It’s been a rough couple of weeks. But not as rough as it’s been for Mishkat, my 23 year old niece.
Mishkat was diagnosed with Typhoid – a not so rare occurrence in our humble Sudan. The doctor who diagnosed her prescribed the necessary medication. Mishkat also has an ulcer. She knew that Typhoid pills are not to be taken by ulcer patients, so she informed her doctor of this. The doctor’s response was to tell her to take them anyway.
That was two months ago. Mishkat’s typhoid is still not cured, and now her ulcer is inflamed. The typhoid has become what is called “resident typhoid”, i.e. the disease version of a squatter. This has caused lacerations in her abdomen, plus the inflamed ulcer, resulting in around-the-clock continuous, agonizing pain. To quote one of the handful of doctors she’s seen, “she’s in a lot of pain now, but if it wasn’t for the sedatives, the pain would be unbearable”. Anything she eats or drinks is immediately expelled by her body, inflaming the lacerations in her stomach, causing more pain. As a result, she hasn’t had anything to eat in 16 days.
It took the doctors a month and a half to figure out what was wrong with her, but they can’t cure her because the meds are not available in Sudan. So she is in pain until someone can find them and get them from abroad. To make a bad situation even worse, Mishkat’s family can’t afford the exorbitant medical bills, so she was forced to leave the hospital and stay home. Her doctor friends install the IV bags for her, and her brother has learned to administer her sedative shots.
Photo courtesy of wetcanvas.com
Sounds like one of those late-night infomercials with the “benevolent” old White guy and the sad little Nicaraguan/Rwandan/Uzbek kids, right? This is the part where I should tell you that with just $1 a day you can save Mishkat’s life, and then pan to a smiling-through-the-tears Mishkat – aaaaand end scene.
Sadly, Mishkat’s problem extends beyond just her family’s financial situation. The whole healthcare system is broken. Sudanese locals, expats, repats, and Diaspora all have some (albeit different) level of understanding of the struggles of the Sudanese healthcare system. Those of us who can afford to get care elsewhere, do. Those of us who can’t either roll the dice and hope for the best, or choose to forgo with medical care altogether.
I wrote an essay in 2009 after a conversation with a coworker in which he revealed that a Cholera outbreak in the city was being passed off as the flu by doctors. Mind you, I don’t work in the healthcare industry, and my coworker went in to get checked out after battling a nasty case of the flu (which was also going around at the time… or was it). His doctor, apparently, breathed a sigh of relief as she prescribed him the necessary drugs, “it’s a good thing you only have a cold. There’s been a cholera outbreak recently, but we’re telling patients it’s the flu so that it doesn’t incite panic in the city”.
This seems to be one of the reigning strategies in the Sudanese healthcare system today – to keep the patient as clueless as possible. This can be lying to them about the severity of their illness, denying them their medical records under the guise that they “won’t understand them” (as was in Mishkat’s case), or not telling them what they have at all, to “spare them”.
The latter was the case of one 16 year old girl, a classmate to one of my cousins. She was diagnosed with cancer in its very early stages, and her doctor, in an effort “not to worry her and her parents”, didn’t tell them. Not only that, she also forbade them from seeking a second opinion. This happens a lot more than we care to admit, in a country where trust is everything, where people are simple and regard officials (particularly healthcare officials) with a deference that they so rarely deserve. When the young lady’s condition wasn’t getting any better, the family finally decided to seek medical help elsewhere – and went to Jordan. Doctors there informed them of the true nature of their daughter’s illness, along with the crushing news that had she been treated when she was first diagnosed, she would have survived. A month later, the young lady was dead.
There are so many issues to be discussed when talking about the Sudanese healthcare industry: the mass production of medical professionals, without any real evaluation of their knowledge or skill (i.e. pay up and get a degree); the complete lack of quality control, retribution or any consequence to malpractice; the dismal conditions of hospitals and clinics in Khartoum and around the country; and so on and so forth.
Writing about all these would make for a very long, very heartbreaking, and all around barely readable post – and as angry and frustrated as i am, i don’t want to put my readers through that. Yes, i am the Kevorkian of bloggers! Aren’t you glad? 🙂
So before i mercy-kill this post, i will say that not all medical blunders are quite as heartbreaking. Some are humiliating and, in retrospect, pretty damn funny. Allow me to share one of my favorite worst experiences:
A few years ago, I came to Sudan for routine summer vacation. One night, I began to feel some strange heart palpitations. Having a history of heart problems, I didn’t really concern myself too much. But a few hours of palpitations later, my parents started to worry, so we all piled in a car and drove to a far off cardiac hospital. Upon arrival, there was no one to be found. Not a single person to help. We finally got a hold of a very disinterested nurse, who informed us that we would have to go somewhere else because “there are no empty beds”.
(We were standing right next to an empty bed)
After a few seconds of shocked silence, my mother explained to the nurse that this is an emergency and we can’t just “go somewhere else”.
Nurse: Well, I don’t know what to tell you. There are no empty beds here.
Mom: <looks at the empty bed; looks back at nurse> This is an emergency! Where is the on-call doctor?? I demand to meet with the doctor.
Nurse: She’s sleeping.
Mom: So wake her up!
Nurse: I’m sorry, I can’t do that.
Me: <laughing hysterically>
Mom: …. What?! What do you mean you can’t wake her up!? It’s her job to be awake at this time!
Nurse: I’m not waking her up. Why don’t you try county hospital.
Having heard the horror stories about county hospital, I begged and pleaded with my mother not to take me there.
Me: Mom, honestly, I feel so much better now. Really. Let’s just go home. I’m sure it’ll just go away.
Me: Mom. I don’t want to go to county. They’ll kill me. Please don’t make me do this.
But ofcourse, it was to no avail, and off to county we went. Arriving at county, I was escorted into the emergency ward (which was basically a big dark room full of beds, and no real equipment to be seen anywhere), and my parents were told to wait outside. As in, in the courtyard, outside. I looked back at my mother with an expression that says, “If I don’t see you again, then I love you and goodbye”. I sensed my mother was thinking the same thing, because she went hysterical as the door closed between us. I could hear her screaming “give me my daughter back!” as I was instructed to lay on one of the beds in the corner of the room. I couldn’t help but laugh, because I realized that my mother was yelling in English.
The doctors – I couldn’t be quite sure if they were doctors, or nurses, or just people hanging out in the emergency ward – moved from their huddled group around the desk (which was just a regular small table) and to the door to watch the crazy woman screaming in English. Figuring out that she was my mother made my experience no easier, because now they were sure that I was from some uppity family, that I probably didn’t speak Arabic, and they could take out all their frustrations about whatever it was they hated about people who lived abroad on me.
I lay in bed for about 30 minutes waiting to be acknowledged as a living patient who needed (emergency!) medical attention, and listened to them talk about my crazy mother and myself and how “it’s so annoying when you have to deal with these people”. I looked around – most of the cases around me were either dead or near death. There was a man across the room who had vomited in his bed. I was pretty sure he was dead, because no one seemed to care that he wasn’t moving, or that he had puked all over the side of the bed, for that matter. The woman in the bed next to me was old, frail, and stark naked. Like. Naked. I had had enough sight-seeing, and thus turned my head to face the wall.
A while later, a plain-clothed “nurse” (in quotes because she later doubled as a janitor. I guess that’s why she wasn’t wearing scrubs or a uniform) came and told me to take off my clothes. I had been through the heart trouble process plenty of times, so she didn’t need to give me any instructions. This is the part where they hook me up to the heart monitor, so I took off my top.
“Nurse”: Pants, too.
Me: … excuse me?
“Nurse”: Take off all your clothes.
Me: … but … you’re gonna hook me up to a heart monitor. What do I need to take my pants off for?
“Nurse”: Just be a good girl and take your clothes off.
Me: …. no. I’m not taking my pants off, that’s ridiculous. There’s no need whatsoever for anything below the waist to be off.
“Nurse”: *clearly exasperated* Look, you don’t know how things work. Just take off your clothes.
Me: Well then are you gonna give me a gown or something to cover myself with?
“Nurse”: No, that’s not allowed.
Me: … What?? What do you mean “it’s not allowed”?!
“Nurse”: It’ll interfere with the equipment.
I feel I should at this point mention the “equipment” in question. I’m pretty sure it was the world’s first heart monitor. I’m also pretty sure it wasn’t working, because the screen was so dark you could barely see any of the “monitoring” it was supposed to be doing. I figured this ancient model must be that sensitive, so I sadly took off my clothes, as she hooked me up to the monitor. I took my head scarf from my head and lay it on top of me, in an attempt to keep whatever shred of decency I had left. I should have known better. She snatched the scarf from my body, barking, “IT’LL INTERFERE WITH THE EQUIPMENT”.
I don’t remember sleeping, even though I was urged to several times to do so by the “doctors”. I was scared, and uncomfortable at being so exposed, not only because I was virtually naked in a room full of people, but also because I had no idea what kind of horrible diseases were floating around in the air in that room, or on the bed for that matter. At around 4 or 5am, the “nurse”, now in her role as janitor, came around to my bed and shook me. Hard.
“Janitor”: Get up.
“Janitor”: Brush your teeth.
She handed me a toothbrush and a small basin, along with a cup of water. The toothbrush disintegrated the moment it touched my teeth, the bristles piling on my tongue like a haystack. I fought back the intense urge to vomit, and rinsed my mouth out into the basin. She took the basin, and spilled the water (the water that had been in my mouth) onto the floor. The floor of the emergency ward. She poured some more water out of a bucket and began to “mop”. I cannot in clear conscience call it mopping, because it was more just moving around large amounts of water, allowing bits of cotton balls (used to wipe away blood), toothpaste, and God knows what else, to float around until she lazily pushed it out the door and into the courtyard.
I closed my eyes, tight, to avoid the horrible sight, and to control the now overwhelming gag reflex, all the while cursing the day I had ever set foot in this country. At around 8am, rounds began. I heard yelling outside the emergency ward doors, and immediately knew what was about to happen.
Leading rounds was Dr. Siddig Abbo (may he rest in peace), my cardiologist when I used to live in Sudan, and my mother’s in-law. I sank deeper into the already sinking mattress as I heard him yelling at my mom for not informing him that I was here, and knew I was about to get the same treatment. He barged into the room, followed by a group of med students. Med students who were all friends of my cousins. Friends of my cousins who now had front row seats and VIP access to my nudist show.
My last memory, before my brain shut down for self preservation, was that one of my cousin’s friends, standing directly across from me at the foot of the bed, had recognized me and was waving hello.