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A Pathway Up the Cliffs

From a Bethlehem Girl to a Hospital CEO in Germany

By Abir Giacaman

When I was asked to contribute an article to this edition of TWiP that portrayed “a professional woman working in Germany – her work, her achievements, her challenges and frustrations” – I was puzzled by the last two words. Have the challenges or frustrations I faced differed from those of other people in my position? I am a Palestinian woman from Bethlehem, the CEO of an acute care hospital in Frankfurt. Thus, my work naturally comprises many challenges. How is this different or special?
After sleeping on it, it dawned on me that, indeed, I have faced a few special challenges. They occurred mainly during my first years in Germany. You see, I moved to Germany at the age of 24, after getting married to a German man. My bachelor’s degree, acquired at Bethlehem University, was then considered partly equivalent to the German Diplom (equivalent to a master’s degree that is achieved in one block of study). I first attended a one-year German language course designed for foreign students and felt quite lucky to be given that opportunity. Obviously, I did very well: I love languages; I already knew Arabic, English, and French; and German strongly appealed to me. The latter may surprise some readers, as may some other statements in this article. Pronounced well, German is a most beautiful and, to my ears, majestic language. Rich, refined, precise, and, in literature – which I love – very akin to Arabic in depth and beauty.

According to a 2020 PwC study, women hold only 17 percent of top management positions in Germany’s health industry.ii A request by the author to PwC as to the percentage of foreigners among those female position-holders showed that this number is unknown.

Quickly thereafter, the most challenging phase in my life started: the continuation of my studies to obtain a master’s degree in business administration. The university system itself, which threw me into an almost complete state of autonomy and chaos, as well as the academic content per se were all but familiar to me. To my chagrin as a proud Palestinian, I had to admit that German universities perform at a much more enhanced academic level.

To the right of Abir is Dr. Plamen Staikov who’s facing Dr. Tobias Leipold. Facing Abir is Prof. Dr. Amadeus Hornemann, the hospital’s medical director. All are chief physicians.

My start as a “lateral entrant” magnified the challenge. For example, students preparing for their final exams are given some information about the specific topics on which they will be examined, but only a few weeks beforehand. Mine included “linear programming,” which I had never heard a thing about until then. Moreover, while back home, economics had followed an American, pragmatic approach, in Germany, it seemed to me to encompass an eternal sequence of mathematical derivations and complex diagrams!

The language was at times an amusing barrier. When I sat for an exam in economics, one task included the phrase “Der Kelch (chalice) des Parsifal,” referring to Wagner’s opera Parsifal. However, I was neither sure about its meaning in the context nor about its relevance to understanding or solving the task. Germany is known to be the country of poets and thinkers (and engineers). This is something you feel everywhere, starting with street names, extending to culture embedded in economics exams (!), and ending with the enormous cultural offerings that are available nationwide. (Germany spent around 15 billion euros on culture in 2020.i) After graduation, I embarked on a career in hospital management and obtained further training in the field. I started as a board assistant, became deputy director, then director, and for the last eleven years have served as a CEO. Looking back, I realize that the path I chose had much to do with female role models in my family: my mother was an almost-lifelong teacher, and my grandmother, born in 1917, held an academic degree and was a pioneer in the sociopolitical fields in Palestine.

It is widely agreed upon in Germany that hospitals are the most complex organizations. Their system is characterized by multidimensional interdependencies of clinical processes while vital work is being performed at point of care, including emergencies. In the process, uncountable laws and regulations must be applied.

However, managing the hard facts and mastering expert knowledge is only one aspect. There is another, more subtle and, to my understanding, more crucial, challenging aspect of being a leader and a manager. I could describe it as perceiving and steering the corporate culture, applying contextually adaptive levels of communication, and bringing together in a productive manner multi-professional and cross-disciplinary teams and interests. This is in fundamental contrast to being an expert, such as a doctor or an engineer, and might be the more interesting aspect to look at while having a Palestinian female in Germany at the top. Apart from mastering the German language at an almost mother-tongue level, a compatibility at sociocultural levels and with the value system is crucial. Moreover, successfully leading the leaders – which is what a CEO does – can only evolve if the high-position-holders you are leading are valued and respected by you as their leader. I highly value medical work and therefore the doctors, particularly the chief physicians, due to their enormous responsibilities.

The first step to being accepted in a foreign country is to accept the new country yourself.

Rheinhessen, State of Hessen.

Perhaps I have the great advantage of having enjoyed good schools in Bethlehem, learning how to tackle questions of life, ponder ethical issues, debate social values, and think in a reflective, independent manner. I am a strong believer, though, that the home has yet a larger impact on shaping us. Ultimately, it is a combination of both. Funnily, I have the image at work of being “Prussian,” which refers to values I represent such as reliability, punctuality, and straightforwardness.

Ranked with five stars and as one of the leading treatment facilities for diabetology in Germany for the third time in a row by The Federal Association of Clinical Diabetes Facilities (BVKD). To my left is the chief physician Dr. Ralf Jung.

So if you ask me, “Are you being accepted as a woman and as a Palestinian in Germany?” The answer is evident. I could in no way do what I am doing if I were not only accepted but rather highly respected by my employers, colleagues, staff members, and stakeholders. The position of a hospital CEO encompasses being the leader of highly educated and sophisticated people, often holding the academic degree of a professor. All this would have been impossible had German society discriminated against me at any stage for being either a woman or a Palestinian.

In corporations, especially those with complex systems, hard facts matter. Yet the underlying culture and the relationships among all protagonists are crucial. The first never functions well without the latter.

I must mention, though, that German society is not quite there yet regarding the equality of women – at least compared to northern Europe. Here are two harmless anecdotes: Many years ago, I chaired for the first time the meeting of the chief physicians. One of them arrived late, storming in and announcing proudly, “I have just finished a complicated surgery on a lady; soon she will be home at the stove, where she belongs.” I gathered my wits and answered, “It might surprise you, but I’d rather be home now preparing a delicious meal than having this ordeal of a meeting with you.” To my great pleasure, I received loud applause and cheering from all his other (only male) colleagues. And that was that. At the same hospital, the medical director once told me, “I don’t need a strong woman backing me.” I replied, “Please note that for you, I am not a woman. I am the managerial director, and my gender is none of your business.” Here again, that was that.

Abir’s parents Elias and Thérèse Giacaman in the 1960s.

It must be the influence of my late father, in particular, who never in any way highlighted our gender as a differentiating factor but, on the contrary, sent us out of the house to hit back the boy who had hit us, which gave me much self-confidence regarding my gender. In fact, my gender never even crossed my mind with respect to my work or my career. I am certain that this is essential. If you don’t question yourself, it is harder for others to question you. I am eternally grateful to my family for all the work they invested in my upbringing, education, and the shaping of my personality. I must also mention my great husband to whom I am ever so grateful for his unconditional support ever since my first day in his country.

During my very first lecture at the university (private law), referring to the discussed matter at hand as “cheap” was quite bemusing. Until I learned that “billig” meant “right and proper” in the language of law.


Graduating from Bethlehem University.

While I must acknowledge that my origin was an additional challenge in recruitment processes, it never became an obstacle. I remember an amusing encounter with the head of the board of trustees, shortly after my start as a CEO in one hospital, who told me, “After the board chose you, I had a sleepless night, wondering how I would spill out the news to the chief physicians that their new boss carries the foreign name Giacaman.” Well, it all turned out just fine. The Germans of today are an amazing people. Open, educated, cultured, and yes, very humorous!

Being serious at work must include and allow for humor and lightness.

Abir Giacaman with her German husband Karl-Wilhelm Fricke at the Church of the Nativity.

The Germany of today is still extremely conscious of and self-conscious about its past. This manifests itself in its political stances – especially regarding the Middle East, often causing chagrin to and frustration among Palestinians. Beyond that, I greatly respect that the Germans are seemingly the only nation at present that clearly and relentlessly holds itself accountable for its past. Oftentimes it seems to me that many other countries, including but not limited to European ones, try to camouflage a horrifying part of their history by pointing at the German one. I wish that Germany could soon develop a healthier relation to its past, without ever denying any of it or neglecting to assume its responsibility for it (for its own sake). Thus it could acquire a more balanced approach while viewing and partly leading the world (for the world’s sake).

Back to the topic of this article: I am a happy, well-integrated, successful Palestinian woman who holds a high position in Germany. For those who care: master the language, be openly and genuinely part of it all, and you will undoubtedly become an integral part of it.

i Bbp.de “Öffentliche Ausgaben für Kultur (Public Spending on Culture),” Bundeszentrale für Politische Bildung, April 2023, available at https://www.bpb.de/kurz-knapp/zahlen-und-fakten/soziale-situation-in-deutschland/61887/oeffentliche-ausgaben-fuer-kultur/.

iI  “Frauen in der Gesundheitswirtschaft (Women in the Health Industry) 2020,” PwC, available at  https://www.pwc.de/de/gesundheitswesen-und-pharma/pwc-frauen-in-der-gesundheitswirtschaft-2020.pdf.

  • Abir Giacaman has been a CEO of acute care hospitals in Germany for over a decade, today leading the DGD Krankenhaus Sachsenhausen gGmbH in Frankfurt that offers a wide range of specialized high-end medical services for over 40,000 patients a year. Originating from Bethlehem, she attended Saint Joseph’s School and the Frères College before studying business administration at Bethlehem University. After a one-year stay in the United States, she moved to Germany, the homeland of her husband, where she obtained a master’s degree in business administration and completed extensive further training in hospital management.

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