Subcontinental Drift: Chapter Twenty-three - The Man in Bed Eleven

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Asia » Pakistan » Khyber Pakhtunkhwa » Chitral
August 12th 2008
Published: August 24th 2008
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A Peek InsideA Peek InsideA Peek Inside

The male ward at HDQ Hospital...
Simon still shows no sign of improvement. His complaints of the pain, fatigue, and discomfort are peppered with explosions of profanity as he rolls out of bed and practically hits the floor. During the night he made several visits to the toilet. His pants barely cling to his waist and he is pale in spite of the sun his skin has absorbed while trekking in the mountains. Ameen rolls up Simon’s red sleeping pad and began packing. Simon is not interested in breakfast but for some green tea and none of us is confident he’ll keep that down. He goes into the toilet, locks the door and before he moans and his insides detonate once again, I take Ameen into the garden.
“We need to go right after breakfast.”
“Yes, sir. But sir, if you don’t mind, Simon wants to check into a hotel first before we go to the hospital.”
He’s a stubborn S.O.B., a predictable Scot. “OK. For now.”
Ameen understood that if I ordered him, we’d bypass the hotel. Simon then hobbles out to the garden for a tea he hardly touches. Devoid of his humor but still conversant, he settles his part of the bill. “Hey, do
Urinals at HDQ HospitalUrinals at HDQ HospitalUrinals at HDQ Hospital

In the male ward...
you want the front seat of the jeep?” I wonder. “It won’t be as bumpy.”
“Nah, I’ll be OK.”
“Maybe. But we’ll be watching.”

Being a foreigner in Pakistan has its advantages. In hospitals this becomes rather obvious. Whether it is the color of our skin, the singularity of our presence, or the fear that if not attended to there will be hell to pay, Simon gets pushed to the front of the line ahead of cases of ear infections, bronchitis, and other ailments. Ameen volunteers for the duty where he can do the most good: he shoves and elbows through closed doors and gains the attention of anyone who appears to be of importance in the crowded and clamorous hallways. I watch as he indiscriminately opens the doors of examination rooms unconcerned with who might be inside and their possible state of vulnerability. If he doesn’t, Simon will idle for hours like all the rest. The strongest, those who fight for a doctor and are the most persistent, get seen first. And Ameen is a good soldier. One of the hotel employees who has come along with us takes care of the paperwork and other details so Simon’s
I Gotta Go!I Gotta Go!I Gotta Go!

One look at this and I tried to hold it...
case can receive some sort of priority. Whether or not his is the most urgent is irrelevant.
For my own comfort and probably to be moved out of the way, I am shown a seat in Dr. Saad’s office and examination room. He welcomes me into his cool and much more comfortable abode, though it becomes abundantly clear he has little time for chit chat with the out-of-place American. Privacy is not a crucial concern when receiving medical attention at the District Headquarters Hospital in Chitral. From what I can gather, Dr. Saad sees patients in an assembly-line manner, many of whom today suffer from irritations or discomfort in the ear, nose, and throat. Age or gender makes no difference. He pokes and prods with the same unsterile scopes and instruments with much authority, assaults each person with a battery of questions, only to produce a prescription in illegible Urdu without too much emotion. Dr. Saad cares, but hasn’t the time to apply a bedside manner. The more time he wastes, the fewer patients he can help. His office is a bare and hollow chamber of one naked light bulb suspended from the ceiling. Exposed wiring enters the room from
IV Drip StandIV Drip StandIV Drip Stand

It has no wheels, so patients are tethered to it...
the hallways outside along with tortuous cries from babies being consoled in their mothers’ arms. Dr. Saad ignores the standard mayhem and calls in the next patient. Silent ceiling fans twirl the stale air, heavy in sickness, at full speed; air conditioning is a fantasy at HDQ that may never arrive.
Simon’s case is given priority. Ameen finds me in Dr. Saad’s office and orders me to come along to the laboratory. Given that language is an issue from time to time, I pull him aside for a private conversation to reveal sensitive information. Meanwhile the lab attendant is pricking Simon’s forefinger with a razor blade, causing him to cry out and yelp sharply. Simon verbally scolds his assailant with nasty profanity buried in his deep, incomprehensible brogue.
“Can you do something for me?”
“Yes, sir.”
“I need to you check with whoever is conducting the test what exactly they are looking for.”
“OK, sir.”
“Also, they already have the list of vaccinations he has taken. Make sure they do not test for any of those.”
Ameen focuses on me very carefully. “Yes, sir.”
“Now, pay close attention.” I hand him a slip of paper. “Ensure that the doctors consider
Medieval EquipmentMedieval EquipmentMedieval Equipment

I didn't even ask...
and eliminate what I have written down here.” Ameen opens up the paper and scans the list. There are four concerns I have noted. They read:

- Syphilis
- Gonorrhea
- Hepatitis A & B

Ameen removes his eyes from the paper and stares at me. I add, “I have learned that there is another part of Simon’s body that ails him. Do you understand?”
“Yes, sir.”
“You also need to insist on giving me or Simon a” and I took the paper and wrote it down, “WBC or white blood count. It will probably be low. The doctor, wherever or whoever he is, will assume a bacterial infection. Simon’s breathing has been shallow. Whatever he has may have settled in his lungs. But I want these four to be part of the test. You must do this. Clear?” With that question ended everything I could tap from my vast medical knowledge, all of which could fit on the head of a pin with much room left near the edges.
Very firmly, “Yes, sir.”
It turns out that Simon keeps a girlfriend from Singapore, two cuties on the side in Scotland, and at least one other

Incomplete paneling in male ward...
encounter with an Irish girl on the road a few weeks ago while trekking. His libido may have gotten the better of him.

“The admission fee is twenty rupees.” We no longer have any need for the hotel employee and have sent him away with our thanks. The three of us sat in an office to do some more paperwork. I pulled out a twenty note and handed the man the equivalent of an amount slightly less than thirty cents. We are ordered to grab a bed in the male ward, a two room Little Shop of Horrors where despondence and hopelessness reign supreme. While Ameen and I carry his belongings, Simon drops his spotted and discolored sheets on his bed. The beds on either side are occupied by gaunt, skeletal men. One is still wrapped in a crouched position on his side, too weak to move. Their other is conscious, but sucks on the inside of his mouth with an undying thirst. Compared to the occupants in beds ten and twelve, Simon looks like a decathlete.
It is then a waiting game. A nurse or the equivalent thereof finally arrives with a list of medications and other needs to get Simon started. He hands me the list and orders Ameen and me to the nearest pharmacy to collect a series of drugs and ancillaries. Just outside the hospital parking lot which holds a maximum of fifteen vehicles, there is a row of wooden pharmacy sheds overstuffed with everything from aspirin to blood thinners and muscle relaxers. I show one pharmacist the list and he dismisses me. “We no have.” Only at the fourth shed do Ameen and I fine a chemist with everything in stock. In addition to all medications, we are forced to buy drips, tubes, syringes, and gauze. The hospital supplies virtually nothing. I gather by reading the labels and asking the “pharmacist”, that one bottle is to clear out any urinary concerns, the white tablets are for pain, and the Effiflox is an antibiotic. In place of administering it orally, I buy the IV bag and accompanying necessities.
Back at the ward, Simon has settled in. He is no more pleased with his surroundings than I am, but softens the blow by telling stories of being hospitalized in China. “At least here some people speak English”, he remembers. DHQ is horrific, but things get done over the course of time. It is functional given the limited resources, training, and hygienic standards at hand.
Yet one cannot overlook the obvious. All the beds are rusty steel racks on which sit tattered mattresses of powdery foam. Some patients have stained sheets, some none at all. If attached to an IV drip, patients are immobile until the liquid has run its course because the stands’ legs have no wheels. The screens on the windows have done little to deter the swarms of flies from sharing the beds with patients, some of whom are so weak they cannot fan the dozens of them off their bodies. In order to sleep, three or four patients cover themselves in grey bed sheets to keep the flies from disturbing them. Technical equipment is corroded beyond repair and outdated. Families and loved ones either sit on hard wooden green benches or on the sections of open bedding of other patients too feeble to fend them off. Hospital staff hoist the man in bed twelve (next to Simon) on the shoulders of a family member piggyback style to bring him to the toilet; he is too weak to make the trip by himself. I follow the team of men to the toilets and they are so foul I cringe in horror. When I go back to tell Simon of the scene, he quips, “I have seen worse…in China.” I believe him.
As the day progresses, I seriously reconsider tomorrow’s departure from Chitral. I do not know Simon well, but I cannot leave him alone in this place. I take an hour to excuse myself and gather departure times and booking options for the next three days; I keep that all to myself. Maybe we can get him out of here. Ameen has to drive back to Gilgit, as his father has grown impatient that he is not back with the jeep and the newly acquired revenue he wants to get his hands on. While Abdul has been extraordinarily kind to Simon and me, Ameen portrays an image at odds with the extroverted and enlightened man we have come to know. “My father, he wants me back in Chitral to be in the shop. If leave now, I will be back by five in the morning.”
“Ameen, you plan to do the entire trip to Gilgit and not stop like we did on the way here?” I am also ready to remind him of the foolishness of driving at night.
“Yes, I will have to. If not my father will be angry.”
I relay this to Simon who makes it a point to call Abdul and inform him that Ameen is needed for one more day in Chitral to see him through his hospitalization. Simon even offers to pay an extra day’s charge to have Ameen at his side, a wise move by the Scot because Ameen has proven his worth. With Simon, Abdul is very agreeable and understanding and even insists he come back to Gilgit to receive better care under Abdul’s supervision.
With the cell phone back in Ameen’s hands, Abdul grants his son permission to stay in Chitral.
Later in the afternoon, Simon’s attending physician hands me a piece of paper and asks me to relay it to him. He has other issues more pressing than Simon. I unfold it and it reads, “Test for malaria: negative.” I walk over to the foot of the bed and Simon is happy to see me.
“I have some good news and some bad news.” I show him the folded paper but refuse to hand it to him.
“OK, let me have it.”
“The blood test is in and you’re negative for malaria. That’s the good news.”
“OK. And?”
“You’re still ugly.” I got him to laugh and temporarily forget that he was in a hospital in Pakistan.

“Ameen, come here, please.”
“Yes, sir.”
I don’t care what the doctors say, we have to get him out of here.”
“But the doctor says he must come back in the morning.”
“What time?”
“More tests.”
Couldn’t blood tests be scheduled at a more sane hour? Ameen will have to go back to Gilgit. My flight out of Chitral is at eight thirty, an arrangement I have already canceled in my mind. I ask Ameen to book me on the flight for the next day. I cannot leave Simon here alone. I just can’t.
Simon is well enough to go back to the hotel for the evening, but is still weak. The three of us share a triple room. Ameen sleeps as poorly as I do. Simon sleeps almost none and makes frequent trips to the toilet. He cannot get comfortable because of the needle left in his arm for future IV drips. All in all, it is a miserable evening.

“Let the freak show begin!” It is Simon’s way to combat his anxiety and displeasure for having to go back. The reference is to his being a spectacle, the target of all eyes. He is the recipient of stares and piercing glares, a veritable circus act. But this is all for real. He hops up on the bed and the “nurse” (I use this term very loosely as I come from a family of them) brings over a drip and the IV stand. He shows me the syringe, tubes, and makes a waving motion. I gather I will have to administer the IV. I explain this to Simon, to which he reacts indifferently. Whatever it takes for him to get out of the hospital will be just fine with him, be damned that I have no training to insert an IV. I suspend the bag at the top of the stand, rip open the syringe, and look for a place to dispose of the refuse. The nearest thing to a bio trash bin is the floor. The plastic piece falls to the concrete among other liquids, including someone’s sick. I insert the needle into the taped knob that is already connected into a vein. It goes in smoothly. Then I open the IV and regulate the flow. The drips are slow and steady and I watch the Effiflox enter Simon’s arm. I grab his attention and exclaim, “Do you realize I could go to jail for this in the States?”
“Did a good job, I think.”
“You got lucky.” I took a seat on the bed and we laughed together at the absurdity of an American teacher administering nursing care to a Scottish truck driver in the northwest corner of Pakistan. No one could make this up if he or she tried.
The laughs do not last long for me because he is moaning again. It is the same boy from yesterday and he is waking up. It devastated me all day yesterday to have to walk by him. No more than four, his head is wrapped in thick bandages to cover a massive wound. His family rushes over to console him, but also pin his arms and legs to the bed. His pain and nervousness cause him to quiver out of control. He is too young to understand much. Then he wails and there is nothing anybody can do. His mother is a mess. The rest of the family, all men, show no emotion as the boy’s torso twitches and jerks on the bed sheets.
I have to get out of here. I can’t take this much longer.
Ameen needs to get back to Gilgit. He is pleased to tell Simon that his tests for anything major are all negative. The doctor’s think it is a chest infection of some kind. The instructions are predictable: take the medicine, get rest, and stay away from raw vegetables.
And stay away from hospitals in Pakistan.


24th October 2008

Wow, Mr. I ....
I didn't kno wyou liked taking pictures of... urinals and toilets... but very good photography! Your not very intelligent student, Katelin
26th March 2009

I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often. Joannah
16th December 2012
Medieval Equipment

Ooof. Awful experience. I hope Simon is well? I have added your blog to my forum post called 'sicko' that highlights international hospital visits.

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