Doctors or merchants [Archives:2003/633/Health]

Bassam Jamil
Don't you be deceived by some of the doctors' white uniform and misleading smile for behind that smiling mask, lies a dark heart of a brutish animal that does not attack with his claws or teeth, but with a surgeon's knife and a medical bill. Above all, he does this with a wide fake smile. Because if your fate is put you in his hands- God forbid- then you'll surely understand that no longer he should be called “mercy angel” but perhaps “tool of torture”, a merchant who is willing to sell his victim's well-being and life for a few thousand Yemeni rials!
It all started when a number of my friends -some actually working in that warehouse called hospitals- told me about the commissions and percentages that are availed by doctors, pharmacists, laboratorians and x-ray specialists, all in a organized system that somehow works very adequately in this chaotic country. Not only do doctors prescribe un-required -and sometimes unsuitable- medicines, but they also request unneeded laboratory tests and surgeries.
When asked if this was true, a pharmacist replied positively, and mentioned that this is widely evident in the private sector. He mentioned that in his particular case, the owner of the pharmacy is a clean and religious doctor, that is why he doesn't have that many customers, and had he been like the others -in paying commissions- he would have earned much more revenue. Another pharmacist explained that he didn't hear of such practices and does not know if they existed.

New phenomenon emerging throughout Yemen
Ophthalmologist Dr. Tawfeeq Al-Khateeb replied to our questions about commissions saying that this is a recent trend that has not been so common until recently. The medical stream still has an honest spirit because it deals with lives of people. Personally, he said, he did not have much information about such negative practices, although he did hear from colleagues about them. An incident he narrated was that of a neighbor who went through an accident and was told by 'doctors' that he had internal bleeding and operated on him and ultimately charged him heavily while it turned out that he didn't require any of that.
Dr. Al-Khateeb explained that perhaps this new trend has emerged because doctors' income in Yemen is quite low, so they seek other ways to increase their returns, whether through commissions from pharmacists or laboratorians or through private clinics. Another reason is lack of supervision by the Ministry of Public Health, where many doctors, especially foreigners, practice their job without any monitoring at all.
Dr. Al-Khateeb emphasized that if the earnings of doctors do not enhance, all of this would continue to happen.

Pharmacists syndicate: 12 years of helplessness
Member of the pharmacists syndicate, Dr. Abdulmajeed Al-Khulaidy says that this phenomenon is widely spread. He added that despite its efforts, the Pharmacist Syndicate has been unable to tackle this issue for 12 years.
He said that the most obvious form of it is in the field of medical insurance where companies and private organizations tend to deceive their employees with. Health insurance in the public sector consumes an operating budget from both Ministries of Health and Finance. This money is obtained from the taxes and then sold to the citizens. It's the Health Ministry's responsibility to ensure public health and provide precautionary medicine to all citizens including vaccines. Treatment is the responsibility of other establishments related to medical insurance. However, it remains a fact that authorized persons are trading with people's health and needs. He added that Yemen's concept of services should improve, and that medicine should be separated from the Ministry of Health because the later is pure science and the Health Ministry's concern should be public safety and health through environmental and precautionary medications. “In Jordan, they have separated the two and that is why medication has improved there.” he said.
Regarding the commissions and percentages trend, he stated that there are such practices by heads of hospitals as well as regular employees. “How can you straighten the shadow when the actual object is twisted?” he asked. Reasons for this practice, he said, are administrative corruption and inequity in job and pay distribution. And there are more privileges given to foreign doctors on the account of Yemeni doctors, as there is little appreciation for Yemeni cadres. “We claim to be a democratic country but frankly speaking, this is just a sing song, because our government refuses to be questioned and there is no accountability.”
About the syndicate's role, he said that it could do very little. During its 12 years, it has been unable to do anything of significance because of the continuous pressures exercised on it. “If we were independent, then we could have taken certain measures, but we are just a part of the flock in a society that is used to acting as the sheep led by a governmental shepherd.” he said. For 12 years we have been demanding that the situation of doctors and pharmacists be improved, but to no avail.
The consequences of ignoring our demands have proven to be severe, because how do you expect someone to treat you honestly when he/she is worried about losing his/her homes because they haven't paid the rent yet?

It's all about money!
Continuing our investigation into this subject, the government had to have its share in our survey. So we went to governmental hospitals to get the feedback of doctors.
Dr. Abdulkareem Al-Khawlani, Vice President of Al-Thawra Hospital said, “We can't say for sure that this phenomenon is not exaggerated. If such incidents are reported, then they would probably be very limited in number. Terming doctors as 'merchants' is quite unfair because doctors do all they can to help relieve patients and cure their illnesses. It's quite ungrateful to talk about them in this way.
In this hospital we have not heard of any complains about such incidents. But I believe these are more common in the private sector because of monetary reasons.” About supervision, he said, there is a monitoring committee and it is concerned with investigation and delivering regular reports to the hospital's management and deciding proper punishments when there is a violation of the medical law. But he also indicated that patients have a hand still in what is happening because of their ignorance and because they want to get higher priority in treatment and they are willing sometimes to give 'gifts', etc. The daily number of patients visiting the hospital reaches more than 400 persons in the emergency section and more than 500 in the internal clinics. Hence, monitoring in this case is quite difficult. He also added that medication in Yemen is relatively cheaper than many other countries but unfortunately Yemeni citizens simply do not trust Yemeni doctors as much as they trust foreigners.

Ask the minister!
Head of Al-Jumhoori Educational Hospital Dr. Abdullah Al-Hamidi agreed with Dr. Al-Khwalani that this phenomenon is mostly common in the private sector. He said this is because in the government sector the state applies some rules when contracting doctors preventing them from behaving in an unsuitable manner. He also added that such behavior is a result of skewed morals and the persons who act in such a way whether doctors, pharmacists or laboratorians are dishonest. “Money is no excuse! They could have an extra job for additional income instead of robbing their patients. Yet the patients are also responsible because they cooperate in this. Doctors simply could not have done it alone.” he elaborated.
We also noticed that the hospital's pharmacy has been closed for some time. “Two years”, Dr. Al-Hammadi said. When asked why, he said it was the minister's decision; he could do nothing about it. “You are journalists, right? Go and ask him!” he said.

Foreign doctors and private hospitals a prime reason
Dr. Abdullatif Al-Hurami, neurology doctor was quite frank with us. He said that in the private sector, the administration states a number of rules on doctors that demand their cooperation with certain pharmacies and laboratories in certain ways. This is because the original owners of most private medical centers are businessmen whose sole purpose is to earn money. For those businessmen, if the doctor displayed objection he is sacked! This doctor who in most cases waits for long years to get a job in front of the Health Ministry would probably not confront his boss in the hospital for such reasons.
He also said that most of the dealers who act this way are the foreign cadre because they have to come to this country basically to earn money, and they view patients as a source of income. Yemen is seen by many of those as a transit station before they move on to a better country such as The United Arab Emirates o Australia.
Dr. Al-Hurami stressed that this phenomenon is simply inexistent in the government sector because dealings there are with official vouchers with fixed prices that doctors cannot alter and that there are monitoring bodies that govern financial transactions.
He said that the hospitals most vulnerable to such practices would be private hospitals and clinics located in remote areas because they are not even licensed. And that the monitoring bodies actually identified some of those hospitals and closed them down.
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