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