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