Mixing business with pleasure

This post comes a little late, but on Tuesday, August 23rd I had the chance to visit a manufacturing facility for a large international Orthopaedic device maker. The plant was located in Le Locle, Switzerland, near Neuchâtel, about 5km from the border with France.
Interestingly, this location started manufacturing medical supplies when a neurosurgeon from South America came to Le Locle to talk with the Tissot family (manufacturers of fine Swiss watches) about manufacturing a tiny motor for cerebrospinal shunts used in kids with hydrocephalus. After a series of business acquisitions, mergers, takeovers, and moves, the facility ended up producing a large amount of Orthopaedic implants, including titanium trauma implants, and spine implants.

I was greeted at the rail station by gorgeous weather, rolling hills, charming houses, and a smiling Antonio and Isabelle, the representatives from the plant. Antonio and Isabelle took me for lunch to a local restaurant, the absolutely fabulous Restaurante de la Gare – Chez Sandro. The restaurant, a short walk from the train station, was started by an Italian couple who have since passed it on to their son, though the father still cooks and entertains the guests (and himself, it seems). If you ever find yourself there, the Saltimbocca with homemade pasta is as good as it gets. It has since made my dreams.

Antonio, Isabelle and I talked about the region, the effect of the Swiss Franc on industry in Switzerland, and their impression of the United States. We enjoyed our food, drank a bottle of local Neuchâtel wine, and eventually made our way to the plant.

The plant tour is probably only interesting to someone like me, but it did give me a concrete image of the “Swiss Quality” that is so often advertised here. It was a great time, and I had the chance to meet lots of great people who were proud to show off the work they were doing.

When the tour was done, Antonio drove me to the train station and I boarded my train. As I rounded Lake Neuchâtel and headed toward Bern I felt really glad to be in Switzerland, if only for a relatively short time. It’s nice to remember to feel lucky every once in a while.

Posted from Münsingen, Canton of Bern, Switzerland.

Barthelmarkt in Oberstimm (part 2)

So, this is just a brief follow-up to yesterday’s post. Mostly I want to share our pictures from our time in Ingolstadt (including our time at the infamous Barthelmarkt in Oberstimm). I also want to put in a small plug for “backdoor traveling.” Basically, you can find the big tourist attractions, the must-see festivals and cities, and the can’t miss tours, but there is nothing that beats being off the beaten path. The best way to do it is to know someone who is passionate about an area and have them show you around. We’ve had just as much fun in small-town festivals and exploring castles in hamlets no bigger than a city block, as we have had seeing all the big sites.

Posted from Münsingen, Bern, Switzerland.

Barthelmarkt in Oberstimm (part 1)

When people think of Bavaria, they imagine men decked out in lederhosen and women clad in dirndls clutching liter mugs of beer, downing sausage after sausage, standing on wooden tables and spouting local dialects over the boom of an Oompah band.

Now don’t you feel just the least bit bad about stereotyping these people? Well, you should. In fact, the German people are a sophisticated culture with Bavaria being a center of high finance, manufacturing, avant-garde arts, and international relations. Chancellor Angela Merkel was recently voted the most powerful woman in the world by Forbes Magazine (apparently beating out Oprah and Lady Gaga).

And lest we forget Germany’s rich history. One of the most richly historic celebrations in Bavaria, in fact, the oldest annual Bavarian festival is the festival known as “Barthelmarkt.” While this festival has certainly been going on for the last 450 years, there is clear documentation of the festival from the mid 1300s, and precursors to the festival go as far back as the 1st century B.C.E.

It gets its name from St. Bartholomew, the patron saint of fisherman and shepherds. The feast of St. Bartholomew is August 24th, and was a gathering time for villagers to buy and sell horses (and other animals). Over the years this gathering began to involve a festival as old friends and horse traders converged on the area just south of Ingolstadt, Germany known as Oberstimm. Eventually it settled on the format of a four-day festival, beginning on Friday, and ending on Monday when animals and money are exchanged.

So this past weekend, we took the kids to Oberstimm, Germany, to meet up with our friend Kristina, and immerse ourselves in the rich history of this German festival. And that is how we found ourselves, Joe, James and Henry decked out in lederhosen and Sarah and Emily clad in dirndls, the adults clutching liter mugs of beer, downing sausage after sausage, standing on wooden tables and spouting local dialects over the boom of an Oompah band.

Barthelmarkt in Oberstimm
What a handsome family!

Damn stereotypes.

This festival features, among other attractions, a man who stands on a small bench, the bench held aloft by fellow festival-goers, while he chugs a liter of beer. There are mechanical rides, pony rides, food galore, large inflated bubbles containing your children that float on water, and multiple tents with bands playing music all day and night.

The highlight of the whole festivities is the singing of the Barthelmarktlied (it’s kind of an anthem). Below is a video from the very tent we were in showing the crowd getting worked up by the band as they sing the anthem. For those of you interested in following along at home with your own hymnal, download the text here.

As a quick postlude, Kristina just sent me the picture below, found on a German website. Enjoy!

Kristina and Joe at Barthelmarkt
Kristina and Joe at Barthelmarkt

Posted from Münsingen, Bern, Switzerland.

It’s the little things

Looking back on the past couple of weeks of school, work, and life, it’s hard to come up with any big things to write about. But, a few of the little updates are…

Emily lost a toothEmily lost two (yes two!) more teeth in the past couple weeks. It turns out the tooth fairy also comes to Switzerland. Emily’s smile looks like a checkerboard. James, who is 6 years old and hasn’t lost any teeth yet, is quite jealous. We tried to explain to him that Emily doesn’t have many more teeth to lose, whereas he has a goldmine in his mouth that is sure to start paying off at some point.

Henry no longer needs his precious nookie. The plan, as recommended by our dentist, was to poke a hole in it and gradually make it bigger until its functionaly was lost and he gave it up on his own. Joe didn’t quite catch the gradual concept, and basically mutilated it right off the bat. It caused a couple of painful bedtimes, but it worked. It’s yet another thing that shows what a big boy Henry is becoming.

We got library cards at the local library. The kids were starved for new books after a month of reading the small selection we brought from home. The collection of English books is pretty sparse (even in the “big” library in Bern), but we immediately maxed out our limit of books we can check out. Emily was thrilled to find quite a few new “Rainbow Magic” fairy books, even though they are in German. I am still impressed that she can read chapter books in two different languages!

Local marching bandWe attended some community events, including a festival at the swimming complex, a 5K run (didn’t run, just watched), and a marching band parade. I also found the Catholic church, though the mass was in Swiss German, so I only understood about 50% of what was said.

So why write about the little things? You know how, when you see other people’s kids only occasionally, they seem to grow so much? Yet, when you see your own kids (and yourself) everyday, its a lot harder to perceive the growth. It’s all the little things everyday that are adding up to big changes.

My new office

I have just got a key to my new office, which I share with one of the Oberarzts (staff doctors). We have a wall with large windows on it that looks down on part of Bern. In addition, the helicopter landing pad is just outside my window. See the pictures below for the view.


This view from my office window looks North.


This view looks more to the Northwest.


And this is a shot of one of the emergency helicopters taking off from the landing pad.

Posted from Bern, Canton of Bern, Switzerland.

It costs how much?! (and what’s that in dollars again?)

I turned on one of my favorite podcasts today (Planet Money), and was suprised to hear that the topic was Switzerland. Specifically, it was about how strong, and therefore expensive, the Swiss franc has become. It’s actually a great episode, if you are into dorky economics, and it gives the big picture of what we are experiencing first hand.

It seems that we have chosen the absolute worst time, financially speaking, to live in Switzerland. Switzerland has always been expensive; we knew that. When we visited here in 2010, we had serious sticker shock. Now, the prices are still high, AND our dollars are worth a lot less. With some practice, we have gotten pretty good at bargain shopping at the grocery store. Meat is particularly expensive, so we haven’t had an ounce of beef (or a gram of boeuf) since we got here. To give you some examples from the past week:

*Swiss tidbit – they don’t actually sell eggs by the dozen here.  They sell them in seemingly random collections of 6, 8, 9, or 10.  But, we did the math.
Item Price (CHF) Equivalent Price (USD)
8 small flour tortillas 4.80 CHF $6.06
1 small chicken (2-3 lbs uncooked) 8.80 CHF $11.12
Dozen Eggs* 4.13 CHF $5.22
Dinner out for the family (not fancy) 120 CHF $152

We don’t buy clothes or other household items unless we absolutely have to. The podcast even talks about Swiss people going across the border to buy things, which made us laugh. We have a list of things that we need to get, which we’ve ben updating ever since we got here. We were planning on buying them in Germany when we visit this weekend.

The unnerving thing, is that native Swiss don’t seem to bat an eye at the prices here. Perhaps it is their inborn reserved nature. Perhaps they are making oodles more money than we are guessing. Or perhaps, when you grow up in an expensive economy you just know that certain things cost a certain amount. It just so happens that now, the Swiss Franc has a lot more buying power outside of the country than it has ever had before.

While, at first, that may seem like a good thing for the Swiss (more purchasing power), most everyone we have talked to is terribly concerned about it. Swiss exports are becoming unaffordable. Stores on the border are struggling to compete with their competitors just kilometers away in another country. Tourism could take a downturn in a country that heavily relies on it (though there are no signs yet). And businesses looking to locate factory work to a country that is known for its precision engineering are finding it prohibitively expensive, even with existing tax breaks for relocated jobs.

Which leads me to our proposal: the “Schwab Family Swiss Holiday Relief Plan” (formerly the “Swiss Family Schwabinson Grrrrrrreat Deal!” – we had to drop it for several trademark violations from Disney and Kelloggs). For those of you planning to visit us, we are happy to offer free lodging and meals that cost less than $30/person!

But no matter the cost, we both agree that we would not give up this opportunity for the world. It’s worth it! At least that’s our two cents (currently worth 1.59 Swiss rappen).

Posted from Münsingen, Bern, Switzerland.

Hospital priorities

Every morning when I walk into the hospital I see a marble bench that contains freshly baked loaves of bread. Each loaf is wrapped in a paper bag and has a tag on it indicating which area of the hospital it is intended for. Typically they go to staff or doctor’s lounges. As people come in for the morning, they stop by the bench, grab the loaf for their area, and head to work.

I don’t know if I’m more amazed by the delivery of fresh bread to the hospital, or the fact that no one seems to be tempted to steal one of these loaves. They look and smell so good. What a great way to go to work!


Posted from Bern, Canton of Bern, Switzerland.

Just Keep Swimming

For those of you who don’t have young children, this title is a quote from the movie “Finding Nemo” that I thought was appropriate for this post for two reasons. First, in the movie when things get difficult, Dory (the blue fish) says, “Just keep swimming, just keep swimming…” I’m certainly not complaining, but lets just say that the first week of school was an adjustment for everyone.  Secondly, we have had some of the most beautiful and hot weather of the summer. During a whole week of sunny, 80-degree days, we spent a lot of time in our swimsuits.

By the creekWe went one afternoon to the local, outdoor swimming complex. We have been there twice before, but this time the kids found some friends from school to play with, which was great. We spent another afternoon at our little creek down the road. It’s small and shallow, but still cool (okay, cold), clean and refreshing. There are rocks for throwing and a rope ladder and swing.

Over the weekend we took an day trip to the town of Murten. It is a fantastic, medieval town a little west of Bern on the Murtensee (Lake Murten). We swam in the lake, Lake Murtenwhich was some of the warmest water for swimming that we’ve found in Switzerland (though that’s not saying much!). We also played at a park near the lake, watched the ducks and the fish, walked through the town, and Emily and I walked along the top of the ancient wall enclosing the old city. We forgot the camera, but I snapped a few shots with my iPhone.

On Sunday, we slapped our suits on once again, and headed to the Aare river. We biked further down the crowded trail along the river past many beautiful outcroppings until we found one that was not claimed and had some nice shallow places for the kids to swim. It’s beautiful, and fun to watch all the swimmers and rafters floating down the river. Joe jumped in again (this time without his glasses) and glided a little further down the river, enjoying the view of the blue water flowing off to the horizon with mountains in the background.

We’ve been told that this kind of weather is rare in Switzerland, so we plan to continue enjoying it as long as wek can!

The New Job

Thursday, August 18th was my first day of fellowship. If you have read any of the information from the About section of our website (particularly this page which explains why we moved to Switzerland) you know that I will be spending the next year studying treatment of adult and (some) pediatric forms of hip disease. Switzerland, and the University of Bern in particular, is a world leader in the understanding of hip disease. I won’t bore you all with the particulars of why and how, but let’s just say it is an honor and a privilege to be here.

Bern, a city of several hundred thousand people, houses at least six hospitals and over 60 orthopaedic surgeons. The Inselspital (German for “Island Hospital” – read more about the hospital’s history here) is the main university hospital in the city. Just like in the United States, most university hospitals are tertiary referral centers. They get the most complicated cases and the sickest patients. They are also hotbeds of research, both clinical and basic science. The difference between Switzerland and the US, however, is that university hospitals leave all of the “bread and butter” cases to the surrounding institutions. If you’re healthy and need a total hip, they won’t take you at the university hospital (whereas, in the US they will gladly take you, especially if you have insurance).

So that makes residency education different as well. In Switzerland, residency training takes 6 or 7 years on average, and is less organized than in the US. Their residents are required to do one year of training at a university hospital to sit for the boards. Most residents spend the other 5 or 6 years in the community hospitals doing general orthopaedics. A few residents, however, choose to spend the majority of their time at the university hospital. These are generally residents with a particular area of interest and, perhaps, a desire to enter academic medicine. The other major difference here is that residents are restricted to 50 hours of work per week, where we allow for 80 hours in the US (but stay tuned for changes to that rule).

So my first day at the Inselspital was most excellent. I was instructed to find my way to the Orthopaedic offices by following a red line on the floor until it took my to the #5 lift. I got there, and when the lift opened, it revealed a box that was roughly two feet by two feet. The gentleman in front of me got in, turned to face me and looked at me like, “Well? Are you getting in?” so I squeezed into the box next to him, turned around, and watched as one other person climbed in next to me. Suffice it to say, it was quite a tight fit, and I’ve never felt closer to my coworkers. Since my arms were pinned to my side I leaned over and hit the button for floor E with my nose. When the door opened at my floor I burst forth from the box like a greased Scotsman out of a ventilator duct.

After that I followed the signs to the Orthopaedic clinic. The clinic offices were very nice… small, but very functional. I found my way to the morning conference room and sat in a chair in the back. People began to file in and I smiled and greeted them if they addressed me. The first part of morning conference was a lecture on periprosthetic infections. While this topic is dry when presented in English, it is even more difficult to tolerate in German. Add to that the European’s general distaste for air conditioning and Bern’s current heat wave, and it was a struggle to stay awake.

Following the lecture there was a routine “sign out” conference. Just like every other program I’ve ever visited, a portion of the morning was devoted to reviewing yesterday’s admissions and planning treatment options on difficult patients. And to drive home the point that medicine (especially Orthopaedics) is mostly the same everywhere you go, even though sign out was conducted in German, I clearly heard one of the staff physicians describe a particularly bad elbow fracture as being “all f*****d up.” In English. Forget Esperanto, swearing is the universal language.

Following morning conference I met with my fellowship mentor, Professor Dr. Klaus Siebenrock. He is chairman of the department and leader of the Hip, Pelvis, and Tumor team. We chatted briefly about expectations for the coming year, potential research projects, and surgical opportunities. We also chatted about my name since he comes from the Black Forest region of Germany, where the name Schwab is stately, if you’ll tolerate a pun.

Then we went to the operating theatre. The Inselspital seems to be under perpetual construction and one of the newest completed portions of the hospital includes a set of operating suites for orthopaedics. We dressed for surgery, he introduced me to a number of surgical staff, and we went to work. The cases were great, the people were very friendly, and I ended the work day with a good feeling about the coming year.

To make the day even better, I had a text on my phone from Sarah saying that she and the kids were in Bern, at a local library, and that we should meet for dinner. We met in the beautiful, and bustling, Kornhausplatz, where the kids quickly spied a McDonalds. We have been eating so much European food lately that Sarah and I agreed the kids deserved a little taste of home. And McDonalds was a good reminder how bad home can taste sometimes. So three Smurfs™ Happy Meals™ later, we took the kids home on the train. It was a great end to a great first day.

Posted from Berne, Bern, Switzerland.

Back to School

Today was the first day of school for Emily and James. I got to accompany Emily to school for the first period of the day. The classroom had small desks with students’ names on them, hooks out in the hall for jackets, a chalkboard at the front, and generally could have been mistaken for any elementary school Emily at her deskclassroom in America, or anywhere else. However, there are a lot of differences, some small and some huge, between school here and what we are used to back home.

For starters, the calendar is very different. With a short, 6-week summer break, school starts in mid-August and goes through the first week of July. But, there are several long breaks throughout the year: fall break (3 weeks), winter break (2 weeks), sport break (1 week to go skiing), spring break (2 weeks), and Whitsun week.

The grade levels are different, too. Last year, Emily was in 1st grade and James was in Kindergarten (K5). Here kids don’t start in elementary school until they are 7, so Emily is in 1st grade again and James is in Kindergarten again at a completely different school dedicated to Kindergarten. There isn’t much academic learning in Kindergarten here, mostly just playing and working on social skills. So, the curriculum is going to be fairly easy compared to what the kids have done back home. However, since everything is in German, including talking to their friends, their brains are constantly on overdrive and they are sure to learn a ton outside of the curriculum itself.

There are no school buses in Switzerland. Children have to get to school on their own, and in a small town like Münsingen, that means walking. So, there are throngs of kids walking Ready to walk to schoolthe streets in the morning without supervision. In fact, James and all the kindergarteners were given reflective sashes to wear while walking to school and Emily was given a bright yellow hat that says, “Back to School! Watch Out for Kids!”

There are no school lunches in Switzerland either, so all of the kids walk back home at 11:50am for lunch. And then, depending on their age, they walk back to school again by 1:30pm for the afternoon periods. However, in Kindergarten and 1st grade, school is only mandatory from 8:20-11:50am. Emily and James both go back to school on Tuesday afternoons, and Emily goes back every other Monday. But, that means my kids are home all afternoon 3-4 days a week!

Then there are all the small, interesting differences that I started noticing when I went shopping for school supplies last week. The primary item Emily needed as far as school supplies I am used to is called an “Etui.” It is a small, highly regulated zipper container with pencils, eraser, sharpener, colored pencils, ruler, markers, ink, and a few other things. All the kids have one that they use from 1st grade through high school. Then, there were some other things on the list, including a toothbrush, water bottle, “house shoes,” black ballet-style slippers, and a gym bag with gym clothes. We bought everything not knowing exactly how it would all be used, especially the odd assortment of shoes.

On the first day of school, we learned that children do not wear “outside shoes” into the classroom. They change into their “house shoes,” which are usually slipper-like shoes with rubber soles that are kept at school. Also, they change into gym clothes (even in 1st grade!) and they don’t wear tennis shoes for gym, but rather special black slippers. And, every other week for gym, Emily gets to go swimming!

All of these differences are neither good nor bad, they are just different. My only hope is that my kids have a good year and, as I wrote on Emily’s “school spiral project” this morning, “I hope you learn a lot, make many friends, and have fun!”

Posted from Münsingen, Bern, Switzerland.