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EDUCATION, YOUTH, SPORT AND CULTURE
Stories from the field

A trip to the emergency room in Tunis

Sofia MARRI in Tunisia
Organisation
Médicos del Mundo ES
About the Project
I worked in Communication mainly for two projects, both aiming to improve access to healthcare and/or facilities through civil and local participation to develop advocacy strategies and new policies. The first project was developed to improve access to healthcare for the migrant population in Tunis, as the information and services are scattered and it is difficult to navigate them and get proper care as a consequence. The second project was focused on front-line health services to strengthen professional's skills and create a social civic network to promote dialogue with elected representatives on the matter. Both projects, as well as other projects by Medecins du Monde Belgique in Tunisia, became pivotal during the COVID crisis, providing first-hand help as well as giving other local associations the means to provide logical assistance to their communities.

I was ready to leave for a weekend camping in the north of Tunisia, particularly in and near Tabarka and Ain Draham, profiting from a breath-taking view of the Mediterranean sea, the Kroumirie mountains near the Algerian border, and luminous peaceful lakes and forests, inhabited by turtles, frogs, fish, foxes, horses and the duo of cow and “cleaning bird that I was used to seeing only in documentaries. Unfortunately, my adventure had to be put on standby because of an emergency. I should clarify at this point; it wasn’t me who had to go to the hospital.

I had rented a car, already scared to drive in the insane Tunis traffic, when my companion of adventure, Ayoub, told me his shoulder was greatly hurting. I was adamant to get him to see a doctor, he was reticent. Luckily, me being a EUAV at Médecins du Monde (Doctors of the World), and him a volunteer in one of its projects, Médibus, we both knew doctors we could quickly call for advice: they told us to run to the emergency room as he could have a broken muscle.

I had no experience with the public healthcare structures available in Tunis; as a EUAV I have generous insurance, thus I only went to private facilities in the city, which I would describe as 70s Italian clinics with great personnel. My Tunisian colleagues had told me to avoid public services, as the queue would be long and might not be too professional. Ayoub, as well, kept saying he did not want to go to the hospital… in a few hours, I would understand why.

As it is COVID time, you were required to wear a mask, however many patients, as well as nurses and doctors, did not. There was no gel available around, nor did they make us sanitize our hands before entering the hospital (we were equipped nonetheless).

As we get in, I see a square old room with four to five rows of light blue chairs on each side of the room. Some are missing; some are occupied by other patients, either in good shape or endlessly waiting in pain – as anyone can relate, I certainly can, given I broke my big toe playing volleyball and had to rush to the ER.

The reception was accepting patients:

“Is there a queue?”, I asked the suffering and nervous Ayoub, as people would just assemble in front of the desk.

“No. It’s like this here”, replied with nervous laughter.

He tells me they asked for his ID as they did not think he was Tunisian – here I remembered what the coordinator of the migration projects at the office said: to have access to the healthcare you need to be a citizen and to prove that, you need an ID, which many people in situation of irregularity cannot get”.

While I could easily go to a private facility with my fancy European insurance for a normal check-up, others do not have access to healthcare because of a piece of paper.

I pay 10TND for him, as he could not afford it being a student, and he was admitted for an exam with the orthopaedist. As a reference, 10TND is around 3euros; when I did a private check-up, I paid 70TND (around 23euros).

We walk through the halls: blue and white doors, sets of doors closed by a piece of cloth to delimit the bed aisle. People getting angry at doctors for waiting. I see a woman crying, staring into a room; she was staring at her beloved who was having an open-door surgery.

Finally, we get to the orthopaedist, there are two people waiting in line, a man and an old lady screaming and crying. My friend, who’s a great communicator, tries to comfort her, she believes she is going to die. She cries, stops, a new person arrives, and cries again. I do not understand what or who is she waiting for, as my friend has already given his paperwork to the doctor, who briefly after calls him in, while she had been waiting longer than us.

A lone man passes by, he has troubles walking and I notice his empty gaze, his mouth drooling.

Water rises from the bathrooms. Patients are holding their bare x-ray sheets, “strange”, I think, as I was told that if not protected it would get ruined.

Amina, who’s also a pharmacist in a close-by hospital, arrives to support our friend. Ayoub exits the room, he needs an x-ray exam to check the damage. At this point, he really is in pain. The nurse comes to ask him to pay for the exam, 20TND this time (for a total of 10euros so far). In just a minute, Ayoub comes out of the x-ray room, which is unequipped of any warning signs, as I’m used to seeing home:

“Apparently, I’m too tall for the machine”, he laughs.

Amina laughs too, I am baffled. Quickly we skull Ayoub as he has both his necklaces and phone on him in the room! However, we are interrupted by what almost turns into a fight between the crying old lady from before and a doctor. Finally, he gets his results.

We go back to the orthopaedist and wait. A woman with what seems to be a broken ankle exits the doctor’s office, on a hospital bed without any sort of covers or lining for hygiene. A man stands halfway through the door, impatient for his turn; it is only at this point that I see that all this time another patient had been inside, in his undershirt, probably just waiting to be alone for his visit. Ayoub has a torn muscle, thus needs to medicate with cream, some painkillers, and absolute rest for a few days.

We prepare to leave; the wondering man walks over, commencing his endless tour once more.

I'm not sure what I expected but I was really surprised. I was used to seeing Tunis, a very modern, European-like city. Obviously, I knew about the infinite disparities amongst the population in Tunis and between Tunis and other parts of the country.  When they told me, my insurance would cover practically anything, even pregnancy to give an example, I felt so fancy; I do not normally go to private facilities in Italy, however here I did not flinch when I needed to, because I knew for one, it was cheaper than Italy, and two I would get reimbursed. A 25 euros visit when necessary does not bother me too much, however, 60 euros one (which I imagine is the equivalent of a 70TND exam for an average Tunisian salary) does make me think about it twice. Health is fundamental, “when there is health, there is everything” my grandma always said; however, we have to face the reality of the economic toll that healthcare has on the vast majority of the population worldwide. This means healthcare is not universal and most importantly is not accessible. I can get a laser to fix my sight, while many go blind because of cataracts. This is why the work of Médecins du Monde, as well as of many other organizations is vital. Access to health should not be a luxury; it must be a universal right and most importantly a reality. I am not referring to plastic surgery or teeth-whitening, but to life-saving or even basic procedures and medication, such as allergy or epilepsy drugs. We have developed robotic arms, but a man down the street from my apartment is living on an old motorcycle because he cannot move.

This three-hour experience has given the work at Médecins du Monde new meaning; it has given me the touch of reality I immensely needed to break the bubble I was in. As a communication assistant, it is vital to be aware of your surrounding and I was ignorant.

Part of me is still in Tunisia
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