Health post: Doha’s patients

For my last week in Doha, I spent every day in the cancer hospital of Hamad Medical City, NCCCR (the National Center for Cancer Care & Research). I was meeting and interviewing patients there, finally cleared to do so after a lot of communication with the Hamad Medical Corporation. It was a goal of mine to meet with patients when I first designed my Watson project, but while I was in Sweden, I realized that it would be very difficult to access real patients due to legal and privacy concerns. Since I’m not affiliated with a well-established company or university, I have no established pipeline to access.

In Qatar, however, this problem was easier to navigate. It’s easier to find the right contacts in a smaller country with one central hospital system. I spoke with someone at the Medical Education Department of Hamad Medical Corporation, a department that has connections to all the Hamad hospitals and has helped clinical researchers in the past. I’m not a clinical researcher – I’m not testing any drug, but rather conducting very informal interviews – so they were a bit confused by my goal but approved it fairly quickly.

Unfortunately, I was only able to interview patients at the cancer center, NCCCR, as they are the only department that responded to my research request. Ideally, I would have interviewed a more diverse group of patients, specifically diabetes and asthma patients, to learn more about technology options for managing these chronic illnesses out of the hospital. Still, NCCCR was very welcoming and organized, and they helped me meet with a total of 15 patients.

The patients were a mix of men and women, 7 in the cancer daycare facility (with private beds) and 6 in the outpatient clinic center. Most had some type of cancer, but some of the outpatient interviewees were there for hematology issues instead, such as artery obstructions. Most of the patients spoke English, and for those that spoke only Arabic I used a family member or nurse as a translator. The age range I interviewed was 15 to 78 (average age: 44, median age: 44). Here are the questions I asked them with tallied results and a couple interesting responses (patient responses are in italics and have been paraphrased for length and clarity).

Where are you from? The Philippines (4); Jordan (2); Egypt (2); Qatar (4); Palestine (2)

Have you been to university? Yes (10); No (3, two Qataris and one Palestinian); Not yet (1)

What technology have you interacted with at the hospital – that is, what scans have you received here? MRI (13); PET Scan (10); CT Scan (7); Ultrasound (6); Echocardiogram (4); Biopsy (3); Mammogram (3); X-Ray (2); Radiotherapy (2); Bone Scan (2); Colonoscopy (1).

Note: These numbers likely underestimate reality. Most people had so many scans that they only listed as many as they remembered or found relevant, and some only referenced the more obvious ones after I asked to confirm (“Did you get an MRI, too?” “Oh, yes, of course.”).

For each scan, each interaction with technology, did you understand why it was necessary and what the benefit was? Was it explained well?

  • Yes (13)
    • It all helped, but it helped the medical team more than me because they needed to understand what was going on. They didn’t explain so much. For them it’s very routine – they just put you in there and do the test.
    • I understood why each one was necessary but not the order in which the scans happened. We did a ton of tests that didn’t confirm cancer, and then finally a biopsy that did. I wish we had done the biopsy first. 
    • I’m happy with the doctor, but I also read all about the procedure beforehand.
    • Sometimes the doctors explained too much! The full set of risks and benefits could be scary because of the risks.  
  • Mostly (1)
    • Usually things were explained well, but not very frequently. The tests were explained with their risks and benefits.

Did it ever seem like too much, like some of the scans were unnecessary?

  • No (10)
    • Doctors explained everything.
  • Not really (2)
    • I feel like I got more x-rays than necessary: 10.
    • I got a PET scan that didn’t show what it was supposed to, but that was a problem with the device and not with the doctor. [I feel like the doctor just ordered the wrong scan, but it was unclear].
  • Yes (1)
    • I once refused an MRI because I had already gotten so many, and it was ordered by Hamad General Hospital instead of NCCCR.

Did you have any fears or worries about the technology? If so, were they addressed by your doctor? Did your doctor answer all your questions about the technology?

  • Yes, but all my fears were alleviated (3)
    • I was worried about exposure to radiation, but I did the scan after the nurse explained it.
    • I wasn’t worried about the technology itself, but rather how it might affect my pregnancy. However, the doctors always explained how it might be affected.
    • I thought the lung biopsy would be too risky because the doctor kept explaining the potential side effects and risks. It wasn’t until I asked the doctor if the risks would be easy to manage and he said yes that I realized it was worth it.
  • No fears (11)
    • I was uncomfortable with the biopsy and MRI, but not out of fear. [more because they are uncomfortable procedures to begin with.]

How do you feel about the technology here – is it good? What about the technicians – are they well trained?

  • Yes, both are excellent (6)
    • However, they need to increase number of machines. There is only one PET scanner in NCCCR and only one MRI machine.
    • What they have is great, but not everything is available. We sent a blood sample abroad once for additional testing.
  • Both are good but not perfect (6)
    • There needs to be better awareness of technology. People here aren’t trained to use it entirely properly.  
    • One day the computer was working really slowly.
    • One day they introduced a bunch of new computers and it was very confusing and caused lots of delays. Now, it’s fine.
    • The technology is well-developed, but the technicians don’t make an effort to make you feel comfortable with it.
  • Unasked (2)

What made you comfortable with the technology?

  • Explanations from nurses and doctors (good communication) (6)
    • Cooperative staff.
    • The doctors are trustworthy, so their recommendation is important.
  • Emotional support from nurses and doctors. (6)
    • 9/10 accommodation. [I asked why not 10/10, and he said that most, but not all, of the nurses are super nice].
    • The most important factors for feeling comfortable with the technology and the hospital experience in general are: having faith in God; being surrounded by the supportive presence of family; cleanliness; and having the support of staff (friendly people, rather than just machine people). I feel pampered by the staff, like I’m in a hotel, which has been important for my emotional health.
    • Emotional support was good when it was there. Many of the nurses would smile, but with the doctors it would depend on your luck. Sometimes you have bad luck and you get a bad doctor.
    • The doctors were always good to me.
    • For the MRI, they asked me if I wanted to listen to music in headphones. I didn’t need it so I said no, but it was an attempt to make me more comfortable.
  • Knowing what to expect in advance because I read about the process (1)
  • Staff technique (2)
    • The technicians consider patient preference.
  • Upgraded tech (1)
    • The initial MRI machine was too claustrophobic, but it was replaced with a more open version that’s better. However, I don’t really care about it as long as the tech shows some reduction of the disease – that’s the goal.

Is there anything you would change in the process?

  • No (3)
  • Yes (3)
    • More non-tech options.
    • There was a lack of communication between the radiotherapy department and NCCCR, so I kept getting calls for appointments that I wasn’t supposed to go to. My cancer returned, so I needed to stop my radiotherapy, but they didn’t get the memo – so they stressed me out with calls and texts.
    • Wait time: I had to wait for a PET scan that finally diagnosed stage 4 cancer. It was frustrating because I had been to the hospital a couple times that year without the cancer getting detected. I might have been discharged too quickly in those visits, leading to the ultimate late-stage diagnosis.
  • Unasked (9)

Follow-up to above: Are there other options (non-tech) that you would try?

  • No (5)
  • Yes (1)
    • Sometimes, you should set aside the technology and take other suggestions. [This cancer patient has done a lot of reading about alternative cancer treatments because he really hates chemo. He said that he wants to try cannabis oil or a new treatment developed by a Russian doctor. He wasn’t saying that technology is bad, but that he’s tired of it and wants to try something else.]

Are you comfortable with technology in general? Do you use a smartphone?

  • Yes (12)
    • The hospital sends automatic SMS appointment reminders.
    • The hospital call center calls me and my husband automatically to remind me of appointments.
  • Mostly (1)
  • Unasked (1)

That’s all. While I’m happy that I was finally able to meet with patients (I almost titled this post “Patience for Patients”), the type of medical technology we discussed in these interviews is not exactly the type that interests me. Heavy duty hospital technologies, like MRI machines, are often not used by patients out of choice. When you have cancer and you are in a hospital, all you want is to be cured; if your doctor orders a scan or biopsy or a surgery, you do it.

So while I was conducting these patient interviews, I was worried that they were not relevant to my project. To date, I’ve tried to focus my project on a different set of technology, that which exists outside the hospital, such as devices that encourage doctor-patient compliance, support medication adherence at home, and help long-term care of chronic illnesses day to day. These are technologies that people have to choose to use, as opposed to the various technologies one is subjected to as part of cancer diagnosis and treatment. Still, PET scanners, MRI machines, and so on are types of medical technologies, and it’s important to see them in this context. Now that it’s been a week, I do think that this was a good choice for my project. I learned that, in the context of more serious illnesses, an important factor for having a positive attitude towards medical technology is the recommendation of a trusted doctor. I think for people with a serious illness, user-centered design processes become less important in favor of robust functionality and expert opinion. Most of the patients I met didn’t mind any discomforts associated with the machines, as these discomforts pale in comparison to the pain and fear that result from cancer itself.

I do hope, though, that in the future cancer patients will not have to assume that difficult and painful treatment is a necessary evil of a difficult and painful disease. I can’t get the image out of my head of the 40-something patient who was desperate to tell me about cannabis oil because he is so scared of doing chemotherapy again. Like he said, sometimes we need to set aside the technology and think of something else.

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Health post: Meddy, a start-up in Doha

Nearly all of my project meetings here in Qatar have been at hospitals. In Sweden, most of my meetings were with independent medical device companies of all sizes. I’ve missed getting that innovative, gadget-focused opinion. So, I was thrilled when I found a medical start-up here in Qatar, where there are hardly any start-ups at all! (I read about it in the ‘news’ section of the Carnegie Mellon University in Qatar webpage). Last week, I met with Haris, the co-founder of Meddy, a website that helps people find the best doctors in Qatar. It allows them to search by location, specialty, and rating; for example, you could use Meddy to find the best dentist close to the Al-Hilal neighborhood. Each doctor on Meddy (only doctors who agreed to be on the site are there) has a starred rating and a list of real patient comments – a bit like Yelp for doctors.

First, I asked Haris what it was like to have a start-up in Doha. Ever since the QSTP talk I attended, I’ve been aware that while the government is excited by start-ups, there aren’t many here in Doha. Meddy is housed in QBIC, the Qatar Business Incubation Center, a new start-up incubator. Similar to QSTP and Education City, QBIC was created and funded by government agencies (Qatar is still far from from having venture capital investment and private accelerators).

I learned that it’s difficult to do start-ups in Doha because of the regulations here. There’s a minimum amount of capital that a company needs to get started. However, it’s the requirement that at least 51% of the company is Qatari-owned that turns people away. As the Qataris are ~13% of the population, that’s not easy, though I completely understand the desire of the Qatari government to include the local population in innovation. Luckily, Haris co-founded Meddy with his classmate, who is Qatari. However, since the local Qatari population already has a lot of money (mostly due to oil), it’s possible that many Qataris wouldn’t want to be so heavily invested in a small, risky start-up. With so much money in oil and real estate, especially without the need to work for it, there is very little drive for Qataris to come up with start-up ideas. This came up at the QSTP chat, too, where they discussed the lack of a risk-taking culture.

What I found interesting is that the creators of Meddy never intended it to be a start-up, or at least didn’t go into it with such innovation in mind – perhaps because of the culture here. Meddy was the result of a senior project for a start-up class at Carnegie Mellon University in Qatar. A member of the press came to the project presentations and wrote something about Meddy, leading to the idea “blowing up” as many people learned about Meddy and became interested.

It doesn’t surprise me that this start-up is the result of a class at an American university, especially Carnegie Mellon. However, a class about start-ups seems like it could easily fall into the trap of creating a solution where there’s no need. I’m thinking of the CMTH fellowship program in Sweden, during which participants had to identify many hospital and medical needs long before even thinking the word “start-up.” Still, the Meddy co-founders did their work to find a real need. Their initial idea for the class was essentially “LinkedIn for doctors” so that doctors could network with each other. However, after telling doctors about the idea, they realized that doctors didn’t have need for a personalized networking platform nor the time or energy to maintain a profile. Instead, the Meddy group found that they were discussing where to find good doctors in Qatar. They realized that the problem was on the patient end; people are always looking for good doctors and trying to avoid bad ones.

They validated that this was a real need by talking to many friends, family members, and professors. When someone in Doha needs a doctor, dentist, dermatologist, or some other specialized doctor, they ask their friends and family for specific recommendations. However, since many of the doctors are expats that are only here for, say, five years, the list of “good doctors in Doha” is always changing and thus hard to keep track of. Similarly, patients come and go, so you might ask around about a good sports medicine doctor only to find out that none of your friends have been to one since they arrived in Doha. Basically, there’s no constant base of people here, so when people seek doctor recommendations from their social circles, those social circles are always changing. Favorite doctors come and go. Therefore, migrating all of this information to a website – with lists of Doha doctors rated by real patients – creates a constant base that can be accessed by anyone at any time.

In the United States, you might be referred to a specialized doctor by your general practitioner or family doctor; in Qatar, it’s not as common to have such a doctor, especially for expats that are only here for a few years. Also, in New York City at least, you could find a doctor via independent rating agencies that publish lists such as “The 10 Best Doctors of 2016,” “The 10 Best Dentists of 2016,” and so on, every year. That’s not the case here in Doha.

Haris asked me if I had heard about Zocdoc and was surprised when I said no. As it turns out, it’s a doctor-finding service very similar to Meddy that was founded in New York City in 2007 and is still based there (hey, maybe I’ll send them my resume!). Zocdoc also has iOS and Android apps, whereas Meddy is entirely web-based (for now). Harris said that Zocdoc is one of many doctor-finding services throughout the United States. If he had tried to launch Meddy there, he said, he would have been crushed almost instantly by the competition. In Qatar, however, Meddy is one-of-a-kind and thrives.

As to whether or not Meddy can make people healthier in Qatar, its target is people who are already looking for a doctor. While Meddy makes it easier to find doctors, people still have to self-motivate to use the service. It also targets people who can afford to shop around without considering the price of treatment – rich Qataris and expats here on salaries with private insurance benefits. Meddy is good for people on private insurance because it connects patients to doctors at private clinics. If you don’t want to make a choice, or if you can’t afford a private doctor, you can show up to the general hospital owned by the governmental Hamad Medical Corporation, where you would be assigned to the next-available doctor in the necessary field.

Once the co-founders of Meddy had their idea, they started building it as their senior project for their start-up class. They had to encourage doctors to join the site, some of whom were hesitant at first. However, they currently have a 100% retention rate – no doctors have removed their profiles. While building the site, they did usability testing to make sure it was user-friendly. They also asked people to start adding reviews. When they presented it as their senior project, as I mentioned, it became their jobs. I asked if any of the patients had privacy concerns about leaving reviews. Haris said that there’s a stereotype that patients are very privacy-focused (all over the world, but especially in Qatar), but that it’s not true. In fact, Meddy had to edit down some posts because patients shared too many personal details when reviewing their doctors.

I was impressed with Meddy, but Haris was very modest about it. “We’re just solving a basic need,” he said, emphasizing that Meddy is mainly an aggregator of opinions. The site gets 50,000 visits per month, however, and an Arabic version was recently released, increasing the site’s popularity. Haris thinks that Arabic versions of health services and startups in general could influence the locals to be healthier and engage with startups – it’s important to reach them in their native language. For example, an “Arabic WebMD” would be useful here. Meddy predicts even more growth in the future since employers of expats continue to offer the benefit of private insurance to new employees in Doha, giving them the freedom to choose any doctor they want. This is especially important considering the wait times at Hamad Medical Corporation; the city’s main healthcare provider is getting increasingly crowded.

Check out Meddy’s website at: http://www.meddy.co/.

Just Doha Things

Doha is a funny place. Many of the city’s oddities result from the rapid urbanization that has transformed Doha from a desert to a metropolis over the last few decades. During my time here, I’ve been keeping track of some of these little Doha things that have surprised me, so I thought I’d share them now.

Doha hardly has any crime. For example, there are free mobile charging stands along the Corniche (waterside promenade). People will leave their smartphones at these stands and walk away for a little while, and no phones are ever stolen.

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The “birdhouse” at Katara Cultural Village, a still-developing non-residential area of the city with restaurants, a beach, cafés, an amphitheater, and a small exhibition hall.

No one drinks the tap water. According to my Lonely Planet, the tap water is safe, but according to the Lancet health study, the water quality is not up-to-snuff. This whole month, I’ve been drinking from plastic bottles or the water cooler at the house.

The more elaborate malls have ice rinks in them year-round. I had always associated ice rinks with being outside at Christmastime (unless you’re at Chelsea Piers for a fifth grade birthday party).

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The beach at Katara Village, closed for the night. Note the dress code restrictions posted on the board – I couldn’t wear my swimsuit here!

I’ve seen lots of American brands and stores here: Coldstone, Starbucks, Shake Shack, Bath & Body Works, Old Navy, and more. Shake Shack was the real odd one out to me!

Thanks to globalization, Qatar celebrates “fall” even though it’s 95 degrees outside. Coffee shops have been selling pumpkin spice lattes and advertising pumpkin muffins with signs that say “fall in love with fall!” Of course, these flavors don’t really make sense without the cozy fall weather to match. Even worse, stores are advertising fall clothing complete with burgundy pullovers! It’s hilarious.

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The strip of Al-Wakrah Souq, the smaller and quieter cousin of the famous Souq Waqif in town.

There are basically no sidewalks. The streets here are wide avenues, built for big fancy desert cars and lots of traffic.

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I had to wait a long time to cross a major highway to get to this weird little oasis between office buildings.

There is so much diversity here! I’ve met people from Lebanon, Pakistan, Palestine, Tunisia, Algeria, Egypt, Poland, Canada, the U.S., Canada, India, Kenya, and the Philippines. I’ve even met people born here in Qatar who do not identify as Qatari. I’ve met very few “real” Qataris, identified often by the traditional robes, who comprise ~13% of the population (the rest being expats and migrant workers from a diverse array of countries). Some of the people I’ve met have lived here for years without meeting any locals.

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With the girls at Al-Wakrah Souq! This souq is mainly restaurants, so we had dinner there.

There is no recycling whatsoever in Doha. After receiving mail my first week, I asked my host mom where to recycling the packaging. “Hah! Give it to me, I’ll toss it in the garbage,” she said. “Welcome to the Middle East!”

The movie theaters show all the latest releases, but they censor some movies. When The Wolf of Wall Street was shown here, it was 45 minutes shorter!

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I loved that Al-Wakrah Souq was by the water. I felt close to real nature for the first time in a while. Also with the boats and the sunset over the horizon, it was beautiful! (You’re not supposed to climb on them, though; this was taken right before a guard yelled at me to get off).

Mail is a bit odd in Qatar. No one has postal codes (zip codes). Individual houses don’t have mailboxes, so people are required to rent a P.O. box from the main post office branch.

There doesn’t seem to be a distinctive Qatari cuisine; rather, the cuisine is Arab/Middle Eastern and a fusion of Turkish, Lebanese, Israeli and even Indian cuisine.

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Post-nightfall in Al-Wakrah Souq.

Last but certainly not least, Aspire Park. This might be the most “only in Doha” place I’ve seen so far. Aspire Park is Doha’s largest park – a completely man-made area with cultivated grass, a man-made lake with imported ducks, man-made hills, and imported trees. It’s a beautiful and fanciful effort to bring a green oasis to Doha, imitating the natural parks of many American and European cities have natural park. But the imported trees look odd, scattered randomly throughout the park and bottom-lit like art pieces, never clustering together.

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One of the mist towers in Aspire Park, refreshing the park-goers with The Torch in the background.

There’s an odd coolness in the park which can only be explained by hidden air conditioning in addition to carefully stationed misting towers (see photo). The pathways in the park were built as a running track and spring up with rubber to meet your step; while unusual, it does feel much better than pavement. There are a couple rows of shiny, new exercise bikes, but they have no resistance and wide seats (I tried them!), so they’re difficult to use. Despite the effort to encourage exercise, the park has a set of free golf carts, driven by employees, to carry park-goers. There are two small buildings that lead to underground prayer spaces, one for men and one for women. The trees have hidden speakers that emit sounds of birds and crickets; the track is so perfectly ambient and realistic that I wouldn’t have noticed the lack of real birds or real crickets had my friend not pointed it out. Overall, Aspire Park is beautiful and well-done, but it grates against my ingrained definition of a “park.” It’s not an area of nature that was conserved, but rather a manmade attempt at nature; it’s not environmentally conservative (using lights and AC! Outdoors!); and it’s not as exercise-focused as it should be. People drive to Aspire Park, ride around in golf carts, eat at the restaurants there, and drive home. Amazing.

Health post: Psychiatry in Doha

About a week ago, I met with a doctor at the Hamad Psychiatric Hospital in Doha, away from the main HMC hospitals in Medical City. The doctor I met with is Egyptian and has studied at the Weill Cornell Medicine school both here in Doha and in New York. She told me that the curriculum here exactly replicates the one in New York; the theory that is taught is the same, and the doctors learn how to apply that theory to their specific location (either New York or Doha) during their residency training with real local patients.

The government of Qatar has recognized mental health as an important issue via the National Mental Health Strategy for 2013-2018. The doctor I was talking to said that she’s observed the same distribution of mental health issues here as in the US. This is supported by the strategy, which states that “mental disorders in Qatar broadly reflect the WHO’s global estimates” (http://www.nhsq.info/app/media/1166. The most common mental health issues are anxiety, depression, and other psychiatric disorders like psychosis and bipolar disorder.

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The government’s “vision for mental health in Qatar.” (From the National Mental Health Strategy of Qatar, p. 5).

The doctor also suggested that overall, attitudes towards psychiatry and mental illness are the same across countries. In any medical setting, the psychiatry department will be seen as the one needing support the least even though it has the most challenging patients (many of whom are prescribed pills but lack the capacity to take them properly). Psychiatry will get the least amount of funding, respect, and support compared to other hospital departments due to a prevailing attitude that mental health isn’t as important as other medical fields. My interviewee said that even other doctors have a stigma against psychiatrists, despite expecting them to do a ton of work. She talked about how many non-psych doctors have a fear of the unknown, often sending medical patients with the slightest hint of mental issues to Psychiatry. So Psychiatry ends up with patients that have other physical issues and has to send them back to the appropriate medical department to be treated there first.

The doctor said that while the stigma against mental health is global, she has noticed it to be more prominent in Qatar than in New York. We agreed that might just be New York City, though, which is typically quite liberal and tolerant and not exactly representative of the rest of the country. “It’s a crazy city!” I said. “…Exactly,” said the psychiatrist, with a look. (Oops – I hadn’t meant that in terms of mental health, but more to say that the city is extremely diverse. I suppose I throw around the word ‘crazy’ too often, especially when telling people how New York City compares to Stockholm, Gothenburg, Malmö, or Doha.)

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“A study of public perceptions of mental health issues…has shown that stigma exists in Qatar. …This leads to unnecessary hospitalization and prolonged illness.” (From the National Mental Health Strategy of Qatar, p. 27).

The doctor pointed out that a lot of the stigma towards mental health is evident in the use of euphemistic names. At the NewYork-Presbyterian hospital, the psychiatry department is called “Payne Whitney.” In Hamad Medical City, the primary provider for mental health services is the “Rumailah Hospital.” She gave another example: the HIV/AIDS department at Weill Cornell is mysteriously called the “Center for Special Studies,” which reveals continuing stigma against the disease.

We also talked about the importance of doctor-patient compliance with mental health patients and how challenging that is. The doctor said that encouraging compliance with psychiatry patients is twice as important than with other medical patients, as such patients usually live at home (with less oversight than patients in hospitals), have long term illnesses that are treated mainly with pills, and have mental issues that make it more difficult to adhere to a specific pill-taking regimen. It is much easier if the patient has a specific care provider, typically a family member. Sometimes mental health patients come to the hospital for check-ups alone, and it’s hard to tell if they’re telling the truth when they talk about their medicine. Others don’t seek help at all. Even if they are cared for a by a family member, negative attitudes towards mental health can still come into play. The doctor told me that she’s heard of some patients being kept at home by their family members, locked in rooms out of shame. When this happens, such patients only end up at hospitals after their family can no longer care for them and the situation has gotten out of control.

I asked the doctor what would make things easier in Qatar and what was currently lacking. She said that she would like to see more outreach programs and more residential services, meaning more space (more beds) for the patients and more funds for nurses to visit patients at home. Resources for residential services are usually allocated to geriatric and non-psychiatric departments; again due to stigma and a perception of psychiatry being least important.

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Goals for 2018 compared to the issues observed in 2013. Qatar should be more than halfway to its goals by now. (From the National Mental Health Strategy of Qatar, p. 8).

The main focus, however, needs to be on reducing the stigma by normalizing mental health issues. The first step is getting rid of the euphemisms used to refer to psychiatric hospitals, services, and illnesses. The next step is awareness through advertisements and education. The doctor said that people in New York seemed more educated overall, which contributed to less of a stigma there. Also, when she was in the U.S., she noticed that ads for mental health treatments are everywhere. It’s true; you might watch an hour of television and see the same antidepressant ad twice. However, there are no such ads here. There’s less exposure to the idea of mental health issues and seeking treatment for them, meaning that it’s not as normalized. Overall, Qatar has to make more of an effort to educate its population about mental health through campaigns.

The doctor made a great point here about the health industry. She said that part of the reasons there are no ads here is because health isn’t an industry in Qatar – certainly not the way it is in the U.S. In Qatar, the government owns most of the hospitals and everyone is on the same insurance. There’s no view of medicine as a financial opportunity, so the hospitals don’t compete to be better. There’s no competition to offer a better experience for the patients or even for the doctors, who have no option for doing a residency outside of the Hamad Medical Corporation system. When there is a monopoly, there’s less of a drive to do better. (What’s interesting is that this could have happened in Sweden as well, where everyone gets healthcare for free and so the hospitals don’t have to compete for patients’ money. However, they all still work together to improve. One reason for this might be the tradition of user-centered design in Sweden). However, the downside to health being an industry as it is in the U.S. is, of course, the expense for patients. If you don’t have the money for hospitals or insurance companies, your health will suffer. Someone mentioned this in Sweden, too – that while the hospitals in the U.S. might compete to be better, it’s a competition driven by money rather than a want to provide the best patient experience. Conversely, Qatar is patient-centered in its recognition that everyone in the country deserves access to healthcare regardless of their ability to pay (also, there is a drive to improve patient experience, as reflected by the goals in the National Health Strategy).

“What about tech solutions for patients?” I asked. The doctor agreed with my observation that no one here uses health apps, which seems to be because people aren’t interested in preventative care or self-monitoring. She said that some patients would probably self-motivate to check blood pressure and glucose levels if given the option (probably diabetes patients). For any patient to use an app or other eHealth solution, however, it would have to be very simple. She suggested that it would only happen if doctors got involved and guided patients through downloading an app and using it, rather than patients finding such solutions on their own.

Finally, I asked about the effectiveness of following New York’s medical school curriculum in Doha. The doctor said that it works, because as I mentioned earlier, the theory is imported but application is localized. However, she told me about a class called “Cultural Competence,” which was about how to relate to patients with a different background from your own. “What if the class had been specifically about working in the Qatari cultural complex?” I asked. She said that the main topics of such a class would be the stigma against mental health in Qatar; the varying levels of medical literacy in the country; the history of tribal families; the need to expect and inquire about the use of traditional healing techniques; the role and education of the patient’s keeper (usually a maid or family member rather than a nurse); and the cultural idioms used in place of the official names for mental health issues.

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The new and beautiful naufar center. (From website homepage, www.naufar.com).

However, Qatar is developing, and as I mentioned, the government has the fairly new National Mental Health Strategy. Development in the country will help develop everything, including attitudes towards mental health. There is also the larger-scope National Health Strategy, which outlines many goals for improving Qatar’s health overall (www.nhsq.info). Though another example of a euphemism, “naufar” is a brand new treatment for people with behavioral disorders and substance abuse issues (http://www.naufar.com/About-Us). It has residential and non-residential facilities as well as an awareness program. The country’s mental health plan also discusses the need to reduce the stigma. Hopefully, ads, television, education, and awareness campaigns will begin to normalize mental health issues in Qatar and eventually reduce the stigma, which could have a real positive medical outcome in the country’s mental health.

Sunday, 10/30/16: This post has been edited to replace “Westchester Program” with Penn-Whitney and to add nuance to the doctor’s observation of the pros and cons of health as an industry vs. government-monopolized health as a service for all.

Weekends in Doha

The weekends here in Qatar are on Friday and Saturday, meaning that the work week is Sunday through Thursday. I’ve gotten used to it by now, but this small change really threw me off at first. I’ve learned that Friday-Saturday weekends are common in Muslim countries due to a special prayer on Fridays. It makes sense, but it’s one of those things I never expected to be different.

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This is MIA Park, to the right of the Museum of Islamic Art. Every Saturday throughout “winter,” there is a Bazaar there, an outdoor marketplace reminiscent of the tradition of shopping at souqs. You can see the shops at a distance here.
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MIA Park also has its own little crescent, like a curlicue off the larger Corniche (the waterfront crescent area of Doha). There is a small café there with a view of the glittering West Bay.

I’ve made some friends here in Doha, some through the social travel site Couchsurfing and others from the tech talk I went to. Many have asked me, “So how do you like Doha?” adding, “There’s nothing to do here, huh?”

I can see how after years and even months, going to the same air-conditioned malls and few sights would get boring in this small city. Even Villaggio would lose its novelty eventually. In Sweden, I went to approximately 25 different museums in 3 different cities; here, I’ve been to one, which means I’ve seen half of the museums in the whole country (there are several more planned for the future).

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Another view from the MIA Park crescent, where old-fashioned boats take tourists on the water.
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A street in Souq Waqif, the renovated ancient marketplace with traditional shops and many restaurants (one of Doha’s main attractions).
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A small outdoor tourist shop in the Souq. I wish I could get rid of that flare when photographing at night, but I just love these Arabian lights.
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Me in front of the pretty lights. (Photo credit: Downna).

But my new friends, and the family I’m staying with, have showed me the attractions that Doha does have, and I’m happy to say that I’ve seen a more fun city than I was expecting. While I know that I wouldn’t want to live here long-term, I’ve learned that I could live here, and that in itself is amazing to me.

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With Downna and Sarah at a restaurant in Souq Waqif.
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Pure Lounge, the bar we went to one night at the Hilton. There are very few bars in Doha, and no restaurants serve alcohol. The only bars legally allowed to sell are those attached to international hotels like this one. I was surprised to find nightlife in Qatar, but honestly, it’s not as exciting as it looks!

Finally, I played Ultimate Frisbee with some new friends last week, and I’m going back tomorrow. There is a small group of expats here that get together every week to play ultimate, and I was lucky to befriend the social coordinator of the group. Since there is only one group, they can’t play against other teams, but they still work hard and scrimmage well. I was so impressed to see the same skills here that I saw in college ultimate.

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We went to the beach in Qatar! Luckily there’s a quiet beach here where you don’t have to cover your shoulders and knees. (Photo credit: Downna).
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Post-beach seafood at a casual Filipino/Arabic restaurant. (Photo credit: Downna).

I think playing ultimate here will be my Qatar version of swing dancing in Sweden. It’s now a goal of mine to find something fun like this in each country that I go to – a local, social event that I find all on my own and then participate in.

I’m glad that I’ve been able to find social activities here in between project meetings. My progress has felt slow; I’ve had about five meetings here so far, most of them with doctors. I wish there were medtech companies here the way there were in Sweden, though I knew that wouldn’t be the case. While doctors provide an important perspective for my project, my engineering background makes me more interested in medical gadgets and user-focused devices than big hospital machines. Still, it’s good to know, and it certainly teaches me something about the attitude towards medical technology here if there aren’t any medical technology start-ups.

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The Pearl, a fancy artificial island in north Doha (well, I suppose most of this city is artificial). There are shops, apartments, hotels, and restaurants here – and lots of yachts!
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The Pearl is essentially a curved strip encircling this small body of water.

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.

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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.

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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.

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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.

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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.

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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?

Italy in Qatar

There may not be Italians in Qatar, but there sure is a huge, Italy-themed mall here. Last night, I finally visited Villaggio, perhaps the most extravagant of all the enormous malls in Doha. By Italy-themed, mind you, I don’t mean that it has Italian stores; it has over two hundred stores for clothing, electronics, sports, food, and more, with all the popular brands (many of them American). No, by Italy-themed I mean that walking through Villaggio is meant to feel like walking through an old Italian village, with naturally curving streets, colorful homes, and clouds in the sky.

And, of course, the Venetian canal…

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Check this out! This is a mall, with a built-in canal!

The first mall I ever went to, and probably the only one I saw for years, was in White Plains, NY. The mall description matched its location – white and plain and pretty regular – but it was exciting to my young eyes. Imagine growing up with a mall that feels like it could have its own mayor!

With Villaggio’s bright lighting and painted blue sky, I felt like I was outside in the middle of the day in perfect weather. But it’s the canal that blew me away. Whose idea was that? How much work did they do to get the water in there? Is it worth it? Hilariously, there are gondolas when you come in, and you can pay for a gondola ride through the mall via canal. I didn’t see anyone doing that, though.

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Me and my “host brother,” 13-year-old Lucas. We’re at the entrance to the mall where the gondolas are!
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This logo really reminded me of “Toys R Us”…hm.

The mall, in addition to regular-sized stores, houses a cinema, IMAX theater, Virgin Megastore, a huge grocery store, and an indoor amusement park with an ice rink (ice rink! in Doha!).

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Probably my worse picture ever, but it gives you a sense of the “Gondolania” indoor amusement park. It manages to keep the Italian theme but also have a rollercoaster! Oh, and I forgot to mention the nearby bowling alley.
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American brands and stores are everywhere, including this weirdly fancy Shake Shack. 
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The area with Shake Shack was also the only part of the mall with a night sky.

Finally, Villaggio has a ‘fancy’ section for all the higher-end shops (Tiffany’s, Bulgari, etc.). Honestly, the whole thing is just ridiculous. It’s certainly an entertaining way to shop, and it’d be an easy place to spend a full day with kids. And since it’s too hot to walk outside in Doha, it makes sense to have such an elaborate indoors, climate-controlled experience. But I know it would drive me crazy before too long.

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The fancy area.
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One last look at the detailed Italian village façades.
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Leaving Villaggio, with the “Torch” tower nearby.

In case you were wondering exactly how rich this city is, I hope this gives an idea.