Monday, June 18, 2012

To The Greatest Dad In The World

My years of college were spent in Sudan, where, for the first time, I was surrounded by Sudanese people from all sides, and found out that the world is not half as perfect as a lifetime in SQU made it look. I saw people from all kinds of backgrounds coming together to study that science that the Sudanese nation (and many other nations) sees as divine: Medicine. Not only the people I studied with, but also the people I was related to. We were different in hundreds of ways: the way we talk, dress and eat, the way we prioritize our finances, our goals in life, and the families we belong to. All their stories made me more and more thankful for my parents every day.

After college I moved to Oman to pursue my career. It was just me and my dad in the house, with the rest of the family coming and going during the holidays. I am curious to know what he made of those 5 years; because if I were in his place I'm not sure I would have enjoyed it much. I did the cooking, and I'm not a very good cook. However, my dad always ate whatever I served with no complaints whatsoever. Sometimes when the thing on the table was unidentifiable, he would politely ask what it was, and then eat it anyway. When the thing was both identifiable and edible, he would compliment my cooking. He made his own bed, arranged his own clothes and organized his things by himself. He wouldn’t let me buy a car because he already had one, and anytime I needed it, it was there, and there was no need for me to waste my money on anything that wasn’t for my education or career. Often he would come back early from an outing just because I had an appointment somewhere and needed it. He never complained about the parking and speeding tickets that he had to pay for me (but I always tried to pay those myself but sometimes forgot). Once, for a whole month, he walked to and from work in the baking heat so that I wouldn’t have to rent a car to drive to a far-off hospital that I had some training in. He never once asked me how much I get paid at work, and any time I needed money, it was there. I was free to travel as I want, wherever and whenever, and he would always pitch in even if I didn’t need it. Despite all the hell I gave him, he never complained about having me around. Anytime I needed advice about work, studies, relationships, etc. he was there, and I was free to make my own decision in the end, even if he thought otherwise. I broke his suit buttons, lost the jack in his car, accidentally washed his white clothes with something blue, forgot to pack his lunch about a thousand times, and was just plain annoying most of the time. But he always was, and always will be, the nicest, funniest, friendliest, most caring, most trustworthy, and the most loved father in the world. I'm sorry for all the trouble I caused, all the things I broke or ruined, all the money I squandered, and all the promises I broke. And I hope more than anything that one day I will meet someone who will be as great a father to my children as you were and still are to us.

Thank you, Baba. For everything.
ربنا يطول و يبارك في عمرك و يخليك لينا انشاءالله

Sunday, June 3, 2012

An Encounter With The Sudanese Healthcare System

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.