Thursday, June 24, 2021

The Power of Relationships and the English Premier League

It is very easy for people to overlook what goes into creating a global neurology program. Many people see a need, have a skill, and feel like things should be able to come together as a result. The major overlooked piece in this scenario is the human element. When I think about my 11 years in Zambia the most important thing that allowed me to launch studies, introduce new diagnostics, and inhabit a work space is based on relationships.


When I am walking through the hospital on an average day, like many people who have worked somewhere for a long period, I am constantly greeted by custodians, clerks, technicians, nurses, and physicians whom I have had personal interactions with for over a decade. Some have helped me learn Nyanja, one of the local languages. Others have asked me to see an ill family member in my outpatient clinic. I will often run into people at shops or in the market while with my family. These interactions give an expanded picture of one's life, fosters community, and provides the sense that everyone is working towards a common goal.


I have tried my best to accommodate each request to see a friend or loved one. It conveys the message that I can be trusted. This trust has been a major driver of why we have been able to develop our program. This was not always the case. I made a number of regrettable decisions, particularly in my first year. I did not appreciate the culture of medicine. I underestimated the pride that people had as clinicians working in this setting, which was well deserved. There was a time when I felt like I could not get out of my own way. I was there to help and I wanted the opportunity to prove it.


The opportunity came about in the most unexpected of places. The University Teaching Hospital has a wonderful physician's lounge where senior consultants go to have lunch. It has large burgundy lounge chairs and couches where people can kick up their feet and enjoy a staple Zambian meal of fried fish, cooked pumpkin leaves, and of course hot nshima (staple starch made of ground white corn). I love nshima and would eat it every day were it not so dense and high calorie. It is also directs a lot of blood flow to the gut for digestion. The feeling of sleepiness or naps required after eating it is affectionately known as the "nshima coma". It is common to have multiple senior consultants and high-level administrators taking a nap in the lounge chairs after lunch.  As a lifelong napper, this culture suits me perfectly.


One of the great pleasures of having hot nshima in the physician's lounge is watching English Premier League Football. People get to watch their favorite teams play (Zambians root for either Manchester United, Arsenal, Chelsea, or Liverpool) while filling their bellies. For a period of several months the DStv satellite subscription had lapsed and the television showed nothing but static, much to the consternation of all who ate in the lounge. The subscription needed to be paid and this involved an invoice passing through multiple desks for approval before accounts would issue a check. This was a tedious task and one that I decided to take on.


I first went to the DStv outlet and waited in line to get an invoice for the amount that needed to be paid. I brought this invoice to the accountant who said it needed to be approved by an administrator. This administrator stated that it needed to be approved by another administrator and so on and so on. Over the course of a month, I followed that invoice from office to office until it had been approved. It was part of my daily routine to check on its status. 


I was so excited for the lunch after the subscription was paid. It could not have worked out more perfectly. The TV was still playing static one day when I came into a room full of senior consultants and hospital leadership. They had been following my efforts to get the invoice paid with amusement. In front of them, I called the DStv representative and told the person that it was not working. The service representative told me to hold on, did something and asked, "How about now?". Instantly, the service was restored to the delight of everyone eating lunch that day. I don't think nshima ever tasted so good as we watched football highlights on SuperSport after a long hiatus. For years following that experience, whenever there was a problem with the DStv people would say, "Tell Dr. Siddiqi, he will take care of it". I took great pride in this role.


I think, in part, I was able to prove myself with the restoration of DStv. I was willing to perform the heavy lifting in order to improve people's experience. I have used this same model in an attempt to improve clinical care. With each struggle, failure, and victory I have been able to build trust over a long period. That trust has meant everything. It has helped in research, training, and securing space for a proposed neurologic institute.  I have learned the extremely valuable lesson that there are few things in Zambia that cannot be solved over nshima and football.


  1. What a great story Omar. Keep writing. I look forward to taste nshima and taste " coma" one day:)

    1. I am so glad you enjoyed it. Nshima coma is one of life’s pleasures!

  2. What a great story Omar. Keep writing. I look forward to taste nshima and taste " coma" one day:)

    Neurological Dubai