An Occasional Visitor to Dumfries & My ‘Scottish Heritage’ by Tarik Elhadd

(This article was written in Dumfries in August 2015)

I have always been fascinated by the Trust Weekly Blog and stemming out from my connection with Dumfries, I thought of posting this reflection, hopefully it will be deemed suitable for publication.

I first came to Dumfries in spring of 2011 several months after departure from my home country, Sudan. My re-traffic to Sudan in 2009, trying to re-uproot, make a living and help my own people, was very much dashed by several factors. Making a living there was second to impossible. Back in 2007/2008 I had an offer to join a thriving health service in the area beyond the far western Canadian prairies, in British Columbia, which encompassed both academic and service domains. Coming to Dumfries was the perfect choice as the job was still vacant. I went to British Columbia a few months earlier in a fact finding mission. Part of the Canadian recruitment process entails inviting prospective candidates and their families to come and see themselves, and then make an ‘informed decision’. Following a week in ‘Prince George’ in fall 2010 we got satisfied and decided to go for it, despite that it is in the ‘end of the world’, being 13 hours flight from UK. But for us, the Sudanese, it was ‘Safe Haven’. The prospect of working and living in the ‘New World’ proved exciting. I had just turned fifty by then, and the career prospect was still rife. I began the process of joining Prince George University Hospital of North British Columbia, but to fill the 9 month gap whilst this took place I came to Dumfries to take up a locum in Diabetes and Endocrinology. One place, one hospital and then off you go to Canada. That was the dream which proved to be elusive.

At Dumfries life was very smooth. I was embraced by everybody, from within the department and from without, as one of the team. I never felt, nor was given, the feeling of being the ‘bloody locum’, who is here to do little for ‘too much money’ and then vanishing away. I was always treated with dignity and respect and always given the feeling of being ‘one of the team’. Everyone expressed love and showed gratitude to the job I was doing. This culture you won’t see or feel in other places as a locum. At Dumfries your expertise and hard work would be appreciated and valued and, despite that I was well paid for the hours I was doing, I was never eyed as a locum and stranger by anyone save one or two people.  Weeks and months and the path to relocate to British Columbia became fraught with obstacle after obstacle. It proved to be a ‘bumpy road’, and my stay at Dumfries continued, not only for nine months but it went to one and half a years.

I left Dumfries in August 2012 pursuing the elusive Canadian dream only to come back again in December 2013 when change of heart and change of fortunes forced yet a move into the opposite direction, this time eastward. The Canadian dream been burned on the altar of destiny. I was heading towards the Arabian Gulf, another safe haven for us, the beleaguered Sudanese. I was again embraced by Dumfries with the same old love, dignity and respect. Despite that my second ‘tenure’ at Dumfries was in Acute Medicine but it was equally enjoyable and blissful. Again I was never been given the feeling of the ‘other’, or the ‘stranger’. Not only that, after over ten months, I left to Qatar with an open mandate to come back at any time if ‘things did not suit me!!! Is that not wonderful and special to be given the feeling of ‘being wanted’ and in demand? Needless to say I was even approached to consider a permanent position and a substantive post.

Back to UK after spending a full working year in Qatar, and having the demand of keeping my license and my GMC registration alive and staying close to my grownups, who were staying in Cheshire, who had all re-trafficked back to UK after completing their University education in Sudan. I was welcomed back to Dumfries. It was the same old fantastic feeling. As a trainee back in the mid and late 1990s, I began my training in diabetes in Edinburgh at the old Royal Infirmary near Edinburgh Castle & the Royal Mile, and returned to Scotland again as an MRC Research Fellow at Ninewells Hospital in Dundee. Not to miss out the two years spell I had in Ayrshire when the educational needs of my youngest son made a re-traffic to UK in 2007 a necessity. So out of over 20 years of my career I spend in UK, one third was in Scotland. I am proud to call it my ‘Scottish Heritage’. One third of this heritage belongs to Dumfries-shire.

Dr Tarik Elhadd is a Consultant in Diabetes and Endocrinology

Surviving and Thriving in a Time of Change by Dawn Allan

I have always been fascinated by human beings and why we are the way we are.

Does our cultural and family background influence us?

Why do some people believe in God and some don’t?

Why are some people able to talk about death and dying so easily?

Why do people focus on their weaknesses, what about their strengths?

How self aware are we?

Who are we when nobody is looking?

Having emigrated from Ayrshire to South Africa where I spent my childhood and early adult years, I discovered the down side of the school playground because I sounded different.  There were only so many times a 6 year old with an Ayrshire accent wanted to mandatory repeat the word ‘potato’ at the class bullies insistence, and then suffer his disparaging comments,

“…doesn’t she sound weird…say it [potato] again…oh, ja, you’re from ’SCOT-LAND’ hey…”!?!

I remember stifling back tears, wishing I sounded like my peers so he would leave me alone.  When I reflect on this childhood bullying memory, it is mainly laughable now and I quickly adapted by adopting a local accent to blend in.  Life nurtured resilience and I learned when it might be safe to confront a bully wisely, when to ignore them and when to ask for help.

This year I relocated from Shetland to live and work in a place, “Often described as “Scotland in Miniature,” South West Scotland’s Dumfries & Galloway region is characterised by its rich cultural heritage, stunning scenery, sweeping seascapes, towering cliffs, rolling agricultural land, and its wide, wild landscapes”.  Who wouldn’t want to live here?!?  So, what about the people?  I am pleased to say they too are fascinating, warm and welcoming.

The 2017 focus for NHS Dumfries & Galloway is the move for many staff from the current DGRI to the new hospital.  From what I am gathering, this process of change is daunting for some.  If communication is key to all that we offer and provide as health care professionals, part of the way we manage our expectations in preparing to move is to be aware of how we communicate with or about each other as individuals, departments and teams.  Having a person-centred approach should be our modus operandi – our behaviour and communication does not go un-noticed by patients and visitors.  Being a ‘relational person’, I believe our hospitality is as valuable as our clinical / social care, our administration skills or our financial targets.

If a holistic approach cares for the whole person, this includes acknowledging someone’s pain, providing them with pain relief and offering them a cup of tea – all spiritual ‘acts’.  We all deliver spiritual care, what I aim to define is that we as staff do not, ‘go Greek’ i.e. compartmentalise and separate a person into ‘bits’, i.e. age, gender, status, patient, service-user, client, spiritual, religious, physical, mental, psychological, emotional…When in physical pain, the whole of our being is affected.  Judeo-Christian views that –

  • every person is born with worth and dignity
  • every person has the ability to choose between doing good and doing wrong
  • every person has the responsibility to help others in need and the community

Whether the person we are caring for or working alongside has a belief / faith or not, they will have a ‘value system’.  I hope having a VBRP – Values Based Reflective Practice – approach will help all of us as we reflect and hopefully learn from the past in the present, to know how to continue or change best practice, including our communication.  Our motives are based on values we apply every day which will help or harm the people we care for, including ourselves.

To be a hopeful presence is how I sometimes describe my encounters with people.   When we are at our most fragile and vulnerable, we need others we can trust, who will listen with their eyes and ears, who can make us laugh, encourage us when we feel stressed, sick or lonely and offer compassion.  My confidential support includes staff – we are all at different stages in our professional roles and our personal lives.  Before anyone ever declares whether they have a belief / faith or not, it is what we have in common as human beings that is paramount.  Difference is a given, but negative overemphasis on difference marginalises people – companionship and inclusion build bridges.  Sometimes, ‘life happens’ and it is the sudden, unexpected occurrences that affect our health and relationships most.

One of my favourite authors C S Lewis reminds me that a man of such academic, creative gravitas was honestly transparent, he said, “I pray because I can’t help myself.  I pray because I’m helpless.  I pray because the need flows out of me all the time – waking and sleeping.  It doesn’t change God – it changes me.”

Rabbi Harold Kushner’s description speaks into my role, “When you cannot fix what is broken, you can help very profoundly by sitting down and helping someone cry.  A person who is suffering does not want explanation: the person wants consolation.  Not reasons, but reassurance.”

If we as individuals think we do not need each other, we are deluding ourselves.  My faith informs my professional practice, without imposing it on anyone.  If the Son of God relied on twelve disciples, who am I to say I can survive without the support and wise counsel of colleagues?  We are only human and we need each other to ensure NHS Dumfries & Galloway not only survives but thrives today and tomorrow.

Dawn Allan is Spiritual Care Lead Chaplain at NHS Dumfries and Galloway

What Scotland means to me by Richard Smith

For me, a Londoner, Scotland is a magical place where I can breathe more deeply, every inch of the country is beautiful, and people are fairer, more concerned about each other, less materialistic, more romantic, musical, and poetic, and infused with a Scottishness that has a reality and intensity that Englishness lacks. My wife, a Scot, is not convinced.

My first visit to Scotland lasted half a day. I was 16 in 1968 and had finished walking a corrupted version of the Pennine Way. We finished at Riccarton Junction (not Kirk Yetholm where we should have ended) and took the train to Hawick, where, perhaps because we were wearing shorts, somebody shouted “bloody Germans” at us. That railway closed a year or two later, but, as somebody who always prefers trains to planes, I was excited to travel a few months ago on the new Border railway from Tweedbank to Edinburgh. This illustrated for me how Scotland, the home of the Enlightenment, has a continuing capacity to reinvent itself.

My next visit to Scotland was in 1970 to start at medical school in Edinburgh. I can remember now walking from Waverley Station to the University halls of residence at the foot of Arthur’s Seat and being slightly shocked by the black buildings but intoxicated with the thought of what might be. Edinburgh is the city of my youth. I know it better than I know London, where I’ve lived most of my life, and every street carries a memory of an encounter, an insight, a party, a tryst, or an awakening. I arrived at 18 and left at 25; I’ve been back many times since, almost every year, but those seven years remain as a sealed repository of the sweetest years when life was newer and more intense than now.

In Edinburgh I was surrounded by poets. Many friends–Brian McCabe, Ron Butlin, Dilys Rose, Liz Lockhead, and Andrew Greig–were and still are poets, and as president of the University Poetry Society (nothing grand, I can assure you) I met Hugh MacDiarmid, Robert Garioch, Norman MacCaig, and Sorley MacLean, poets I read now in 20th century anthologies. I remember Sorley MacLean reading in Gaelic as if in pain and then reading English versions translated by others.

As a boy with two bothers and no sisters who went to an all-male school, it was in Scotland that I began in earnest my lifelong attempt to understand women. Despite meeting many wonderful women in Scotland and around the world, I’ve never succeeded, but, as my wife reminds me, what matters is “the quality of the search.”

During my first four summers as a student I cycled to Vienna, picked tobacco in Canada, took the Hippy Trail to India, and travelled overland from Nairobi to Lusaka to do an elective, but the fifth summer was the most exciting–when I abandoned neurosurgery as a lost cause for me (a correct judgement) and immersed myself for a week in the Edinburgh Festival and Fringe. I still love the hurricane of creativity that is Edinburgh in August, and it was in 1977 that I saw my brother, Arthur Smith, when he first performed on the Fringe. There were four of us in the audience (my future wife, two friends of my brother, and me) and five onstage, and as the show included audience participation there were soon nine of us onstage and nobody in the audience. But the National Review Company (as they were pretentiously and possible illegally called) became one of the most popular acts on the Fringe, and my brother, who has been almost every year since 1977, has become a Fringe Legend and a National Treasure.

But perhaps the mountains were the most special thing. My first Hogmanay I travelled to Inverness to stay with friends, first-footed all night, and fell asleep on a concrete floor. They were train enthusiasts, and we took the train to the Kyle of Lochalsh, from where I saw Skye for the first time. We stopped and drank whisky in Achnasheen, or was it Achnashellach? One February I travelled to Ben Nevis with the mountaineering club and marvelled at the two leaders whistling Haydn sonatas to each other all the way from Edinburgh and then leaving the coach to bivouac on the mountain. The next day we climbed the North Face of Ben Nevis with ice axes, and one of our party, an American, fell to his death. Another time I travelled to Caithness and felt further away from London than any place I have been since, including New Zealand, China, Chile, Zambia, and some 50 other countries.

And then there was the medicine. I applied to Edinburgh because in 1969 people would tell you it was “the best medical school.” But it wasn’t. I loved Professor Romanes producing exquisite chalk drawings to show fetal development, and I remember the first cut on our corpse–when I pressed too hard and put the scalpel into the dead woman’s heart. The course felt “anti-intellectual” to me, and we had an aborted revolution in my fifth year. Some of my teachers had a great influence on me, but my defining moment was listening to Ivan Illich argue that “modern medicine is the major threat to health in the world today.” That experience in an Edinburgh January blew me of course medically, and it always strikes me as ironic that it should have led to me becoming editor of the BMJ, a position in the medical establishment whatever I may have thought.

I tell these tales to try and illustrate why Scotland has come to have such a special place in my heart and to feel so different, so much more magical, than England. Once while staying in Edinburgh one summer I had to attend a funeral in Hertfordshire. I took the train down and back, and as I came close to Edinburgh with the Firth of Forth lit by the last of the day’s light I was sure that I was living at the end of the East Coast Line.

In the May before the referendum on Scottish independence I walked the South West Coastal Path with friends from Edinburgh and the Borders. They were divided on what to vote. I had no vote, but I feel sure–for emotional not political–reasons that one day Scotland will again be independent. It is a different and better country than the rest of the UK. My only hope is that I won’t need a passport to visit.

Richard Smith is a doctor, writer and businessman. he is a former editor of the BMJ.