Sooner than I thought, I have had my first brush with the Sudanese healthcare system as a patient. Or actually, as an attendant of a patient. Naturally, I did not like what I encountered. One of my sisters came down with a fever and sore throat which later evolved into neck pain. The neck pain turned out to be caused by a collection of inflamed lymph nodes. This is a normal process in case of local inflammation/infection such as a sore throat, and usually does not need an antibiotic (contrary to what everyone thinks). However, the lymph nodes then became bigger and matter together. That, coupled with the background of her exposure to animal through her studies, the possibility of zoonotic (diseases transmitted from animal to human) disease arose. This warranted an antibiotic, but only after a blood culture has been collected. So, early Friday morning, we headed into the downtown in search of a laboratory that will run the test so that we can start on the antibiotic. Here came the first problem: how to find a respectable lab to run the test? Blood cultures are a nuisance in that they can be easily contaminated by any bacteria and therefore give a false result. Therefore, it should be run at a respectable lab. I was surprised to find out the lab we headed to first, which is a very well known lab, has the reputation of giving such false results. Regardless, we asked about the availability of the test and found it to be available, but with the price of 160 pounds. That was 3 times what I expected it to be, and more than what I had in my handbag, which was supposed to be for the tests and the medicine as well. That was the second problem: that we could not afford to pay for the test at that time. Happily, we had insurance, and pulled out the card, only to be faced by the third problem: we cannot request the test ourselves, only a doctor within the same network can do it for us. Of course that makes sense, since the whole point of health insurance is a network of providers through which healthcare is delivered free or subsidised at the point of delivery, and then providers are reimbursed later from the companies. That meant we had to go see a doctor. I have had some experience with Sudanese doctors in the past, the result of which was an official complaint to the authorities (me against the doctor and nurse). However, I decided there was no choice. Only to be faced by the fourth problem: how to find a provider that is in the same network as our health insurance company. It turns out that this company, which was previously the most popular, does not pay its providers back, so everyone backed out. After driving around and asking at every door for an hour whether or not this and that hospital had our insurance, we finally ended up in the hospital I hate the most in the world. The same hospital my late grandmother was admitted in for around a week after a massive heart attack, and which was the very epitome of dirt, dishonesty, and robbery. However, we had no choice. After filling in the necessary papers, we entered the ER, which is a tiny room at the end of the corridor with 2 doctors (or a doctor and a ?nurse?) sitting at a desk reading. I introduced my sister (but not myself), and explained the problem. The doctor ignored me and asked my sister what the problem was. She told him she had enlarged lymph nodes in her neck that were painful. He then asked her to sit on the examination bed, examined her neck, checked her throat, and that was it. He did not ask about a history of fever, nausea or vomiting. He did not ask about exposure to anything at all. He did not enquire about other symptoms related to lymph node enlargement such as malignancy and connective tissue diseases, the latter of which are extremely important in females of this age group. He didn’t examine anything other than the throat, and even that without a tongue depressor. He didn’t even check her ear. Needless to say, he did not look for lymph nodes elsewhere, or palpate the liver or spleen, and any other organ necessary.
This is not a laughing matter. Lymph nodes do not pop up all over the place every day, and when they do pop up, they're never good news. Especially in the presence of fever. And especially in young girls. They can meet a whole lot of things, and you need to be careful. This is basic medicine, its not something that you need to watch House MD for. Anyway, this isn’t the topic of this post. The topic is that, at the end of this very brief history and examination (1.5 minutes flat), we finally got to the blood investigation phase. I stopped pretending that I care what the doctor thinks and asked him to just order a blood culture and let us be on our way. He said no. Problem number five: a blood culture is something that only the specialist can order, which means we have to come again tomorrow. And even then, our health insurance doesn’t cover blood cultures. Only very basic tests such as the haemoglobin level and total white blood cell count. I couldn’t believe it. A blood culture can only be ordered by a specialist? It’s a blood culture! It is not even a specialised test! It's something that should be routine for patients in the presence of fever of which the source is not immediately identified! Anyway. We eventually asked for the help of our cousin, who hooked us up with Royal Care and we managed to get the tests done. We then bought the antibiotics for almost 120 pounds (twice what I thought it would cost).
My point is this. I wonder how people in Sudan can afford healthcare. I wonder how they can afford to pay for what little care they get from doctors like that kid in the ER who couldn’t even be bothered to properly examine his patient for something that could be anything. I wonder why people who are in charge of healthcare in this country treat patients like they are worth nothing. While driving up and down Khartoum's busy hospital street, I looked at the people around sitting on hospital steps or walking down the road; either waiting for sick relatives or carrying sick relatives or looking after sick relatives. I saw a couple carrying a small yellow bundle with a tiny yellow foot protruding from underneath, and I could just imagine the nightmare they were living, coming to Khartoum from God knows where, with God knows how much in their pockets, only to be treated by someone who has no interest whatsoever in the owner of the yellow blanket's wellbeing.
This has got to stop.