Abu - Sulaiman
HE Khalid Mohammed Al Mana
HE Khalid Mohammed Al Mana, peace be upon his soul, was the minister of health in Qatar from 1972 to 1989. I respected him and considered him as a father during the 18 years of our association.
I can not forget the first time I met him in 1978. He was a calm, decent, and pleasant old man. I was young, enthusiastic, full of energy, and a semi-rebel. I went to his office in Rumailah hospital to protest a social issue.
A few days after I started working in Rumailah hospital in the summer of 1978, I received an official invitation from the office of the Minister Of Health to attend a party honoring members of the ministry advisory board from abroad. The party was hosted in one of the residential houses of a senior ministry official in the Rumailah compound. I had never attended an official party in Qatar before. I was curious to attend such a party.
It was a shocking experience. A variety of wine, beer, and hard liquor was served to the guests. I found it outrageous that the Ministry of Health in Qatar, a conservative Islamic State, should sponsor such a party. To add insult to injury, the advisory board was preaching that a small country like Qatar should not invest in developing specialized medical service. “The country is wealthy and its citizens should be sent abroad for specialized medical care”, a board member advised. I concluded that this board was not an “advisory” board but rather a “colonizing” board. I was aware that during that summer, over ten thousand persons from Qatar (some were not even Qatari citizens) were vacationing in London at the expense of the government of Qatar. The Ministry of Health sent those persons under the label “patients”. I lost my appetite, so I finished my tomato juice and left.
I protested to the minister the following day. I told him that it was not appropriate for the Ministry of Heath in Qatar to serve alcoholic beverages. There were religious, health, and social reasons against such practice in our country. Such practice was illegal. The minister was not aware that ministry officials were serving alcohol on the expense of the ministry. He agreed with me. That was the last time our ministry of health ever served alcohol officially. He also added, “I hope that you do not tell your father about this.”. My father was a Qadi (Islamic Judge) who used to sentence any Muslim caught drunk to be flogged 80 times with a stick. Later on, as a health official, I tried on one occasion to get the government to adopt such “flogging therapy” for cigarette smokers but I failed! After that meeting the minister and I became friends. I used to call him Abu-Sulaiman, i.e. Sulaiman’s father (Sulaiman was the name of his eldest son). It is customary for us to refer to a person as the eldest son’s father. It is a sign of respect. If the person has no son, he would be called Abu. . . followed by the name his father with the expectation that the soon-to-be would carry the first name of his grandfather.
In 1979 I accompanied the minister to a conference for the Arab Gulf Ministers of Health held in Muscat, Oman. During that conference, the Gulf ministers of health would spend most of the evening in Abu-Sulaiman’s suite for a social gathering or private consultations. Traditionally, seniority by age dictates status in the Arab Gulf. As he was the most senior by age he was allowed appropriately to proceed ahead of the other ministers when entering the meeting halls, shaking hands with or sitting next to the head of a host state, like Sultan Qaboos of Oman.
In July 1980 he issued a ministerial decree appointing me as chairman of medicine as well as head of cardiology. He did not know then that I would be appointed as undersecretary of health a year later to work closely with him. Neither did he know that I would become his physician and supervise his care until his heart gave way.
In August 1981, I was appointed undersecretary for health and I started to work closely with him, accompanying him on almost all his official trips. During those trips, he entertained me with stories about the old days, when he was a child. He was born in Doha in 1913. He never had a formal education.
He told me once, “Life is the best school.”. He learned Qur’an and mathematics from a traditional teacher. He spent most of his youth days accompanying his father who traveled to India and other countries for trade. During those frequent trips, he learned to speak Urdu, Farsi (Persian), and a few words of English. He communicated on several occasions with Indians and Persians in their language in my presence, but he could not speak English.
Abu Sulaiman loved to tell us jokes, especially on topics relating to below the umbilicus. He also collected much variety of drugs, which he kept in his office drawers, for “strength.” He ordered them from India, China, and Europe. Those drugs were his favorite gifts to his elderly friends. I used to tease him a lot about this. One of my favorite anecdotes is the following incident:
One day, I received a file from the medical board committee requesting advice on a difficult request for referral abroad. It was a case of a young man with impotence referred by the psychiatrist for sex therapy. I called the psychiatrist to explain to me the scope of such a therapy abroad. He told me that the young man would be stimulated sexually by a naked attractive girl as therapy. I refused to accept such a referral abroad by the ministry on religious and moral grounds. If such a case was sent abroad on the government’s expense, many patients would request such a referral. Our ministry would become a “sex therapy ministry.” Someone had told that patient that I blocked his referral. He went to the minister and complained against me. He gave the minister a copy of the psychiatrist’s report. The minister could not read English and do not know the kind of therapy involved. He surprised me by entering my office without announcement with the report in his hand.
HE Khalid Mohammed Al Mana with Dr. H. A. Hajar Albinali
“Son”, he said, “why did you not allow this poor chap to go abroad for treatment?”
“Do you know what kind of treatment he wants?” I replied.
I, then, explained to him the so-called sex therapy abroad and added:
“If the ministry will send men for such a therapy abroad, then the minister of health should have priority.”
“You are right”, he replied, laughing. He told the patient that he agreed with me. That patient, however, succeeded in going abroad on the expense of a higher authority
In 1984 I traveled with the minister to Bahrain for a meeting. After the plane took off he told me that over the last two days before the trip he had been experiencing recurrent chest pain with shortness of breath, especially with exertions.
“Abu-Sulaiman, I meet you almost daily, why did you have to wait until we are in the air to tell me about your chest pain?”
“I was waiting for it goes away by itself” he answered.
After taking more history I was convinced that he had angina. I convinced him to allow me to perform a coronary arteriogram as soon as we returned to Doha. During the flight, I was very anxious. What would I do if he developed chest pain or heart attack in the plane? I had no emergency medication or equipment with me. I succeeded in hiding my anxiety. I entertained him with a pleasant story to keep both the minister and myself relaxed. Even though the trip from Doha to Bahrain seemed long at that time, it was actually only 38 minutes. We landed safely. He neither had chest pain in the plane nor in Bahrain.
In March of 1984, I admitted him for cardiac catheterization after an inadequate stress test. He was relatively healthy at that time except for hypertension of 30 years duration and chronic osteoarthritis of the knees. While I was puncturing his femoral artery, he told me that his family and friends tried to convince him to go to London for the cardiac catheterization, but because of his personal trust and confidence in my ability, he refused to consider their suggestion. He had normal left main, left anterior descending, and circumflex coronary arteries. The mid-right coronary artery had only 45% stenosis.
I used to see him frequently in the office during work. After meetings, he used to ask me to check his BP. It was difficult to control his BP because he was not consistent in taking his medication and the NSAID for his osteoarthritis interfered with the BP control. After his retirement in 1989, I arranged for him to come to my clinic for follow up. In my clinic in 1990, his BP was 210/80 and I heard a murmur of aortic insufficiency for the first time, then, in addition to the systolic ejection murmur of aortic sclerosis which was present before. I explained to him that the new murmur was due to inadequate BP control, which made him concerned sufficiently to take his medication religiously thereafter with relatively good BP control.
In 1995 old age started to creep up on my friend’s health so to speak. He developed prostate cancer, cervical and lumbar spine degenerative disease, hearing loss, and adult-onset diabetes.
He had nine other admissions to Hamad hospital over the following twelve years after the above-mentioned admission for a coronary arteriogram. Physicians always had difficulty finding his real age on record. He usually made himself younger if a nurse asked him about his age to record. “Abu-Sulaiman, our files show that you are getting younger and younger”, I told him during one of his admissions to the CCU.
“That is my main benefit from your hospital. Do not make me an old man in front of the nurses”, he said, smiling.
“Why should you care, you have two wives, you do not need more”, I said.
“Claiming to be younger is a good omen”, he said.
But he did look younger than his real age. The fact that he never grew a beard and mustache, contrary to the norm for his generation in our society, made him look younger. A physician in London noted in his medical summary after a general medical checkup in 1986 that Mr. Almana “.appeared younger than his stated age”.
Table: Mr. Al Mana's age recorded during each Hamad Medical Corporation admission
I reviewed his stated age in the hospital record during each admission for this article and found the inconsistency was embarrassing (see table below). His age ranged from 58 to 82 years in 1995, younger than the previous year, which was 85. Our medical staff recorded the age as stated by the patient or as recorded by the nurse or the clerk without noticing the significant variation on each admission.
This occurred despite the fact that his birth date was clearly recorded on the patient ID card used to imprint on all medical forms. On Abu-Sulaiman’s last admission on 16-7-1996, the admitting clerk recorded on the admission card the correct date of birth 1913 but filled the age and sex boxes as 59, male. The admitting physician stated 30 minutes later, “this is 70 year-old-male. . .” while the calculated age should have been 83.
His last visit to my clinic was in July 1996. He had more difficulties with congestive heart failure and insomnia. He was admitted the following day for control of worsening heart failure and work-up of right pleural effusion. His left ventricle was poorly contracting on echocardiography. His family refused diagnostic pleural aspiration and requested a referral to London.
The old man became very aware of impending death. He needed assurance from me every day. He kept requesting me to spend more time sitting next to him. Each time I had to leave, he would plead, “Please do not leave me.” I was sympathetic and felt sorry for him. I had to run away from him once because I felt like crying. I did not want him to see me crying. It would have made him feel worse.
I finally told him that due to the wish of his family, we will arrange for him to go to London for further management. He immediately told me, “If I go to London I will come back home in the “black box”. He did go to London on 3.8.1996 and died there on 20.8.1996. “Wherever you are, death will reach you” (Qur’an: S. IV.78). His prediction was correct - he came back in a “box” to be buried in Doha. I was very sad that Khalid Al Mana died. May God have mercy and peace on his soul.
“Every soul will taste death” (Qur’an: S. III.185).