Several weeks ago a relative woke up with shortness of breath. He had been fighting an infection picked up from an earlier trip to Makkah. As a result he goes to a government run hospital not too far from his home for treatment. He realized he should be given some oxygen as well as be seen by a doctor. If you can imagine this, he walks up to the emergency entrance door and sees a sign prominently displayed in English and Arabic stating “The ER is closed to adult patients as there are no more beds.” Fortunately he found another way in and proceeded to the emergency room. On entering a male attendant looked up in surprise at our relative and remarked “Did you not see the sign? We are closed. We have no more beds.” My relative told them he was in distress and all he wanted at the moment was some oxygen to see if that would help him breath better. Usually this man is very polite and diplomatic but being told the ER was closed and to go home prompted him to respond “What is this? A Hospital or a Grocery Store?” He was finally given a cursory examination by a physician who kept telling him “I cannot admit you because we have no beds. “ The physician prescribed some medications and sent our relative back home. However we all continued to remain astounded that an emergency room could be arbitrarily closed. And the hospital, you ask? King Khalid University Hospital in Riyadh.
Filed under: culture, Health, Saudi Arabia, Saudi culture, Saudi customs, travel
Uugghh- hospitals…My biggest pet peeve of the ME…what are we chopped liver? Your relative was correct in his assessment…
Doesn’t surprise me at all.. I’ve never seen or heard the ambulances where I work using sirens or even moving and from what I’m told if you’re in an accident they couldn’t get to you anyway (if they tried) because of the crowd of rubber neckers taking pictures of your dying bloody body. And if they do get to you and try to help they won’t take you to the private hospital, they take you to a gov’t run one like this one where they actually think it’s reasonable to refuse service.
Incredulous!
I do need to say that the physicians at King Khalid University hospital are good and know their stuff. The problem however is with the infrastructure and logistics.
Anon – you also raise a very important aspect – what does one do when an ambulance is required? As I understand the ambulances here are required to only take an individual to the nearest hospital even if they happen to have a patient who may already be registered with another hospital. One thing to also be aware of is that some hospitals, such as KKUH will not begin treatment until the paperwork has been completed and a file number created, in spite of a patient maybe being in active distress.
All systems have their flaws. Emergency treatment seems to be a weak spot all over the Kingdom. I’ve often wondered how a proper ambulance would navigate the traffic.
The ambulances I saw were few and far between. If lights were flashing, no one paid attention, not even the ambulance drivers.
I think this oblivion to the “golden hour” concept in medical treatment is an outgrowth of the Arab disregard for time in general. The Arab– and yes, I am generalizing here– lives in one continuous NOW moment. The concept of time passage with respect to activities and emergencies simply doesn’t sink in very easily.
can we also mention that nationality is also important for medical treatment here. Certain nationalities recieving lest than adequate treatment, non saudis would have been shoved out of the door altogether at the government hospital. I hate the question “what is your nationality?”
Marahm – I had not thought about it before but can see the relation between the Arab concept of time in general and how that in turn can impact in some (not all) aspects of medical care. And of course the traffic congestion in Riyadh (and other cities) do make it virtually impossible for timely movements. There are no emergency only lanes on the roads and streets here.
Nzingha – The nationality question here in KSA reminds me of some US hospitals who will not treat an individual if they are uninsured.
Back when I was in university, I once became quite sick and my concerned room mate drove me to the nearest gov’t hospital which happened to be King Abdulaziz University Hospital. Since it was night we went to the emergency ward and were shocked to realize that they didn’t have one!
That is a surprise, Saudi Jawa! Where is this hospital?
Never surprise to me!!
Our goverment hospitals constantly have shortage of beds which is a shame!! However, an oxygen doesn’t require a bed!!
“The nationality question here in KSA reminds me of some US hospitals who will not treat an individual if they are uninsured.”
All ERs in the US are required by law to treat you regardless of insurance or immigration status and they’re supposed to keep you until you can walk out again
Does the nationality question have to do with determining ethnicity/race (which is always asked when documenting a patient’s medical history) or is it really being used in a way to screen who gets treated in what hospital and how they are treated?
It is not a surprise that the government hospitals of KSA have a shortage of beds given that it is a national (similar to socialist) health care system as well as Saudi families being typically larger than Western or European families resulting in greater odds of someone needing care.
Tulip – Granted I’ve not lived in the US for some time so I would like to hope that all hospitals in the US will give a patient fair treatment with or without insurance.
bedu- we deal with private hospitals and that is the next question “what insurance”
Tulip- Nationality is importnat for everything in saudi not just in a hospital. I brought my daughter in for a fall she took her bike “what is her nationality?” the nurse asked “What does her nationality have to do with her treatment?” I asked
It doesn’t but like everything else nationality matters in everything not for medical information but how you’ll be treated and who you’ll be treated by at times.
But the ultimate question is why an emergency room close regardless of overall bed status- it goes against what emergency rooms are for- to triage and treat…its an emergency that may or not be life threatening and only a qualified healthcare provider can assess the urgency AFTER triaging the patient!
And yes Bedu by law all US emergency rooms have the obligation to triage and treat a patient regardless of insurance and immigration status-
What is it about the person who needs care that seems NOT to be a priority in ME hospitals, or is their “vision and aim” to treat only a particular type at particular moment?
There is an article in today’s Arab News which is somewhat relevant to the topic at hand as well:
http://www.arabnews.com/?page=1§ion=0&article=116630&d=24&m=11&y=2008
Inal- I wish I had the answers to your questions but I do not. I ask the same questions.
Carol:
The hospital in question is the teaching hospital attached to the Faculty of Medicine of King Abudlaziz University. It’s one of the more prestigious gov’t hospitals in Jeddah. They have since moved into a bigger and better building but I have no idea if they had remedied the emergency ward problem.
The ambulance drivers are just that drivers. I have never seen a paramedic. Due to this a nurse will usually accompany them.
Thanks for the info Saudi Jawa.
Umm Adam – I have met several paramedics (Australian) who were hired and sponsored by the Red Crescent Society so there are indeed qualified paramedics in (some) ambulances.
Ummadam, Emergency Medicine is still a field that the Saudi’s have little experience in. Just recently that Saudi government showed actual interest in improving the Medical services across the board. I think Military attached hospitals and specialist hospitals are some of the best but the MoH ones are overwhelmed and underdeveloped.
EMT staff is also a hard currency here.. Most of Ambulance drivers are trained for a year but not as well as paramedics.. those though are the red creasent drivers. I am not sure about private dispenceries ambulance drivers. I have to say though.. EM technicians are not plenty enough to cover the emergency needs.. I do hope that the recent directions to Medical colleges now will help the health sector to prosper.
Carol, its a tragedy to see a hospital that would not triage for the poor excuse of having no beds. Everybody knows hospitals can be overwhelmed.. but thats no condition that forces an ER to stop it’s admissions.
BTW; there is a correlation between your nationality and/or ethnic group and certai diseases- in NY for example it has been shown that the Chinese have higher incidences of cancer; south asians for diabetes, cardiac problems; and oral cancer; arabs for cardiac problems; and among women the incidence of breast cancer shows marked numbers among the african american and hispanic communities; same goes for being lactose intolerant- because we ask where you are from and where do you live- we have even pinpointed areas where asthma is most prevelant – the Bronx in NY is the highest in the state.
And TAT or turn around times are crucial in healthcare- so the comment of time in the Arab world concept is appropo…
Sorry…it is my passion as a healthcare administrator- I would have fired quite a few doctors and nurses in the ME for poor job performance…
Overall health care in KSA is indeed good. I don’t want anyone to have trepidation if they require treatment in KSA. And like anywhere in the world some places are certainly more desirable than others for seeking treatment and care. Frankly, based on recent experience at King Khalid University hospital, while the doctors are good and very professional, this post illustrates quality control and logistical problems which at least give me pause to recommend KKUH to anyone. And like DW pointed out, MoH facilities are also usually understaffed and underdeveloped as compared to the private hospitals, governmental hospitals, speciality hospitals or institution like National Guard Health Affairs.
Inal – glad to hear your input based on your experience in the field. Many medical researchers come to the ME and specifically KSA because there may be diseases, ailments or inflinctions here not seen anywhere else. And sadly, breast cancer among women in Saudi Arabia is among the highest in the world. I’ve done earlier posts on this topic with facts and statistics.
Bahrains ER is always over filled and consequently closed…apparently the cause is that Bahrainis will flood to it with everything from the common cold to a tummy ache…plus the accidents and real emergencies. The ER just cant take the workload. The director of Sulmania is constantly making public pleas to please not come to the ER unless you are seriously in need of emergency care…nobody cares.
My own experience with ambulances was when I had a near fatal gall bladder infection…I was “rushed” to the ER in an ambulance that took 35 minutes (generall a 15 min drive) not to mention I was not strapped down or anything…consequently each time we went on a round about or something I had to brace myself or risk falling off the bed…plus there was no attendant for me. So I was not being administered any drugs or even being calmed down for the trip. It was horrendous.
AB-
Tulip is right… in the US it is a HIPAA violation for an ER to refuse treatment (and therefore illegal) based on…well anything. My best friend is an ER nurse, and has told me that she isn’t even allowed to know how much things cost. You come in, you get seen…. eventually.
I would flip out if I saw a “closed” sign on an ER door. I hope your relative will be ok. Does he have any legal recourse? Can he report them to anyone?
I had a scare earlier in the summer which required a visit to an ER. Even though I was “heavily oozing” from the area where I had had recent surgery, rather than call an ambulance and wonder how long we’d wait or what kind of ride we’d have, my spouse elected to drive me to the hospital. I’m so thankful that he was home when the incident occurred otherwise I’d have had to made the call ambulance or limo (taxi).
Monica – I’m not positive but I “think” if one is Saudi they can elect to take legal action if they are so inclined. Perhaps someone more knowledgeable than me can comment in that regard. But if I’m not mistaken, the culture here is less likely to take legal recourse or report. And again, speculating, if one were to report I’m assuming the options would be Ministry of Health, the hospital director or the press. But it is questionable what if anything would happen.
Your summer incident brings up a question I’ve had… maybe its stupid but I am curious anyway. If your husband hadn’t been home, and you’d have had to call for an ambulance, would there be an issue with you as a woman being alone in a vehicle with unrelated men? I assume men since women aren’t allowed to drive. Or are the EMT’s usually foreign and therefore ok?
Usually a female nurse will go along for the ride.
Monica – here is one of the greatest contradictions…women are prohibited by law from being alone with an unrelated man whether Saudi or foreign yet exceptions are made for drivers!
OK… so now then Ummadam, isn’t the nurse in violation when enroute to the patient, and then after drop off?
The religious views can be leaned for Medical and Clinical staff. In terms of Islam view its okay to permit whats haram if the situation makes such persmission a nesscity.
The problem is not gonna be from a religious authority in such cases.. but from pan-religious traditionalist.. which some don’t even stem from religon at all.. but ultra traditionalist people accepted its interpertation to what seemed to fit their views. For example those who think you should have borqa on even though you are having a respitory arrest.. not because he follows Islam.. but because they follow the stupid “They should not see our maharm”.
I believe the paramedics team should drive the ambulance- in other words the drivers have to be paramedics- one drives the other stabilizes patient- guardian/parent of patient goes shot gun with driver. Then there is no doubt of the urgency. There is no need for a nurse with two paramedics.
ERs should have internal staging for treatment past the triage point: (1) Urgent Care for non life threatening care; (2) Cardiac Care; (3) pediatric care that has (a) trauma/asthma and (b) all others – all with separate area away from adults; (4) adult Emergency and (5) Trauma slot with its own Adult ICU… That should cover all of emergencies- it works for us- we are 900 plus beds; 15 Operating Theaters; 45 ICU beds and 10 PACU beds…
KSA will soon have so many contradictions with a woman’s place that they might misplace her completely- let alone who she can be alone with or not…and I have a feeling some of these things are made up on the fly- which is why they contradict each other.
I guess the hospitals there aren’t good enough for royalty though since they come here to the U.S.
ROCHESTER, Minnesota (AP) — Members of Saudi Arabia’s royal family spent enough during a visit to the Mayo Clinic to give the area’s economy a shot in the arm, according to Rochester, Minnesota, officials.
Saudi Arabian King Abdullah bin Abdulaziz and his entourage’s visit brought riches to Rochester, Minnesota.
Rochester officials say Saudi Arabian King Abdullah bin Abdulaziz arrived on November 15 for a checkup at the Mayo Clinic and was accompanied by at least five princes and hundreds of others.
The king left Wednesday, but some members of his group remain in Rochester.
Rochester Convention and Visitors Bureau executive director Brad Jones says a conservative estimate of the royal family’s spending on the trip to Mayo Clinic is up to $1.5 million.
1.5 Million dollars would probably buy a pretty good hospital in KSA don’t ya think?
Really, who needs to bring along hundreds of people for a simple check up? And I would think that if I ran a country and I was richer than dirt I would make sure that I had the best right here in my own country. If it isn’t good enough for the royals it shouldn’t be good enough for the citizens. But, that’s just my opinion.
Of course, the care in the Kingdom is good enough for the royal family! KFSH has separate, special wings and personnel to accomodate them. I suspect the trip to the US had an additional, and perhaps more important, agenda.
It is not only King Faisal Specialist Hospital but National Guard Health Affairs, Security Services Hospital, King Fahad Medical City, Military Hospital and others which have exemplary care and service and do indeed treat royals.
While it may sound like a large entourage, if you take a look at how many even accompany the US President or other world leaders, it’s kind of average. Anytime the leader of a country travels there has to be the support team for coverage of all contingencies. It may not be as noticable among US delegations for the team may be dispersed between different aircraft and not all arrive on the same day.
Inal – thanks for the breakdown. It sounds like you are working at a large and well-equipped hospital. No doubt you and your expertise would be welcomed in KSA!
“Rochester officials say Saudi Arabian King Abdullah bin Abdulaziz arrived on November 15 for a checkup at the Mayo Clinic and was accompanied by at least five princes and hundreds of others.”
The King has an amazing entourage. I knew a nurse who came from Australia to be a nurse to the king. Her entire responsibility was to administer eyedrops in the morning and again in the evening. That was it. So for every little thing, there is someone to do it, including other nurses and even an orthodontist to do the morning and evening teeth clean. It all adds up to hundreds! Needless to say, she was bored out of her brain and went back to Australia pretty quickly.
My experience of healthcare in KSA was pretty hit and miss. I myself had a mis-diagnose/mis-treat experience and several of my friends had similar experiences with incompetence. I also knew people who had had treatment for quite serious to life threatening conditions that were very happy with their experiences. Its all in the luck of the draw and which doctor you happen to get. Its inconsistent at best and potentially dangerous at worst. And there is little accountability and certainly no way to take action against anyone if things go horribly wrong.
Regarding why they ask nationality in hospital emergency rooms, I think its because of the way racism is a celebrated national sport there and also in the UAE.
Also, though this is related to the UAE, both countries are very similar in many aspects, my colleague is an Emirati and when her father was sick, he didn’t seek treatment in the UAE. He travelled to Germany and paid cash for all treatment whilst there for 2 or 3 weeks even though locals get free medical care in this country.
Personally, I have had issues with Indian, Filipino and Muslim doctors in the UAE bringing culture and religion into consultations. I have no time for this in a medical situation where my requirements for science far outweigh my requirements for some sort of divine intervention or “acceptable cultural behaviour”.
Ryan – in this region culture and religion is ingrained and embedded in the practice of medicine. Many medical colleges will give classes on Medical Ethics and specific lectures pertaining to practicing medicine in align with the culture and religion. I have no doubt that some from this region may be taken aback by the differing practices if treated in the West.
Ryan, I feel the same way about “medical treatment” in the US. They ask a myriad of personal questions that have nothing to do with the “condition.” Of course this includes pop/quasi-psyche evaluations which have different implications depending on the race/religion/class of the doctor vs. patient. I put on far too much weight in my first pregnancy but one of the idiots on my “labor team” asked me on every visit if I was fasting as this was during Ramadan and she was so familiar with the practices of Muslims–but appearently unable to just read the medical chart.
Thanks Bedu; I think a stint in KSA would be a tad agonizing for a few people- those on the receiving end LOL… I was trained on precision in healthcare- and that goes against many attitudes out there- so sparks will fly
There are healthcare providers better qualified than others to get to the root of a person’s condition depending on how well they were trained; their experience; and their social view as providers- diagnostic differentials can only be had with a good history and physical- otherwise a few things could be missed that point erroneously to something major or minor…so pick your doctors carefully; and at the same time don’t let your preconceived notions get in the way of asking if the questions they are asking are relevant or not…
We have in Administration a Patient’s Communication Committee- it came about from a “near miss” and another “sentinel event” with patients not only of different cultures but languages- the near miss was because a Begali couple came to the ER- the Begum was silent while her husband answered all of the nurse’s triaging questions- but while the Begum was silent she kept almost listlessly shaking her head from side to side- the answer from her husband was always the same- her stomach hurts- the nurse was a tad worried and called for an interpreter who asked the Begum directly what was wrong–”its not my stomach- its my head if I don’t move it around my eyes get dim and I can’t focus” the pain at times is so much that I even throw up”… The Begum was sent for a scan of her head that showed she had a tumor… So much for the “stomach ache”…
Ouch! Even if the emergency wards are full, shouldn’t they try to assist in one way or another by directing the patient somewhere to sit and wait for assistance or to the nearest hospital instead of shooing someone who needs emergency?
Someone’s life is hanging in the balance and at the very least, they could have tried to do something about it.
wow Inal – thank goodness they were able to find a translator who knew bengali!
Firdaus – exactly…what happened just goes against the grain of what one expects from a hospital emergency room.
Bedu-we have various ways of getting translators to our patients-via phone; via full time paid staff; and volunteers who donate a portion of their day to this important endeavor.
But I think in SKA that needs further exploring is the cultural view of giving/providing healthcare at various levels- the personal; societal and as a by product those who actually enter the health science professions… I have read and seen a certain disdain for the sick in the ME; even have heard that being a nurse, for example, is considered a demeaning profession; others are in it for the money and prestige that comes, in some cases, with having an MD added to your name; and then you will find those who move heaven and earth for their patients well being- but it seems to be a lesser group in the ME than we care to admit to.
ME society will have to comes to terms with not only how people need to be treated when in need of healthcare; they will have to come to terms with how they view their providers…
If something is wrong say so…every drop on a rock will eventually break it.
I would say that the doctors I have seen in KSA are way above those I’ve encountered elsewhere. They are dedicated and compassionate professionals – male and female. Nursing does continue to have some biases (for Saudi women) which has much to do with perceived cultural stigmas.