Change of character

It was fed back to me this week, by a male colleague I work with, that one of the doctors in the hospital had told him that one of his many problems with me was I should "Change your character a bit to fit with Khmer culture" Initially I wasn't sure if this doctor meant I should be more like a Cambodian doctor - only care about money, status symbols, be closed minded & not interested in improving patient care. I am of course being facetious - this doctor meant I should be more like how he expects a Cambodian woman to behave - silent, respectful, not challenging him, agreeing with him even when he is dangerously wrong and certainly I should drop being so passionate about patient care & the right to health for everyone including poor people who cannot afford bribes.

I am sure if I tried I could behave like this but then I probably wouldn't be able to do a very good job of capacity building health workers. As I have said numerous times before if they aren't shouting at you then you are probably doing something wrong. When a system is so rotten, broken & terrible, trying to suggest politely even very small changes can provoke an aggressive, defensive back lash & is certainly doesn't win you many friends. The Pinner/Arkill genes in me hold me steadfast & stubborn on this particular point. I won't be bullied by these people to stop challenging them and I certainly can't stop believing that things need to change & improve for Cambodian people to access decent & acceptable healthcare. 

It is hard sometimes, especially when you are being told to change your character & that everyone hates you not to take it personally. At times this week I have felt like it must be all my fault & what a terrible person I am, when this happens I have reminded myself of something that happened a fortnight ago & also meditated on these words "This too shall pass"

The MoH had come to deliver haematology training a few months ago but no doctors had attended, even after the director attempted an emergency whip round in the afternoon there was only 4 doctors who showed up. Understandably the MoH were not very impressed by this so had organised a second training day where attendance was mandatory. When I heard about it I asked if I could go along as I have previously tried to train on blood tests interpretation & safe blood transfusion, I wondered whether I was in line with MoH thinking. "Why not?" replied my Deputy director. 

The first session was a typical Cambodian trainer - a 'Professor' from Cambodia, powerpoint presentation in English obviously written by an international expert, very high level, lots of talking, talking, talking with no pause for breath, never checking to see if the participants understood, in fact there was no participation so we could call them an audience of the Professors enormous ability to talk very importantly on a subject so that no one could actually understand it. 

This is what Cambodians are used to. If you teach at a basic level that explains first principles, is understandable, ask lots questions, allow lots of questions & involve the participants this is generally seen as a poor educational method. Use of a lesson plan I was told recently, "may be ok for Barangs but for a Cambodian it means you are weak & do not know the subject."

When I think of the hours I have spent writing lesson plans that will never be used because it is better to look 'clever' & 'strong' rather than actually deliver good quality, consistent training, 

Even when the professor talked there were still roughly half the audience on their mobile phones talking loudly behind a hand covering their mouth (this is not an effective sound barrier, I'm not sure they realise this) or watching youtube videos or playing candy crush on their smart devices. I have seen pre-school children with more of an attention span & respect of a learning environment.

The next session was run by a NGO doctor who I have worked with before. He may not be a professor from a Phnom Penh Hospital but he has trained for the last 10 years with international experts & probably has a much better medical education as a result. Because he has been exposed to barangs his teaching style was different - he was more informal, didn't talk incessantly but asked questions, prompted the participants for their ideas or experience, explained things from evidence base & not just his anecdotal experience. 

Hence he was giving quite a good lecture that I was actually engaged with & following despite it being in my very second language when something not unusual here happened, it was surprising however because I previously thought it only ever happened to me.

One of the surgeons (these are the same surgeons that didn't know how much blood was in a human body) stood up & interrupted the speaker - "Stop talking now, you are not good, you have bad attitude & are disrespectful, you ask us questions because you don't know anything, it seems to me you have no knowledge. I will not listen to you any more, I will only take information from the Professor. You are just a NGO doctor. Sit down now"

The NGO doctor smiled & sat down (I was taking notes at this point as I am sure this is what I too am expected to do in these situations) and then the Professor started talking very quietly. The room was silent, people put away their mobile phones & actually listened. Very calmly the Professor continued the lecture reiterating everything that the NGO Dr had said. Never saying openly that the NGO doctor was right nor showing he thought the surgeon was rude or condemning his behaviour.

I was stunned - I had always assumed it was because I was a female foreigner but apparently 'low status' male Cambodians can be treated the same way.

Afterwards I spoke with Dr ON the deputy director - he couldn't see what the problem was. I had to explain that in my country what the Surgeon would have been extremely rude, disrespectful & offensive. ON shrugged - But the speaker was an NGO doctor, we don't respects NGO doctors here! - I was told in no uncertain terms.

So when a poorly educated, ignorant but rich, high status doctor is rude & dismissive of a higher trained, professional  NGO doctor who he considers "lower status" to him, the correct response apparently is to just smile & sit down silently. And there it is, thats the part of my character which it would appear is in need of an urgent change.

I have an opinion about what they can do with this part of khmer culture but unfortunately it would probably go against the personal development advice I was given earlier this week.