ST. CATHERINE: Away from the tourist-heavy Jabal Moussa and the famed monastery, the mostly Bedouin town of St. Catherine, with an estimated population of 4,000-6,000, is facing a crisis in healthcare. According to residents, Israelis arrived in St. Catherine in 1967 as part of their takeover of Sinai, and built the first school and hospital there. In 1982, Egypt reclaimed the Sinai and took charge of the formerly Israeli-run hospital, later building a new one, the present-day St. Catherine Hospital. Egypt's late arrival to the area is thought to contribute to Bedouins self-identification as 'Arab' rather than Egyptian. It is not hard to get someone to tell you a horror story or two about St. Catherine's Hospital. Bedouins I spoke with, most of whom wished to remain anonymous lest the hospital discriminate against them (names have been changed accordingly), told me that most doctors in St. Catherine are young and inexperienced, and are usually there to serve their mandatory governmental duty. They claim that these amateur practicioners often make grave mistakes. Om Youssef told me about how her sister's blood pressure was misread. She had gone to the hospital because she felt extremely fatigued. A nurse measured her blood pressure and told her it was very high, and was about to give her an injection to bring it down. "When the doctor came he told her that her blood pressure was in fact very low. Had she taken that shot, it could have been fatal. The Bedouins are not just accusing the doctors at the hospital of inexperience. It's also common for doctors to insist that patients supply their own syringes and gloves, and in at least one case, an IV. Ameera, another young Bedouin woman, told me: "I went to the hospital because I felt fatigued. The doctor told me I needed an IV, but the nurse didn't agree. He told me I could get the IV from anywhere else, and yelled at me. Other people told me stories of going to the hospital with a fever, only to be told that it wasn't important because the hospital had no thermometer with which to measure their temperature. That is, of course, when the doctors are there, which several people report is not always the case. "My grandmother couldn't find a doctor. He was having sheesha at the ahwa, and the nurse said 'he's coming now,' reported one disgruntled resident. It's common to go at night and find no doctors: There is "one doctor working day and night. If you go at night he's sleeping. People also complain that the hospital does not have enough specializations, forcing people to travel a few hours away to El Tor or Sharm El-Sheikh for treatment. There were many stories surrounding pregnancy and delivery. One grievance is the lack of female obstetrician-gynecologists, a big problem since most Bedouin women appear in public with their faces covered. "Arabs are embarrassed in front of men, Om Mohamed told me. But it doesn't just end with embarrassment. Sameera recounted the story of her cousin's delivery. "When she came to deliver, the baby was coming out feet-first, and the doctor kept pulling and pulling. We said, 'we're going to take her to El Tor, at our own expense,' but he kept repeating that she would give birth any minute, and kept pulling, from 3 am to 6 am. The sun came out. When the hospital director came and saw what was going on, he kept yelling in English at the doctor. We didn't understand what he was saying, but they sent her to El Tor. My cousin traveled all the way to El Tor with the baby's head inside and the legs out. They said there's water in the embryo. The baby was stuck in between the two stages, [her uterus and outside]. "The baby was stillborn. After that she conceived one, two, three times, but they were all miscarriages. They said it was caused by looseness in the womb. It's carelessness by the doctors. The doctor was just trying things out [not working from experience]. We tried to complain to the general director so anyone would do something. But they said the problem isn't from the doctors, that they did everything they could. Everyone covers up for everyone else. The doctor is still working. Reflecting on the incident, Sameera pointed out that her cousin should have had a caesarean. When I visited the hospital, I did indeed find it to be big and clean, but oddly devoid of people inside. I found Dr Magdy Elias, who is highly regarded by many at St. Catherine's. A Cairene, he is one of the few doctors that have stayed for a long time. Elias had plans to transfer out of St. Catherine years ago, but they haven't worked out, and despite the passage of time, he still feels as though he is in transit. According to him, doctors don't stay in St. Catherine because their government salaries are paltry. Moreover, St. Catherine's small population means there is no opportunity to start a private clinic to increase income. At the same time, the small population also means that a doctor won't gain much experience, especially in his specialization. The majority of doctors who come to St. Catherine's have traditional specializations such as gastroenterology, pediatrics and obstetrics/gynecology. Reportedly 75 percent of the work done at the hospital is preventative including vaccinations, care for mothers, deliveries and family planning. The hospital itself, along with the conventional modern medicine it dispenses, is a fairly new phenomenon for the Bedouins of St. Catherine, who have relied on traditional treatments such as herbs and kay - cautery, a treatment in which a heated object is used to destroy infected tissue. According to Dr Iman El Bastawisi, a social anthropologist with 20 years of experience with the St. Catherine Bedouin, healthcare is just one of many aspects of life that are changing for the Bedouin. While some Bedouin still use traditional treatments, others are turning to the hospital for healthcare or use a combination of both. One resident told me he would rather have his arm cut off than have a shot. He explained that others felt better after taking pills because of a placebo effect - perceived improvement due to expectation of improvement. Nobody I spoke with explicitly said that they had stopped using traditional health methods out of a conviction that they didn't work. Om Mohamed told me that herbs and kay work, but that medicine is faster. "I've been treated with kay. It works but it leaves marks. She uses a lot of herbs along with her prescriptions. I spoke with an old Bedouin woman, Om Hassan, to find out more about traditional Bedouin healthcare and why it was being abandoned. She told me she delivered her nine children "alone on the mountains with her goats, without doctors or a hospital. Back then, women worked until the day they gave birth, unlike now, when they're advised to stop working from the very first month of pregnancy. For herself, she said that "herbs are better. "I had kidney stones ten times. The doctor gave me shots, but they were only painkillers. The herbs expelled the stones, she said. Another woman said that pregnant women no longer went to the midwife or daya, though she didn't know why this was so. "Things changed and you don't know what happened. El Bastawisi explained that people were turning away from traditional healing because it takes more time and they lacked the "patience to wait. Furthermore, the young generation has "lost confidence and belief in traditional healing. Modern healthcare, on the other hand, is very effective. Clearly the demand for the hospital is there, but how can it be improved? Bedouins becoming doctors and working at the hospital seems like a good solution, but as El Bastawisi pointed out, "It's natural that since [the Bedouin] go to schools, they could go on to university and study medicine. But where will they work? "They won't necessarily come back and stay in St. Catherine. She added that many people from Egyptian rural areas who became doctors chose to live in Cairo to build their careers. Bedouin or not, a possible solution to the hospital's problems is for the government to provide sufficient incentives for skilled doctors to come and stay at St. Catherine's. According to El Bastawisi, "The fault is not in the transition. The health units are equipped, but there's no motivation [for doctors]. [They] need more money. Accommodation is not provided. It's a government issue which exists in other places, like Egypt s rural areas - it's not unique to the Bedouin.
