The Industry of Leaving

Clinical Centre of Serbia; Photo: Ajdin Kamber

Every year, thousands of medical workers leave Serbia and the surrounding Balkan countries for Germany, where hospital and retirement homes are more than willing to dish out hefty sums to intermediaries who bring in fresh employee material. It is a play on people looking for a better life, with plenty of money involved. But who are the key players?

Mundpropaganda is a German word for spreading the word, by the watercooler or via social networks, chatting with a neighbour or in a bar. That is how the word about prospective employment in Germany came to Danijela Trajković (48), a nurse from Niš in southern Serbia, suffering from a too-typically Serbian problem – lousy pay and a rising pile of unpaid bills.

A year later, Danijela was at the Rostock University Clinic, as part of the first group of Serbian medical workers employed there. Danijela was surrounded by co-workers cooing about cheerful things in life instead of endlessly stressing about how to cook the cheapest possible lunch, and there she thought that she “could finally feel like a human being.”

She marvelled at how sensor-enabled doors open automatically and how there is a separate service for changing the bed sheets and removal of used medical instruments. “In Serbia, when you are doing the night shift, you first soak the instruments in a solution to let the blood soften and then you clean it slowly with a small brush… If you don’t wash it thoroughly before sterilization, the blood goes cement-hard and it’s a pain to wash it off”, Danijela reminisces of her previous work experience, happy that she will never have to repeat it again.

So, it’s a happy ending? Not exactly and definitely not always. Especially when relocating to another country in search of basic dignity means a real possibility of ending up in the embrace of an intermediary who only sees you as a means to a quick profit.

According to the data from the German Federal Employment Agency, in March 2019 there were 50,000 people from the West Balkans employed in health and medical services in Germany. That is approximately 6,500 more than in 2018. However, this number could be misleading – there are no records of how many have lost their jobs, returned to their home countries or received German citizenship, which would make them disappear from the “Balkan States” column. The number of people coming to Germany is therefore probably significantly higher.

Industry insiders say that more than ten thousand caregivers are annually imported from the Balkan region, mostly from Serbia and Bosnia and Herzegovina, but also from Kosovo, Albania, Macedonia and Montenegro. Nurses from Balkan countries are a hot commodity – they are supposed to fill the gaping hole left in German medical services by its rapidly aging population. According to the bleakest predictions, in only five years’ time Germany will be short of 200.000 medical care professionals.

Despair in the Balkans and demand in Germany have opened up a space for an entire new industry of leaving, where workforce intermediaries and their field “recruiters” collide and collude with language schools, consultants, and embassy appointment slot scalpers who stand in the way of people wishing to apply for German visas… And among them, you would not be too hard pressed to find your share of sweet-talking swindlers.

Research undertaken over the course of our investigation points to this being an industry with several hundred million euros in annual turnover and as unregulated as the proverbial Wild West. Who are these people who work there? How do they make money? And do they ever think about their role in the unprecedented migration taking place, which is leaving Balkan countries emptier with every passing year?

How much for that caregiver?

“Posting a job opening for a caregiver in Germany? That would be an exercise in futility,” tells us the head of the HR department of a giant German retirement home chain. He has agreed to speak with us on the condition of anonymity. An official interview was declined, despite being agreed upon previously – and they were not the only ones who would rather have this subject not be scrutinized by the press.

The same source told us that their workforce comes exclusively from abroad, with Bosnia and Serbia being the main providers. This chain of retirement homes is willing to pay between eight and ten thousand euros for a single professional caregiver. Other off-the-record sources in German agencies that serve as intermediaries for incoming medical professionals confirm this information, and tell us that some clinics pay more, up to fifteen thousand euros. A portion of this amount is divided between language schools and recruiters, with the agency keeping the rest as profit.

Local agencies in Serbia and other countries are willing to turn over less of a profit, being satisfied with 1500 euros per nurse sent to Germany. Serbian authorities do not keep track of how many such agencies operate in the country. The Ministry of Labour has 118 employment agencies in their records, but there is no data on how many of them send people abroad.

Branko Valčić can’t say things are going bad. Four years ago, this Croatian solicitor decided to return from Berlin to Zadar together with his family, and he opened an agency called Jobs&Spirit. “We did mostly Bosnia, Serbia, Macedonia. We didn’t find more people in Croatia because all the Croats have already left”, say Valčić as we sit in the restaurant of the “Moskva” hotel in Belgrade. He is here to meet representatives of a big German employer, and a deal with them could prove to be a veritable golden goose for him.

Things started out slow for Valčić’s agency. First, they put out ads in Croatian newspapers, but when that didn’t produce results, they transferred their efforts to Facebook. And there, it was enough to publish a post and candidates from all over the region would come flooding in. He has sent over a hundred people to Germany this year alone. “I can say that the money is good, we have a nice life. We have two employees. Still, I make less than when I was a solicitor in Berlin”, says Valčić with a thick German accent.

Main Bus Station in Sarajevo; Photo: Ajdin Kamber

“Practicaly human trafficking”

Danijela Trajković knew nothing about the money involved when she found herself in Belgrade in 2015, where one Berlin agency (known to the reporters) rented out a congress hall. Around a hundred people gathered there, each with their own hopes and dreams. They listened to a lady from Berlin speak, then they talked to her individually.

The nice lady had an offer for Danijela ready: a job would be waiting for her; she just needs to learn the language and pass the so-called B1 German proficiency test – and navigate through the murky waters of the German visa application system.

The offer sounded fair: the agency would pay for the language course, even for the first three attempts to take the test in the Belgrade Goethe Institute. Danijela would pay for document translation, visa fees and travel expenses out of pocket; in the end, this amounted to more than a thousand euros.

“Honestly, I did not want to cause any adversity. She did me a service, I could never pay for all that myself”, says Danijela as she sips cappuccino in a café in Offenbach. But the road to Offenbach was a long one.

The nice lady from Berlin did not, for example, get into fine details regarding Danijela’s degree. In Germany, a nurse from Serbia can initially be a Pflegehilfe – literally, a care assistant. Hospital staff. She, and it is almost always a she, is not allowed to administer medicine, assist the doctors or take blood samples. She usually assists the patients with personal hygiene, and the monthly pay is often less than 2000 euros gross.

“I felt humiliated,” says Danijela. “Someone who wasn’t even born when I started working comes and tells me that I can’t do something because I’m just hospital staff.”

This “hospital staff” is supposed to roll up their sleeves, get to learning and acquiring practical knowledge, so that they can be recognized as caregivers which is the official term for a nurse, according to German law. Today, you can get the necessary theoretical knowledge as well as practical training for a German caregiver degree in Serbia – through their own academies or cooperation with medical schools. However, most people complete their training when they reach Germany.

The degree matters because the title of a caregiver brings with it approximately a thousand more euros on the pay check. But the road to this status increase can take a year, at best. “I had no idea about it. They told me that I would be hospital staff at first, until my degree is recognized. But how the degree gets recognized, they told me nothing about that.”

That is how Danijela ended up in Rostock with only 1350 euros a month after taxes, retirement and medical insurance. In the far reaches of Eastern Germany, where rents have not yet skyrocketed, that is almost bearable, providing that you share an apartment with your co-workers like graduate students. But when you are sending a good chunk of that money to your children back in Serbia, you are left with barely enough to scrape by.

Kay Simon smiles a weary smile when he hears such stories. He is in his office, in suburbs of west Cologne, where his agency IPP Health is located. The agency brings hundreds of caregivers to Germany every year and is one of the largest operating in the Balkans.

“It’s hard for people who come here to make their first steps. And if the agency promises something unrealistic, so your expectations get high – it’s even worse. They promise them unrealistic wages, they tell them that they can take their family with them right away, and then they come to Germany”, says Simon. “It’s cold here, it’s raining, the family is far away, the pay is not as promised… That destroys people.”

That’s not the way, to promise people this and that, to transplant them from where their roots are, and then it turns out that you were lying. That is practically human trafficking, tells us Simon.

DEKRA Academy, caregiver course, Kragujevac; Photo: Ajdin Kamber

Medical workers recruiting medical workers

The intermediaries we had a chance to talk to claim that they are legitimate, that they do not lie to their clients and that they do everything in accordance with the law. The swindlers are always somewhere else. Still, they all keep secret the identities of their field people, that is, those who search out medical workers for agencies. Some are agency employees, some work as contractors and get paid per head hunted. The word is that they enter hospitals and shamelessly recruit people in their workplace, or that they give juicy kickbacks to doctors and nurses who send a colleague their way.

“We don’t do that, but I know it’s happening”, says Nikola Petrović, the owner of Bonn-based Vispero agency. He is constantly in a cloud of activity, phones ringing, people coming to the airport or needing transportation from their Balkan homelands. Petrović was born in Germany and has a string of prayer beads wrapped around his wrist, in the Eastern Orthodox manner. When talking about Serbs he regularly uses the expression “our people”.

What is it his people don’t do, but others’ do? “The agents literally buy off someone in a clinical centre, a staff employee, who then recruits people”, says Petrović. Another agent – the only one who openly admitted to recruiting people directly in hospitals – tells us that he has several nurses who hunt clients for him. “So she calls me up and tells me she has three co-workers who want to go to Germany. If it all works out, I pay her around three hundred euros per person.”

Nobody talks about this in Serbian hospitals. One thing is certain, though: today, there is much less noise in staff rooms then a decent healthcare system would require, and still there are examples of promoting job immigration to Germany right inside the clinics. Der Spiegel has published a report in May with photographs showing representatives of a German clinic in the “Abdulah Nakas” general hospital in Sarajevo, recruiting nurses with the blessing of hospital management.

When reached for comment, the representatives of the hospital told us that Der Spiegel has blown the story out of proportions and that their recruitment problem is not serious. Many hospitals across Bosnia and Herzegovina and Serbia take an identical official stance on the subject.

A doctor from the Serbian northern region of Vojvodina has agreed to speak with us but did not wish her name or the city that she works in to be revealed. She claims that she has also heard, from a colleague, about an agency which is supposed to guarantee a job in Germany.

“It was my impression that they drag out the process. At the very beginning, I asked them directly, and they said I would pay nothing, that the hospital where I am supposed to work is paying them. But after three months they asked for 250 euros for assistance in submitting documents for a work permit.”

Many people have no idea about such shenanigans. The industry considers it almost an iron rule: intermediaries who ask for money from candidates are simply – swindlers. “Our services should incur no cost to the candidate,” says Petrović, who owns the agency in Bonn. “We charge only the employer.”

The employers, of course, are no pushovers. They make sure to pay the intermediaries in three parts – the first when the caregiver signs the employment contract, the second when they arrive in Germany, the third when six months’ probationary period ends or the caregiver completes theoretical and practical training and has a degree recognized in Germany.

But intermediaries are no pushovers, either. They know quite well what can spoil their bottom line – they are left empty-handed if they invest in language schooling and candidate training, and the candidate relents before the contract is signed.

That is when most of them become all about family problems, mum is sick, grandpa has died… But we assume that they actually have a relationship with another agency, that has promised them outlandish pay and filled their heads with rubbish, says Kay Simon, the boss of IPP Health from Cologne.

He relates some bizarre examples. A nurse from Serbia acquired a forged language certificate, and when she came to Germany, it turned out that she could not speak a word of the language. Since then, the agencies have adopted the practice of meeting with the candidates via Skype. The agencies have also been especially careful ever since Bosnian journalists uncovered just how easy it is to buy an official medical school diploma there: all you need is a thousand euros and the right phone number.

Clinical Centre of Serbia; Photo: Ajdin Kamber

The circle closes

Some intermediaries want to insure themselves by resorting to questionable practices. Pro Sert, an agency from Kragujevac, an industrial city in the heartland of Serbia, asks for the candidates’ signature on a contract that states the candidate will pay a penalty of three thousand euros if they renege on coming to Germany. The candidate pays the penalty if they find another job by themselves or sign up with another agency, or if they refuse two jobs offered by the agency or decide to leave an employer before two full years are up.

The agency commits to finding a job opening that will bring a monthly pay of at least 1600 euros gross – which is barely more than the minimum wage in Germany. If you don’t like it, you can pay a penalty to the agency if you want to find a better job.

“Everything must be regulated with contractual penalties”, says Ivan Kovačević, director of Pro Sert. “If there are justified reasons, nobody can force anyone to accept employment. We’ve had people who have already signed the contract, and then their spouse gets a job somewhere else in Germany, and so we go a little out of our way and help them find a job there.”

Medical professionals tell a different story. Pro Sert is not amicable and easily reaches for those contractual penalty clauses. Mario Reljanović, a research fellow at the Institute of Comparative Law, tells us that each side in a contract has the right to seek damages through litigation anyway, and so those penalties might not be justified. “It seems to me that thhttp://www.masina.rs/eng/mario-reljanovic-citizens-serbia-will-pay-dearly-basic-medical-services-everything-else-will-available-can-pay/e court would be lenient towards the private person and could rule that the contractual penalty is too high, that it should not exist or that the amount should be symbolic.”

Pro Sert works with Dekra academy – and that means a lot to German employers. The umbrella organization of the academy, Dekra, has a yearly turnover of 3.3 billion euros and mostly specializes in vehicle technical inspection. Every German knows the name Dekra.

The Dekra Academy in Serbia is headed by Aleksandra Talić, and according to information publicly available from the Serbian Business Registers Agency, she was the director of the aforementioned Pro Sert until April 2019. The revolving door has come full circle: Dekra trains caregivers in its centres in Belgrade, Niš, Novi Sad and Kragujevac, and Pro Sert sends them off to Germany.

“All candidates have to do is to complete the course, to study and to take the test”, says Talić. On the subject of penalties, she claims that “If there is no realistic reason for a candidate to be indecisive, we have to set those boundaries, and force… or rather, help the candidate choose what they want to do.”

A nurse from Novi Sad, who now works as hospital staff in Cologne, has succeeded in defeating such a contract with the help of a solicitor. He tells us that: “Some have managed to get there, some didn’t make it yet, some also gave up, some were threatened with legal action.” Finally, he went to Germany with the help of Vispero from Bonn.

Slavija square hotel circus

Danijela Trajković, the nurse from the beginning of our story, was ready to sign just about anything, just to get away from poverty. “When I got to Rostock, I singed a whole bunch of papers. I remember I joked that if in a year’s time they came and asked me for my kidney, it wouldn’t be strange. That’s how little idea I had of what I was given to sign.”

She was lucky – no kidney claims so far. But she gave up on Rostock when, after a year there, she was told she would have to undergo eleven months of theoretical and practical training for her degree to be recognized, and her pay increased by about a thousand euros. That seemed like too long of a wait, so she transferred to Tibingen for a spell, before settling in a private clinic in Ofenbach.

The town is situated in the Hesse region, where authorities are quicker to recognize Serbian diplomas, or at least Danijela had hoped so. But here, too, she had to train for ten more months in order to be allowed to do what she does. “Now I have to keep quiet, play nice and do as I am told”, laughs Danijela. That is how this nurse from southern Serbia has learned the hard way that shortcuts in Germany do not pay off.

Some intermediaries, on the other hand, cannot seem to get enough of shortcuts – from desperation to cash. Summer of 2017 saw the “Slavija” hotel in downtown Belgrade more busy than usual. Some halls were hastily redecorated as classrooms, and more than a hundred people would be there every day, behind heavy velvet curtains, learning German for eight hours straight, with a one-hour lunch break, from 8AM to 4PM.

“People were promised jobs, they were told that all they had to do was complete the language course. And the rooms in ‘Slavija’ hotel were paid by the school as long as the course lasts, they even had lunch and a small allowance. They came from all over, a lot of them from Macedonia”, recalls a German language teacher who was employed there. She says she was nicely paid to work there, but that the work itself was almost mission impossible.

“The goal was for them to reach B1 proficiency in four months. Some of them quit their jobs so they could fulfil their language school obligations. I don’t know what kind of a contract they signed, but some did give up, because the goal proved really difficult to attain. They would start skipping classes”, she tells us. She also does not want her name publicized. “Some acquaintances of mine complained that the agency had tricked them, after they had left their families at home, pinning all their hopes to this.”

Then, suddenly, it all stopped. Artigum Management, the agency that claimed that it was “owned by a German employer” let go of its teachers after six months of not paying them wages. How did this instant business model break so easily?

Nobody answers the listed phone number of the supposed owner of the agency. The circus has packed up and the teacher we talked to tells us she has heard of it being set up again, under a different name.

This guy hacks

This game of people’s destinies is played for large sums. Skulking behind the caravan of intermediaries, like coyotes in a prairie, come small-time scoundrels. Some have discovered a new business opportunity when the tide of medical professionals splashed against the doors of German embassies. Time slots for appointments in German consulates are available only online, on a first-come, first-served basis.

“You can have a go at it a million times, no way you’re getting it”, said a deep male voice to our reporter, back in August 2016. It belonged to the owner of the agency called “Evropa”, which has a small office near the German consulate in Belgrade, where it offers photocopying and such. But “such” turned out to be so much more when the agency struck upon a new niche. “I have ten guys who hack, specialized for that technology. They have the website open 24 hours a day and as soon as a time slot become available, they grab it five seconds later. Those are professionals and they do it for money.”

Our journalist then introduced himself as a nurse who needs an appointment fast. The price turned out to be 250 euros in cash. You bring a copy of your passport to them and they snatch the first available time slot using your data. “You have to hire experts. There’s nothing illegal about it – you know how many people have gone to Germany that way… Just like you can hire an agency for your vehicle registration, you can hire one for other things in life, that’s the way it goes”, the voice said.

That niche disappeared when the Germans allowed legitimate agencies to get their own time slots. When one has all the necessary documents – employment contract, work permit, translated diplomas and recommendations, and a language certificate – an appointment at the consulate is usually a month or two away.

The police and state prosecutors have not bothered with this sort of fraud much, even when it has received media attention. In one example from several months ago, two fraudsters were fined and sentenced to three years in prison and ten months of house arrest. They had scammed more than fifty people, offering them jobs in Germany, and defrauding them of around 6,000 euros.

DEKRA Academy, German language course, Kragujevac; Photo: Ajdin Kamber

A serbian surplus

One could be forgiven for having the impression that this entire exodus industry has the tacit support of authorities in Belgrade. Workforce export is seen as state policy, apparently. Recently, the Serbian president Aleksandar Vučić, when speaking in a local TV programme, had this message for the German Minister of Health, Jens Spahn: “Spahn, he is a very capable health minister, he tells me: ‘I’m coming to Serbia to get your nurses.’ Like hell you will come here! I told him: “Don’t you come!’”

Could this dialogue be just another in a line of Serbian President’s overly dramatic yet mostly fictional adventures? Because Spahn has no need to “come to Serbia” to “get” nurses. Since 2013, the agreement between German and Serbian Employment agencies has been in force, and it serves one primary purpose: nurse export.

The project is titled “Triple Win” because it supposedly benefits all three sides: the German employers, the people emigrating, but also Serbia. And how does Serbia profit? Or Bosnia and Herzegovina or the Philippines or Tunisia, all countries with which Germany has identical agreements? “Home countries profit by decreasing the pressure on their job market”, claims the website of the German Federal Employment Agency. Meaning, Serbia gains by exporting unemployment (see the interview with Mario Reljanović).

German employers pay 3700 euros into this fund per person, getting a much better deal than when going through traditional intermediary agencies. “At this time, we have more than 10.000 unemployed medical professionals”, said Zoran Martinović, the director of the Serbian National Employment Agency, in an interview a year ago. “That is more than enough to satisfy domestic needs and leave enough people who can look for their place abroad”.

It would seem that the World Health Organization shares the view of Serbian authorities that Serbia has a surplus of medical professionals, so big in fact that public health services are prohibited from employing new staff.

The “Triple Win” project supposedly follows the ideal of circle migration – people leave, but they also return home, enriched with new experiences and knowledge. However, while GIZ (German international cooperation agency) sends over a hundred medical workers to Germany every year, the number of workers that enrol in their annual repatriation programs is in the single digits.

Just like caregiver export is Serbian official policy, so is their import a priority for Germany. In October, a state agency whose purpose is to facilitate the arrival of nurses opened in Saarbrücken. The agency’s budget is 4.7 million euros. The aforementioned minister Spahn spoke at the opening, assuring the journalists that Germany brings over nurses only from those countries who have a surplus and where the population is “particularly young”.

Serbia’s population, however, is particularly elderly, and this demographic abyss is allegedly a priority of the Serbian government. When asked about what sort of caregivers are most sought after, Kay Simon, the owner of the Cologne-based agency smiles and tells us: “Young, and with a lot of experience.” Candidates over 40 seem to have drastically reduced chances.

Does it ever bother him that he is helping a sort of a great migration? When answering, Simon also relies on data which says that Balkan countries have a surplus, but he is aware that it is not a bottomless pool. “It is clear to us that this will be over in the years to come. It can’t last for decades.” And then, he says, he will have to deal more with the Philippines.

When all is said and done, most nurses who settle in Germany will be forever grateful to those who have brought them there. This sentiment is shared by Branko Valčić, the agency owner from Zadar. “We get negative comments on Facebook, how we are imperialists, how we make a bad situation worse in Serbia. We answer that we don’t force anyone, people decide for themselves if they want to go.”

Is Valčić worried that there will come a day when him and his generation will be old but there will be no one left to provide medical services? After thinking a bit, he answers with a smile: “Fortunately, I am in good health.”

Translation from Serbian: Mihailo Tešić

This article was originally published in Serbian in Vreme magazine on Dec 11, 2019.

This research was enabled by “Reporters in the Field”, a program by Robert Bosch Stiftung hosted with the media network n-ost.

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