Description of my experience in Saudi Arabia after four months

I arrived in July to Riyadh. The day-time temperature in July-August rose to above 50 degrees centigrade which felt hot even for a sauna-passionate Finn. My work place is the leading arab-nation hospital King Faisal Specialist Hospital & Research Centre, which provides work for about 2000 employees from 80 different nations. The amount of locals employed is increasing, but remains at a low 6% thus far. Almost all specialized departments are well represented in the hopsital. The patients are mainly categorized into three categories: patients in need of intensive care from all over the Kingdom, VIP-patients, and the hospital's staff.

The orientation program for new employees is very well structured. The orientation commenced with a three day general introduction for all employees and for nurses it continued thereafter for three weeks with different caretaking issues. Themes included writing, medical care, and wound care. After this we transferred to our own units where everybody was assigned a mentor. King Faisal is a US accredited hospital, and due to this every new employee must display knowledge based on various tests. The tests and samples are usually linked such as pharmacology as well as medicinal calculation and healing. Preparing for these tests during the probationary period took its time, and also naturally created some pressure for the new employees.

Several surprises were in store for us. Taking care of things here are every now and then pleasantly progressive, however sometimes also very beurocratic, demanding time and patience. Simply the opening of a bank account here demands a trip to five different gentlemen as well as a spot of luck. Also, from my personal experience, another example is when my contract-assigned work-post changed, which also happened with a few others. The apartments are of very varying standards. Some of them are brand new and equipped with their own bathroom while others seem to have more history and been through a great deal of different occupants. All issues can however be negotiated here on site.

Perhaps the biggest surprise to me has been the difference in nurse roles in different units. Treatment decision making is extremely limited and practically all procedures need a signed permission from a doctor. On one hand this divides responsibility, but on the other hand it slows down work progress. Also the patients varying level of education has an affect on work. My estimate would be that approximately 70% of patients in my unit are arabic-speakers, and roughly one third of them speak english either extremely well or close to it. While I find this rather fascinating, it also slows my work down significantly. Initially, I believed that patients were angry with me when they yelled at me, but a helpful interpretor informed me that they were simply raising their voices at me in order for me to understand their arabic better! The patients and family are very pleased with every communication effort made in arabic and they are also very hospitable. During shifts a patient has his/her own nurse, who in turn has a supervisor who coordinates the entire unit's progress as well as cooperation between doctors and nurses. In emergency situations however, the patient's direct nurse is responsible for delegating the tasks in the team, differing from the Finnish system, where usually the doctor assumes the leading role.

The Saudi population are a nocturnal people. Many doze off and sleep during the day and then activate themselves late in the evening. Our group arrived during Rammadan which was quite the exceptional case. Although the patient's are excused from religious traditions when admitted, many of our patients wanted to fast, which meant we were only able to delegate medicine and take blood-sugar readings after the 6 pm prayer session. The paitent's that refused to eat during the day compensated for this; the amounts of food, that were personally delivered by the families in their own pots and pans to the ward, was probably enough to feed a small army. Food and its delegation between one family is all in all a very important role in the ward. Along with the patient's family, the kitchen's bowtie and vest attired staff serve the patients meals which the patients themselves pick from a menu-- these are then delivered to the paitent on a golden cart.

Religion is a visible part of the patients day to day routine and also affects the planning and execution of our work. Respecting the prayer sessions, covering of the female patients, healing herbs and blessings in addition to procedures are all part of caring for the patients. Visiting a patient is an important social event for muslims. Many of the patients have their own sitter, who's tasks include particularly the emotional and social support for the patient. Guests often visit, and many of them are very committed and loud. As a leader in quiet cultures, this all seems a little bit contradictory in the beginning, but I have slowly begun to get used to the fact that everybody speaks at the same time. Family ties are important, and meeting family and close ones requires much preparation. Women put a lot of effort into their appearance and maintaining a pleasant atmosphere in the room. All sorts of sparkles and decoratives are appreciated. The most well equipped VIP patients have outfitted their rooms with Eastern carpets, crystals, as well as high arm chairs for guests which for example one certain VIP guest ordered 20 of in anticipation of guests. Yesterday I was admiring a flower delivery; its height peaked above 1.5 metres and contained among others 30 orchid branches.

It's easy to find things to do during free time. Keeping in touch with your close ones takes time of its own and is made easy with internet access. In the city there is a lot of sights to see and many different hobby opportunities. Various organizations and embassies arrange events as well as trips both domestically and internationally. Also, the hospital offers for example sporting activities, educational courses as well as movies. Shopping is a popular activity among both locals as well as visitors, and Riyadh's facilities definitely matches this interest. The only difference in free time here is that it does require some planning beforehand. Like in Finland, you can go for a run here whenever, but you cannot run out of your front door in your shorts like at home. Wearing an abaya and covering myself has been easy, and I believe that like with other cultures, you will adapt just fine with the right flexible attitude.

Regards,

Kaisa

October 2009