Hospitals under attack

Not a day now passes without news of an attack against doctors, nurses, or hospital workers, including assaults in hospital emergency rooms. The result has led to a dramatic spate of

Not a day now passes without news of an attack against doctors, nurses, or hospital workers, including assaults in hospital emergency rooms. The result has led to a dramatic spate of closures of emergency rooms in some of the busiest hospitals. While closure is usually temporary, even that can have a tragic result if a patient misses out on urgent medical treatment.

The Doctors’ Syndicate has been demanding that the Interior Ministry helps to secure hospitals against attack, which may range anywhere between a fist fight to the use of knives or gunfire. Since such attacks are usually waged by the family members or friends of patients who allegedly are not being provided with adequate medical care, the syndicate has also demanded that the Health Ministry works to upgrade medical services.

Family intervention

A typical scenario is that the family of a sick or injured person takes him or her to the emergency room. If the patient is left lying around for some time before a doctor comes to see him, or if after he is checked into the hospital he receives what the family sees as inadequate care or medication, or—worse—if he should die, it may spell disaster. The family or friends may see this as gross negligence or medical malpractice; a fight follows with the doctor or nursing staff, and all reasonable behaviour goes by the board.

It stands to reason that, in most cases, the medical staff are not to blame. Yet they have to bear, unprotected, the brunt of the abuse. In the few cases where they are palpably to blame, they place the blame on the Health Ministry, which in turn says it has not sufficient means.

The head of the Doctors’ Syndicate, Khairy Abdel-Dayem, recently reviewed a number of proposed resolutions to protect doctors and solve the problems of emergency patients with the Health Minister, Mohamed Mustafa Hamed.

Ending attacks

Will this contribute to putting an end to attacks on both hospitals and doctors? Watani took the question to Mona Mina, a tireless advocate for doctors’ rights, a member of the board of the Doctors’ Syndicate and spokesperson for Doctors Without Rights.

“Unfortunately the series of closing emergency rooms or even entire hospitals continues,” Dr Mina said. “But worse, when they reopen, they reopen without any security.”

So why do hospitals allow a large entourage to enter with a patient? Surely it would be safer and more convenient for the hospital to allow patients in with only one or two companions’?

“Over the past year and a half—that is since the January 2011 Revolution—we have been pleading with the Interior Ministry to provide hospitals with enough security personnel and to be allowed to prevent such large numbers from entering,” Dr Mina said. “But there has been no response. The huge number of ‘visitors’ or ‘companions’ has continued to come in; the outcome being that in cases of any disagreement the doctors and nurses are beaten up. The hospital administration, unfortunately, is forced to close down the emergency department in such cases, and the patients are the victims.

“One hospital that was closed in the East Delta town of Zagazig, the Ahrar Hospital, alone receives close to half the patients in the entire Sharqiya governorate.”

Vulnerable hospitals

Watani spoke to Ahmed Lutfi, member of the board and spokesman of the Doctors’ Syndicate. “We asked the branch syndicates in Egypt’s governorates to determine the hospitals more exposed to attacks,” Dr Lutfi said. “The results listed some 100 hospitals, most

of them State hospitals in Cairo, Sohag, Damanhour, Mansoura, Sharqiya, and Abu-Qurqas in Minya.”

But why the attacks in the first place? And is this a recent phenomenon? “The phenomenon is not unheard of,” Dr Lutfi replied. “There used to be cases where the family members of a patient would attack a doctor or other member of the medical staff once the patient’s condition deteriorated or he or she died, but this was the exception not the rule, and the attack was usually no more than a fist fight. But since the January 2011 Revolution, matters have escalated. The number of fights has risen dramatically, and the use of knives, daggers, and gunfire has become very common. Emergency rooms have been damaged, and in more than a few cases medical equipment has been destroyed. In the Qasr al-Aini hospital in Cairo, the teaching hospital of Cairo University’s medical school and among the largest and best equipped hospitals in Cairo, an entire floor was damaged in one such fight a couple of weeks ago.”

Junior doctors

The most common reason for a fight, according to Dr Lutfi, is that a patient’s family believes their relative should receive individual, intensive care, disregarding the fact that the number of injured has increased in the aftermath of the 25 January 2011 Revolution. “A patient’s relatives always see any delay or deficiency as unacceptable,” he says.

On the other hand, many of the doctors in the emergency ward are young, and may not posses the experience or patience to explain matters to a patient’s relatives. This sometimes ends badly.

“Which does not mean that there is no deficiency,” Dr Lutfi says. “We frequently have to put up with a shortage of medical necessities like cotton, canulas, or even some types of medication. The numbers of beds or incubators may be insufficient, and technical maintenance may be inadequate. There may even be too few doctors.

“There is poor distribution of doctors; most are placed in Cairo and the Delta, while there is a shortage in Upper Egypt where patients may have to wait for hours until a doctor can see them,” he added.

Lucrative incentives

Watani reminded Dr Lutfi of recent promises by the Health Ministry of lucrative incentives to junior doctors who accept to work in the more remote areas. “True,” he said, “But these incentives have remained ink on paper and never materialised. The result is that we are still on Square One.

“No doubt improving health and medical services would help solve at least 75 per cent of the problem.”

Recent news that the Doctors’ Syndicate has been demanding that doctors carry arms caused something of an uproar. “This demand has been widely misinterpreted by the media,” Dr Lutfi said. “The idea was not that a doctor should be armed while on duty. Doctors are often targets of armed robbery since they may have to drive on lonely roads or are assumed to be wealthy, so the syndicate has demanded that it should be made easier for them to obtain a licence to carry a gun, for self defence.”

In the right direction

“This is how Egypt has been living since the January 2011 Revolution,” Adel Abu-Zeid, managing director of curative medicine at the Health Ministry, laments. “Protests, sit-ins and unrest everywhere, even in medical and security establishments.”

“Does it mean that there is no hope for a remedy any time soon?” Watani wondered. “On the contrary,” Dr Abu-Zeid noted, “the Health Minister has allocated some EGP300 million, instead of the current EGP20 million, to finance urgent medical care, including emergency units in hospitals. The Abuja declaration Egypt signed in 2001 stipulates that 15 per cent of any

State’s funds should be allocated to medical care. In the case of Egypt, the allocation does not reach 4.7 per cent.”

During the recent talks between the ministers of health and the interior, it was decided that a small police unit should be placed in each public hospital. The Health Ministry, for its part, has issued a decision that emergency rooms should at any given time include two consultants, besides the usual number of junior doctors. All those whom Watani talked to, not to mention a large portion of the public, hailed this as a move in the right direction.