patients with serious visceral and systemic disease. To determine the application of this procedure, we reviewed retrospectively the characteristics and outcomes of 30 patients who underwent extra-anatomic bypasses during April, 1986 to April, 1997. Three EABs in brachiocephalic reconstruction were done including 2 carotid-subclavian bypass, 1 femoral-biaxillary bypass. 27 EABs in aortoiliac reconstruction were done including 22 femorofemoral bypass(FFB), 4 axillobifemoral bypass(AxBF). In the latter, EABs were used in older patients with medical comorbidities and contraindication to direct reconstructive procedures involving the abdominal aorta including aneurysms, graft infection, and trauma. One and five-year primary patency rates for entire EABs and FFB were 76.9%, 63.8% and 83.1%, 63.5%, respectively. In FFB, patients with limb- threatening ischemia proved to be inferior to those with claudication as measured by primary patency(p=0.013). Age(>65yr.), sex, smoking, medical comorbidities, duration of symtoms, preoperative angioplasty, use of externally supported graft did not influence primary patency in FFB. The 5-year patient survival rates for entire EABs and FFB were 70.4%, 67.9%. Limb salvage rates for entire EABs and FFB were 65.1%, 66.7% at 3 years. Our results suggest that strict selection of patients with limb-threatening ischemia and medical comorbidities may contribute inferior patency rate of EABs. To determine the application of EABs in aortoiliac reconstruction, the nature of intraabdominal pathology and operative risk with vascular surgeon's experience and judgement should be considered.