The grass is always greener...

I am requesting all of you to indulge me in a moment of exuberant self-importance…I got an email from the editor of the book in which my submission (see first blog entry) will be published. We have officially received endorsement from the one and only Greg Mortenson!! THE AUTHOR OF ONE OF MY FAVORITE BOOKS HAS READ MY WRITING!!! The endorsement is as follows:


“The extraordinary nurses’ stories in Caring Beyond Borders have the power to ignite a movement of international volunteerism. As a nurse, this book reinforces what I already know: wealthier and more technologically advanced countries have a responsibility to help the undeveloped ones, not only through a sense of charity, but in order to promote permanent peace and security. With its insightful glimpses into universal health concerns, this collection incites reflection, examination, and hope.”
—Greg Mortenson, author of Three Cups of Tea


The story I will share today is from my recent spur-of-the-moment escape to Argentina. When I was unable to find employment (and unable to say I tried very hard) for September following my 2 months of summer vacation post-Saudi, I decided that it was time to go down south. WAY down south. I wanted to stand on the tip of the world. I wanted to see if Patagonia was all it was cracked up to be. I booked my ticket, and was on my way 6 days later.

I started out in Ushuaia which is the southernmost city in the world. The community of about 60, 000 in Tierra Del Fuego (literally “Land of the Fire) is nestled cozily into the side of the mountains and flanked by the Beagle Channel which is the gateway for expeditions to Antarctica.

Perhaps one of the most marked traditions in Argentina is the preparing and consumption of the green, earthy tea “yerba mate”. Mate is consumed from small, mug-sized dried and hollowed gourds (also called “mates”). Dry tea is placed in the mate and hot water poured over top. The tea is sipped through a long filtered metal straw (the “bombilla”). It is a very social ritual as each time the mate is refilled with hot water (the tea is kept for multiple uses), it is passed on to present friends/family to drink the next round. This is a custom that transcends all social classes and the Argentine people are ubiquitously seen at all hours of the day toting thermoses of hot water to replenish their mate.

After 5 super fun and adventure-filled days in Ushuaia, I was set to fly out that afternoon. I thought that some yerba mate tea would make a great gift for a few of my friends, so while I was at the grocery store, I picked up three 1kg packs of organic tea. I tucked these into my backpack and set off to the airport to catch my flight out of Ushuaia to Patagonia.

Due to extenuating circumstances (I will avoid the lengthy explanation at present, even though it would add even further ridicule to the antics which follow…) post check-in, I had to make a very rushed, semi-emergency trip back into town. Luckily, I made it back to the airport with minutes to spare – I pushed some cash at the cabbie and flew towards the front doors of the airport. Five steps into my frenzied rush, the automatic doors of the airport swooshed open, and I was face to face with 4 security guards, a disconcertingly large German Shephard, and a rather distraught airline attendant. I changed my whirlwind trajectory to curve around side of a guard with a unibrow so heavy, it appeared he had been on the loosing end of a battle with a glue gun and an extra wide strip of black Velcro. I was surprised and slightly annoyed when he stepped into my path…”Fio-NA Mac-lee-OOD??” In a flash decision, I evaluated the circumstances and concluded now was not the time to discuss proper Scottish pronunciation of my name.

**left eyebrow lifts** ”…si?”

The airline attendant managed to sputter that there was a problem, and I suddenly found myself surrounded by Velcro-Man and his cronies as I was escorted to a small back room. The room had nothing in it except a wooden table, and on top of it, my backpack lying like a corpse on an autopsy gurney. I was herded over to the table.

“Open it.”

As I tried to figure out what could possibly be provoking this, I prayed to the powers that be that my underwear were tucked securely in another compartment of my bag (this is in contrast to when I used to re-enter Riyadh and I would purposely put all my underwear on top…one flustered look at a woman’s exposed ginch and the suitcase would be snapped shut and we would be hurriedly waved through security). As I opened the top of my bag I realized what the problem was.

It was just as well I didn’t know enough Spanish to let my occasionally sharp and sarcastic tongue to flick out a remark eluding to the fact that were I transporting 3 kilos of South American grass (marijuana) across the country, I likely wouldn’t choose to store it in 3 neatly packed paper bags labeled “mate” stuffed into the detachable fanny bag of my checked-in 90L backpack. However, judging from the expressions on the faces of the pompous, arrogant guards, the loud donkey bray laugh that inadvertently hurled itself from my throat and into their faces at that point proved rather conclusively that you don’t always need spoken language to get the message across…

As they humored me, I humored them while Velcro-Man’s skinny chachi friend stared at me and stuck his greasy nose up to the bag of tea and sniffed. Without taking his eyes off me, he lowered the bag to the dog who twitched and turned his head away in disdainful boredom.

“Put it back. Go”.

The smirk on my face leaked out and seeped into all my actions as I overcautiously tucked my “stash” back into my bag, looking up often with lifted eyebrow to seek “approval” with each step. Finally, I gave them a cheerful “ciao ciao!” before sprinting for the last boarding call to Patagonia. I am happy to say that my tea and I both made it safely to Patagonia, around the rest of Argentina, through Mexico City and back to Canada with no further complications.

Fi
xo

Mother Fiona

“…and this is a great bench to come and sit on whenever you want to just relax or if you ever have to clear your head and re-focus.”

It was the end of my first day of my first day back to work since my return from Saudi Arabia 3.5 months ago. My new boss was showing me around the area for which I would be responsible in my temporary contract job as Public Health Nurse for First Nations and Inuit Health in the Lillooet area.

I stared, transfixed by what was quite possibly the most perfect bench I had even seen. It sat alone on a cliff overlooking the icy turquoise blue waters of Seton Lake, just on the outskirts of Lillooet. The bench was partially sheltered from the wind by the thick, knobby trees surrounding it, but the sun still managed to warm the worn, varnished wood as it seeped lazily through the bare gnarly branches. While the sun’s rays cast their calm, quiet beauty on my future sitting spot, I realized this picture-perfect scene was in reality the epilogue to a summer so dry and hot, much of the area (to within a mere kilometer of the town and to the point of evacuation) had been under siege of raging wildfires, and many of the trees had actually been bare for months. The slowing of time seemed to extend to the valley itself as the snow capped peaks yawned apart in the distance, and the lake seemed to empty at some indefinite point into the alpine esophagus. The mountains nearby yielded towering craggy, humbling rock faces, spattered with fiery autumn ground vegetation, almost as if the traumatic events of a few months before had been still-shot into the landscape as an unresolved grudge of mother nature’s recent rage.

Strangely enough, I was only vaguely aware of all this surrounding me as I eyed the bench warily…judging from the events which had taken place that day, my rear end would no doubt become well acquainted with that bench during the next few months in the “clear-your-head” context.

I knew I was in a little over my head, and I accepted this position well aware of this in degrees of varying potential. All I was hoping for was a boss with whom I could be transparent about this fact, and as long as I showed initiative and willingness to learn, she would be supportive of me in every way possible. In this way, I got my wish. However, THIS I did not expect:

It started within 20 mins of arriving this morning…my experience thus far with the agency who had placed me here had been marginal at the best of times, so I showed up with a general idea of what I would be doing, but by no means did I have an actual job description. Following introductions, my wonderful new boss did not hesitate to go over this disparity with me. For the next 6 weeks, maybe more, I would have a brand new government truck with very cool gov. of Canada logos, studded winter tires (for driving to the reservation under my jurisdiction which was 1.5 hrs one way down a sketchy logging road), I would have my very own huge office overlooking the mountains, a wad of keys bigger than my head for all the secure cupboards, drawers, and remote health clinics I would be using, a government expense credit card, and every other Friday off…Sweet…but I would also be responsible for the health of 3 reserves in the area, all of which housed between 200-400 people, all influenza and H1N1 vaccination blitzes and education, co-ordination with health Canada for reporting, implementation of prevention programs, pandemic identification and management…Shit…but it didn’t end there.

As my head spun a little with the immensity of this scope I would be responsible for with essentially no real relevant experience and 2-3 days of orientation (the life of an agency nurse!), I realized that my new mentor’s mouth was still moving, and I focused and re-tuned in: “our other equally important scope here is healthy mother and baby programs”.

The silence became slightly awkward as I waited for the “catch” phrase of “but as you are only here temporarily, so you will only have to worry about the influenza and communicable disease protocols”. It didn’t come. Yes, friends and family, for a minimum of the next 6 weeks, I will be solely responsible for pre and post partum assessments, teaching breastfeeding, proper health and rearing of infants and children, assessment of developmental stages in preschool kids, and I am sure many other little brat-related health issues I cannot even begin to fathom in my blissfully child-ignorant mind.

***We are going to take a pause here for those of you who know me well enough to know that my reproductive biological clock has not yet even evolved to sundial stage, let alone started to tick. Please, go wipe your eyes and empty your mirth strained bladders as you find the ironical humor in this situation that I have not quite yet come to terms with***

The reality set in as I started to pick out words like “trimester”, “infant dental hygiene” (WTF babies don’t have teeth!? Who knew you had to wipe the little things’ gums with a facecloth?!) and “breast pump” (oh God.). Each new term was like the addition of more vinegar to the grade 3 science fair baking soda volcano that was my anxiety. I realized that I was about to undertake a learning curve so steep it might very well teeter over backwards and crush me.

Now writing to you several hours later, having spent a good portion of the evening in sub-catatonic denial, I have somehow managed to come to very distant terms with this. Actually, I have pacified (haha) myself with the knowledge that for the next couple of weeks at least, the influenza vaccines will be the priority thus giving me several more weeks of relatively warranted ambrosial ignorance to the child related responsibilities ominously pending over me. Thus, I will enjoy these last few blissfully adult weeks of my life, starting by finishing this second glass of good red Argentinean wine in blissful silence…

Karma works in strange ways…

Xo

Fi

Here we are again....

Hello all!

Well, it may have taken me 4 months, but I have finally managed to get my act together and start up a new blog from Canadian grounds. For those of you reading for the first time, I spent a year nursing in the Mid East and documented all my adventures/misadventures at www.behindtheabaya.blogspot.com. I had an amazing work-free summer back on Canadian soil, a month long stint in Argentina in Sep/Oct, and I am finally back to reality this tuesday when I start a 6-week public health contract in Lillooet.

I have many stories to share from the last few months, but I will start with a bit of exciting news: Kaplan Publishing has chosen a submission made from Behind the Abaya for print in Beyond Borders which is a compilation of nurses' stories working abroad. The book is for release in April 2010. Below is the entry which will be printed:

“In the Doghouse”

In July of 2008, looking for a bit of adventure, culture, and travel, I left my comfortable research job in Vancouver, British Columbia and set off to the Middle East. I had accepted a one-year contract working on a ward at a large research hospital in Saudi Arabia. Little did I know at that time, that these 12 months were to be the most significant learning experience of my entire life to date, culturally, professionally and personally.

One of the most significant things I have learned is just how powerful language can be. Making the effort to acquire and use even a limited vocabulary of the local language can create bonds and help to seal off deeply running cultural fissures.
Often, my narrow berth of the Arabic language limits me to using words that I know aren’t exactly right in a particular context, however in most situations, the point usually gets across and my faltering attempts are generally met with encouragement and endearment. My efforts also provide much needed comedic relief for both the patient and myself within the sober hospital environment.

Every day, I am adding to the list of words that I keep in my pocket, and every night, I try to practice each one and commit it to memory. I am proud to say that I can now ask any Arabic speaking patient if they have moved their bowels today, yesterday, or the day before yesterday, whether he/she has had any diarrhea, whether or not they are constipated, and if they would like any medication to assist in whatever dysfunctional bowel pattern they may be experiencing. Unfortunately this wealth of knowledge does not transfer well to communication with the general public (e.g. at shopping malls, with cab drivers, etc). I should also make clear that, at the beginning, while I could get a basic point across, I generally spoke either in very short sentences with devastatingly poor grammar, or in single words punctuated with animated gesticulations to get my point across (the latter method was not always well received before I learned all my bowel-related Arabic).

My first language blunder happened in the first week on my new ward. First, a bit of background:
Though the holy Qu’ran emphasizes kindness to all animals, dogs are considered “dirty” in Islam. Muslims do not keep dogs as pets in Saudi, and generally the only place one can see a dog is a fleeting glimpse of a wild Saluki in the desert. Touching a dog voids “wudu” or the ritualistic washing of one’s self with water prior to each of the 5 daily prayers (sala).

One of my first proud new words was “gelb” which means “heart”. The “G” sound in Arabic is quite soft, and can almost be mistaken for a “K”. On one particular day, I was happily doing my morning assessments in my patients’ rooms. When it came time to use my newly acquired vocabulary, I would lift my eyebrows, point at his/her chest and say “kelb?” as in “can I listen to your heart?”. By the third patient, I could not shake the feeling that I was getting a little bit of hostility (though I was telling myself that it was a cultural thing that I was no doubt misinterpreting). It wasn’t until later on that day, when I was practicing my Arabic with one of my Lebanese co-workers, that I realized my embarrassing blunder. Apparently, I had been pronouncing my “G” sound TOO softly, and it was coming out as a fairly audible “K”. While “gelb” means “heart”, unfortunately “kelb” means “dog”…in case there was any doubt as to whom I was referring when I uttered the insult, I must remind you that I was pointing at my patients’ chests while saying it. As an aside, I also found out later that single-finger pointing at someone in any capacity in the Muslim culture is also insulting. Oh dear – strike 2.

My Arabic has come a long way since this first incident, though not without additional and equally amusing blunders. Though I am proud to say that I have developed a fairly good “working knowledge” of the language, I am also aware that in certain situations, it is not appropriate to have any ambiguity around what is being said. In some instances, the necessary explanation or command of the language goes far beyond what I am capable of. A very important lesson I have learned is that sometimes, just staying completely silent while doing your job quickly and expertly speaks louder and more articulately than the most intelligent and thought provoking exchange in any language...

In keeping with this, I would also like to share a more recent experience with language:

One of my patients was scheduled for a bone marrow biopsy. If you have ever experienced either receiving, observing, or assisting with a bone marrow biopsy, you know well that “barbaric” is a gross understatement in describing the procedure: The patient lies in a semi prone position while the doctor drives a needle roughly the width of a chopstick and the length of your hand from wrist to tip of your baby finger through layers of dermis and muscle, and into the bony pelvis. The intention is to collect a corkscrew-like sample of bone marrow to analyze for blood cancer. I say “intention” because often, it takes more than one trip boring the needle through the fleshy tunnel and retracting it to check if the sample attempt was successful. This procedure is done under local anesthetic and a needle as long as your middle finger filled with xylocaine is driven into the flesh and alternatively eased forward and backwards to ensure that an adequately wide area has been “frozen”. The patient gets some pre-medications for pain and for anxiety, but I liken this to offering someone a Tylenol and a lavender oil neck massage before a bilateral leg amputation.

This particular patient had a history of chronic pain and depression, and was particularly anxious and teary prior to and during the procedure. I had pulled up a chair beside her bed, and was holding both her hands, speaking in my best soothing voice, and trying desperately to pass on strength and will to the distraught woman. The woman was crying out in pain and clamping my hands in a diaphoretic vice-grip as the needle drove into the back of her pelvis.

The doctor who was performing the procedure is an incredibly smart man, meticulously conscious of minute details “behind the scenes”. Unfortunately, however, his bedside manner would no doubt cause Florence Nightengale to have a serious nervous meltdown. He is not a native Arabic speaker, but seems to truly believe that knowing how to say “is there pain here”, “you are not feeling pain”, and what is the problem?” in Arabic was an acceptable range of vernacular to competently perform this procedure. As these questions were being delivered in his signature manner with a harsh, accusatory “HUH?!” after every question, I could feel my jaw clenching tighter and tighter as the patient’s cries grew louder and my “Western-style” temper erupted violently over the edges of the gender-repressed container I had packed it into for the time being in order to assimilate into my new culture. The third “THERE IS NO PAIN, WHAT IS THE PROBLEM, HUH?!” was cut short by an urgent, even statement that surprised even me as it quietly but forcefully escaped my lips: “With all due respect, doctor, I think the crying and the yelling is fairly indicative of the pain, and the problem is that she has an 8 inch needle the size of a pencil stuck into her pelvis…can we just get this over with as quickly as possible please?”.

The room was suddenly silent except for the whimpered Qu’ran verses escaping the pursed lips of the young woman. You could have cut the tension with surgery shears. I calmly and firmly met the Doctor’s patronizing stare despite the creeping fingers of crimson slowly making their way up my neck and prickling my ears. Just when I was certain that the doctor was going to stalk out of the room leaving the biopsy needle protruding out of the patient’s pelvis like a Saudi oil rig, he broke the gaze muttering something about protocol, and the remainder of the procedure was slightly tense, but thankfully quick, quiet, and relatively uneventful.

My point here is that although I cannot express how important it is to gain at least a small handle on the language spoken by those you are caring for, it is also just as important, and perhaps even a professional responsibility to know your limitations. In order to competently perform our duties, we must use sound judgment and honesty about the range of our abilities both with ourselves and with others.

January 2009


More to come as soon as I get settled up north.

Love to all

xo
Fi