CAIRO: When Marwa Yehia's four and a half year-old daughter was still an infant, she was coughing up blood. But it was only five months, three pediatricians, three surgeons and one gastroscopy later that little Noora was properly diagnosed with a congenital defect in her stomach. Though doctors knew she had a stomach ulcer, they could not determine why. One doctor told Yehia that the ulcer developed as a result of her daughter's cough medication. "He misdiagnosed her, said Yehia, having returned to her original pediatrician, who suggested she do the gastroscopy. "I learned that I should trust my doctor, because the doctor who's been with [a child] from the beginning knows best. Yehia is only one among many parents who struggle to find the right pediatrician for their children. While competing diagnoses and ineffective prescriptions often push parents to hop around from one pediatrician to the other, doctors continue to complain that parents are not following their advice. "Some parents consider themselves scientists. They take each others' opinions and start drawing their own conclusions, said Hussein Helmy, a pediatrician with 35 years of experience. "Once a man came yelling at me because his daughter didn't respond to the medication the same way his friend's daughter did. The young girl suffered from a curvature in her legs, which can either be hereditary or caused by Calcium deficiency. The father didn't understand that his daughter's curvature was probably of the hereditary type, Helmy said. However, this problem deepens with cases of misdiagnosis and increasing competition among doctors. Sometimes, Helmy said, doctors will mold a child's symptoms to fit a predetermined ailment or disease, while other doctors never cease to bash the expertise of their colleagues. "If only they followed the philosophy of; 'there are 80 million people, leave only one million to me', he said jokingly, adding there was no reason for doctors to get competitive. Outside Helmy's office, the waiting room is saturated with anxious parents. Infants lie cuddled in their mothers' arms, tightly wrapped in warm blankets, while older children sit in small, bright blue, green and pink plastic chairs. Two girls in pigtails play a game of exchanging chairs, while others watch intently the movements of two small canaries sitting in a cage. Every once in a while, one of the parents gets up to ask the assistant, "How long is it before it's our turn? Helmy said 90 percent of his patients are there because of "mothers' anxiety, and not any serious ailments. However, failure to follow even the simplest of instructions can often lead to the most dangerous of consequences. According to Helmy, at least three of his patients have died because their mothers decided to give them regular, unpackaged milk instead of the powdered baby milk he prescribed. This milk is contaminated on the farm as well as during the exchange of hands by the milkman, and often contains a host of microbes. "But some women just follow the advice of their mothers and give them regular milk. By the time the children get to me, it's too late for me to help them with medication, Helmy said. Reham Meky, a young mother of two, said mothers and mothers-in-law often play a significant role in their grandchildren's health, especially when it comes to suggesting what they should eat. Meky, however, does not depend on advice from others and arms herself by reading a number of books about child-rearing and health. "Our generation is different. A lot of food we ate when we were children actually shouldn't be eaten before the age of two, Meky said. "Our parents aren't acquainted with the new techniques and trends. Sometimes, Meky will not even follow a doctor's advice if it contradicts her research. "It's worked well for me, especially with the food issue, she said. But she is also wary of giving over-the-counter medication. A friend of hers once bought cough medicine for his child while assuming that the medication was the same for dry and wet coughs. "[The child] was blue and he couldn't breathe, Meky said. "The story stuck with me. For Meky, the key to developing a trusting relationship with a pediatrician is to be psychologically at ease with him or her. "Never go to a pediatrician you're not psychologically comfortable with, because even if he's right, you will doubt him and doubt his medication, and that will affect the health of your child. Nevertheless, Meky does not feel that there is a general trust problem between pediatricians and parents, but that "people take anything that has to do with their children seriously. In general, parents want a doctor who will treat their children well, keep an organized account of their history and take the time to describe the child's condition and answer any questions they may have. According to Meky, it is disconcerting when "you enter and you're out in two seconds, or when doctors "treat your children like they're robots or machines. Parents are also uncomfortable with doctors who prescribe excessive medication, particularly antibiotics. "It's become a fashion, Meky said. Helmy said most parents bring their children to his clinic because he has developed a reputation for only prescribing antibiotics when absolutely necessary. "In 99 percent of the cases, children don't need antibiotics, he said. Though most parents have found at least one pediatrician they're comfortable with, they are forced to experiment with others when he or she is unavailable. Miriam Shafik has visited several doctors who have treated her rudely and undressed her two-year old son violently. Once, when she challenged a doctor on his antibiotic prescription, he simply replied, "You're not going to know more than the doctors. According to Yehia, parents can fight this perception by educating themselves and putting on a good impression for the doctor. If doctors see that a mother is well-educated and the baby is clean and well-kept, he will trust and respect her. "We now have the internet and a lot of resources to do research. As an educated person, I must do that so I can understand the doctor and debate with him, she said. Mothers know their babies best and they need to be able to communicate their observations to the pediatrician, she said. Helmy agrees that there is no substitute for a mother's instinct. He sometimes prescribes three different medications and asks the mother to report to him on what works best for her child. "I always listen to the mother, because she knows [her baby] more than me and she is more observant than I am, he said.
