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Stroke Trek - Chapter 5
Turkey
October 2000
I left Uzbekistan with three pictures in my head: the dancing tile-work of the Registan in Samarkand, the hush in the air at sunset in Bukhara and the two families of whom I had the pleasure to spend time with. So where next? Via bus and car I crossed the surreal Oxus River into Turkmenistan, a country full of ancient history. Unfortunately, Mother Nature and the Monguls left little behind as reminders, specifically the great city of Merv. Through the desert via train and then across the Caspian Sea by way of cargo ship to my next destination, the Caucuses. Azerbaijan, a land overflowing in not only oil but hospitality as well, and Georgia, the land of wine and music as well as some of the most beautiful landscapes I have ever laid eyes on.
So where am I now? Well, I am in a city where minarets line each side of the Bosphorus like brittle eyelashes. A city where the rising and falling vibrato of Islam's call to prayer whisks through the air, curling up from the Sea of Marmara, and a city where Byzantine's architectural masterpiece, the Haghia Sophia, rests like the wisest of elders on one of the city's seven great hills....Istanbul, Turkey
Straddled on two continents, the face of Istanbul is Asian in many obvious ways, yet for the first time in six months, Istanbul has shown me the first reflection of a European/western approach towards stroke, specifically, stroke rehabilitation. My journey has taken me through countries where the word rehabilitation is followed by such responses, "We don't...." or "Not until recently....". In addition, I've been in countries where treatment consists of herbs, potions, massages, rituals, prayers and even time. So in this sense, Istanbul's foot is firmly planted in Europe.
This last week I walked into a facility that brought an immediate smile to my face. From the street level, built into the stairs, was an electric lift wide enough for a wheelchair. Through the tiled main hallway was a large reception room where three woman sat answering phones and working behind computers. As is the case with all doctors offices and medical facilities, labeled files could be seen everywhere. Sofas, chairs and coffee tables with small stacks of home decorating magazines were placed around the walls of the waiting room.
On one floor I was shown rooms where patients leg and arm muscles went through electro-shock treatments, on another floor I was taken to a large room that consisted of five padded massage tables, two sets of parallel bars and high-tech stationary bicycles, to name a few. In the basement was a small swimming pool and in an adjacent room a Jacuzzi. And on each floor, an abundance of nurses and physical therapists. The Ornoram Rehabilitation Center provided a warm, positive and facilitative atmosphere in every corner I walked, and my conversation with Chief Physical Therapist, Muharrem Oksay, introduced me to an attitude and perspective towards stroke rehabilitation absent thus far in my trip.
Open for close to 30 years, the center now sees on average 40-50 patients per day throughout the six day work week, with 20% being stroke, or in Turkish feltch, survivors. Like most of its kind in Istanbul, it is a private facility that operates on an outpatient basis only. One of the first questions I asked concerned the use of traditional Turkish methods of rehabilitation, if there was such a thing. "We practice the same methods as those in the West. When a doctor or therapist comes over from Europe or the United States, they say there is little difference here at our center from theirs at home. Most of what we learn and study began in the West anyway." And this could easily be seen by the volumes of English medical encyclopedias and texts in one of the offices Oksay showed me. "Of course, much can be learned and shared by the Internet," Oksay said. For 12 years Oksay has been working at the center. "Six of the universities here in Istanbul have Physical Therapy undergraduate programs, and if one wants to become involved in Occupational or Speech therapy, Masters Programs are available as well."
For close to an hour I walked with Oksay and his friend Ali, who introduced the two of us and aided in translation. "Most of our stroke patients are between the ages of 40-55." And when asked about the number of stroke survivors in Turkey, I was provided this answer: "Turkish families are extremely strong. We protect those in our own family. We don't know the number of people in Turkey who have had strokes because many families are so protective, you would never know there is a stroke survivor amongst them. But as the population becomes more modern (younger) this family strength will weaken in a way. People will start to look out for themselves more. This will result in more people visiting the hospitals and seeking post stroke treatments and rehabilitation."
So like many countries, the severity of feltch throughout the population is still unknown, but at least in my eyes, visiting the Ornoram Rehabilitation Center and meeting rehabilitation professionals like Muharrem Oksay was a welcome change towards stroke awareness from that of Greater Asia.
Now meet Eser Eti....
In 1946 Eser Eti was born. At the age of 26, Eser moved to Germany to work as an Electrical Engineer. Three years later, at the age of 29, Eser fell out of a third story window while working. The impact resulted in severe head trauma, and was followed by a massive stroke. The stroke left his right side disabled and affected his speech as well.
Eser, now 54, lives in a private hospital/care facility across the street from the Ornoram Center. As we talked, he sat in his wheelchair and responded to my questions in a way that was slow and labored, and within his deep breaths between sentences and intertwined in his soft, broken and hesitant speech, was a knowledge of life as a stroke survivor I hadn't encountered on this trip, until now.
I asked Ali to ask Eser, "As a stroke survivor, what have you learned about life?" He looked at me through his thick glasses, took a deep breath and pointed at me while giving his response....
"For those who are uneducated, who don't have friends, who don't have skills....they have lost very little. But for someone who is educated, who has many friends, the stroke takes it all away from you. I've lost everything. My friends are all gone, I can't work, I can't support myself, I have no family of my own...I've lost everything...so what have I learned from my stroke...nothing. I've learned nothing about life!"
And then he set his hand in his lap, looked out the open door for a second, looked at me, took at deep breath and welcomed my next question.
After a brief pause Oksay looked at me and said of Eser, "He is the elder here at the hospital". Eser laughed. "He tells us how things can be made better. The other patients consider him to be their best friend. He tries to help out with everything. He has a brother who is really sick with polio. Eser was transferred here from the center in Germany, and the German government pays for his rehabilitation and gives him a small pension. Since arriving, Eser has made every effort possible to help take care of his brother. He really is special." And the feeling was mutual when I asked Eser what he liked and disliked about rehabilitation.."I like rehabilitation when Oksay is here, and I dislike rehabilitation when Oksay is away." The two smiled at each other. It was a smile of respect and admiration between the two but more importantly of trust.
My visit with Eser ended a few minutes later, but my thoughts about him and his comments and his voice and his mannerisms and his smile have stayed with me ever since.
©Greg Constantine, available at www.strokesafe.org with the author's permission. For inquiries or reprint permission, contact gregc@strokesafe.org.
