Friday, 25 November 2011

G6PD aka Favism aka What do you mean he can't eat Ful (mashed beans)

I'm about to get scientific on all your asses right now so please bear with me.

There's a disorder out there called G6PD deficiency. Now G6PD is an enzyme called Glucose 6 Phosphate Dehydrogenase. It's an enzyme that protects the Red Blood Cells against oxidative damage. Now you might not know what oxidative damage means but all you need to know is that there are certain food items and medications that have molecules within them that can essentially destroy a red blood cell. G6PD is an enzyme that protects the red blood cell from this destruction.

The deficiency is pretty common especially here in Egypt, and it can be quite disastrous for the parents. Why is that you might ask? 

Well, remember when I said certain food items. By certain food items I mean Ful (

Looks appetizing no?

Ful is the commonest and cheapest dish prepared here in Egypt. It's basically mashed beans along with some olive oil and garnish. Suffice to say, many people of a lower socioeconomic class have designated Ful to be their prime nourishment throughout their life. It's cheap and it's satisfies the hunger more so than any other meal I've heard of. 

Having a deficiency in G6PD means you cannot eat Ful, forever.

If a person with a deficiency eats the beans, his or her red blood cells start getting destroyed (hemolysis) and the person presents with a case of acute severe anemia that cannot be corrected except with a blood transfusion. The destruction can be so severe that it can cause death in some cases. 

There is no cure or anything like that. The only cure is to stay the fuck away from all food items, including Ful, that may induce hemolysis.

Now as far as enzyme deficiencies go, this one is awesome. Most enzyme deficiencies are fatal and severely affect a person's lifespan because they're involved in vital functions of the human body. G6PD is just a 'protective' enzyme and so all it does is protect the cells. So, whenever a kid comes with this condition I usually tell the parents that it could've been alot worse.

Problem is, parents don't quite see how it could be alot worse. 

As I said, people of a lower socioeconomic level depend on Ful for sustenance. They can have it for breakfast, lunch and/or dinner. And in a country where more than 50% of Egyptians are on the poverty line, they try to be as economically wary as possible. 

To them, it's a death sentence. Reactions I've had from parents who were told their kids had the deficiency have ranged from sheer disbelief to just mental breakdowns and tears. I remember laughing a little on the inside when a certain family just broke down into tears about the subject. I thought they were being dramatic. After all, they came to us in the ER and there were kids dying everywhere, so just needing a blood transfusion and staying away from the stuff, to me, was a win. After going back home and talking to my friends about it, we realised they were crying because they literally had no idea where or how they were going to get enough money to feed their kid something that doesn't contain beans. 

We've had parents come in over and over again, because their answer was "We have to feed him something! He's going to die anyways if he doesn't eat, so we get him to eat the Ful then take him to the hospital for a blood transfusion." 

These are parents who are willing to take the risk of their child dying because they can't substitute Ful with anything else.  

Fucking crazy.

All in all, it's a sad disorder to have if you're living here in Egypt. Ful has seeped its way into culture even and many (myself included) are not considered full blown Egyptian if they don't eat Ful at least daily. 

I'll end this post on the funniest line I've heard from a patient's dad when I told him his son couldn't eat Ful forever, if only to document the mindset and to alleviate the sad tone of the post.

"Is this some sort of conspiracy? Is there going to be a Ful shortage so you're being forced to tell me that my son can't eat it? No, its impossible! God would not do this to the Egyptians. He can't! He knows how much we need Ful!"

It's funny, but also sort of sad.

Thursday, 17 November 2011

Stupid Things I've Heard Mothers and Fathers Say (Part 1)

Here's a list:

  • "NO! You will not take another sample from my son's precious blood! You're draining him away!" -Scared woman who was pissed off at us for taking a few samples for reports. I think she also said something about selling her baby's blood in the black market. 

  • "I don't know why I didn't bring him sooner Doc. I just thought that his head growing faster than his body and that's where the brain is right? So he'd be getting smarter too!" - Mother who brought in her hydrocephalic child after months of leaving his head to grow in size. (Google hydrocephalus if you want, but I must warn you, it's pretty disturbing.)

  • "Listen Doc, I know he had a seizure and he needs to be under observation for a few hours, but I have work in the morning and his mother's tired. Can't we just leave him here and come back to pick him up in the morning?"  -Father after realizing he was going to have stay 5 extra hours with his child that had a convulsion.

  • "Can't I just give him my blood Doc? Yeah I understand it has to be a match but I'm his daddy and I know MY blood will specifically save him." - Father upon hearing it's not like the movies and that it  actually takes an hour for a kid to receive blood from the hospital.

  • "I'm worried about his poop Doc! It's brown and it smells nastier than usual. What do you think it could be?" - Mother discovering that poop is actually brown and smells pretty bad.

  • "So.... You're saying we SHOULDN'T feed him to the point of vomiting? But that's what my mom did and look at me! I'm fine!" -Mother reveals her wonderful technique for feeding her baby that is also, a family trade secret

Wednesday, 16 November 2011

A New Start.

So it's been a long time since I've posted (4 months and then some) so I figure I should update you on what's been going on.

Country's in shambles. Islamophilia and Islamophobia are on the rise all at once, and it's not looking good for anyone who's living here. However something monumentally life altering has happened:

I've finished my internship.

Now this might mean that the blog is done and dead. No more wacky stories from the intern who gave you a peek at an Egyptian Government hospital. Don't fret! For I have bigger news:

I start my Residency in a month (hopefully less), and it's going to be in Pediatrics, but for now I'm volunteering every now and then at the hospital so that I'll know my way around when it all becomes official.

Now, I know what I said before about me not being able to post that many stories when I was interning at the Pediatrics hospital, but, after much thought and exposure to both stupidity and mind altering moments of clarity, I've decided to keep posting about the stuff I'll be seeing. Keep in mind it might not be funny all the time, and sometimes, it's going to get a little dark and depressing. Anyways, let's get started.

A few days ago, in the Pediatric ER department we had a patient that went into shock.We stabilized her but she needed to get into the ICU. Luckily, the resident at the ICU department said there was a free space available (a rarity in its own self) but we'd have to wait a while until the patient using the bed previously actually got discharged i.e: her parents would come and pick her up. So we comforted the mother and told her, and needless to say, she was ecstatic (she knew about the difficulty in actually finding a free bed available) After a few hours and dozens of patients we'd realized that the resident in the ICU hadn't called us back to tell us to bring her in. So I went to go talk to him about it.

"What happened? I thought you said it was a done deal and your patient would get discharged."
"Yeah, about that, the patient's parents aren't picking up their phone."
"What do you mean they're not picking up their phone?"
"I mean they're not here in the hospital and I can't just kick her out into the street now can I?"
(Keep in mind the soon to be discharged patient was 4 months old)
"Well, keep calling them. They'll have to pick up eventually right?"

4 hours later.....
"What the fuck man? It's been 4 hours. Did they not pick up?"
"They did but we have a bigger problem.They don't want her."


"Like I said, they don't want her. It turns out they weren't the ones that brought her to the hospital. That was her uncle. Her parents don't want to have anything to do with her."
"I don't understand. What do you mean they don't want her?"
" I mean they don't want her. They said something about worrying she was going to die if she left the ICU but from what I gathered, they just don't seem to want her back."
"Did you tell them we're not a fucking orphanage and that bed's needed."
"Yeah yeah, all that, they still don't seem to give a shit though."
"What am I going to tell the girl's mother upstairs? We practically promised her the bed."
"Well, she's going to have to leave eventually. When she eventually leaves the bed's still guaranteed to your patient upstairs."

So yeah.. 

Now, it's not relatively uncommon for parents to not give a shit about their kids. If I keep posting, you'll soon realize how frustratingly apparent and common it's become.  What ticked me off, was that there was a bed that was available that could have really helped another patient, and it was being wasted on someone who didn't need critical care. 

And that. Fucking. Sucked.

I went upstairs and told the mother. She was amazingly decent about it. She kept asking me one thing though:

"What sort of mother would do that to her own child?"