Libya and medical ethics

Working in a public hospital in Libya opened my eyes on so many things but one of my biggest concerns is The Medical Ethics issue ,I already knew the same as most of the Libyans that our hospitals filled with unethical doctors and health care staff and how in our hospitals the way the patient treated is less than a prisoner anywhere else in this world ,but it was shocking to live this fact and to see all the violation of the patients privacy and the way the doctors treat the patients , I don't know if all this because the medical ethics wasn't introduced as a studying material in Medical school until recently or is it because all the hospital staff doctors and nurses feel like they are above the law and no one will judge them when things go wrong .

It's just so sad to see a doctor with no ethics and to see a patient treated as a subject not as a human being , private hospital or public it doesn't matter because the same mentality working in either places, that what makes almost 90% of the Libyans go to Tunisia for therapy or check up , even most of the hospitals in Tunisia are working only to get as much money as they can from the Libyans but I can't blame the people who go there because I know at least they will get the attention and the psychological support that they will never find here, and it's not only our doctors and health staff who make all these people seek health care outside Libya but also the shortage of everything in our hospitals starting from the plaster to the Imaging machines .

there is a lot more to add but I will leave you with this nice article I read in the Libyan Medical Journal

	Medical ethics in Libya: where to start?
			Elmahdi A. Elkhammas, MD, FACS Department of Surgery, Division of Transplantation, 343 means Hall, 1654 Upham Dr., Columbus, Ohio, 43210, USA

---

When it was decided that I will write the editorial for the second issue of the Libyan Journal of Medicine, I was not sure where to start. There are many topics that are related to global health issues and many are specifically related to the health system in Libya. For this issue, I decided to start some discussion on medical ethics as it relates to the Libyan medical culture. In our culture we tend not to inform the patient about the seriousness of his or her illness especially if the case is terminal. We do tell the family and some times other relatives. We even answer questions about it during social events. This means that the patient’s lack of information is complicated by lack of privacy and confidentiality. We have very little time to sit with the patient and discuss the issues with him. Of course the situation is better in private practice (anecdotal, but no scientific studies). Some consultants tend to make rounds as they wish without respect to their teaching duties or their patients needs. Others have neglected patients after a major surgical procedure and not visited the patient at all until the patient’s death. Is it a wrongful death? The answer is beyond the scope of this editorial. It is not unusual to be sarcastic and make fun of the older patient who present with symptom of sexual dysfunction and remind him that he is too old for that and he should be ashamed of himself. The social status of the patient is a key factor for how he or she will be talked too and treated. If you are rich or poor, high ranking official or average human being, young person or old, presented to a Government hospital or to a private clinic, all of the above criteria may make a difference in how the patient is received or treated.

I have to admit that the issue is very complex. Most of the ethical or unethical behavior of physicians of my generation was obtained as part of the cultural and the religious backgrounds. No courses on medical humanity and ethics were taught as part of medical school curriculum. One might argue that common sense and the basic principles of our religion should be adequate to lead us to the ethical behavior. That might be true to some extent, but when you see your teacher’s behavior over seven years in medical school, and during the time you spend with him or her (attachment, internship, house officer) you will certainly be influenced. Therefore, it becomes our responsibility to read about medical ethics and to develop the correct courses with the help of professionals in the field.

It is our obligation to be the role models for the new generation of physicians and medical professionals. It is our obligation to show our students and residents that the patient is not a number. The patient is a human being who is suffering from illness, and came to you as an expert in the field to solve his problem. If we learn to show them that, then we will also show them that we need to talk to the patient with respect, honesty and full truth. We need to listen to them and give them a chance to explain all their symptoms. We show the students how we take patients’ complaints seriously. It does not matter if the case is in a general hospital or a private clinic. We need to go back to a very basic principle which tells us that if you lack knowledge you cannot teach it. So if you lack the ethical behavior, then you cannot teach medical ethics. I am stressing our role as seniors to start with ourselves and improve our ethical behavior. We also need to make sure that we have a strong course of medical humanity and medical ethics being taught at our medical schools.

It makes sense to me if all medical schools in the country have one committee to develop such curriculum to be taught cross the country. There is a need for a code of ethics at all levels. We need Code of ethics for the secretary of health, faculties of medicine and all hospitals. We need to train and form ethics committees in all hospitals and teaching institutions.

As Libyan Journal of Medicine being the official publication of Ibnosina Medical Association, it makes sense that we follow Ibnosina (Avicenna) footsteps. He was the ideal physicians and philosopher who followed ethical principles with his profession. For that reason UNESCO established an Ibnosina prize for ethics in science during its 166^th session (2002). The first prize was awarded to Professor Margaret A. Somerville, Professor of Law and medicine at McGill University, Montreal (Canada). I believe it is about time to make medical ethics part of our life in Libyan medical education and profession. Maybe one day we can nominate one of our professors to this prize. At this point I think it would be a challenging task to choose one.

Dermatology

I've been hanging out at the Dermatology Clinic lately, not that I like dermatology that much but what to do, I have to learn these things. It wasn't much fun there cos dermatology is considered one of the coldest branches of medicine. Dermatologist are believed to be the luckiest doctors because as they say the majority of their patients never heal or die (لا يبرا لا يموت).

I want to share some of the interesting things I have learned, don't worry I wont bore you with all the complicated stuff. These are some things that are nice to know.

The Hair

• The average number of hairs in an adult is 100.000, yea I know not that much, we all think it's millions :S


• The average hair loss per day is 100 hairs , yea too much , but this is still normal so don't you worry girls if you wake up finding couple of hairs on your pillow .
  


• The average growth of hair per day is 0.35 mm , this means almost 13 cm a year, now go stand in front of the mirror and check out where your hair will reach next year.

Now most cases that come to dermatology for hair problems are the Alopecia Areata patients which is what we call in Libya الثعلبة , what is so upsetting with alopecia areata is the psychological effect it has on the patient because other than that it's not dangerous to the patient and not infectious. In short, it's simply the body immune system attacking the hair follicles and making the hair fall , it can affect a local area making it a patchy loss of hair or even worse affecting the whole body hair, I can't tell you how upsetting it would be if you wake up one day finding a 5X5 bald patch on your head , and you go from doctor to doctor with no improvement even when the hair is back it disappears again with no reason, this is the problem with dermatology most of the diseases can't be explained why and how they happen, remember the patient never heals or dies.


The Skin

• The Skin is the biggest organ in the body, yes it's an organ because it has functions to do like every other organ in the body.


• The Skin weighs about 15 % of the total body weight, so if you are helpless and wanna loose some weigh go on and cut your skin off .


• The thickness of skin varies from 0.05 mm in the eyelid to 3 mm in thickest area in palms and soles, but still quite thin don't you think?


• Total body skin covers an area of 2 square meter in adult , this makes a great coat so instead of killing twenty foxes to make one coat, one human is enough I think :P

there are hundreds of skin diseases and in just few hours at the clinic you can see all the kinds of skin diseases , but what attracted my attention the most is the Psoriasis patients ( الصدفية ) , this is again a very psychologically upsetting non curable annoying skin disease, and what makes these patients problem worse here is that the doctors usually don't tell the truth to the patient because this is what most of the patient wants , we all think the doctor is cruel when he tell us this is incurable disease and you have to live with it all your life, I have even seen doctors and families hiding the fact that this patient has a cancer because it will make the patient's condition worse when he knows the truth , so these patients with psoriasis live quite difficult life because no treatment is effective for long time although there are a lot of ways and methods of treatment but I am sure everyone with long time Psoriasis already tried everything , what we need to do is a simple discussion with the patient this can make him accept the fact of his disease , simply telling him that what you have is like having diabetes or hypertension it needs treatment everyday and life long , taking good care of it will make it go well and you can live a normal life , don't wait for it to disappear , stress will make it worse so just take your medication live normal and by time you will see that you are no different than any other healthy person .

because of lack of honesty with the patients what I saw is that everyone wants a magical cream that you put it on the skin to turn it normal in no time , so people basically drop their treatment and so many come frustrated and out of this frustration they come after using traditional mixed herbs and other gross things like for example some people use Camel's urine , first I thought they drink it but they just apply it on the affected skin , so many things they have tried and every time it returns back , I believe that healing is in god's hands whatever you did for it using medications or using camel's urine or some kind of weeds but it's too risky to use traditional medicine because it's something not understood scientifically so better to avoid it because humans aren't experimental animals to try things on them , I've seen a lot of people coming with a very worse rash after using a mix of some old lady (3zooz) that heals people with herbs and strange stuff .

But this doesn't mean that all the traditional ways are wrong because there are explanation for some of them even the people who use it don't know why but it still works , like for example in Alpecia areata some of people rub garlic on the site of the hair loss and hair starts to grow after a while , this is no magic because one of the drugs used to alopecia areata do the same thing as garlic , so what garlic does is irritating the skin of the hairless patch and this cause the immune system to alert the immune cells which are already attacking the hair follicle as I explained in the nature of Alpoecia areata , so teh cells leave the hair follicle alone and go to the top of the skin where the irritant is and then the hair becomes free so the hair can grow again but as you can see once the irritation is gone the hair unfortunately will be lost again .

Alopecia Areata

Psoriasis

note: this post can't be used as a source of medical information but only a personal opinion

Digital Electronic Stethoscope

I came across this funny weired but may be great idea of a new stethoscope , here what they say about it in their web site

Amplify Mode with Adjustable Volume - amplifies up to 50X with continuously-adjustable Volume Control to set the desired augmentation for each patient. Increase Volume for faint heart sounds, obese patients or noisy environments. Use moderate Volume for children with loud heart sounds.
Acoustic Mode - electronically provides the sound of a conventional stethoscope without the losses of air tubing. Provides a painless transition from old stethoscope technology - just click to Acoustic mode, and listen to a crystal-clear version of a conventional stethoscope.
Ambient Noise Rejection, 2nd-Generation (ANR2) - Activate noise rejection in high-noise environments, or deactivate in quiet office settings. Adapts to your work environment so you're not compromising your physical exams.
Mute - When patients chat, cough, or cry, simply mute the sound until you're ready to listen. An example of the attention to detail that makes the ds32a stand out.
Programmable Preferences - Preset the ds32a to your preferred auto shut-off time (2-5 minutes) and favorite operating modes, so it powers up already set for you. Your ds32a learns to follow your workflow so you can focus on the patient.
Audio Input/Output - Connect your stethoscope to your iPod or mp3 or notebook for recording and listen to heart sounds on your stethoscope, for accurate audio reproduction. Interfaces with ease to existing audio equipment. Use free software for data visualization. Cables included.

but hey with all that it still doesn't give you the diagnosis , I wonder when they gonna make one that tells you the diagnosis , and it would be more fun if they make it an MP3 player too .

more crazy medical gadget here

Clinical Exam

Today I did my clinical exam in Medicine which is the last subject I have and I still have an oral exam on Tuesday after that I am exams free at least until the results come out .

I didn't do so well today though I don't know why , was the defect in me, in the patient or was it in the examiners , let me first tell you how the Medicine clinical exams go , we have five exams divided into one long case in which you sit with the patient for one hour history taking and doing complete physical examination ( not enough time for all that at all ) , then you go to two examiners and they discuss and ask you about this case for 20 minutes ( feels like 20 years) , the other four exams are short cases exams where you go with two examiners to the patient and they ask you to preform certain examination like examine the respiratory system in this patient and they give you five minutes for that then they will ask you about your findings , the short case exam is 15 minutes each but it feels like one hour , one of the four short cases is Dermatology case and since we had dermatology two years ago it's so difficult remembering anything now .
I start my exam on the long case at 7:30 , yes in the morning , the first few words with the patients were like this

صباح الخير كيف حالك اليوم
الحمد لله بخير
الاسم الكريم
................
خير لاباس من شنى تشكى
ما فيا شى دخلونى للمستشفى على خاطر الامتحان وانى والله ما عندى خلوق لهدا كله

since the moment she said I don't feel like talking and giving history I knew this exam will be screwed and the end result will be so bad , I tried being nice and kind and get the information I wanted I even begged her sometimes to answer the questions ,she was so mean and I knew she hide so many things from me , the history taking took all my time and I had ten minutes only to do the complete physical examination and surly I didn't finish that , so the bottom line I screwed this exam , I am not mad cos it wasn't my fault that the patient was so uncooperative and I had to deal with it anyway cos if you refuse they will tell you this is part of the exam ,how to deal with uncooperative patient !! , this is how our university deal with us ,again the same thing you hear everywhere here in Libya خود ولا خلى.

Id3oli and wish me luck .

Libya and Psychiatry

The joy of Eid didn't last for long , as I was visiting some relatives and friends on the first day I found one of my relatives is very sick and after sitting with him I found that his illness is psychological , in Libya it's a shame for 90% of the people to have a psychological disorder, for this relative of mine he has been sick for 10 days and no one outside the house know anything and they have been bringing Shiks and doing all these things thinking the problem is related to Jin or Si7ir or something like that , for 10 days he was suffering and no one thought of getting a medical help , I don't want to act like a saver here but alhamdulilah after I saw him and saw the clear signs and symptoms of Mania we took him to hospital and since it was Eid it was so difficult finding help ,but alhamdulilah now he is ok and Dr Ahmed Kara the best Libyan Psychiatrist saw him and gave him the medication which made him sleep after not sleeping for 10 days and made him calm and quite after being hyperactive , talkative and aggressive .
my point is why we think about psychological problem with shame , why it's like a taboo , why people leave their relatives get worse and worse , why no one think of seeking a psychiatrist for simple things ,why people look at any one with psychological problem as a mad or crazy person , they are humans and they feel and know everything and they just need help and when they are treated they can live normal , but hiding them and leaving them is what makes things worse .
And why it's always si7ir or jin that first thing people think about , we have a very low rate of illiteracy but yet we still have thoughts and believes that most people still follow and they should disappear forever , no one can deny the presence of si7ir and Jin but nowadays we should think scientifically first and then see the results .

Medical Mnemonics

Anatomy is my favorite subject in Medicine and these days I started my Surgery course so I got back to studying Anatomy again, it reminded me of the old good days 4 years ago when I was in the first year , Anatomy is what made me love Medicine because as you know I got to Med school without having much love for it ( read it here) , I used to have a lot fun studying Anatomy and memorizing all the contents of the body , we used to use shortcuts and mnemonics for things to remember them ,one of my favorite mnemonics is the one we used to memorise the carpal bones of the hand ( Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate ), the Egyptian doctors were teaching us to memorise them with the Egyptian mnemonic

Sara Lama Til3ab PoKer Tiksab Tikhsar Kolo Hals
سارة لما تلعب بوكر تكسب تخسر كله هلس

but we had pur own Libyan mnemonic

Su3ad Lazim Tal3ib Batish ,Tarba7 Takhsir Kolha Hyaja
سعاد لازم تلعب بطش , تربح تخسر كلها هياجة

so it seems like nto all doctors have good memory but they just tend to make it simple for the brain to memorize things with simple medical mnemonics .

Complaining

studying is taking all my time lately and still I have so much going on my head , it's bothering me so much that sometimes I cant sleep at night , I am in my last year and things got more difficult with the new exams system that came two months ago .

first we have three main subjects , Medicine , Paediatrics and Surgery , and for the last few years exams always start later in December and there is always one month break between each exam , but this year the examination committee came out with a new brilliant idea which is finishing all the exams in one month , can any one tell me how can we study or revise for those exams in one week break for each subject, OK since Surgery is first to come it will have more than one week time , but what about Paediatrics and Medicine , I mean if anyone know anything about Med school then can you imagine one week for revising medicine and for those who don't know then take a look at the book I have to finish and tell me how , until today and for one month and a half I still didn't finish revising half of it , it takes so much time and so much memory to remember everything ,and in the exam they want you to act like you are one of them and you've been working in the hospital for 20 years and you can get and know everything ,, in the past students used to complain of how unfair the exams are , well look at us this year and you will feel so lucky you had more time than we have now , I really don't know what is going to happen and I cant imagine dropping one of the subject so I can study the others , all I know is that I am depending on god and isnahllah whatever I do it will get me through all the difficulties they put for us , I know we aren't in urgent need for new doctors here because the country is full of them but I want to get over with this as soon as possible , in the end pray for me all I get through this .

The Big one is the main text book

boy or girl

Magazines always come out to us with stories of a guy changing to be a girl after many years of living as a guy or the opposite , we all look at it as wow this is something very strange , well it's but usually it's just a medical problem and the whole problem is that a disease like Congenital Adrenal Hyperplasia causes what is called ambiguous genitalia , the baby is born and the sex cant be known with the normal appearance ,but need a chromosomal analysis , this is a problem when a midwife delivers the baby at home and I mean the Arabic midwives ( daya) which is usually decide which sex is the baby by guessing or sometimes she tells the parents andthey choose what they want or may be as in the rumor Ross made in Friends show that Rachel was abnormal when she was born but her parents flipped a coin and choose to raise her as a girl .
Family education is so important so these cases can be treated very early and avoid the complication of being a man or a woman.

finally this is funny but sad story one of our doctors told us

A family with two children having Congenital Adrenal Hyperplasia ( almost 99% related to consanguinity) visited a doctor , the doctor asked the father are you and your wife related , No said the husband , the doctor said No way this is impossible , the man went out pulling his hair and shouting I knew they are not my children I knew it .
well there is always 1 % to be considered .

The Male Key

when somene goes into epileptic seizure (fit) just give him an old key to hold it in his hand and this fit will subside , this is what our grandparents used to do and it really works as once you give the patient the key he will get relaxed and the fit will stop , but this has a meanengful explanation whish is while they are looking for an old key the fit will go in its all stages and once they find it usually the fit will be over so when they give him the key he will be getting back to normal ,so the key has no role in here .
I dont know if somewhere else in the world they use somethign else other than old key which is in libya we call it male key because it lloks like the male sympol .

زمان كان لما واحد تجيه نوبة صرع يقولو هاتوله مفتاح ذكر و حطوه فى ايده تو تمشى منه نوبة الصرع
والحكاية مش خرافة لانه بجديات اول ما يشد المفتاح فى ايده يهدا وتمشى منه نوبة الصرع
لكن فيه تفسير لكل هذا وهو انه ما بين لقوله مفتاح ذكر تكون نوبة الصرع قريب تكمل و اول ما يعطوه المفتاح يهدا , يعنى المفتاح زايد ناقص والحكاية كلها زقاطة

picture from
Dreamstime

Libyan 911

While having a lecture on Cardiopulmonary Resuscitation (CPR) I was thinking how many Libyans know the Emergency numbers , I am sure they know the American 911 as they hear it all the time on TV , but I am not sure if they know the Emergency Numbers here in Libya , I know some people might say it's useless , well it's kind of true because here if the patient was at home and he's dying his relatives will carry him to the hospital in their own car , and if there was an accident one of the crowd people around him will take him to hospital while half of people crowded around him are armed with camera phones to get the first shots of the disaster or just standing their blocking the way so they can witness everything so later on the day they can talk about it, it's like something cool saying I saw this accident today or I took a video of this accident and you can see that we have a very large number of videos spread by the Bluetooth , the rest of the crowd usually afraid to take the man in the smashed car because the police will question them when they arrive to hospital as if they did this to him , but if the man is lucky there will be an ambulance car near the scene and they will carry him to the hospital but even then there is no use of a car running fast with no useful equipment inside .

so is there a response to a Emergency number calls , I don't know because I've never tried it and I don't know anyone who tried it , so in the end every one should know the Basic Life Support steps in the CPR so you can be ready at anytime and to know what to do if you witness someone went into cardiac arrest .

so do you know what is the Libyan 911 ?

Craniofacial

I went to the plastic surgery symposium yesterday and it was so nice finding Dr. Kenneth salyer , it was so nice having him here in Libya , he is one of the best craniofacial surgeons in the world working mostly on the cleft lip and cleft palate , he has done very good work over 36 years on this field , I am so lucky I got to attend his lectures and see his work .

World craniofacial foundation

Plastic Surgery

This week I started Plastic surgery course at cosmetic and Burns surgeries Hospital ,I think it is the best hospital I saw here in Tripoli and apart from having a website there are a lot of things that are so different from other hospitals , like the good system they have in the hospital , and there is a lot of good doctors doing a very good job in their specialties , Plastic surgery it's not only about making a person looking better as most of the people think , it is mostly about giving the person the function and the shape of something he lost or he was born without it , this is what is mostly this hospital doing here , their work mostly on correcting the congenital abnormalities, burns and traumas .
tomorrow there will be plastic surgery symposium in dat el emad and there will be four surgeons coming from abroad , one of them is Prof. Kenneth Salyer who did the separation f the two Egyptian conjoined twins back in 2003 , so inshallah ( hopefully ) I am going tomorrow to attend it tomorrow .

Orthopedic

Today a team of two German and one Brazilian surgeons were at ALkhadra hospital . they gave us two tutorial one on Humearal head fractures and the other on non union of bone fractures , then we had this nice workshop on the instruments used in orthopedic , it was so nice learning from them especially Dr Norbert who was very helpful and patient with all the questions we had.

The beginning

I am thinking of writing about my days as medical student after a motivation from couple of people who visit my blog , I don’t know what I am going to talk about but I am sure some interesting things will come out eventually .

First I want to start with my story with medicine , my story might be different in the beginning because I’ve never thought I would study medicine , and I’ve never wanted to study it , it all came by chance , I am not a nerd or the kind who love studying but when I think how I got till 5ht year straight I have second thought and believe more in myself , I’ve never had a dream of becoming a doctor , so what brought me here I still don’t know , but what I know is that this is the thing for me , I didn’t choose it may be but it choose me , this is what I am made to do .

I finished my high school and I was wondering what is the thing I like , what is the thing I am good at , what I want to be , they were tough months just trying what to study in univesity , here in Libya it’s hard to decide because first there is no much choices and second of all you don’t get any motivation from any where , and of course no one direct you in school towards anything , so it had to be my choice , I wasn’t good at anything , I used to love engineering even I was so bad in math , it was the thing I wanted to study until I finished high school , I think that’s when my brain was mature enough to tell me am not good for that , my parents told me that when I was a kid I used to say I want to be a janitor , I think it’s because I used to stay a lot with the janitor of our building , I used to see him so popular everyone knows him ,every one salutes him and he helps everyone in the building ,I wanted to be like that I wanted to help people and to make them love me the way they do with him , when I got older by the time I realized this isn’t gonna work for me , so engineering was the thing I wanted to study because I though only people who deal with numbers are smart , I wanted to be smart until but then time passed and I finished school without being smart with numbers .

I heard about Medical school and how it’s quite good here , I heard about the 7 long years you have to study and then I took it out of my head , I thought about a couple of other colleges like Business & Social Science , but there was nothing I liked , I guess I was too late to choose , I should have thought about it before ,one day I was laying back and started thinking what are the things I can do , I settled down on medicine because the only thing that made me not like it is the long time it takes to finish and this is the reason that makes most of the European or Americans not study medicine , because there is no benefit from wasting your life on medicine , you could get whatever you want from life in younger age if you study something more simple , something like business administration , there is huge number of foreign doctors working in UK and in USA , because they have shortage in native doctors , it’s funny that most of the doctors world wide are from what is called third world .

So medicine it is that’s what I told myself two days before they closed the registrations at the Medical school , and I was lucky not like my friend who a pigeon pooped on his head the first day he came to the Medical school , I had and still having good times in school , I started loving what I am doing by the days and I started being good at it , I don’t study for the marks but I study for myself ,I enjoyed every year with it’s good and bad , and what makes us different from people who study medicine abroad is that we are not spoiled , we learned Anatomy on 15 years old cadaver , not two people dissecting a fresh human meat , we were more than 30 on one cadaver , but yet we could pass , we could recognize the nerve from artery even the whole body looked like an old tree with nothing to distinguish between it’s branches , this only a simple thing in all the things we faced ,and that’s why most of our doctors get on top when they go abroad , because they are trained use their imagination and not only to deal with what they see .

I made it to the fifth year and all I can say that this year is more though than the 5 years I’ve passed (primary year + 4 years), so I need your prayers for me that I pass it so I can finish my journey with honor .

1 hour @ ER

Today in less than one hour at the casualty ( ER ) in TMC hospital there were two young girls with drug poisoning after trying to commit suicide , one had a full pack of antihypertensive drug , the other girl which came few minutes later had some rat killing drug , add to that 5 patients came with severe attack of asthma , on old man came with cardiac arrest ,he died in front of us after trying everything with him .

this wasn’t the first time I see someone dying in front of me , I volunteered to work to work for two months at Abo sleem hospital two years ago , I worked at the ER , I saw 5 people died there but the only one I still think about is that young girl which was hit by a car , actually it was her brother who run over her in the garage because he didn’t see her ,when we went out he was asking us how is she , that hurt so much because he knew she was dead but he kept shaking me asking how is she , I didn’t say anything and I still remember him looking at me trying to see any hope , but there wasn’t any , but above all that I still remember all these people we saved their lives , I didn’t do much back then but I knew I am going to be like this one day , that’s why I love what I am doing , I want to help people , to give them what they most need , to give them life when they think it’s going away .

Coming again with more from the hospital

H5N1

That day in supermarket an old man was saying this is tair ababeel (طير ابابيل)of this age , we all laughed and said inshallah rabi yister .

H5N1 is the name of the virus causing the bird flue which is scaring our area these days , we dont know if it's here yet or not , nothing official until now but that they have enough vaccinations ( tamiflue) , but taking percautions is the best thing I guess , first stay awya from all kind of birds touching or eating even cooking the meat kill the virus but one year ago this virus didnt exist and one year is too fast to know evrythign about it, second stay away from any one who's in contact with birds even no history of transmission between humans .