There’s a project plan for me to follow, with a main action committee supported by several sub-committees. Perusing the papers from these various committees, however, several things become apparent: the terms of reference keep changing, no one can decide who is the chair, the next meeting is not arranged and there are no action points in the minutes.
Nothing has happened over the summer because of Ramadan and holidays, so the accompanying Gantt chart - designed to plot progress against targets - is a complete fiction. The cynic might say that this is not dissimilar to the situation in the NHS and I confess that I am not unduly concerned because in spite of the cultural differences I still believe that I will change things.
Simple decisions like what to wear become important: I’m acutely aware of sensibilities and choose my clothes carefully for work. Knees and elbows should be covered and necklines should be very modest, so my lovely Italian dresses which would be perfect in this climate are entirely unsuitable. Air-conditioning is kept fiercely cold so a jacket or similar is necessary indoors.
Most of the indigenous women are dressed in the long black abaya, a robe-like dress accompanied by a scarf (shayla) that covers their hair. They glide along looking surprisingly elegant, particularly since they are all wearing expensive killer heels and carrying designer handbags. Some show their faces, often very beautiful with heavily made-up eyes, while others cover their faces completely, which is disconcerting and slightly spooky.
Doha is a cosmopolitan society. Western women in the hotels dress freely, and the Muslim women from other countries who merely cover their hair with coloured scarves look independent and modern. The men are dressed in traditional white robes and head-dress, but at the swimming pool they wear western casual clothes. At the hotel we see an extraordinary sight; a young family with the man in shorts, T-shirt and baseball cap, little girls in sweet polka-dot dresses and their mother completely covered from head to toe in black. I’ve already learned that there is a problem with vitamin D deficiency among the population generally but especially in the women.
I am finding it unnerving to see these apparently faceless women walking around but when in the Ladies yesterday, failing at washing my hands because I couldn’t work the taps, a woman threw back her veil to help me; she was young, smiled and we had a good non-spoken conversation.
At work, I am repeatedly told about the strong tribal ties in this region and the off-stage decisions that are made. Influence comes through the majilis, which are gatherings of the men in a family. Many are related to the Royal family and are therefore only a phone call away from the Emir. This makes any organisational structure difficult to maintain and also difficult to develop. It becomes a constant theme.
There is a learned helplessness exhibited by many of the staff - Arabs and other races alike. I am not an office worker by profession but even I could see that the filing system in the department was archaic, chaotic and plainly did not work. There were piles of papers scattered about the floor, which had to be navigated through in order to reach anyone’s desk.
“We need an electronic system, as paperless as possible,” I suggest.
“Oh yes, you are right,” replies Theresa, the Filipina office supervisor. “We have been saying that for years”.
“Great. So what have you done?”
“Well nothing. We are waiting for someone to tell us what we need.”
“But you know your systems. Can’t you put some ideas together?” I ask.
The answer is no. Self-determination as a concept is not an option.
Finance for big projects is not difficult to find, but minor bureaucracies abound and the rules of engagement are still very opaque. The city with its magnificent new buildings still feels like a frontier town on the edge of the desert. There are building works everywhere in the hospitals with some beautiful new courtyards under construction for the patients. Those that have been finished have fountains, flowers, and an atmosphere of peace and tranquillity.
However, people are very reluctant to go outside and I am constantly being offered cars to take me two hundred yards because of the heat, which - they say - is impossible to walk in. Or maybe people just don’t like walking. I do walk and they find me eccentric. They also worry that the air-conditioning in my office is not working because I refuse to walk into a cold blast from the intense heat outside. I keep it at a gentle level.
Small things tax my concentration, such as the fact that the calendar facility on Microsoft Outlook shows a working week from Monday to Friday and I am forced to fiddle around to make it read Sunday to Thursday. Even so, Monday feels like Tuesday and so on. The day is punctuated by the call to prayer and it is important when meeting people around midday that their need to pray is respected. They will not terminate the conversation, out of politeness, but will be uncomfortable.
I seem to be spending every second of the day observing, trying to understand and make sense of this new world.
Walking through the long hospital corridors, I am constantly greeted by strangers on the hospital staff with a respectful “Good morning” or even “Good morning, madam”, but these workers tend to be Filipino or Indian in origin. The traditionally dressed Arabs of either gender do not greet me and I confess to being wary of making eye contact, because of cultural sensitivities.
Living in five-star luxury sounds grand but can never be home. The food is excellent and the staff are charming, but we are keen to have our own place. The good news is that we’ve made progress on getting our Residence Permit. This is important for several reasons: it means that we can live independently, we can have debit and credit cards, we can get a licence to buy alcohol (and bacon, it is rumoured) but most importantly we will get our passports back with multi-exit visas. It is a very benign society but nevertheless there are restrictions such as needing permission to leave the country, unless you do something wrong, in which case you can be thrown out within twenty-four hours.
The weekend is very welcome and we are off to brunch in the hotel. We discover, when we turn up in shorts and T-shirts, that this is the social occasion of the week for ex-pats and is an opportunity for (amongst other delicacies) traditional Sunday lunch with a roast, Yorkshire pudding and all the trimmings, but also an excuse to dress up. The Western women are in high heels and silk dresses, the men in smart casual. We sneak off and change before reappearing in appropriate garb.
2. Learning the ropes
We decide that we really should learn a few words or phrases of Arabic. At Lionel’s Heart Hospital, only four of the fifteen-hundred staff are Westerners, so he really is in a foreign land. We investigate the possibility of lessons and his secretary Noora, who has wasta, is on the case. Wasta simply means that you know how to influence and get things done around here. This may be because you are from a prominent family or may simply be that you know everyone.
It is a fine example of a mixture of tacit knowledge, nepotism and good old-fashioned charm, to the right people of course. Noora has all of this and proudly announces that she has found us a brilliant teacher, a professor of Arabic at the university and we are honoured because he doesn’t usually teach English to people like us.
“How did you manage it?” we demand.
“The professor is my father,” she says with a wry smile.
We’ve no choice but to follow her through the chaotic evening traffic to his house. The noise of the road has gone and we find ourselves outside a splendid villa with a lemon grove adjacent to it. There she leads us through a gate in a high wall, to a haven of peace beyond.
We’re ushered into the house by a bevy of Filipina maids and the professor’s wife. Coffee and cakes are served before the great man makes his entrance. Although we are not hungry it would be rude to refuse the fig roll cakes, which are filled with crushed rose petals, fragrant and delicious.
Lionel has already picked up a few words of Arabic from
his drivers and is convinced we should not attempt to understand the writing but simply learn a few expressions with the correct pronunciation. So imagine our dismay when the professor sits between us at his dining table and proceeds to teach us to write the Arabic alphabet. At the same time he pronounces the letters and encourages us to speak. Unfortunately many of the letters sound the same, essentially a noise in the back of the throat that to the untutored ear sounds like someone attempting to be sick.
Well, we try. We make our dismal vomiting sounds, all of which are wrong, but at least we can copy the letters. Except that he isn’t happy with those either. We are, of course, writing from right to left and, because he is a classical Arabic scholar, he insists on showing us three different notations for each letter. I confess that I don’t understand but it is something about the name of the letter, its pronunciation and the way it is written within a word or sentence. He races through the letters and although Lionel is manfully keeping up, he loses me completely.
The experience is truly humiliating, akin to being a remedial child in kindergarten. Our next lesson is fixed and we dutifully do our homework, learning the letters as instructed and he tests us at the beginning of the session. We don’t do too badly but we still haven’t finished the alphabet so the first session’s process is repeated. We are both tired at the end of the day, the traffic has been dreadful on the journey there and although the professor is very kind, especially when he sees that I am close to tears with frustration, it is all too much.
We both realise that we were being overambitious so we manage to extricate ourselves from the arrangement without any loss of face on his part. In truth, we suspect he didn’t really want to teach us anyway and it is probably a relief to him also.
However, we did feel honoured to be allowed this fascinating glimpse into an Arab home. The rooms are large, with huge chandeliers, marble floors, heavy curtains and gold embellishments everywhere. I am reminded of extravagantly decorated baroque churches.
As we leave, his wife beckons to us.
“Come and see the garden,” she says.
We follow her into the warm night air where the scent from the lemon grove is intoxicating.
“The scent of those lemons is amazing,” I remark, whereupon she summons one of the maids.
“Pick a lemon for our guest,” she says, brusquely.
It’s an interesting culture where no one is expected to do anything for themselves if there is someone else available. During our lesson, Lionel had taken off his jacket so the professor assumed he was too hot and summoned a maid to turn up the air-conditioning. This onerous task involves pressing a button but would be far beneath the master of the household.
Things are no different in the hospital. Lionel has an Italian coffee machine in his office but an Arab guest looked up in horror, quite unable to cope when Lionel leapt out of his chair to make the coffee.
“Please, Dr Lionel,” he said, “sit and talk to me and get someone else to do that.”
When Arabic coffee is served, the ritual is to take a small half cup which is replenished by holding out the cup for more and when one has had enough then the cup is shaken from side to side. Incidentally, this Arab beverage does not taste of coffee but is delicious with a mix of spices, cardamom being the most prominent (unlike NHS coffee, which doesn’t taste of anything at all). Of course this ritual presumes that there is someone to stand in the corner of the room just in case anyone wants more coffee, while the conversation goes on around him.
We make a similar observation when we wander into an upholstery shop in the souq, where an elderly toothless Arab is sitting on a large cushion, talking on his mobile phone while an Indian man is squatting on the floor, busily reupholstering a chair. He looks like a skilled craftsman but he is summoned to go and find fabric swatches for us while the Arab owner chats to us in completely unintelligible broken English. Needless to say, we decide against trading with him, partly because he has no suitable fabric but also because communication would be impossible.
Because we need to travel around independently, we each hire a car. Lionel is worried for my safety and I’ve promised to behave myself. Road rage is a universal phenomenon, especially here where the men drive their cars as if they were riding camels - hard, fast and randomly. Driving in my rented car, I am hooted at by someone on my tail in the middle lane. There is nowhere to go but when it is safe I pull over into the inner lane whereupon he proceeds to cut in front of me.
Shaking my head and laughing at this appalling driving, I then realise that my response has been noticed by the bad driver who gesticulates wildly at me before turning off right in front of me. Idiot, I think (and other less polite expressions) but I am still laughing at the absurdity when he does a quick U-turn and drives at me at great speed before swerving away at the last minute.
No points for guessing that he is an Arab in full robes and head-dress driving a huge four-wheel-drive Land Cruiser complete with go-faster stripes. Lionel suggests, “I should think being laughed at by a western woman in a poxy little car was an affront to his manhood.”
Later, when in traffic today, the driver of a car in front opens his door and spits onto the road - a good footballer’s gob - I suppress my expression of disgust. It would seem that a serene expression is safest. Maybe that’s really why the women veil - so they can express their emotions with impunity.
But what about the working environment? For me, one of the best things about being a doctor is the patients. They keep me grounded and remind me why I embarked on this profession. However, I also realise that without good clinical systems, we fail to do the best for our patients. For example, I might suspect that a breast lump in a patient is cancerous but if I cannot do an ultrasound, take a biopsy and get the result to her quickly, then her life will be dreadful for a few weeks, whatever the outcome. Patients always say to me, “The waiting is the worst bit”.
My job in the UK was a combination of hands-on doctor, clinical leader/manager and educator. I would have relished the opportunity to treat patients in the multi-cultural setting of Qatar, but I am appointed to run the show. People ask me if I would do some clinics, report some CT scans, do some biopsies; but I decline. Why? It’s such a wrench to give up seeing patients and yet it is the right thing. I reason that if I have to be called to a meeting at short notice I’ll be expected to attend. Fine, but if I have a clinic then for me the patients would always come first. Would this be a conflict and would my new Qatari masters understand my viewpoint? I elect to give up direct patient contact. It is the right move.
I have to adjust to my new role in an alien environment. I know that being a doctor gives me kudos but I feel the need to use that advantage carefully lest I am judged as a mere administrator. As ever, shwai, shwai, slowly, slowly is my tactic.
This is how I started: without a clinical role it would be difficult to understand the hospital, so I have taken to wandering around the corridors just to get a feel for the place. It is very multicultural with different nationalities, languages, dress and very few Westerners among this mix. Certain nationalities appear to be assigned to particular staff groups. For example, my secretary, the wonderfully named Honeylet, is from the Philippines as are many of the secretarial staff and I hear them talking in their local tongue.
One of the senior secretaries in my patch, Abdulrahman, is Sudanese and he is very supportive of me, taking me personally to meet various awkward people such as the transport manager. Male secretaries and male clerical staff are common out here. They are usually from one of the Asian nations, never from Qatar and only rarely from Arab nations such as Sudan. It was the transport manager who approved my (very beaten-up) temporary loan car and he likes to see prospective drivers personally. He made no secret of the fact that he dislikes foreigners and embarked on a conversation on the Holy Book, the Holy Month and why fasting is important, before launching into a long diatribe
against colonialism.
He did manage to concede that as far as colonial masters went, the British were marginally better than the French, whereupon Abdulrahman replied staunchly that frankly his country wanted the British back to sort everything out. I was excluded from the conversation at this point until Tricky Transport Man turned to Abdulrahman and asked, referring to me, “So, can this doctor drive?”
I must have somehow passed muster because I was taken to my car personally by Tricky Transport Man, whereupon we both examined the car for bumps and scratches before I drove it away. It is an accepted fact that the bodywork on most cars will be less than pristine.
There are flower and chocolate shops in the hospitals. These are set out as stalls in the large concourses and sell extravagant displays of flowers, particularly in the maternity wing, where huge gifts of chocolates are also sold. These may be several feet high, with elaborate mosaics of foil-covered chocolates, mounted among glorious flowers. It is all rather wonderful if completely over the top.
A western friend observes that her aesthetic has been somewhat altered since living here and she finds herself looking at objects and thinking, “That needs a little gold rim!”
The hospital corridors and public areas are busy with white-coated doctors sweeping along in ward rounds, nurses wearing surgical scrubs and workmen - usually Indian - in blue overalls. Last Thursday in the afternoon I suddenly encountered dozens of workers clad in grey uniforms embroidered with the legend Domestic Staff, the women wearing identical headscarves tied at the back of the head. The women were talking animatedly in a language that sounded a little like Chinese: they looked Asian but I couldn’t pin their nationality down further. The men were a different race and judging from my conversations with the hotel domestic staff, I think they were Bangladeshi. There were literally hundreds of these people all moving towards a destination at the back of the hospital.
800 Days in Doha Page 2
