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Wednesday, September 7, 2016

Completed a year since leaving Saudi Arabia ... and why NHS is so admirable.

This is a reminder to me that I left the Kingdom of Saudi Arabia on the 3rd of September 2015. Hopefully, it would be my first and only stint of working in the Kingdom. The major takeaways of that stint of nearly 4 years were  the fact that I was able to perform Umrahs and Hajj; that I was able to save some money; that I was able to emancipate my family from being dependent on me; and that I completed the exams that would serve as my stepping stone to enter the United Kingdom (I am talking about the M.R.C.P.C.H.). 

I am unable to say which of these four achievements have led to the maximum benefit to me and my family. I would probably say each of them had their own merits. Spiritually, I came closer to Allah with my Umrahs and Hajj. Mentally, I was able to study further and get qualified with an additional, U.K. approved, post-graduate qualification. My family's "independence" served to liberate me as well. Today, my wife Nishrin and my children, Inas and Hannah have become largely independent and only occasionally have to consult me. Finally, the bank balance has permitted me to take positions in some investments within my country, something that I could not have done earlier.

Since my arrival here in the U.K., I have learned to adjust with the entirely new and unfamiliar system of medical practice. I have realised that I have a long way to go before I will get accepted by my bosses. I am currently learning a lot of skills by working at different trusts in the North Western part of England (and occasionally at other trusts in the U.K.). These skills include communication skills, cannulations, lumbar punctures, planning therapy, child protection, and a lot more.

Over and above this, I am beginning to understand how the English health system (the NHS) functions below the belt. Its underbelly, if you understand what I mean. Initially, I struggled to work, especially when it came to managing the out-patient clinics. Now, don't get me wrong. I have had a clinic for nearly 25 years in India before I went to Saudi Arabia. Nothing prepared me, however, for the kind of patients you see in the U.K. There is acute paediatrics, of course. In the clinics, however, it is all about chronic stuff. Things that can stay in a child's life for years, if not decades. Until 16 years of their life, they are ours to see. In some cases, especially with children having chronic, incurable illnesses, we continue to manage them even when they cross that age. After this, however, they transition to adult medicine. In India, the most we could do was to see them until they turned 13. I did have a few of my old loyal parents who came to me with their 15 and 18-year-olds to have them treated by me, but it was legally untenable. 

However, it is not just about age, or the chronicity of problems. It is about the range of diseases and problems that are totally different from a tropical country like India. Additionally, it is the inherent knowledge patients have about their own illnesses and about their own biological stuff. Finally, it is about how to communicate with them. British sensibilities are completely different from ours. What we discuss with patients openly in India has to be said privately and with much more empathy, for example. The risk of being sued in courts always hangs upon you wherever you work, but it is definitely much more in the U.K. compared to India. 

There is yet another, very crucial difference. In the U.K.. there is a huge infrastructure of community and outreach services that have no comparable example in India. A child with cerebral palsy, for example, has to spend huge amounts to even reach a level of mediocre care in an advanced city like Delhi or Mumbai. Even then, when it comes to successfully rehabilitating that child and integrating him with society, we can hardly do anything. In the U.K.. the system is so advanced that the child gets automatically eligible for a range of rehabilitative services. For example. even his home can be modified at government expense to get him to have a ramp to ride his wheelchair on. If a child with excessive illness related to pollution applies, he and his family can be given an entirely new place to stay by the government. Of course, the family will pay off whatever they can over years and years, but care to the child will not stop because the family does not have the means to fund it.

Child protection is a big thing and abuse of a child sets off a chain of governmental remedial actions that include but are not limited to removing the child from the influence of his abusive relatives, handing him over to an appropriate foster parent, or hand him over to court, which will then place him appropriately, police action that is swift and commensurate with the degree of the abuse, and so on. Social care services will then continue to monitor the whole thing ... until the child can be, if feasible, returned to the family - or be kept away for as long as is needed. 

With such services spread nationally, it is not difficult to understand why the U.K.'s NHS is considered to be one of the best health services in the world. And the services are 90% free to the people - not just British or English citizens, but also legal residents and immigrants after their stay has been legally sanctioned. 

This is all I will be writing about in this post. Do leave your comments below. 

Thanks for visiting, reading and interacting with me.

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