Life of an expat in the Middle East: Paramedic – part 2

Rachel McDonald

By Rachel McDonald

Rachel McDonald is a British paramedic who spent two-years working at one of the biggest hospitals in Riyadh, Saudi Arabia. Whilst working as an EMT, she was headhunted and honoured to provide medical support for a royal family whilst they travelled.

15 Jul 2018

Life of an expat in the Middle East: Paramedic – part 2

Ambulance in Saudi Arabia Editorial credi - Ali Al-Awartany -

‘I had an incredible and life changing experience whilst being apart of the medical world in the Middle East. I am delighted to be able to share my experiences via this series, the life of an expat in the Middle East. I aim to portray the various aspects involved in relocating to the ME for work and the many benefits.’

Read part 1 

Now that I had arrived, and the ground was slowly starting to settle beneath my feet, I could focus on finding a daily, working routine.
My induction training was taking place at a different hospital, managed by the same company, which was across the other side of the city. It required me to catch a bus provided by the hospital. At that time no women were able to drive within the Kingdom of Saudi Arabia and so bus or taxi where my only options.

Riyadh Saudi ArabiaI have always been fiercely independent and gained my driving licence at seventeen. Therefore it was alien to me to be dependent on others to get around. However, I actually started to enjoy the bus-taking process; I would wake up around 6 a.m., eat breakfast and make fresh coffee, after I would walk over to the bus stop to catch the 07:10 bus. It turned out to be a good time to put my headphones on, listen to music, and gather my thoughts, people watch, or do some last-minute studying. Occasionally I would bump into my clinical supervisor, but the conversation wouldn’t be taken over by work topics instead she would tell me useful local information.

The other partner-hospital catered for chronically unwell children and had its own ambulance station within the grounds. The training centre was directly above that. Linda had the training room set up with resuscitation mannequins and a whole variety of medical kit to have contact with.

Life of an expat paramedicLinda and I would go through the training programme and then stop to have a little chat or pick up some food every now and then throughout the day. Linda was always very enthusiastic about all the travelling she had done during her seven years stay in KSA. She would show me her pictures of her hiking to the top of Kilimanjaro or diving in the red sea, all the while my adventure to do list was getting longer and longer!

Whenever a new employee starts at the hospital they are placed in a three-month probationary period, meaning you can’t leave the country or take any annual leave until that period has ended. You also need your exit visa and a hard have your iqama (personal identity card, stating your employment and marital status) processed before your 30-day visa runs out. This time was possibly the longest three months I had to do. The holiday plans were being made in my head, so I had something to focus on when times felt a little stressful or when home-sickness kicked in.

When I arrived in the country and for the first month of my training it was the holy month of Ramadan. It generally arrives at peak summer time, but its specific start and end dates follow the lunar or hijra calendar. During this time my Muslim colleagues were fasting and as you can imagine this is a challenge and the utmost respect must be shown during this time. Which means you cannot eat or drink in public after morning prayer (Hijra) or before last prayer (Isha) in the evening. There were designated spaces for dining within the hospital for people who were not fasting.

My training day would end around 3 p.m. and we would walk out for the 3:15 p.m. bus back to the main hospital.
My training weeks were quickly evaporating and soon I would be on duty for my preceptorship (mentoring) weeks. Linda placed a big emphasis on me being confident with the infusion pumps and electrical cardioversion. I remember going over them repeatedly to try and become confident.

After the four weeks of training, I had finally completed all the subjects and was deemed competent. I was assigned a preceptor (mentor), called Chris who I would work alongside with his emergency medical technician (EMT) partner. The assigned EMT partner speaks fluent Arabic so they were either local or had spent long enough in the kingdom to have learnt to speak it. That person became your right hand man. They ask all your questions and basically repeat your patient assessment to every patient, they will help you communicate with lesser confident English speakers and they will also direct the ambulance drivers who did not speak English.

At first, my preceptor’s and the EMT’s working style was confusing to me, but I just did my best to take everything in and formulate my own working style.

I remember the first morning with my preceptor and we had to attend a code green call. This is the same as the crash cart being called in a UK hospital. The ambulance department helped form the code team. It was a manic situation to be involved in and the best thing I could do was listen to all the important information, document drug dosages and times of administration, airway type and size, patient’s medical history and time of collapse because as soon as the patient is stabilised everyone leaves the room and its over to you to convey and keep stable until they arrive at their destination, which would usually be an intensive therapy bed on the other side of the hospital.

The problem with this current patient was that their blood pressure was dropping and the quickest way to increase and stabilise it was to administer two minutely medication. We gave this whilst conveying the patient around the hospital by road ambulance and to the main entrance and intensive care unit. In that single situation, I saw Chris manage the critically unwell patient, doctors, and nurses, his EMT partner, the none-English speaking ambulance driver, the physical element of a patient on a stretcher being ventilated and heavy kit bags in the desert heat. It was a full-on situation but over and done with in under two hours and then we were on to the next patient.

Read more next time!

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