So let me talk a little about Saudi culture before I delve into the work stuff. Some of this is factual and some of this is just what I have observed over the past 6months. As you know, Saudi is an Islamic state that governs everything concerning their daily lives – personal, work-related and governmental – according to their interpretation of the Koran. Saudi is unlike most Islamic countries in that they interpret the Koran to the extreme. The words of the Koran are bent and twisted, interpreted to suit the needs of the men in this country. It is the strictest Islamic country in the world. ONLY here are women not allowed to drive, and this has nothing to do with Islam, it's strictly cultural. Also, ONLY here are women expected to veil and wear an abaya. Only in Saudi are men and women segregated in their daily lives. Only in Saudi are there separate entrances to businesses for men and women, separate seating areas in restaurants/public places and only here are women generally not allowed to work outside the home.
The most ironic part is that since women aren't allowed to work in businesses, for the most part, when a woman goes into the women's section, she is forced to do her business with a man, which is against their culture! Men and women generally do not speak to each other, as it is the general Saudi culture that a woman and man cannot speak to each other unless they are married or related. Men and women do not socialize, dating is forbidden. Arranged marriages are still the norm and most men and women do not meet before they are married. A girl is considered marriageable (and must begin to veil) when she gets her period, no matter what the age. A man can have up to 4 wives. So let's talk about the men…..I've learned a lot about why men act the way they do here…most of it is appalling.
When a male is born, it is cause for great celebration. When a woman is born, it is a time of sorrow. From the time of birth, a male child is doted upon and made to feel like he is the king. If he has a sister, she witnesses this behavior as she is virtually ignored by her father and brothers. She is taught to believe that men are superior and she is worthless. This thinking has been passed on from generation to generation. Males get their hearts desire and learn at an early age that they are the chosen ones and that it is their job in life to oppress the women as they are only put here for 3 reasons: to serve their men, to be sexually available to their husbands at all times (unless on her period) and to have children – male children.
A man may take up to 4 wives at a time – apparently there is a practice of serial wife taking….if a man grows tired of the 1st wife, he simply takes another and the first wife really has no say in the matter. Some of them are actually relieved to share the burden of their miserable lives with another. There are stories of the wives becoming fast friends as they hate their husbands so much they bond over their misery! So if a man has more than 1 wife, they must all be treated and loved equally, according to the Koran, but this only happens with the wealthy, who can afford up to 4 palaces. If one is lucky enough to be beautiful and born into money, a woman will be a first wife and if she is really lucky, she will be loved and will be the only wife and she will bear sons. If she is poor, then she may or may not find a love marriage and she may or may not always be the only wife. If she is really poor, then she'll probably be married off at the age of 14 to an abusive old man who has tired of his 1st, 2nd, 3rd wives and she'll be the 4th wife to a man 3-4x her age. He will use her to rape her nightly and live out his twisted sexual fantasies and there is nothing she can do about it…such is her lot in life. She has been purchased as property (dowries) and has no say in the matter.
Once a man tires of her, if she is one of 4 and he seeks a new sexual partner (legally), then he simply divorces one of his wives and takes a new one. A man uses this fear of divorce to keep his wives in line as once a woman is divorced, it's difficult for her to re-marry unless she becomes a 2nd, 3rd, 4th wife for someone else. To divorce, a man simply tells his wife that he divorces her on 3 separate occasions in front of a male witness. For a woman to seek a divorce, she must go through the courts and demonstrate just cause, but the judge may or may not grant her divorce. If a man and woman divorce and there are children…female children almost always go with the woman as the men generally don't want to be burdened with them. Male children stay with their mother by law if they are breast feeding. By law, a mother keeps her son until he is 7, then he can choose where he wants to live and the husband always makes sure he is the chosen one, so no matter what, the mother will lose her son in a divorce. She will most likely then return to her home and live with her family, either parents, brothers, cousins…anyone she is related to.
Women are not allowed to live alone here….they cannot rent apartments or buy houses in their names. Women are not allowed to travel unless accompanied by a male escort (family member/husband) and if she is married and traveling without her husband, she must have a legal document that states he has given her permission to travel without him. Women are not allowed to make any decisions regarding to control her own body, such as with medical decisions, which I'll touch upon later. This is the horrifying stuff: if a woman is raped, it is her fault as she was not chaste and provoked it. No point going to court as the men will never be punished. When the father finds out she was raped, she'll often be put to death somehow to defend the family honor and since she's not a virgin, is unmarryable anyway. If a woman is walking down the street and shows a little leg, arm or hair and there's a car accident because a man was looking at her, it's her fault for not covering properly!
A women must be a virgin upon marriage; if it's discovered she's not, she's divorced and can be put to death for sex before marriage. Men are expected and often hailed for having as many sexual partners as possible, often traveling to the far east to take prostitutes or sleeping with "loose, slutty western women." It's truly appalling the way a woman's word means NOTHING. If she is unluckly enough to be involved in a sexual crime, she will suffer for it, for it's always blamed on her and her lack of Islamic values and modesty. Of course, there are exceptions and there are women who travel and sleep around – I've read that hymen surgical repair is a common surgery or women resort to such trickery as placing a sheep liver inside the vagina to make a man feel like she's a virgin and give the inevitable show of "blood" upon intercourse.
For most women, the first time for sex is rape by the husband….very sad. Women are basically prisoners in this country – prisoners to their husbands, prisoners in their homes and in their lives. If a woman is lucky, she will have progressive parents that will allow her to choose her husband, that will allow her to have an education, and that will allow her to travel and see the world and maybe even have a professional job outside the home…speaking of which, women are only allowed in some professions – teaching, nursing, sales (to other women). A woman cannot study to be an engineer. Women's colleges, again segregated, only offer a few subjects and engineering and other "mens" degrees are not offered. However, that being said, more and more women are entering colleges and working outside the home, so things are slowly changing. Some women are choosing not to veil, but can be harassed for their choices.
Back to the men….So I see evidence of the way men are brought up to believe they are superior in my daily life and it's infuriating. For example, if I am talking to a shop owner or in line to pay for groceries, obviously I was there first. However, a man will come up and stand directly in front of me and take over my place or interrupt my conversation like I'm not even there! It's like he does not see me or acknowledge my existence and I'm a WESTERNER, imaging how the locals are ignored!
If I am walking towards a door and a man is walking next to me, he will enter the door first and NOT hold it open for me! At the airport, it was hot and dusty, I was wearing my hot abaya and tired….waiting for passport control and my turn in line. I was next but when I started to walk to the counter, 2 men walked past me and put their passports on the counter! I was so mad, but of course, could not say anything….it's been very hard for me to hold my tongue, of course, not speaking the language helps! The men walk around in their flowing white thobes with their red ghuttras on their heads and they act like they are gods walking on earth. The way they walk is even irritating – they just push their way to wherever they want to go, never saying excuse me…however, when they come upon another man, they are all smiles and friendly greetings, so courteous of each other!
For the most part, the men who are educated and especially those who are educated in the West, are a bit different and more liberal and are more likely to treat their women as (almost) equals. There are a lot of female doctors now and their husbands are also professionals, so their lives resemble what we see back home. These women are independent and outspoken and often come from families of money. It's mostly the uneducated, poorer people that are so disrespectful of women.
Let's talk about health care in Saudi. Rules first, then observations. A woman who enters the hospital must be accompanied by a male family member as she is not allowed to sign any consents for medical treatment. When Dooly's sister flies in from the western region, he accompanies her to her appointments. A woman must have a sitter present at all times – this is either someone who is paid to sit with them or, most likely, a family member. Males don't always have to have sitters, unless they are confused. A doctor will not discuss medical issues with a female unless a male family member is present in the room and then, he addresses the male, not the female directly. I have to be present in the room if the doctor needs to examine the female and the male family member is not present. If a procedure is needed, the males must sign the consent. The shocking part of this is that the female does not always know what the procedure (on her body) is that has just been consented! The males do not always tell the females what their medical condition is.
For example, a mother came in with her sons for a below the knee amputation. They consented to the surgery and told their mother she was going for a simple test. She woke up without a leg and there was nothing she could've done to prevent it! Women are not told they are sick or dying and death is never talked about. DNR's are rare. They require 3 signatures by physicians and the family agrees to the DNR. However, they are not always told what DNR means. For example, I had a 3 year old adorable girl with terminal brain cancer that was actively dying. She was made a DNR by the doctors, with the consent of the father. When the child stopped breathing and started turning blue, the wife got hysterical, wanting the doctor called and the husband (after fainting), wanted her taken to ICU….they didn't understand why we were just standing around and monitoring her breathing and heart rate.
There is NO preventive care here. When people finally seek medical treatment, their conditions are serious. 1 in 4 people in this country have diabetes, undiagnosed until entering the hospital. Many have high cholesterol and heart disease because the diet is very nutritionally poor. Lots of obesity and with a sedentary lifestyle, you can see the recipe for disaster. For example, most women who come in for cancer treatment are stage 4…They are not taught to examine their breasts to catch the cancer at stage 1, where it is almost always 100% curable. There is a tremendous need for education here, but the men don't want their women educated, which is part of the problem. Narcotics are not freely dispensed here like back home. Islam believes that there is dignity in suffering and that the rewards in paradise are more if you suffer in this life. Only when the pain is extreme is morphine ordered. The drug of choice here is tramadol and even then, it's treated as a narcotic - possession of narcotics here is punishable by death and the accounting of narcs is highly monitored. For example, if we use morphine, and take 2mg out of a 4mg vial, we have to account for the other 2mg (multiple witnesses needed) and put the empty vials back in the pyxis so empties are also counted by the ministry of health! It's ridiculous.
There are signs everywhere that reminds us that narcotic abuse is punishable by death! Narcs are counted twice a day at shift change and any discrepencies are seriously investigated – and we complained back home about having to do it once a week!!! So, that's about it for the rules…now for the observations.
Coming to the hospital is like a social event for most. Usually, the entire family accompanies the patient to the hospital and there is almost always a room full of visitors – sometimes only males, sometimes mixed, but the women are always veiled in the presence of men. Women use this as a opportunity to socialize with other women and to get dressed up and get out of the house! It's quite the social event. You will often see one male followed down the hallway by up to 10 females, all clad in black – mother, sisters, daughters, wives….all coming for their social visit. The women are chattering away with each other while the man is walking in front, superior. They are almost always carrying huge bundles of flowers, food from home, large displays of candy/nuts/dates, etc…They are very big on the gift giving. A diabetic patient will be given tons of candy by family and we can't do anything about it and it's frustrating when we walk into his room and he's eating McDonalds followed by a giant shake and cake then doesn't understand why his blood sugar is 600!
The general Saudi culture is taught that once one enters the hospital as a patient, they are to assume the role of the helpless one, so often we are called to the room for little things, like turning on the light or TV – it's annoying….some patients assume the role of prince/princess, expecting us to cater to their every whim, and then when we have an actual princees/princesses, THEY tell US when we can take their vitals and assess them, and when they will take their meds….they are all such big babies. The cool thing is that they give us "tips" and lots of their food. One guy, who clearly didn't have money, gave me 50 riyals (about $15) after cleaning up his father, and another lady gave me the ring off her finger after combing her hair.
In the evening, after the heat of the day has begun to fade, everyone that is able goes out to sit in the garden. Their families bring dinner and coffee/tea and they have picnics on the hospital grounds – this part I actually find kinda sweet, except when I need to see my patient and he's nowhere to be found! One thing that is really weird is that patients do what called "out on pass." For example, limited procedures are done on Wednesday and no procedures are done on Thurs/Friday as it's the weekend here (unless emergent). A patient will come into the hospital on Tuesday, for surgery scheduled from Saturday. The patient will come in, get admitted, then ask for permission to go "out on pass." This means the patient simply goes home and comes back on Friday night to prep for his OR on Saturday. It's so strange. The hospital holds their bed for them until they come back – they can be gone up to 72 hours. In America, where insurance rules everything, this would NEVER happen! If you're sick enough to be admitted, you' re too sick to go home and if you choose to go home, they don't pay! But here, every Saudi citizen is entitled to free healthcare. The government foots the bill and there are no private insurance companies. Tests are freely ordered, no matter what the need or the cost. It's kinda nice not to have every move regulated by insurance companies.
Dealing with cultural issues and language problems are the difficult things. For example, I go to give a med and my patient is praying, so I have to remember to come back later but when I do, my patient has gone to the garden, so it's can get quite frustrating at times. Patients generally like to sleep until noon and do not like to be awakened for vitals, meds, etc. Most won't take their meds until after eating, even protonix or synthroid no matter what we tell them. The trays do not come unless the patient calls the kitchen for them, so they often order breakfast at noon when they wake up! I use the translators a lot, but my Arabic is coming along nicely. I've got the general phrases down, but use the translators for education stuff as I want to make sure they understand me. All in all, it's in imperfect system with the same nursing challenges as anywhere else, but the cultural and language stuff makes it difficult at times. There are days when I just go to the bathroom and cry out my frustrations, but then again, I did that at home! I've had 2 marriage proposals from either patients or their sons….sweet, but no thank you! I think some of the boys just come to visit their relatives and friends to see flesh…in the real world, women are covered from head to toe and these young boys have never seen skin or uncovered hair…except on TV, so they come and see the Western nurses with arms and heads exposed. I heard that when the hospital first opened, the young boys would sneak in at night to gawk at the nurses, so they had to increase security! It's sad that society is so oppressed that that's what boys did for fun!
So that's basically my life here in Saudi Arabia. Dooly and I do "date" but it's with great fear. I have to veil so I'm not drawing attention to us when we are in public together, since it's illegal for us to even ride in the same car together. If we are caught, I will be arrested, fired and deported. He will get a slap on the wrist. It's always scary when we go out as there's the constant fear that we'll be caught, so we don't venture out too much. I don't like veiling as it makes me feel like I can't breathe and of course, I can't see worth a damn with a veil over my eyes! I don't know how women do it! Once married, safety will no longer be an issue and we can do more social things and get out more.. Usually, he picks me up after work and takes me to his apartment where we hang out…he goes to work and I stay home…pretty boring. I can go out with other women anywhere I choose if I take a taxi. There are some Western ladies that I go shopping with or we take social club trips to areas around the city. There is a large Western community here and many social activities are organized for us, so we don't die from boredom! Despite that, life here is pretty boring, but with the good money, at least we can frequently travel to places where we can actually have fun!
