Public confidence in the health system is at rock bottom, reports Karim El-Khashab The recent, widely publicised deaths of children being treated in public hospitals have led to the entire public health system being placed under scrutiny, with criticisms pouring in from all sides. The father of 11-year-old Ahmed Gharib, who died after he was administered an anaesthetic before undergoing a routine operation at a hospital in Benha, says that it was clear from the moment his son was admitted that the hospital was badly run. "From the beginning the nurses treating him appeared confused about exactly what he was being treated for," he said, adding that the sheets on the bed had clearly not been washed, and nothing seemed clean. "All of this we are used to, but what happened to Ahmed is a crime," he said, holding back tears as he vowed to prosecute the attending anaesthetist. Hospitals everywhere are being criticised. In Fayoum patients being treated for renal failure panicked when news leaked out that the equipment being used was unsanitary. Mohamed Kamali, a doctor who works at the hospital, says the people in charge of maintaining the equipment were being investigated, but the incident was the tip of the iceberg. "Because of exhaustion, and a host of other reasons, we see instances of patients receiving the wrong operation at an alarming rate. The hospital always manages to keep the problems quiet," says Kamali, who adds that he has witnessed similar patterns of incompetence in almost every hospital in which he has worked. Qasr Al-Aini hospital, the largest of Egypt's public hospitals, has been singled out for the most intense criticism. Recently it emerged that the hospital has been selling medicines past their expiry date to patients. Doctors at the hospital have been hesitant to speak out against this, and other such cases, for fear they will be penalised by those in charge. One doctor at Qasr Al-Aini, speaking on condition of anonymity, describes practices at the hospital as an "all out circus". "The pressures under which doctors work here are greater than anyone can be expected to handle," he says, adding that the hospital lacks the basic manpower to deal with its workload. Hisham El-Mohamedi, who has worked as a hospital inspector at the Health Ministry for more than a decade, says the situation is even worse in the many unlicensed clinics that dot the country. The ministry has vowed to crack down on such facilities, saying they often harm patients rather than cure them, and it is then left to already overburdened public hospitals to clear up the mess. MP Mimi El-Omda questions whether the failure of public hospitals to fulfil patients' needs is simply a result of inadequate resources and overwork. El-Omda, who has long campaigned for better health facilities for his constituents, argues that the Health Ministry has consistently failed to make the best use of both the money and human resources at its disposal. "The ministry's budget increases annually, and at a rate that is greater than that allocated to the majority of government departments. One problem is that the Health Ministry appears determined to spend vast sums on the latest medical equipment rather than allocate its budget in a way that will ensure the greatest health benefits to the greatest number of people." A majority of deaths through negligence, he says, are a result of nurses being badly trained, as well as poorly paid. "If doctors complain about demoralising hours and pay, then what are nurses supposed to do, working more hours and being paid a pittance." In an attempt to draw public attention to the employment conditions of medical staff, a group of young doctors have set up their own organisation, Doctors Without Rights. Abdel-Rahman El-Taib, a member of the group, says he had dreams and ambitions when he joined the medical profession but found the reality to be utterly different. "We all know how hard it is to get into medical school, how much you sacrifice, and after all of that I am paid less than many manual workers," he says, adding that the salaries paid to young doctors are among the lowest in the public sector. In their first public statement the group has called for the minimum salary for a doctor to be increased to LE500. Patients outside the Qasr Al-Aini hospital say they know the risks exist they face but have no other choice. Aisha Basouni, who has been undergoing dialysis at the hospital for years, says she has seen endless examples of incompetence but can afford no other treatment options. "If I had money I would do like many others and go to China for a transplant and treatment," she says. "As it is, I'm stuck with this."
