For thirty years, Wageningen student physician André Godkewitch (64) has been around to sooth study blues, stress, mouse arms, and to give advice on anti-conception or living in the Tropics. He is the last of the students' doctors in the Netherlands. Next year, he will retire.
After your studies, you worked as a family doctor for a while. Why the switch to students' doctor?
'In the days of the seventies, family doctors often prescribed large quantities of valium and librium. For me, the physical ailment is a signal, and it cannot be separated from someone's mental condition in most cases. As a family doctor, I didn't have time to look into that. When I spotted a job vacancy for a students' doctor in Wageningen in 1980, things fell into place. They were looking for a family doctor interested in handling stress problems. I didn't want to apply a plaster to a wound; I want to look for the cause.
'Have students changed in these thirty years?
'When I began, students were idealistic and wanted a lot. It was the time of democratization and back-to-nature trends. Although there were also students who were prim and proper, Wageningen, of course, was about agriculture and cows. Some students came for their appointments in wooden clogs.
'Those times saw more free spirits leaning towards anarchy. Students nowadays are more conventional. They also take their study requirements more seriously. The two phase structure has been implemented, a limit has been set on the length of studying and student funding has stricter requirements. There are good sides to these, since being a perpetual student isn't desirable at all. But I do see more students nowadays with big ambitions who set high aspirations for themselves.'
These aspirations lead to stress, don't they?
'You do need some stress for doing well. But if the pressure becomes too much, students often develop concentration problems, RSI, fatigue or other physical ailments. Everything becomes tougher. Frustrations set in and the problems become worse. You often need to really work at convincing them to let go for a while. They insist on carrying on, though, but that would be self destruction.
Students have yet to find out who they are. Often, they have a completely unrealistic self image. To overcome their problems, they have to learn to face reality. But I do find such impulsiveness and pigheadedness charming.'
Are you therefore also a therapist in a way?
'If the problems are purely physical, I would refer them to the family doctor. In my first years in Wageningen, I attended psychotherapy training to learn to recognize and treat psychosomatic problems. Quite a lot of students have depressive spells. Much of these are not visible on the outside. When it's clear that problems cannot be attributed to anaemia or be cured by taking a pill or two, then tears start flowing in the consultation room. This is often the first and only place where emotions are brought up. It takes a couple of conversations to see where the problem lies. A few consultations and some relaxation techniques, for example, can quickly lead to results, especially for these youths.'
You also lend a helping hand at the university meditation and yoga courses.
'When I was a perpetually overworked family doctor, I had a serene neighbour who practised Zen meditation. That seemed to be a good way to handle the enclosure in your head, where thoughts keep raving round and round. You learn by observing yourself, by living more purposefully and consciously, without being sidetracked by all sorts of thoughts, fears and worries. I have benefitted very much from Zen; it brings me to the core. I have gained useful elements from my own experiences. The university started Tai Chi, meditation and yoga several years ago for students and employees for the prevention of RSI and other ailments. These courses are incredibly successful.
About 15 percent of the foreign students visit the students' doctor. Do they have the same problems which Dutch students have?
'Partly. Foreign students often work unbelievably hard and study till late every night. They are afraid of losing face if they should fail, whereas passing will bring a gigantic boost to their careers. So much is at stake. Besides, some have difficulty getting used to the climate, or they miss - even more than Dutch students do - their safety nets. Some have severe medical problems. In developing countries, you contact severe illnesses easier as healthcare there is often very much worse than that here.'
In addition, you also treat people who go to the Tropics. What changes are there?
'The travels are now more extreme and some of them border on expeditions, with all the accompanying risks. In the past, someone with a kidney or immune disorder would not think of travelling to hostile areas. Nowadays, this happens. Students often have little experience but big ideas. We try to make them see the risks clearly and we tell them, for example, be sure to take prophylaxis against malaria because malaria can kill. The university naturally wants students to return home healthy.'
Are there students who return in poor health?
'Topping the list of risks are traffic accidents. Besides that, people often return with infections and parasites, such as decimeters long worms. Such cases are easy to treat but they can also have severe consequences. Medical checks upon returning often show up such ailments; they have become routine work for us. Often, students get post-traineeship dips. They have been through a very intense period, they change and return with experiences which they cannot share. People have difficulties and are slow in getting back to their routines.'
When you retire, the last students' doctor in the Netherlands will be gone. How do you feel about this?
He laughs. 'Yes, I'm the last of the Mohicans.' He then adds earnestly: 'The trend was started years ago by other universities. Thanks to the work in the Tropics, this position has been retained for this long in Wageningen. It's been declared that student physician work is not a core activity,. That decision is not based on rationality but on cost.
'Studying is a form of work. Just as employees need a company doctor, so do students. I stand behind the motto: the ability to concentrate is to the student as the back is to the construction worker. Sickness, whether physical or mental, affects the power of concentration directly, setting off a vicious circle. Prompt action is needed. The student physician is easily approachable for students with both physical and mental ailments which can affect their studies. In such cases, they need more than the ten minutes offered by a family doctor.'
Seeing the doctor
Last year, 679 students saw the student physician at least once. That is 13 percent of the student population of Wageningen University. Reasons for seeing the doctor are:
study - 539 times
graduation regulations - 342 times
others - 341 times
stress-related problems - 292 times
therapeutic consultations - 247 times
travel to the Tropics - 137 times