Wednesday, 25 July 2012

Why the Health Care System in Cairo is Doomed.

Well it's not exactly one reason. There are a number of reasons the public health sector in Egypt is entirely flawed and not up to par with any golden set of standards imposed on it by even the saddest of developing countries.

Lack of finance, lack of resources, lack of decentralization. These are all very valid points.

But let's focus on one that can be changed but won't ever change due to how the health care system works.
I'll call it the Circle of Residency.

Now bear with me because I'm about to compress a lifetime of a medical student in a few measly sentences.

First off, let's consider the student that just got accepted into medical school. Let's even assume he actually wanted to go to med school and wasn't forced to fulfill his parents' failed dreams of success. He's ecstatic, he's hopeful but most importantly he knows he wants to be a doctor to benefit society. He makes an oath to himself, swearing to study hard and become a success despite the poor teaching conditions in most of the public universities here.

He finally finishes those 6 years, still wide eyed and full of hope. He guarantees a good enough grade to work in the hospital with a guaranteed teaching position.

Then he starts his internship, and that's when things start to turn sour. He witnesses the corruption, the poor ethical standards, the abysmal working conditions of the resident. He starts to realize that maybe, just maybe, life isn't going to be that easy. He's still set on making a change though. He brushes off all the horrible attitudes the residents take and tells himself he will not be THAT resident. He finds a field he's comfortable with and decides to spend all his free time there, soaking up and absorbing all sorts of information to prepare him for when he becomes a resident.

The year ends and he finds out he was 2 marks away from getting that field he wanted.
So he settles.
For a field that that he wasn't so in love with in the first place.

No matter though, his heart will not be broken, his spirits uncrushed, he moves on! He goes into the field wholeheartedly, anticipating all the excitement. After all, he's a resident now. Now is when actual professors will give him advice on management and treatment and he'll finally notice how much of a difference he makes.

Until the professors never really show up. And he's forced to make decisions based on his minimal experience and then he unintentionally harms a patient because he was forced to make a gut decision due to the fact that there was no one there to guide him.

His mind begins to jade.

And when the professors actually show up, they don't offer guidance or help. They ostracize and demean the poor resident. They put him in harsher conditions not offering him even the tiniest bit of solace or gratitude.

He soldiers on.
He tells himself, "It's alright. I'm going to be an Assistant Lecturer in 4 years. Then I won't be the one getting shit from the professors. Not only that, but I'll show them. I'll show them how it's supposed to be done. I'll teach the new residents. I'll be there all the time and guide them and make my hospital a better place."

The man falls in love with a girl. They get engaged and soon to be married. Just as soon as he finishes his residency.

He succeeds and gets his Master degree thus ensuring his position as assistant lecturer.
It can only go uphill from now, he thinks to himself.
He gets married, his wife gets pregnant and he's there teaching the new residents and enjoying his life.
Then he realizes the money isn't enough. That he needs to work in the private sector.

"It's only a few days a week. I can manage. I can do both."
But then those days become weeks.
The new residents call him on the phone, asking for the guidance but he's too busy. A month passes and he finally shows up and sees the department in a mess.
He shouts at the residents for their poor management skills. He tells them how he barely made these mistakes when he was a resident.

He forgets how hard it was.

Eventually as time goes by, he becomes exactly what he hated, and the cycle repeats itself.
Believe me when I say, that I haven't even begun to shed light on what happens to residents in public hospitals. Believe me when I say, I totally understand why we become jaded, cynical and just not the greatest of human beings.

It still doesn't make it right though. 

Sunday, 15 July 2012


So we were sitting the Emergency ward me and a few other residents (one of whom is a Muslim non veiled girl because yes, they've become a ridiculously rare breed in the public sector) and we had two patients that needed an incubator. One let's call Mohammed, the other let's call Peter.

They both needed to get operations done and they were both in pretty bad shape.

Now, amazingly enough, we actually had an empty incubator available. Fucking fantastic, only until you realize I used the singular version of the word. Thankfully, it wasn't our choice; the ICU surgical resident (who gets to decide) decided to choose Peter (for actual medical reasons, he had a somewhat better prognosis), and we had to somehow explain to Mohammed's parents that Peter was going in and Mohammed wasn't.

They didn't take it too nicely.

Here's what they said and forgive me if it's not word for word:

"Well OF COURSE you're going to pick the Christian kid. This is what happens all the time everywhere. We get treaded on while the Copts get all the special treatment. It's not fair."

This was of course directed to my non-veiled colleague.

My Muslim non-veiled colleague.

Let's break this down and go over that sentence again.

Mohammed's mother,

1- Assumed the doctor was a Christian and so gave preferential treatment. This is fine. I'll forgive her for that. I've seen it happen before and I don't really mind it. I've never seen it during a critical call though. Just silly shit like donations and stuff.

2- ACTUALLY fucking said, "This is what happens all the time".  Here. In Egypt.

In a Muslim Brotherhood run Egypt.....
......During the aftermath of what was possibly the worst year Copts have had to endure when it comes to death.

3- Further reassured her point by saying "It's not fair"

Fucking Copts. Seriously you guys, aren't you all going to die already? Your 10% is totally putting a damper on the 90%.

Rest assured, I explained the situation to her, not calmly of course.
I told her why Peter was chosen. I had a beard. She had to listen to me.
And all was well (until he arrested and died but that's not the point).

You might be wondering, "Well, doc, it DOES happen! I've seen Christians give other Christians preferential treatment or whatever"

You probably have, and that's your fault. Majorities have to to tend the minorities and let's face it, we haven't been a pleasant majority now have we.

Everytime you wonder why some Christians give other Christians preferential treatment, remember the last time you said something along the lines of
"Oh man, it's a shame he's a Copt."

It's our fault for putting them in that particular situation, and if anyone needs to start a peaceful (and non hateful) coexistence, it should be the majority.

Funny end to this story: The resident (non veiled) came up to me and said, "How do I prove to them I'm a Muslim?"

I told her to tell them the Shahada (There is no God but Allah) so that they'd think they converted her out of shame.

She didn't.

Some people can be such spoilsports sometimes.

Friday, 13 July 2012

I'm Sorry.

After almost 6 months of being a resident, this is the one thing that's still pretty difficult to deal with: Telling the father or mother of a child that their kid is either terminal, hopeless, or just not going to be their same old son or daughter anymore.

 It's an emotional rollercoaster that's always different with each family. There's no routine to how it works or what you're supposed to do. I'm sure abroad there's a whole system or class teaching you how to deal this particular piece of information out but here, it's just an afterthought.

Which sort of sucks.

It's gotten to a point where I jump at the possibility of delivering bad news to families because I feel I'm the only one equipped with the ability to emotionally convey bad news and at the same time, share the emotional fuckage the family experiences. I don't think I'm better than my colleagues at it. I just think that they've been at this longer than I have, and that they've reached a certain jaded level of consciousness I'm not sure I'm ever going to get to... or want to at least.

It's also a whole lot harder to do than say, telling the family their kid died. There's a finality to death. But with terminal illness or affection, I always feel like I'm damning them to both feel the loss of their child profoundly but also hope that maybe, through some sort of God given miracle, their kid will be the 0.0005 percent that miraculously becomes okay.

And man, do they stick to that hope. Because after all, "God is almighty and works in mysterious ways."
I sometimes thank God that I don't have to deal with atheists and agnostics. It becomes a whole lot easier to accept when the doctor says something like "Well, God is here and this is what He wanted to happen so who are we to judge."

And I feel like a prick every single time I say that because it works every.single.time.

So yay for Egypt not having any atheists.

Another one that's always harsh is "Was there anything that could have been done to prevent this? Was it my fault doctor? Was I too late? Did I do something wrong?"

I pride myself in honesty, but goddamnit does that become a whole lot harder when I say, a single shot of Vitamin K could have saved their newborn from having intracranial hemorrhage and subsequent brain atrophy for the rest of their life.

And I tell them that. But I also tell them it's never their fault (unless it's aspiration pneumonia, ESPECIALLY after I've told them not to fucking breastfeed their kid but that's a whole other story entirely).

After all, ignorance is rather rampant here as you might have sussed out from my previous blogposts.

I have a few stories about a few of these moments and I might or might not share all of them here but here's one that really did a number on me.

We had a 10 year old girl who got admitted into the hospital for having pancytopenia (all blood cells, including Red , white and platelets are decreased) Now, there are alot of causes for pancytopenia but we usually screen out leukemia first by doing a bone marrow aspirate and sometimes biopsy. So we managed to book her aspirate a few days later and I remember going upstairs to the labs to pick up her report.

She had leukemia.

I'm not going to lie. I felt nothing reading the paper at first. To me, this was just another girl who had cancer and we were going to tell her parents that and then she was going to go on to the Cancer Hospital and get her treatment and then maybe get better, or maybe not.

Pretty standard stuff.

But then I bumped into her father, who had been waiting for hours outside the lab for the test results.

"Did the results come out Doc?"

His eyes were wide open, full of worry and anxiety.

"Yes, let's sit down first."

So we sat on the bench in the hallway.

"Well, your daughter, she has leukemia."

"You mean cancer?"


Then and there he just broke down in tears, as if crushed by this immense weight. Not as if. He was, and there I was, sitting next to a crying middle aged man who just found out his 10 year old girl had cancer.

I felt like shit.

I felt like shit because I felt nothing a few seconds prior to seeing him, and now here I was, just emotionally syncing with him and feeling every ounce of sadness seep out of him.

That's a lie, because obviously I couldn't even experience a fraction of what he was feeling, and even that small fraction was already too much for me.

"It's not the end of the world. It's tough. It's going to be very tough, but I've seen kids with leukemia go into remission and get better and move on with their lives and become healthy individuals."

"So you're saying she's going to be alright?"

I fucking hate that question.

".......... Listen. We're all going to do our best here. You're going to do what you can and the doctors are going to do what they can, and well, the rest we can leave to God. Okay?"

He was still crying.

So I hugged him.

Might have not been the by the book thing to do. Might have not even been the right thing to do.

But there we were; two sad men sitting on a bench trying to get through life's hurdles.

And boy are those hurdles high for some people.