MOROCCO An exotic land

MOROCCO An exotic land

Imagine six goats 10 to 15 feet above the ground climbing around in a tree. The tree has a fruit much like an olive that lures the goats into risking danger. After they eat the fruit, they regurgitate the pits. Shep- herds gather these pits, remove the tiny seeds within the pits, and extract a rare oil which i s considered a delicacy.

The 81 travelers who took part in the AORN International Symposium found that Morocco affords many oddities and scenes foreign to our way of living. There is a blend of different civilizations that after disappearing left only traces in the sands. These traces comprise Moroccan culture. Al- though the country i s in Africa, it i s not African. Although it i s a Moslem country, and the people speak and write Arabic, i t i s neither typically Moslem nor Arab.

As we boarded the buses at Casablanca for Rabat, we no longer felt fatigued after the overnight flight from New York City. From the bus window, we saw a modern city of wide avenues brilliant with bougain- villea blossoms. The Atlantic Ocean with i t s long stretches of sandy beach followed the coastal road as far as Azemmour, an old Portuguese fortification. From there to the little village of Sidi Moussa, eucalyptus trees lined the beach. The ride to the Rabat Hilton seemed quite short as our guides, Mitch and Abdul, gave a running cornmen- tary on the places we passed, intermingling the descriptions with history of the country.

The Rabat Hilton was a pleasant relaxa-

tion before our evening welcome party where we were greeted by Robert G Neu- mann, US ambassador to Morocco, and his charming wife.

Our first hospital visits were in Rabat. The largest was "Hospital Avicenne," a complex of 1,500 beds. Dr Abdelhag Jou- ahri explained the services provided and defined the Moroccan health care system. The more complicated medical services are available only at this hospital, the hub for all medical care in Morocco. Each town and community has a "dispensary" which han- dles routine medical problems. Those cases needing more expert medical help are sent to a nearby large city.

The other hospital we visited was equally as interesting. Dr M Bouzerki explained to us the various functions performed in Mou- lay Youssef Hospital. We learned that open heart surgery is not performed in Morocco. This i s not because of any religious ar gov- ernmental restriction, but simply because they have not yet advanced to that point.

At the first seminar in Rabat we were joined by several nurses stationed at the US Naval Air Base at Kenitra, a small town 32 km north of Rabat. They shared with the group some of their experiences working with Moroccans as well as caring for Mo- roccan patients. Two French-speaking Mo- roccan nurses joined us and had many questions about nursing in America to ask of us.

In Tangier, from a vantage point that

324 AORN Journal, February 1975, Vol 21, N o 2

A camel trader tries his best to make a sale and Karen Stadther finds it hard to resist.

afforded an excellent view of the Atlantic Ocean merging with the Mediterranean Sea, we could see Gibralter in the mist over the Cap Spartel. We saw an even greater cross section of culture as we visited several hospitals, one run by the Spanish, an- other by the French, and the third, a small Jewish hospital. These various government- owned hospitals are remnants of the fre- quent changes in ownership in Morocco. Up until World War II, it was a Moorish suburb of Europe. Today, it is a lovely port city that boasts of having King Hassan’s summer palace situated in one of the sub- tropical parks constantly cooled by winds of an ocean and a sea. It was in Tangier that most of the nurses haggled in shop after shop to buy just the right djellaba or caftan.

Back on the buses that were eventually to take us over 1,200 miles of the Moroc- can countryside, we headed for Fez. As we passed through the Rif, the hilly region along the Mediterranean coast, we went through Tetouan with i ts 27 mosques. We saw clever-fingered craftsmen seated in their alcove-like boxes working at their art.

In 808 AD, Moufay ldriss founded the

city of Fez. town before

It was long an active trading it became the center of learn-

ing under the Merinidian rulers in the 14th century. Much from the early days is still preserved in Fez and life in the old medina has not changed perceptibly in the last 1,000 years. The maze of narrow alleys, the crush of humanity, the preponderance of donkeys carrying oversized loads still remain in one’s memory as an “Arab fairy- tale.” It was in Fez that we learned not to let the entrance to a mosque or a restaurant fool us. What at first glance seemed like an uninviting doorway suddenly became the gateway to a former Sultan’s palace or a most delightful dining room with intricately designed blue and green mosaic tile topped by carved cedar wood ceilings.

Although we had some difficulty with pronouncing names of hospitals we visited in Fez, Al Ghassani, Ibn Al Hassan, Omar- Drissi, we had no difficulty in visual translation. Surgical suites and all their equipment relate the same story in any tongue. Without exception the doctors graciously answered our questions and took us through the entire hospital.

The seminars, too, were kee’ping pace

&+o 328


with our itinerary. The first seminar dealt with anthropology and nursing and afforded an insight into the necessity for nurses to understand other cultures. Nurs- ing's premise today is to treat the patient as a "total individual." This cannot be done unless the nurse has a full understanding of how cultures and subcultures affect in- dividuals. The other seminars dealt with the legalities of nursing in stress Clare areas. The final seminar in Agadir was a "wrap-up" session. We used this time to share with each other how well we had learned to evaluate the nursing care in a foreign country by putting i t in perspective, remembering what we had previously dis- cussed about culture, health standards of other countries, and the legalities involved in America and in Morocco.

Marrakech, the "Pearl of the South" as the Moroccans call it, fourth of the ancient royal cities, l ies at the foot of the Atlas Mountains and nestles in a forest of over 10,000 date-palms. We had seen many strange unfamiliar sights but the sight of Djemaa El Fna caused wonderment. Trans-

lated, the name of the open square means "Square of the dead, the beheaded, and the hanged." Walking through the square i s like being transported in a time machine back to Biblical times. Enormous crowds of people, merchants displaying their wares, and beggers animate the squalre by day. In late afternoon it i s taken over by acrobats, story tellers, snake charmers, musicians, healers, and tooth pullers. This daily activ- ity i s not simply a tourist attraction but i s the entertainment available for the residents of the medina.

We were fortunate to be able to tour Ibn To Fial, the largest hospital in Mar- rakech. Here, as well as in other cities in Morocco, each hospital has its specialty. The concept of general hospitals, as we know it, i s not present. Ibn To Fial patients were either ob-gyn or cardiovascular. We learned from the chief doctor that their mortality rate in obstetrics is remarkably low, despite the fact that, for example, a patient with a ruptured uterus might wait as long as 48 hours before appearing at a hospital for treatment. The doctor told us that in

AORN travelers Jsabel Magewick and Mary Boscardin join the native dancers and musicians who mingled with the group.


over 40 cases of ruptured uteri in one year, the mortality rate was less than 10%. Many women from the city do have their babies in the hospital, but many thousands more living a distance from the city deliver at home with the usual rape suspended over the bed to enable the woman to pull on it to aid the "bearing down process." It i s still the custom for nomadic Bedouin women to deliver their babies while crouched in a knee-chest position over a hole dug in the ground.

The sight of 15 horse-drawn carriages, one behind the other, winding through the narrow medina streets and carrying the 81 registrants created quite a stir among the residents. We were being taken to a sump- tious, typical Moroccan dinner complete with native entertainment in an ancient building turned into a restaurant. Over 100 years old, the building had been built by a "pasha" or governor as a palace.

Reluctantly leaving Marrakech, we trav- eled to Agadir, a seacwst resort town com- pletely different from what we had seen previously. The entire city was destroyed by an earthquake 14 years ago. The rebuilding process of the last six years gives it the appearance of a modern city.

In Agadir, our hospital visit offered not only an invaluable educational experience, but also afforded us the opportunity to give of ourselves. As we arrived, a nurse greeted us and through the translation by our guides, informed us that a patient in surgery was critically in need of a blood trans- fusion of A+ blood. True concern for this patient enabled her to ask her colleagues in nursing if someone would donate blood, Nine of the registrants donated 250 cc each; Morocco law forbids taking any more than 250 cc of blood for donation.

During a tour of the nursing school at- tached to the Hassan hospital, we learned that 50% of the nurses in Morocco are

men. Men consider it a worthwhile profes- sion and many continue on to become doctors. Most of the male nursing students start out as porters or orderlies in the hospital. There are three levels of nursing: brevete, graduate, and state. The brevete nurse i s nearest to our nurse's aides and practical nurses. The next classification would approximate our associate degree program and the state nurse i s the most highly qualified and educated and prob- ably the equivalent to our baccalaureate nurse. The progression from one classification to the next i s not difficult.

We failed to find nurses in any category wearing distinctive uniforms. A white coat over street dress made it difficult to ascer- tain whether the person was a nurse or a doctor. In the OR, a variety of shoe gear was in evidence. Clogs were quite common. In one hospital, a muslin-type knee high boot was worn, This boot had one-inch wide strappings circling the ankles and up the calf of the leg to the knee. We were told that it helped maintain good circula- tion during surgery for the personnel. It was worn by both doctors and nurses.

The day before we departed from Mo- rocco, the buses drove south to Q town named Goulimine where the paved roads end and the caravan routes across the Sa- hara sands start, In addition to being the largest meeting place for the nomads from the desert, it i s also the site of a camel market. This area is called the country of the Blue Men because indigo blue robes are traditionally worn. All that remained for us now was to journey back to Agadir, stopping briefly at Tiznit to see the gold and silver craft for which the city is famous.

The last evening in Morocco was filled with the enjoyment of entertainment, good food, and much picture taking.

Caroline Rogers, RN Direcfor of membership

330 AORN Journal, February 1975, VoE 21, No 2

Documents

MOROCCO An exotic land