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At the heart of general practice since 1960

Postcard from...the Middle East

Dr Malcolm Maclean, who set up his own practice in the Northern Emirates three years ago, explains what life is really like in this fast-moving part of the world

Dr Malcolm Maclean, who set up his own practice in the Northern Emirates three years ago, explains what life is really like in this fast-moving part of the world

Several things prompted my decision to come to the Northern Emirates. I was working too hard in the UK, I needed more sunshine and I'd had a previous enjoyable experience of the Gulf in the 1960s when I worked in the medical department of the Kuwait Oil Company. My son is a property development consultant here and one of his clients invited me to develop the building into a medical practice and sponsored me.

Financial incentives

It is probably best not to allow the prospect of higher earnings in the Middle East to influence one's decision to come here. With the exception of Saudi Arabia, earnings are generally less than in the UK. Inflation in at least one Gulf country (Qatar) is running at around 10% and Gulf countries have started to detach their currencies from US linkage which will cause a depreciation of the pound.

Job contracts

Contracts in the Middle East are potentially open to liberal interpretation.

The way around this is to consider employment only with an organisation that has a sound track record and does not have a history of rapid staff turnover. Try to ask around, although this is more difficult if you are outside the country.

Setting up a practice

The costs and complexities of setting up your own practice are enormous. Property prices are now on a par with New York and the costs of business and practice licences together can run into tens of thousands of pounds. With limited exceptions, an invitation to practise is required.

There are shortcuts to this procedure but the last case I heard of was going to cost over £500,000 – and not many people are prepared to wait several years before recouping that amount of outlay in a part of the world considered to be at risk of instability.

Expat patients

Many, if not most, UK expatriate patients are dehydrated during the summer. Stress levels in their lives are greater than they were among my former patients in London. Working hours are long – 12-hour days, six days a week is not unusual.

Many female patients have husbands visiting various sites of their multinational employer, and are unsupported and isolated from friends and relatives. Services for young, inexperienced mothers are incompletely developed.

There is marked inflation, road conditions are chaotic. There is a general reluctance to schedule short breaks and of course there is the problem of cultural difference.

Anxieties express themselves in different ways. I have much longer consultations here and remain alert to the patient's agenda. If they are looking for the usual quick fix then this itself can be a sign of desperation arising out of anxiety.

Compared with other Western countries, UK expats will have had fewer investigations under the NHS and can become alarmed when their cases are sent for investigation here.

Arab patients

An Arab doctor friend once said to me about his own Arab patients: ‘You may be examining them but, be sure, they are examining you.' There is a strong tradition among Arab patients of shopping around for the opinion that most accords with their prejudice.

Psychiatric disease tends to be rare among Arabs but when it does arise it expresses itself more readily in psychosomatic complaints rather than the anxiety/depressive symptoms commonly displayed by Westerners. So the difference between the two groups is not quite as great as might first seem to be the case.

Liability for referrals

Strange as it may seem, if a GP refers a patient to a specialist who mishandles the case, the GP may be held responsible.

There are numerous specialists in the oil-rich emirates, so many in fact that one wonders if they have enough throughput of cases to maintain their proficiency. Broadly speaking, the depth of experience of local specialists is not yet fully developed. I had occasion to discuss arrangements for the hospital admission of a patient with prolonged fever (ostensibly PUO because of tropical disease). The acting tropical disease specialist got involved and I was astonished to realise they knew less about tropical disease than me. I embarked on a prolonged search through the local hospitals to find a specialist with experience of tropical PUO.

Pharmacies

Pharmacies are not permitted to stock many powerful analgesics. The range of medications is surprisingly limited and my drug formulary book is 152 pages (my UK edition is 390 pages). Prescriptions for antidepressants require the use of a special Health Department prescription pad and such powerful analgesics as are available, for example tramadol, are restricted to about three days' supply. Medications are being manufactured all over the world these days and some Gulf pharmacies prefer to stock brands manufactured in places other than the West.

Falsification of medications is said to be widespread. You can therefore spend a lot of time ringing round to find a pharmacy that has the medication in stock and checking it has been prepared by a reliable manufacturer.

Lifestyle

The climate is an obvious advantage of living here, although it's too hot for some. There are excellent recreation facilities and cuisine and service on a par with Paris. The crime rate is low, which is one of the main reasons people give for living in the Gulf. The local press and Al Jazeera TV service give more balanced news coverage than anywhere in the West (including The Guardian).

I also find the absence of political correctness most refreshing. The different races celebrate their own festivals without anyone looking over their shoulder to see who is being marginalised. For example, there is a rule during the Ramadan fast that there should be no eating, drinking or smoking in public. This is accepted and everyone just gets on with life out of respect for local norms.

I am aware that establishing myself here has been relatively easy because of the introductions I've had. But the sunshine, architecture and the buzz here means people will always come to find out if life in the Middle East is for them too.

Dr Malcolm Maclean is a GP in Jebel Ali, Dubai

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