Category Archives: healthcare

change of plans.

June 30, 2016

So, in my last post (or maybe the one before?) I wrote about how Lavender and I were going to be in Missouri for three months, with Mr. Mostafa coming in mid-June in order to spend our last three weeks with us before we all returned to Riyadh together on the 10th of July.

Yeah, well…change of plans.

In my last post, I did write all about what’s been going on with my pregnancy, and how difficult it’s been. Well, after I wrote that, it didn’t get any better. In fact, it got worse. And worse.

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the ouchie.

January 3, 2016

My mom is here in Riyadh for a visit, and I am thrilled. Obviously. I always miss my mom, but I was especially in need of a mom hug after the week we had before she arrived.

Shortly before Christmas, after my plans with a friend got cancelled, we decided to make an impromptu trip to Bahrain for a few days of relaxation and holiday cheer. We were enjoying our time, soaking up the Christmas music and decorations. And then disaster struck. (A pretty mild disaster, in the grand scheme of things, but it was still somewhat traumatic for all of us.)

Since we arrived in our hotel room, Lavender had been fascinated by the bidet. She loved to run into the bathroom and play with the bidet and call, “Wash hands! Wash hands, Mama!” See, the bidet was exactly Lavender’s height, so she just thought it was a cool sink that happened to be exactly her size. Needless to say, we weren’t super thrilled about the idea of her playing a hotel room bidet, you know? It didn’t seem super sanitary. Not to mention that she seemed to be fascinated by everything in general in the bathroom, and she kept trying to stand on the bidet and boost herself up onto the bathroom sink/countertop. And that didn’t seem super safe at all.

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love, tonsils, and cerelac.

October 19, 2015

Hollywood has a history of giving movies present participle titles that include the word “saving,” presumably to indicate that this is a Very Important Film. Saving Sarah Cain. Saving Private Ryan. Saving Mr. Banks. And I think there are like, four different movies called Saving Grace. (Spoiler alert: I’m pretty sure the main character in each one is named…wait for it…Grace. Punny.) And then there are the not-so-important movies that piggyback on this precedent, like Saving Silverman.

I think if Mr. Mostafa and I had a movie, it would be called Saving Cerelac. Because we always seem to end up eating Cerelac.

Once upon a time, about seven years ago, Mr. Mostafa and I paid a visit to the only Middle Eastern store in our city (or town? I’m confident that some people would call the place where we met a town; its population is around 165,000. But for me, growing up two hours southeast in a town–or I’m confident some people would call it a village–of 212, that big “town” was, to me, the big city. Also, fun fact–that Middle Eastern store was also a Latin American store, because the couple who own it are bicultural–the husband was Middle Eastern and the wife is Latin American. Love). Anyway, Mr. Mostafa took an immediate liking to this store, obviously, because it was the only one in town (city?) that carried such homesickness-alleviating items as black limes and Vimto.

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the artist and the butcher.

August 13, 2014

The saga of the toe goes back a long time. (“Before any of us could even pick up a baseball.” Name that quote.) It started last year, in November, while we were in the States.

By the time we landed in Missouri, my big toe on my right foot was hurting, but I didn’t think much of it. Within a few weeks, my toenail was totally ingrown and obviously infected. Mr. Mostafa, along with my parents, tried to get me to go to a doctor in Missouri. I refused because of the expense, and I insisted that if it got a whole lot worse, I would go to the doctor when we got back to Riyadh. Mr. Mostafa and my mother ensured that my foot was perpetually soaking in a bucket of hot water and Epsom salt, and they tsk-tsked and commiserated about me: “I knew this would happen eventually. She cuts her toenails too short.” “I know, I try to tell her not to do that, but she never listens!”

I deny this, and with some plausibility. I really don’t believe that my toe issues (or, at least, my current bout with my toe issues) have anything to do with my podiatric grooming habits, because lately, I’ve been really trying not to cut my toenails freakishly short, as has generally been my wont (partly due to my desire to have an appropriate toenail canvas for Jamberry nails, which I discovered recently via my sister-in-law and am obsessed with. Miracle product, I say, and the one thing that has managed to entice me to give up nail biting for the long term, after years and years of relapses).

But I freely admit that I have been guilty of such an offense.

In general, I have a thing about keeping my nails short. I’ve been biting my nails (or fighting the temptation to bite my nails) ever since I had teeth in my mouth; there has always been something very satisfying to me about gnawing on my nails. (No, I have never had a toenail-biting habit, although my dad will still tell you about the time when I was three years old and he came into the bathroom to retrieve me from my perch on the toilet and he found me happily chewing on my toenails. It’s literally one of his favorite stories.) When I was a kid, my mom did anything to discourage me from nail-biting. She tried that stuff that’s supposed to burn the kid’s mouth when they nail-bite; I laughed and kept on chewin’. She bought me erasers and pencil grips and encouraged me to chew on them instead. I obliged, but I just worked them in to my regularly scheduled chewing routine, along with my nails.

When I was seven, desperate for me to stop biting my nails, she paid for me to have a set of acrylic nails put on. As these were the days before Toddlers & Tiaras, it must have looked so strange, a little seven-year-old whose feet couldn’t touch the floor, sitting in the manicurist’s chair, getting her acrylics put on. I loved my fancy long nails while I had them…but you know what I loved even more? When they started to pop off a few weeks later and I discovered that the nail beneath had grown soft and pliable, ripe for the chewin’.

But something finally did make me stop. And his name was Prince William.

I am not even kidding. At some point during my adolescence, I decided I was destined to marry Prince William, because duh. (Please remember that I am a nerd who grew up in a town of literally a few hundred people. Imagination was necessary to my survival.) One day I looked down at my fingernails and I imagined Prince William down on one knee in front of the Eiffel Tower, holding out an emerald-cut diamond solitaire engagement ring in the requisite Tiffany box…and I realized that if something didn’t change, that ring would have to be placed on a finger with a gnawed stub of a nail, and oh, my God, what would the Queen think? So I stopped biting my nails. Just like that. (Ironically enough, when Mr. Mostafa proposed to me, my nails were the last thing on my mind. In fact, I now can’t recall at all what my nails looked like on that day.)

But even as my fingernail-biting habit was kicked, my toenail-cutting ritual was solidified. One day, during the same school year, a classmate of mine ended up severely tearing her big toenail during some sort of lighthearted roughhousing outside during our lunch break. I sat next to her in geometry class, right after lunch, and I remember looking down at the injured toe peeking out of her sandal, her ripped toenail still bleeding, and thinking, “Oh, my God, my toenails will never, ever get long enough to let that happen to me.” Even now, the image of that torn nail is burned into my brain, and as a result, long toenails totally gross me out.

But as it turns out, an ingrown toenail from cutting a nail too short is just as painful, and probably more dangerous, than having a ripped toenail because it’s too long. Huh.

By the time we got back to Riyadh, my toe was the size of a golf ball, and Mr. Mostafa and I were both beginning to panic. He made me an appointment with a doctor and off we went.

The doctor was an older man, Egyptian, and all smiles. He could best be described as jolly. He asked me what was wrong. I told him. He came around to our side of the desk and glanced at my toe.

“Oh, yes,” he assured me. “I will give you antibiotics, and a pain medicine if you need it. After you finish the antibiotics, come back and we will do a surgery.”

“A surgery?” I asked nervously.

He nodded. “Yes, a surgery. Very easy surgery, no problem. Take the antibiotics first.”

I looked at Saleh, slightly panicked. “I’m breastfeeding,” I told the doctor. “I can’t take some medicines.”

“You are American?” the doctor asked.

“Yes,” I said, nodding.

He shuffled papers on his desk and began writing out a prescription. As he did so, he said, “I know a man from Egypt, he married American woman. She loved the food so much. She ate all the time, all the food. Like this.” He mimed the action of shoveling food into his mouth. “She got very fat,” he added.

I patted my stomach and said jokingly, “I have the same problem.”

The doctor’s eyes lit up as he laughed and said, “Yes! Yes, she was just like you!”

Well, thanks, Doc.

He wrote out a prescription for antibiotics and instructed me to take them for two weeks and then come back for the surgery, which he never was very specific about.

“I don’t know if I like that guy,” Mr. Mostafa said, as we walked out of the hospital. “He looks more like a butcher than a doctor.”

“Why do you say that?”

“I don’t know. Just a feeling. Like, he’s nice and everything. I’d buy meat from him for Eid, but I don’t want him cutting on your toe.”

“I don’t want him cutting on my toe, either.”

“So…we’ll wait and see if the antibiotics fix the problem, and if it does, we won’t go back to the doctor. Is that the plan?”

“Exactly,” I said.

So that’s what we did. I took the antibiotics and luckily, within another week or so, my toe was back to normal. It stayed normal for several months. Then, a few weeks ago, the toe began to hurt again. And it began to swell again. And before I knew it, I developed a hole in the top of my toe, where (icky overshare warning) the infection was oozing out.

“Um, Saleh?” I said one afternoon. “Remember how my toe got ingrown and we had to go to the doctor?”

“Yes.”

“Well, it’s doing it again. But now there’s a hole in my toe.”

“Excuse me?”

“There’s a hole. In my toe.”

“I don’t think you’re supposed to have a hole in your toe.”

“Me, either. I didn’t have a hole in my toe last time. I don’t know if that’s good or bad, though. Like, I didn’t have a hole last time, so all the infection was trapped and my toe got all swollen and stuff. Now that I have a hole in my toe, all the infection and nastiness is coming out. So…like, does that mean it will heal faster because all the infection can come out instead of stewing in my toe? It seems to me like the hole is a good thing, but I don’t know.”

“Huh. Well, should we go back to the butcher or should we try to find a new doctor? Personally, I prefer that we go to a different doctor. But that’s just me. What do you think?”

“I think I don’t want to seek medical treatment from anyone you refer to as ‘the butcher.'”

“I don’t want you to, either!”

“Okay. Just go to the pharmacy and buy me a box of the same antibiotics that I took last time.” (Here in Saudi Arabia, pharmacists can sell antibiotics and certain other medications without having a prescription.)

“What kind did you have last time?”

“Uh…I don’t remember. Just ask the pharmacist for a course of antibiotics that are safe for breastfeeding mothers.”

“It was called omega-man-teen. Or something like that.”

“Omega-man-teen?”

“Yeah, I swear it was Omega-man-teen. Just Google it, honey. You’ll find it. Omega-man-teen.”

“Google doesn’t read minds, Saleh.”

“Yes, it does. Just put in the first three letters and it will tell you the rest!”

“I remember now. It was Augmentin. Not Omega-man-teen.”

“Yes, that’s it! Augmentin! I told you, just Google it!”

“I didn’t Google it, I remembered it!”

“But now that you remembered it, you can Google it and make sure it’s what we’re looking for!” He paused. “You know what, never mind. I think we need to go to the doctor. It’s a bad idea for you to just prescribe yourself antibiotics. But not the butcher. I’ll make an appointment for you with a different doctor.”

So the next day, we went back to the hospital, to the office of a different doctor, a Pakistani lady with whom I was very comfortable. She asked me many questions about my health and about the toe. She sat me on the examining table, put on examining gloves, and looked closely at the toe. She touched the toe. She nodded and explained exactly what she would do.

“We will give you antibiotics again,” she explained, “because I cannot do an operation while the toe is infected. After the infection is gone, I will do a very simple procedure in which I will inject your foot with a numbing medication; you won’t feel anything after that. Then I will take off about half the toenail.”

“Half the toenail?” I repeated fearfully.

“Yes,” she said. She went to her desk and retrieved a blue marker, and then drew a vertical line down the middle of my toenail. “Just this half. I will take it out, since this is the second time you have had this problem.”

I thanked her sincerely for her opinion and her thorough explanation, and I assured her that if the toe had not healed by the time I finished the antibiotics, then I would be back for the surgery. She agreed and handed me a prescription for antibiotics–Augmentin, of course.

I admit that at first, I thought, “Are you nuts, lady? You’re not taking off half my toenail! I need that toenail! Jamberry nails, man!” I thought the nail would be removed permanently. But I did some research, and it turns out that after a simple surgery like that, it does grow back. So I’m not as scared of the possibility of the surgery as I used to be.

But so far, my toe seems to have healed well, and I’m hoping that I don’t have to deal with this ingrown toenail issue again. But if I have to go back for a surgery, I’ll be returning to the doctor who drew the pretty blue line on my toenail. When it comes to doctors, I much prefer an artist over a butcher.

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packing…and the emergency room.

October 24, 2012

My journey to the States begins late Sunday night, and I’m starting to pack. I’m taking all three of the suitcases in my luggage set, but for the trip there, I’m hoping to close my medium suitcase in my large suitcase, so that I’ll have a whole extra piece of luggage with which to bring back delicacies from my homeland.

Regarding my trip home, I am currently maintaining two lists in my iPhone. One is titled Things I Will Eat While In Missouri–i.e., things I love but haven’t been able to source here in Riyadh and can’t feasibly be brought back with me. So far, the list includes Springfield cashew chicken with crab rangoons, real mozzarella cheese (the super-soft kind that comes in a ball), Pillsbury Toaster Strudels, Cream of Wheat (although I know this is technically just semolina, which is plentiful here, I haven’t been brave enough to just buy a bag and try to cook it. The red box–and the directions!–are comforting), my mom’s French toast, my dad’s pancakes, artisan pastries from Chantilly’s…and Claussen’s dill pickles.

My other list is Things I Will Bring Back To Saudi Arabia. Thin Mints! (Oh, how I hope I can find them!) Cranberries! Grits! Those pink-and-white frosted animal cookies with rainbow sprinkles! Cheez-Its! Pop-Tarts! Triscuits! Those pastel after-dinner mints that melt in your mouth! Tums! (For both me and my husband.) Swiffer Wetjet refills! (For both me and my mother-in-law.)

However, while I already have a detailed plan for bringing things back to Saudi Arabia, that is not to say that I’m not bringing many things to the tried and true homeland from the new one. I’ll have even more space in my luggage once I give away the presents and treats I’m hauling home.

packing

My suitcase is already chock full of treats. I have an abaya for my mom (in the black bag)–she will need one when she comes back to Riyadh with me! Several Saudi mabkharas for friends and family. House thobes for my little nephews (my brother’s son and my best friend’s son). Sweets from Saadeddin for my cousins. A shmagh and igal for my dad. A big tin of maamoula type of Middle Eastern date cookie (sort of like a more decorative and more delicious version of a Fig Newton, but stuffed with dates–although you can get them stuffed with other fillings, such as pistachios) for my dad’s best friend, who came to Saudi Arabia in the U.S. Army during Desert Storm and came home with a taste for maamoul (and, as far as I know, hadn’t had them since his time in Saudi Arabia until he met my husband…I think one of the first things he mentioned to Saleh was, “Hey, so if you’re from Saudi Arabia, do you know about those cookies with dates in the middle…?”). I also brought home a wooden maamoul mold for his wife, so that she can take a crack at making them herself for him if she wants to.

As excited as I am to go home for a few days and see my family and friends that I love, I’m also nervous about leaving. I’m looking forward to being there, but I’m not looking forward to not being here, if that makes any sense at all. Having spent two years mostly on opposite sides of the world, neither Saleh nor I are quite ready yet for another international separation, however short it may be. A few days ago, as he was helping me organize my things to take home, I just burst into tears, threw myself at him, and sobbed, “I don’t want to leave you!”

Yes, I really wish that Mr. Mostafa were traveling with me. But at least this time apart is quite short. And my mom is coming back with me. It’s a good situation, and I’m grateful.

But I’m also nervous about leaving now because Saleh is under the weather. Last night, as I was composing this post (which was originally intended just to be about my prep for traveling), he woke up from a nap with a stabbing, unbearable pain in his right side. We quickly got dressed, woke up his brother to drive, and Saleh, his brother, his mother, and I all headed for the emergency room to figure out what was up. We suspected it might be kidney stones, as Saleh had had kidney stones while in the States about three years ago, and the symptoms had shown up in almost exactly the same way. Still, since this time the pain was on his right side, visions of appendectomies crowded my head, and I was terrified that his appendix had burst or something like that.

When we arrived at the hospital (Dr. Suleiman al Habib Takhassusi Hospital), we walked into the emergency room entryway, where a nurse met Saleh, saw him clutching his side in pain, and immediately put him in a wheelchair and pushed him back to a bed in the emergency room. Once Saleh was in the bed, his vital signs were immediately taken and the nurse wrote down his symptoms and asked if he had any allergies to medications. Then he said that a doctor would be with us shortly and suggested that I go to the reception desk and check Saleh in and provide our insurance information, if we had it (we did). My brother-in-law and I headed to the reception desk (in case I needed a translator) while my mother-in-law stayed with Saleh.

By the time we got back, the doctor was there with Saleh, speaking to him in Arabic, naturally. I was lost, but I sensed a plan was in action. When the doctor left, he explained, “He is going to give me pain medication and then they’re going to figure out what’s wrong.”

The span of time between the doctor leaving and the pain medication arriving was about ten minutes. At one point, frustrated because Saleh was literally shaking in pain, I went over to the nurses’ desk and let them know that he very much needed some pain relief. The nurse at the desk said, “Yes, ma’am, the doctor is right there”–she pointed behind her–“getting his medicine now. He will have medicine very soon.” Sure enough, I saw the doctor prepping two IV bags.

A few minutes later, the nurse came back, inserted an IV in Saleh’s arm, set up two drips of pain medication, and gave him a localized pain relief injection. As all this was happening, another nurse wheeled in an ultrasound machine on a small cart. Once the pain drips were set up, the nurse left, telling us that the doctor would be back shortly.

We waited for about twenty minutes. Slowly but surely, the pain meds kicked in, and Saleh began to relax. Two doctors and the nurse came back to his bed. It was a little crowded around his bed, so my brother-in-law and mother-in-law went to sit in the waiting area for families while I stayed with Saleh. One of the doctors prepped the ultrasound machine while the nurse prepped him for the ultrasound, squeezing gel on several places on his tummy. The doctor began examining his stomach with the ultrasound transducer as the rest of us watched the screen.

And that’s how we found out that Saleh has one kidney stone of a significant size (about half a centimeter), and several smaller stones (the doctor called them “gravel”). The doctor prescribed a pain medication, an antibiotic (since he has a history of kidney stones…and also because I think the Saudi system is really antibiotic-happy to begin with), and lots and lots of water, and gave us a referral to a urologist at the hospital and recommended that we see him to establish further treatment, if necessary. I went to the reception desk and was able to immediately make an appointment (this was around one in the morning) with a urologist–if Saleh hasn’t passed the stones by Saturday, we will go to the appointment to see what else can be done. As I was doing that, my brother-in-law went to the hospital pharmacy to get Saleh’s prescriptions.

And that was it. We were home within two hours. Total cost for the emergency room visit, including medicines (with our insurance): the equivalent of less than $20.

I couldn’t help but contrast this experience with the one we had in the States three years ago. In that case, the symptoms started almost exactly the same way, except on the left side. We went to the emergency room at seven o’clock that evening. Saleh was obviously in excruciating pain, but he could breathe, talk, see, and move all his limbs (which meant he obviously wasn’t having a heart attack or stroke–the only way to get a straight shot to a bed in the emergency room if you walk in), so we had to sit at the reception desk while his insurance information was entered first thing. Then we sat in the packed waiting room for a couple hours, Saleh writhing in pain the whole time. Then he finally got called back to triage, where a nurse took his vital signs and wrote down his symptoms. We sat there for another hour or so.

Finally, he got a bed. Nurses checked in on him occasionally, but they couldn’t do anything for him until he’d seen a doctor. So basically, they’d look behind the curtain, see that he was still in pain, and leave. At one point, I got really angry and stomped out to the nurses’ station and demanded to know when a doctor was going to see him; he was in horrible pain and nothing was being done about it. They assured me that he would see a doctor “soon.”

Yes, after a few more hours, a doctor came, which meant Mr. Mostafa finally got some pain medicine, and he was able to sleep a bit. A nurse came and drew about eight vials of blood. Then another nurse came and wheeled him away, into an elevator, and up to a different floor for a full CT scan, which is how they found out that he had kidney stones.

He was prescribed two medicines, one for pain, and sent home after eight hours in the emergency room. But the pain medicine ended up making him horribly sick; he couldn’t eat or drink anything. So the next day, we were back in the emergency room. He spent 45 minutes throwing up in the waiting room restroom as we waited to get called back to triage. Then, once they took his vital signs, he spent another hour sitting in a plastic chair in the hallway, throwing up into a plastic bedpan one of the nurses had given him. Finally, he got a bed. After some more waiting, he got a medicine switch and some nausea medication. That emergency room visit was five hours.

Total cost for those two visits? The hospital billed Saleh’s insurance company about $15,000 (nope, not a mistype), and that was without his medications. Thank God the insurance was excellent and he didn’t have to pay anything. But what if he had been an uninsured American? God only knows.

And this is why I get so irritated when I hear people argue that “everyone in America has access to healthcare. If you go to the emergency room, they have to treat you.” Well, technically, yes. Emergency rooms in America are legally obligated to treat anyone who walks through their doors. But that is not access to healthcare. Relying on the emergency room for healthcare is not an efficient system. For one thing, when you walk into the emergency room for treatment and can’t pay, it drives up the cost for everyone else. For another thing, when scores of people rely on emergency room as their “access” to healthcare, emergency rooms are crammed, and wait times are ridiculous. When you let your ingrown toenail fester to the point where you can’t walk on your foot and then have to go to the emergency room, one, your treatment is more costly because you didn’t (or couldn’t) get the care you needed earlier, and secondly, when my husband shows up at the emergency room projectile vomiting continuously, he has to wait for a bed–and thus, treatment–for hours because you got there hours earlier and now have an emergency room bed for yourself and your ingrown toenail.

This isn’t to say there aren’t crammed emergency rooms with ridiculous wait times in Saudi Arabia. From what I’ve heard, there certainly are, although I haven’t experienced them for myself. But this situation is one much more likely to be encountered in a public hospital–where all Saudi citizens are treated for free. I hear so much nonsense about what America’s healthcare system will become if it is reformed, but all those fire-and-brimstone predictions are already happening in the States, except they come with a $15,000 bill. At least here in Saudi Arabia, if we didn’t have insurance, I could have taken Saleh to a public hospital and let him puke in the hallway for free. And even if I had taken him to an emergency room in a private hospital without insurance, the bill would have amounted to around $500, maybe $1,000, at the most.

From what I’ve observed, healthcare is accessible for Saudis, and it isn’t for most Americans. I have no doubt that when compared to Saudi Arabia, America has better, more innovative treatments available. America is a place of medical innovation, absolutely–companies are motivated to develop those innovations because in America, they can be sold at the highest possible price. And thus, many of those treatments are only available for those who can afford them.

I’ve mentioned in an earlier post that the last time the World Health Organization ranked healthcare systems, the United States came in 37th, while Saudi Arabia was ranked 26th. Saudi Arabia didn’t beat the U.S. because it has the most innovative cancer centers or the most brain surgeons. It doesn’t have either of those things; America beats Saudi Arabia by far there. What it does have, though, is a system in place so that all of its citizens can have access to healthcare–including emergency rooms when necessary. And America trails Saudi Arabia by far there.

I don’t want to make it sound like Saudi Arabia has it all figured out in terms of healthcare. It doesn’t. But what I do know is that I’ve seen my husband go through the exact same medical problem twice now–once in the States, and once in the Kingdom, and if he has to go through it again, I hope we’re in the Kingdom when it happens. I’m grateful that I’m getting a chance to experience healthcare in another country, because for me, it has really shed light on how broken the system in my home country really is. Even countries that Americans are trained to avoid like the plague (my mom: “I’m going to Italy!” Her friends: “Ooooh, how exciting!” My mom: “I’m going to Saudi Arabia!” Her friends: “Ooooh, are you scared?”) have certain elements of the healthcare system figured out much better than America does. Before I had ever thought of living in Saudi Arabia, I remember thinking, as Saleh writhed in pain in a waiting room chair, “There is no way that this is the best healthcare in the world.” I wish that someday, the powers that be all around the world would be able to put aside their differences (and their greed) in order to learn from one another when it comes to healthcare and its administration. Both Americans and Saudis would be better off for it.