Hospitals under stress
More and more patients are flocking to government hospitals, putting greater pressure on already overextended medical facilities, writes Mai Samih
Since last year's 25 January Revolution, security hasn't been back to normal on Egypt's streets, and though the police are now back on the beat many areas still suffer from occasional violence, with some people apparently believing that they are above the law. The public hospitals have been affected by this wave of insecurity, with the relatives of wounded citizens sometimes attacking hospital staff and others.
According to Abdel-Rahman Abed, manager of the Umm Al-Masreen Hospital in Giza, "due to the state of lawlessness after the Revolution we have witnessed unprecedented incidents in the Hospital, such as fights that begin in the streets and end in the wards. Doctors, nurses, and members of our work crew have been verbally or physically insulted. As a result, we have closed our emergency department down in order to reconstruct it to cater to such security problems."
The Umm Al-Masreen Hospital is a government hospital that caters to 3,000 patients per day, including 2,000 in clinics and 1,000 in the emergency department. It mainly serves poor patients free of charge, and it has a considerable workload, Abed commenting that "we do 140 x-rays per day, and in the clinics we do 100 x-rays."
Mahmoud El-Shennawi, the manager of the Al-Hilal Hospital, agrees. "The main problem is the crowded emergency department. Because we are in the centre of Cairo, we are constantly subjected to pressure, particularly because other hospitals close their emergency departments at night. We also specialise in bone surgery, meaning that we have a lot of patients."
"The problem is that many of the patients who come to us have already been to other hospitals that have been unable to provide them with help. As a result, they come to us, and we have to bear the brunt of their frustration."
In dealing with difficult or abusive patients, the police should have the final responsibility, El-Shennawi says. "Of course when a problem occurs we take legal action, and we try to train doctors and employees to deal with difficult patients and try to support them as they do so. However, until the present wave of violence comes to an end, hospitals need security reinforcements."
While there is a police post in the Hospital, this has only one officer on duty, which El-Shennawi argues is inadequate. "The Hospital is in Ramsis Street close to Ramsis Station, Wekalet Al-Balah, and the Al-Sabtiya and Al-torgoman neighbourhoods. These areas have one thing in common: fights," he says. The Hospital also treats patients from other governorates, and Al-Shennawi complains that some doctors have been threatened with knives, while nurses have found themselves being dragged by the hair.
"We are just one hospital to have been threatened by attacks, but we have not closed our emergency room because of our responsibility towards our patients. I wish that the day would come when a hospital would not need guards and that people's attitudes would change."
The Al-Hilal Hospital was established in 1936, and it is now a centre for bone injuries and surgery in Egypt and throughout the Middle East. Ahmed El-Guindi, 32, an emergency department manager in the Hospital, described what it was like to be a doctor there."We work more than 18 hours per day. The problem with the patients is that they seem to think we come to the Hospital to play around and not to work, which of course is absolutely not true."
Some distance away is Cairo's Qasr Al-Aini Hospital, which has also recently experienced attacks. Hesham Abou Eisha, manager of the emergency department at the Qasr Al-Aini Hospital, gave an account of the hardships faced by doctors.
"We receive between 500 and 700 patients per day, though this number could be as high as 900 on Fridays. There are 20 soldiers on duty to guard them and eight doctors to treat them. There are others that we can call on within the Hospital, but we still do not have enough staff. We don't have enough beds in the intensive care unit for the patients that need them either, and because of attitudes people have acquired since the Revolution, there is a belief that the patients should be able to get anything they want without anyone objecting."
"Some even think they know better than the doctors and give orders to the doctors as a result. When the doctors do not obey, they resort to violence."
Abou Eisha has ideas about the way such problems can be solved, including reducing the number of visitors to one per patient, though his promotion of this idea has only caused further turmoil.
One doctor, who spoke on condition of anonymity, said that doctors at the Hospital have to work hours away from their families. "We work 48 to 72 hours per week, which is liable to increase. We serve a larger number of patients than we can successfully deal with. As a result, a patient comes to a crowded emergency room, and, assuming he will not be seen, becomes violent. We can't send a patient to another hospital if there is no room, and this affects our work on patients with critical conditions."
Abou Eisha described a recent attack that had taken place in the Hospital. "There were three patients with knife injuries, two in the head and the third in the chest, but there was only one doctor on duty in the emergency department, and he was operating on a patient with a critical condition. Nevertheless, this doctor found himself being dragged out and threatened with a weapon in order to operate on the man with the chest injury. Eventually, the military police had to intervene."
Ayman Ahmed, 45, a relative of several patients, argued that the conditions in the public hospitals were inadequate. "The services are ok, but the doctors are unable to do their jobs as medication is not provided to them. The labs don't work efficiently either. Three of my relatives came for treatment here, all with gunshot wounds, and we were told we wouldn't receive the results of tests before seven the next morning."
Because of the lack of proper equipment, the doctors have to use manual inhalers on the patients. "Where does our tax money go," Ahmed asked.
Sitting on the floor of the Hospital, Faheema Bayoumi, 59, is waiting for her husband as doctors operate on him. Bayoumi has witnessed several incidents that have affected her sense of security. "I wish that we could all live in peace and that the violence would stop," she said.
The doctor who spoke to the Weekly on condition of anonymity said that he believed that better communication could solve some of the Hospital's problems. "Hospitals should be linked to a database that would inform ambulances of places available for critical cases, so that these could be sent to hospitals with places for them. This would help to improve the present chaos," he said.
However, the main demand expressed by all the hospitals surveyed was the need for greater security, and the Al-Hilal Hospital saw a role for the media in raising public awareness of the problems and instructing people on how to deal correctly with doctors.
Abed said that more institutions should be involved in solving the hospitals' problems. "While we are planning to train our doctors and nurses to deal with patients and their families, this effort should be complemented by efforts by society, the media and the police." Private security companies are not efficient from Abed's point of view because of their lack of experience. "We now have the military police guarding the Hospital, but I don't think they will stay for long. I think that if the police stations are secured, then the hospitals will be as well. The government should also work to improve the financial situation of hospital employees. If this does not happen, there will be no solution to the problems."
El-Shennawi made an appeal to the public to help solve the problems the hospitals are facing. "Those who work in the hospitals are your brothers, and they are there to serve you. They should be treated well, in order that they can give you a good service. There are some short-comings, of course, but this does not entitle anyone to mistreat doctors in order to demand medical services," he said.
Abou Eisha said that the courts should be stricter with anyone found guilty of attacking hospital employees. "If anyone attacks a doctor, they should be thrown into prison for 10 years. A crisis needs drastic measures to overcome it. This is what would happen in developed countries," he said.