Doctors strike demanding increased security at one of Cairo's busiest ERs

Interns at Cairo's Qasr El-Aini's emergency ward are struggling with a security vacuum threatening their own lives and the lives of the patients they work with

At 10am Wednesday morning at the Qasr El-Aini Hospital near downtown Cairo a group of about 20 senior house officers (SHO), interns, made a stand in front of the administrative offices, protesting the lack of security in the emergency wards and the lack of administrative response to several attacks on doctors.
The SHOs were busy talking to an administrator when the hospital manager, Dr Sherif Nasseh, walked up to the protesters. One of the trainees complained that there was no action being taken in response to the assault on a doctor two days before. The hospital manager's response imparted an inexorable position: “There is no action in the entire country. If you don't like it here, go do your training at Ain Shams Hospital. Anyone who doesn't want to work here can go home.”
“God willing when the country's security has improved, you can repeat your training next year,” the manager threatened.
The doctors, who had one week left in their course, refused to remain silent and to let the next interns deal with the ward's dangers. “I'm not going to let my brother die,” a young doctor said.
The dean of the faculty sent a staff member to summon one or two representatives to address their grievances, but the SHOs refused, arguing that anyone could come and speak to all of them. They feared that the representatives could be isolated and pressured.
Lack of security
A country-wide security vacuum has troubled many Egyptians for months. Talk of robberies, kidnappings and rampant chaos has floated about - not all completely inaccurate. The police have been reticent to take action on the streets, often withdrawing when needed, and the military have given the impression that they simply can't be bothered with everyday issues. Everything is affected as a result. In the case of Qasr El-Aini hospital, the security void has potentially put the lives of doctors and patients at risk. Patients received into the emergency ward are often accompanied by parties of, at times, five or more. At times, some are carrying weapons. According to the hospital's manager, the ward receives about 60,000 patients per month – an average of 200 per day.
The SHOs did not wish to be named, fearing repercussions by the hospital's administration. Pseudonyms will be used instead.
Dr Ibrahim explained the situation in detail: “At any moment a doctor can be assaulted, either physically, which has happened, or with guns (God forbid). Just yesterday a supervising doctor was slapped across the face. The first assault took place with knives. We're not going to wait for someone to die for there to be appropriate security measures taken.”
“The private security personnel do their job, but they aren't enough. They say ‘why should I die, it's none my business' and often step aside,” he stated. When asked about the military police that had been sent it to assist in the interim, Dr Ibrahim and a fellow doctor stated that they were not enough neither in number, nor in efficacy. The doctors' words proved accurate. Wednesday's excursion into the emergency wing showed that the military police were, indeed, sent in unarmed and would often sit inside, leaving the main entrance unguarded.
Dr Ayman, a supervising doctor, also emphasised that the patients' often come escorted by too many people: “We work with very critical cases. Sometimes a nurse tries to get near to a patient, but is unable to; a doctor finds it nearly impossible to measure a patient's blood pressure. The security is often too scared to speak to the escorts. We can't work in such a threatening environment.” The escorts would often impair the doctors' efficiency by surrounding the doctor and asking endless questions.
The ward has closed several times since 25 January due to such issues, which sometimes last several days in concentration. The hospital workers experienced this twice in the past two weeks.
Dr Ayman was a bit more optimistic than most, believing that since the last assault security has begun to get better, but he was not without scepticism. When asked how the situation would get better, he hesitated. “The administration is twisting the arms of their SHOs. Doctors scared to work are threatened with repeating their rounds. Others with the prospect of being hired are told they might jeopardise their chances. They are, in this manner, forced to work in unacceptable conditions.”
When asked about his threatening words to the administration and future doctors, Dr Sherif countered that it wasn't a threat. He says that, simply, anyone who did not wish to participate in this year's course would have to retake the course if they wished to graduate. “There are no sit-ins in the emergency department by law; it's no joke. If we close people will die,” he emphasised, adding, “The ER is a critical place with circumstances unlike any other place.”
The critical nature of the emergency department is indisputable. The SHOs argue that it is due to the ward's critical role that they need to work in a safer, more orderly environment, however.
“I can't work with a knife to my throat,” Dr Ibrahim insisted.
Police measures and the administration's response
In response to the most recent assault, one of the SHOs went to file a report, with witnesses, at the nearest police station in Masr Al-Qadima. The section officer at first refused to file the report, saying it was too late, but a legal expert stated it was perfectly legal and directed him to the prosecutor's office. It was his right to make a complaint. The report was eventually filed at the police station.
Furthermore, the SHO complained about the lack of documentation when checking-in patients. Certain types of injuries – stabbings, gunshots or anything suspect of having a criminal nature – are, by law, required to be reported to the police. The SHO stated that police reports were never filed at Qasr El-Aini.
Dr Sherif refuted this, but the facts on the ground weighed heavily against any claims that police were present and guarding the entrance. When this reporter toured the ward, though it was not a busy period, the lack of security was definitely palpable. There were no guards standing at the entrance, save for two men in civilian clothing asking about people's business. Nobody escorted anyone about the halls.
Though best characterised as being hard line, the administration's response has, at times, been detached. The faculty dean reasoned that the SHO's hadn't come to her with complaints. How, then was she expected to give a response? She had asked for representatives to come and speak to her, but they had refused. In general, however, the issues raised by the SHOs relate to the police, the security and the military – not to the administration. They were not medical issues, according to the dean. Protesters could go to the military themselves if they wished to rectify the security situation.
For his part, Dr Sherif reasoned that these scenarios occurred in all the hospitals and have nothing to do with the revolution. Explaining the rough nature of the patients and their escorts, he asserted, “They aren't from the Sorbonne or Oxford. What do you expect?”
“This is the maximum we can do at the moment. We have a moral, physical and social obligation that stretches back more than 170 years,” the manager emphasised. “This isn't a seven-star hospital. We all need to make sacrifices.”
So this is not the best scenario, but could it be better? “We wish that private security could be increased, preferably armed, but we need more funding. Basically, we're under-budget, over-stressed and over loaded. We are not being lazy; [the SHOs] are making a problem out of nothing.”
Eventually two doctors, who had already finished their emergency ward duties, went up to speak to the dean and the head of the surgery department. The doctors argued that while these were security issues they affected their ability to work with patients and practice their medicine. The response by the faculty was terse. If they didn't like it they could go home or deal with it. Perhaps, it was suggested, they could form their own popular committee, which worked during the 18-day-uprising, to protect the other doctors. The young trainees pleaded that they were truly worried about their safety. But it seemed their complaints were largely falling on deaf ears.
A third doctor walked in and sided with the two interns. He suggested the ward be shut and an official university and hospital complaint be sent to the Cabinet and health minister.
When the manager was posed with the question of whether they had made attempts to contact the Cabinet or military council, he said the hospital had, indeed, contacted the military - not the Cabinet - for the past six months, asking for assistance. An officer came, but few troops were sent. “They aren't free because of Sinai, as you know. Also, keep in mind that we are very close to the Israeli embassy.”
Dr Ibrahim did not agree. “We are asking for an appropriate amount of security. We are no less than Ain Shams, who have an armoured vehicle to maintain security. There are plenty of military police and security standing around in Tahrir Square; they can bring us some of them to stand at the entrance.”
The demands
According to the SHOs, the emergency ward's manager has not taken any action. Rather, he is waiting for their rounds to finish, leaving the next group of interns to come in unaware of the dangerous work environment. He is, according to Dr Ibrahim, dependent on the quick intern turnover.
The SHOs are, therefore, demanding that the ward's manager resign for his inability to appropriately deal with the situation. They ask for better treatment of the interns and, most importantly, for a minimal level of security.
As of Friday morning, the SHOs have decided to return to work, citing divisions within their ranks. Many feel inclined to maintain the emergency ward operable due to its criticality and others do not wish to act without a unified front. Nevertheless, with no concessions by the administration, the interns are still organising for future action.