10. Building bridges

The Arabs want to embrace western medicine. They understand it in terms of the science and technical advances but in their own milieu they tend to revert to cultural norms. So although there is ostensibly a willingness to embrace teamwork across the professions, in practice the hospitals are still very hierarchical. This perpetuates a blame culture where mistakes are hidden, complaints are ignored and patient care is inevitably compromised. Not that we are perfect in the western world: we too have a long way to go.

One of the problems in HMC had been a disconnection between administration in the corporate offices and the clinical staff in the hospitals. Because of my strong clinical background I am able to build bridges between the two. The problem is how to get the messages across those bridges. I decide that we need a series of conferences or workshops where we can share ideas, discuss international research and together improve the systems underpinning patient care in our hospitals.

My slowly slowly, shwai shwai approach is working. The groundwork in reaching out to the hospitals across the country has been worthwhile. In terms of getting the doctors on side, I am pushing against an open door.

The corporate view is to engage some experts from out of town, somewhere convenient like London or New York. We have already done some work with the Harvard Business School, who have been fantastic, but only a small number of senior clinicians could be included in such an approach. My view is that we need to tap into the considerable expertise of our own doctors.

Moreover, I am not going to be there forever and I want to overcome the passive resistance and that learned helplessness that we all encounter. I want to cede control to the locals, to give them self-belief, to stop the constant blaming of the administration and encourage autonomy with inclusivity. Less of, “I’m the doctor and I know best,” and more of, “We are a team. Let’s work together to do the best for our patient.”

So we invite every single consultant in the country to attend one of a series of one-day workshops in Doha. I will have the opportunity to meet each one individually, and to reinforce how much they are valued by me and the organisation. They will all have the opportunity to air their views.

It is a gamble and a risk. We wonder if they’ll turn up: they do. We even have to put on extra days to accommodate them all. By giving everyone large easy-to-read name badges, I am also able to pretend that I know all their names, all six hundred of them.

I arrive after the usual battle through the traffic, draw up at the grand entrance and simply get out of the car, leaving my key in the ignition. I am greeted by, “Good morning ma’am” as I walk into the hotel. My car is valet parked and retrieved for me at the end of the day. When I arrive at the workshop venue, my completely veiled member of staff embraces me warmly, comments approvingly on my clothes, then presents me with a bunch of fresh flowers.

There are fifty senior doctors attending each day and I wander round the tables greeting people and chatting. Everyone is very warm and they all want to talk.

Discussion between lectures is vigorous and there are some great ideas around leadership and clinical practice. In the interests of inclusivity and breaking down barriers, I have invited the corporation’s senior lawyer to one of the sessions, thinking that it will give him some insight into our medical values. We are doing much work currently on patient safety and on promoting a ‘No Blame’ culture. Our Sudanese lawyer with his British degrees is a confrontational man, as evidenced by his correspondence on dress code.

When he expresses concern that there is no rigorous punishment for doctors who have made mistakes, the response from one of the Qatari surgeons is voluble and emphatic in the extreme. With thobe and ghutra flying, he is on his feet shouting at the lawyer, who returns in kind.

“What does he know about medicine? He would put us all in jail for a simple mistake,” pronounces the surgeon.

“Doctors think they are gods. He only operates for money like a typical plastic surgeon. The country needs lawyers like me to keep these doctors under control!” comes the swift riposte.

The insults are explicit. At one point the surgeon asks me, “Why is this man here?” to which I point out “He is my guest.”

The exchange lasts several minutes before I am able, as chair, to restore order. Needless to say, the lawyer doesn’t last the day and he is subsequently very peeved that I gave him no right of reply to the accusations against him. For good reason - it would have turned a skirmish into a full-blown battle, which none of us needed.

The gossip has already elevated the heated exchange to a stand-up fight. I am still not sure whether my reputation is enhanced or hindered by the incident.

If a session is in danger of over-running then I check with one of the senior Arabs to ensure that we are not running into prayer time. One day, the men decide to stay in the lecture room for prayers. One stands at the front with several others facing him and starts proceedings. They are at a slight angle to the geometry of the room so presumably someone knows the direction of Mecca. I also assume that they all kneel and touch the floor with their foreheads but I slip away quietly before they reach that stage.

Imagine such a scene at a UK conference. Here in Qatar, it is assumed everyone is religious and they all believe in God. These highly educated Arabs have no problem with the concept of evolution and have reconciled God and science in their minds and in their culture.

Occasionally I have interrupted someone at prayer in their office. Devotion is such a part of daily life that no one is surprised except us westerners. Many men display an area of thickened skin, a callus, on their foreheads from repeatedly touching the ground with their head when at prayer. A local who works in an adjacent department popped into my office recently with gifts from Mecca. He had just returned from pilgrimage and presented me with Arabian dates and holy water in a tacky plastic urn. He instructed me to drink it and pray. I was grateful and very touched, but can you imagine such a scenario at home? Not for the first time, I find myself musing that we are living in a modern world with a medieval mindset: but then the date here is 1450, so perhaps that makes sense.

The Emir publicly prayed for rain last week and this week we had a deluge. Since drainage is not a strong suit out here, the roads are consequently flooded and the accident rate is even higher than usual. No doubt the prayers are part of a long-standing ritual but I am sure many will believe that the rain was due to the Royal intervention.

Still, through my worries, the unexpected squabbles, and expected prayers, several people compliment me on the workshops, usually along the lines of, “I didn’t want to come, but it has been good.”

One neonatologist beckons me over to her table.

“I prayed to Allah that this would not be a waste of my time,” she said. “Eight precious hours away from my patients is too much.”

I looked into her eyes and waited.

She continued: “Allah answered my prayer. I have learned a lot today so I thank you.”

Now I can smile and reply, “And thank you for being such an engaging participant.”

The workshops are well received, my team is very supportive and well organised, and the hotel does well, with excellent food and facilities.

My personal learning is greatly enhanced by a camel conversation with two Arab doctors who confirm my suspicions that camels are supercilious, stubborn creatures. They can survive for seven days in the desert without food or water but if they don’t like you, they won’t budge an inch. On the other hand, get it right and a camel will be loyal for life.