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State of ill health
Published in Al-Ahram Weekly on 10 - 07 - 2008

The country's health system is falling apart but reform is reportedly under way, writes Reem Leila
Lack of professionalism is a major problem in many fields, perhaps none more so than in the medical sector, where we often talk about life and death. There have been numerous cases of fatal medical mistakes and people are now questioning the proficiency of physicians and surgeons. It is no secret that in many cases patients have come to mistrust doctors, while most senior officials prefer to receive treatment overseas.
A 57-page survey issued by the Forum for Development and Human Rights Dialogue (FDHRD) on 5 July regarding the health system in Egypt stated that in 2007 nearly 280 patients died due to health deficiencies.
The survey, which analysed all health news published in 20 local papers across the country, revealed that 14 per cent of the deaths were due to flaws in the anaesthetic doses given to patients, 14 per cent was attributed to doctors' mistakes either during or after operations whereas 72 per cent died due to inefficient nursing, electricity power cuts and lack of essential equipment.
Thirty-one per cent of the patients who died due to medical laxity lived in Cairo, 10 per cent in Alexandria and the remaining were residents in various governorates.
Well publicised tragedies have raised the issue of the efficiency of the Egyptian healthcare sector. Shocking was the death of four neonatal infants and one adult on 22 May following a power cut in Egypt's second biggest hospital, Al-Matariya General Hospital in Cairo. In June 2006, a fire in the newborn incubator unit in Al-Shatbi Hospital in Alexandria killed 54, 50 of whom were infants.
Sometimes the problem concerns a misdemeanour with the help of doctors. Two Egyptian patients were caught seeking to donate their kidneys to a Saudi and a Sudanese, even though according to Egyptian law, Egyptian citizens may not donate any of their body organs to a foreigner, and may do so only among close relatives.
According to the survey there is dire need for a more effective health system capable of providing citizens with high quality medical service at their outlet of choice.
Shadi Abdel-Karim, a member of the FDHRD and one of the survey's contributors, believes the health system in Egypt is in bad shape. "It has no real supervision, a doctor works in two or three places at least to earn more money and does not give real care to the patients. The management of most hospitals, especially governmental, is unprofessional. They are simply physicians who are old enough to be managers but with no real managerial or medical skills."
Mohamed Sharaf, former chairman of the Public Treatment Institution, believes that insufficient training is very much to blame. "The increasing number of medical students makes it very difficult for the teaching staff to maintain high standards," Sharaf told Al-Ahram Weekly. Meanwhile, young, poorly paid physicians are compelled to work at more than one clinic or hospital to make a decent living. "This means they do not have enough time for each patient," Sharaf said.
Business-oriented physicians have also gone off track, giving priority to personal gains rather than the health and well-being of patients. Sharaf highlighted poor administration as another flaw in the running of hospitals. However, "there is a difference between professional mistakes and complications that may arise due, for instance, to the side effects of drugs," added Sharaf.
Professionals are not always to blame. Poorly equipped operating theatres and hospitals are often to be condemned.
But according to the survey, physicians' mistakes are recurrent due to the lack of penalties imposed on them and lack of proper training of physicians and nurses. Hamdi El-Sayed, head of the Health Committee at the People's Assembly and president of the Egyptian Physicians Syndicate (EPS), said one of the problems is underfunding. Minister of Health and Population Hatem El-Gabali has said he needs an additional LE18 billion to improve the medical sector nationwide. The ministry's budget for 2007/08 is LE8.5 billion.
El-Sayed noted that the EPS has called for an independent inspection body to supervise all medical establishments. He suggested a system "which measures their performance. A doctor with weak performance should be permanently suspended."
Official spokesman of the Ministry of Health and Population Abdel-Rahman Shahin agrees with the facts presented in the FDHRD survey, stating that Egypt's health sector is in dire need of an overhaul. Things have started in that direction. Nearly 1,000 medical centres around the country have been closed down because they were not in accord with national health standards.
Shahin said a draft law on organ transplants to be passed by the PA in its next session will include severe penalties to be imposed on physicians who are found negligent that could reach 10 years in prison and a LE500,000 fine, instead of one year in jail and a LE500 fine. He said another law is to be passed soon by the PA organising training programmes for physicians. According to a draft law on sustainable profession development, physicians will be granted a five-year permit instead of the current lifetime licence.
According to the draft law, permits will not be renewed unless the physician has undergone theoretical and practical training courses. "This will guarantee the improvement of physicians' performance in the long run. If the physician does not attend the training courses conducted at the National Training Centre and affiliated to the Health Ministry his or her permit will not be renewed," Shahin said.
Some LE360 million of the Health Ministry's LE10 billion next fiscal year budget will be allocated to increasing physicians' salaries "in order to encourage them to enhance their performance," Shahin added.
According to the new draft law which is prepared in coordination with all concerned authorities, the Ministry of Health intends to gradually decrease the number of the current 9,000 would-be doctors by 10 per cent each year until medicine graduates are cut to 3,500 to suit the country's needs. "There are nearly 170,000 physicians in the country who are considered a burden on the health system," added Shahin.
El-Gabali recently announced that the government plans to establish 50 new state hospitals in Egypt, using both local and foreign private sector financing. The project is scheduled for completion prior to the implementation of the new public health insurance scheme in 2011.


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