Friday, March 18, 2011

A day in life….

The hospital is not unlike any hospital in the United States.  Its original building consisted of a single story laid out something like a ranch house that extended approximately a city block.  The building housed some clinics, inpatient units and associated buildings.  Built in the early 1940s, it was very similar to the US hospitals built around that same time.  As times changed, technology evolved and the need for services expanded the original building expanded as well.  It has become as maze of hallways, crosswalks, and buildings built adjacent to and around the original Dhahran Health Center, now known as the Saudi Aramco Medical Services Organization or SAMSO.  The complex now covers approximately 2 square miles of the camp.
Every day the halls are filled with people in all shapes and sizes from all cultures dressed in everything from the traditional Saudi thobe and abaya to the orange jumpsuits of the Bangladeshi groundskeepers and the blue jumpsuits of the Sri Lankan or Filipino housekeepers.  The uniforms are culturally appropriate and supplied by the company.  This means that while nurses for the most part are dressed in white, it might be a white abaya with white nijab (scarf) and veil or it might be just plain with scrubs.  Some scrubs are long sleeved and the majority of the Muslim caregivers wear a head covering.  The physicians typically dress in western slacks/dress shirts but it would not be out of the question to see someone dressed in a thobe and gutra.  Although I haven’t become familiar enough with the different regions, you can tell the caregivers that are Saudi versus Egyptian or Lebanese by the way they wrap their scarf. 
Nursing units are much like the nursing units in the United States.  Since the entire company of Aramco is built on a US Military model, most everything looks and feels like the US.  Signage is in both English and Arabic and all signs are basically the same size, shape and color making finding your way around quite difficult.  Staffing on the units is a mixture of nurses from around the world.  You might see a floor staffed with nurses from Saudi, Eqypt, South Africa, the UK (England, Scotland or Ireland or all of these), Norway and the Philippines all working side by side together.   While that might seem idyllic, it really is quite challenging.  The language that is used throughout all of Aramco is English.  That too would seem idyllic until you begin to realize that English takes many forms!  The different accents, dialects, colloquialisms, and general understanding of the language make communicating very difficult.  For the most part the different cultures result to their native language to accomplish communication when possible and always for personal communications.  Each patient room is equipped with signage indicating the direction for prayer and prayer rugs.  Prayer is announced 5 times daily and patients, families and healthcare workers are permitted to participate.  There is a male and female mosque located in the hospital for payer as well.    Essential employees have to make arrangements to leave patients in the care of someone else if they go to pray and although prayer is announced the basic work of caring for patients does not stop to observe it.

Nurses are easily identified from other healthcare workers because each discipline has a dress code that by either style of dress or color makes them easy to identify.  However, the cultural expectations of what nurses do and what the practice of nursing is varies greatly, especially among the patients.  For example, many Saudi families have hired workers such as housekeepers, drivers, gardeners, etc.  When a Filipino nurse in a white uniform enters the room, a male Saudi patient perceives them to be the “housekeeper” and will often treat them accordingly.  There is also a cultural expectation by many of the different cultures that the nurses are there to do everything for them so patient participation in the care can be very challenging to say the least!  Adding to the complexity of care is the societal norm that men and women should be separated.  Men do not look at women, other than their wife, so when nurses try to teach male patients or even assess them, the man will most likely be looking at the wall or the ceiling.
Every Aramco employee is assigned an ID Badge number.  It is the first form of identification you receive and it could be considered equivalent to our Social Security number.  If you need maintenance done to your house you must first provide your badge number, if you want to make an appointment at the clinic you will need your badge number, if you come on camp in a taxi you will be asked to provide your badge number since the cab driver is your responsibility while he is on camp.  Additionally, all dependents of the employee use the badge number for identification.  In the US we have a requirement to identify patients using 2 identifiers before any care or treatment is provided.  The same is required here but the challenge is determining what 2 identifiers.  Saudis use the lunar or Hijri calendar for all important dates such as expiration dates of such things as your iqama (resident card), your passport, your birthday, etc.  It is common for the US to use the patient’s name and birthdate for the 2 identifiers.  Here, those are meaningless.  Islamic names are passed down from generation to generation, so it is not unusual for several people in the family to have the same or very similar first names.  Men are frequently named after the Prophet or associates of the Prophet.  And last names are formed by combining your mother’s maiden name and your father’s name – I don’t profess to really understand the exact nature of how this works but suffice it to say names can be very confusing and birthdates are not in a convention that relates to the Western calendar dates.  Women don’t drive, therefore have no driver’s license and since in the most extremely religious situations women are not allowed to have their face be seen, they also have no photo ID.  I think you can see where this is going, positive identification of patients is a challenge and a solution is very complex and cannot be based on a western model.
The cafeteria is a vibrant place that is perfect for people watching and experiencing the subtleties of all different cultures.  Food lines consist of lines for vegetarian food like stews or Indian dishes made without meat, traditional Arabic food such as rice, tandoori kabobs, and stews of lamb or chicken, traditional Western food such as beef wellington or roast chicken, a salad bar with all the trimmings to include hummus and a roasted eggplant spread that is similar to hummus and very tasty.  There is also a Joffery’s Coffee shop – the Arabic equivalent of Starbucks!  Coffee and tea are very important to the daily life here and coffee/tea kiosks can be found in every public area of the hospital.  Drinking coffee or tea and socializing is a popular pastime for men and women here in the Kingdom – just not men and women together!
As I close in on my first month in the Kingdom I am struck by one very important concept:  nothing is as it seems here.  Just when you think you have something figured out, there are 10 other reasons it doesn’t really work like you thought!  The people here are incredibly kind and generous.  Even though we all speak different languages, have different religious beliefs, wear different clothes and prefer different food, somehow it works.  It isn’t perfect, but people eat together, socialize together, look after each other and in general put their differences aside to make a difference for their patients.    

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