I am having a spot of bother with one of the hospitals I work in. It would appear to be an issue of differing expectations.
I expect them to do the very basics of nursing & medical care for all their patients within the realms of their ability & resources available, with support & advice from my NGO colleagues & myself.
They expect me to only praise their work & to never point out areas for improvement of try to discuss methods for improving care. They think that they "know it all" - this is an actual verbatim quote - I wish I could say the same with such confidence (another blog on this particular affliction will follow shortly), therefore whether they actually do it correctly or not is irrelevant to them.
Previously - whilst in the midst of a civil war - they had MSF doctors that did their job for them. I have tried to explain that now it is their turn to 'do' & I am here to share my knowledge & skills with them; to capacity build them. They would prefer that I just did all the work, gave them lots of equipment/money & shut up.
One particular doctor has a problem with my NGO following up on MoH guideline & training of severe acute malnutrition (SAM) on his ward. He asserts that he is a very important man & as a mere female NGO doctor, who am I to comment on his wards performance or coach them how to improve? A few weeks ago he completely lost the plot with me in a clinical area - yelling & throwing personal insults - after I had asked if we could meet to discuss SAM follow up. Everyone it seemed, including my male Cambodian NGO colleagues, thought I must have some how been responsible for his behaviour. I have never been spoken to by another 'professional' in such a manner before - which as an emergency physician is saying something. I didn't think that I had said or done anything to particularly provoke him - but perhaps he can read my thoughts. My assistant was with me & she confirmed it was indeed unprovoked & completely inappropriate.
Since that incident he has been given the follow up report, which I had been trying to give him when he physically removed me from his ward. Now he claims all his problems with me & the NGO I work for are due to this report which had been written to reflect feedback & coaching done with staff on his ward last month. The report he hadn't even seen or read when he behaved like a complete misogynist **** towards me & my assistant.
A meeting was called by the hospital to discuss this.
I have been told that I must surely exaggerate events for dramatic effect for this blog. I am a little bit fed up that people don't believe my stories about health care in Cambodia, despite other people - foreigners & Cambodians - who witness these events or similar, concurring with me. I am tired of people thinking that it must only be me that has a problem. I admit that I am frustrated that I can not seem to help towards realising the goal of better health care for the Cambodian people. Since starting this blog I have always tried to give a relatively balanced re-telling of any events portrayed, which I would be happy for all characters involved to read, hence the blog being in the public domain. I hope that when I report my feelings about things that happen in my work place here that they are read as just that; my feelings, my view of my reality & my version of the truth.
So for those of you who doubt this, my assistant - to practice her English - wrote her perception of the meeting we had with the hospital, maybe you will believe her truth, even though she is young, female, & not rich.
"One day, J, Esther, R, and I had a meeting to solve difficulties in follow up with staffs in pediatric ward under facilitating of two deputy directors, Dr. ON and Dr. H. When the meeting started, Dr. H told us there are some feed backs in the follow up are contradicted to what the pediatric staff has done. They disagree and do not accept those. Then he asked us to explain what the follow up is , what the objectives of the follow up are , what the advantages we will get from those follow up, and what the follow up will be used for. J gave the general information of the follow up. Then he asked what tool comes from. “It came from NNP and MOH. They worked with us to make this follow up tool” J said. When she finished the explanation, we began to talk about the problems we have with the staffs. Dr. CP asked is it true that tool gets from the MOH and NP. Mr. R said” yes, it is.” He continued to ask,” why you scored us in low when we have tried to do. Why you cannot give us 4.” He never kept time for us to answers at all. He always shouted and asked aggressively. I felt so angry, but I could not say anything as I am not either a nurse or NGO staff. Just keep silent. The whole one hour of meeting was just for Dr. CP to talk and show who he is. We already knew who he is and what his ward has done. At end of meeting, we asked him whether we can do SAM follow up next time. He said wait until he make sure that it came from NNP and MOH .Esther asked him about the TB screening follow up whether we can do it next Friday. He did not listen at all. He just said that if the child is suspected have TB, we send him/her to TB service. Esther replied quickly “no, we just asked about the screening, about what the doctor thinking about TB when screening the child”. Even she talked clearly, but Dr.CP just turned deaf ear to her. No matter how we try to explain in short time, he did not take a look at us. I wonder if he take breathe or not for an hour talking. After this meeting, I realized that there is a cultural problem, mainly saving face culture which I do hate. It is not about the translation errors. In Cambodian, even if you are either a professional doctor or nurse from other countries, you cannot criticize truly from what you see to Cambodian male doctors. If you tell them like that, they will think that you hate or accuse them. Also, if you are a good nurse comparing to them, but you are low status-not rich as them, you cannot criticize also. Even you criticize them, you should say please……..like begging them to change as I have noticed from what has been told by Dr. CP. And if you can put them the high score, then you can criticize things. So i think the person who can observe them is only people in high government position. I know that the culture problem is hard to be sorted out. It can be solved if the doctor wants to be changed. Therefore, the meeting is just saving face problem for doctor as he cannot accept the reality. For the follow up next time as just in case he approves us to do more, it is more likely that the only the higher Cambodian people can do it."
I expect them to do the very basics of nursing & medical care for all their patients within the realms of their ability & resources available, with support & advice from my NGO colleagues & myself.
They expect me to only praise their work & to never point out areas for improvement of try to discuss methods for improving care. They think that they "know it all" - this is an actual verbatim quote - I wish I could say the same with such confidence (another blog on this particular affliction will follow shortly), therefore whether they actually do it correctly or not is irrelevant to them.
Previously - whilst in the midst of a civil war - they had MSF doctors that did their job for them. I have tried to explain that now it is their turn to 'do' & I am here to share my knowledge & skills with them; to capacity build them. They would prefer that I just did all the work, gave them lots of equipment/money & shut up.
One particular doctor has a problem with my NGO following up on MoH guideline & training of severe acute malnutrition (SAM) on his ward. He asserts that he is a very important man & as a mere female NGO doctor, who am I to comment on his wards performance or coach them how to improve? A few weeks ago he completely lost the plot with me in a clinical area - yelling & throwing personal insults - after I had asked if we could meet to discuss SAM follow up. Everyone it seemed, including my male Cambodian NGO colleagues, thought I must have some how been responsible for his behaviour. I have never been spoken to by another 'professional' in such a manner before - which as an emergency physician is saying something. I didn't think that I had said or done anything to particularly provoke him - but perhaps he can read my thoughts. My assistant was with me & she confirmed it was indeed unprovoked & completely inappropriate.
Since that incident he has been given the follow up report, which I had been trying to give him when he physically removed me from his ward. Now he claims all his problems with me & the NGO I work for are due to this report which had been written to reflect feedback & coaching done with staff on his ward last month. The report he hadn't even seen or read when he behaved like a complete misogynist **** towards me & my assistant.
A meeting was called by the hospital to discuss this.
I have been told that I must surely exaggerate events for dramatic effect for this blog. I am a little bit fed up that people don't believe my stories about health care in Cambodia, despite other people - foreigners & Cambodians - who witness these events or similar, concurring with me. I am tired of people thinking that it must only be me that has a problem. I admit that I am frustrated that I can not seem to help towards realising the goal of better health care for the Cambodian people. Since starting this blog I have always tried to give a relatively balanced re-telling of any events portrayed, which I would be happy for all characters involved to read, hence the blog being in the public domain. I hope that when I report my feelings about things that happen in my work place here that they are read as just that; my feelings, my view of my reality & my version of the truth.
So for those of you who doubt this, my assistant - to practice her English - wrote her perception of the meeting we had with the hospital, maybe you will believe her truth, even though she is young, female, & not rich.
"One day, J, Esther, R, and I had a meeting to solve difficulties in follow up with staffs in pediatric ward under facilitating of two deputy directors, Dr. ON and Dr. H. When the meeting started, Dr. H told us there are some feed backs in the follow up are contradicted to what the pediatric staff has done. They disagree and do not accept those. Then he asked us to explain what the follow up is , what the objectives of the follow up are , what the advantages we will get from those follow up, and what the follow up will be used for. J gave the general information of the follow up. Then he asked what tool comes from. “It came from NNP and MOH. They worked with us to make this follow up tool” J said. When she finished the explanation, we began to talk about the problems we have with the staffs. Dr. CP asked is it true that tool gets from the MOH and NP. Mr. R said” yes, it is.” He continued to ask,” why you scored us in low when we have tried to do. Why you cannot give us 4.” He never kept time for us to answers at all. He always shouted and asked aggressively. I felt so angry, but I could not say anything as I am not either a nurse or NGO staff. Just keep silent. The whole one hour of meeting was just for Dr. CP to talk and show who he is. We already knew who he is and what his ward has done. At end of meeting, we asked him whether we can do SAM follow up next time. He said wait until he make sure that it came from NNP and MOH .Esther asked him about the TB screening follow up whether we can do it next Friday. He did not listen at all. He just said that if the child is suspected have TB, we send him/her to TB service. Esther replied quickly “no, we just asked about the screening, about what the doctor thinking about TB when screening the child”. Even she talked clearly, but Dr.CP just turned deaf ear to her. No matter how we try to explain in short time, he did not take a look at us. I wonder if he take breathe or not for an hour talking. After this meeting, I realized that there is a cultural problem, mainly saving face culture which I do hate. It is not about the translation errors. In Cambodian, even if you are either a professional doctor or nurse from other countries, you cannot criticize truly from what you see to Cambodian male doctors. If you tell them like that, they will think that you hate or accuse them. Also, if you are a good nurse comparing to them, but you are low status-not rich as them, you cannot criticize also. Even you criticize them, you should say please……..like begging them to change as I have noticed from what has been told by Dr. CP. And if you can put them the high score, then you can criticize things. So i think the person who can observe them is only people in high government position. I know that the culture problem is hard to be sorted out. It can be solved if the doctor wants to be changed. Therefore, the meeting is just saving face problem for doctor as he cannot accept the reality. For the follow up next time as just in case he approves us to do more, it is more likely that the only the higher Cambodian people can do it."
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