Foot rheumatoid arthritis treatment in 41 Orthopedic surgery clinics in Germany

My mother had the chance to lie there for a short time because she had a brain tumor, but we could have left it alone because she was very unhappy there. The doctors were great, but many of the staff were a disaster in the early rehab. I saw my mother lying on the floor during visiting hours and she screamed for ages until someone came, even though the door was open and I opened her in fear was found on the operated side and this is said to have happened often, even though the rehab is better staffed than the other wards and then she was transported to the hospice without giving me the information, which I found really annoying. The doctors and the ward managers, the therapists were great and there was also a colleague who my mother really liked, but the rest was unfortunately a flop.

I can only say good things about dermatology. All the nurses and all the doctors are incredibly friendly and competent.

Dated decor here and there, especially the rooms. I was successfully helped. A wonderful park where you always like to go for a walk....even after your stay. Many old half-timbered houses, all of which belong to the Klinikum Bremen Ost. Various therapies take place there.

Completely rude and incompetent stuff , I went once to emergency , as I am first time pregnant and I had huge bleeding in the start of my pregnancy , the women on the desk she saw how terrified I am but kept saying me it’s better to wait and go to see your doctor (my doctor was closed that day ) then with really rude attitude she finally accept as . PS: the emergency was totally empty only one women was there waiting Today I called again to take appointment for giving birth (they remind me that I should not give birth here ) the first guy who picked my call he just transferred the call without saying any word , no hallo even , the second women since the start of my call she kept saying in German I cannot understand I cannot understand! And I just said hello , my name is hana nothing else ( in German ) I said sorry my German is not so good and I repeated my sentence and she said again I cannot understand call again and just cut my call !! Ok I am not a native German speaker and maybe I have accent but that’s totally normal and I know that I am talking correct German at least make some effort and talk correct to people !!! Have some manners !!

The staff at the primary care clinic was so friendly and professional, but once I got to the oncology department the staff were bigoted unprofessional and abusive.

My wife had a very strong headache. With "very strong headache" I mean - she couldn't talk, walk normaly. At the reception she answered a lot of questions. We were by family doctor. She had already the referral slip for MRI. They took blood and gave her something that had a little helped. They denied to make the MRI because of missing plausible Reason. They didn't check even the blood pressure. All my wife saw in this Emergency was only indifference and loss of care. How we must be sure that we will live a long healthy life, when the persons who are paid for that don't take reasonable steps to prevent a Death? Shame on german Health System. I recommend to search for another Emergency Point in the City. At Uniklinikum you have a very big chance to die. And they will say - "we didn't know" or another stupid argument. This happened on 28.10.2022. We came at 17:00 and left at 22:00. Besides - they found nothing.

Very bad hospitality.

My girlfriend went to their E.R. It took them seven hours to accommodate us. A nurse misplaced her chart adding to the delay. I understand that there is a triage system that prioritizes severe or emergency cases but waiting for the whole day is absurd. It was especially hard for us, since we are foreigners and cannot speak fluent German. Honestly, it was a horrible experience.

Super...

I am a professional who moved here to contribute to uplift industrial activity in my own area. Heard great input from friends on Helios, about English speaking staff, better handling than long and declining German medical system. When registered my wife for birth and checkup at the last stage of pregnancy - and recently visited, the rooms are hot (making the patient more inconvenient), then we requested female doctor/nurse due to our own comfort and values, but instead when the female doctor arrived she ended up giving me lecture to understand their culture, you are in germany, even in your home country there are only Male doctors & Staff (which she doesn't know 60-70% of medical employees are female in my home country). She was straight forward denying the service if we do not agree on the male attendant. We had no other option but to say yes, however, this has been traumatic experience turned from a happy moment. As a Service provider the doctor should be able to provide a relaxing and comfortable environment. And the treatment was not something that couldn't be done alone when requested. It was a one person job, she could have do it herself, but forced to have male attendant to just hand over tissues or so. And even after that told me to expect male attendant regardless you want or not during delivery.. Service providing is the key. highly disappointed.

I could put 0 or -5 if that was possible. I guess 1 star goes to nursing personnel some of whom were nice. My mother was admitted there with stomach cancer and fluids in abdomen supposedly for immune therapy (we know it is a last resort). Doctor (Ali Nuri Hunerliturkoglu) even wasn't fully aware of the diagnosis at the admission. At putting the port for immune therapy/chemotherapy, lung was punctured leading to an infection. Biopsy results were late, hence no promised immune therapy was provided just a general, non-specific chemotherapy, which weakened the patient together with hospital-induced punctured lung and infection to the point of not being able to walk and normally function. No help at all, just prolonging of suffering. To top it off, transportation to pick her up and deliver home was not allowed to approach hospital premises and a lying patient on a rolling bed had to be transported for 10 minutes outside in the cold. Avoid if possible

I had this year three operations in Krefeld hospital.Two of them was not planned one of them was planned.Everything goes smootly.Personal are very friendly doctors also will try to explain everything till the end.Food quality also not that bad like hospital food.My plate was empty always.I had only one small minus the pillow for your head its like a carpet to clean your shoes so tin and not comfy at all 😀 Even this hospital is one hour where i live but anyway i would always choose this hospital and recommendate to others

one day I was very sick and had to go to the Emergency. They said they would not treat me. Because I had to be referred to the home doctor first. I wonder which house doctor can be reached at 4 in the morning? They didn't treat me and I wasn't even able to walk. I cried and had to go to another hospital. Besides, the staff working there were very rude. They were talking to me as if they were shouting at me. And even when I asked some questions, they wouldn't even answer me. They didn't even look at me because I was a foreigner. I do not recommend it to anyone. If I had fainted there, I think they would have referred me to a home doctor.

I visited for the second time the emergency today. The first time nobody could point out a doctor as nobody could speak even a little bit English. Today I found a kind lady in the morning reception who gave me instructions to come again at 18:00, visit the 1st floor, to see a doctor for my emergency. I did. As I arrived I said that I don't speak German. None of the assistamts there could speak. They kept my Insurance Card and I was waiting for my turn. I heard my name and a nurse gave me a cup to pee. I used google translate to ask what the cup has to do with my pain and if they have at least someone speaking a little bit English to say what my problem was. They were explaining to me in German and as I could not understand they were just rolling eyes. If you are German prepare to get some rude responses as the specific assistant was yelling to people. If you do not speak German prepare to die as the punishment for not knowing German is death. I feel very disappointed

Really shocking service - be ready to waste your time. I wonder - what would the world be like if we all had the same attitude to each other as the staff do to their patients? HORRIBLE

Awful. Patient Management is closed when it have to work. No response via phone to ask why you must pay specific amount of money and for which services. Huge respect for doctors, but management of clinic is awful and they deserve even less than 1 point out of 5.

After almost 30 hours, they still don’t know when they can perform surgery on my kidney stone. They only gave me 5 glasses of water! When I asked them about my situation and the plan, nobody answered! I’m thirsty, hungry, and in pain from the stone for more than 1 day. This is simply the worst hospital I have ever seen in my life!

Unfortunately but I have a pleasure to have surgery on pancreas cancer here. UK NHS said its noopetatable😬. The rooms 10 stars out of 5🙂, super clean, staff constantly checking on you, everything went smooth and pain free(thanks to epidural and painkillers). I have been sent home when I was ready, no complications and, 7 month out and good so far. Highly recommend, plus beautiful town which I was able to see before surgery.

I, or we, would like to thank the doctors and nurses who looked after and cared for our father and husband from the bottom of our hearts. The situation wasn't easy for us, but everyone always answered our questions openly and honestly, even if they asked the question 20 times. They stood by our side in his and our most difficult hour. The ITS2 is not a ward like any other, but people with heart work there ❤️. Thank you thank you thank you

They are really unfiendly. I am learning German because I live here but my german is not sufficient enough to book medical appointment. If you can't understand me that is okay but you don't have to be rude!

Nurses are kind, the place is clean. You must speak german at least on a minimum level and understand what they say to use the services.

I got a brain surgery in 2017 and stayed for over a week here. I felt well treated, especially by the staff of international nurses and some doctors. I got some complications that I don't know whether they came from the care I got or if I dodged a bullet (6 hours surgery). Follow ups are a pain, emails don't work, phones only, and one has to wait for months for something.l, but the system is the bigger problem. I trust the professionals here, some will even talk English to you if asked. (Sure, don't come to the emergencies if you can be treated elsewhere). The facilities look a bit better than other hospitals in town.

the worst hospital I've been to. I broke my leg and they told me to go at 7 in the morning for the operation and they left me until 8 in the evening without giving me any information, without water. Then they remembered to come and inform me. The next time I was driving with my mother, who had a bypass and her blood pressure was quite high. The doctor asks me if he is dead? does someone have to die for us to go to the hospital? Because we also pay insurance for the doctors.

This is going to be a long story about my terrible experience in the emergency service. An ambulance brought me here at 21:30 with a broken swollen ankle. Since the emergency guy brought me inside and put me in a bed, no one came to me to do the first check-up. I begged 3 "nurses" to at least bring me ice because I am dying of pain. They go and never come back. They didnt give me ice, nor pain killers, they didn't even do a first check-up on me. How professional! especially when I can see them talking to each other, laughing, talking over the phone. The level of ignorance that I saw here is unimaginable. They are lucky that I was in pain otherwise I would have called the police. So around midnight finally someone came to do xray for me. half an hour later someone came to me to explain the severity of the injury, put the cast for me and gave me the crutches. Then he told me a nurse will come to explain everything, show me how to walk with the crutches, bring me outside with a wheelchair and call me a taxi. But no one showed up. I was screaming and no one heard me. At the end, around 02:30 I had to ask a "guest" for help. Luckily he was a nice guy unlike the nurses and stuff here. He helped me to walk outside and waited with me for a taxi that I called! I am waiting to fully recover and then I will see a lawyer about this. I even called them after days to send me the xray because the doctor wants to see them and they ignored my emails and phone calls. 5 hourse in the emergency with a broken ankel. No help, no check-up, no ice, no pain killers. No one helped me to leave and they didnt even call me a taxi!!

Worst criminal violators "working" there!! Stole one of my Organs also, when i was three years Young, and many litres of blood!! Other Details, you dont really wanna know 🤢🤢🤢🤮

Ok where do I start… first of all I don’t understand the negative comments here. The doctors are very good, excellent! They are so excited when they know our mother tongue is English and they want to talk English to us! We even had today two nurses, they asked if we can stick with English, since they never get the chance to talk in English! The nurses are just so nice and welcoming! We feel so good treated from the doctors and also from the nurses, generally all staff! You need to understand this is a VERY BUSY hospital, people are coming from many kilometers away to see a specialist here! If you don’t have anything severe, don’t keep this hospital busy. Since people like us travel miles in order to come to this Zentrum! We are very happy to be treated well. Just the organization feels sometimes kind of chaotic, probably is due to the busyness of this hospital. Thank you MHH for taking great care of us! Yes the architecture and rooms feel sometimes outdated, because this hospital was built like 60 yrs ago. But who cares about that, when the care is very good! Our comments are for two clinics: Hepatologie and also Viszeralchirurgie! Can only highly recommend it!

0 humanity,0 empathy. It’s not up to anyone to work in a hospital.some are juste heartless.

Was there at 10:30 PM . They registered quick , took blood and immediately send me to the concerned department. However had to wait 3 hrs before a dr finally addressed me . Really is this how they define emergency?

A tertiary hospital with a lot to offer, successful surgeries and high tech equipments. Problem is the people working in it. It puzzles me why some staff doctors and nurses are incompetent, arrogant, rude and unfriendly.

Disaster! Avoid coming here by all means. Hours and hours waiting when there are no other patients and you are being told just to wait a little bit more! Catastrophic, the worst ever!!!!!!

Accidentally my mother is sick,she is a 3 month visitor,I called 112 , the crew came very fast ,they were very kind, professionally treated my mom and they helped me with language when we reached the hospital , the nurse, receptionist,the Dr all give professional service ,with smile in their face,I stayed almost 8 hours, they were very busy ,they receive now and then emergency sick people.i just can say ,God bless you all the time ,God give you healthy life as you help a sick people under God will.thank you very much to all Ak clinic crew ,l💕💕💕💕

I was here two weeks ago as I cut my finger by accident. It was bleeding A LOT. Dripping onto the ER floor. Nobody cared until I had a panic attack. There was at least one good nurse with empathy. She was young and had black hair. Should have known her name.. The other middle aged nurse would mock me while passing, saying sth like she (obviously me) keeps crying and crying 😒 (with this face haha). I’m sure she thought I could not understand German only by looking at my appearance. Anyway I waited for like at least four hours there. Okay, yes, I was not obviously dying and I knew that, but at least I wish I had known what was going on and all. And the ER was not busy at all. Like four patients before me, I think. When I could finally get the x ray done, the woman in the x ray room was the WORST. My tendon was 100% cut so I could not move my finger. And yet, the incompetent woman tried to force my finger straighten up so hard and it gave me a lot worse pain than the one I had before going into the x ray room. Anyway, in the end I got transferred to St. Georg’s Asklepios and got surgery for re connecting my tendon after a long waiting time. I don’t think my nerves were connected properly as I cannot feel right side of my finger very well. I’m visiting a different hand surgeon at a different praxis. If this symptom persists, I’m getting the check up outside of Germany. Just like one review I have read here, I would rather just die (lol, with a bit of exaggeration) or fly to my home country with better health service if necessary. Even Cambodia had a better hospital, where I had to visit because of anaphylaxis during my travel there.

Very friendly staff overall. I came here to get my booster shot and I was at the wrong building, the security guy showed me where I needed to go. Then at the vaccination facility, the doctors were very helpful and informative.

Do not go here. In our experience there, they did not take our pain seriously. On top of that, they made sexist comments!! I would not recommend this place to anyone for anything.

I have visited Orthopedics department 2 times, really awesome service. Could be better, little more waiting time however currently it is really good, humble staffs and polite in nature.

Negligent in their duties, they don't follow medical guidelines. Many workers are just arogant and would want you soon out of thier way rather than trying to find the cause for your ailment. It's sad they are a university who make helathcare workers of such low quality.

Context: Foreign patient/tourist Lack of signage for foreign patients is what exacerbated this horrible experience not knowing what is the correct entrance, the fact that you can't go any doctor and must go straight to the emergency reception for example (flat fee is also 200 EU which luckily was refunded by my travel insurance) 1 receptionist out of 7 was friendly, rest were horrible to an ill person despite being polite as possible 1 doctor in the emergency ward was pretty careless after dismissing me from the hospital (and was dismissive), not even providing a proper dressed bandage for my wound after removing a drip needle that was never used to give fluids (something usually done for pain or dehydration - I was expecting some for relief but none was given) A trainee had better bedside manners The doctors in the gyni section were absolutely fantastic, explaining everything, being friendly etc. However, nothing was found for the cause of my pain which was distressing and no pain relief was offered even. A traumatic experience for someone traveling alone. I hope this review helps someone in the future. Will never be traveling back to Cologne as the reception to tourists is 99% of the time cold as ice.

First , I can not comment on medical services , but the buildings and the arrangements, the wide variety of specialties and advanced equipment all are amazing. Well organized campus.

My wife gave birth there. This was the only good experience we had in hospitals. I want to give thumbs up for the best team in the world and especially to Frau Hannah. 🙏

We also experienced the worst possible care. We were there the same night, September 11, 2023, when Marcia Lorena recently posted about the inhumane treatment toward her 87 year old grandmother, who the ER refused to treat. We are witnesses to this horrible treatment/nontreatment. We also were ignored for 3 and a 1/2 hours. We believe we were ignored because we are Americans. Several wonderful German women helped us by asking in German when my husband would be seen. They helped us four times. They were appalled that no one would see us. The desk person kept telling us that we had to wait and that they did not speak English. However, they told us a female doctor spoke English and would see us soon, but never did. It was 10pm at night and no one was in the Emergency Room and they still ignored us. During the 3 and 1/2 hours, we saw lesser cases come in and get assistance, while we continued to wait. We eventually left. I can tell you this would never happen in the United States of America. In the United States, they take you and care for you, no matter what country you are from. I wish these ER hospital personnel could experience the helplessness that we felt when they ignored us, when they are sick and outside of Germany, but unfortunately, if they are traveling in the United States, they will be well taken care of. Shame on them! Also, the Hospital Northwest should receive ZERO stars, but I had to give one, to do the post.

I was in for a sleeve gastrectomy and I could not have wished for better care in the week I was there. Absolutely amazing staff!

Management needs to be improved. A lady called me to cancel my OP the day before and said I have to wait 2 months even though I did all the pre-OP exams and of course arranged my work for sick leave before 1 week of hospital stay. When I asked if I can have the surgery with the same doctor who examined me, she started to yell, HE'S NOT MY CHEF ANYMORE in German and hung up before I responded. So I had to find another hospital to have OP. I don't understand how they can throw out a patient when their own doctor strongly suggests a surgery urgently. Also, why do they have to get ANGRY at patients just by asking questions who's already suffering and feeling already miserable?

Came with toothpain on sunday,didnt wait too long cca 2 hours, doctor and nurse were very kind,spoke English,helped me with pain,so im happy i came there,just parking is pretty expensive.

The emergency department is just a disaster. Organisational chaos. As a result- hours in a waiting line.

I really hope Google will someday let me give negative score to this place. I had to wait 2 months for an appointment, only to come here and sit in the waiting room for 1.5 hours (and the appointment is for a 2 minute consultation). The level of inefficiency and incompetence is just astonishing

I have been to this hospital twice, and both times I got disappointed. First time I needed a paper from the doctor that I was sick. She wrote incorrect information on the paper, and I only noticed it when I was home. My documents were not accepted by my uni as a result. Then, today I went to the Blutbank to donate my blood. I have a rare blood type, and I already had experience donating. I am also completely healthy and have enough muscle mass to donate without any conscequences for my own health. First, when they took a small sample of my blood from the ear, they put a plaster straight onto my hair. It was very hard to get it out of my hair later, and, mind you, very hurtful. Then, I had a talk with a very incompetent doctor/nurse. I speak english better than german, and at one point I asked her if she spoke any english. By the way, I do speak german, I just understand english better. So, I was told: "We speak german here, if you cant speak our language then there will be no donation." Excuse me?? I didn't know that the people I wanted to donate to have such a LUXURY to only have blood from people speaking fluent german. You would refuse half a liter of healthy blood on such a basis? So, in the end I did not donate, I got told to "come tomorrow". Honestly I don't think I will come here ever again. In less than 30 minutes all my will to help people got destroyed. I will make sure to avoid this hospital at all costs, and you should too.

Very long waiting times and you get send from one place to another. Some of the places have no real waiting areas. Once I did get seen the nurse was very friendly and helpul though.

Most racist doorkeeper ever :(

I was transferred back to the emergency department where I waited for hours in excruciating pain to be seen by J. Straub and Dr. med T. Mederer for less than 5 minutes each completely ignoring my recent scans and the notes from the referring hospital. One of these supposed medical professionals told me they have a program that could help me but that I couldn’t be treated any further because I only spoke English. They administered Iv pain medicine that made me feel worse and pushed me into the waiting area until my family could pick me up. I am requesting a formal response from the hospital administration and the head of Neurochirurgie Prof. Dr. N. O. Schmidt. I will also file a complaint against the hospital through Tricare.

US military here. I would definitely not recommend this hospital. Poor communication, rude staff (case management). Make sure they can 100% confirm your appointment on the first day of your visit (at least on your pre-op appointment)! Make sure your surgery is not "selective", otherwise they would schedule you and let you know 24 hours prior that your surgery was rescheduled for in another 6 weeks (almost like on aspace-available basis). This happened to me. If you are an active duty military member feel free to reach out to me. Unless you wanna be your commander's favorite and put in and cancel your convalescent leave as if you're a civilian... Also talk to your local Tricare office about this hospital.

I was extremely honoured to have been at Regensburg University Hospital. They outmost trained professional students and their highly educated doctors. Their program is unmatched and superb. Simply the best!

Two weeks ago I got a fixed appointment to see a specialist. When I showed up on time for the appointment, we were told that no doctor would be there today and the appointment would not take place! I was kept there for 4 hours with unsuitable staff and in the end I was just given a piece of paper with a different phone number so that I can try to arrange a next appointment. I was present with my mother in a wheelchair, who is chronically ill and in severe pain. The emergency room didn't help us either! Thank you, I hope you stay healthy!!

I had vomited 4 times, was in sever pain and fever. I went to the emergency for some assistance at 6am in the morning, the doctor and the receptionist refused to take me in and instead said you won’t die if you dont eat for another 2 days. Extremely rude and racist behavior. Never EVER anybody with a person of color should go there. Don’t deserve even 1 star.

Extremely rude attitude even at the reception. Then we visited the eye clinic and there the "head" of the department was arrogant, rude, mean and disturbingly angry. I would not recommend EVER! We were waiting for an examination of a child, but it never happened.

Extremely inflexible and unhelpful.

👌🏽👌🏽👌🏽

If I could give a no star I would. The worst experience me and my family had in this hospital. My dad was put into the ICU-intensive care unit. U would think each patient is in good hands Once handed over to any hospital but I wouldn’t say in this case. We waited for hours and hours until someone finally came back to tell us even what was going on..it was a mess and a poor communication even for a German citizenship like me. Unclear what he even had after so many hours waiting in the waiting area. Once my dad was “stabilized” we were able to enter. 2 nurses were attending him laughing and joking about some ridiculous joke they were talking to each other. (Keep in mind my dad was on the machine with pipes unconscious) and we as a family stood there in shock! A doctor in charge came along fiddling with the oxygen machine since it kept making noises. He just casually went oh get another cable from the Keller or any fake Chinese one will do. Well it hadn’t to do with any cables in the end. IT WAS BECAUSE IT WASN'T EVEN CONNECTED TO ANYTHING!! Starting with this and throughout the night readers can guess how it ended up with my dad! To the lady nurse who was a visitor that day from the neighboring hospital we thank you for giving us the time you gave us explaining us that dad had good chances of survival and giving us hope that our dad will come home again.

I want to give Zero star. There is not a single thing good in this hospital. I broke my foot (multiple hairline fractures) on 17 July. I went to the emergency department (Notfall) and waited almost 6-7 hours (there were hardly 5-6 patients). The doctor did only the XRAY and said no bone is broken. Please take Ibuprofen and sent me back home with an appointment to see me again after 5 days. On Monday i went again, the pain was unbearable. I told the doctor and they did CT scan (waiting time was again 4-5 hours). She told me later that my bones are broken and they put Gips on my foot. After every two weeks, i came for a basic check-up with an appointment but still had to wait 4-6 hours. Today, 04 Sept, i had an appointment at 11:00. I came on-time and still waiting (it’s been more than 4Hrs+). Is this how a developed country’s hospital should be? Why they are unable to manage a small amount of patients? There are hardly 20 patients. I’m really irritated, disappointed and angry on the public health care system of Germany. Better to get treated from a developing nation, where doctors are more competent and you get better service and treatment.

The worker here are so lovely and caring…despite I don’t understand German but I was loved

I made an appointment on Friday at 11:15 . I come to the appointment and they say they don't have it. They send me to the emergency room instead, where i wait for 3 hours. You sit there, without any clarity, afraid to going to the toilet so not to miss your precious turn, getting hungry and anxious, watching all your day plans crashing apart. Story #2: I've made an appointment, at "Notaufnahme", the doc told me "make it early", so I scheduled for 8:30. I spend 130eur on taxi to reach the Klinik from Clausthal (the only way to reach at this time). They have a complete haos (bad weather, understandable). Aftet 6h of waiting, it turned out that THEY LOST MY FILE. (and I asked about my file at the 6h of waiting and received then a rude "you have to wait", instead of them checking if my file was present). In total, my waiting time: 8;30-20:30, that is 12 (TWELVE) hours. From the nurses/admin I received no apologies nor kind words nor anything of this kind. The doctor was the only person who got into situation, and applied good "comm skills", kudos to him. So it happened twice: first, they lost my appointment and told me they didn't have it. (story #1). Second, they lost my documents (story #2). Story#3: that is a normal interaction: had an apntmt at Notaufnahme at 8:45, waited 1h, got invited, then doc said "surgeon is busy wait for more 30min, go have a tee if you want", came back after 30min, got "serviced". Thanks to the doc for clarity ("go have tee for 30min"). That is a positive interaction: only 1h30min waiting in total, everything was clear. Added one ⭐ (now one, prev 0zero). On the negative side: turned out my Monday visit with 12h waiting was absolutely useless. Story#4: so they gave me a receipt for physiotherapy, but put the WRONG name on it. I ve an appointments with the physio, waited for three weeks, attended 3 sessions, and the physio now cancelled all the other appointments bcs of the wrong name on that receipt that they gave me. Now I need to get another physio prescription from UniKlinik, then wait another three weeks (?) for new appointments with physio. And all this while doctors are urging me "you really need therapy, or you have big troubles with your joint". Lesson: always check the documents they give you, they make mistakes.