December 5
After what was a short long flight, we arrived to the warm 75 degrees (I have to start thinking Celsius…which is 5/9th’s times (Fahrenheit degrees minus 32) or about 25 Celsius.
We had been advised of all of the very strict rules that Qatar has about bringing items into the country. We were told that no narcotics (pain medications ) or psychotropics (clonazepam for sleep) would be allowed into the country without a lot of scrutiny. As for the rest of mixture of prescribed and OTC meds we didn’t have a clue. All of our worry was for naught. Without even filling out a declaration form, our bags passed through an X-ray type of machine like TSA uses and we picked them up and were on our way. (The 100 plus Lortab, Lisa’s hormones, and a few 44 Magnum rounds that were somehow left in my headlamp bag all came through without any questions). In retrospect, the lack of bureaucracy and paper work is obviously an oversight on the part of the Qatari government. There is much unused opportunity there for numerous forms and a whole cadre of employees in some type of militia-like uniforms to slow the entry process.
December 6
My ride came to pick me up a half hour early and then left without telling me of a new plan. Since I was supposed to be picked up at 0800, I decided not to work on other transportation until after 0830. But at 0805, a honk announced the arrival of Saif (safe) and Houssain.
While I was in the contract negotiation phase of getting here, everyone wanted me here yesterday like they had to have me on board before they could get the whole “show on the road”. While I was welcomed warmly, there was no angst about me getting into motion soon.
Peter Fowler was headed into a board meeting when I arrived and after he introduced me to them asked me to just “hang out” in the clinic until later. For how long, and for what, I didn’t know. But I went to clinic and spent most of the morning sitting with the nurses and asking questions and meeting many new people. I tried to keep notes about each person, their name, position, and nationality….but still I was unable to keep track of them all. In my conversations that morning, I learned that while English was the language of the hospital, there were 46 different nationalities represented and 34 different primary languages. For my deaf ears, that is a huge challenge of accents. I learned too that seeing people’s names tags really helps one understand and remember their name……but, when a woman’s name tag hangs on her chest, one is a bit shy about staring too hard lest the wrong first impression be given….and I would never think of giving too much attention to a woman’s chest.
I spent time in HR that PM and met many more people and was shown to my office which will be awesome once I get a bit of the “Montana flavor” developed. It has a view of both the Aspire Tower (which we hope will burn the Olympic flame in 2016) and the Khalifa Stadium.
December 7
Pearl Harbor Day isn’t on the calendar here.
I started the process of getting more “moved-in”. HR helped me get lined up for the “medical exam” which turned out to be only a blood test and chest x-ray. But, it was an experience. I was dropped off with the husband of a lab employee of the hospital who was getting his sponsored Resident Permit (“RP”) with his wife being his sponsor (He was South African and was a paramedic working with an oil company in Nigeria…he had some good stories to tell and showed his cool HTC PDA with GPS.) We were put in line with people of all nationalities and obviously from a lot of different social strata. We stood out because we were white, bigger than most everyone else and one of us had on a sport jacket. We found our way to the head of the line and learned that our medical exam was only the x-ray and blood work and were out the door in 45 minutes. It took me back a bit when I took off my jacket and shirt for the chest X-ray and stood in line and realized that every one was staring at me….I had more bulk than 4 or 5 of most of them combined….I didn’t worry any further about leaving my jacket hanging while I had my picture taken.
Only as could be done in a developing country (meaning that they are learning to have a bureaucracy) they don’t spend a lot on government and they get less than they pay for….unlike the opposite that happens in the US, we had to travel to a second location for blood typing. Why this test is necessary is beyond me unless someone in the Qatari (pronounced “Catarri”) government owns the second lab. I hope that if I need blood here that they do more typing than just my type and Rh factor (I was happy to see that they confirmed that I was B positive).
I learned today that my job in the hospital was really going to be up to me to define. While they need some medical people on board to meet the criteria for “Certification” (does that sound like the JCA crap where the tail wags the dog…but it provided me with a cushy job so I will shut up for now). So, I spent time with different nursing administrators and other docs getting some ideas of how the hospitalists (there will be four of us by April) will function and provide some value.
We have an interesting group of docs here.
Dr. Mohammed is the head cheese. He is a Qatari MD but has no clinical role. He is the local chief who implements the government’s “plan” (it keeps changing) and implements ideas that come from the other docs. He is a very charming and charismatic guy who I think I will like as I get to know him more.
Dr. Peter Fowler is a Canadian orthopedist (orthopaedist as spelt in the British form) who is the father of sports medicine in orthopedics in western medicine. He was co-founder of the Fowler-Kennedy Sport Medicine Center in Ontario and as such developed the sports medicine training track for many family docs. He is past president of both the Society of Sports Medicine Physicians and the Society of Arthroscopy (he has been doing joint scopes since the sixties).
Dr. Craig Bottoni is a Florida native but comes most recently from Colorado and Hawaii. He retired from the Air Force and had a private practice in Colorado. He has a strong interest and research experience in cartilage injury and regeneration. He has a military style that I find comfortable and I suspect we will become friends as time goes on. I have a couple of old knees upon which he may want to experiment.
Hamid Chalabi….He is a rather manic French Italian who speaks both languages very rapidly and often at the same time. While he has the stereotypical animated and somewhat loud presentation of his nationalities, when he speaks English, his voice drops to a whisper. I don’t think he quite knows what to do with a doc who is both medical savvy and sports medicine savvy.
Mateao Christiani is a Swiss orthopaedist. He is quiet but seems competent. Since he speaks French well, Hamid consults with him a lot. He is young and well trained. I look forward to getting to know him more and learn more about the Swiss life.
Neboshic Popovich is from Croatia and from I gather from his story is that he left there years ago due to the difficulties in the old Yugoslavia. He went to Belgium where he got his medical degree and two PhD’s related to sport injury orthopedics. He speaks with a heavy French accent but my ear and his speech are both improving. He has lots of stories to tell and we will enjoy getting to know him and his wife Brancha better.
Christiano Eirle is an Italian sports med specialist whom I don’t know well since he travels with a professional soccer team and has been gone a lot with them and then the Christmas holiday as well.
We are scheduled to get about six more docs over the next 3 or 4 months. Someone is going to have to work hard to keep all of us busy.
The mission here appears to be a moving target. While their initial goal was to treat only high level athletes due to pressure from the Sheikh we have had to open the doors to anyone wanting ortho care. It seems as if my first impression with the locals is good too since I am having people just walking in and asking to see me. That is a nice compliment.
I have a lot to learn about this society. I incorrectly thought that all Qatari’s got a piece of the oil and gas profits. Only the royal family (about 5500 people) participates in that along with other non-royal citizens who have invested in and developed the industry. So, the rest of the country has to work for a living. That being said, they all get a lot of help with things financially. Free healthcare, subsidized loans for building a home, a piece of property on which to build and zero taxes. For the average American, I suspect that would represent a 40% increase in annual income if they had that kind of help.
The locals are dealing with a lot of change. Because the government is spending so much on infrastructure, there are not nearly enough Qatari’s to fill the jobs. As a consequence, over 2/3 of the population are ex-pat workers. Many of these come from the third world and are paid poorly (about $150/month plus room and some board) and are treated with little respect by many of the locals and some of the other ex-pats. There is a real pecking order here with those in positions of higher income assuming a superior attitude with these blue collar types. Some of the natives are particularly bad and act very overbearing with all ex-pats. Maybe it is because of my lack of understanding of the culture but there seems to be a lack of respect on the part of the Qatari’s toward the ex-pats. This is reflected by the way they drive (ignoring the traffic signs, speed limits and common courtesies between drivers) and the way they act in public by ignoring “no smoking” signs, butting into line, and being aggressive and rude with sales staff. In the hospital, the docs see little of this. I think they see our education and background as making us worthy of respect.
In observing the local men, I have been struck with how effeminate many of the younger men are. They handle their head covers with many gestures that I see women use when they manage their long hair…constantly flipping it and adjusting it. The posture of their hands, body language, and a rather timid presence gives off a feeling that they have no good idea of their personal identity or self. (I noticed that many of the men have the inside mirror of their vehicle adjusted so that they can see themselves rather than what’s behind them. Perhaps this explains why they are such bad drivers…they are blinded by narcissism.)
My medical experience has been notable for the fact that I have to learn a lot of new names for old drugs since the formulary they use here is largely Asian, Indian, and European. And all lab results are given in millimoles per liter rather than milligrams per deciliter…..leaving for some interesting conversions being used to keep my brain on track.
The local health system is not people friendly. There are few locals who practice and many of the people in private practice have poor training and are not trusted. There is no primary care infrastructure so most of the medicine is practiced in hospital affiliated clinics. It appears that there is so much change occurring that the locals and ex-pats haven’t been able to find a medical home. There is a lot of competition between clinics and hospitals but none seem to have really figured out the model that keeps patients happy and healthy.
While I am licensed here and will be getting my “Drug ID number”, it’s not clear to me if that allows me to practice anywhere except the hospital. While they have asked for my credentials in multiples, I am not sure that anyone ever went back to see if they were authentic. It seems that since I came from the US, and was hired by this hospital, that that was enough for the local bureaucracy.
Since we don’t have a lot of “in-patients” in the hospital, I am starting some clinics for the care of the hospital staff and to address medical concerns of athletes who come in for ortho issues. All of the hospital staff are ex-pats and many of them professional ex-pats, meaning that they have migrated from one foreign home to another over the years. As a result, many of them have not had the routine medical care that they should have (by my standards). So, next week, Phillip Balmer and I and Peter Fowler will have a sit down to discuss how far we want to go with employee health. My leaning is that we do the full scope of primary care since we will have adequate manpower and it will be a good policy to keep our staff healthy and at work. And then if they are happy, they will bring in non-employees for care.
So, with Lisa giving our story from the social perspective, this is mine from a more personal and professional perspective that brings me current to today….11 January 2008. I will continue to add to this as moments of significance are imbedded in my memory.
January 15
We have had some of the rare rain this past week. Qatar gets less than 3 inches per year….that is dry even by Montana terms where 12 to 15 inches is not enough.
The infrastructure shows some of its growing pains with all the moisture. Doha is in the midst of building major arterials for the traffic flow and with that, they are establishing a storm drain system. However, because the projects are unfinished and since they are banked and higher on the outside, the water flows to the middle. So the middle lane was covered with 6 to 8 inches (14 to 17 cm) which served to drown the cars who tried to drive there and if they didn’t drown, the wave of spray that they spewed outward effectively blinded the outside lanes…so, tangled traffic and dirty cars.
“Sand and Sunny” is the usual day to day weather here. A slight coat of sand dust builds up overnight on everything outside and a frequent washing is necessary. The roads also get this same deposit but it’s not noticeable until the rain comes and then a sandy mud forms on the highways and this gets deeper and wetter and more slippery with more moisture. The construction has left large areas of disturbed concrete and asphalt and in these areas, which seem to be all the low spots, huge puddles form and the expected chuck holes as well.
The rain also showed that the roofs are not built for rain. Most homes and businesses get leaks and we heard about some that actually fell apart because the ground settled under them. It was amusing to note at the hospital, where the entire lobby ceiling was leaking, that the maintenance people were heading to the roof with cartons of caulking compound. I can only imagine how that is going to work during the next rainy season after we have had a summer of 120 degree weather.
January 19
One of the privileges of my position is that I have an excuse to talk with many native Qatari’s. Since we do general orthopedics as well as sports ortho, we get some older patients as well. It was with apprehension that I interviewed my first Qatari woman who wore a Burka and Abya. And I was talking with her to follow up on a neck MRI that incidentally showed enlarged lymphoid tissue in the oropharynx. Obviously to evaluate this, an exam of her throat was necessary. So when I explained that in my country my next step was to look in her mouth but since I was ignorant of local custom, we could proceed however she felt comfortable. With a laugh she lifted her burka and showed a nice smile…..so much for her sense of modesty and formality.
Another interesting encounter was with a man of about 65. He was being admitted for knee surgery but found to have some lung disease and I was asked to get him tuned up so that we could do surgery later. After we got the medical issues over, he started to talk through the interpreter about his life and times. He is a 5th generation Qatari and very proud of his country, nationality and family heritage. From what I gather he is involved in agriculture but lives in Doha with his property elsewhere. He invited me to visit him at his home after his surgery was completed. He reminded me a lot of the ranchers of Montana with his heart on his sleeve and his obvious pride in himself.
January 24
Patience is not a virtue in Qatar….it is a necessity.
While the hospital is supposedly managed in a fashion similar to western standards, projects, missions and assignments don’t have the need to be completed in an expedient fashion. Business cards are a 6 to 8 week endeavor. ..despite the fact that others have already been through the process, the people who make these act like it is the first time they have ever done it.
I finally got a “box” in the clinic where I could have labs and other communications deposited. My first problem was that someone kept moving my box or taking my name off. Then, someone started taking all of the labs out before I reviewed them and sent them to medical records. Then this past Thursday, apparently the guilty party was back and attempted to make amends….my box was full of labs…mine and every other doctor’s as well.
We went to the Doha Masters Golf Tournament today. It was a rather cool breezy day but there were a lot of spectators. The country really put on a nice show and the audience was treated to some nice displays by prominent businesses. There was a noticeable absence of locals at the party however. While this country is sports crazy and wants to be a known as a sporting country, they support sports with the pocket book but don’t attend many of the events. As a result, the audience was one that you could have seen on any European or American course.
On our return from the tourney, we went to the Intercontinental Hotel for their Friday brunch. Many of the hotels here have a big brunch every Friday (the Arabic holy day). The IC is known for its seafood so their brunch was centered around a seafood buffet. It was a wonderful feed with some awesome chocolate desserts. We still think however that so far in our exploration that the Marriot has the best Friday brunch.
March 6
Since the last journaling, I actually have been well occupied. The business at the hospital has been picking up and the tasks that I have acquired seem to have multiplied. That has kept me busy most days.
But just “doing stuff” here takes a lot of time. It seems like you have to go through three people to get anything done and often times as you go through the sequence, one undoes what the prior person did and then redoes it his/ her own way. As an example, when I went to the Qtel office to get my internet and phone service. I had filled out the form that was given to me. Then the clerk took this form and copied from it all the information and put it onto a similar form of a different color....not just one, three new forms. When completed, he handed them to the next clerk who started taking the information of the form and entering it into a computer. While the information was all the same, he entered the same info onto 3 different screens. I did notice that when he was done, he had looked at only one of the forms that the first guy had filled out and when he was done, threw all 3 away. In this process a third clerk had taken my Resident Permit and stapled a copy to each of the forms that the first guy had filled out. These went into the trash with the rest of the forms. I think the only thing they didn’t throw out was my deposit money.
Another day, I got a call from the Transportation Department saying that I needed to come down to fill out a statement regarding a fender bender in which we were involved. (We were rear-ended and pushed into the car ahead of us). After the accident, I had gone down to the same office to give them a copy of the ticket given to the person at fault and that had had all the info about the accident written by the policeman on the scene. They seemed very efficient on that visit and just took a copy of my drivers license and gave me a form for the insurance company and told me that everything was kosher (actually, I don’t think they used that word). Now this call. So I go down during my lunch time and locate the officer who called. He spent 20 minutes copying the information written in Arabic from another form saying it was the statement given by the person who accepted the fault. He got to the end and asked me my occupation. When I told him that I was a physician, he seemed surprised, crumpled up the paper and he apologized for troubling me. He did ask me to sign the other persons statement, agreeing that it was accurate but since it was in Arabic, I had to take his word for it. He didn’t understand my joke about having to trust him that it was accurate since I couldn’t read it.
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