CAIRO: “I chose to study medicine because I wanted to help those in need, to make a difference – but it turned out that this was impossible.
So says Mina Zekry who currently works in a human rights organization, but is a qualified doctor. He was driven out of the profession by the economic hardship and difficult working conditions which are the reality of life for Egyptian doctors.
Zekry says that he found it impossible to survive on the wages he received while he worked as an anaesthesia intern.
“I was working 12-hour shifts, which left no time for outside work in private clinics. My wage – LE 180 per month – didn’t even cover transport costs. Wages are so low they’re a joke. A new graduate doctor receives LE 150 per month, meaning that he’s torn between working with dedication and integrity, and trying to survive financially, Zekry told me.
Zekry’s experience epitomizes the rigors faced by Egypt’s 170,000 doctors. After six years of university study and an internship year, graduate doctors working within the public health system find that the years dedicated to study are rewarded with long working hours in a pressurized environment for pitifully low financial compensation.
“I myself advised my two younger sisters not to choose medicine because of the problems you face in the job, Mona Mina, a doctor who has been practicing for 25 years told Daily News Egypt.
“Doctors and medicine are in a bad state in Egypt. Doctors want a reasonable salary, want to work in a decent, well-equipped hospital and have opportunities for education and training – continual training is a fundamental part of the profession, she continued.
Mina Girgis, a resident doctor based in Cairo’s Tumour Institute says that stressful working conditions affect the quality of service he delivers to patients.
“At the end of my outpatient clinic I’m not the same as when I started my day because of the huge flow and the pressure. We don’t have separate rooms.in one room we’re examining three patients screened off by curtains, he said.
“Each doctor treats about 10 – 15 patients and my unit treats about 100 people each day in the outpatient clinic. In my department there are 24 beds which are always full. The problem is that we have a huge load, a heavy flow of people coming everyday so the service isn’t that good, Girgis added.
The Tumour Institute made headlines last month when a surgeon left a towel inside a patient as a result of which she died.
Girgis says that while the treatment offered in the Tumour Institute is compromised by working conditions and poor pay, vulnerable, politically-disenfranchized patients do not often complain.
“People do not usually complain because they are of a very low social standard and are not aware of their rights, Girgis explained.
The continuing deterioration of their working conditions have propelled Egyptian doctors into action.
In May 2007 they formed ‘Doctors Without Rights’ www.atebaabelahokook.blogspot.com which aims to draw attention to the plight of medical practitioners in Egypt.
The group’s founding statement lists low salaries, negligence in government hospitals and the economic exploitation of patients in private clinics as the motivating factors behind the group’s establishment Low wages force many Ministry of Health-employed doctors to supplement their income by working in private clinics but, as the founding statement points out, this solution is untenable given that there are 170,000 doctors in Egypt and only 40,000 private clinics. This struggle to make enough money to live inevitably affects a doctor’s performance, as Mona Mina explained.
“Doctors have to look for alternative sources of income in clinics and consultations in hospitals, meaning that they work on average 16 hours a day. Where’s the time for rest, for study? When does a doctor go to a patient relaxed? she asked.
Zekry says that private healthcare has contributed to the deterioration of the public healthcare system because “Doctors approach private healthcare as a business and patients pay the price.
Zekry in any case had ethical problems with entering private medicine.
“I didn’t want to stay in medicine and be forced to open a private clinic because this goes against the principles which motivated me to enter medicine in the first place, he said.
Both Mina and Zekry said that doctors driven by economic circumstances to open private clinics are often under-qualified.
“Students don’t receive adequate training, neither in university nor during the internship year. The problem is only made worse when new doctors begin work because they’re supposed to learn through practical experience, which is lacking, Zekry said.
Doctors Without Rights have four key demands. They want a minimum wage of LE 1,000, want allowances (for night-shifts, for example) to be increased, want new graduates to be able to pursue further education more easily and for course fees to be reduced (it currently costs a prohibitively expensive LE 1,500 to pursue a masters in medicine) and, finally, want state spending on the health sector to be increased.
Doctors Without Rights state that currently only 4 percent of the national budget is allocated to health. They want this figure to be doubled because, as Mina told Daily News Egypt, “The problem is that doctors don’t work alone, they work as part of a health structure in hospitals and require equipment, medicine, and so on. In order to perform well they have to be part of an organized health system, she explained.
Doctors Without Rights works in coordination with the Doctors’ Syndicate – Mina said that while the demands which the Syndicate has repeatedly made over the years accurately reflect doctors’ grievances, nothing has changed.
“The group benefits from the weight the Syndicate gives it, but at the same time is necessarily more dynamic because of the involvement of young doctors, she said.
Doctors Sunday held a protest in front of the People’s Assembly to draw attention to their grievances.
Some sixty doctors occupied a pavement opposite the People’s Assembly on Qasr El-Aini Street, a busy thoroughfare in downtown Cairo watched by a heavy security presence who, while they didn’t interfere with the protest, were quick to move on interested by-passers and traffic.
Head of the Doctors’ Syndicate Hamdy El-Sayyed told Daily News Egypt the protest is part of an ongoing campaign.
“This is part of a series of peaceful actions we have planned for the next few weeks to draw attention to the plight of doctors, El-Sayyed said.
In an extraordinary general meeting held on Feb. 1, members of the Syndicate decided that they will go on strike between 9 and 11 am on March 15. Doctors working in the Accident and Emergency (A&E) and maternity units will not be striking so as not to put patients’ lives at risk.
“Doctors spend a long-time studying, are on duty day and night and deserve a special wage-scale – we’re the lowest paid of all public employees. The government continually says that there is not enough money for everyone, not just doctors, but we think doctors are a special case because of the hours we work and the fact that we require continuous training, El-Sayyed added.
While doctors’ basic salaries are supplemented by incentive payments and allowances, Mina says that these can be manipulated by hospital administrations who do not wish to pay them because they are not fixed.
“The Ministry of Health says that it is trying to make things easier for doctors with the incentive payments, but we strongly doubt its intentions. The evaluative methods which decide whether incentive payments are given make it easy for a hospital administration to reduce incentive payments for one reason or another. We can’t rely on these payments, she said.
El-Sayyed also said that Parliament is currently examining a draft law which proposes that doctors’ ability be re-assessed every five years by the National Committee for Professional Upgrading. “Given current conditions, this could threaten many doctors’ livelihoods, he said.
nding side-by-side in the protest clutching banners were two doctors at the opposite ends of the career path.
Amr Youssef graduated in 2004 and currently earns a basic wage of LE 150 in an Alexandrian hospital where he is a resident doctor.
Salah Metwally Hussein from Beni Suef is an obstetrician who, after 28 years in the profession, earns LE 600 a month.
“It’s not enough to buy a suit, never mind support a family or buy a house or a car – which is essential for a doctor, Hussein told Daily News Egypt.
Hussein described his work schedule: He works in a government hospital from 8 am to 2 pm and then goes to a private clinic in the evenings. He is on emergency call at least once a week and must be available to assist at any time if a major emergency occurs. “I work 16 hours a day, he said.
The Doctors’ Syndicate says it will continue its protest until the government responds to its demand that doctors receive a wage enabling them both to live with a semblance of dignity and give patients a decent standard of treatment.
“We’ve been talking about the conditions doctors work in for 20 years. Twenty years ago conditions were bad, now they’ve become catastrophic. A doctor these days would earn more if he cleaned homes, Mina said.