Sinta, The Indonesian Prisoner-Housemaid, Part One

When I first met Sinta, an Indonesian housemaid turned into a prisoner of a hospital room, her entire being had an effect on me that I'll never forget. Sinta's sincerity was so genuine it made her appear almost child-like in her trust of others. The kindness of her heart shone through the lovely but shy smile on her face. A smile that would light up the whole room and bring a special kind of glow to it. Sinta was one of the most approachable and accepting people I've ever met. She would make everyone feel at ease from the minute they'd meet.

This is the first part out of three of her story which I think is too long and too much to digest in one post.

Sinta's story of how she ended up living with "Mama Ameenah" in that tiny and murky hospital room was told to me by the Malaysian nurses on the ward. They and Sinta had become friends because they understood each others languages. Sinta spoke some Arabic too, but she was not fluent, nor was I when I first arrived in the Kingdom to work on a surgical ward.

Sinta had been in her late 20’s when she left to Saudi-Arabia’s capital Riyadh to work as a housemaid in a large Saudi household. She was from a tiny impoverished village, had no education and could barely read and write. She knew Arabic mostly from memorizing some Quran.

Sinta had a teenage daughter and a 9-year old son together with her husband, who by profession was a mechanic, but unable to find a job or support the family. They lived in severe poverty and something had to be done. It was Sinta who had decided she would go to the Saudi Kingdom to try and earn a living for the rest of her family as a housemaid. She'd heard it was good money, enough to send both her children to school, feed and clothe the kids, her husband and her own mother who lived with them in their small and humble house. Sinta had dreams. She wanted to ensure her daughter would be able to study and have a better life than she did and that her son would one day become a doctor. She was ready to sacrifice everything for their well-being.

Sinta's new family was a typical upper middle class Saudi family living in a large villa in Riyadh's suburbs with many family members under the same roof. Sinta’s main duty besides cleaning and cooking was to assist with the elderly mother who she affectionately called “Mama”. Her Mama was the sweetest woman and always treated Sinta with kindness and generosity. The rest of the family however did not share the same affectionate approach.

One of the sons with his family and a 40-year old spinster daughter lived in the same villa. When Sinta’s work with the Mama was done, the Mama's children took care that she didn’t get a moments rest in the day. Especially the daughter, who spent all her days sleeping in, shopping and gossiping until late at night, would take advantage of Sinta's kindness and hardworking attitude forcing Sinta to work until late at night serving her.
Sinta's duties would never end but she did not complain. She just said alhamdulillah (Thank God) for what I have! A big and house to live in, food to eat, a soft bed to sleep in and money to send home.

During the six years Sinta had worked in the household, the son, who was also her sponsor, had never allowed her to go for vacation to meet her family. Her passport had been taken away on arrival. Sinta had been out of the villa on a few occasions to go to the store with her Mama. She'd been given a mobile phone but was hardly ever able to use it because she had to charge it from her salary of 600 SAR a month. Despite her difficult situation and unfair treatment she remained grateful and hopeful, believing her employer's empty promises "soon you will get to go on vacation, just a few more months!".

Sinta never had a day off, she was made to work by the spinster daughter on Friday’s too. She laughed when she told me of the one and only time she'd been given the day off. Sinta had been sent to the son's second wife's villa 'to unwind'. In reality, she was made to clean there all day. But her Mama’s kindness and their friendship kept Sinta hopeful and patient that one day all her hard work would be rewarded.

Then one day her life changed forever. Sinta's Mama had been ill for a while, complaining of abdominal symptoms. She'd been accompanying the mother to various doctors appointments and procedures to try find out what was the problem. The doctors had finally decided to schedule a gastroscopy for her after the relatives had pushed and insisted upon it for months.

When the day of the procedure came, the Mama had been leaving to the hospital without Sinta which left her heart-broken from worry. She was due to return in the evening. Before the Mama left the house she had asked Sinta to prepare all her favorite foods, as she would be so hungry from the three days fast she was put on prior to the gastroscopy. She promised Sinta they would have a big party when she came back. Sinta had been very pleased and went in the kitchen to prepare.

In the afternoon the family was alerted from the hospital, their mother had been rushed to the ICU because of complications during the procedure. Her heart had stopped. She was now unconscious and connected to machines, the doctors were unsure if she'd ever wake up.

Sinta rushed to the hospital together with the rest of the family. Sinta was so shocked and terrified of the sight of her Mama, lying lifeless in a maze of tubes and loud machines she'd never even imagined could exist that she had fainted on the spot. In the meanwhile the sons had been extremely angry at the hospital staff asking how this could have happened, demanding to know the reason that lead to her state.

The doctors told the family she was brain-dead and paralyzed. Because of an allergic reaction during the procedure, the mother had had a major seizure which they were not able to control and it eventually lead to her heart stopping. They managed to revive her but she didn't gain consciousness.

The sons were outraged when they learned that their mother had been given a drug she was allergic to. Their mother's severe allergy to this particular drug was well known by everyone in the family and had been documented and labeled everywhere on her file and electronic patient records. Despite all these precautions the staff had administered the drug intravenously (into the bloodstream) with the devastating consequences.

The family was understandably horrified, devastated and outraged, after all this was supposedly the Middle-East's leading hospital, full of international expertise and the latest state of the art equipment. How could this have happened?! The family launched complaints, filed a medical error report against the hospital and they appealed their case with the Emir, after being rejected by the Ministry. They demanded financial compensation and for their mother to be taken care of in the same hospital for the rest of her life. The mother would require expensive medical equipment and around the clock medical care because of her state. All this was of course very expensive and required a medical professional's supervision.

Perhaps from their anger, the family could not think clearly what was best for their mother. Having her stay long-term in a hospital setting would expose her to multiple risks, some even life-threatening ones such as multiple drug resistant bacteria. Her care on the ward would cost hundreds of thousands of riyals daily. They wanted the hospital to pay for their disastrous mistake.

Eventually the administration of the hospital had to bend to the family's demand to admit their mother to a ward on the hospital permanently because of the cardinal error the hospital had made. Sinta was assigned to be their mother's private sitter, never leaving her side or the hospital. Sinta ate, slept, prayed and showered in the room over four years. She hardly came out of the small dark room and never left the ward. It would become like a prison cell to her.

"Mama Ameenah" lay in her bed motionless, with the same expression on her face. Her eyes were often open and at times it seemed as if she heard and understood the conversation, but there was never confirmation that it was true. Sinta didn't give up trying though. Sinta kept talking to her, relating to the daily events and played Quran tapes from her little recorder next to the bed. Since the hospital didn't provide any kind of rehabilitative care, this was the only stimulation the patient ever got.

Sinta took care of the Mama as if she were her own mother. I was amazed by how her spirit had not been broken despite her fate. I found her positive attitude and thankfulness remarkable. As I watched Sinta hold the Mama's hand, softly talking to her, I realized how this was something really special in a world full of cold and selfish people.

Part Two: My friendship with Sinta, planning for the future and her escape

Part Three: The world as Sinta knows it ends, Sinta's disappearance

Ramadan And Over-Crowding Hospitals In Saudi-Arabia

The Holy month of Ramadan changes the daily rhythm drastically in Saudi hospitals. Basically the hospital, just like the rest of the Kingdom of Saudi Arabia, becomes alive at night and quiets down for the day during the Muslim fasting month. Read more here on how the Saudis usually visit the sick at hospitals. 

Needless to say the amount of visitors during Ramadan will at least double, especially during the last ten days. Visitors will come late and stay until early morning which is allowed because of the changed visiting hours. Visitors will bring along vast amounts of arabic foods to break the fast with like sambosa, all kinds of tiny pastries, cookies, dates, chocolates..

Large Saudi families come to the hospital to join in Iftar together with the sick family member.  It's not uncommon to find the entire family eating with their hands, on the bedsheets spread out on the floors! Saudis will generously give the nurses a taste of everything, sometimes offering huge trays full of different sweets or salty snacks.

Another peculiar thing that happens during Ramadan is handing out money to nurses. Patient or relatives might slip Riyals into the nurses pocket or openly offer money anywhere from 10 to 1000 riyals at a time. The gesture usually makes nurses feel somewhat awkward and because of cultural differences might be misinterpreted to be some form of bribing. Nurses are naturally not supposed to accept the money very few will reject it every time especially because the person offering the money will become very upset if rejected and they can be extremely pushy and just stuff the pockets with the money. The reason behind this is Saudis wanting to give 'charity' and do good deeds during Ramadan and the families wanting to show their gratitude and appreciation to the nurse.

Only a few patients will be observing the Ramadan fast, and if they do, they will also abstain from all medications including injections and intravenous drugs during daylight hours. That makes it a bit difficult to accommodate the medication regime to the fasting timetables. Basically it means that the medications normally given around 8-9 am will be given at fast breaking time around 6:30 -7 pm. The next dose will be at midnight and finally just before the morning prayer at 4 am. This can cause problems with the efficiency of treatments with antibiotics and pain killers.

For some patients it's fine to fast (health-wise) and it will not make their condition worse. Every once in a while there will be a patient who insists on fasting even if doing so will severely adversely affect their health. The patients don't want to miss out on the blessings of fasting. Some are diabetic which means their blood sugar levels will be uncontrolled and it might put the patient in risk of coma, or they will refuse insulin injections resulting in sky-high blood sugar levels. Patients with bowel problems might get complications like obstructed bowel, liver patients may suffer irreversible consequences that may even need surgery and then there is the odd patient who will even refuse to be operated on.

Toward the end of Ramadan the emergency room usually begins to fill with patients suffering from bowel obstructions, liver coma, severe dehydration and so on. Many are elderly patients needing full time hospital care meaning that the hospital will be full to its maximum capacity and often patients are left to wait for an available bed in the EMS. Patients suffering from gastrointestinal diseases and disorders, diabetes, metabolic disorders and other diet controlled conditions further crowd the ER beds making it the busiest time of the year in the hospital. Nurses and doctors are often exhausted from the workload this month brings along.

The Muslim medical personnel will often opt to work night shifts to make fasting easier or alternatively if they wish to work days they can work shorter hours. The total amount of working hours during this month for Muslim nurses, doctors and other muslim personnel is also cut down. Generally there will not be any operations other than the most urgent ones.

The patients' sitters will all usually be fasting and the hospital kitchen provides food for them as well as the fasting patients in the early morning hours. A three course 'breakfast meal' called sohoor will be distributed at 2 am well before the Fajr prayer.

The iftar meal, complete with dates, laban (buttermilk), soup, vegetables, rice and meat, dessert and juice will be distributed to the rooms at 6 pm. Even if a patient is not fasting, they will usually be up all night chatting with relatives, reading Quran or watching Arabic soap operas or the live televised show from the grand mosque in Mecca. This makes the night shifts exceptionally busy and hectic while the day shifts are slow paced and quiet.

I personally enjoy working during Ramadan, patients and relatives are in good spirits and it's nice to spend some extra time with them in the rooms having some arabic coffee and sweets. Generally the atmosphere is more laid-back and patients are not complaining as much as usual :)

P.S this post is a revised edition of a previous Blue Abaya article about Ramadan in Saudi hospitals from 2010.

In Search Of The True Meaning Of Ramadan

Ramadan Mubarak to all Blue Abaya readers!
The following article was published in Saudi Gazette on Wednesday. I wrote the article because every year that I spend in Saudi Arabia during Ramadan, the more all the over consuming and madness is starting to bother me. The true, original meaning of Ramadan has been totally forgotten and it makes me feel really sad to see what is has become for some.

Most non-Muslims know this month as the time when Muslims abstain from food and drink during the daylight hours.  Before I came to KSA, admittedly, just like most non-Muslims living in western countries, I was pretty ignorant about Ramadan. I knew that this was the month when Muslims fasted from sunrise to sunset, but that was pretty much it. I had heard people saying 'them mohammedians' can eat only at night because Allah doesn't see in the dark or that Muslims need to fast only part of the day because they couldn't handle a week in row and other such nonsense. I remember wondering, what was the real reason behind the Muslim fast, but never bothered to find out the real answer. That is, until I came to the Magic Kingdom.

During my first Ramadan here I became very curious to find out more about this month as it all suddenly became much more of a reality to me. To my surprise, as Ramadan drew closer, my expat friends grew grumpier. "I hate Ramadan!" "Everything is closed, nobody is working" "Muslims skip work and leave all the work for us to do" "Whatever you do, don't stay in Saudi for Ramadan, it's just crazy" "they will arrest you if they see you drinking water during the day" etc etc etc. I did not hear a single positive comment about Ramadan. So naturally, I became somewhat weary of what Ramadan would bring along and started to dread the beginning of it along with all the other expats.

So Ramadan rolled along and the entire hospital turned upside down. Read here what Ramadan is like in a Saudi hospital. Patients ate at the strangest hours, visitors came and went in the middle of the night, Muslim working hours were cut, some Muslim employees would disappear in the middle of shifts, medicine regimes had to be changed and fasting patients could not even be administered intravenous medicines during daytime. It was all very confusing.

Despite all the weird schedule changes, I could not help noticing other changes too. There was a remarkable sense of unity, cheerfulness and a feeling of high spirits among my Muslim colleagues. The patients, if possible, became even more welcoming, friendly, and hospitable. There was a sense of elation in the air that I could not quite put my finger on, but it made me even more curious.

One day I watched all the ward clerks praying together with some nurses and doctors in the staff room where I was doing charting. I finally mustered up the confidence to ask about Ramadan, despite the fact that they were all Saudi males and I felt a little intimidated to approach them on this matter. I remember simply asking "why do you fast during Ramadan?"

I was blown away by the reply. Looking back, the way one of the men explained it to me in such a nice and respectable way was commendable, despite my seemingly super ignorant question.

He told me: "We fast to remember all those people who cannot eat and drink daily. We fast to feel their suffering, to remind ourselves of how blessed we are to have food and water. "

"We fast to feel those same pangs of hunger that our poor sisters and brothers feel daily around the world."

"We fast to become more generous, to practise self-discipline and to strive to become better Muslims and people."

His words had a profound impact on me. Somehow I had failed to see the true meaning of the fast. I started to look at it from an entirely different perspective.

I came to realize, that in reality, Ramadan is so much more than just abstaining from food and drink during the daylight hours. Basically, Muslims are supposed to abstain from all harmful acts as much as possible and concentrate on becoming a better person and Muslim. Everyone can set their own goals for Ramadan according to their life situation and abilities. While one person struggles to quit smoking, another might set as a goal to read the entire Quran during Ramadan. Some might plan to pray extra prayers every day, donate to charity or memorize a new Surah from the Quran.

So I learned from my Muslim colleagues that Ramadan is also about remembering our Creator, reading the Quran, which was sent down during the month of Ramadan, doing good deeds (out of a sincere wish to do them, not by habit or force), being kind to others, giving out Dawah (teaching, not preaching non-Muslims about Islam) and remembering the poor and the less fortunate. Ramadan is about being humble, modest and abstaining not only from food, but from extravagance, over-consuming, spending, wasting food, money and resources.

Sadly, what I see today is very disturbing in that many people in Saudi Arabia are doing the exact opposite. The true purpose has been long lost and forgotten. I see people stocking up on food and spending on groceries like crazy, cooking and baking like there is no tomorrow. Women are spending their days in the kitchen instead of focusing on their religion; some out of their own will or perhaps out of learned habit and routine, some by demands from husband and even peer pressure.

When time comes for iftar, people indulge in extravagant meals and then lay around all evening snacking on deep fried, highly sweetened and unhealthy foods, watching Arabic soap operas on TV, gossiping with friends and staying up all night. Many go to shopping malls which are now open until the early morning hours for mindless shopping. Some even force their kids to stay up late or wake them in the middle of the night so that the parents don't have to get up early with them! The next day they sleep until the evening until it all starts over again at sunset.

The Prophet Muhammed (pbuh) taught Muslims by example to break the fast with simply dates and water and eat a light meal later. Pray Tawareeh prayers, then go to sleep as one normally would, get up early for night prayers and suhoor (breakfast) and go about the day working and doing things that one would normally do.

Let's not forget the true meaning of Ramadan, its purpose, and all the blessings of this month.
Break those unhealthy and binding routines and habits.

Make your Ramadan beneficial, not superficial!

Exotic Paradox: Expats Blog In Saudi Arabia

The following is an excerpt from an article published in Newsline November 2012 issue. Journalist Naima Rashid writes about the three most popular expat blogs written by foreign wives to Saudis; American Bedu, Susie of Arabia and Blue Abaya. She talks about what all these blogs have in common, and how they offer a unique perspective and window into the Saudi culture.The entire article can be read on Newsline and for Blue Abaya readers here's a extract of the article and the Blue Abaya part itself.

Exotic paradox: Expats Blog in Saudi Arabia

"For several reasons, the Saudi culture is impenetrable to the outsider. An almost sacred guardianship of private space makes access to it pretty near impossible. A large part of life in Saudi Arabia takes place indoors or in metaphorical ‘chambers’ accessible only to insiders. "

"A curious axis around which are clustered three of the most interesting blogs is matrimony. Foreign wives married to Saudis have long held the banner high for cultural chronicling in the form of blogs. Their initiative created a niche in a territory that was virgin when they started, but which has since thrived. The best known among them come from cultures diametrically opposed to the Saudi culture,  namely American and Finnish. "

"These blogs go by names seeped in a charge of orientalism that comes from juxtaposing evocations of opposite cultures and to some extent, a sense of free-spiritedness and rebellion (‘American Bedu’, ‘Susie’s Big Adventure: An American woman moves to Saudi Arabia’, ‘Blue Abbaya: A Scandinavian Princess in the Magic Kingdom’). "

"...the authors, coming from Western cultures and a background in Western education, bring a natural ease of expression, documentary zest, outspokenness and an analytical bent of mind to bear upon the superset of their experiences in Saudi Arabia. Being married to Saudis, they have a direct canal to the culture they are tackling through the deep end – direct immersion. Where their clarity of observation, their willing embrace of a foreign culture, and the amusing contrasts between an Eastern and a Western culture meet, a thing of great value and beauty is created."

 "The third blog in the trio is called Blue Abbaya. Much younger than the other two, Laylah, in her early thirties,  is a Finnish nurse married to a Saudi, living in Riyadh and blogging since 2009. Susie and Carol have openly divulged their identity, but Laylah blogs with more discretion, and while her blog is all about Saudi culture through the prism of her personal experiences, she doesn’t always divulge her personal coordinates as openly."

"Her blog has a more distinct character than the other two, and her writing, detailed and diary-like. She has a very strong personality that comes across quite forcefully in her writings – witty, unforgiving in her sarcasm, sharp in her observations but aggressively positive in her conclusions. Between her spirit of forward motion, and her signature bite is the spice that marks her writing."

"Reading her blog, one traverses two regions equally mysterious to many – Finland and Saudi Arabia, and her blog pierces the mystery of both lands to offer us a window into both cultures through the eyes of somebody who embodies them both to some extent.

After surviving the tragic-comical challenge of a wedding à la Saoudienne, it’s been a mildly bumpy ride, to say the least, but her Finnish hardiness has helped her keep her feet firmly on the ground. Some unavoidable, amusing and enlightening comparisons between the Finnish and the Saudi way of life, whether they emerged unconsciously as survival tactics, or as a conscious reflection about the cultural polarity she embodies, make for some delightful traipsing for the culture vulture. 

Scandinavian ice and deserts of Arabia are physical reliefs, but like all environment, they become landscapes of the mind at some point. In ‘Blue Abbaya’, blue is the colour of the Finnish sky, and the abbaya is a cultural norm of Saudi Arabia. In its name and its nature, the blog is defined by the richly opposed but co-existing worlds that the author is part of, and the best and worst of which peppers her real and virtual space."

"In one post that went on to become a hot favourite, Laylah is choosing her make-up style for a wedding. Before she concludes upon an understated European look, she runs her readers through some popular make-up styles, naming each one with her characteristic sly wit. The list includes the poison-ivy look, the Herpes look, the raccoon look, the peacock look, the angry owl look, the Boy George look, the spider look and last but not the least, the measles look!

As a general rule, nurses are great people to gossip with in Saudi Arabia. The nature of their work and the sheer range of exposure across all social classes that they have access to in the course of a working day make them great story-tellers. Perhaps, the best stories they have to narrate are those relating to royalty and its pomp and decorum  as they have witnessed in the corridors of the VIP wings in hospitals.

 Some of Laylah’s most delicious anecdotes are about royalty and set in the King Faisal Hospital, Riyadh, where she works. ‘The Princess and the Pimple’ is a tale about a spoilt princess who wakes up one morning with a pimple on her face and throws a tantrum, as a result, her pimple is treated with more protocol than other human lives. 

‘The Royal Morgue’ is an unforgettable Chekhovian sketch of what happens when a member of the royal family is deceased in a hospital, the image of princesses in expensive abbayas and smelling of high-priced attars accumulating like ravens around the body of the deceased and the nurses hiding in the corridors and making themselves scarce for fear of offending anyone from the royal family.

Unsurprisingly then, the most colourful  yarns in Saudi Arabia, the most informative as well as the most entertaining, and the ones that rip open its cultural core, lie beyond the bland prose of newspapers, beyond the country’s few bookshops and television channels, along yet another diagonal axis."
-
        -  Naima Rashid


Published in Newsline, November issue.

Welcome To The World Little Prince!

We were blessed with a healthy baby boy a week ago. Everything went well with the labor this time and we had a beautiful all natural birth experience. I could not have done it without the support of my husband! It was the most amazing experience of my life. We are so proud of our little peanut. His birth weight was 4 kg and he was 53 cm long like a Viking!

The little man is keeping us very busy and eating non-stop so I will probably not be able to blog much in the near future from this milk monsters demands :)

The hospital we went to is a large private hospital in the center of Riyadh. The reason we went there was actually to be able to do the labor with a western midwife, not a doctor and thus have a better chance for a more natural birthing experience. Because my first delivery ended up in an emergency cesarean section also here in Riyadh, we were hopeful to have a VBAC this time. I had been told by all the obgynes I had seen (there were over 15 in different hospitals) for the entire nine months that this would be practically impossible. These physicians only discouraged me and pushed me for another c-section that I had lost most hope to actually succeed in avoiding another c-section.

Birthing in Saudi has become such a business it's actually sad to see how far people have gone. Many if not most of women going to private hospitals are now opting for elective c-sections. Having experienced both a natural birth and a c-section, I cannot fathom how anyone would choose to have the surgery. It is simply a nightmare to recover from and is a huge risk as surgery always is both to the mothers and the babies. The c-section rate in Saudi-Arabia is very high, one of the highest in the world.

All this laboring business has somehow become about making the delivery most convenient for the mothers (although I still don't see how major abdominal surgery would be convenient for anyone). Nothing about child birth seems to be natural anymore, it's all about getting the baby out as "easy" as possible with least damage down there to the woman and then after the birth going overboard and showing off. Many Saudi women are so concerned that their husbands would take a second wife if they get damaged from childbirth and this is even openly discussed among women here which came as a surprise to me.

I was shocked how the hospital was offering all sorts of "vanity" services to mothers who have just delivered, as if the baby itself is secondary importance. Most important thing here seems to be looks. The hospital catalog was more like a five star hotel directory. The services on offer tell a lot about the priorities of women giving birth nowadays.

Where are the breast feeding support services and lactation consultants? How about nutrition and exercise support and advice? Which of these services actually support bonding of a healthy mother and a baby? The sad truth is breast feeding is not at all encouraged and all newborns will be offered formula from day one unless the parents specifically refuse it. Infants will spend most of their time in the nursery where nurses change diapers and give formula, then bring the tightly swaddled babies to the rooms for viewing.

We were told by the pediatrician that our baby was in fact starving and NEEDED formula. Unbelievable. How did the human race survive I wonder? And for the record our baby has gained 200 grams in just six days on breastmilk only, despite the fact that infants normally LOOSE weight for the first two weeks.

Only in Saudi? In room maids and private nurses so that mothers don't have to "lift a finger".

The most shocking service to me was the piercing of the newborn babies ears. In my country it's simply not common at all and girls get ears pierced at the around the same time they would start doing other "beautification" such as wearing make-up. So to me piercing a babies ears has always been strange but I understand that it's a cultural thing. To do it on the first days..and while the baby is sleeping? As if they want to say it will not wake up to this? Quite frankly in Finland this would be categorized as child abuse.

I'm all for women being able to look and feel beautiful after delivery and it surely makes us feel better after all those 9 months of feeling bloated and what else..But maybe this is going a bit overboard..This is not Oscar night, it's a special time with your baby..

The price of this service is mind blowing. 5200SAR for room decorations! For the love of God I don't see the point. Even if you swim in money, it's just too much. I would like to see how the beds are decorated with crystals and lights though, it must look like a spaceship.

And after they are done entertaining the guests for a good 4-6 days..How to get all this stuff out of the hospital?? Answer: Hire a TRUCK.

My husband had ordered these balloons for me. Now in Finland people would probably laugh their butts off if they saw someone bring all these balloons to the hospital, but in Saudi these are actually quite modest.

And now I'm off to feed our little prince again!

How I Met My Saudi Prince

Exactly four years ago my shift at the Saudi hospital had started out like any other night. The allocated patients kept me busy and life seemed to be rolling on as usual. Little did I know that night would change my life for good.

I was thankful to have my friend "Katherine" working on the same shift, it was always a relief having another westerner and English speaking person to talk to during the night shift. We had again agreed to exchange our patients over to each other to enable a break in the middle of the shift.

The moment that would change my life happened very randomly. I was looking for Katherine to ask her which coffee she wanted from Starbuck's. It was my turn to fetch that night's caffeine dose and I was on my way down to the coffee shop. I saw her nurse presence light on in one room and decided to pop my head in quickly.

As I peaked in, Katherine was chatting inside with the patient and his relative. The Euro Cup football match was playing loudly on TV. She excitedly motioned me to enter the room further so curiously I did, at the same time asking what her Starbucks order was going to be.

As I glanced at the patient sitting there on his bed, something strange happened. As if time had stopped, like a missing piece had fallen into its place. A handsome young man looked back at me, equally baffled by the moment. For just a few seconds our eyes met and then both of us shyly looked away. I greeted the men with salaams and smiled. They replied back politely, not even looking at me for long but eyeing the floor or the TV. I had learned by now this was a sign of respect, not disrespect as my own culture would tell me. They did not want to make me feel awkward.

I felt a rush of blood going to my head, I was blushing now. Oh how I hated when that happened! I wanted to leave, but then I felt a certain curiosity of this man who I thought was probably one of the most handsome men I had ever laid eyes on. He had a certain sparkle in his eyes that intrigued me and his smile seemed to light up the room. I didn't want to leave anymore.

I lingered for a moment, asking about the game on TV. The truth is I knew nothing about football, the only thing I cared about was the Italian football team, for other reasons than their skills. He made a joke about the Italians and we all laughed. I told him I was rooting for Italy and more jokes were thrown around. Secretly I was thinking to myself how the patient actually reminded me of an Italian football player with his long black hair brushed up in a ponytail and his smiling dark chocolate eyes.

When I couldn't think of any more excuses to stay in the room I left to fetch the coffee. I kept thinking about the patient and wanted to ask Katherine about him. I felt drawn to go talk to him more. Later that night my chance came when Katherine and I swapped patients for her break.

Katherine had informed her patients she was leaving for an hour and meanwhile nurse "Layla from Finland" would be taking over. As she was leaving she teased me, "he will call you for sure, something tells me he wants to see you again. When you walked into the room it was like something made a "click" sound! I swear I could hear it!"

About five minutes after she left, the call bell rang. Room 42. It's him! I was nervous to enter and felt my heart racing. The young man asked if he could get a pain killer. Sure, I said and left to check his files. When I returned he thanked me for the medicine and shyly asked a few questions about me.

I was amazed how it felt so easy to talk to him, his English was perfect and I forgot he was even Saudi. It was as if we already knew each other somehow. It became apparent that we had actually lived in the same area in the U.S as kids. What a coincidence! We talked about Finland and at some point I mentioned how we have so many moose there but I couldn't remember how to say the plural. What was it, perhaps mooses? He laughed and told me it must be meese! To this day I remember that silly joke and how it made us both laugh so hard.  His smile filled my heart with joy.

Thinking back to that day and where I was in my life I realize how fortunate I was meeting this remarkable man. From that night shift, it has been a long, sometimes extremely hard but rewarding journey to where we are now. We have had to overcome so many obstacles on the way. No one believed in us in the beginning, except us.

Never in a million years did I think something like this would happen to me when I landed on Saudi soil. When I left Finland for Saudi people used to taunt me, you will find a Saudi Prince there, fall in love and stay forever! I told them, in your dreams only! I guess sometimes fairy tales do come true.

The Royal Morgue

People often ask me how is it to work with the members of the Saudi royal family, what are the Princes and Princesses like? To put it short, they are just like any of us, but with some financial and social benefits :)
I wanted to share this interesting incident that once happened to me at work.
The Saudi royal family is huge, estimated to consist of around 15,000-20,000 members. The royals have their own specific services in some of the Saudi hospitals, read more about them here: http://blueabaya.blogspot.com/2010/10/saudi-arabia-and-vip-patients.html

Although they're not designated to accommodate the Saudi royal family, there are the occasional royal patients admitted on the regular wards. Many of them actually request to be assigned a bed on these wards to be under the specific medical service rather than the VIP service, thus getting care more specific to their condition, not status. That and some want to avoid the VIP ward like the plague because of rumors within the extensive royal family. A patient will have many visitors and the other royals will recognize which family it is and there will be talk.

So the incident happened when I was relatively new to the Kingdom and not fully familiar with all the VIP protocols and hassles. It was a regular night shift until the charge nurse received a phone call for an admission from the ICU. I heard her screaming on the phone informing them we didn't have empty beds, then shaking her head in disbelief and putting the phone down. The other Asian nurses gathered at the nursing station starting to speak loudly in Malay and Tagalog. Since I had noticed this was common occurrence I thought nothing of it.

After a while the admission was to arrive and I saw some nurses getting a room ready. They had transferred one patient onto another ward to empty the room. I was busy with my own patients and because I was not the nurse allocated to receive the new patient, continued to ignore the racket the Asian nurses were causing over the transfer. I was the only western nurse on duty and they usually didn't bother to tell me what was going on so I thought it was insignificant.

When the patient finally arrived from the ICU on her bed suddenly all the other nurses, including the charge and the allocated nurse suddenly disappeared like samboosas on Ramadan. I saw the western ICU nurse pushing the bed with some five male relatives. The patient was totally covered with a white sheet, which is normal in Saudi for the female patients. When they get transferred on their beds around the hospital, for privacy reasons they pull the white sheets on top of the whole patient resulting in a going to the morgue-look.

So as the only nurse around I received them with a friendly greeting and directed them to the room. Next we had to transfer the patient to the ward bed. We turned the patient and placed the sliding board underneath pulling her to the other bed. I thought it was odd they still hadn't wanted to remove the covers, but had gotten accustomed to seeing all sorts of things and again thought nothing of it. I took notice of the pristine white crisp thobes and strong perfumes the men were wearing and assumed they were of upper class status.

Next the male relatives started to fuss about the A/C. The most common immediate complaint the patients have when they come to the rooms is the air conditioning is too COLD. Saudis are afraid the cold air will worsen all illnesses. So I assured them I would adjust it to make it at hot as possible. The looks on their faces were as if I'd said something to the likes of " I will give the patient heroine".

The oldest one replied now clearly upset in English, "no we want cold! And bring ice! We need lots of ice." I informed them of the ice machine we had in the patient kitchen which they could use freely. The men looked at each other and I got a feeling they weren't liking my services so I excused myself and left the room.

I had the patients file now in my hands but did not have time to look at her details, rather I wanted to find the allocated nurse to hand over the file to but she was nowhere to be found. Next a myriad of black clad women started entering the ward. They were all dressed in designer abayas, wearing high heels and had covered their whole heads with the ends of their shaylas (scarves) thrown over the faces. The smell of expensive bohkoor and perfumes filled the ward. I felt a sense of curiosity now and checked the patient name. Al-Saud. And the two names before that made me gulp.

Now it started to make sense why all the Asian nurses had vanished and were still hiding in the patient rooms. I was still the sole nurse visible on the ward, standing like a statue now at the nursing station not knowing what to do. The female relatives asked for the room number and inquired what would happen. Some were weeping frantically and waving their hands in the air chanting something I assumed were prayers. Others were being walked by two Ethiopian maids on each side. One needed a wheelchair. I had seen all the drama Saudi women could create but nothing to this scale before.

Finally the frightened charge nurse emerged from her hiding place. I asked her what was going on and the whole insane truth was revealed. The patient was indeed a royal Princess. As a matter of fact, she was also deceased. They had just admitted a dead body. I had unknowingly been transferring a deceased royal Princess. I gasped at the thought of not only handling a dead body like one that was alive and thought back at everything I had told the relatives. Why didn't the nurses inform me? It seemed I was the last to know again.

Naturally in Saudi like all other hospitals around the world, the deceased patient will be washed and prepared and then transferred to the morgue. According to Islam the body should be buried as soon as possible and any decaying of the body should be avoided. The process in Saudi is very swift compared to what we are used to in the west, where the bodies might be in the morgues weeks at a time for example. Very seldom are autopsies carried out in Saudi-Arabia. Once the patient dies, the families take it as a decree from Allah and the reason of death to them becomes insignificant, unless they suspect a gross violation from medical staff which is extremely rare (that they would suspect or care).

So why was the dead body of a royal Princess occupying one the beds on our ward, not the morgue, or the VIP ward which has huge rooms complete with separate guest rooms? Well the reason is simply that is what the family wanted and because of their status, they could make it happen. They wanted for all the relatives and especially the King to be able to say goodbye to her before she was taken away, and the morgue would not be a place fit for a Princess as high as her. How could the royal relatives visit the morgue anyway?

So ice was brought in by the truckloads, the AC was adjusted, gigantic flower arrangements and golden chairs fit for Princesses to sit on were brought in from the VIP ward and when there was no space left inside the room, the hallway leading to the room was lined with them. Expensive bokhoor was burned in the room (it is forbidden normally) and the "royal morgue" was up and running.
Relatives kept coming in and out causing quite a lot of confusion in the other patients. There was hysterical crying in the hallways, maids coming in with trays of chocolates, pastries and other foods serving Arabic coffee from the intricate golden dallahs, drivers and guards were hanging around the hallways.

One of the younger princesses couldn't handle the stress and Her Highness was brought to me to measure her blood pressure. I took the moaning and groaning princess to sit in a quiet area and took the readings. They were slightly elevated but nothing to worry about, I said. The male relative strongly disagreed and demanded to see a cardiologist at once. He ordered me to give blood pressure medication on the spot.

I tried to explain to him how first of all since the woman was young and not on any medications I could not just go and get a blood pressure medication randomly, and second there are maybe hundreds of medications and doses to choose from and third, I could not even get it out of the machine without a doctors orders and her being listed as a patient on this ward, and fourth no doctor would even prescribe to her any medication based on these readings. I told him it's best we let her sit for a while and drink some water and try to relax, she will be just fine. He was clearly upset at what I had suggested and acted as if the woman was going to have a heart attack.

But as is common with demanding Saudi patients my explanations were not good enough and so I was forced to call the cardiologist who in turn had to come from the cardiac surgery unit down to the floor. He was extremely angry at me for calling him, even if for a royal princess. When he saw the readings which were by now even better, he simply laughed and left. The male relative (could've been her husband, brother, father or grandfather you never know here) was upset at the lack of service and took the faint princess elsewhere. I was relieved.

It was now nearing Fajr prayer time and the worst traffic to the newly established morgue had quieted down. The Asian staff were all mostly hiding in the staff room or patients rooms, trying to avoid any contact with the royal family in fear of saying or doing something to upset anyone and as a consequence, loosing their jobs.

There was still no word when the King would make his appearance to say his farewells. There were guards placed on all the entrances and all of the staff was anxiously awaiting his arrival. I was actually excited to have the opportunity to at least see him.

By the time night shift was over the ward had started to have a distinct deathly smell to it. Especially around the room turned morgue the stench was getting almost unbearable despite all the bokhoor and flowers. To my diappoinment I never got the chance to meet the King.
Eventually the King had arrived for a quick visit that afternoon and only after that was the body taken to the cemetery for burial.

This is one of the stories from the hospital I will never forget. And it could only happen in the Magic Kingdom!

Saudi Hospitals, Bureaucracy And Bullying

A colleague I used to work with recently asked me, don't I miss work? My first reaction was yes in a way I do miss it. I miss the patients mostly. I miss interaction with them and the opportunity of meeting so many different Saudis from all levels of society and learning about the culture and customs. Especially I miss having the Bedus as patients and seeing those smiles on the pediatric patients faces.
Read more about quirky bedouin patients here: :http://blueabaya.blogspot.com/2010/06/bedouins-as-patients.html
And more about why I love working with Saudi patients here: http://blueabaya.blogspot.com/2010/11/thank-you-my-dear-saudi-patients.html
Learn about the amazing Saudi hospitality I experienced with patients here: http://blueabaya.blogspot.com/2011/12/saudi-hospitality.html

Patient care was always the best part of the job. Naturally I miss some co-workers as well. Many, many awesome people from all over the world I was lucky to meet along the way. I made some great friends and found many like-minded people during the years. I miss the social aspect of work and of course the extra money, who wouldn't!

What I don't miss in particular however is the bureaucratic nature of the hospital. Everything is just so DIFFICULT. Things don't work anything near to how they do in the west although the hospitals claim to be run by the American model. This is 100% a Saudi model complete with a mix of discrimination against sex and nationality, pecking orders, red tape, complicated policies, gross incompetence, random unfairness, cosmetic campaigns, some unprofessional management and so forth.

I don't miss that one bit. If I could just interact with the patients and not have to deal with the rest of the load, I would be running back. But in the end I think, is it worth the stress and hassle? At the moment I feel it isn't but I might change my mind in the future, who knows.

Let me give you an example of making simple things complex. Say I have a patient complaining of headache on night shift. I assess her pain and want to give her a mild pain reliever. What I would do in Finland:  Go check her computer file for any allergies, previous medications, current medications and illnesses, then proceed to medicine cabinet, open it with the keys I have to get the pain relief of my choice based on my education, knowledge and experience and then go give it to her and document it. Taking about 3 minutes in total.

For comparison lets look at how this simple procedure in Saudi-Arabia turns into something so complex and frustrating it will have you pulling your hair out in no time. Same scenario, patient with headache. I go check her file in the automated medicine dispensing system called PYXIS and find she doesn't have a pain killer on her list of approved medicines. Then I go to her paper files to double check if there's any written orders by the physician for a Tylenol (also known as paracetamol, the only drug a physician in a Saudi hospital will write as telephone order) that has been missed by previous nurse. No luck.

Next I have to page the correct doctor. I need to check which team my patient is under and find out who is the on call doctor. If I'm lucky I find it relatively quickly but it might be under a service i'm not familiar with and I will have to do a computer search. I page the number and wait for a reply. If I'm lucky he might actually call back within minutes. According to policy I have to wait 10 minutes. The time goes by and I call again, no reply. Another 10 minutes and finally a reply, the doctor was busy (in some cases, he was sleeping).

Next I have to explain to the doctor the whole history and current condition of this patient just to get this simple medication that anyone can purchase by the truckload at any Saudi pharmacy no questions asked. He finally gives the telephone order and I write it down in the file. Another nurse has to come sign it with me as a witness. The order is STAT meaning the pharmacy should prioritize and activate it right away.

Next I have to fax the order to the pharmacy. The pharmacy staff may or may not be helpful. Usually the latter. I wait for a while next to the machine tapping my fingers on it and then decide to log in to check if the pharmacy has activated the medicine in the machine yet (nothing comes out of this machine without it being on the patients list, not even hand cream). Naturally sometimes nurses take the same drug out under other patients files but this is not the correct way to do it.

Meanwhile the patient has rang the call bell every three minutes. Because I didn't have time to go to their room and none of the Asian colleagues sitting nearby gossiping in their own language are offering help to resolve the issue, the angry relatives have now ventured out of the room to the hallway demanding for pain relief. I have a reassuring conversation trying to explain the procedure to the shouting male relative and they may or may not calm down and go back to the room.

After waiting another 10 minutes I call the pharmacy and in the most polite way possible (knowing the night shift person is usually in the worst of moods) remind him of the missing STAT order. He goes nuts on me and slams the phone on my ear. I take a deep breath and go back to the machine. Someone is using it so I have to wait until they finish. The relative is breathing down my back looking at me like I'm the most incompetent, lazy nurse in the world.

Finally I get the medicine out and can go give it to the poor patient who has had to wait in the worst case scenario for over an hour for this basic medicine. For nurses the priority is always the patient and their well-being and not being able to help because of these silly limitations imposed on the nurses is very annoying.

The nurses in Saudi hospitals are treated as incompetent, unreliable and uneducated staff. Mere maids sometimes. At least this is how the western nurses often feel about it because they are used to something very different. The lack of independence in the nursing field is the single most maddening and frustrating factor for most western nurses here. It comes up in every aspect of a nurses work in Saudi, not just giving medications, but everything. A nurse has to have doctors orders to give water to the patient after surgery, sometimes to change her position or get her out of bed, or even for applying skin moisturizer (no joke people!) Sometimes it feels as if our whole education was a just waste of time.

So as we were chatting with this colleague she told me how things are still the exact same on the ward. The same problems still exist despite a cosmetic attempt to correct some issues. Such as the bullying. This is not only a problem specific to the ward I worked on, but this particular organization as a whole and in fact the entire Saudi-Arabia wherever there are mixes of nationalities.

The reasons behind the bullying problem are complex but ultimately it has to do with human nature and psychology. Regardless of our backgrounds, religion or nationalities, humans will start acting in certain ways and displaying negative behaviors if placed under certain circumstances. When one nationality is paid 10x less for the same job than another just based on their passport color, problems will arise. When the majority of the staff are of the lower paid nationalities and there are only a small minority of personnel getting the significantly fatter paycheck, more problems arise. If management is under-educated and lacks skills to deal with workplace violence, more issues arise. If the organization and system favors bullies and allows them to easily climb the ladder to higher positions, obviously the problems worsen. And when there are no set rules or policies against bullying, the problem not only persists, but gets worse by time.
This is the sad equation in many Saudi work places, particularly hospitals where people work under extremely stressful circumstances.

The typical Saudi way of doing things at the workplace is having things appear as if something is being done, but in reality it was just for show. Posters, campaigns and workshops against bullying can be issued to make it seem as if the problem has been dealt with. Behind the scenes however if a victim of bullying steps out, or someone exposes the problem or dares talk about it, he or she will in fact be facing denial or brushing off of the issue from most of the management. In other words problems are best swept under the carpet and the people who speak out better silenced.

Now this is typical for most workplaces around the world, bullying will always be a problem and management usually won't know how to or want to deal with it. In Saudi-Arabia the issues however become more severe and the victims more vulnerable. For one the staff is mostly a mix of expats, all or most far from the support of their families, working in a land with strange culture and customs, perhaps suffering from culture shock. They work under pressure to perform and sometimes using a foreign language. The mix of nationalities can be rewarding in many ways but it can also back fire if there's a significant imbalance and one nationality feels spite for another because of the differences in treatment and salaries.

I could go on about this problem but I will leave that to another post.

So after talking to my colleague and thinking it over, I don't miss the hospital and the problems that lie within it but I DO miss the patients!