Saturday, November 29, 2003

Let me be your eyes..series II.

I promised to tell you about different aspects of life in Iraq before and after the liberation, so today I'll be writing about another aspect (HEALTH CARE)
To those who think that conditions in Iraq nowadays are worse than they were under Saddan's regime, here are some notes involving the Medicare in Iraq before and after the war based on the events and facts I had witnessed during my 5 year service in the medical field before and after the war:-
1-before the war there was a system called "self financing" that was applied in almost all the hospitals and health centers. As one may imagine that the term must mean that each hospital should be responsible and independent in its financial affairs, actually what it meant was a much different formula.
Each hospital charged high prices for medications and medical services as compared to the average income of the Iraqis at that time, but this is not the major problem, as this system is used in many countries, the problem was that 20 % of these funds were taken to cover the defect in the military budget and 40 % were taken back to the treasury (Saddam's pocket) and this was the regular and officially documented system.
The remaining 40 % were supposed to cover the expenses of the hospital and to pay for the medical staff and other employees.
Today, the (self financing) system no longer works in pediatric hospitals( children under the age of 12 are treated without charging any fees). For older patients, however the system still works but after a 50 % discount of the prices and the funds no longer related to the salaries of the staff.
The whole money goes back to the treasury and the whole needs of the hospital is provided by the treasury, taking in consideration the 6-10 folds rise in the salaries of most employees and with the exchange value of the Iraqi Dinar to the Dollar being 1: 2000 which is very close to that before the war you can see the benefit for both the patients and the health workers, the former paying less and the latter getting more.

2- the most important change is that most of the emergency medications were provided in an amount that was far from being adequate. I used to go to the hospital for my night calls and the pharmacist comes and gives me the list of the remaining drugs, and I find that it contained only a single diazepam injection, three or four ampicilline injections with a few syrups and some times a single injection of hydrocortisone. This was not the case always, but this was the usual condition with very few exceptions.
I had to turn into a magician or a warlock to treat all the patients who come to the hospital, the no. of whom was by no way small knowing that it was the major hospital in al -Kut , one of the 18 Iraqi governorates in which over a 100 thousand people live.
The similar condition applied for most hospitals in Iraq with few exceptions.
Most of the chemotherapeutics used for treating malignant tumors were not available in hospitals and they were sold in the black market with prices reaching a 100 $ for the single injection (a fortune for most Iraqis at that time) forcing some families to sell their cars, furniture and sometimes their houses to keep the faint flame of life in their loved ones' hearts.
Today almost all of the emergency medications are available in all the hospitals and in more than a sufficient amount.
Almost all the chemotherapeutics are available for free for all age groups in most of the major Iraqi hospitals.

3- every one or two months we (the junior doctors) were forced to spend a week or two in Saddam's fedayeen camps and the so-called al-Quds(Jerusalem)army camps to supervise their (Dobermans’) health.
I recall when of my colleagues didn't show for 1 day, a military police unit was sent to his house where he was dragged (still in his pajamas) to the camp, he was told to choose between wearing a military uniform, holding a rifle to guard a spot for 24 hours, and spending 3 days in jail.

4- The police protection was near to nil. When a patient dies due to the lack of drugs or any other natural cause his shocked relatives would find no one but the poor doctor in duty to throw all their anger and frustration on, a phenomena mounted in numerous cases to the use of fists and boots and sometimes knives.
Today the junior doctors are free as all Iraqis are and no one compels them to do anything beyond their legal and moral responsibilities. The military service has become voluntary and even started to gain some appeal, after it was considered for along time as hell on earth for most Iraqis.
In every hospital there's a full FPS(facility protection service) unit to keep order and peace and to protect all the hospital employees.

5- The salaries of dentists rose from approximately 5 $(no, there are no missing digits!) to about 120 $ and those of the junior doctors and nurses from approximately 20 $ (again, no missing digits) to 120-180 $.
I know it's still a very low figure, but it's a good step forwards, putting in mind that most of the prices are still the same, with imported goods getting cheaper and local goods rising about 1.5 - 2 times the price before the war, and we were promised a big raise with the beginning of the next year. Besides we're not in a hurry, as we know that our country is passing through a very difficult economic distress, with all the huge debts, their interests and the money needed for reconstruction which demands some sacrifice and patience on our side.

And in case the GC do not fulfill their promises, well, we're not afraid any more and we will demonstrate, protest and keep the pressure until we get what we deserve.
There are no more torture rooms, no more mass graves and we will make sure that it remains so.


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