Health post: Going to the hospital

After my meeting with the doctor at Cornell, I met with one of his PhD students at the Hamad General Hospital. This hospital is one of eight owned by the Hamad Medical Corporation, HMC, the government system for health and medicine in Qatar. I spoke with Dr. Adnan Khan, from Pakistan, about health in Qatar in general and about the technology that the Cornell doctor brought into the country.

The technology of CCM, corneal confocal microscopy, allows doctors to diagnose complications associated with diabetes. As I’ve mentioned, diabetes is one of Qatar’s main health issues, and it’s important not just to diagnose and treat diabetes but also to understand its extent by seeing what complications it’s causing. These consequences include neuropathy (which can lead to foot amputation), heart attack, and stroke. A doctor wants to identify these issues as early as possible to stop them from getting worse and to know when patients are high risk. Such complications prematurely disable patients and increase their risk of dying.

CCM is an ophthalmic test to diagnose neuropathy. It is essentially a camera that lightly touches a patient’s cornea and scans it. The cornea has sensory nerve structures; for example, nerves in your eye make you tear up to expel dust particles. Diabetes patients with neuropathy will show far fewer nerves than healthy patients. The Cornell doctor told me that an older way of diagnosing neuropathy in diabetes patients was to perform a biopsy on leg tissue and send the sample to a lab, which is obviously more invasive and time-consuming.

I thought of Vibrosense, the Swedish startup, whose main product is a vibration tester for diagnosing HAVS (hand-arm vibration syndrome). It had the added benefit of being able to identify neuropathies in diabetes patients and was also a non-invasive device, though perhaps less accurate than CCM.

IMG_5422 (1).jpg
Here, I was sitting in the Hamad General Hospital between the separated “Male Waiting Area” and “Female Waiting Area.” The hospital feels sophisticated and offers every service imaginable, as listed on the long directory by the elevator door.

While I was at Cornell, I asked the doctor about how he brought this technology to HMC; if he had to convince them to use it and if they were open about it. He said yes, he did have to convince them, and that they were open about the technology but not about him. When he was a newcomer two years ago, he felt that he made the Qataris insecure – as though they thought he was going to “steal their thunder.” I’ve noticed through many conversations and observations that the Qataris are painted as being both very proud and fearful, worried that outsiders will prove to be smarter and better than them, even though they invite these outsiders to learn from their expertise. But, as the doctor said, “the world is too small” to let ego come before health, and at the end of the day the technology is good, so now it’s here in Qatar.

With Dr. Khan in Hamad General Hospital, I had the chance to try the eye-scanning technologies. In addition to CCM, they had an OCT machine – “optical coherence tomography” – which also uses light to take 3D images of the eye but at a slightly lower resolution. Both processes were super easy as the “patient” and went very quickly. I could barely feel the CCM machine touching my eye. From Dr. Khan’s side as the user, the machine’s computer interface seemed more complicated. However, he knows the machine very well and navigated the system quickly, showing me my eye scans almost immediately.

The OCT machine and associated computer monitor. The machine itself is made by Heidelberg Engineering, a German company.

Good news: I have all my nerves! So I don’t have neuropathy. If I did, I could be tested for diabetes; however, CCM and OCT can’t be used to rule out a diagnosis of diabetes, as diabetes does not always cause neuropathy right away.

I asked Dr. Khan how other patients had responded to the CCM and OCT technologies. He said that it was all about communication. He works hard to make them feel comfortable, talking them before and during the experiment, which makes them happy and open to using the technology. With some patients there’s a language barrier, so he’s not sure exactly how these patients feel, but they never react badly to the machines – probably because they know that their doctor recommended the procedure.

Dr. Khan prepares the CCM machine.

I also discussed general health attitudes with Dr. Khan and his colleague, a woman from Australia – let’s call her Ann. Ann told me that the rich Qatari locals are pushy and act entitled to every service at the hospital at any time. She’s seen Qataris ignore being told that they have to wait for a room and go stand by an occupied room, demanding to be let in. Others haven’t accepted the timing of their appointments. There have been multiple times when Ann has told a Qatari, “Okay, your surgery appointment is at 8am,” and gotten the response, “Absolutely not. I’ll be asleep. I’ll come in at noon.” And what do you do with that?

So even when it comes to important surgeries, health is not a priority. There seems to be a certain laziness in the Qataris’ approach to health, evident in their refusal to come to the hospital early and with their “god willing” attitude. A common Arabic phrase is inshallah, meaning “god willing,” and it comes up in all sorts of situations. “Will I see you tomorrow?” “Inshallah!” (If God wills it!). It can mean sure, maybe, no – you get the idea. Ann said that people use it in response to illnesses, too. “I have diabetes? God willing it goes away!” Rather than take an active role in their treatment and medicine, they let fate decide; there isn’t a lot of motivation to be in control of one’s health.

We also talked about the diabetes, and Dr. Khan and Ann repeated what the Cornell doctor said – that the social culture here revolves around food. People offer food to each other at meetings, in offices and at home, and apparently it’s rude to refuse. However, there is a trend towards being sportier. Ann mentioned that malls are starting to have indoor “walking routes” (though I’m not sure where; I haven’t seen any at the five malls I’ve been to), and she pointed out that 38 Qatari citizens participated in the 2016 Olympics compared to 12 in the 2012 Olympics.

Dr. Khan analyses my eye scans from the CCM machine. His left hand is close to the part of the machine that touches your cornea.

In contrast to the Qataris, the migrant workers are not so pushy. Ann has observed that the workers do whatever the doctor says, though they have poor health due to low wages (leading to buying cheap, unhealthy food) and a complete lack of health education or awareness (so they might have symptoms that they don’t notice). Ann told me about a technology initiative at Hamad General Hospital. The hospital bought expensive wristbands that act as blood pressure monitors. They are supposed to be more accurate and user-friendly than the standard blood pressure arm cuff, as they allow for longer-term and subtler monitoring. Some patients were given the opportunity to try both so that the hospital could determine if the wristbands were a good idea.

Ann asked these patients which they prefer more, the wristband or the cuff, and observed the following differences. The uneducated workers give her no preference, which might be due to a language barrier; she said that in response to “Which do you prefer?,” she often received the answer “Yes.” The more educated expats (from India, Pakistan, and so on) prefer the wristband because it is smaller and easier to wear. The local Qataris demand the watch and throw the cuff back at her. Dr. Khan laughed at this, agreeing that it fits his observation but suggesting that the locals, as a minority in their own country, have to be pushy to assert themselves. “If not, the Indians would take over!” he joked.

Leaving the hospital, you see this gift shop with the most ridiculous and extravagant gift baskets. Ann lamented that almost all of the options are enormous baskets with far too many unhealthy chocolates.

Apparently, the blood pressure wristbands aren’t the only fancy technologies around.Dr. Khan and Ann told me that Hamad Medical Corporation has imported a ton of fancy technology for its hospitals, as it has the money to afford the best. However, much of it is sitting unused, as people aren’t trained to use the technology. So it seems that they import the right tech but not the technicians. What does that say about the attitude towards medical technology?