Ramadan And Over-Crowding Hospitals In Saudi-Arabia

The Holy month of Ramadan changes the daily rhythm drastically in Saudi hospitals. Basically the hospital, just like the rest of the Kingdom of Saudi Arabia, becomes alive at night and quiets down for the day during the Muslim fasting month. Read more here on how the Saudis usually visit the sick at hospitals. 

Needless to say the amount of visitors during Ramadan will at least double, especially during the last ten days. Visitors will come late and stay until early morning which is allowed because of the changed visiting hours. Visitors will bring along vast amounts of arabic foods to break the fast with like sambosa, all kinds of tiny pastries, cookies, dates, chocolates..

Large Saudi families come to the hospital to join in Iftar together with the sick family member.  It's not uncommon to find the entire family eating with their hands, on the bedsheets spread out on the floors! Saudis will generously give the nurses a taste of everything, sometimes offering huge trays full of different sweets or salty snacks.

Another peculiar thing that happens during Ramadan is handing out money to nurses. Patient or relatives might slip Riyals into the nurses pocket or openly offer money anywhere from 10 to 1000 riyals at a time. The gesture usually makes nurses feel somewhat awkward and because of cultural differences might be misinterpreted to be some form of bribing. Nurses are naturally not supposed to accept the money very few will reject it every time especially because the person offering the money will become very upset if rejected and they can be extremely pushy and just stuff the pockets with the money. The reason behind this is Saudis wanting to give 'charity' and do good deeds during Ramadan and the families wanting to show their gratitude and appreciation to the nurse.

Only a few patients will be observing the Ramadan fast, and if they do, they will also abstain from all medications including injections and intravenous drugs during daylight hours. That makes it a bit difficult to accommodate the medication regime to the fasting timetables. Basically it means that the medications normally given around 8-9 am will be given at fast breaking time around 6:30 -7 pm. The next dose will be at midnight and finally just before the morning prayer at 4 am. This can cause problems with the efficiency of treatments with antibiotics and pain killers.

For some patients it's fine to fast (health-wise) and it will not make their condition worse. Every once in a while there will be a patient who insists on fasting even if doing so will severely adversely affect their health. The patients don't want to miss out on the blessings of fasting. Some are diabetic which means their blood sugar levels will be uncontrolled and it might put the patient in risk of coma, or they will refuse insulin injections resulting in sky-high blood sugar levels. Patients with bowel problems might get complications like obstructed bowel, liver patients may suffer irreversible consequences that may even need surgery and then there is the odd patient who will even refuse to be operated on.

Toward the end of Ramadan the emergency room usually begins to fill with patients suffering from bowel obstructions, liver coma, severe dehydration and so on. Many are elderly patients needing full time hospital care meaning that the hospital will be full to its maximum capacity and often patients are left to wait for an available bed in the EMS. Patients suffering from gastrointestinal diseases and disorders, diabetes, metabolic disorders and other diet controlled conditions further crowd the ER beds making it the busiest time of the year in the hospital. Nurses and doctors are often exhausted from the workload this month brings along.

The Muslim medical personnel will often opt to work night shifts to make fasting easier or alternatively if they wish to work days they can work shorter hours. The total amount of working hours during this month for Muslim nurses, doctors and other muslim personnel is also cut down. Generally there will not be any operations other than the most urgent ones.

The patients' sitters will all usually be fasting and the hospital kitchen provides food for them as well as the fasting patients in the early morning hours. A three course 'breakfast meal' called sohoor will be distributed at 2 am well before the Fajr prayer.

The iftar meal, complete with dates, laban (buttermilk), soup, vegetables, rice and meat, dessert and juice will be distributed to the rooms at 6 pm. Even if a patient is not fasting, they will usually be up all night chatting with relatives, reading Quran or watching Arabic soap operas or the live televised show from the grand mosque in Mecca. This makes the night shifts exceptionally busy and hectic while the day shifts are slow paced and quiet.

I personally enjoy working during Ramadan, patients and relatives are in good spirits and it's nice to spend some extra time with them in the rooms having some arabic coffee and sweets. Generally the atmosphere is more laid-back and patients are not complaining as much as usual :)

P.S this post is a revised edition of a previous Blue Abaya article about Ramadan in Saudi hospitals from 2010.

Camels-Miracles Of The Desert

Camels, the animals designed specifically to survive in the harshest of environments-the desert.Every single detail of the camel has been carefully designed and constructed to perfection.
It is one of the few animals specifically mentioned in the Quran:

"Have they not looked at the camel - how it was created?" (Surat al-Ghashiyah: 17)

A patient of mine recently gave me some freshly milked camel milk to taste and mentioned all the health benefits that it has.  It was so good that it inspired me to find out a little bit more about this amazing creature! 

Camel Anatomy

Numerous anatomical and physical adaptations have allowed the camel to survive the incredibly harsh environment of the desert. Heat storage within the body of the camel, selective brain cooling, fur, concentrated urine from unique kidneys, adaptions in the respiratory system, special physical features, unique blood consistency and hormones all serve as important characteristics for the camel in terms of thermo-regulation.

The camel actually increases its own body temperature during the scorching heat of the day. That way it minimizes water loss from evaporation. In the night it cools its body temperature down 7 degrees Celscius, saving almost 5 liters of water this way.
To protect the brain from overheating, the camel has an 'airconditioning" system installed.

The extreme survivor
The camel can survive up to eight days in 50-degree temperatures without eating or drinking-circumstances that would kill a human in 36 hours. It usually drinks 4 times in the summer and only one in the winter! Most of the time the camel is in a state of dehydration, but when it gets hydrated its physiological system quickly adapts to the massive change in body volume.

When the camel does find a source of water it stores it up. Camels can drink up to a third of their body weight of water in ten minutes meaning up to 130 litres in one go.

What's in the hump?
Contrary to common beliefs, the camel doesn't actually store water in the humps, but they consist of about 40 kg of fat!  Concentrating body fat in their humps minimizes heat evaporation and creates and insulation throughout the rest of their body. When this tissue is metabolized, it acts as a source of energy and yields more than 1 g of water for each 1 g of fat converted through reaction with oxygen from air. This process of fat metabolization generates a net loss of water through respiration for the oxygen required to convert the fat.

Special features
The camel's red blood cells have an oval shape, unlike those of other mammals which are circular. This is to facilitate their flow in a dehydrated state. These cells are also more stable in order to withstand high osmotic variation without rupturing when drinking large amounts of water. WOW!

The kidneys of the camel of course play an important role in water conservation.They have a special shape being able to produce very concentrated urine and thus increasing water retention. The concentration of the camels urine is higher than seawater, it resembles syrup in consistency. This also enables the camels to drink salty water without problems. Also the levels of hormones responsible for water levels significantly increase in the dehydrated camel.

Most of the food sources in the desert are dry and thorny so the camel’s digestive system has been created according to these harsh conditions. The animal’s teeth and lips are constructed to enable it to eat even sharp thorns with ease. Its stomach, which has a special design of its own, is strong enough to digest almost all plants found in the desert.


How camels survive in sandstorms
The eyelids of the camel protect the animal’s eyes from dust and grains of sand. However, they are also transparent and that enables it to see even with its eyes closed which would come in handy in the midst of a sandstorm. Its long, thick eyelashes are created to prevent dust from getting into the eyes.

There is also a special design in the camel’s nose. When sandstorms blow, it closes its nostrils with special lids. The nostrils are also designed to reduce loss of water through respiration with a unique cooling system and nasal passages that are able to absorb water that passes through them.

The camel’s feet are specially created for the desert so that it doesnt get stuck in the sand even if  its carrying hundreds of kilos loads on its back. The animal’s wide toes stop it from sinking in the sand and function just like snowshoes. Its long legs keep its body away from the burning heat of the desert floor.

Protection and perfection

The camel's body is covered in thick, hard fur. This protects the animal both from the burning rays of the sun by reflecting the heat and from the desert chill in the night which can go below zero.

Some parts of its body are covered in thick protective layers of skin that comes into contact with the ground when it sits on the scorching sand. This prevents the camel’s skin from burning.

These thick layers of skin are not calluses that develop over time; the camel is born with them. The equivalent to a human baby being born with thickened skin on the soles of its feet! This special design brings out the perfection of creation in the camel.
The thickened skin cannot be explained by the logic of the theory of evolution That and all its other extraordinary features reveal one evident truth: That the camel was specifically created by God to help man survive in the desert.

Camel in arabic actually comes from the word beauty. Arabs have known the curing affects of camel milk and urine (yes URINE) since the times of Prophet Muhammed who advised people to use it to treat certain illnesses like liver diseases and rashes. Recently scientists have proven this to be a fact. Camel milk on the other hand is especially beneficial for type1 diabetics, helps the digestive system, is cholesterol free, rich in vitami C and it even tastes good!

Read more on the health benefits of camel milk and urine here:http://blueabaya.blogspot.com/2010/06/camels-milk-urine-potential-cure-for.html