Kuwait MD: Depression

Post by Dr. H

Post by Dr. H – A family medicine resident working in a polyclinic in Kuwait

Its been a while since I’ve posted due to the fact I’ve been on holiday. Now its back to reality and I was thinking about what my next blog post would be, when I saw this patient and realized that it should be on the least discussed ‘taboo’ topic in kuwait – depression.

I see so many patients who are truly suffering with this disease, however with the lack of supportive services in Kuwait, they continue to suffer in silence, told by their families to ‘become more spiritual’ or ‘just snap out of it’.

So first off.. what is depression? Depression is a mood disorder that causes a persistent feeling of sadness, and a loss of interest. There are many other associated symptoms, such as trouble sleeping and loss/gain of appetite. There are many theories on the etiology (cause) of depression, one is biological – So it basically says that there are certain ‘chemicals’ in the brain, and when you have depression, these chemicals are a bit off, so you get symptoms. Its multifactorial, theres a lot of other theories, it’s still poorly understood what causes it.. but the bottom line is that it’s a disease. Yes a disease. Just like asthma is a disease.. ever asked someone to ‘snap’ out of asthma?

So.. back to my patient.. I saw a 30 something year old lady, who has been suffering with lack of sleep, low mood, anhedonia (loss of interest), and has been this way for the past 3 months. She was miserable. It was taking a toll on her work, her marriage, and her kids. She did every medical test out there, most importantly her thyroid (gland that produces hormones, when dysfunctional can mimic depression), all her tests came back normal. So I started discussing depression with her, and the treatment options available. I was met with ‘shno depression? lesh tgolin 3ani maynona’ ‘what depression? why are you calling me crazy?’. She refused to discuss treatment or medication and stormed out. This just highlights a huge issue in Kuwaiti society, the taboo of mental illness.

Depression can be very successfully managed with medications and lifestyle modifications, but mention an antidepressant and 90% of patients will refuse.

You must be thinking.. what about psychiatrists? doesn’t Kuwait have a new mental health centre? A centre dedicated to mental illness? Why not refer patients there? What is their role in improving mental health and increasing awareness?

Here’s a fun little fact.. people who get treated at the Kuwait mental health center wouldn’t be considered for jobs in sensitive positions, such as parliament, certain ministry of interior jobs, army, etc. that does a lot to defeat the taboo right? What a good way to move forward Kuwait! Its one step forward two steps back. On the one hand the ministry of health is improving mental health care, on the other they’re saying if you have a file in the mental health center or problems with your mental health then you’re banned from certain jobs. What kind of image does that project?

I was thinking of ways that mental health can be improved, and ways to increase awareness, and I remembered when I was in med school abroad, we had a student hotline and a suicide hotline. These were 24 hour hotlines that you call, free of charge when you feel suicidal, sad, overwhelmed, or unwell. You would call and there would be someone to hear you on the other end of the line to offer supportive services. I think implementing something like this in Kuwait would be a huge step forward, and easier to set up than changing the politics behind being banned from jobs for following up with a psychiatrist.

We’re a long way away from defeating the taboo of mental health in Kuwait, but I think small changes and an increase in awareness would go a long way. So if you’re reading this, and you notice that you or a friend or relative has been suffering with low mood, loss of interest, change in appetite, trouble sleeping, or anything similar, please go to your polyclinic and discuss it with your family medicine doctor. There are a lot of resources out there, antidepressants can be prescribed by your family physician in the polyclinic, and you can be referred to a more specialized clinic if need be. Please do, thats what we’re here for!

(If anyone has any questions, or is suffering with anything similar please do not hesitate to contact me, I’m more than happy to help)

Post by Dr. H – A family medicine resident working in a polyclinic in Kuwait


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Kuwait MD: Dr. Can you please give me an injection?

Post by Dr. H

maid

I’m a 20 something year old doctor working in family medicine in a polyclinic in Kuwait City. I’m Kuwaiti but I was born and raised abroad, and then finished med school abroad. When I graduated I decided to come back to Kuwait. There’s a lot of ups and downs of being back, it’s been a joy and struggle at the same time. So i’ll be writing about some of that, as well as healthcare, and life as a Doctor working in Kuwait. For my first post, I’ll be discussing an issue I face on an almost daily basis in practice, one that I almost always feel helpless in solving. The treatment of foreign workers in Kuwait.

Patient: Dr. Can you please give me an injection?

Me: Which injection?

Patient: Something that will make my flu go away, that will make me able to work again

Me: I explain that flu’s take time, and that she needs to rest, and that its vital she does so.

I see hesitation.. followed by

Patient: Please, give me anything madame says I have to work

This is sadly a very common scenario. Typically it would be a housemaid, who’s come to seek treatment for a flu or common illness, and is worried that she’ll get in trouble, get deductions from her salary, or even worse, get hit if she doesn’t work through her illness. This is a trend I noticed very early on while working in family medicine.

I thought for a while about what the solution could be, so I started asking for the numbers of their employers, and started explaining to them; the need for rest, how ‘contagious’ a flu can be, and how vital rest is to ‘speed up recovery’ time. Coming from a ‘fellow Kuwaiti’ it wasn’t hard to convince… and trying to appeal to their own selfish nature by implying that they’ll get something out of letting them rest also helped. As if showing a little bit of empathy and basic humanity isn’t enough motivation to do so.

This just highlights a major issue in this country that largely goes un-noticed. Or perhaps its noticed, yet nothing is done. While I was working on a OB/GYN residency, a housemaid came into the emergency room in tears, claiming that she just found out she was pregnant and that she’d been raped earlier. I was horrified, and I contacted the police. Instead of them taking a statement from her, doing their best to protect her.. they dragged her down to station for ‘questioning’ and detained her! “illegal pregnancy” they said.

There are not enough laws to protect foreign workers. We have people from all over the world coming to work in Kuwait whether it be in homes, streets, hotels, restaurants. Immigrants make up a huge percentage of the population of Kuwait.. a percentage that Kuwait wouldn’t be able to run without.

What support systems are in place should they need help? Who can they approach? Is there a helpline they can call? Is there a ‘union’ that defends them? Are there organizations in place?

These issues need to be addressed, if not for the country’s sake, for the sake of maintaining a little bit of humanity, and not losing track of the reality that we live in.

Post by Dr. H – A family medicine resident working in a polyclinic in Kuwait


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