Doctors face unnecessary risks
Salma Shukrallah, Wednesday 22 Jun 2011
As their struggle for pay rises and an increased health budget continues, doctor's describe the state of Egypt's public sector hospitals and the risks which both they and their patients are exposed to daily

Egypt's doctors have been systematically staging demonstrations and strikes since the January 25 Revolution. The doctors successfully held two nationwide strikes, on 10 May and 17 May, calling for several demands which include pay rises, the increase of the health ministry budget and heightened security measures in hospitals.

The cabinet had promised to meet their demands, and accordingly, the doctors took a decision to freeze the strike. However, doctors say their main demands have been circumvented. The health ministry budget has remained the same, and the doctors were only promised a raise in salary as part of the government decision to raise all salaries through a new minimum wage.

Speaking to doctors, one hears startling accounts of their current work conditions which in many cases can be life threatening for both patient and practitioner.

“I have not had myself tested either for hepatitis C or for HIV/AIDS, because I know I have a very high chance of being infected with either,” says Hasnaa, an emergency doctor at one of the health insurance organisation hospitals, a branch of Egypt's public health service.

Doctors who have been demanding an increase in salary have also been demanding higher compensation for risk of infection, now as low as LE19 per month. Doctors explain that the risk they take, especially in under equipped hospitals, is life threatening.

“One time there were twelve of us in the operation room, including the doctor, when the patient’s peritonitis exploded, covering all those standing with blood. None of those standing were wearing the necessary protection clothes. The doctor was the only one wearing a gown and he was not even covering his face,” narrated Osama Abdallah, a doctor working at the emergency room of the Qasr El-Aini University Hospital, part of the public health sector.

“Theoretically when a doctor is conducting an operation he should be covering himself from head to toe. The doctor should be wearing gloves, a mask, a head cover, a gown, medical shoes and goggles to cover the eyes. Not only should the doctor be wearing all these things but so to should everyone in the operation room, whether a doctor, nurse, trainee or worker. That is not the case though; no one ever wears all these things. I, for example, have never seen anyone wearing the goggles before,” added Abdallah.

Hasnaa said she first realised the health risk she was facing when she got an acute infection from the gynaecology department where she was finishing her intern year. Hasnaa explains that such an infection was simply a result of the unchanged contaminated bed sheets which she sat on as she was examining the patient. While such acute infections can be immediately detected, major ones are harder to spot without testing.

Hasnaa who currently works with thoracic patients says that the amount of money she has to spend on medication to treat all the infections she picks up during her work can sometimes cost up to three to four times as much as the compensation budget she receives. “I sometimes need to take antibiotics to fight my now chronic chest problems which are enhanced by my work with thoracic patients. My insurance covers an antibiotic which is locally made but not effective in my case. I am forced to buy the more expensive but more effective one which costs around LE60 a box in addition to cough medicine and another medication to lower my temperature. In the end, however, the risk-compensation salary I get is LE19.”

The doctors’ demands have not only been to increase their salary or risk-compensation but to raise the total health budget from only 3 per cent to 15 per cent. “Developed countries have very low communicable diseases, they are almost non-existent, but in Egypt, they are very widespread as basic infection control measures are not applied.

For example hand washing is one of the most important control measures used in hospitals, possibly eliminating 50 per cent of infection spread, but not enough sinks are made available between one patient bed and the other. If I am in a hurry in the ER and the patient flow is high, I do not have time to run back and forth to a sink if it is located far away; I will need to have a sink ready available nearby and equipped with soap or alcohol detergents,” said Ahmed, a doctor at the Qasr El-Aini University Hospital.

“After stitching a patient for example, the equipment used needs to be sterilised for about 2 hours in the sterilising machine; due to a time and equipment shortage and the high volume of patients we receive, it is usually sterilised no more than half an hour,” he added.

Mostafa Abbas, a doctor who used to work in hospital administration, explained that while the ministry upholds the slogan “equipping hospitals is a necessity,” its enforcement is practically impossible due to the gross misappropriation of funds. A lot of money goes into infection control and quality control courses while hospitals lack funding to make the necessary equipment available, Mostafa asserts.

The absence or shortage in infection control mechanisms does not only impact doctors physically but also psychologically. Doctors explain that they suffer from an immense level of stress knowing that they are constantly being exposed to such dangers and, what is more, suffer a lot knowing that they sometimes either compromise the patient’s health or are forced to choose between their health and that of the patient’s.

For example, explains Abdallah, when there is a shortage in gloves and a doctor has just operated on a patient in the emergency room and another patient, in a critical state, is rushed in, the doctor has to choose either to reuse the same gloves, used with the previous patient, or use his bare hands. The first option would put the patient at risk while the second would put the doctor at risk.

Some doctors say they buy their own gloves and masks. However, with the low salaries public sector doctors earn, many probably cannot afford to regularly fund their own equipment. Hasnaa says she used to earn a monthly salary of LE680 ($114.4) in her previous job, including risk compensation, bonuses and travel expenses, as she worked in one of the new cities, far away from Cairo's centre . However, since the bonuses and all other expenses are usually up to six months late due to bureaucratic problems, Hasnaa says she only received her basic salary regularly which is LE282 ($47.4) per month.

Apart from health risks, doctors also face other forms of risks. Gerges, a neurosurgeon who used to work in a health clinic in one of the villages of Upper Egypt’s Sohag where he was assigned, says doctors have to work at hospitals and clinics that have no security and are often exposed to threats and attacks either by patients’ angry family members or thugs.

“Since there is a shortage in intensive care beds, we often have family members of patients fighting with doctors for not taking the patient into the intensive care unit. One time, a family of a patient stormed into one of the intensive care units and forcefully removed a patient who was already on the bed in order for their relative occupy the bed instead. The doctors couldn't do anything since the families would attack them if they objected; police are not available to interfere as well. Likewise, we are often attacked by angry family members if something happens to the patient or if they feel the patient is not getting enough medical attention,” says Gerges.

Furthermore, Gerges explains that the stress levels doctors go through exceed the normal levels. “I rest a total of 12 hours a week and I sleep at the hospital where I work,” says Gerges. Most often hospitals and clinics, explains Gerges, are not equipped to have doctors sleep over as there are no suitable beds, clean sheets or a place to eat, and despite this doctors are often expected to be available for a 24 hour long continuous shift.

Gerges was the only doctor available at the clinic where he worked in Sohag, which is often the situation in remote rural villages where only one doctor is assigned, meaning that he had to live in a room attached to the clinic. Gerges says: “It was completely unequipped, and it was extremely cold in winter and extremely hot in summer, as is the case in Sohag, with no heating or cooling equipment available.”

While lack of infection control and lack of hospital funding obviously affects the quality of health care patients receive, very little attention is given to the impact it has on doctors. Egypt’s doctors who have been trying to make their voices heard through strikes and demonstrations are not only suffering from low pay but explain that they are facing daily life threatening risks due to a health care system which is so alarmingly under equipped.