The past two decades have witnessed increased migration of doctors from developing countries to rich countries in what is widely known as the brain drain phenomenon. Practicing medicine in a different culture brings about several challenges and opportunities. I wish to share with the reader my experience as a Sudanese doctor working in the Irish health system.
In my view psychiatry is probably the most difficult specialty for a doctor to practice in a country other than her/his own. While the basic principles of medicine such as history taking and physical examination are more or less taught similarly in medical schools around the world, it is the knowledge of the host culture or lack thereof that could make or break a successful career in psychiatry. Let me give you few examples. My first job in Ireland was with a consultant who specialised in alcohol addiction. When I started the job my knowledge of alcohol was limited to what we were taught by our mentor before we sat the Irish medical council assessment exam. This was basically knowing how to diagnose alcohol dependence and that a pint of beer contained 2 units, a glass of wine and a shot of spirit contained one unit. Little did I know that taking history from patients was not as straightforward as I thought it would be. Not least of my difficulties was being able to understand the Irish accent, I soon started to realise the importance of understanding the Irish drinking culture. I remember taking history from a patient who kept telling me that he went to AA. For me at that stage the only AA I knew of was the insurance and road assistance company who had an advertising booth in the shopping centre near my house. Recognising the bewilderment on my face, the patient kindly explained to me that AA stood for Alcoholic Anonymous, a support group for people with alcohol problems. I also remember struggling with phrases that both patients and colleagues used such as ‘high as kite’ when referring to somebody being markedly elated or even simple words that Irish people use like ‘grand’ when you ask about their mood.
Another important issue is overcoming the fear of being exposed, something that probably stems from the medical education system in our country where doctors are treated like gods who are expected to know everything and that one would probably feel embarrassed to say I don’t know or ask questions for fearing ridicule. I have to say, and I know I can speak for many of my colleagues who were in the same situation, that most people are ready to help if one takes the right approach. I remember the first consultant I worked with stating reassuringly that he knew I was new to the system and told me not to worry about asking silly questions and that he would actually get worried if I didn’t ask questions.
If I were to give advice to my colleagues who are embarking on new career in Ireland, based on my own experience, I would say what I have found most helpful in those early days of my career in Ireland was the collegial support of my fellow compatriots and the support of Irish colleagues. I think the key to surviving the transitional period in a new country is enlisting as much support as possible both from people from one’s own culture and colleagues in the new workplace. It is quite normal to be anxious and worried at the beginning and in time they will be able to look back and laugh when remembering those days.
Dr. Sami Omer
Kingdom of Saudi Arabia
The objective of the day was to address the challenges facing doctors new to the Irish Health System, and provide a comprehensive overview of essential skills such as writing a CV, performing an audit, interview skills etc, and ease the administrative burden.
The day consisted of lectures directed by consultants and senior colleagues well accustomed to the pitfalls facing both current and future doctors. It was attended by newly registered junior doctors eager to launch into their fresh careers in Ireland, doctors who have already established in the Irish system and keen to advance their careers further, and the aforementioned senior colleagues, ever willing to share their invaluable experiences and offer their guidance on advancing in this demanding profession.
SDUI wishes to thank all the speakers at this point, for invaluable contribution, and we are ever mindful of the demands on their time. Following the seminar, feedback from our colleagues was positive, and we hope to have the opportunity to conduct similar workshops for our junior doctors in the near future.
Furthermore, the enthusiasm following the success of the workshops has inspired us to look into new approaches to support our juniors, and we are pleased to announce the initiation of the Mentorship Program.
This program is open to all newly registered doctors, and involves linking each junior doctor to a senior colleague in their chosen specialty, who will act as their mentor. The main aims of this arrangement are to provide one-on-one confidential advice and supervision on all aspects of career, based on individual strategies and aspirations.
We also recommend the formation of a “six monthly plan”- goals as agreed between mentors and junior doctors, and frequent reviews to ensure its implementation and achievement. The fundamental purpose of this initiative is to aid the career progression of our juniors by whatever means we have available to us. And to this end, we are open to more suggestions and proposals.
We are grateful to all our colleagues who have so far signed up to the Mentorship Program, and are confident in the hope that your time and advise will continue to prove highly useful. We recognize that many of our colleagues are now hoping to leave the Irish Health System and travel abroad to broaden their horizons. We acknowledge this decision, but would still encourage our colleagues to take part in the Mentorship Program, as it promises to deliver highly relevant skills and counsel, that will no doubt be of benefit to you wherever you choose to establish your career.
We once again extend our gratitude to our esteemed colleagues for their time and their effort. We would also like to thank Global Medics Ireland and everyone who participated in the organization of the day and all those attended and helped make this day a successful and productive event.
Belonging is a complex emotion one that I feel is more influenced by personality, life events and personal relationships with others, than by birthplace or physical residence. For Sudanese in the Diaspora this issue is no doubt currently topical. A whole generation of young Sudanese adults now exists who have neither lived in Sudan nor known a Sudan pre-1989. Moreover, the seismic shift in the country’s geography and unravelling of its social fabric in the past 24 years has brought to the foreground the deep rooted ambiguities in our sense of nationhood.
I suspect most Sudanese families, like mine, who have left in the 1990s did so reluctantly and with a sense that this is likely a temporary state of affairs. Until recently my UK-based existence was measured – similar to the school year – by academic progression and family holidays. It was not until I spent a few months in Sudan feeling somewhat lost socially and professionally that I mournfully accepted my British reality. My move back to the UK was a cold and calculated one. The associated emotional burden was immense and sense of loss acute. There was now no denying that my perspective on my own country and people had changed, that my physical connection to my homeland had waned, whilst loved ones were carried further away in the brutal daily struggle to etch a living that defines life in Sudan today. Moreover, my medical background has laid this burden more heavily on my shoulders as I struggled to reconcile my decision with the sense of betrayal of my medical oath and the real adverse repercussions of a rapidly vanishing medical workforce on the state of Sudan’s healthcare.
My sense of belonging may have shifted but that of duty towards my country folk remained the same and became more urgent.
Medical practice has been a source of solace. Whilst the art of medicine can sometimes be lost in translation, the universality of human suffering help us bridge those cultural differences and empathise with and endeavour to positively contribute to our patients’ sense of wellbeing.
In contrast to Sudan’s cultures that are deeply rooted, tribal specific and sharply defined, being British, it seems at times, is what one makes of it. A broad canvass in which one can assemble one’s own collage of experiences, places and people to make up one’s own version of their new culture and weave it into their life story. And so it is that one slowly gives legitimacy to those cherished aspects of British life – the fervent uphold of the rule of law; the fight to retain the essence of the NHS, free at the point of use; the guardianship of the freedom of the written and spoken word, and the respect of the equal rights of others.
The hope is that our individual experiences in the Diaspora enrich our interpersonal dialogue as Sudanese so that we would ultimately be able to reconcile our differences and rebuild our nation.
Dr. Rawya Kamal
Respiratory medicine registrar NEWCASTLE UK
vice academic secretary, SDU UK & I