I have spent over three months in Aden, almost four to be exact. Time has really flown by! It was only yesterday that I was trying to settle in to the new system and now I am a veteran. There are so many things I wanted to do and planned to do and now I can see that if I don’t start to do them, I might never get them done.
My job as medical director has been hard! To be honest I would say it has been one of the more difficult things I have ever done. I shy away from confrontation or arguments, I’d rather keep quiet than ruffle any feathers but I have not been able to do that with this job. I have to speak up, correct people much older than me all without blinking an eye or feeling sorry for them! I have to deliver rebukes not sugar coated or honey dipped but firmly and without any trace of levity. In the midst of those who are not happy about change, there are others who are very happy and supportive of the change being made so we are encouraged.
The office © Tomi Lamikanra
Working with the doctors has been fun and also frustrating. Old habits are hard to change but fortunately I have had help. For the last one month we had an experienced anesthetist from New Zealand. He is on the teaching staff of his hospital back home and has brought many changes with respect to patient management. With his help we drew up a plan to highlight the weaknesses in our system and put in place checks to make sure we have little or no medical errors.
Next week we get to discuss Atul Gawande’s article on Medical Malpractice, it actually highlights one of the problems that arise when doctors do not document what they have done. Hopefully our discussion will illustrate what ‘noise’ I have been making about poor documentation and drum into the consciousness of the physicians the need to properly examine and document patient encounters.
One of the highlights of my week is my Arabic classes. Initially I had classes with one of our interpreters alone but now I have a proper teacher and two other classmates – our finance administrator and logistician. I am able to understand a bit more of what is being said around me and the staff is increasingly surprised when I stop the translators to say a few things to patients or them in Arabic.
I am learning a little bit more about the culture. Women do not shake hands with men and vice versa. Our teacher explained that according to the culture women do not shake hands with anyone they can marry, everyone else is probably a very close relation. Marriage to first cousins’ is still very common so women do not shake their first cousins' hands. I shake the hands of more than a few men probably because I am viewed as an outsider.
I have made a few friends and have been delighted by staff (a husband and wife) who called me to whisper to me that they are expecting a new baby. I shared their distress a few days later when the wife was admitted on account of vaginal bleeding and a loss of the pregnancy. We have a delightful cook, Noor, who whips us up meals from every continent. She learns new dishes from every expat so a few times a week we are surprised with traditional meals from India, France, Germany, Nigeria, Tunisia and many other places! We never know what to expect for lunch. You can bet that I have picked up a few cooking tips from her.
Snapshot of a typical lunch here © Tomi Lamikanra
Work has been pretty light so we have spent a few days this week preparing for a mass casualty. We have a Mass Casualty Plan (MCP) and it is my responsibility to activate it when we have a sudden influx of more than eight patients at the same time. Thankfully we have had only one MCP activated and we had a total of 40 patients following a civil demonstration.
Today we simulated a mass casualty with some of the staff playing patients. One of the staff actors went above and beyond the script. He was supposed to play the part of a patient with a gunshot wound to the chest. His mimicry of the patient was perfect and was a good reminder of some of the challenges we might face in the likelihood of such an event.
The next time I write, I would have gone on holiday to a nearby country. I am definitely looking forward to the break.
Elephant rock, a popular spot in Aden © Tomi Lamikanra
Tomi wrote this post in March 2014