Tuesday, August 02, 2011

Inside Morocco's Healthcare System (sort of)

Probably the best way to end a lovely evening that includes a yummy dinner on a lovely restaurant terrace while being entertained by belly dancers (two young and gorgeous, one older, fully dressed, and dancing with a large tray of candles on her head!) is NOT to take a spill on a stair and land sprawling on the stone floor of the restaurant. Still, if you want a peek inside a Moroccan hospital, a minor injury is the way to go. Although my own recent experience with medical care in Marrakesh was more surreal than anything else, I would hate to need "real" emergency care in that lovely but strange city.

As many followers of our adventure already know, I sprained my ankle on our last full night in Marrakesh. It’s much better now; still a bit swollen but only hurts a little. A relief, since we’re traveling and not being able to walk would be a huge bummer. At the time, though, it was very painful and upsetting. Most of the diners were up on the terrace level, so it wasn’t quite the show it could have been, but it was still a lot more drama than I’m generally up for. A few restaurant employees came by and said, "All right, then?" almost in passing, as if of course I was and it was perfectly normal to be lying on the floor with my sweetheart bent over me. But once it was clear that I’d actually hurt my ankle quite badly, they were all on the spot and very nice and helpful. Of course, they did all get a lot more concerned and stopped mentioning travel insurance (which we do have) after Paul got out the camera and took photos of my foot and of the crumbling step I’d tripped on. The ambulance/no ambulance question was settled when I fainted briefly. Nights in Marrakesh in July remind me of those steamy nights in New York City back in the day when I had no air conditioning, sitting in an outdoor cafĂ© in the late evening, skin permanently mildly sticky. Up on the terrace, the heat felt sultry and not unpleasant. Down inside the restaurant, though, with the shock of falling, it was just too much. Scared the hell out of my poor sweetheart, not to mention the restaurant people.

All things considered, I probably couldn’t have gotten myself down the two flights of stairs to the square (place, plaza, piazza) below on my own. Still, I don’t recommend being carried down a narrow, winding, stone stairway on a rubber stretcher. I’d hoped for a chair of some sort, but no: rubber stretcher with no straps. Erg. I didn’t get the feeling that those carrying me were particularly skilled at it, but who can tell? It’s a very odd sensation to be carried that way, not least of which because, having to look straight up, I couldn’t see where we were going. I had to stop holding on to the sides of the stretcher when I almost lost fingers a couple times. I also don’t particularly recommend riding in an ambulance through the bumpy streets of Marrakesh. The ambulance was full of diesel fumes, which did nothing to make me feel any better. And again, I couldn’t see anything except the ceiling and Paul. Not, it turns out, that there was anything else to see.

"There’s nothing in here," Paul said. No medical equipment, no bandages, not even water. A lone empty plastic bottle rolled up and down the empty supply cabinets, its hollow clatter emphasizing the lack of supplies of any kind. Luckily, I didn’t really need anything, but it did make me wonder what would happen if someone, say, had had a heart attack in a restaurant? Or a fall that involved lots of bleeding or something? Would they send a different, better equipped ambulance? Or the same kind I was in, which was clearly intended for transport only?

We’d already heard more than once (apropos of what, I can’t remember) that you never want to go to a public hospital in Morocco. There are several private clinics in Marrakesh, apparently. For reasons still not clear to me, we went to the military clinic. For reasons also not clear to me, the place was all but deserted. No other patients, not much in the way of staff either, at least that I could see. The room they brought me to had a bed but--again--almost nothing else in it. On the near-empty shelves there were a stethoscope and blood pressure cuff, but that was it. You’d think, given the lack of anything going on there, that they’d be happy to have something to do. You’d be wrong. They put me into a wheelchair, with nowhere to put my foot up (my wonderful sweetie knelt down to provide me with a footstool!) and, despite the fainting incident, no one checked vitals or asked me about anything. When I said I felt sick, the doctor brushed it off: it’s normal, he said, as if annoyed that I’d even mentioned it. After straightening out some paperwork, I was wheeled down a long, dark, empty corridor marked by many archways, the noise of Paul’s footsteps echoing in the empty hallway. I wish we’d taken a picture; it was totally surreal, something out of Harry Potter or, better, some black-and-white film noir from the ‘40s. We passed empty room after empty room and finally arrived in a bare-bones X-ray room. Two minutes and a few pics later and back we went down down down the long dark corridor (were the lightbulbs all burned out? were they over their electricity allotment for the week?) and back we went to the (ahem) emergency room. No fracture, it’s fine, the doctor said, almost accusingly. We were handed a piece of paper with prescriptions for an anti-inflammatory and a painkiller and told to buy a compression bandage the next day. Well yes, the doctor said when asked, it would be better to wrap it right away, but the drugstore wouldn’t be open till morning, I’d have to wait till then, he said, as if we were nuts to expect that they might have something--anything--available at the actual hospital. After Paul said, "can’t you wrap her ankle here now with something?" several times, the orderly rather reluctantly fished around in a drawer and came up with a tiny roll of gauze and wrapped it around my ankle as best he could, holding it in place with tape from an almost-empty roll that he cut with a loose scalpel blade from the same drawer. I reminded Paul that we needed a copy of the admit form or something in case we needed to make a claim with the travel insurance if our trip was delayed or further treatment was necessary. A copy? They seemed confused by the request. Why would we need a copy of anything? As it turns out, THEY DON’T HAVE A COPY MACHINE. They gave us the X-ray and we later got the prescription sheet back with the doctor’s name on it--luckily no further claim was necessary.

Again, this all worked out fine for me. But I wonder what would have happened if my ankle had been broken? They didn’t seem to have supplies of any kind. Worse than that, did they bring actual SICK people here? And, as Paul pointed out, this is the military hospital! While there’s no active combat going on in Morocco that I know of, do they not still have a military? With soldiers who do training exercises and might have the occasional accident or illness? I had a vision of an alternate reality, one that only came into being when some magic switch was pulled. One that turned the hospital into a well-lit, well-supplied care facility, buzzing with activity.

I should mention that the X-ray cost the equivalent of $35 dollars. We only know this because, though the restaurant paid for the ambulance and X-ray, the nice waiter who’d accompanied us to the hospital was a bit short of funds. After an initial worrying exchange, we realized that the balance due was 25 dirham, about $3.50! Also, there was almost no waiting around at all. It wasn’t even an hour later when we got a taxi home. The nice waiter came with us then got out halfway there to go fill the prescriptions. (So there is at least a late-night if not all-night pharmacy in Marrakesh!) He reappeared about a half hour later--of course he got lost looking for our riad, who wouldn’t--and promised to purchase the compression bandage the next day, which he did. He really was very sweet.

So despite the absolute weirdness of the hospital experience, my little injury drama worked out all right. The people from the restaurant were very helpful and kind. The restaurant manager texted Paul the next day to ask how I was. I spent the next day in our comfortable room in the riad with my foot up on pillows until it was time for dinner and then to leave for the overnight train back to Tangier. Our kind host at Riad Aguerzame, Laurent, rearranged rooms for incoming guests so I didn’t have to move before it was time for dinner and the house cook, the marvelous Wafaa, brought me orange juice and fresh baked croissants while Paul was out shopping. The overnight train and subsequent travel day was not as pleasant as one could hope, but since then the ankle has healed remarkably quickly. Maybe it was those magic anti-inflammatory pills from the Marrakesh drugstore.