Ian Young spent the summer of 1970 as a medical student working at a hospital in the province of Kabylia in Algeria. He was assigned to the Maternity department, where he worked primarily with two Bulgarian doctors. Most foreign medical personnel in Algeria at the time came from Eastern bloc countries, as "Islamic Socialism" was the official political system in the newly independent (1962) North African country. According to Young, obstetrical care for the mostly Berber women of the area was brutal, disorganized, antiquated, and dangerous.

Dr. Vasilev, the head of the department, is a passive and indecisive man, who spends most of his day reading the newspaper. Once roused from his lethargy, which doesn't happen very often, he demonstrates competence and concern for his patients. His colleague, Dr. Kostov, is an aggressively brutal man who introduces himself to pregnant patients by shoving his fist into their vaginas.

Both doctors excuse their behavior by saying, "We just can't do it here they way we do it in Bulgaria." For the most part, they do not use sterile technique, and although anesthetics are available, neither Kostov nor Vasilev typically use them. The Algerian nursing staff provides at least a modicum of organization and care in this dreadful environment.

At first Young approaches the situation with disbelief and anger. He then attempts to improve the quality of care, first by introducing a flow sheet for obstetrical care, and later by submitting a report on the poor conditions to the hospital director.

Mild-mannered Dr. Vasilev supports him, but no one uses the new flow sheets, and the Director considers the report a personal (and political) affront. Meanwhile, Ian Young presents the reader with a seemingly endless series of fascinating patient cases and interesting stories about hospital personnel, as well as about his excursions to various parts of Kabylia.


Early in this book I was struck by the negative images of Drs. Kostov and Vasilev and by the thoroughly bleak obstetrical care, which comes across as far below "normal" Third Word standards. I was also a little put off by the author's hubris (e.g. a medical student's taking it upon himself to write a report on how to remedy the hospital's problems). Yet, Young is a fine writer, and his narrative is consistently interesting, especially the pace and texture of the patients' stories.

After a while, I found myself warming up to him, just as he eventually warms up to his Bulgarian preceptors. Koskov and Vasilev prove to be far more complex characters than they initially appear and, in fact, compare quite favorably with Dr. Nikolenko (a Russian) who joins the staff toward the end of Young's stay in Algeria. Of Nikolenko: "Her mouth's tight; she's as cold as ice."

The book's title is misleading. It contains very little discussion of Islam and then only in the context of "Islamic Socialism." The obstetrical patients, of course, are poor and uneducated Muslim women, mostly from the mountains. Frequent reference is made to their desire for privacy, but any women of no matter what culture would certainly be horrified at the Bulgarian doctors' disregard for patient privacy.

Likewise, some of the husbands appear to consider their wives to be chattel, but this dynamic also transcends religion and culture. Thus, "The Secret Life of Islam" tells us nothing about the secret life of Islam. It does give us a compelling narrative about incompetent and insensitive medical care in a Third World hospital.


Allen Lane

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