Dr. Abdulnasser Al-Munaibari: “There is a great need of qualified Yemeni doctors in this country’s health-care system.” [Archives:1998/37/Interview]
September 14 1998
Dr. Abdulnasser Ali Al-Munaibari has been recently appointed by the President as General Manager of Al-Thawra General Hospital. With a Ph.D. degree in cardiology and being assistant professor of medicine at Sanaa University, Dr. Al-Munaibari, 42, has been nominated for fellowship of the American Heart Surgeons Society. He also has his own private practice in downtown Sanaa. So Dr. Al-Munaibari seems to be the right man in the right place.
To know more about the measures taken to reform Al-Thawra’s administrative system and health-care facilities, Mohammed Bin Sallam of Yemen Times met Dr. Al-Munaibari. He filed the following interview. Excerpts:
Q: What are your plans to reform Al-Thawra Hospital?
A: I have been working in Al-Thawra’s General Authority since 1983. The hospital’s infrastructure (technical and administrative staff, diagnostic facilities, etc) are all below par.
My first priority is to reform the performance at the hospital’s various departments. The hospital’s General Authority is now concentrating on improving facilities in the x-ray, emergency and intensive care units. We also aim to reduce as much as possible ward overcrowding.
Another important thing is to move some of the tasks of the special medical committee, assigned the task of reviewing the eligibility of patients to be treated abroad, to another place. This will allow other hospitals to take part in deciding which patients are to receive medical treatment abroad on the government’s expense.
Q: Which other hospitals will be involved with the work of this special committee?
A: A special meeting of Al-Thawra’s General Authority was held recently, presided over by the Minister of Health himself. It was decided that the special committee be directly accountable to the Minister’s office. Al-Thawra Hospital will be responsible for cases of heart and kidney diseases, Al-Jumhoriya Hospital for adult cancer cases and Al-Kuwait for children cancer cases.
The committee will be chaired by Dr. Ahmed Al-Kibsi and will be independent, answerable only to senior officials at the Ministry of Health.
Q: What other changes have been introduced?
A: Instead of working from 8am to 1pm and then from 4pm to 7pm, doctors will now work from 8am to 4pm with a break in the middle. This will save a lot of time and effort as well as car fuel for the buses used to take the staff home and back. Patients visiting the out-patients department will also benefit. Instead of having to come later on in the day or even the next morning, they can now get all their medical examinations and lab tests done on the same day.
Other steps taken include improving the labs. The hospital will receive modern equipment in the next three months. The General Authority’s adviser, Dr. Mohammed Ali Ba-Sohaib has evaluated the present staff, and recommended the necessary training courses.
Q: What are your plans for the emergency ward?
A: Dr. Abdulsamad Al-Hakimi, a well-known anesthetist, is currently re-organizing the emergency department. We aim to make this department really unique in Yemen. Only the patients who really need emergency treatment will be referred to this department, unlike before when patients with chronic or mild illnesses also came to the emergency ward. This used to put a lot of pressure on the doctors and nurses working in emergency.
Another important matter will be turning the hospital’s fourth floor into a modern private hospital. Plans are drawn with the help of Dr. Yahya Al-Horaibi to establish this hospital according to international standards.
Q: What new departments will be opened in Al-Thawra Hospital?
A: There will be modern centers for heart surgery and kidney transplants. Big advances have been made in the latter project by Dr. Abdulaziz Al-Sayyaghi. The heart surgery center will be run by a Yemeni team of doctors, including myself and Dr. Ali al-Rabo’i. We’ll start with the facilities we have now, and work on importing the necessary modern equipment.
A: The most major obstacle is a psychological factor. Most of the staff we have now are emotionally and psychologically disappointed and frustrated. Their salaries are low, they have no chances of doing higher studies, and not much reward for their efforts. We are planning to attract the Yemeni specialist doctors currently working abroad by offering higher wages and greater incentives. Hopefully, the salaries of the Yemeni staff will be equal to those received by their expatriate counterparts.
The other problem is of a bureaucratic nature. Long-winded routine procedures have stifled the administrative system at the hospital, creating a source of corruption and mismanagement. I believe there should be administration specialists to run Yemen hospitals.
The third problem is not unique to Al-Thawra Hospital, namely over-staffing. Almost all public bodies in Yemen are over-staffed by 65%, creating confusion and poor performance.
Q: How many doctors, nurses and other staff members are there at your hospital?
A: There are about 1,450 people working at Al-Thawra. We are now in the process of redistributing the excess staff on other public hospitals and health centers.
Q: What are the cases that cannot be treated at Al-Thawra and are sent abroad?
A: Diagnostic cardiac tests such as cardiography and endoscopy of the coronary arteries are now done at the hospital. More complicated heart surgery cases have to be sent abroad. Sometimes international medical teams visit the hospital to do major operations. Cases needing micro-neuro-surgery are also referred to hospitals abroad.
Q: Do you receive any support from donor countries and organizations?
A: International medical teams such as Interplast of Holland and others from the US, Canada and Germany regularly visit Al-Thawra and other public hospitals. We hope that, in addition do performing surgeries, these teams would also train Yemeni doctors.
Q: How many foreign doctors are there working at Al-Thawra and what privileges do they get?
A: In the past more emphasis was on numbers, at the expense of quality. So we would get foreign doctors who were sometimes less qualified than their Yemeni colleagues. Some of them were even learning from the Yemenis and receiving tens of times higher salaries. This frustrated the Yemeni staff immensely, and made them sometimes leave work altogether.
The present plan is to invite highly qualified doctors to work in Yemen and train Yemeni doctors at the same time. The most important thing is they have to be really experienced and highly qualified, even if they demand very high salaries.
Q: Do you submit some of the hospital’s needs to international donor countries?
A: The problem in the past is that the requirements of Yemeni hospitals used to be submitted in a vague and unclear way, confusing the potential donor organization. Also, some donors sometimes sent obsolete equipment or equipment badly in need of maintenance.
On other occasions, medical equipment is sent, but never reaches their intended destination. They are usually kept at warehouses to collect dust. Sometimes the local technical staff would not be able to repair the equipment in cases of breakdown or technical failure.
Q: How many patients visit the hospital each day?
A: The emergency department receives about 140 to 180 cases every day. This reflects the service provided by the out-patient department. The internal medicine ward, for example, receives about 2,500 patients a year.
Q: Is the number of doctors working at the hospital compatible with the number of patients?
A: No, the numbers are not always compatible. In some wards we have two doctors assigned one patient; while, in other departments there is a marked staff shortage. The total number of doctors, however, is quite sufficient. The problem is in distribution and the need for more specialists.
Q: How do you advise young Yemen men and women who wish to study medicine?
A: I strongly encourage brilliant and aspiring Yemeni youths to become doctors. There is a great need of qualified Yemeni doctors in this country’s health-care system. The future of this profession seems very bright indeed. In addition to being a humanitarian profession, medicine is also a very satisfying vocation.
Q: What do you think of privatizing health services in Yemen?
A: I don’t mind the privatization of the health-care services, provided its done in a reasonable and rational manner. Private health care does not necessarily mean that a patient has to pay for the service out of his personal funds. In other more advanced countries, there things called health insurance, etc, where people’s access to a health service is assured.
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