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Unintended Consequences (International Version)

I’m writing this while confined to my hotel room in Cairo, Egypt. As a #healthcarejournalist, and someone focused on #PatientSafety, I wanted to share some observations about unintended consequences of seemingly good ideas.

I had a flareup of a pre-existing condition, which may or may not have been caused by someone giving me bottled well water instead of bottled purified water. Or an extremely helpful waiter who didn’t fully understand or communicate my significant food allergy or the result of spending a full day in the extreme heat we are experiencing in Egypt this week. That’s travel. 🤷🏻‍♀️

Anyway, at a restaurant last night where I ate very little, my hosts told me that I should go to a pharmacy and pick up some medicine. It was past 10 PM but I was assured that every pharmacy had a doctor on staff, and that all of them are open until at least midnight. Just that alone was fascinating to me. Think about what that level of #accesstohealthcare could mean in the United States. What if every CVS and Walmart were staffed with a doctor on call?

The doctor at the pharmacy told me the medicine I was seeking isn’t available in the Egyptian market. He recommended an alternative medicine that he said would do the same thing. And it’s cost me $2.60 equivalent in EGP! Wow!

I asked him if that medication contraindicated any of my current medications and supplements and he said I was fine. So I bought it and took it back to the hotel where I had Wi-Fi. I looked it up. I couldn’t find anything about the brand name but the specific ingredients were searchable.

Well, that’s when the fantasy met hard with reality.

The “doctor“ hadn’t asked me my age, any of my other medical conditions, and seemed surprised when I showed him my list of medications and medication allergies. I don’t think he read it. He prescribed a drug that contains benzodiazepines. There’s a good reason why they are a controlled substance in the United States and other countries. They’re addictive, they can easily lead to overdose, and they can harm seniors, or make it impossible for someone to participate in daily activities, a tour of Luxor for example.

Doctors can't treat what they don't know exists nor can they cure if they don't have time to see the patient.

I threw it out and I am certain I will be fine in a day or two but maybe there’s a good reason why we do not have doctors prescribing medicines from pharmacy windows.

The other example of unintended consequences is this: down the street from my hotel there is a hospital for pediatric cancer. It’s free and supported only by donations! Our driver pointed out that they were building a whole new wing for the hospital. How fabulous, I thought. Until I heard that the incidence of childhood cancer is higher overall here, and the wait for care could last weeks, even months. Some pediatric cancers progress by doubling in size daily which supports the local statistic that the rate of death from pediatric cancer is higher than other places.

Our guide shared his ideas on why the pediatric cancer rate is much higher than other countries: it's due to the combination of polluted drinking water, environmental hazards, unsafe housing, poor diet, and unprotected sun exposure. Add #DelayedDiagnosis and #DelayedTreatment and you have a major healthcare crisis for Egyptian children despite the existence of free care. Doctors can't treat what they don't know exists nor can they cure if they don't have time to see the patient.


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