Sophia's Peace Work

Monday, May 24, 2004

The Prognosis is Not Good

I went to see Dr. M, Ahmed's Doctor (for those of you that have just joined us ... Ahmed is a 17 year old boy living with his mother in the Mukhabarat Squatter camp in Baghdad. He has Multiple sclerosis) at the MS Clinic here in Baghdad. I wanted to check on Ahmed's status and learn from the doctor what his prognosis is. I've made several trips to the Medical City, a maze of buildings that house the public hospital, lab facilities, a College of Medicine and the Italian Hospital. The MS Clinic is in the public hospital and it's a huge, drab and depressing place.

The one working elevator is staffed with a worker that has to pack his human cargo in like cattle. We have been told more than once on the ground floor that Dr. M is on the tenth floor. After facing the elevators once, we now walk the eleven flights (The first floor is always the Ground floor!) even though my translator claims that she will kill me herself if I ask her to do it again. I just laugh and tell her she should stop smoking.

After several unsuccessful attempts to find Dr. M, I finally tracked him down during a busy Saturday morning at the hospital. He is a thin man in his 30's and he seemed more than happy to talk to us.

"Basically there are three components to the treatment of MS patients," he said, "Steroids, Beta-interferon, and physical therapy. Even abroad the treatment would be the same."

He then proceeded to tell us that there were approximately 900 patients being treated for MS at the hospital and that two thirds of the patients who needed these medications, particularly the Beta-interferon, were not getting them.

When we asked about the prognosis for Ahmed, Dr. M said, "It is not good. He can expect many relapses."

I asked, "How much Beta-interferon would Ahmed need to treat his disease?"

"Up to fifteen injections per month," Dr. M said.

I pointed out to Dr. M that there was a CPA-sponsored program to take patients out of Iraq for treatment outside of the country if they could not get proper treatment inside the country. All Ahmed needed was a written letter from his doctor stating that proper treatment for his disease was not available inside Iraq and he might be able to seek better treatment elsewhere.

Whether this last part is true is debatable. I know this program exists but I have no idea how effective it is. Still it is an option that Ahmed could potentially pursue if his doctors would agree to write such a letter.

But then something strange occurred. When I mentioned the CPA program, suddenly Dr. M's story changed. He kept insisting that MS could be treated inside Iraq.

"But you just told me," I said, "that you don't have enough Beta-interferon to treat two thirds of your patients. You just told me that Ahmed's prognosis is not good. Is this not true?"

Dr. M appeared flustered. He told me that I had misunderstood. He said that MS is a serious disease, which is not clearly understood and that is why he indicated that Ahmed's prognosis was not good. And no, there was no major problem with having the medicine. They have enough Beta-interferon ... the only problem was that the supply was not stable. Sometimes the supply they have on hand fluctuates. He even took me to where they stored the medicine and I was shown a refrigerator with approximately two to three hundred boxes of Beta-interferon (three injections per box).

Assuming there were even 600 boxes of this medicine in that refrigerator, that would mean a total of 1800 injections. Two shots for each MS patient and your finished! But Ahmed alone would need fifteen shots a month! But then I was assured that this was only part of their store of Beta-interferon. There was more somewhere else.

I was also told that not all patients in the MS Clinic need Beta-interferon. Some respond well on just the steroids and therapy. Ahmed must go before a panel of doctors in the next two weeks to determine if he is a candidate for Beta-interferon.

Admittedly, perhaps there was a misunderstanding here. Dr. M spoke excellent English and my interpreter jumped in to smooth any gaps. But the conversation had a strange feeling about it, as if Dr. M was trying to convince me that there was no problem at all at the MS Clinic. Though I thought pretty clearly that, at the beginning, he had said there was a very big problem at the Clinic. And this change occurred when I mentioned the CPA-sponsored program.

In a few days, I'll be going to visit Ahmed again and I'd like to go to the Ministry of Health and the man who runs the CPA program. There are many unanswered questions here.

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