Rashwan Shaaban, Assistant Secretary-General of the Egyptian Doctors Syndicate, states the problem in a nutshell. “The strikes started in May and October 2012 and then again in January and February 2014 because the state of the health system and those who work in it are not satisfactory. In fact, the system is bad on both the economic and scientific levels. A newly appointed doctor earns just LE900, and on retirement his income is around LE3, 000.” How can the system not be in crisis, he asked. “Last Monday, 50 per cent of the country's doctors were on strike. In January the number was about 75 per cent. We have been calling for improvements in education and the quality of the hospitals. We want to see doctors better protected from the hazards of their profession and in some cases from their patients,” Shaaban added. Funding is currently not adequate to provide the services that patients deserve, and while the government does not suffer from this directly, many doctors do since they are on the front lines of the health service. As if to underline the problems the profession is facing, at last Friday's meeting of the board of the Doctors Syndicate members called for the resignation of Minister of health Maha Al-Rabat, saying that she was “standing in the way of the profession's demands.” Al-Rabat was referred to the Syndicate's ethics committee, the move coming in the wake of the resignation of the Syndicate's Secretary-General Mona Mina, though this was not accepted by the board. “Egypt is party to various international agreements, including the Abuja Agreement which recommends that governments spend 15 per cent of national income on healthcare. However, in Egypt we only spend around 4.6 per cent. In addition, there has been little care given to efficiency, with some hospitals spending more on buying new ceramic tiles than they do on basic medical equipment, for example. It was only recently that the University of Alexandria Hospital had to close its emergency room because it had no surgical gloves,” Shaaban said. “Law 14 of 2014, which provides the framework for medical training, needs to be revised. Law 47 of 1987 equates a Bachelor of Medicine degree with any other graduate degree, making doctors government employees like any others while in fact they have to invest some 30 months longer in their education. Doctors' working hours are longer than those of other government employees, and they also work on public holidays and at weekends,” Shaaban added. Egypt's doctors should receive salaries more in line with their working hours, particularly since while a regular civil servant works from 8:00am to 2:00pm, a doctor can easily be expected to work for 48 hours if there is an emergency case or an accident, for example. “The system of salaries in Egypt makes fixed remuneration only 25 per cent of the overall salary, while the variable remuneration, which includes bonuses and incentives, is 75 per cent. This means that when a doctor retires, his pension is calculated on 25 per cent of his salary, and this is far too little for all his years of service. In fact, it is not even enough to buy the medicine he himself may need during his retirement,” says Shaaban Mohamed Allam, head of the Gynaecology Department at the Om Al-Masriyin Hospital in Giza, agreed. Doctors at the hospital had been forced to take part in the strikes, he said, since they had found themselves working around the clock and having to cover for other hospitals that barely had any medical equipment. “We do not want anything for ourselves. We are striking for the generations to come,” Allam said. “If the budget of the Ministry of Health increases, the hospitals will become standardised, meaning that they will all be able to provide the same services for patients at the same quality. This will enable us to divide hospitals into healthcare units, central hospitals, public hospitals and private specialised hospitals, adding to efficiency, and there will be better opportunities for doctors to receive proper training.” Such improvements would have clear advantages for patients. A patient living in Assiut, for example, would not have to travel to Cairo to be treated because the quality of medicine would improve in his home town. “There should be a plan to improve post-graduate education for doctors and provide chances for them to attend seminars to update their training. There should be single protocols observed by doctors in every hospital in Egypt, as at the moment hospitals differ wildly from each other. There should be more security in hospitals to allow doctors to work more efficiently,” Allam said. Mohamed Azzam, also a doctor, agreed. “There should be allowances for doctors who work in distant governorates and incentives for medical-school students who are in their practical training year. There have been cases in which doctors have been prosecuted for negligence, and this should be reviewed. What we need is a system more like the one in Saudi Arabia where doctors receive comprehensive professional insurance that meets the costs of any mistakes or possible litigation. The draft law that the government plans to issue does something for doctors now in service, but it does nothing to improve the lives of pensioners,” Azzam commented. Ahmed Kamel, a spokesman for the Ministry of Health, said that the current round of strikes had started in the aftermath of the 25 January Revolution, when there had been many demonstrations and strikes. “Negotiations started in order to draft a new law covering the medical professions, including doctors, pharmacists, dentists, nurses, physical therapists, scientific technicians and medical technicians,” he said. According to Kamel, there are 514 government hospitals in Egypt, along with 139, 999 state doctors, 51, 300 pharmacists, 12, 817 physical therapists, 21,606 dentists, 153, 965 nurses, 6, 043 scientific technicians and 75, 786 medical technicians working in government hospitals. Last Wednesday, only 15 per cent of these hospitals were on strike, he said. “The government decided to go ahead with applying the law that had been negotiated with the medical professions and the Ministry of Finance, resulting in LE6 billion more being spent on salaries in the medical sector. We also have a plan for improving hospitals and carrying out projects that were postponed in the past, including improved medical training and teaching. We also aim to improve the working conditions of doctors and the medical services as a whole, and LE750 million has been set aside especially for this purpose. Five syndicates have approved the new law, and only the Doctors Syndicate and the Pharmacists Syndicate have reservations,” Kamel said. The Pharmacists Syndicate wanted to see years of study included in pension rights, and it wanted to see its members have the same rights and privileges as doctors, he added. “Salaries will be increased soon and financial rights will be given retroactively starting from this January. Some parties have been trying to politicise the problems of doctors by saying that the government does not care about the country's health services. This is simply not true, and we have been talking to the Ministry of Finance, the crisis management committee of the Ministry of Defence and the president to find solutions. Besides, many of us here in the Ministry of Health are doctors ourselves. Why should we neglect the needs of our colleagues,” Kamel asked. Kamel dismissed the fears of some doctors that the raises in salaries would just be temporary. “The money comes from the Ministry of Finance, and it has been permanently allocated to the Ministry of Health for salary purposes,” he said. While he acknowledged that there had been deficiencies in some hospitals, he said that the ministry was working on improving conditions. Kamel reassured doctors that basic equipment was available and functioning. “We have 30 million antibacterial masks in our storage warehouses, enough for many years to come. Everything is there. They just need to ask for it,” he commented. Last Thursday, the ministry gave details of the new law at a press conference in Cairo, saying that it would standardise the salaries of Ministry of Health employees. A copy of draft law 14 for 2014 in the possession of Al-Ahram Weekly includes articles on professional evaluation and promotion (Articles 4 to 6), appointments (Article 8) and additional bonuses and incentives (Articles 9 to 18). It also states that the ministry will fund the post-graduate studies of doctors working in government institutions if this serves their specialty, depending on the state of the ministry's financial resources (Article 7). In 2011, there was a two-day strike on 15 and 17 May that aimed at sending a message to the government that doctors needed better salaries as well as better working conditions if they were to improve medical quality. The strike did not include units dealing with critical cases, intensive care units, premature children's units and kidney failure departments. In September of the same year, doctors went on strike once again in 55 hospitals and organised a sit-in in front of the prime minister's office. In 2012, due to the strikes the families of some patients attacked doctors in some government hospitals or forced them to treat patients at gunpoint, triggering further strikes. In 2014, the Doctors Syndicate decided to start partial strikes in all government hospitals every Monday and Wednesday until their demands were met. According to Shaaban, future governments should work on improving the country's medical institutions by improving buildings and medical equipment and the lives of those working in them. “We need a framework that will ensure that all doctors have their financial rights and work in suitable conditions. We need the budget of the Ministry of Health to be increased so that doctors are able to work more efficiently in the hospitals,” he commented. “We have our doors open to everyone, and we are talking to our colleagues, the doctors, pharmacists, nurses, dentists, everyone. At the end of the day, these people are the ministry's best resources. I'm sure they understand the economic situation the country is going through and the fact that we all need to work together in order to pull the country forward,” Kamel said on behalf of the Ministry of Health.
