Intercultural Medicine and Practicing with Cultural Competence with medical doctor Nabard Faiz

In this captivating episode of the AMBOSS Podcast: Beyond the Textbook, Sophie Neale hosts an engaging interview with Doctor Nabard Faiz, a cardiology and internal medicine resident physician in Germany. Doctor Faiz shares his incredible journey from fleeing Afghanistan to becoming a respected physician and advocate for culturally sensitive healthcare. His story of resilience in the face of adversity and his commitment to serving diverse communities is not only inspiring but also a call to action for medical professionals everywhere. Tune in as we explore Doctor Faiz’s personal experiences, his involvement with the "Afghan Diaspora in Germany," and his efforts to support female Afghan medical students. Take a deeper look at intercultural competence in medicine and go beyond the textbook with us!

Doctor Nabard Faiz Die Welt Interview: 
https://archive.is/20230815195910/https://www.welt.de/politik/deutschland/plus198442313/Integration-Wie-ein-afghanischer-Fluechtling-Medizinstudent-wurde.html# 

Doctor Nabard Faiz X: https://twitter.com/nbardEff

Doctor Nabard Faiz Instagram: https://www.instagram.com/n_bart_f/

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Transcript

Sophie: 0:22

Welcome to the AMBOSS podcast beyond the textbook We're your hosts Sophie Neal and Dr. Tana Schrank. And today, we are honored to host Dr. Nabad Faiz, a resilient individual whose journey from adversity to accomplishment is truly inspiring. Born in Afghanistan and raised in Germany, Dr. Nabad has overcome a number of obstacles to pursue his passion for medicine. He is currently resident physician at Maria Hilf Hospital in Cardiology and Internal Medicine in the West of Germany, where he also manages the emergency department, intensive care unit, stroke unit, and chest pain unit. his commitment also extends beyond the hospital walls. From co founding the Afghan Diaspora in Germany group, to advocating for culturally sensitive healthcare NABAD's societal engagement is absolutely profound. Join us as we explore his experiences and insights and delve into his ongoing efforts to make a difference. Faiz, welcome to the show and thank you for being here with

Nabard: 1:17

Thank you so much for this warm introduction. Thank you. And welcome to all the listeners.

Sophie: 1:23

Thank you very, very much for being here and I mean, it sounds like your path to medical education has definitely not been an easy one. From fleeing Afghanistan to growing up in Germany and ultimately becoming a very successful medical doctor. What would you say are the biggest challenges felt you're faced on your journey?

Nabard: 1:39

when I fled Afghanistan with my family at the age of 4 it was. Not only the initial adaptation to a foreign culture or foreign country at that time, learning a completely different language, I was not able to speak, of course, I was a child, but I still, I was bilingual raised in Persian and Pashto, the two major languages in Afghanistan, I also had to learn German relatively quickly, not just for myself, but because I was the oldest in my family and the one who had to translate official documents for my parents, accompany them to government offices. So you could say I was the family's interpreter. So, The responsibility that has been placed on me, it was very high at a very young age. And to be honest, it's unfortunate that these hurdles and challenges are still not. not socially recognized, but rather assumed to be the absolute standard. and. From my point of view now that I believe that it became apparent that in Germany, it's not just a matter of origin, but also a matter of financial needs, which my family did not possess at the time. So, all of this mixes into a social climate of rejection towards migrants, but thank God, this has changed and improved in many areas during the years.

Sophie: 2:54

Wow, you sound like, you've seen so much that I'm sure has really shaped how you work and how you conduct yourself, And You co founded the group Afghan Diaspora in Germany and you've used your social platforms to address cultural discrimination. How does addressing discrimination and promoting inclusivity play a part in your daily life as a physician?

Nabard: 3:16

Yeah, well, I think it was during the 1st lockdown in Germany. when a good friend of mine, me and others. With this idea, and I thought to myself, it's very interesting from the outset because the Afghan community outside of, for example, the United States, Australia, or England are not as organized as they should be. And we were able to successfully not only present ourselves, but the Afghan diaspora as we call them in many events, YouTube formats, social media appearances, not only to educate the German society, but also to educate ourselves within. And given my own biography and experience, it was for me very clear from the beginning that I wanted to use my platform not only to highlight grievances from incidents that happened around me or us but also to take active steps and demonstrate how things can be done differently and how they can be done better. Especially as a medical student, I have repeatedly experienced discriminatory behavior, but also discrimination towards patients and health care workers who let's say, openly identified as migrants or not typical Germans, as we call them. But also as a doctor, I've encountered such incidents, and this is why I always try to counteract these behaviors. And if you allow me, I will try to give you 2 examples what I mean with them. The first, I was a student in my final year. So you have this final year where you work with doctors, and I was in the orthopedics department of the emergency room and a young woman, apparently from Syria with a headscarf on emerged, and she had fallen, she tripped and she had great pain in her right ankle. So as a student, You're naturally on the forefront of examination. You take the patient's history and you present your suspected diagnosis to the physician, And the doctor at that time replied to me, Saying, yeah, the patient shouldn't make a big deal of it. You know, those type of people just give us some mild painkillers and we'll check again, like, in an hour or two. So, I was kind of confused because, you know, we have SOPs and This is what I learned and I said, okay, but wouldn't be an x ray, good diagnostic tool to see if there might be some fractures and anything, but I wasn't hurt and after an hour, the patient was still in pain and I strongly insisted, honestly, on the x ray, as it turned out, it was unfortunately an ankle that was indeed fractured on multiple places and required and eventually a surgery for the patient. And so. The thing that occurred to me was that the doctor never reacted It was more like, yeah, well, bad luck for her We'll check again, and the other accident was when I was running the emergency department at my hospital and the ambulance brought us a young patient who just had a nose surgery a few days prior and was taking very strong medication, was now complaining about abdominal pain. So while the patient was still on the stretcher and I received the handover from the paramedic and the doctor I quickly formed a diagnosis in my head However, the paramedic and the doctor presenting me the patient commented, yeah, you know, those people, they always exaggerate. And just for you and the listeners to know the young lady was dark skinned and turned out that she later had severe ulcer like in her stomach and needed high dose IV stomach protection and we had to charge her in for a couple of days. When I also speak with colleagues from other hospitals, they report similar incidents, it's it's a culture in medicine that unfortunately, due to the lack of evidence and experience is oriented towards not believing certain people are not believing that certain people are experiencing pain. Pain or symptoms, but rather tribalizing them. And I consider this to be extremely dangerous. And I hope that in future we'll have valid data in Germany to counteract this because we practice evidence based medicine, right? For people, for patients, and we should not discriminate or dismiss their suffering.

Sophie: 7:11

Wow, what incredible stories to share. Thank you for sharing that. I think that's really important for people to hear and the work that you're doing, you know, to try and counteract that is incredibly important. I mean, as well as co founding the Afghan Diaspora in Germany group, you've also collaborated with the Afghan University of Medical Sciences to support female Afghan medical students. Now, speaking as a mentor and a role model for medical students or future medical students, what are the biggest hurdles that you feel they need to be prepared for?

Nabard: 7:43

Yeah, that's a good question. I believe that generally and broadly speaking, every medical student should be aware that there are Not only working with people, they're working with people who are suffering, people who are seeking help and these individuals may also have family members who naturally would like to be informed or kept in the loop. Right? Additionally, the patient will eventually be discharged home. And we want the patient to a good home. So we should assure that home care is sufficient. So, as you can see, it's not just about making the right diagnosis or monitoring the patients And regarding the Afghan University of Medical Science, I'm very, very grateful to my dear friend, Dr. Ahmed, who's also one of the co founders of the Afghan diaspora. He's a radio oncologist in Switzerland. he established something so unique for Afghanistan and for Afghan women within the last year with other colleagues. And I'm so glad that I could be part of this project in Germany. I mean, as we all know, the Taliban regime on power in Afghanistan and occasion, especially for women and girls, it's not only controversial, but it's partly banned under the Taliban regime. And thanks to so many supporters Inside and outside Afghanistan and within the international medical community, we were able to establish a platform so that medical students, female medical students can continue their studies, attend lectures and, yeah, thankfully expand with digital offerings.

Sophie: 9:12

Wow. I mean, what incredible work to be part of. I don't know how you find time to fit it all in. I was actually reading a previous interview that you gave to the German newspaper Die Welt and you mentioned the importance of role models in medical school. Would you say you had a specific role model that inspired you and kept you motivated to complete your medical educational journey?

Nabard: 9:36

yeah, to be honest, my parents have always been my biggest role models because I mean, they shaped their lives, they changed their lives, their friendships, their families, their responsibilities, so that me and my six siblings we can achieve our goals here in Germany. And this is something that I will never forget because my father used to say he could have went to anywhere in the world, but he said he would choose Germany so that we could have a proper education. And I have to admit, becoming a doctor was never on my radar from the beginning, honestly. I was always someone who was very socially and politically engaged. I loved history. And then at some, point. I don't know. I was maybe 13 or 14 years old. I was sitting with an old friend of my father who came from Afghanistan, who was sick and he received medical treatment here in Germany. And when he asked me what I wanted to become I told him that I did not know what I wanted to be. What I wanted to do or study or wanted to become maybe something like, I don't know, in history or something in sociology. So I remember him saying, that it would be very nice and a very gentle tone that if I could became a doctor I could help people. And I remember not only that I made him this promise I hope that in his eyes and his mind I have become a worthy and good doctor because unfortunately, yeah, during the Taliban regime, he was murdered. So this is one thing why I do what I do, and on the other hand, it's because of my family, my friends, my environment, the people they have accounted over the years who always made me feel that I should keep going. Because it's not just me who can benefit from all of this. And, yeah, of course, during my studies all my classmates, everyone who suffered with me from day one, day and night in the library, doing night shifts, Yeah, we drove each other crazy, you know, by constantly quizzing one another, and today I just a successful and passionate in their professions. And this is something that's also like giving me the courage and the confidence to do what I do.

Sophie: 11:39

Wow. I'm so sorry to hear that. And I absolutely agree with you, you know, in terms of, role models you know, thinking about your parents because parents make such. Big sacrifices for their children and I'm sure it wasn't easy for your parents and for you to move to a completely different country, you know, you didn't speak the language and I thought your answer was yeah, really beautiful. So, thank you. yet you're currently working as a resident physician in cardiology and internal medicine, and on top of that, you're managing the emergency department, intensive care unit, the stroke unit, and the chest pain unit. what drew you to those particular specialties?

Nabard: 12:18

Well, It's also part of the rotation that we do. So you have to, you know, take care of all those, departments, but it's fun because I like what I'm doing and I'm a trained radiology assistant and I developed a strong interest from the beginning and everything that's technical and everything that's in radiology and I thought to myself, I would pursue a career in radiology, honestly, and then in my final year of my studies, I encountered a highly experienced specialist in cardiology Was now a senior attending physician at another hospital, and we hit right off right away. Like, moreover, we had the same background. He was, of course, quite older than me, but he went all those ways. And he asked me at the time, which speciality I wanted to pursue, but I was still undecided because, yeah, radiology, the places are very rare, and I don't know if I get a job in radiology. Kind of depressed and demotivated. The only thing that I knew was I don't want to become a surgeon. So I felt a little bit lost. However, we got so along very well from the start and he became a mentor to me and Yeah, he was a cardiologist, internal medicine doctor, intensive care unit doctor. And as the days and weeks passed by, and I was able to learn so much from him eventually the day came when I had to make a final decision because I had my exams. I was doctor, but I didn't know which career path I was going to. And he Contacted me and he recommended me that I approach his former mentor, who fortunately is now also a very good friend of mine whom I still seek advice from today. And he assisted that. I should go to him, learn from him. So applied not knowing about, all of the fields, but I said, okay, if there's someone who can teach me, I should. Go and pursue it. So I applied. I got the job. Thank God. And as a beginner, it's reassuring to have someone to learn from, right? Like a mentor who can truly teach you all the facets of medicine and not only everything that's technical. So therefore, I'm very glad that I ended up in this field because I did not only learn the technical aspects, but also gained a significant understanding of the human side of medicine. Realizing. I mean, that it's just not about treating the patient, but also addressing all aspects around them, like to ensure optimal care at the end of the day. And yeah, this might sum it up, why I ended up in this field of medicine.

Sophie: 14:47

yeah amazing. I mean, I think that leads us really well into our next question, So, in your experience, what are some common challenges or misconceptions that healthcare professionals may face when providing care to patients from diverse cultural backgrounds and how do you think these can be addressed?

Nabard: 15:03

I believe the biggest mistake one can make is is not taking the patients seriously or tribalizing the suffering. What we know from valid data, for example, for the United States is that people of color who are patients receiving significantly fewer pain medication than non POC patients and patients with perceived immigrant background may receive inferior medical treatment compared to those without such backgrounds. And I have to say, unfortunately, we don't have or valid data is still lacking in Germany, but I'm confident that we will have this data in the due time. But I think it's most important When a patient comes to you or to me, but pain or with distress, we should take them seriously. And this might sound trivial or simplified, but in practice it can sometimes be overlooked. Unfortunately, in all, the stress of the emergency room or the intensive care unit or on regular wards, we often see patients suffering from pain and not receiving the comprehensive diagnostics. They receive, sufficient pain medication, or we don't take them seriously. And this should not be our standard as doctors. On the contrary, regardless where they're from or where they're coming from. And I have to acknowledge that people from different cultures or backgrounds, they have the same physiology and biochemistry and anatomy. Just like or white European people. I mean, this might sound obvious. Of course, they're human beings. We're all human beings. But I often encounter the opposite when patients report different experiences with other doctors. And yeah, of course, in our training, we have thought to assess things or to scale things, whether it's physical visual. however, I mean, we forgot that the rest of the world may perceive and express feelings, pain or suffering differently. Some may vocalize their pain or suffering like loudly, while others may be more reserved. Due to their, I don't know, culture or religion, for example, feeling obligated to visit the sick in large numbers or not to visit them. And fortunately, thank God, nowadays we can easily educate ourselves on these matters with just a click on the internet, But I think the most important thing, however, is to approach the patient without bias, to understand that if my patient is in the hospital or in my emergency department if If there may be a language barrier there can be a family member who can translate for me, or to help elevate the patient's fear, or I can use some apps, new technologies, and I think we should no longer meet people from a condescending position as doctors and healthcare workers, but look them in the eye and see them as fellow human being who needs help.

Sophie: 17:42

Absolutely really, really brilliant answer and I think it must be difficult from the perspective of, working in an emergency room, definitely from a cultural perspective, but I wonder, is it difficult sometimes, you know If you're working such a long period of time and you've seen so many patients does it ever get difficult to keep a perspective, and have a fresh, you know, Face for each person.

Nabard: 18:05

it is. Honestly, it is, it is tough, but it takes experience.

Sophie: 18:10

Yeah.

Nabard: 18:11

but it's honestly, honestly, it's very hard. It's very tough. Because when you start, journey as a doctor, You have no experience what it means to organize yourself, what it means to treat patients, to go on walks, to go on rounds, to talk with nurses and all the other professions your hospital. And you might drown. This was like my first six months, but then you realize, okay, this is a human being and I can ask everyone. In the hospital, who's more experienced what to do and how to do it, how to approach. And this gave me a huge

Sophie: 18:48

I think that's really good advice as well to give to our students who might be listening And I how can medical students and healthcare professionals improve their cultural competence and provide more equitable care to their patients from diverse backgrounds?

Nabard: 19:01

Yeah. Well, encounters always break down prejudice, right? And in this case, I agree with that sentiment We should have more encounters. We should meet more people. And thankfully, unfortunately, there is no hospital in Germany without a diverse team, whether it's in the medical profession and nursing and all the other stuff. And what I mean by this is we, as doctors, we need to step out of our academic bubble. Approach the nursing staff and other hospital personnel they might come from different backgrounds as we do. and we should ask questions if you don't understand something or if we are not sure how to handle a patient, it's not only our superior doctors, we should ask, but also the nurses and we can also search in the internet read the textbook or look it up on ombuds, but it doesn't hurt to ask the nurses and all the other stuff, as I said before, or maybe just ask the patients of the family. And when this patient has, I don't know, like a long lasting chronic illness, it doesn't hurt for us to consult the general practitioner either because they know the patient and we can ask them. And I feel that many still experience a very. Hierarchical tone in hospitals during their training, but I don't think that it should be the case nowadays. If as a doctor if I stop asking questions, I'm giving away my most valuable tool that I have, like the ability to speak and to inquire. And specifically what I would wish for is that we would Intercultural medicine as part of our curriculum in our medical studies, right from the start, to break down prejudice and dispel myths not let certain stereotypes take hold. I mean, yeah, because sooner or later, we will encounter a patient who we may not understand, who doesn't speak English, German or our language. Oh, yeah, of course. Or to whom we must deliver a life altering diagnosis. We don't know how they react because we assume that everyone reacts like a normal European or like a white European or like someone from our surrounding. I mean, the good thing in medicine is becoming more and more diverse. But this doesn't just mean there are more people from different cultures. But also there are more individuals from different cultures. financial backgrounds now have opportunity to study and they bring new perspectives, which are resources and must tap on those resources we must use them as the additional tools in our diagnostic and therapeutic toolbox

Sophie: 21:27

I think this is a really great point that you make, and again, something that might sound simplistic, but to ask questions, and it's something that a lot of people in lots of areas of life don't do, because we're afraid that that we will be judged for asking a stupid question. And I'm sure everybody's been, you know, in a class where someone said, you know, no question is a stupid question, but it's absolutely true. No question is a stupid question. And in my experience, if you think of a question in your mind, someone else is thinking it as well, they might just be too afraid to ask. And so I think the point you made about, you know, challenging This kind of hierarchical form of, teaching and asking questions and speaking to patients and asking families questions is a, a really great point that you made. Absolutely. Well, there's been some brilliant nuggets of advice in this interview, Navad. Thank you so, so much. I, have to ask you for just one more. bit of advice, which we ask all of our, interviewees. So if you could give our listeners any advice beyond the textbook, what would you say?

Nabard: 22:33

Oh, okay. This is a very philosophical and difficult question. I'm still convinced that the concept of encountering of approaching each other, speaking together and asking questions are the most important asset when it comes to intercultural medicine, but when it comes to be also a doctor mean, I would, I particularly recommend the younger colleagues and students to look beyond the usual, questionnaires and multiple choice tests to view the world and realize that we as a doctors, we are not just doctors in Europe, in Germany, in the United States, around the world, we are doctors. So, therefore, we should strive to break down our prejudice and stereotypes wherever possible and approach the world with an objective view. Yet, we should be. subjective enough to counteract discrimination and discriminatory behavior. I mean, especially in our profession.

Sophie: 23:25

Amazing. Thank you very, very much. And once again, Nabad, thank you so much for giving us some of your precious time because I know you're such a busy person

Nabard: 23:34

You're welcome. Thank you.

Sophie: 23:35

Truly been inspiring to chat to you today.

Nabard: 23:38

Thank you so much. And thank you for having me on your program.

Sophie: 23:42

Well, that's it for today's episode of the AMBOSS podcast, Beyond the Textbook. Thank you again, Nabad, for letting us experience some of your journey and for the wonderful insights that you provided. Thank you to everybody who's been listening today, and we hope that the episode sparked an interest for you in intercultural medicine and advocacy. Be sure to subscribe to our podcast for more exciting episodes covering everything in healthcare and medical education. And please don't forget to leave us a great five star review. Take care, everyone. This has been Sophie Neal with AMBOSS Beyond the Textbook.