How I came to be walking down the streets of Meknes with a woman holding a plastic jar with pieces of my stomach in it

This blog entry contains some personal medical information. Although I am providing this information for the purpose of illustrating what I think are interesting cultural differences, if this sort of thing makes you uncomfortable, you can skip reading it. Rest assured that, despite the provocative title, nothing dangerous happened to me today, and my health is relatively stable.



I have hinted in previous posts that my health has not been at its best since coming to Morocco. I haven't written much about it because…well…I didn't think it was really that interesting.

But in some ways, I guess it is, and maybe writing about it is relevant to the purpose of this blog. Definitions of and attitudes toward health and sickness are culturally bound. (An example with which many Americans might be familiar is the changing stance of the American Psychological Association on homosexuality.) The procedures used for identifying and treating illness – from how one makes a doctor's appointment to options for laboratory work – also change from culture to culture. The theoretical frameworks from which doctors approach diagnosis and treatment may be different, and the social roles of doctors and "patients" are also culturally defined.

I am someone who has always found medical systems difficult to understand and navigate, even with parents who are nurses, even in my own culture, even communicating with people who speak the same native language I do. As I wrote about previously, all of those things that cause difficulty for me in the U.S. cause more difficulty here.


In the U.S., we really are used to "one-stop shopping" when it comes to medical care. Most of the medical professionals we need to see are going to be centralized in one building. And if we need laboratory work – such as a blood test – the blood will be drawn in that facility.

Not so in Morocco. One of the things that I absolutely cannot understand as a foreigner is the fact that sick people have to travel all over the place to try to get medical help. My journey began a couple of weeks ago when I went to a clinic in Meknes to talk to a doctor. He referred me to a specialist. You usually aren't going to find the specialists in the clinics or hospitals. They tend to have their own offices, marked only by small plaques outside the buildings, in different parts of town.

I went to see the specialist yesterday. He wanted to do an endoscopy, but of course he hadn't told me that before I came, so I'd already eaten a little breakfast. This sort of thing, too, seems more typical of medical experiences in Morocco than in the U.S. Back home, one generally gets bombarded with preparatory material before any procedure. Here, one is told, "Come around 9 AM." Part of the medical experience here, then (at least for T and me), is the expectation that we will always have to go back the next day to do whatever we weren't able to do the first day.

So T and I returned to Meknes today for the endoscopy. Luckily, this was not a procedure I have ever been subjected to or observed in the U.S., but I suspect some differences (perhaps any medical professionals out there can confirm this). Maybe I'm wrong, but I'm thinking these procedures are usually done in hospitals in the U.S. I also suspect – or hope – that a variety of tube sizes are available to fit a variety of body sizes. This doctor just had me swallow some lidocaine and then stuffed what felt like a garden hose down my esophagus and into my stomach. I'm a little person, I thought. Don't you have an extra small tube?

UPDATE to the previous paragraph: I just had an upsetting conversation on Skype with my mother. It went something like this:

Mom: "How did the endoscopy go?"
Me: [Some random details about the procedure.]
Mom: "I'm surprised you remember so much about it."
Me (confused): "What you mean? Why wouldn't I remember it?"
Mom: "Usually people don't remember the procedure very well because of the sedation…"
Me: "#$&%!"

ANOTHER UPDATE: Yes, there are different-sized endoscopy tubes in the U.S. Double #$&%.

One thing that's easier here is making the payments. When we finished with the appointment, the receptionist asked us for 600 dirham (that's about $75). In the U.S., I might be waiting for weeks or months to get the bill after my insurance company has processed it. And I guarantee you it would be for more than $75.

Actually, in the U.S., I might have been able to get away with not doing the procedure at all. Because one thing the doctor was checking for was h. pylori, which is tested for in the U.S. with a simple blood test. Here, though, one gets the pleasure of a biopsy to check for said bacteria.

And one has to walk one's own biopsied flesh to the laboratory. As far as I can tell, no clinic or doctor's office has a laboratory in it. They are completely separate entities. So any time a doctor wants you to pee in a cup or get some blood drawn or get a piece of your stomach analyzed, you have to go to a laboratory to provide the specimen.

And that's how I came to be walking down the streets of Meknes with a woman holding a plastic jar with pieces of my stomach in it. The doctor didn't want to explain to T and me where the laboratory was (it ended up being a few blocks away), but we needed a receipt to submit to our insurance, so the only way to get that was to go with her as she delivered the specimen to the lab.

But our travels aren't over. Because in Morocco, if you want to know what the lab results are and you're expecting to get them in the mail, you'll be waiting forever. You have to go back to the laboratory and pick up your results. No one at the laboratory is going to interpret or explain them to you, so you then have to take them back to the doctor for discussion.

This doesn't sound like a big deal, but imagine going through all of this if you're very weak and ill, or if you're waiting to find out if you have cancer, or if you don't have your own car and have to take public transportation back and forth so many times (T and I have been lucky this week in being able to borrow cars from friends).

I suppose putting the burden of transportation on the patient helps to save money. I also recognize that, as a foreigner, I don't understand the system and sometimes do things in a maximally inefficient way. In any case, I am finding navigating the medical system to be rather exhausting at a time when I don't have a lot of energy reserves in the first place.

But I have also learned that I am tougher than I thought, having survived an endoscopy with no sedation. Go, me.