Earlier Thoughts

Friday, February 4, 2011

One Year Here

                                                         “The farther one goes
                                                           The less one knows”
                                                                                                   -          Lao Tsu, c. 550 BC

Living in Saudi Arabia has helped me to learn directly about the people, and political system of this country and the Middle East.  Today I watched television broadcasts showing the misery of Egypt as their people protested for freedom.  I visited Egypt a few weeks ago to stand in the very location at the Cairo Museum where rioting and destruction are happening now.  Here all is stable and calm.  Some rumors floated this week about minor protests in Jeddah about the unemployment situation and issues over flooding following a second year of heavy rainfall.  Life goes on without missing a beat in Riyadh.
I am now at the one-year mark as an expatriate.  It is strange to think of myself in this way, as someone who belongs in California and not here.  My enthusiasm to have an international work opportunity and to make a good impression among people of Saudi Arabia as an American importing valuable “western” hospital practice is a bit more realistic now. I had earlier underestimated the challenges of this endeavor.
I am an expat, but the meaning of this label isn’t clear.  When among westerners, expat means you are someone who is anxious do some work, to get something done, eager to demonstrate the “right” way.  Not all expats are equal. Those from impoverished or third-world countries don’t receive the privileges of North Americans, Europeans and Britons. Demographic information like expat headcounts by country or region of origin are dissected into groupings of professionals or laborers. All of the data sources are suspect. The numbers don’t true-up when compared against each other. I have accepted the idea that the Kingdom is populated by about 24 million people of which 4 million are expats with 1 million being professionals. Some think that professional expats are overpaid and have privileges that others don’t receive. 
Expat can be a derogatory term associated with our transient nature or a concern that we are overpaid.  Expat contracts are for time periods of between one to five years, and most have provisions that allow the employer (also known as the Sponsor of the work visa) to end employment at-will for breaking work rules, committing legal offenses, or becoming redundant.  This at-will employment contributes to the volatility of the expat work force.  As the Kingdom builds internal capability by educating its people, the Interior Ministry increasingly limits the number and types of visas issued to professional expats. This effort to train and employee Saudis makes sense.  The absence of sufficient number of on-the-job training slots for new technical and academic graduates to gain journey level skills is hindering this transition. (My recall of the literature is that a new graduate requires 10,000 hours -- five years -- of working time to be fully qualified.)  To the concern that we are overpaid, I don’t agree.  Tax benefits for all of the Western expats do afford a lift in our wages; our hourly rates are only equal to what we would have earned at home. At least this is true for me.  Adapting to a different culture, living thousands of miles away from family and friends, and becoming only an observer of life (not a new experience for my Canadian friends) isn’t entirely offset by salary gains.
Never in my wildest dreams did I imagine how difficult it would be to get my house fixed-up enough to have working Internet and television connections, or repairs made to provide hot water or air-conditioning.  It took almost nine months to settle my living arrangements.  Now it is finally possible to go home at the end of each day to prepare a meal and relax. 
It is still surprising to find myself tired and emotionally exhausted at the end of workday.  Every day is an ongoing challenge to get access to information and help from co-workers. Asking for assistance, to be greeted with an announcement that what I ask is difficult and requires invoking God's blessing before beginning worries me.  Most often my colleague takes action and progress occurs, but my worry sometimes turns into 4-in-the-morning awakenings and an early ride to the office.   
But what about my time at work?  One person told me in the first two weeks of working here that I didn’t bring anything meaningful to the hospital as all that I knew was available on the Internet.  Fortunately most staff is open to discussing ideas and incorporating new information into ways of doing things differently.  Work life, the committees and hallway conversations are much as they occur at home.
My enthusiasm for working here isn’t any less than it was a year ago, as the level of my involvement in the operations of the medical division is engaging.  I know you must think that the politics in America, with independently practicing physicians possibly losing control to business people (accountable care organizations and insurance companies), is at least as emotionally charged as anything in Saudi. Let me assure you that the differences are real. 
The experience is in me now and I am being shaped by it.  Insha’Allah tomorrow will go well. 


  1. The Force be with you. Don't let the Bodysnatchers get you.
    Don't ever change.
    Don't ever change for work.
    Don't ever work for change.
    Forgive the ramblings of yours truly.

  2. I love what has happened to your writing since going in-country. Your introspective abilities, in the past somewhat maudlin, were always suspected but not on such a scale. You are letting us read what it is like to be shaken to a core that is now seen from a new perspective. The reflections are sufficiently global that I find myself developing ideas that were a seed when I contemplated your departure. Keep writing, please. I am certain you are in the vortex of an international realignment of cultures, capabilities, expertise and fear...or is that wonder?

  3. Thanks for sharing your experiences - valuable insights for those of us who have not taken the leap. Keep up the good work!

  4. Beautifully written, Ron! Arianna Huffington began with a blog – 315 million dollars ago (you might have heard she sold to AOL recently) :)
    Please keep sending these to us.

  5. Expat. Is it any less meaningful than VP? Update on Accountable Care orgs - they are going to be staffed and run by physicians. Will healthcare reform in the USA move any more quickly than in KSA? I hope so.