While calls are made to improve security in Egypt's hospitals amid near-daily attacks, doctors point to the root cause: the woeful deterioration of medical services and strains on the medical profession Recurrent nationwide attacks in Egypt's public hospitals started amid the security vacuum that has been lingering since the 2011 uprising. Upon close inspection, however, these assaults– which are usually labeled thuggish–cannot be entirely explained by reference to the country's security status. It is often the family and friends of a patient who wreak havoc in hospitals. Physical abuses by angry mobs against doctors and medical staffers have repeatedly occurred to an extent that prompted several doctors to stage protests and go on strikes in disgruntlement. A junior doctor on his compulsory post-graduation internship at Qasr El-Aini Hospital, in downtown Cairo, said that even Egypt's largest public hospital has been witnessing such attacks almost on a daily basis, with the perpetrators usually armed. "For example, if one man was severely injured or ill and doctors couldn't save his life, his family members or friends would take their rage out on doctors, who would have no other option but to run for their lives," he told Ahram Online on condition of anonymity. "The patient himself might turn violent too. I once saw a man who sustained a gunshot wound to the chest decide to physically fight a doctor right before undergoing surgery, because the doctor cracked some joke that he didn't like, and thus he flew off the handle. "He was supposed to have general anesthetic, so the doctor was trying to distract him from the injury and make him less tensioned. Instead, his words led to a fist fight after the man engaged him, despite his condition. "Violence has become an integral part of our daily work in recent months. Doctors are always threatened and the security presence at hospitals is feeble. At Qasr El-Aini, there are usually a few military police personnel, but they do nothing to contain such situations." Late in August, the board of the Doctors' Syndicate threatened to declare a general strike in all hospitals across the country, citing what they describe as the "negligence" of the interior ministry in securing hospitals. The syndicate's general assembly is holding an emergency meeting 21 September to discuss the problem, while the interior and health ministries are to appear at a press conference Thursday, 6 September, to offer possible solutions. Ex-Major General Mohamed Kadry Saied, a strategic and military analyst at Al-Ahram Centre for Political and Strategic Studies, believes the "attacks on hospitals are very intensive," and that "the interior ministry cannot provide enough troops to secure them all." Yet recently after many complaints over the raids on public hospitals, the interior ministry reportedly decided to launch a new security department only commissioned to deal with assaults on hospitals, with a special phone number to report violence or misconduct. The service, whose efficiency is yet to be tested, is considered to be a "great" step, according to veteran doctor Mohamed Debes, the former general manager of Um El-Masreyeen (Mother of Egyptians) Hospital and the Suzanne Mubarak Specialised Hospital for Children. "It is really great to have such a service that would definitely come in handy," said the prominent urologist Debes, adding, nonetheless, that securing medical facilities is not a permanent remedy to the current problem. Frustration at medical services Not all those who made scenes or turned violent at public hospitals were thugs. Some were ordinary people who lost their temper because of "deteriorating" and "insufficient" medical services, or at the bad treatment they received at hospital receptions or by doctors, Debes opines. "Just go visit any public hospital or medical centre and you would understand," he said. "One would be treated in the worst possible way by the staff there, not to mention that all of these facilities always bustle with swathes of patients, which increases disorganisation and chaos. "Speaking of equipment, you can find four doctors share one medical headset, or one big public hospital where the doctors do not have a single working blood pressure gauge at their disposal. This kind of insufficiency surely makes people angry. "After the revolution," added Debes, "people tend to speak out against whatever they don't like or think is unfair, and there is a lot to complain about when it comes to public hospitals and medical centres." The junior doctor at Qasr El-Aini Hospital narrated horrifying stories in this regard. "I can assure you that some full-scale operations are conducted without general anesthetic, when the hospital does not have any," he said. "Doctors would just falsely convince the patient that they drugged him, whereas they would give him a mere salt water injection. Tricking the patient would physiologically help him endure the acute pain to a degree. "You can find whatever crosses your mind in public hospitals. I have seen kittens delivered in the emergency room of a public hospital in 6th of October City (on the outskirts of Cairo). People are supposedly not allowed to get in without being sterilised. Echoing Debes' sentiments, the junior doctor added: "And the daily pressure on doctors further worsens the situation. "An emergency doctor would literally leave a patient die just to get some sleep at the hospital. It happens at Qasr El-Aini," he said. "He knows that there will always be some patient in a critical condition and he knows that he cannot save them all while working around the clock." The 70-year-old Debes continued: "From my perspective, the young doctors these days are much less soft-hearted than senior ones, who used to be really keen not to break a patient's spirit. That's why doctors are dubbed the 'Angels of Mercy.' "That is not the case with most of today's doctors, who wouldn't hesitate to tell off patients or bluntly inform them of [unpleasant] truths that needed to be delivered in a gentle way. But let's not forget that all circumstances are changed in comparison to my days. "For instance, some of the young doctors nowadays are from low social classes and they treat people accordingly, unlike my time when doctors used to come only from wealthy and high-class families." Debes also highlighted that doctors these days, apart from working without the ample equipment or resources and shouldering an immense daily work pressure, are greatly unsatisfied over low pay. "Young doctors these days are frustrated too, mainly because of low pay. If one young doctor is taking a monthly salary of LE1,200, a banker at the same age would take LE4,000 or 5,000, so they are underpaid and unsatisfied." How to fix the situation? As long as patients are unable to find proper medical care and doctors are bemoaning their work circumstances and salaries, attacks on hospitals are not likely to stop, Debes reckons. "I heard some really absurd solutions suggested to end the attacks on hospitals, such as surrounding hospitals with barbed wire, permanent deployment of security forces at each facility, or hiring thugs to stand against possible assailants," he said. "Such suggestions would not put an end to the problem and would only turn hospitals to something else– bunkers or whatever. The only way to end this is to improve the public medical service. "Every patient has the right to be received respectfully at public hospitals and find the proper care from doctors, who in return have to be fairly paid along with the other medical staffers, with the required medical equipment provided. "But making the service at public medical facilities equivalent to that in private ones will cost a lot, and we don't have enough money to do that, it seems." Egypt's 2012-2013 health budget is estimated at LE27.414 billion, comprising five per cent of the state budget. Funds allocated to health have increased 18 per cent since last year. In April, the Right-less Doctors movement along with a similar group, Defending the Right of Health, lobbied for a significant rise in the health budget, before the release of the current state budget. They triggered a national campaign to raise the health budget to 15 per cent of the total state budget, in order to enhance the level of medical care, especially that provided to the poor. The campaign, however, seemed to tail off in subsequent months. http://english.ahram.org.eg/News/52036.aspx
