CHU: Monday – Friday July 15th – 19th
Orientation for the internship at CHU Hassan II Hospital was completed on Friday, July 12th. We were given scrubs, a tour of the departments we will rotate in, and met with various staff from the different departments. The internship officially began on Monday July 15th. The first stop was the Nephrology Department where we spent this entire week. Monday was very busy and hectic. There were many patients that had to be seen and the Attending Physicians (known as Professors here in Morocco) and the residents were very busy tending to patients. The next day we each were paired with a resident doctor who we shadowed the entire day. I had the fortune to be with Dr. Yassine Allata who continuously educated me, answered all my questions graciously, and allowed me to shadow him multiple days. The next day three Attending Physicians: Dr. Kabbali Nadia, Dr. Basmat Amal Chouhani and Dr. Ghita El Bardai, along with Dr. Allata allowed me to shadow them to observe the peritoneal insertion of a catheter in a patient for peritoneal dialysis – peritoneal dialysis is when a patient uses the peritoneum as a membrane by which they can exchange substances with the blood and remove excess fluids and waste. The rest of the week was spent shadowing other resident nephrologists who prepared patients for hemodialysis and also inserted various types of catheters (jugular or femoral) on patients for hemodialysis.
One particular observation that stood out to me was that most of the supervising doctors in the Nephrology Department were women. This examination made me very happy. Some people have the wrong idea of women having the right to an education, especially in the African, Eastern and/or Middle Eastern countries. The three attending nephrologists I shadowed are living proof that they are capable of excelling to the highest boundaries of receiving an education and they are also phenomenal at disseminating it! You can clearly see the fruits of Fatima Al-Fihriyah, the Muslim woman who founded the first university in the world in Fes, Morocco.
The resident, Dr. Yassine Allata (behind the masked supervising physician Dr. Ghita El Bardai), and supervising Dr. Kabbali Nadia -to my right- completed the peritoneal catheter insertion procedure for peritoneal dialysis. The patient will be able to use the catheter in 2 to 3 weeks after the surgical wound heals.
Since CHU is a public hospital, all insurances are accepted. There are two types of healthcare insurances in Morocco: Assurance Medicale Obligatoire (AMO) which is mandatory for all citizens with lucrative jobs; this insurance covers all medical expenses. The second type is Regime Dássistance Medicale (RAMED) for those citizens who do not have lucrative jobs and are considered earning less than the average person. RAMED covers hospitalization and medication that are available in the public hospitals. If patients decide to purchase medication, AMO will reimburse them. RAMED does not reimburse patients.
The Moroccan population is very diverse, mainly Arab and Berber (which can be further divided into groups). Hence, their health may vary population to population. It is interesting to conduct research about the different groups and I had the chance to meet a PhD candidate who is doing research at CHU on therapeutic drug monitoring in the Moroccan population. I also learned about the Moroccan method or system of medical training. Surprisingly, medical students are on strike here. I did some digging online to find out why. I learned it has been over 6 months that medical students are on strike because of the poor training conditions (due to lack of medical equipment) and the privatization of medical education. Another issue students in public institutions face is that those students who attend private medical schools are taking residency slots in public hospitals that otherwise would have been for the public medical school graduates/incoming residents. As an aspiring medical student, this is heartbreaking to hear and I hope that the Ministry of Education will resolve these issues and meet the appropriate needs of the students. After learning about the Moroccan healthcare system, it made me reflect on our challenges with insurance companies back home in America. Some other issues we need to focus on in America and try to find some sort of solution are pharmaceutical lobbyists, shortage of staff, long hours/shifts, and medical education/training that takes a huge mental toll on student doctors and resident physicians. These challenges made me reaffirm my belief that no place or system is perfect. However, we can always strive to improve and be better!
College of Medicine and Pharmacy in Fes, Morocco. This institution sits adjacent to CHU and has not had any active lectures since the strikes began.
A hospital is where my second home is – first home will always be back in New York City with my family. It made me sad that there were no students to be seen on the floors doing their rotations or any getting type of medical training in the hospital. It felt a bit empty, as they are the closest to me in terms of my current academic standing. They are in the next phase of their lives to soon become healers. I truly wish the best to medical students here and around the globe. There certainly is lots to fix in medical education and training not only in Morocco, but globally, and back in the U.S.
To end on a positive note, this Saturday we are visiting Ifrane (Southeast of Fes) and Sunday Rabat (Southwest of Fes) – stay tuned for the discoveries we make.
Will write soon – Mohammed