like symptoms and visit a nearby clinic or hospital to have a swine flu test are finding that their local health center may not have the H1N1 screening facility. The tests, which cost anywhere from SR350 to over SR500, are available at only select private medical centers, apart from government outlets. Earlier, the Ministry of Health recommended an immediate visit to the “nearest health facility” in case of common flu symptoms with a continuous rise in temperature for more than three days or difficulty in breathing, chest pain, bloody sputum or the body turning blue, and said that the cost of treatment of confirmed cases would be borne by the government. However, as Saudi Gazette has found, not all of the “nearest health facilities”, especially private polyclinics, are able to screen for swine flu. Dr. Abdullah Moopen, director general of Al-Abeer Polyclinic in Jeddah, said that if individuals come to the clinic with flu-like symptoms, “we will counsel them and inquire about their medical history, whether they recently visited any foreign country, mixed with people infected with H1N1, etc.” He said that it is not feasible at the moment to conduct tests and treatment for swine flu suspects at clinics, and that only treatment for (common) flu-like symptoms is possible. “Big private hospitals have been given the go-ahead to treat swine flu patients. This does not include private polyclinics. The lab facilities required for the detection of the flu are very expensive. Moreover, there is a lot of space required. Patients diagnosed with the flu need to be kept in ICU-like facilities, which is not possible in polyclinics,” Dr. Moopen said. “The government,” he said, “wants to keep count of the number of swine flu cases. Also, they do not want the quality of the tests to be compromised by increasing the quantity of the places offering the H1N1 tests. But this may happen in the future as number of cases increase,” Dr. Moopen added. Saudi Arabia's private health sector has seen a proliferation of private clinics in recent years. They are in demand because they are relied on for some of the routine health problems faced by the lower and middle strata of society, especially foreign workers. As of 2004, Saudi Arabia had 113 private hospitals, 1,043 private dispensaries, 404 private clinics, and 544 polyclinics. A physician requesting anonymity at a hospital in Jeddah said that he has written a note to the administration requesting that H1N1 tests be conducted at the hospital he works in. “It is better if these tests are available here especially in the coming two months when the number of cases is expected to rise dramatically,” he said, adding that a number of people come to the hospital with flu-like symptoms asking to be tested. “We tell them to go to a bigger hospital. We write a note to refer them,” he said. The Ministry of Health said that it has given instructions to all private hospitals to deal with swine flu cases and that a clear procedure for the purpose has been established. “We have not received any information or material from the government about swine flu. We have no facility so we cannot diagnose,” said Dr. V. P. M. Mustafa, Medical Director of Al-Ryan Polyclinic in Jeddah, adding that every day 10 to 15 “anxious” individuals come to the clinic asking for the tests. He said that those with minor symptoms should stay at home, and “take vitamins, paracetomol (pain reliever), and light food. The majority will recover if they get good nutrition”. He said that those who have chest or lung infections or are diabetics are at high-risk for complications due to H1N1. This is particularly disquieting as about a quarter of the Kingdom's citizens (25-27 percent) suffer from diabetes. A lack of proper directions has generated much confusion leaving many people in doubt about when and under what circumstances they should visit a doctor or get tested. Dr. Essam Mousa, internal medicine consultant at New Jeddah Hospital, said that in case of flu-like symptoms, one should visit an internal medicine doctor or a chest doctor. “Especially the elderly, those with a history of chronic diseases and children should immediately visit the doctor,” he said. Experts recommend those who are otherwise healthy to stay at home while they are ill and to have someone to provide care. In case of pre-existing medical conditions, including asthma or other lung or immune diseases, they say it would be appropriate to seek healthcare as early as possible in order to avoid serious outcomes. It is also recommended that pregnant women and the very young also seek medical evaluation early. Dr. Mousa said the screening test – nose or throat swab test - takes a “few minutes” and that the results are out in 24 hours. He said the specimen is sent to government labs, “which is done to maintain a unity of standards”. “Because of the phobia that has swept the country, many people are coming to the hospital to get tested,” said Dr. Mousa, adding that Dr. Sulaiman Faqeeh Hospital and Dr. Erfan and Bagedo General Hospital among private hospitals, and government facilities, such as, King Saud Hospital, and King Abdulaziz University Hospital have the screening facility as of now. Tamiflu, the antiviral drug in a pill form that interferes with H1N1's viral reproduction, needs to be taken within 40 hours of catching the flu or it may not work. But what if the flu is not even detected in that period, either due to a delay in contacting a health facility or getting tested, or because of a doctor's misdiagnosis? “Tamiflu, if administered even after a week of catching the flu, can prevent complications, by 30 percent,” said Dr. Mousa. Describing swine flu as “milder than ordinary flu,” Dr. Moopen said: “Panic notwithstanding, one should take the same precautions as for any respiratory disease – keep away from infected people; minimize contacts, such as shaking hands; wash hands and cover the face while sneezing and coughing. Lastly, instead of panicking it is important that you put your mind into it.”
