The Hospital

I went to my first day of internship with the wide-eyed curiosity/zero responsibilities combination of a toddler. My white lab coat meaning every ward was accessible, every patient smiling and responsive. I geeked the hell out of the place in the first couple of months (which made me hit the intern limit a bit too early).

My internship is in a public hospital, a place where the gradual remission of socialism has turned major operations from free to heavily subsidized. Where high government budget makes lots of cool gadgets you wouldn’t expect available (surgeons having the ability to overindulge in multiple “clips” each costing over a thousand dollars, in a country where the average wage is 240$). I also witnessed its incompetence, how the lack of hospital beds had doctors choosing between two serious cases who was “worthy” and who had to be sent limping back home. I saw one month waiting lines on subsidized CT scans.

You arrive hearing the stories. An underground of nihilism and apathy, where corruption and nepotism reigns, and human suffering is a nuisance nudging you out of your daily lethargy.  I guess cultural hyperbole explains why your first impression is usually really good, and the positive curve stays with you. God bless low expectations.

Public hospitals, especially in the major cities, are one of Syria’s “government hotshots”, institutions that get a lot of funding thrown at them, and a lot of attention dedicated in order that they function properly. Most of the dirty work is of course done by interns, who instead of becoming demotivated, actually prefer not asking the patient for a cash deposit every time they need a new blood test (and let’s face it, the interns never see the cash anyway). They’re geeky, drone-like, stressed till wits end. But in no way can I call them apathetic. It’s like scrubs with the Dr. Kelso factor ruled out

No insurance you say? Shovel him out

 

But I didn’t understand how essential this system is until I did a stint in a Syrian Private Hospital. Your first disappointment is the moment you walk in: A private hospital is usually a small business venture, so the building shrinks, the equipment become much more archaic, and the only customers there are people who are ready to pay five-fold to not mingle with the commonfolk (fun fact, if your case is too tough, you get sent to the free public hospital). But then I found out about the sick underbelly of this business.

Medical insurance is a fledgling enterprise in Syria, only three years old. Therefore operations, diagnostics and check ups must be paid cash and up front. In the private hospital I saw what it means when the well being of your patient is a concern among many. I saw tricks, dupes. I saw a system that works more on prestige than practicality. My last straw was when I saw a doctor deciding to perform an invasive surgery on a person with widely disseminated lung cancer, a hopeless case. When he said that he wasn’t even going to tell him or the family that he had cancer, I walked away in disgust. I’ve never set foot in a private hospital since.

In a region where most of the laws are mishmashed relics left behind by temporary occupations, you can’t rely too much on the court to stand up for the little guy. Arabs usually get the short end of the capitalism stick.

Syria has made me skeptical about capitalism in general. Of course I know the free health care thing is only floating on oil money, I have been witnessing it dying in front of my eyes as the oil runs out. But it was good to experience being a part in an institution with no interest in making a profit. It taught me that the main goal of a system (in this case good PR) is a very important part of its overall functionality. I have my eyes always open for something better.

The problem is however, with the nerdy interns, and the elitist doctors, there is something essential that is lost. Syrian hospitals have the patients best interest in mind, but the patient has no say in the decision making process. Constantly looked down upon as simpletons unable to comprehend that which ails them, they are patted, prodded, inoculated, cut up, while obviously confused and having no idea what is happening. Yes, there are people who insist on being told what’s going on, but they are seen as a nuisance. Choice is never given, and a patient refusing care is considered proof of  their perceived infantile mentality. I have seen people stay an entire week in the hospital without having the faintest idea what their condition is.

To be honest, talking to the patients is the best part of my day. They’re much more “real” than people of my class, their way of thinking is much more rational. I experimented with explaining to them, never once did they fail to comprehend a simple direct presentation of their case. I’ve always had this positive belief of the capabilities of any human, something which every class discrimination apologist  has failed to shatter.

The challenge in the coming days is to make Syrians believe in each other, infuse in them the idea that any responsibility or freedom given to the people will not automatically result in a crazed self-annihilation berserk. I understand why its easy to hate the private system, but scary to tinker with the public one. But I do believe that with a little power in their hands, the people will keep on doing what they know is best for them, no matter what the fears gripping us whisper in our ears.

This allegory is dedicated to #Jan25, and all the hope it represents.

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14 Comments on “The Hospital”

  1. abu kareem Says:

    From a middle-aged doctor to a green intern: I like you ideals and attitude; please don’t let your experiences make you cynical (I doubt they will). The best thing about being a doctor is the appreciation of the patient for whom you did your best; it is not the money and should never be. There a few more noble professions and none that involve as intimate an interaction with other human beings. Cherish it.
    As you are of the Jan 25th generation, our hopes for change are pinned on you. If all of your generation is as idealistic and civic minded as you are, the future is bright indeed.

  2. 50% Syrian Says:

    I don’t know how to congratulate you on an excellent post, without sounding wrong. This post shows a lot of your ethical fabric, big heart, and awareness of non-physical social illnesses, such as class discrimination. I once read that a good doctor is someone who is aware of all dimensions pertaining to their patients (physical, spiritual, social, etc), plus their moral duty towards them. It is a great blessing that Syria has someone like you.
    My heart caved in when you mentioned the doctor who decided to operate on a no-hope case. People like these have no conscience and it is a pity they hold a job/duty they don’t deserve or honor!

    • seleucid Says:

      Wow, I don’t know how to respond to this…. thank you.

      I have good news however, most of the students my age have a similar mentality and although there are some elitist stereotypes and sometimes caring more about the case than the patient, I can generally say I’m proud of my class🙂.

      Thanks for visiting my blog, hope we meet someday

  3. drfa_78 Says:

    Insightful post. If you want to do something about it please contact us at naa-group.com (nour al amal group). We look forward to hearing from you.

  4. Ayman Says:

    Beautifully written!


  5. This may not qualify as a comment. For reasons of no interest to anyone but myself my curiosity has been moved. I see you haven’t mentioned a whole lot about yourself and it is within your right not to do so (talk about stating the obvious). To cut through it all; I would like to know where you were born and where you received your education. If it is something you do not wish to divulge a “NO” rather than a “NO COMMENT” would be much appreciated.

    • seleucid Says:

      I was born in Syria, and other than the first seven years of my life all my education was in Syria.

      Any other curious questions/discussions are welcome🙂


  6. Should my questions peeve you or in any way appear to be presumptuous, I sincerely apologize.


  7. I had only read the first few lines of your post when I left my first “COMMENT”.
    Now that I have read it in its entirety – a second one is warranted.
    You have illuminated a subject that either very few had recognized or many did but few wanted to talk about.
    In the precedence of order, doctors in Syria view themselves as the apex. And it would have been fine had it been confined to their self-esteem, but it is the dominating factor in their dealings with others and even more apparently so with their patients. If it were even possible to keep self-esteem out of the dominion of action it would be fine. BUT IT ISN’T …
    Elitism is real, if not in all the connotations of the word at least in some. We can all gladly and reverently bow our heads when Ronaldo is talking about scoring a goal or when he is scoring one. He has something which we haven’t – be it whatever it may. (Even Ronaldo may benefit from an observation made by one who is not part of the football elite – he isn’t perfect).
    I don’t mean to belittle their toil, they have after all worked hard to become doctors. And the public is all too sympathetic to that, perhaps rightly so. Yet being well familiar with the educational system that they have passed through, their assumption doesn’t stand on two feet. It is limp; an unfree system largely – to say the least – dependent on memory. Mind you, I’m not branding them as brainless (forgive the loose expression) memorizers. I’m simply saying that the other, equally if not more, important “leg” has not been tested. They’re not the ones to blame for these shortcomings in the educational system, they’re not the ones to blame for their social status, but they’re to blame for propagating it on false grounds.
    At the other end, at the base of this sideless pyramid* are the public. Doctors use the public’s mentality to further assert that image of elitism – being all too aware of its limpness in reality – by blatant disregard of any “other” opinions, by scathing undervaluing of the patient’s “butS…” or when that is impossible by making them feel – as you say – as a nuisance and by their thinking that keeping patients in the loop is a total unnecessity. All with such kind, condescending words and gestures.
    A patient should be ashamed of voicing his concerns and questions! This is one of the saddest results of this phenomenon.
    I don’t see it dissipating as you do. From my experiences in Syrian public hospitals I see it well afoot and marching on. There are reasons for that, beyond hospitals and doctors, but that’s another story.
    ———————————
    * to carry on the figure of the Syrian doctors’ view

  8. Daniel Says:

    I follow you on Twitter (@XzanderX <- that's me). I and I just wanted you to tell you that I'm a Swedish designer and journalist. I lived in Damascus as a kid hence my interest in Syria. If you hear anything about the protest please let me know!

    /Daniel

  9. Zendette Says:

    I agree, great post. Your idealism should inspire many. I have seen the reality of medical capitalism in the US, and the public system we have where I live now. I much prefer the system here, overall, although like in Syria,many doctors fail to inform the patient and family. And the system backs them. There is very little medical malpractice litigation here. In the US there is a huge amount, which drives up doctor’s insurance coverage and ends up raising the overall price of medical care.

    Likewise, elitism is rampant, and definitely affects the level of care. When someone with education and some knowledge of their condition and options, they can get the best care in the world. But for the average person who comes in with a complaint, the doctor will often make a general diagnosis that follows accepted public health protocols, and fail to delve into the background of the patient, and how that may be a factor, both in the disorder as well as their ability to pay for and then take any given medication as directed. I’ve seen many cases of people who are taking meds and they don’t even understand why. More commonly, poorer people will go to a clinic, get a prescription and discover the co-pay is beyond their means.

    In the US, under a private system, you can easily die if you don’t have money to even start a diagnostic process. There is medicaid, but few understand how it works, and most try to maintain their private, or semi-private coverage. This allows the insurance company to make health related decisions with the bottom line in mind. Not a real problem when its a question of replacing brand meds for generics, but a very big deal for someone who needs an MRI.

    Overall, I’m an informed patient at a large central region, so I make certain to get the answers and treatment I need. But I’ve seen how the elderly are treated, and often the system decides they are too old to treat, so the doctor may abstain from even doing a biopsy.

    I had a doctor tell me, flat out, that it was pointless to biopsy an elderly woman because she wouldn’t survive treatment if anything was found. I explained that perhaps the patient, as well as the family, would like to know so they can make personal decisions. Doctor eventually agreed, but somehow bureaucracy got in the way, and a biopsy was never performed.

  10. veronica Says:

    Hi!

    Excellent post! I am a research analyst based out of Dubai and my name is Veronica. I am conducting a study about healthcare in Syria and I hope you can help me. I have basically just started so any help would be highly appreciated! Can you contact me via email please? veronicacone (at) gmail . com

    Thank you and keep writing!

    Veronica


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