We are not going to budge; we are not negotiating for a interests agenda. We are demanding a better healthcare set-up, both for doctors and for patients. This is not something to give up on,” said Amr El-Shoura, member of the Doctor's Syndicate council and coordinator of an on-and-off strike of medical workers, which includes along with doctors, dentists and pharmacists.
It was as early as 2000 when El-Shoura joined the School of Medicine and realised the first challenge of decent quality healthcare: medical education.
“We are really behind in curricula, but we are also so rundown in terms of educational capacity. Back in 2000, I had to stand on a stool to see over the crowd of students on my first anatomy class and I had to bow to the private lessons system, which prevails at the School of Medicine, where the highest grades are reserved for the children of teaching professors for the most part,” El-Shoura said. “This is not what medical education is supposed to be about,” he added.
Improving the quality of medical education in a country where joining the School of Medicine is in high demand is a top priority goal of the medical workers strike that El-Shoura is determined “will go on, no matter the offers made for us to end it."
Firm monitoring of private medical schools and financial and logistical support for postgraduate studies for graduates of the nation's dozen or more government schools of medicine are also part of a range of demands aimed at improving the quality of medical education and thus bettering healthcare services in country where poverty drives illness to shocking levels.
“We often hear people complain about the declining medical ability of new doctors and we see them insisting to spend the last pound they have to solicit the consultation of older generation physicians. Well, it is obvious that more effort needs to be put in the training of medical doctors in Egypt,” El-Shoura argued. “This is one thing that I think those angry with our strike seem to overlook.”
Another demand of the strike that El-Shoura, who is now acting under the umbrella of the Physicians Alliance rights group, in cooperation with Doctors without Rights, is to improve the quality of public hospitals — from medical equipment to security.
“When you get a seriously ill patient rushed into your emergency room and you simply cannot save them because you don’t have basic medical equipment or basic medications, and then if they die it will be you as a doctor who will have to put up with the understandable wrath of the family; you then realise that something must be done about these hospitals that have been so run down,” El-Shoura argued.
El-Shoura, along with other activists, made it clear during a meeting last week with the minister of health of the newly appointed cabinet that the time is now and not later to upgrade the share of health services in the state budget.
“We received no clear or conclusive promises; I really don’t see why it is impossible to cut a little from the augmented share of the police budget, which is clearly not spent on providing better security services. Replacing one cabinet with another will not resolve the issue of public anger at the quality of public services. More citizen-oriented policies need to be put in place,” El-Shoura argued.
Then again, this enthusiastic activist argued with passion: “What is a good hospital, that is if you have one, without an efficient doctor?” An efficient doctor, he insisted, is someone who is well-trained and adequately paid.
“Doctors working at public hospitals which, along with university hospitals, cater for the majority of millions of patients, are so poorly paid,” El-Shoura argued.
As a radiologist who graduated some five years ago, El-Shoura’s salary doesn't top LE2000. From this amount, he is supposed to support himself and his family. He is married with a one-year-old daughter and hopes to pursue postgraduate studies.
“It is a joke, right?” he said with a smile. The sad reality, he added, is that most doctors have to compensate for the severe financial shortage by taking "a few extra jobs" at private clinics and hospitals. “At the end of the day, a doctor is overworked because he is underpaid; an overworked doctor and a rundown hospital is exactly the opposite of what an Egyptian patient needs,” he added.
El-Shoura is aware that this image of overworked and underpaid doctors is not what comes to mind when people hear of the medical workers strike. “I know that people immediately think of the big name physicians who charge a good deal of money for an appointment that the patient would have to wait weeks before getting. But the fact of the matter is that those are no more than five to 10 percent of the entire physician community in Egypt. The rest are like myself,” he said.
“Yes, we will go on; the strike will go on and we might be soon joined by nurses and physiotherapists. We are not looking for bits and pieces here and there, but for a package that could make us better equipped to serve the patient — and also to be properly treated when we fall ill,” he said.
El-Shoura’s father, a medical doctor in the public health system, had no decent insurance to cover open-heart surgery he needed a few years ago. The family had to pay for the surgery and related expenses, which wiped out any savings they had struggled to put aside.
It was then that El-Shoura junior entered the Doctor's Syndicate to do some paperwork for his ill father and saw the first limited sit-in of doctors “demanding the very basic rights that we are still demanding today.”
On that day, El-Shoura chose to join the small group who were demanding better treatment from the state.
Throughout the interceding five or more years, ElShoura has not lost faith in the cause. On the contrary, he considers parting from the study of radiology to embark on a career in hospital management.
“Listen, I don’t want to be in an emergency room and face a patient dying when I don’t even have the machine to see through his ailing body and help colleagues decide on emergency treatment. I cannot have it and I won’t have it,” El-Shoura said.
He added: “Plus, someone must decide to work on fixing this maze that we call public hospitals. It has to be done if we claim to ourselves that we have something that could be called a 'public health service.'"
El-Shoura is convinced that with continued pressure, “and hopefully eventually with public support," this system will be fixed and the health share of the national budget would increase from the current dismal three or so percent to a decent 15 percent, to allow for hospitals to run properly and for people for who do not have access to the private sector service to be covered with a decent insurance.”
“We will make it happen,” El-Shoura underlined.
