Thursday, August 22, 2013

Working alone ... my 4th week

My regular readers know that my colleague Dr. Yasser has gone on his annual vacation since the 25th of July 2013. I have, since then, been on call every single day, and although work has never been back-breaking, it is the sheer tension of being on call 24 x 7 that affects the solitary doctor who works without a replacement. 

My detractors would probably raise a flag and remind me that when I was in private individual practice in India, I was, even then, on call 24 x 7 every single day - at least as far as my patients were concerned. The difference is that when you are in your own homeland, you are with your family and the entire support system, whereas when you are working in a foreign land where the indigenous population is waiting to put you in the dock for perceived acts of omission or negligence. 

Even so, I have remained in good spirits generally. I have begun to have group discussions on Skype with a few doctors who are all going to appear for the final part of MRCPCH either later this year or the next year. This, "the final exam" as it is called, is a clinical exam where the Royal College judges the candidates on their clinical proficiency, their communication skills and their diagnostic and analytical abilities. As such, there are no standard online question sets or guidelines for passing this exam. One has to constantly practice clinical and interview skills with friends and try and smoothen one's difficult areas so that during the exams, one is able to confidently face the examiners. 

In other news, I discovered a Punjabi style Pakistani restaurant on the highway just a few hundred meters from the original North Pakistani Peshawari restaurant that I used to visit earlier (last year, that is). They actually make delicious food and also tandoori rotis the way I like them! I have begun to bring rotis, and occasionally some curries to eat with the rotis. 

On another level, I have begun to exchange food with some of the staff nurses in the hospital. They love my food, and in return, they bring something from their own kitchens! Thus, I am enjoying the experience. Last week, I made a mean spicy cashew chicken, and got some nice Chicken Adobo in return! (This is a spicy Filipino dish). 

One surprising thing that has happened in the last few weeks after Ramadan ended is the sudden spurt in deliveries. I think over 18 pregnant mothers came to the hospital in labour and have delivered their babies. This is a huge spurt, as usually, we have 3-4 deliveries every week, and about 15-20 deliveries in a month. Nowadays, there are 1-3 deliveries almost every day. This hasn't really taxed me as most deliveries are still NORMAL. However, it has added to my calls, as some of the deliveries are "high-risk" cases and some progress to a problem that needs a surgical delivery ( a Caeserean section or a C-section as it is called). 

I wish to end with a few asides. I watch Indian Idol Junior on Sony Entertainment Television, and the singing by the final 6 children has been fantastic. I was deeply impressed by all of them, but in particular by the 14-year old Debanjana and the 8-year old Sugandha who is truly prodigal. 

The other thing I wish to comment on is the abominable economic condition of my homeland. India is facing multiple problems, but the biggest one that is threatening to bring India on its knees is the explosive inflation, the rapidly depreciating Rupee vis-a-vis the U.S. dollar and the crashing stock markets. Already, credit agencies have downgraded India two or three times. the Industrial production index has plummeted to zero or even under this, and the Wholesale Price Index is at a hitherto unseen peak.

Friday, August 16, 2013

Do you get to relax when you go to India on a holiday - a question for NRIs

Today, I have chosen this unusual topic because I have realised that whenever I go to India for a holiday, more than the chance to relax, I am constantly occupied with doing things that were not done by my family members (who are in India and not with me) in my absence. This has to do mostly with financial matters, but, also, there are things like shopping, planning a with-the-family holiday, stuff to do with your own affairs - whether professional, legal, social or others, visiting your elders, remembering to purchase return gifts for members of the family, relatives, neighbours, and what not. 

On my last annual holiday, I had to run to get my Aadhar Card, a sort of National I.D. Card. Although I completed all the formalities from my side within 2 visits, the card actually arrived at my residence in Mumbai THREE months after I had returned to Saudi Arabia. I also ran from bank to bank to submit forms and signatures to get the new cheque books which were mandated to replace old cheque books before 31st March 2013. Although they extended the deadline later on to 30th June, I was able to complete the transition during my stay because I remained steadfast on this job. Between the four of us, we operate about 12 bank accounts, give or take, so I had to literally struggle with this procedure ... at multiple locations, ranging from Mazgaon, where I stay, to Mohamed Ali Road (+3 km), Charni Road (+4 km), Bhendi Bazaar (+2 km) to Byculla (+1.5 km) to do these things. At each place, I was required to first bring home a form, get it signed by the account holder, attach copies of proof of identity, proof of address and photographs, and then re-submit the same to the banks for acceptance. So, you can see this involved a lot of running around. I was significantly handicapped by the fact that I had no 2-wheeler this time, and it is not possible to take one's car to so many locations. 

Coming to the social aspect, I had to visit several elders of my family, but was ultimately able to visit only a few of them. I was to visit one of my aunts who stays in Pune (a city that is about 250 km from Mumbai by road), but was unable to do this due to lack of time. Due to the problems of distance, I was similarly unable to visit so many others. I felt bad because of this, but what was I to do? Meeting up with friends from my school was also on my agenda, but I could not do this either. To some extent, I must admit it was because of time constraints, but, it was also because many of my school friends did not show any desire to meet me. I tried to coordinate this with my good friend Hemen Majithia, with whom I have chats on Skype, but eventually, it did not work out. I did manage to go on two outings with 2 different groups of friends, and I must say alhamdolillah at least for that.

My mother stays in a separate house and has a lady companion as she is now alone. I made it a point to visit her at least 5-6 times during the entire month. Each of these visits lasted at least an hour or two, and sometimes, I shared a meal with them. I also took her out once - to see flamingos at the Sewri mud-flats. It was something she had never seen before and I enjoyed seeing her relax, watching the thousands of flamingos feeding, flying or simply ambling a few hundred meters away from us.

There was yet another factor that took up a lot of my time, and that was escorting my family members to their place of study or work, or bringing them back home in the night from these places. To this end, I must have travelled at least 300-400 km during my one month stay! On one day, it would be Nishrin requesting a lift to the parlour; on the second, Hannah would ask for a drop to Churchgate, where her college is located; on yet another, it would be Inas, wanting me to go to Colaba to pick her up from Juice. I must have spent at least 5 - 10% of my total day-time doing this activity! Not that I totally hated this, but it did eat up into my free time - time when I could have relaxed.

As the rest of my family is out for most of the day, it devolved upon me to look after affairs of the home ... such as supervising the maids who came to wash the utensils or clean the house, starting the washing machine cycles - then putting out the clothes to dry - then taking them back in and folding them into neat packets and putting them into respective almirahs, putting all the dried vessels back into the larder, receiving courier-parcels, answering the doorbell, taking phone calls, managing unforeseen household accidents or emergencies (such as when you try to take out a bottle of tomato sauce from the refrigerator, and it slips from your hand and falls to the floor, spattering the sauce and the broken glass all over the kitchen, over your clothes, and over everything else, besides.), and so many other things that make up house-keeping. On the positive side, it made me realise how difficult life must be for my ladies when I am NOT there. They must do all these things only in the evenings or at night. On the negative side, I used to sometimes get so tired of all this activity that all I wished was to run away from the house ... or even ... return to Saudi Arabia.

I think I have said most of what I wanted to say ... perhaps now it is time for you, readers, to comment upon this post. Thank you for reading.

Wednesday, August 14, 2013

Life goes on ... but is it worth it?

Many thinkers have wondered if a humdrum life is worth living, or should there ALWAYS be some form of excitement and challenge. I have often seen statuses of people writing "I am bored all alone in my room" or something to that effect on Facebook. Feeling bored is a sure sign that you are not living it up and not challenging yourself. In short, it is acceptance of the under-realisation of your own potential.

I have now completed nearly 21 months in the Kingdom, of which about 4 months could be deducted for the time spent in India on my holidays. Each time I am in Mumbai, or elsewhere on a holiday, I am filled with life and its various challenges. From mundane stuff like getting into a just closing office to complete some official work, to life-shaking events like the passing away of my father, I have embraced challenges and used them for self-development. If I had to buckle in while trying to meet some of the worst challenges in my life in the past two years, I would have long resigned to the failures and returned to India to continue living my pathetic life ... 

In fact, this is the case with most medical professionals working in peripheral areas. There are no fitness facilities or gymnasia, nor options of healthy food that can be bought in large malls, no opportunities for long walks or hikes, no means to relax - really relax - other than surfing the net or sleeping off the days when one is not on duty.  I have seen so many doctors who are out of shape and continue to worsen. And not just doctors. The class 3 and 4 workers who man the municipality, the hospital's house-keeping services, and so on, get equally lazy and age faster than their actual age as they earn money and lose health in the Kingdom.

I could have slid in the same way. Instead, I chose to grab the bull by its horns. I was past 50 when I took a decision to pro-actively change my life; deciding to come to Saudi Arabia was a simpler thing once the first step had been taken. I did have some insecurity, since I was, for the first time, leaving the comfort zone I had lived in for over half a century! At the Delhi airport, just before I entered the passengers' concourse, leaving my family outside, I dithered a lot; if, at that moment, even one of my family members had suggested that I NOT GO, I tell you, dear reader, I would have returned to Mumbai and wilfully missed the flight that eventually changed my life from that moment on. 

Readers who have been following my diary since I first began writing into it in mid-November 2011 know the hardships I faced during my first fortnight in the Kingdom; regular followers would, however, also know how great and entertaining the last several months have been for me. I have been able to visit several cities in the Kingdom - all on my own - and have been able to improve myself in other ways as well. Spiritually, I am better. The only area that I haven't improved in is my physical shape. It remains as bad as it was two, nay, five years ago. I weigh in at 83 kg, and have remained there since all these years! 

In addition to the weight that I have gained here, I have also gained remarkable experience; goodwill; friends; companions; virtues; and last, but not the least, peace of mind. The experience of working in an alien country with village folk has taught me a lot. It has taught me to be patient, kind, understanding and humble. It has become apparent to me that the average Saudi Bedouin is good at heart, intelligent and very sociable. The outer shell crumbles once you break through their hauteur. They invite you into their homes, bring you food from their homes, drive you in their cars, help you out when you are in trouble, and most important, learn to value you and to respect you. This was a revelation. Not all Saudis are as good, but that is understandable. Not all Indians are good either, right? 

The goodwill is earned through your kindness and patience. If I make an effort to be helpful to a stranger, the good-will earned earns me respect as well. This I have seen multiple numbers of times, and I am grateful to God for giving me the insight to understand this better. 

Of course, I have many new friends ... at least a hundred, if not more. I have friends from nine or ten countries now. Saudis, Egyptians, Syrians, Sudanese, Tunisians, Filipinos, Sri Lankans, Pakistanis, Bangladeshis, Kuwaitis, and a few Emiratis. This has expanded the horizons of my mind, taught me so much about their countries' geographies, histories, socio-economic problems, current problems, social and cultural activities, and so on. Knowing so many Muslims from so many different parts of the world has also enabled me to understand Islam better. It is humbling to see Muslims from so many different places in a single small town in the Kingdom. In fact, in Makkah, one is liable to see many more nationalities of Muslims, particularly Malaysians, Indonesians, even guys from China, Russia, other European countries, and even some Americans. Of course, there are many more African nationalities in Makkah, in particular, Ethiopians, Congolese, Kenyans, Tanzanians, Lebanese, Libyans, and Maghrebi (Moroccans). 

Some people I have grown to like more than the others, e.g. Dr. Measser, a Syrian doctor working in the ER. He is a very friendly and caring person. As also Dr. Emaam, another ER doctor, an Egyptian, Dr. Mohammad Abd' jawad (ER, Egyptian), Dr. Alaa Ashweh (ENT surgeon, Egyptian), Dr, Niaz Qureshi (Gyn-Ob, Pakistani), several nurses from the Philippines and Pakistan, many of the helper staff (Indian and Pakistani males, Filipino females) and some skilled workers from outside who work in different shops, such as Akmal (Mobile shop, India), Niyaz (Electronics repairs, India), Adil (Mobile shop, India), etc. 

The virtues I have earned here are a better frame of mind, patience, forbearance, tranquillity and a child-like enthusiasm in tackling new challenges. In India, I was, to put it mildly, a different individual: frustrated with the keen competition among doctors in Mumbai, I had grown into a short-tempered and irritable person and I would frequently snap at people for things that were not in their control. I learned here to be forgiving and tolerant of others who perhaps are more disadvantaged than me when it comes to intelligence, understanding, financial abilities or knowledge. This change of the frame of mind has been, to me, a sort of invigoration that has made me healthier, more happy and more content than what would be apparent otherwise.

There have been many hurdles on the way, but you look at this not as obstacles, but as opportunities to strengthen yourself and jump across them as if you were in a hurdles run, or an obstacle race, so that when you breast the finishing line, you are exhilarated, not anguished, and happy, not irritable.

Such has been my experience. Do write in into the comments area to let me know what you think of my post. Thanks.

Monday, August 12, 2013

Celebrating Ramadan Eid - the "sheerkhurma"

The last few days were memorable. This is my second Ramadan Eid in the Kingdom. While I have stayed in touch with my family and my friends from India through various modes of communication like the phone, email, Whatsapp, Wechat, Skype, etc. I tried (and am trying) to reach out personally to everyone I know in my town to wish them personally, whether they are "ajnabees" (expats) like me, or Saudi acquaintances.

A few days before the actual day of Eid, the hospital takes on different hues as the nursing staff go about decorating the various work areas with floral designs, stars and the moon, and hanging as well as wall-mounted festoons. Their effort is really noteworthy, as they (especially the Filipino nurses) are extremely talented in the arts and the crafts. They work ceaselessly till the various areas of work are adorned with beautiful decorations. 

 The photos alongside are just a few of the decorations they put up.In addition, they also put up streamers and balloons. It looked like a party! It reminded me of the decorations that Christian nurses put up during Christmas, or Hindu nurses put up in Diwali in India. However, in Saudi Arabia, there is no music, singing or dance. Hence, the celebrations just don't measure up to the image I have in my mind or the idea of celebration. 

Even so, it was nice interacting with the staff in the hospital. Of course, during Eid, we continue to work, as there would be compensatory offs later on. However, there are hardly any patients during the last few days of Ramadan and the first few days of Shawaal (the ensuing month, the first date of which is the Ramadan Eid). 

To celebrate Eid, the hospital distributed a few chocolates to each staff member. 

On the day after the Eid, I took out the time to prepare "sheerkhurma" the special drink for myself as well as for my friends and acquaintances in the hospital. To this end, I had begun preparations about four or five days ago. Purchasing 3 litres of milk and a small box of saffron, plus the needed quantity of all the dry fruit that is needed for making this drink, I was busy dicing the dry fruit a few days before the actual preparation. 

The actual preparation takes about three hours, as the milk has to be boiled first. 

Boiling the milk

Boiling and reducing the milk further

The sheerkhurma is ready ... yum.
After this, one takes a big cooking vessel, adds ghee to it, and once that is hot, one fries all the chopped dry fruit in it; then, one adds sugar, chopped dried dates, and milk to this mix. Also, one adds vermicelli. I used roasted vermicelli for the same. 

After this, one boils and boils the milk till it is reduced by about 25-30%. During this process, one can add yellow raisins - which will bloat up as the milk heats them. The last step is to add saffron leaves, which imparts the unique flavour to the drink. The sheerkhurma must be drunk hot ... as hot as the tongue can tolerate it. 

In some ways, this drink resembles the south Indian payasam.However, there are different kinds of payasam, but only one kind of sheerkhurma. My sheerkhurma was near perfect; the only ingredient lacking in this is called the "charoli", a humble dal-sized dry fruit that adds texture and taste to sheerkhurma.

When I took the drink-filled vessel to the hospital on the afternoon of the Eid, there was a lot of curiosity. Most people who partook of the half glass of the drink that I served to them were amazed at the taste and loved it. It was very gratifying when the hospital director also praised the drink; one of the nurses went so far as to doubt that I had made the drink! The entire drink was consumed within an hour. I regret only that I was unable to share the drink with the remaining hospital staff who would come to work in the afternoon and night shifts.

The Eid duty meant that we had to work even on an otherwise off day, viz. Friday. The loss of an off day was extremely disappointing, but I made up for it on Saturday, which was an off day. Eventually, work resumed on Sunday, and, as I write this, it has been an eventful week.

Thank you for reading this ... and have a wonderful Eid, dear readers.

Thursday, August 08, 2013

An Australian expat's view of India, specifically, of Mumbai

Here is an interesting link:


On the eve of the Eid in Saudi Arabia

The peculiar employment rules of the Ministry of Health require those who are doing their duty during the Eid holidays to work for six hours in two shifts on the last two days of Ramadan (as we did during the rest of the month) and to work for eight hours (as we do during the rest of the year) on the first and second of Shawwal, the ensuing month ... the first of Shawwal being also the Eid feast day. Thus, this time, I did the split duties on Tuesday and Wednesday, but on the Thursday and Friday, I would be doing the full day's duty. 

This is then compensated by the management granting us 4 days' leave. This is the so-called MURABTA. Thus, while my colleague is enjoying his leave in Egypt, I'll be busy doing work - including the next two days. However, I should probably not complain, since that's the way the cookie crumbles out here.

Anyways, Ramadan was quite interesting. There wasn't much work. Dr. Yasser was here with me for the first two weeks, and it is only after that that he left for Egypt on his annual vacation. Just before he left, I was able to travel to Makkah for my Umrah, alhamdolillah.

Back at work, emergency calls were few and far between. There were a few challenges, but that was it. During the long afternoons that ended with the return to duty at nine p.m., I slept, surfed the net, studied (a little), chatted with online friends, called my family and so on and so forth. I fasted as usual, and broke my fasts at home except for a few days, when I was invited to break the fast with my friends Salman (from the pharmacy) and Dr. Emaam (from the ER). Both the experiences were fantastic.

I cooked very little food, as I had lots of food leftover from the past month, as well as the items that I had brought from the Asian restaurant during my last visit to Ta'if. In addition, I was unable to eat a lot of food on account of the different eating hours. In the end, I cooked barely 4-5 times during the entire month, not counting snacky items like fried potatoes, samosas, etc. 

To sum it up, it was an interesting month. And now, I am looking forward to what happens during the next three months.  And that's it for now.

Monday, August 05, 2013

Are patients always nice to doctors in practice?

The title of today's post came to me as a sort of reflection in reaction to obnoxious behaviour by one of the patients who I saw yesterday night. The specifics of the case were as follows: I was called by the ER resident to the hospital at about mid-night on Saturday/Sunday. The indication was to see a 4-year old spastic child who had come with cough, had a feeding tube in his nose, and was found to have slightly low oxygen levels in the blood (as detected by an instrument applied to the thumb). 

The child was brought by his parents from a village that is over 65 km from Al Muwayh. They wanted the feeding tube changed and needed medication for the cough. The father was an overprotective person who was vigilant about what was being done to his son, and kept reminding me of the various steps in the management of the child. And, mind you, he had no politeness about him. He grew increasingly impatient while I tried to clear the child's throat and nose with a suction machine. The oxygenation levels immediately jumped from the mid-80's to about 97%, which is a very healthy level. Next, I proceeded to remove the old feeding tube and began to insert a new one through the same nostril. The father gruffly indicated that he wanted me to pass the tube through the other nostril, thank you.

However, there was some bone or cartilage that prevented the easy passage of the tube through the other nostril - and this happened, not once, but twice. Whereupon, the father, incensed at my "inefficiency", abused me and raised his hand to hit me, but his wife stopped him. He then refused to allow me to continue the management, and I had no option but to leave the child and complain about his bad behaviour to the ER Manager. The latter, I am sorry to say, did not intervene on my behalf, and almost apologised to the patient's father, who deserved no apology. He (the manager) then asked me to suggest someone else in my place to come and pass the feeding tube. I spoke to the anesthetist on duty, and the latter then came and passed a new tube through the SAME NOSTRIL  the old one had been removed from.

The incident had an adverse effect on me, naturally, as no patient had ever abused me in the Kingdom. I am sharing this incident only to highlight this one incident; no reader should think that this is the NORMAL way patients' relatives behave with the doctors. In fact, the indigent population of Al Muwayh has the greatest respect for the hospital and its staff, doctors and nurses both. 

I have had many patients actually prefer me over my colleague, just as some patients have preferred my colleague over me ... which is an acceptable thing, really, as such preferences exist all over the world. Patients, after having known me for over 18 months now, are friendly, invite me to their homes for breaking the fast, appreciate my diagnostic skills, and speak out their problems candidly before me. Hence, no, I have not normally been a victim of abuse from crude patients, and it has been a privilege to know my usual patients and their families.

If there are doctors, or if the readers have experiences of their own to relate to me, please do comment in the section below, and share the experiences with me and the other readers of this blog. Thank you so much.

Sunday, August 04, 2013

Ramadan ... your last week is upon us.

As I did in India, I am now counting the days to the end of the holy month and the celebration of Eid. Alas, it isn't the same here as it is in India. The Arabs call the Eid as the day of the Feast. They prepare their delicacies and they eat them in the afternoon of the first of the ensuing month after Ramadan (which is, by the way, Shawwal). In India, we prepare shirkhurma, a payasam-like dish with milk, dry fruit, dates and vermicelli, all cooked in pure ghee. A drink that I miss here in Saudi Arabia, although I did make it last year, and perhaps will make it this year as well. Let's see.

After the departure for vacation of my colleague Dr. Yasser, I am alone here in the department of Pediatrics. This means that I am continuously on-call, and cannot leave the village until a substitute is provided in my place. So far, it's not been a problem, since it's only been about 7 days since he left. However, as the days pass, I am surely going to miss a break. As employees of the MOH, we are entitled to 2 days' break every fortnight, but I would like to save my break until my need to go to Riyadh, which would be in the third week of September. 

So far, Ramadan hasn't thrown up many surprises. The fasts have been long, yes, as Maghrib is only after seven p.m. However, most of the time, we live in an air-conditioned environment, so thirst isn't a big problem. Hunger, sometimes, is. My being a diabetic has led me to a snack/mini-meal every three to four hours, and that creates a major hassle, especially when I am home in the afternoon and about 5-6 feet away from a well-stocked larder and a well-stocked refrigerator. 

For iftaar, I usually eat a dinner-like meal, though I did have stuff like samosas, sandwiches, burgers, etc. on those days when I could manage to cobble together the stuff, or buy it from the one and only snack shop in the village - this one is at the end of the village, next to the garden. It is managed by Yemeni cooks and assistants. Besides the usual fare of sandwiches, tea, coffee, "tamiya" and fruit juices, they make samosas in Ramadan. The entire group of Yemeni guys who work there are great to chat with. They are humble, friendly and cooperative. 

A few days ago, I was invited to iftaar with Dr. Emaam Sayed at his home. He had also invited Drs. Mohammad, Ehab and Ahmed Ouf. The food prepared for the occasion by his wife was great. There was Molokhia (which I finished an entire plate of, drinking it like a soup), foul (beans), rice, a beef kofta curry (that I avoided, as I have left eating beef since many years), salad, juices and other miscellaneous stuff, besides samosas and large pieces of chicken (roasted). I enjoyed small portions of all the items. This is the second consecutive year that Dr. Emaam has invited me to break fast with him and some friends, and I really appreciate it. 

I have just finished compiling the first issue of the Hospital newsletter, and submitted the same to the Medical Director, Dr. Ahmed Ouf. This being the first issue, the first page is full of congratulatory messages and an editorial by me. The second page will see short interviews by a doctor, a nurse and an administrator. This time, we have featured Dr. Moataz (our Egyptian anesthetist), RN sister Nouf (the Saudi in-charge Nurse) and Mr. Abdullah Qatthani (the admin in charge of house-keeping services in the hospital). On page three, we have a clinical case, a radiological quiz scenario and a small How-to section where we plan to explore the needs of the expatriate staff in the hospital. Finally, on the last page, we have put in place a section for jokes, classified advertisements and a feedback section. As the executive editor of the newsletter, I feel very possessive of my baby, but also excited to see it reach the end of a long gestation period and expect a normal, healthy delivery of the baby in this month.

That brings me to the end of this contribution. Do let me know through comments as to how you found it. Thank you.