Groupe de champs
Settling in and dressing the part

I’m in Islamabad, Pakistan. I’ve been here for about three weeks and I am here as expat nurse responsible for the neonatal nursery, inpatient paediatric department, and both the in and outpatient therapeutic feeding centres serving communities close to the Afghanistan border.

I’m in Islamabad, Pakistan. I’ve been here for about three weeks and I am here as expat nurse responsible for the neonatal nursery, inpatient paediatric department, and both the in and outpatient therapeutic feeding centres serving communities close to the Afghanistan border. The only challenge with that – no wait that’s not true – one of the main challenges with that is, due to current visa limitations and recently increased security restrictions, I cannot go there…

This means I am working by remote management. I manage my various departments through frequent telephone calls and emails to my nurses in the wards and medical focal point in the office. Obviously this comes with challenges. I am line manager to about 20 staff who I have not yet met. I have no concept of the hospital in which we are working – the layout of the neonatal nursery, the size of the beds in the paediatric department or the distance from one department to another. I discuss babies’ care by doing ward rounds by telephone. Babies are born. Most are discharged home, some are transferred to Quetta, and some die. I have no idea what they look like and that’s quite surreal. But as it could be a few months before I get to visit, I need to start thinking well outside the box in how to enable communication and gain understanding of this hospital.

Before coming to Pakistan I had assumed we could share video and photos of the field environment – staff, patients, and the hospital itself, to have an understanding of the context, but you know what they say about assumptions… Security restrictions include absolutely not taking any photographs in the field. This is because of perception. People can misinterpret the reasoning for taking a photo. Initially when I pondered writing a blog one of the more exciting components for me was imagining beautiful photos I would take in the field and then share (last year in Tajikistan I took 5,000 photos – yeah, I have a problem). So it is my goal to instead describe to you through words the photos I would take if I could.

For now my thoughts are focused on the clothes. While I am in Pakistan I will wear local dress – shalwar kameez – at all times I’m in public and at the office. This is made up of long loose trousers, a long loose tunic top with long sleeves, and a headscarf. In Islamabad there is some freedom with this – I can wear jeans underneath, the length of the tunic can be above the knee and can have a split up the side, and I don’t need to cover my hair. But when I eventually go to the field the tunic will need to come down to mid calf length or longer, with any split no higher than the knee, the trousers must be loose and at all times I will need to have my hair covered. Some people really struggle with this enforcement of dress code. For me though, I don’t mind. It’s kind of fun – like playing dress up. Some of the clothes are so pretty and feminine. Compared to what I normally wear it’s like being in Victorian times with high collars and full-length skirts. And I find myself feeling more feminine in them, giggling behind my scarf, responding demurely to people holding doors open to me and avoiding eye contact or handshakes with men. It’s not the reaction I expected to have, as I thought my inner feminist would be crying out for freedom of expression. But don’t get me wrong I’m still irritated by this – the male expats can wear what they like. Women here are told what to do, when to do it and given virtually no room to challenge this. I’m not going to go into that now though.

For now, I’m trying to not focus too much on the challenges and difficulties. I think I am already making relationships with my staff, starting to implement improved patient care, and I’m having a blast with my expat team. Also as a consolation to not going to the field I’m treating myself to a manicure at the local spa – maybe a massage too. See…? It could be worse…