I Got An OB/GYN Exam In Iran And Was A Little Shocked By The Differences
As I am getting ready to leave for the doctor’s office, Auntie Shadi gives me a warning: “Now don’t expect to be seen exactly on time. This is not America.”
“Oh. Ok,” I say, instead of admitting that we don’t necessarily get seen exactly on time for our doctor’s appointment either. During this one-month stay in Iran I have learned to choose my battles with misconceptions. I only correct the important ones, like the one where they assume that anyone who lives in America has lots of money without working.
Since I had left a lucrative career as an oral surgeon to become a writer, money was tight and most of my activities were on hold. When dad invited me to Iran on an all-expense-paid trip, I gladly accepted. As most everything is cheaper in Iran, I decided to get some of my annual medical exams out of the way, too. My father takes a particular pleasure in going to the doctor. It’s his fear of hospitals that makes him so diligent in preventative care to the point that when he runs out of things to do, he just pops in for some blood work. So, hearing about my interest in seeing a doctor (any doctor, really) was good news. He secretly wanted to show off the excellence in Iran’s medical care.
A routine check up at the OB/GYN could not be that complicated, I reasoned. Besides, nowhere in the United States does a specialist visit cost $16.
From what I remembered, more than 20 years ago when we lived in Iran, the two physicians who had cared for us, both men, had immaculate bedside manners. Hence, I prepared to just give myself over to this woman doctor — she’d probably be Mother Teresa herself. Even her name translated to “angel.” I imagined how, despite practicing in a third world country with lack of access to the state-of-the-art resources, she hovers over her patients, putting them at ease with her saintly demeanor in a modest office, perhaps even a hut. Admittedly, I may have gotten slightly carried away imagining a hut in the middle of Tehran, a metropolitan city, but what good is an imagination if not allowed to run wild at times?
My enthusiasm, however, was quickly extinguished by her cold mien. After the initial interview we walked into the examination room where she asked me to remove my clothes and lay down on the table, with her still present. No gowns here.
“Slide forward and put your feet in the stirrups,” she said in a distant, barely audible voice.
By the time she turned around, yours truly was fully exposed everywhere except for my head. Somehow, an urge to preserve my dignity translated into using the only cover I had to its fullest extent. In this women-only office, where scarves were not required for a change, I (the girl who ordinarily challenged most of Islamic Republic’s dress rules) felt a glaring need to make sure every strand of hair was concealed under that scarf.
Thus began the exam.
Having friends who have recently been diagnosed with breast cancer and cervical pre-cancer, I asked for a Pap smear during the initial interview.
She said: “We offer something better. It’s called ThinPrep.”
Whatever. Let’s do this. “Great,” I said.
“That would be another $16.”
Again, a price well worth paying if it meant finding out the state of my cervical cells. The next series of events, though, made me regret being in such a rush to get medical work done in Iran.
She handed me the biopsy brush case to hold like an assistant — still in stirrups, of course. Then, without warning, without small talk, and most of all, without much lubrication she inserted a rather sizeable plastic speculum, which made me gasp for air. I nearly dropped the tube I was holding. She took her sample, removed the speculum, and proceeded to check the size of my cervix and ovaries with her fingers, again, sans warning. Then she announced the organs were normal in size after she removed her hand.
By the end of that physical exam I hopped off her table feeling utterly violated. I used to feel shy with my own OB/GYN doctor here because he was a man. Suddenly, I was missing his sweet bedside manner, the care he took to warm the instruments, and how he always explained what he was going to do before he proceeded. That’s how I used to treat my own patients, too. As healthcare providers, our job is to actually care for people who have trusted themselves to us at their most vulnerable state.
Once I put my clothes on, the ice angel handed me a prescription along with the specimen jar. “This is for you to drop off at any lab.”
So used to having my own office tell the patients “We’ll contact you when the results are in,” I was taken a back when she handed me the bag. I understand that in urgent cases like acute infections the fastest way of getting the results is to have the patient deliver the specimen, but this was a routine exam.
Mother and I took the bus to the nearest lab. The buses in Iran are arranged such that men occupy the front half of the bus and women the back half. Admittedly this arrangement carried some novelty for me. I was segregated in broad daylight in the 21st century. Unfortunately by 6 p.m., when we arrived at the lab, it had already closed. Our next option was the hospital, an hour away in Tehran traffic.
At that moment, remembering dad had to go for blood work in the morning, I called to enlist his help.
“Dad, I had to drop something off at the lab but it was closed. Would it be possible for you to take it with you tomorrow? I have a prescription and everything. We will have to go to the hospital if you can’t.”
“Sure, no problem,” he said. “Just head home.”
A fact worth mentioning here is that Persian culture commands a strict boundary between parents and children regardless of age. Certain topics, especially sexuality, we don’t discuss. In a way, we follow the “don’t ask, don’t tell” principle. Furthermore, it is assumed that a single woman remains pure by abstaining from sex until she marries or, in my case, remarries. So, I did not reveal the nature of the specimen to my father. There was no need. I assumed once he dropped it off, the lab would do the work and send the results to my doctor’s office.
Also, my family members, irrespective of education or profession, firmly believe in their own medical knowledge. Thus, when in Iran, I have learned to set aside my doctorate degree and defer most medical decisions to them. There is no point in resisting. In my doctor mom’s opinion, I was to put the specimen in the refrigerator, as soon as we arrived home, along with my prescription plus dad’s insurance booklet. Yes, papers in the fridge. That way he would remember to take everything in the morning. Hence, before long, a collection of my cells, part of my body, was sitting in a jar next to the low-fat yogurt container, insulated by a plastic bag.
The next morning I left on a tour bus to see one of Iran’s oldest caves. On the way, my cell phone rang startling the woman next to me out of her nap. Caller ID showed dad’s cell.
“Ms. Anooshahr?” asked a woman’s voice. “Can you tell me the date of your last period?”
Great way to start a phone conversation. It must be the lab. I gave her the date.
“Do you take any hormone pills? Birth control pills?”
“Any history of sexually transmitted diseases?”
“Not to my knowledge.” Good God, had they found something unusual? What kind of disease do I have? Did they find cancer?
“What method of birth control do you use? Natural? Is it natural?”
This is the Islamic Republic of Iran. Why are we discussing sex, dammit?
“Ummmm. Excuse me. I am on a bus,” I said lowering my voice.
“Ok. No problem. Just tell me first or second. Natural? “
“Yes. That. Option two and rarely option one.” I whispered.
The woman laughed. “Ok, dear. Thank you.”
I hung up realizing that she was probably just asking protocol questions. Nothing to worry about, until…
Wait a minute. I rechecked the caller ID. D-A-D’S-C-E-L-L! Oh my God.
That can’t be possible. What about privacy laws? My health information is mine and should not be shared with others without my permission. Surely they must have sent him away for his own lab work. My father, a Middle Eastern man, didn’t just hear about how my sexual habits. Right? And even if he did, he would never mention it. Right?
Let me just make a little insertion about the importance of medical privacy laws. Having our medical information float around can have grave ramifications. What if the company decides to downsize and they have access to medical information? It can affect their selection process not based on performance, but on your medical history. We can get extreme with it, too. Think about a fundamentalist pro-life group getting hold of the medical records of patients who, for whatever reason, had to have abortions. We are not just talking about a threat on financial security. Now a person’s life can be threatened.
At dinner, dad asked about the trip and listened intently as I told him stories. When we finished dinner it was his turn to talk: “You should definitely get your blood work done at the lab I went to. You’d love it. The place was immaculately clean and very well organized. Every station had two nurses except the pathology department, where I dropped off your stuff. It only had one staff member. But she really knew what she was doing. I was standing right by her when she called you.“
I could swear that living in America for 22 years had changed me into a woman who could discuss just about any issue openly. Evidently, certain beliefs are much more deeply ingrained in us to stay behind as we move forward in space and time. Some boundaries just can’t be crossed. Dad continued talking, but I could not longer hear his words. Instead, I faked a stomach ache and walked away, mortified.
As the adage goes everything has a price. My dignity and privacy? Those went for the low, low price of $32.
Reprinted with permission from The Frisky. Want more?