Dr. Abdullah Al-Hamedi: “Social values impede the recruitment of female nurses.” [Archives:1998/46/Interview]
November 16 1998
Al-Jumhouri Teaching Hospital is one of a few public health establishments in Sanaa. First opened in 1925, Al-Jumhouri is also one of the oldest hospitals in Yemen.
To know more about Al-Jumhouri Hospital and the level of health services it provides, Mohammed Bin Sallam of Yemen Times talked to Dr. Al-Hamedi, and filed the following interview.
Q: Could you tell us briefly about Al-Jumhouri Hospital when you first assumed your managerial post?
A: I found conditions at the hospital quite bad, I’m sorry to say. I’m not really saying that the people before me didn’t work, but that is how I found the place.
Only 80 beds were used in a hospital with a 600-bed capacity. Out of the 7 floors constituting the hospital, only three were used. Broken equipment and scrap metal were stored on the 7th floor. Unbelievably, the 2nd floor housed water and septic tanks. The 1st floor was closed all but for two rooms – lacking in essential conditions for humans. They were used for burns victims.
All in all, only about 25% of the hospital’s capacity was used. So we started implementing plans to improve the place. Differences in statistics between January and June or July, say, attest to the success of our reform program.
Q: Are there any obstacles impeding your proposed reform?
A: The major hindrance is lack of funds. People are invited to donate. This has helped us carry out extensive renovation and refurbishment work. Closed floors are now open, and the scrap-metal floor is now a private clinic.
We decided to allocate 10% of Al-Jumhouri for private medical practice. Evening surgery hours will start soon, to be devoted to private-sector employees with health insurance. We strongly aim to provide top health services.
Doing renovation work is easy. But staff changes are a different matter altogether. Regional, tribal and partisan affiliation influences are at work in the hospital. However, we were successful in bringing people together through weekly departmental meetings. A friendly atmosphere prevailed in a relatively short time, successfully overcoming sectarian and tribal sensitivities. Only this way can we provided an advanced and humane service at the hospital.
However, there is a lot more to be done, whether regarding facilities and equipment or staff relations. We are determinedly on our way to achieving a full team spirit among hospital employees.
Q: To what level have services been increased and improved?
A: I can proudly say that work standards have risen by a minimum of 200% in some departments. Other departments have witnessed huge improvements in services.
For example, when I took over management, there were only two patients in the maternity department, which has a 50-bed capacity. Now 40 patients are receiving medical care there.
Q: Could you tell us more bout the hospital’s staff?
A: There are 183 Yemeni doctors with different specialities. Only two Chinese doctors work at Al-Jumhouri; a neuro-surgeon and an ENT specialist.
As for nursing, there are many social obstacles preventing Yemeni females from working as nurses. A female Yemeni nurse cannot possibly stay at work after 6pm. So we have to rely on foreign cadres. There are only 20 Indian nurses. At least 250 are needed. I’d like to use this opportunity to call on the Ministry of Health to suspend its decision banning the employment of foreign staff.
Q: How many Yemeni nurses are employed at the hospital?
A: There are about 100 female nurses, but they only work the morning shift. Also, they are not very well trained. Only 45 male nurses work here. Receiving only YR 5,000 a month is just not conducive for nurses to work in the public sector. Many of them work in private hospitals in the afternoon.
Q: Haven’t you considered employing more male nurses to work afternoons and evenings?
A: This actually what is happening. But male nurses cannot possibly work in maternity and gynecology wards. Our Indian staff are overworked.
Q: What are the main departments at Al-Jumhouri?
A: We have all general medical departments: pediatrics, gynecology, general surgery, neuro-surgery, etc. Al-Jumhouri is the first hospital to open a department for dermatology. Other hospitals in Yemen only have small clinics for skin ailments. There are three types of emergency wards, orthopedics and intensive care.
A special department for cancer and radiotherapy will be opened soon.
Q: What departments are overcrowded?
A: The pediatrics ward and intensive care unit are particularly overcrowded. The bed turnover is gradually increasing with the public gaining more confidence in the services provided by Al-Jumhouri.
The out-patient department has the capacity for receiving 400 patients a day. It now receives 800 to 1,000 patients. The whole ground floor has now been turned into three emergency wards.
Q: Do you have an emergency department for car accidents and other injuries?
A: This actually requires huge funds – about $500,000 – and specialists in chest and blood-vessel surgery. We are actually discussing this matter with the bodies concerned.
Q: Is equipment purchased through the Ministry of Health?
A: This is a somewhat thorny issue. We sometimes have to purchase essential and much needed equipment direct, because going through the usual bureaucratic procedures is time-consuming. We know that this is not strictly going by the book, but it has to be done to avoid jeopardizing patients’ lives.
Q: What are the hospital’s urgent needs?
A: These are many and varied. For example, we don’t have a proper morgue to keep dead bodies. The laundry machines are old and always failing.
It is crucial that we have enough funds to be able to run the hospital properly.
Q: Do you receive any aid from international organizations?
A: Some international NGOs do provide assistance. Medical teams such as Doctors for Peace visit the hospital every now and then to perform surgeries and train doctors. Italian, Canadian and German organization have expressed their readiness to help.
The German team that took part in the recent medical conference has visited the hospital, and a cooperation agreement was signed. But we still need more facilities such as accommodation and funds to pay airplane tickets to be able to receive these doctors.
It is hoped that the World Bank will also chip in. Their representatives were quite impressed with what we have achieved.
Q: Are you supported by the official health authorities?
A: Yes, we receive a great deal of moral support and help from the Minister of Health. But the Ministry itself is often short of funds. Only about 3.8% of the state’s annual budget is allocated to health care.
Thanks to the great efforts made by Minister Abdullah Nasher, many international donor organization have resumed their cooperation, which was stopped due to the Ministry’s previous bad policies.
The first good step taken by the Ministry was to allocate a standard-bed budget. But still there are some discrepancies. Al-Jumhouri’s annual budget is only YR 60 million; while, some other hospitals with less bed capacities are getting more funds. Sixty million riyals is a very small amount for a big hospital like Al-Jumhouri. It barely covers one aspect of expenditure.
Q: Much has been said about how Yemeni doctors are poorly paid. What can be done in this regard?
A: This is quite a painful and disconcerting issue. It is one of the major factors causing the marked deterioration in Yemen’s health services. How can a poorly paid doctor with financial difficulties take care of his or her patients?
In the 1980s I used to get the equivalent of $1,000 a month; now, I only get the equivalent of $90! I mean if you take seniority and inflation into account, I should be paid more than $2,000 month. Low salaries are also a major factor in spreading corruption. A complete restructuring of public salaries is in order.
Q: How much more does your hospital need?
A: A lot more. At the Saudi hospital in Hajja, for example, the budget is around $200,000 a year. This is quite normal if proper medical care, food and comfort are to be provided for patients.
A standard hospital bed at Al-Jumhouri costs around YR 90 a day. So we are really talking about $290,000 a year for the whole hospital.
Q: What are the most common diseases and epidemics in Yemen?
A: Almost all common epidemics are known in this country. Malaria, for instance, has now spread to Sanaa where it was rather rare before. We are now receiving many malaria cases.
Other increasing diseases include malnutrition, chest infections, bowl ailments. We need a lot of funds to deal with the rise in numbers of patients.
Q: What are your future plans of Al-Jumhouri Hospital?
A: My ambitions know no bounds. Al-Jumhouri must become the top medical establishment in Yemen.
One of my pet projects, for which funds are sought, is to establish a national cancer and radiotherapy center. Proposed designs for this establishment are already being studied by the International Atomic Energy Agency. Philanthropist businessman, Mr. Ahmed Fahem has already adopted this project, which is now twinned with a cancer hospital in China.
Another project, which have already started, is to connect Al-Jumhouri Hospital with international hospitals via the Telemedicine and Internet computer networks.
A health insurance system for the hospital’s employees and their families has recently been put into action.
Evening working hours for private practice will start early next year. Bids by private catering companies have been invited so as to provide good quality food and accommodation.
Q: What about the poor, how will they cope with rising health-care expenses?
A: Al-Jumhouri Hospital is for disadvantaged people. Token fees are charged, which represent only about 5% of the actual cost of services. However, medicines are not readily available. Frankly speaking, we don’t receive our full quota of medicines.
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