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
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.