I've written about 'up-skilling' before & it is not just the expats that have a problem with this. This week I discovered one of the nurses who works for the same NGO as I do has also been at it.
The very first time I met this particular character he introduced himself as follows - Hello, my name is M & I have a masters in public health. He has been heard to say that knows more than any Cambodian doctor, he told my friend that he knows better than all Barang Doctors too. I have only ever seen him demonstrate ignorance & arrogance - but I think we have already established time & time again that what the hell would I know about medicine?
When being constantly ignored & diminished I have found that an effective coping strategy is avoidance so I have skillfully managed to minimise the time that me & M spend in the same room. Its not difficult as he is busy chasing American doctors that visit once in a while, whose gifts of pens & tie pins he treasures & idolizes. From a distance I can even find his behaviour amusing.
This week I visited another hospital which M had also been to the day before. On the way the Cambodia Doctor I was working with - the Bong - told me that M had diagnosed a patient with a pericardial effusion with the new ECG monitor. I looked disbelievingly at the Bong & his lips twitched imperceptibly upwards. I eye rolled & the Bong said ruefully - I think it is important that people work within their roles, if you are a nurse then you should nurse the patient.
There are certain people here who love touching my blue paper, I don't think that the Bong is one of them. In fact he doesn't even like my character, it was him who told me recently I should try to be more Cambodian - but it appeared on this occasion that he was deliberately trying to wind me up.
After we had delivered some training at the hospital, we went to ER to show them how to use their new equipment. We discussed a case from the day before, an overdose of diazepam. The young female ER doctor wanted to know my opinion on gastric lavage. I know here that it is expected by relatives of any patient that has taken an overdose, the same as every patient regardless of their complaint must receive an IV of 5% dextrose - but I also know it is rarely clinically indicated & has a risk of aspiration as a complication. They knew this but found it hard to convince patients & their relatives which I appreciated from many similar conversations. Pick your battles is my mantra - and gastric lavage is by no means the biggest barrier to effective emergency medical care here.
The ER doctor then turned to the Bong & started to talking to him in khmer about what had happened yesterday to spark this conversation. Now my khmer is terrible but given context & a clear speaker I can sometimes get the gist so after she finished I asked her who had M made so very angry. She looked a little surprised & the Bong explained to her, in khmer, that she should be careful as I understood some khmer.
I could see that the ER doctor was weighing up the situation before finally deciding to continue the conversation in English. She explained that they had been doing the lavage outside the entrance of their new emergency room & M had openly criticized them, shouting at them that they were wrong in front of the patient, his relatives & all the other patients & relatives in the ER. She earnestly told me that this was extremely rude & inappropriate in Cambodia.
This I know because I have spent the last nigh on 3 years tip toeing around cultural norms, saving face culture & often delicate egos to try & advocate for half decent medical care. I would never openly even advise in front of a patient as I learnt early on this does not improve patient care & only serves to increase clinician hostility & resistance.
I explained to the doctor that I try really hard not to offend people but have recently managed to completely alienate myself from the paediatric ward of my base hospital.
No, no - she assured me - you have been fine, most doctors that visit are fine. They advise how we should do things but respect that it is our decision to change. It was only that doctor yesterday that was aggressive with us, was disrespectful & too forceful.
Doctor? - I confirmed with a raised eyebrow shot in the Bong's direction.
Yes - she nodded - that Doctor was very rude!
Walking back to the shiny white, AC, 4x4 I couldn't help but remind the Bong that he had no reservations telling me to "change your character to be more Cambodian" yet he wasn't even prepared to correct the false assumption that one of his fellow staff members was a Doctor when they were in actual fact a nurse.
It seems that a male Cambodian who trained as a nurse & did a masters in public health in Cambodia that both aren't recognized internationally and can just as easily be bought without a minutes study for a price, can think & let health staff also believe that he is a doctor, dispensing all kinds of false or dangerous advice is perfectly acceptable. However I am still being ignored & provoked extreme hostility for suggesting a bottle ban on the Malnutrition unit & encouragement of relactation to improve SAM treatment - I guess my internationally recognized medical education & specialist registration plus my higher education counts for nothing because it turns out that saving face, being an arrogant & delusional are what actually counts.
So the old adage 'Trust me I'm a doctor' is redundant here because trust doesn't even enter in to the equation & any one can be what ever their money & status allows.
9 days to go & counting......
The very first time I met this particular character he introduced himself as follows - Hello, my name is M & I have a masters in public health. He has been heard to say that knows more than any Cambodian doctor, he told my friend that he knows better than all Barang Doctors too. I have only ever seen him demonstrate ignorance & arrogance - but I think we have already established time & time again that what the hell would I know about medicine?
When being constantly ignored & diminished I have found that an effective coping strategy is avoidance so I have skillfully managed to minimise the time that me & M spend in the same room. Its not difficult as he is busy chasing American doctors that visit once in a while, whose gifts of pens & tie pins he treasures & idolizes. From a distance I can even find his behaviour amusing.
This week I visited another hospital which M had also been to the day before. On the way the Cambodia Doctor I was working with - the Bong - told me that M had diagnosed a patient with a pericardial effusion with the new ECG monitor. I looked disbelievingly at the Bong & his lips twitched imperceptibly upwards. I eye rolled & the Bong said ruefully - I think it is important that people work within their roles, if you are a nurse then you should nurse the patient.
There are certain people here who love touching my blue paper, I don't think that the Bong is one of them. In fact he doesn't even like my character, it was him who told me recently I should try to be more Cambodian - but it appeared on this occasion that he was deliberately trying to wind me up.
After we had delivered some training at the hospital, we went to ER to show them how to use their new equipment. We discussed a case from the day before, an overdose of diazepam. The young female ER doctor wanted to know my opinion on gastric lavage. I know here that it is expected by relatives of any patient that has taken an overdose, the same as every patient regardless of their complaint must receive an IV of 5% dextrose - but I also know it is rarely clinically indicated & has a risk of aspiration as a complication. They knew this but found it hard to convince patients & their relatives which I appreciated from many similar conversations. Pick your battles is my mantra - and gastric lavage is by no means the biggest barrier to effective emergency medical care here.
The ER doctor then turned to the Bong & started to talking to him in khmer about what had happened yesterday to spark this conversation. Now my khmer is terrible but given context & a clear speaker I can sometimes get the gist so after she finished I asked her who had M made so very angry. She looked a little surprised & the Bong explained to her, in khmer, that she should be careful as I understood some khmer.
I could see that the ER doctor was weighing up the situation before finally deciding to continue the conversation in English. She explained that they had been doing the lavage outside the entrance of their new emergency room & M had openly criticized them, shouting at them that they were wrong in front of the patient, his relatives & all the other patients & relatives in the ER. She earnestly told me that this was extremely rude & inappropriate in Cambodia.
This I know because I have spent the last nigh on 3 years tip toeing around cultural norms, saving face culture & often delicate egos to try & advocate for half decent medical care. I would never openly even advise in front of a patient as I learnt early on this does not improve patient care & only serves to increase clinician hostility & resistance.
I explained to the doctor that I try really hard not to offend people but have recently managed to completely alienate myself from the paediatric ward of my base hospital.
No, no - she assured me - you have been fine, most doctors that visit are fine. They advise how we should do things but respect that it is our decision to change. It was only that doctor yesterday that was aggressive with us, was disrespectful & too forceful.
Doctor? - I confirmed with a raised eyebrow shot in the Bong's direction.
Yes - she nodded - that Doctor was very rude!
Walking back to the shiny white, AC, 4x4 I couldn't help but remind the Bong that he had no reservations telling me to "change your character to be more Cambodian" yet he wasn't even prepared to correct the false assumption that one of his fellow staff members was a Doctor when they were in actual fact a nurse.
It seems that a male Cambodian who trained as a nurse & did a masters in public health in Cambodia that both aren't recognized internationally and can just as easily be bought without a minutes study for a price, can think & let health staff also believe that he is a doctor, dispensing all kinds of false or dangerous advice is perfectly acceptable. However I am still being ignored & provoked extreme hostility for suggesting a bottle ban on the Malnutrition unit & encouragement of relactation to improve SAM treatment - I guess my internationally recognized medical education & specialist registration plus my higher education counts for nothing because it turns out that saving face, being an arrogant & delusional are what actually counts.
So the old adage 'Trust me I'm a doctor' is redundant here because trust doesn't even enter in to the equation & any one can be what ever their money & status allows.
9 days to go & counting......
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