Portuguese Nurse in Riyadh
Arriving to Saudi
I have been here almost four months. Initially, I thought it would be more difficult to settle in. The first weeks, especially the first two-three days, are very difficult. At this point you're thinking that you want to go back home. I think this is something most people go through when they first arrive. You are sort of thinking "why on earth did I come to this country?". Then you start settling in. It is the culture shock that you experience on arrival as everything is so different - the culture, the habits people have, the way of life. But then you get more used to being here, you meet new people, and if you're lucky like me, you might find that your flat mate is very nice. My flat mate helped me a lot in the beginning and we're good friends now. I also met some Portuguese nurses who were already here. They were a very great help in the beginning - and still are. Once you get past the first three or four weeks, it gets better.
I think the most difficult thing in the beginning is missing everybody you left back home. Secondly, it's the culture shock as the country and its customs are quite different from back home. You have to get used to the way we (women) dress. As a woman, you can't drive, but instead you need a driver to take you everywhere. These are things that you didn't have to think about back home. At home you're used to going anywhere you like by car or by public transport. There are no public busses or subways in Saudi. Here we move around with taxis. Initially this seems very restrictive. But then, it all boils down to your point of view. I have come to think that maybe not being allowed to drive is a blessing in disguise as the traffic is extremely busy. Even crossing the road can be dangerous, because of the enormous roads with heavy traffic.
Living in Saudi
There are a lot of parties and we do get to socialise and, all in all, we are able to have a very nice life here. You just have to adjust to the different setting and its regulations, like the abaya, the scarf (which you should carry with you, but only need to wear if someone requests it) etc. You also have to get used to being separated from male friends in public - single males and single females are not supposed to mix. At home, you might be used to just grabbing a book or a newspaper and going to a cafeteria terrace to read it, but here you can't do that. This is only allowed for men. This is again, because single females aren't allowed to mix with men. Another thing that differs from back home, is that you don't see people in the city - you just see cars. I thought this was very weird in the beginning, but now I've come to understand that it is so hot here that you can't be really walking around for that long. People say that it's not that hot in the winter, but people still drive. Rather than walking around, the mode of transport is the car - for female nurses this is the taxi, of course. So the empty streets are something that might surprise you on arrival. But you will find people in the shopping centers, for instance.
I don't walk to the shopping centre myself as it's a bit too far. But I have a local medium sized supermarket close to my accommodation and I go there on foot. I just have to walk a little and then cross the road, so it's actually almost next door. I don't mind walking around myself, but I don't walk alone in the night. I really have no problem walking to the supermarket during the day. Of course, if you have a lot of shopping or your bags weigh too much, you need to take the taxi.
Getting used to the taxi system is very easy. The hospital provides a taxi service, which you can rely on. On arrival, as a new nurse in Saudi, you will be offered contact details to particular drivers by other nurses. Each nurse seems to have their "own" favorite driver(s) whose number(s) they have.
I think being in Riyadh is like being in any big city in the world. You wouldn't go to certain areas in every city and you might avoid walking alone in the night - it's the same here. I think that many of us are a bit scared coming over here, as we have a certain image of the place. It really isn't as bad or scary once you experience it. I don't mind going around by myself during the day, eg. to the mall. When I told people back home that I was moving to Saudi Arabia, I was greeted with a lot of incredulous comments and questions asking why on earth would I want to go there. People don't know much about this country, and once the imagination is allowed to roam free, it often builds negative images. When asked why I wasn't going to some more familiar country, I answered that I'll get new experiences that I wouldn't experience anywhere else. And this is true. Of course the culture is very different and the religion is very different. It is good to remember that in addition to having to wear the abaya, you are not allowed to wear any religious emblems (even a small cross around your neck). But you know all these things before you arrive, and you just have to respect them.
I met this Irish girl here, who is planning to set off to Singapore with her boyfriend. She said that she is a little afraid of leaving Saudi as she feels so secure here. I didn't really understand what she meant so I asked her. What she answered is true, and it very much sums up the financial the benefits of coming to work here; the salary is good and we have everything paid for. We don't have to pay for our housing, electricity, water, gas - everything is taken care of for us. She pointed out that we don't have "a normal life" here, as you would, nowhere else in the world, have a living like this one. It is a bit like going back to living back home as a teenager - you only need to pay for your food, internet and transportation, but otherwise you can do what you will with your earnings. After her explanation, I understood very well what she meant. She is afraid that once they go back to the "normal way of living", which includes taking care of all the bills and rent, she doesn't know how well they will manage.
When my friends back home have asked me about my life here, I've told them that, of course my life here is a little bit strange - even a little awkward with some of the cultural differences, but I am experiencing a way of life which wouldn't be available anywhere else. So you just have to weigh the pros and cons and see if it is worth it for you, or not.
I enjoy my work a lot. But in addition to the work, the social life and free time is what you can really enjoy here.
I go out a lot more here than I did back home. I don't go out during the week (in family medicine, we don't work the weekend). After work I usually go to the gym, make dinner and go to bed by 10:30 pm, because we start very early in the morning, at 7:30 am. But then, during the weekend I go out a whole lot. I meet lots of friends. For example, today I am going for dinner at the Four Season's Hotel. There are a lot of parties in the embassies, especially at the American embassy, which has some party every single weekend. Then, you also find a group of friends that you spend time with. I get together with the Portuguese nurses regularly. We also have a wider range of Portuguese expats (they work in e.g. engineering or telecommunications). So we've been out a lot. None of us are married, but there are some restaurants that have these booths that are made on purpose, where people can be more private. And then they have these bigger rooms where everybody is sitting next to each other. So even though there are rules that don't allow for single men and women to mix, the reality - for Westerners at least, is a bit different. We go to both international restaurants as well as some local restaurants. People know which places to go to, and you'll learn these from others. The religious police, the mutaween, don't disturb people in private places. On occassion, you might be asked to cover your head with your head scarf if you are in a public space, but then you just comply with the request.
You are able to save money here, if you like. You are also able to spend a lot of money here if you like shopping or travelling. The shopping opportunities are fantastic, you're able to find everything here. It is also very easy to travel almost anywhere in the world from here, and it is a great opportunity for visiting the neighbouring countries.
You are brought directly to your accommodation after arrival. If, for some reason, you don't like your accommodation or have problems with your flat mates, the hospital will try to re accommodate you somewhere else. I didn't have this problem, but I have some friends who were relocated after they requested this, and it didn't seem like any trouble at all. If you are new, they can usually transfer you in a week or so. The hospital does try to facilitate your needs and they do what they can to help you feel more comfortable.
There are both single and double accommodations. I share an apartment with a girl from England. We get along very well, and in the beginning she was very helpful in assisting me with settling in. Each of us has an own room, a bedroom. The difference is that I have a bathroom connected to my room. The other room, my flat mate's room, is not an ensuite, but the bathroom is just opposite her room door. The house is nice, of course it is not luxurious, but it has everything you need. The kitchen is a normal kitchen and has everything you need - they give you the dishes, cutlery etc. If you need something that isn't already provided, they tell you that you can request these items. They have a store house where they store a lot of items, and your requested item might be found there. You can ask for more furniture if you like as well. I think that they try to accommodate your needs and make you feel more comfortable.
Familiarising yourself with the hospital
There is a hospital orientation for all new staff first, and this is proceeded by a orientation for all new nurses. The nursing orientation is known as GNO, which stands for General Nursing Orientation. I found the GNO very tiresome, very heavy as there is so much new information and while you're trying to take all of it in, you are also rushing here and there trying to get everything done (getting all the paperwork sorted, bank account opened and so on). You are trying to adjust and there is so much new information to digest. The first day I arrived, one of the Portuguese nurses who already worked here warned me about the quantity of new information. She told me that I will have to filter some of this - and I think that she was correct. The thing is that we will probably use all the information later, but there is so much of it at one go. While you are learning about the job, you also have to sort out your Saudi Commission license, your iqama, inventory of the apartment etc. I couldn't wait for the orientation to end and get to actual work. However, it goes past quickly.
You make your first friends in the GNO (unless you already know someone here). You are all in the same boat - you're all starting at a new hospital in a new country. I still keep in touch with my GNO friends. None of the nurses from my orientation work on my ward, but one lives next door. The others I don't see that much, but I might meet them at lunch or then a bunch of us get together and share our experiences. Then there are the other Portuguese nurses who were already working here before I got here. They were very friendly helpful when I arrived and helped me to settle in. I didn't know these nurses prior to arrival, but now I spend a lot of time with them - we get together every weekend.
Once you get a little more familiarised with the hospital, with the new people and your unit, it gets a lot better and you'll find it easier.
Working in the hospital
I work in family medicine, so I don't have experience with in-patient wards in Saudi. The family medicine is an outpatient clinic that attends to employees and their dependants. Family medicine has several areas; we have a triage and a pre-emergency area, we have a doctors' clinic where a doctor sees the patients with appointments, we have a "well baby" area where the babies go (the babies who are not sick) and we have a nurse work area (here adult patients go to have their vaccinations. We also have a travel clinic. For me, the job hasn't been that different from back home, as I used to work in a primary health care centre. I didn't work in a hospital anymore (I had before this), so there was no in-patient wards. The patients came in for some treatment or for vaccines. My work here is pretty similar. Of course, there are some things that are different - the way things work. Here, our family medicine is very big with various departments. But the actual job that I do is rather similar. I do vaccinations, I take care of walk-in patients with eg. diarrhoea, back pain, nausea if I'm working on the pre-emergency area. The employees who are not feeling well would come to us through the pre-emergency area. If these patients need to be attended to on a ward, they would be transferred, but if it is something we can attend to, then we'll treat them after which they can go home. I would say that the procedures are pretty much the same as they were back home; e.g. the way we put in the IVs are the same. Of course here, everything is very well protocoled. They have a protocol for everything that you can imagine. In Portugal it wasn't quite as organized. But my colleagues from elsewhere in Europe (e.g. England and Finland) say it is very similar to their jobs back home.
However, I think that there are a lot more differences from back home in the in-patient wards. I have many friends working with in-patients within the hospital setting and they have outlined a number of differences. For instance, I have colleagues working in the ICU and they have a lot of chronic patients on their ward. Back home there weren't any chronic patients on the ICU, but here they can stay for extended periods of time - even more than half a year. Back home we would let life run more of its natural course with a patient suffering from a terminal disease - here they don't, they'll do everything and hence they might get stuck on an ICU for extended periods of time.
When you start working here, you might feel like you are treated a bit like a student nurse. I had a Portuguese colleague starting work here a couple of weeks back and she told me that she felt like she was treated like an unqualified nurse even though she has been a practising nurse for over 20 years. I told her that I felt the same way when I started - and I have also been a nurse for 15 years. I think that we all feel like this in the beginning. I tried explaining to her that all newcomers are new to the hospital and the new colleagues don't know what each newcomer knows and doesn't know. Everybody gets told the same things with the assumption that you don't know something. I don't think that they want to make you feel bad on your new unit, I just think that it's the hospital policy to explain everything a certain way, which is not meant to offend you. You just have to listen to what they tell you. You will probably know a lot of the things that you will be told here, but some things that you know already, might be handled in a different manner here, so you just have to go through the very basics in the beginning.
The number of patients per nurse is generally less than back home. The nurse work room has about 100 patients per day, which is similar to back home. I am currently working in the "well baby" area of family medicine, which is a nurse led clinic. Like nurse work room, we have a lot of autonomy here as well. This area is not as busy as what I was used to back home.
Another difference is that the patients here will pray five times a day. This is very visible on the in-patient wards. This isn't so much a part of my working environment, as patients come in and then they leave. This might be a culture shock for some nurses working on the in-patient wards, as you can't disturb a praying patient - for medication or anything else. It might be a little difficult to adjust to these details. Now it is Ramadan. This means that the Muslims fast. The rest of us, everybody who isn't Muslim, we can't go around with water or food so we can't eat or drink or even carry a bottle of water. This is hospital policy and you have to keep these details in mind. This fasting can be a little tricky with some of the patients, but they really don't want to eat. This is something that might shock and raise ethical questions in a European nurse, but one has to understand that religion has a very different position in the culture here than in most of Europe. Of course, during Ramadan, you are not meant to eat while the sun is up, but you can eat when it sets, so it's not like you don't eat at all. In general, you have to keep in mind that religion is very much part of the everyday life here.
The Muslim women are required to cover their hair. But actually, the women here cover their faces. So I meet a lot of these women in the "well baby" area at work. We talk to the parents a lot and actually get to have a nice relationship with them. Sometimes the women uncover themselves if there are only women present (own husband can be present as well). But even beneath all that cloth, under which you can only see their eyes, I have learned to read their expressions. I can tell when they are smiling or when they thank you and are grateful. In the beginning, not being able to see their faces shocks you as you are not able to read the faces the same way as you are with uncovered faces. But you get used to it, and learn that you can read a lot from just the eyes. Furthermore, back at home you are taught that you should look a person in their eyes when you talk to them - otherwise you are being disrespectful. But here, it is the opposite.
In the beginning, once you start on your unit after the GNO, you have a preceptor and you have to do all these check off's. You might get a bit frightened by the talk about these check-off's. But now, having done mine, they are not really a big deal. The check off's are very simple things. You know all the things you need to know already. The way this is presented at the GNO - hearing about all the check off's, what you have to learn and the preceptor guiding you - might scare you a bit, but there is really nothing to worry about. In the end, they are just making sure that you know your work, ensuring that you are comfortable in your area. The testing that they do here is no problem for a nurse who has been working in Portugal. My medical calculation was fine, and I haven't been working in an area where I would have had to do medicine calculations for a very long time (I worked on an ICU seven years ago before I started in family medicine). But I still remembered how these are calculated. You are given some information that you read and use to refresh your memory before. Everything on the check off's is very basic - like aseptic technique or oxygen therapy. There is nothing very scary - they are very basic things that all nurses already know prior to coming here. Now I did my BLS course also and it was fine as well.
The working language here is English - and this, of course, is something that is different from back home. It can bit quite a challenge. I was born in England, but left to Portugal when I was 10. I almost never practised my English and it felt like I had forgotten it. But the brain is a very intelligent machine. I feel like I've been picking up the terminology very quickly. You just need to practise a lot, and here you do it every day. Some people take longer to pick up a language, especially if they are able to use another language, but here you can't - you'll just have to use English at work. I speak English even at home here as my flat mate is English speaking. I have colleagues who said their English wasn't that good on arrival, but that they haven't experienced any major difficulties. Sometimes there are words that you don't know, but you just write them down, check them and learn them. Sometimes we know the word but not the spelling and we'll just ask someone. Of course, it is helpful to read a lot in English before you get here. I don't think that the language has been such a big issue.
Then there is the Arabic language as well - the language of the patients. I am lucky as 95% of the patients (as they are employees and their dependants) speak English. I have only about 10 patients a week who don't speak English. We have some Saudi nurses and they work also as interpreters (this is agreed upon in their contracts), and we have 2-3 interpreters on each floor as well. So if there is an Arabic speaking nurse available, I'll ask her to translate or get one of the interpreters to help. But this is not that common in my work. If the patient is a dependent who doesn't speak English, like a wife of an employee, she might have her child with her and the children here speak very good English. These young children, only 7-8 year olds are interpreters for their mothers. All the kids know English. It is very rare that the children don't speak English. In the in-patient area, this must be a bit tougher as the patients aren't employees, and they are likely to only speak Arabic. But on the in-patient ward, each patient will have a sitter. Every patient will have a sitter. So let's say there are 20 patients on a ward. This means that there will be 40 people on the ward (excluding the nurses and doctors).
Tips for Portuguese nurses
First of all, I am about to go on a holiday to Portugal, and I am planning to bring a lot of the clothes that I left home over here once I return. You can wear everything over here. You can even wear nothing under your abaya if you want to. I thought I wouldn't have any use of my summer clothes here, so I didn't bring them. You can wear every single thing here as you did back home - the only thing is that you need to wear your abaya over them.
Another thing that one gets a little worried about is what items to bring, certain brands that one is accustomed to. You'll find all brands here that you're used to back home (cream, shampoo, toothpaste - even foods: cereal, biscuits, chocolates etc.). Of course, if you have some very specific product, like a cream for a skin problem, for instance, you might want to bring this over with you.
I didn't bring an abaya, I borrowed an abaya from the nursing affairs. If you can find one back home, you could bring it with you and this would be one less thing to worry about in the first hectic moments over here. But this is not necessary. During the orientation, the whole group goes to the souks (market) to shop for abayas together. This is done with every single orientation group. They also organise an introductory tour where they take you to the supermarket, take you out for dinner, show you the museums etc.
The first few days are very difficult - but this is normal as it's so different here. It is a culture shock - the culture is so very different. But at least I didn't want to go a "normal place", something very similar to home. But when you arrive, you question whether you are crazy to come to such a different place. But, I've spoken to a lot of people about these initial feelings and they are quite normal. You settle in after a little while.
You have to have the right attitude and make the best of it. It might be difficult before you settle in (both the surroundings and on your ward). But you have to ask yourself "were you absolutely happy back in Portugal (or where ever you are from) and do you really want to go back?". Of course you miss things back home, but ask yourself if you really had a nice life there. In Portugal, the economic situation makes life very difficult at the moment for nurses as the salaries are very small and benefits are being reduced all the time. This is something that we have to keep in mind. You should think about how, here, you get a good salary and benefits (like accommodation). You can also get money saved here, especially after a while. Of course this requires some sacrifices - you miss people and some aspects of life back home and you need to adapt to the new country, the heat and some restrictions that you aren't used to. But back home, it is likely that you weren't really happy, because you didn't have what you needed. You just have to balance the positive and the negative. You need to have a positive attitude and make the best of what you have. My flat mate is planning on going back to the UK next year. She has already sent some boxes home. She told me that she was never used to having the amount of money to spend as she does here. So far she has bought herself six or seven designer bags. Myself, I don't really care for bags, but she loves them. Anyhow, she showed me the bags -each of them ridiculously expensive - and she told me that she doesn't even really like them anymore. So they are all in these very nice boxes and she is packing them for back home. The point I am trying to make is, where else - unless you are rich - are you able to do things that you do here? You don't have to spend on designer items, you can also travel. You can go to Dubai for your weekends, or you can travel to e.g. Asia on your vacation. You can also save this money, if you prefer. So it might be difficult to come here and adjust to the new culture, but you can have a nice life here - better than back home. This is something that you ought to keep in mind. After being here for a while, you get used to the surroundings and it becomes much easier.