Friday, 19 June 2009

Two Weeks in a Moroccan Public Hospital: Bachir's Story

Bachir was at the hospital. His mother and Aziz, his friend since he was a child, had managed to get him to Fez.
But there, nothing could be done for him. The doctors were helpless, because they didn't have the equipement to diagnose him. He needed to be transferred to Rabat, the faster the better.
Fred spent the entire afternoon at the hospital, waiting for a vacancy in Rabat.
An ambulance finally came to get Bachir. Aziz was the only one who could stay with him in the vehicule. In poor Moroccan families, men are the ones who accompany the sick. Women stay home, and wait. I can't imagine how hard it must have been for Bachir's mom. She went back to Ouled Tahar, alone. And waited.

We had been told that Rabat public hospital was the biggest hospital of Morocco.
We knew that Rabat was a modern city, much more modern than Fez, a very traditionnal city.
In the car, on our way to the capital, we were hopeful. We were very relieved to leave Fez.
And we pictured the hospital in Rabat bigger than the one in Fez, with more nurses, with better equipement, and more dignity for the patients.

Oh my, were we wrong.

We understood it as soon as we entered the hospital.

 photo : ortizmj12

No nurse, except for a very old man, who just stood there, in the neurological ER – where Aziz had been waiting for us, trying to calm Bachir down, who was delirious with pain.
Only one doctor in the ER – who had to admit the patients, diagnose them, decide what to do with them, and, and, perform surgery on the patients.
No phone in the ER. I mean, no phone for the ER staff – that was a staff of three. The doctor on call, the old nurse, and the « surveillant ». So, when we were told by Hugues, the doctor, that Bachir needed to go to a private hospital to have a echography of his heart, the « surveillant » had to use a payphone outside the hospital.
No pharmacy, and no medication available in the whole hospital. When we got back from the private hospital, at 2 am, after having dismissed the hypothesis of a heart malformation, Bachir was in extreme pain, completely delirious. Since he left Fez, at 4 pm, nobody had given him any painkiller. So Fred had to go, in the middle of the night, in a city we didn’t know, find a pharmacy on call – twice, because the first time the doctor made a mistake in the prescription.

And at 3 am, Bachir was finally admitted in the neurology department.
Where there were no sheets on the beds. No pillows. No doctor.
Moldy walls.
Bachir got a half broken bed – and he was dangerous, in his delirium. He moved a lot, wanted to get off the bed.
The nurse tied him the broken bed with some bandage.
Didn’t give him any medication.
Had to wait for the on call doctor to authorize a sedative injection.
(But he was downstairs, remember, with a dozen patients, and with an operating room to take care of).
So we got angry. Bachir too, in a way. Half an hour later, the insults he was screaming made the nurse give up and she gave him the sedative.

We left Bachir at this point, because there was nothing more that we could do.
The arteriography was scheduled for the next morning.
It almost didn’t happen, because a nurse who fed Bachir with some yogurt when he wasn’t supposed to eat anything for the procedure.
I can’t tell you how much we were angry at this point.
But the doctor told us not to tell anybody about the yogurt. And the arteriography went well.
36 hours after Bachir had the stroke, we finally had a diagnosis – a malformation in his brain had provoked the bleeding. Hugues was optimistic.

The worse in the Moroccan public health system is the solitude.
Nobody comes to you to see if you need something. You just wait, and wait, and wait. To get someone to help you you need to insist and threaten. Most of the people we’ve seen at the hospital are just resigned. A co-worker told me that the patients are afraid of the doctors won’t take care of them if they get angry. Corruption is very strong in Moroccan hospitals – drugs get stolen, some doctor will only perform surgery if you bribe them. The system is very sick.

And you’d better not be alone, or poor, when you have an accident in Morocc.
You can’t get an examination or an operation if you don’t pay first.  In France, the health system is great in comparison. Health insurance is free for those who can't afford it. 
Oh, of course, it’s free to a certain extent too in Morocco. That is, most of the population is considered to be « indigent », and « indigents » don’t pay for consultations or operations. But they still need to pay for the material. And that is very expensive.
So if you have no money, I guess you can just die in the ER.
We were so glad we went to Rabat with Bachir. We payed, he got what he needed.

In Morrocan hospitals, the patients are always accompanied by a family member, who literaly lives by their beds. Since the nurses don’t give medication or wash the patients, families are the real nurses. What would happen to somebody who doesn’t have family ? Or whose family lives far away ?

Aziz spent 17 days at the hospital, in Bachir’s room. He gave Bachir his medication. He kept him clean, walked him to the bathroom, fed him. He held Bachir when he was delirious – most of the nights. He slept in his friend’s bed, because there was nothing else available for him. He bought the medication and talked to the doctors.

Imagine how brave is Aziz. He didn’t sleep much during those two weeks, because of Bachir’s screams and pain. He barely got out of the hospital, except to buy Bachir’s medication and some yogurts. Just try to imagine. The room with four patients, and their sons or fathers. The small bathroom. Bachir screaming all night, waking everybody in the service.

Bachir and Aziz

That makes me so angry. Because everything is not so bad in those hospitals. The machines they use are modern – when you finally get to the point that they , after hours, or days. The rooms are big and bright. But they desperately need some makeover.
The doctors are competent. The nurses too, probably. But they are overwhelmed, lack of everything. Helpless. The budget of public hospitals in Morcco is way too low.

And I know that we didn’t see the darkest side of the system, because we’re French, and that Bachir beneficiated from some kind of affirmative action just because we were with him.

Bachir is getting better and better. It’s incredible, considering how he was just after the stroke. Sometimes though, he looks like a child, is scared of the dark, he who usually is so strong and so brave. We don’t know if he’ll be able to work again.
And. He is absolutely convinced that he spent four months at the hospital.


Kristin @ Going Country said...

Wow. Americans are fond of complaining about how screwed up our health system is, but nothing like you have described would ever happen here, even for the poorest person. I wish the rest of my countrymen understood how privileged we are in comparison to a lot of the world.

Bachir is incredibly fortunate to have friends like you and Aziz.

Jeannie said...

In general is the healthcare that bad there in Morocco? My husband, who is Moroccan, wants to move back there in a few years. This kind of story makes me scared to do so because of the health care.

Ali la Loca said...

Sobering. I hope his health recovers as well as possible.

This reminds me of a good friend giving birth to her first child in the public hospital of Chimoio (Mozambique) the first month I'd moved there. It was nothing short of horrifying, as she had complications and they were absolutely unequipped to deal with her situation. Mother and baby made it, thankfully, but it will stay in my mind forever as one of the worst things I've ever witnessed...and she was someone who, for local standards, had quite a bit of money. Imagine what it is like for the others...

Marie said...

Thanks everyone.
Kristin - yes, Americans are privileged, but in France we are even more. But I can understand why people complain - a good health system is precious, we have to defend it.

Jeannie - yes, it's very, very bad if you're poor. But there are very good private hospitals don't worry. Some of them are as good as hospitals in Europe. You just have to take a health insurance that will cover you in Morocco. Don't hesitate to come to Morocco! It's such a beautiful country (and you could visit us in the countryside!)

Ali - the situation must be a lot worse in Mozambique, since it's much poorer than Morocco. Life must be very hard there for poor people.

Anonymous said...

Marie, I would love to visit you when I visit too! I am coming to volunteer at the childrens hospital. I am a pediatric nurse here in the US. I would like to donate some medical supplies too.

My contact information:

Mary Ann DeCelle-Austin