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.

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!

Saudi Salary Racism

In a previous post I wrote about the workplace bullying problem in Saudi-Arabia. It was mentioned how the salary disparity between different nationalities is at least partly to blame for this unfortunate phenomenon. Read that post here: http://www.blueabaya.blogspot.fi/2012/05/saudi-hospitals-bureaucracy-and.html

The wage system in Saudi-Arabia is completely based on color of the employees passport. This goes for all companies hiring foreign staff. My experience is from the nursing field so I will talk more about that specifically.
In most countries the nursing salaries are seen as too low compared to the education level and the actual job responsibilities and duties. The salaries will however usually increase as the nurse gets more experience and training over the years. In Saudi-Arabia on the other hand the staff nurse with only two years working experience and the one with 30 years experience plus additional training earn the same. There are no age or experience benefits and specializing in a field will only slightly increase the salary.

The only determining factor for the salary is the passport with which the employee is applying for the job. In fact, not even nationality matters.
Take for example an Indian national who worked in Great Britain and obtained a British passport and dual nationality. He will naturally apply to work in Saudi with the British passport because of the much fatter paycheck.
Some Asians (particularly Filipinos) knowing this, travel to Canada just to get the passport. It's the easiest country to obtain a passport from in just a few years. The expats then relocate to the Middle East, applying for the job as Canadians, this way multiplying their earnings.

To illustrate the gross salary disparity, I drew up a totally fictional salary table of nurses working in Saudi-Arabia. This table is in no way based on any official documents whatsoever and is completely made-up. I honestly don't even have the specific amounts in my knowledge. I have however during the years come to hear people talking about their salary and other's salaries and even seen some pay slips that had been left laying around in the staff room accidentally (or purposely?) to have a very generalized idea about it. There's plenty of info available online too.
Salaries of course vary from one hospital to another and there is a difference between private hospitals and government owned, with the latter paying higher salaries.

Passport                                  Basic salary per month Saudi riyals
Indian                                      2500
Filipino                                    3500
South African                          7000
Malaysian                                8000
Arabs (Lebanon, Jordan etc)   10000
Saudi                                      11000
European (British,German etc)16000
American (Canada,Australia)  18000

So basically the lowest paid are the Asian passport holders and highest salary goes to U.S. and Canadian passport holders. This system is said to be based on the standard of living in the home country of the employees. In other words, what the money will buy the employee back home and the cost of living and value of money in each country. It's also said to be based on the quality of the education that western vs. Asian nurses have.

For example a Filipino earns so much in the Kingdom she's able not only to live a very comfortable life there but also support her extended family back home and maybe even purchase a house and a car. The money the Filipino nurse earns in Saudi, although MUCH less compared to what their western colleagues are earning, will in comparison get them more back in their home countries.
On the other hand the American nurse, although she earns more than in the U.S, does not get a significant pay raise. Many are able to travel and save some money, maybe pay off loans but there is no way they could support others and make large purchases at the same time.

According to this source the starting salary for Indian nurses in their home country is 2300 rupees a month which is about 41 U.S dollars (150SAR). The maximum salary with all benefits would be around 5000 rupees, or 90 dollars. The estimated earnings of an Indian nurse in Saudi-Arabia, around 2500 to 4000 SAR is around 1000-2000 U.S dollars at the current exchange rate. That would add up to roughly 58,000 rupees. That's a staggering difference to what they earn back home.

Filipino nurses earn approximately 5000P a month back home in Philippines, which is about 450 SAR (120 U.S dollars). A news article from 2009 states Pinoy nurses salaries in government hospitals will be raised from 2550 to 3500SAR. If they earned the estimated 3500SAR a month in Saudi-Arabia that would be roughly 39,000P. That's almost ten times more than what they would earn in the Philippines.

Compare this to the European nurse. Say she earns about 2400 euros at home, minus taxes leaving her with about 1600 euros a month. That's roughly 7500 Saudi riyals, or if counted from the salary before tax cuts, 11,000. In Saudi her salary will increase about 30% from this. If the European were to get a comparative pay raise to the Asians, her salary would end up being something around  26,000 euros or 120,000SAR a month! Gasp.

By doing some more maths (which I suck at btw) I discovered that the Filipino who first went to Canada to get the passport, actually literally becomes a millionaire (but only in the Philippines) by just working a few years in the Kingdom!

Another interesting aspect is how the Saudi nationals themselves get lower pay than westerners. This is very strange to me. Why don't they value their own citizens more? Do they think Saudi employees are not as efficient or highly trained as the western nurses and thus don't deserve as much pay? I have to admit I hear many nurses complaining about the laziness or lack of training of the Saudi nurses.

Even though I understand partly why they thought up this kind of system in the first place and it does have some sort of rationale behind it, it still causes a lot of tension at the workplace. In the end of the day it IS unfair to pay one employee ten times more in Saudi riyals for the same job, just because of their nationality. The difference in salary causes tension and conflicts in the working environment and can potentially cause one nationality to hold grudges and feel jealousy toward another.

So is there a solution to this salary racism? Could all employees be paid the same salary regardless of their passport color? If the wages went down significantly how would Saudi companies be able to attract western employees anymore? If employees from poorer countries started earning the same salaries as westerners in Saudi do, what would happen? An overwhelming influx of Asian employees? How about raising the Saudi's salaries in order to motivate them more? Would making the salaries more equal make the working environments more tolerable places for all nationalities to work harmoniously in?

If these salaries are based on the cost of living back home and education levels then why do some employees get paid according to their newly obtained passports? What about a Saudi or Asian employee who trained in the west? Or a western nurse that got their education from a third world country? This system seems to have so many loopholes and other negative aspects to it that I think at least some sort of reform could certainly do good for the Saudi workplaces.

http://www.abs-cbnnews.com/pinoy-migration/07/05/09/pinoy-nurses-saudi-govt-hospitals-get-wage-increase
http://www.gmanetwork.com/news/story/230710/pinoyabroad/filipino-nurses-in-ksa-urge-action-on-hospital-pay-gaps
http://www.philstar.com/Article.aspx?articleId=785893&publicationSubCategoryId=63
http://www.nursingsociety.org/VolunteerConnect/Pages/DiMarzioIndia.aspx

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!

An Expat's Tale From A Saudi Jail

It's my pleasure to introduce you to an expat nurse and friend of mine who worked in Riyadh for a few years. Her memories from Saudi are positive despite some negative incidents that occurred during her stay here such as a short jail sentence! Read on to find out more about her life in the Magic Kingdom!


First of all thank you for agreeing to this interview and for sharing your experience about life in Saudi-Arabia as a working western expat woman. You had some pretty out of the ordinary experiences while you were here! 
What got you interested in coming to Saudi-Arabia in the first place?
What was your very first impression about the Kingdom, and did it match what you had expected it to be?
You worked as a RN in a large government hospital. How would you describe the hospital compared to ones in Finland and what was the most difficult thing to adjust to in Saudi?


So how did I end up in Saudi-Arabia for work? It wasn't my plan... I just needed to get out of Finland during that time and do something extreme. One call to the agency, and next thing I noticed I was filling up the papers to Saudi! Nobody believed I was really going there, neither did I, but 6 months from that call I was packing my life to move to Saudi. 

I left with mixed feelings, didn't know what to expect, so I didn't expect anything. I only knew I will wear abaya for next one year and work like crazy! 
I landed in the scary Riyadh airport after midnight. Men all around and all looking at me! Where's my abaya?! Of course I didn't have one at the time..Only thing I knew I needed to get out of this airport as soon as possible, luckily after passport check there was a hospital sponsor waiting for me. 


It took me a short time to settle down around my hospital, I was open to everything! Seemed everyone were super friendly and helpful! I met loads of people, and started to make contact with the surroundings. Hospital was massive, things looked and sounded as if they were going smoothly there. But after working a while I started to notice many things that only sounded good but in reality they didn't actually work. As long as things were looking good to outsiders, people were satisfied with their work. That was hard for me, but then I realized it was impossible to come and change anything, only thing I could do is follow my nursing ethic and do my work, do my 12h shift and go home. 


What were your days off like, and your typical weekend like in Saudi?

Free time in Saudi surprised me in a positive way, there was loads of things to do on your days off. 

Many daily activities like dance lessons, pool days, tennis and gym kept us busy after work! On weekends we had dinners with friends, embassy events, desert walks and camping, snorkling in Jeddah! We did traveling around Middle East, around the world! I met awesome people in Saudi and shared these experiences that I could not have ever thought of experiencing back home! These experiences and possibilities kept me working there up to 2 years. 

I always admired your courage to walk long distances around the city, which is so uncommon in Saudi! There are no sidewalks and traffic is very unfriendly toward pedestrians. What sort of places would you usually walk to and how was your experience, did you get harassed a lot?


 We did walks around the city to the malls from the hospital compound even though it was a bit scary sometimes since the streets weren't made for walking! Many stares from men, but we kept walking! I missed the feeling back home where you could walk freely.

So now to the jail incident..
Tell us what was the situation before you were confronted by the Haia (muttawa)?
What were the factors that lead to your arrest?Were they accompanied with police officers?
How did the Haia treat you and others involved in the incident? Did you feel you were treated with respect? Did you understand what was happening at any point?

I had some incidents during my 2 years there with muttawa, but the scariest one was when I ended up in Saudi jail during Ramadhan. The worst nightmare I could ever think that could happen to me! I was asking my male Arab colleagues (western nationality) to pick me up after work for take away food. While we were waiting for the food to be ready, I decided to step out of the car and wait outside since it was crazy hot! In a few minutes there were muttawa and policemen around me asking questions! 

My friends were inside the restaurant picking up the food. Things started happening when they came out with the food, no questions were asked anymore, we were separated. I was put inside a different car and my friends were taken away in another. I sat in the back seat, doors were locked. I didn't know what was about to happen. I was scared, they took my phone and talked only in Arabic. I couldn't reach out to anyone! Worst case scenarios crossed my mind, horror stories that I had heard happening in Saudi to females - is it about to happen to me? 

After driving around quite along time, I was brought to a big building and saw Saudi females in their uniforms. I felt relief seeing females.. But when I was entering to the building I realized it was a Saudi female jail! I saw scary looking females banging the bars and screaming and crying! And in no time I found my self inside with them, I was so scared. I really thought they would hurt me. I was so shocked of the situation, I separated my self from everyone else, I was just sitting in a corner for hours.  


At the prison, who dealt with you, and how was their treatment toward you?
Did they search you and how was that done? Were you told what they were they jailing you for? Did you have a chance to inform your family or anyone from your employer?

 Female guards asked me to undress for 'inspection'...I was feeling a bit uncomfortable, because I was wearing a top and a short skirt under my abaya. Anyway had to do what they asked and so I removed my abaya. First thing I hear is laughter and words in Arabic, judging my outfit I assumed. I was asked to strip to my underwear and show that there was nothing inside my clothes. They kept looking and going around me, repeating the word mashallaah all the time. After having their fun, they were ready and I was put into the jail cell with my own clothes on. No one spoke in English nor even tried to explain what was the reason I was there at any point of my arrest or stay and no one told me how the process will continue later on. I tried asking many times can I make a phone call, or could somebody explain what will happen next.. but they just ignored.  

What was your prison cell like? 
Did you have other women sharing the same space? How did you spend your time there and how long were you in jail?
Did you get food, water and toilet facilities? What were your inmates like?


It was a big hall with many doorless rooms, in every room there was 6 bunk beds. There was maybe 40-50 prisoners in that area where I was. I saw females socializing with each other, they came to me offering food and water. I realized that these women were like me, jailed for similar cultural reasons like me. One had a newly born baby with her and quite many were with their kids there. 
In that big hall they had a washing room that included 5-6 toilets. Going to toilet, washing yourself, doing your dishes (people had their cups for food)all were done in that same space. Also the kids were washed there too. It wasn't too bad, but maybe too small for that amount of prisoners. 

Also there was a minimarket where you could do your shoppings, it was open certain hour a day. I didn't have any money so I couldn't buy anything, but some prisoners had some. I don't know how they had money since all my personal belongings were taken before they locked me in. In that shop they had snacks, toilet paper (yes you needed to buy your own toilet paper if you felt like you needed one) clothes, like pyjamas, hygiene stuff etc... 

As the night turned into morning, we were offered our first meal because it was Ramadhan also the prisoners had to fast. They threw a big tray on the floor for everyone to pick up their food from there. Next meal would be only later in the evening. I was starving between that time! My jailmates where friendly, and I had a few chats. But only thing in my mind was how to get out of here. They didn't allow me to call anyone, only asked few questions once a while.
I ended up spending two nights there because of the weekend.

What happened to the males involved in the incident?
Were you scared something serious would happen to you, or did you trust your sponsor to help you out?
How did you get out?


Afterwards I heard that my male friends were jailed also, but only for 1 night and were able to inform my family, friends, and the hospital about the situation. After the weekend was finished they called me out for an interview, I told the story as it was, signed some papers and then the officer said I was ready to leave. I couldnt believe it, the sponsor representative for these cases was there waiting for me to drive me back to hospital compound! I was so relieved I didn't care even if I was  going to be sent back home, I was only happy being safe! 

How did this whole incident make you feel? What are your thoughts afterwards?


I was lucky because my jailmates were super friendly to me, some of them gave me things to use. I remember one lady giving me a new pyjama to wear to feel a bit comfortable for sleeping. Most of the ladies in jail where from Asian countries like India, Philippines, Indonesia, Bangladesh. Many of them maids. I think I got along so well with them because my origins are Asian too. I never actually told them my real western nationality, I felt being 'one of them' would make my stay there easier, and it did. There was only one white western lady there, but she came just before I left. I saw her crying most of the time and nobody in jail tried to approach her and offer their friendship like they did to me. But she looked she didn't want to be approached either, I think she was having the first after shock hours like me when I got there. 
Things ended up well for me, but I'm sure not everyone will be as lucky as me if they would end up in the same situation! 

You always have such a positive outlook on things, I think that helps in coping with the sometimes stressful life in Saudi.
What would you give as advice to women living in or planning on moving to Saudi? How to cope with the different culture and customs?


 Respect the cultural rules, don't cross the boarders if you don't need to. Breaking the rules has consequences. It's hard in Saudi to adapt the western life style, but you should be aware that you are living in Saudi... exceptions may be allowed, but don't trust that you will always get away with it! 

I would recommend Saudi Arabia to anyone who is open for cultural differences, to new perspectives in life and who are easy going. Don't come to change things, come to experience. You wouldn't want to experience the same things that you have already experienced back home? Wishing everyone unforgettable moments in Saudi! I surely did and I'm happy I exceeded myself, my life is so much richer, full of great memories after Saudi!

Thank you very much for the interview and best wishes to you and your family!