Collective action anesthetized: The Doctors Syndicate from 2016-2018
How has the Doctors Syndicate gone from a vehicle for mobilization to beset by low participation?
Doctors' silent stand, February 20, 2016 - Courtesy: Doctors Syndicate

Even after the family of one of his patients assaulted him, fracturing his nose in four places, doctor Mohamed Awad is sympathetic to the structural problems that plague Egypt’s healthcare system under the government’s austerity conditions.

“People come in frightened that their relative will die, but it’s not our fault that there is a shortage in medical supplies. I understand [this fear], but I cannot tolerate attacks on doctors,” says Awad.

The patient whose family attacked Awad came into the Sahel Teaching Hospital on May 18 with a brain hemorrhage and in need of a place in the intensive care unit. Without a bed to offer her, Awad was forced to deliver the news to her family that the unit was at capacity, and that he’d called the Health Ministry to find space for her elsewhere. Angered by the news, the family attacked Awad and three other staff members at the hospital.

Awad’s story is part of a larger mosaic of repeated attacks on health care practitioners. Coupled with stymied reform measures meant to improve professional and patient care conditions, this violence has tried the patience of many of his colleagues and driven a wedge in the politics of the Doctors Syndicate.

The current situation is a stark shift for a syndicate where collective action had seemed possible as short a time ago as 2016, when 10,000 doctors gathered in an extraordinary general assembly to demand the dismissal and investigation of the health minister, and nationwide protests were held in hospitals across the country in response to an assault on two doctors at Matareya Hospital by police officers after the doctors refused to falsify medical reports.

If political capital for reform or collective action can be measured, recent litmus tests the syndicate has undergone suggest it is diminishing. After a doctor was dismissed from his post and sentenced to one year in prison over a disagreement with a local prosecutor, only 500 members of the syndicate attended a call for a general assembly to address how to handle the violation. Failing to meet quorum, the syndicate could not issue binding decisions. Mona Mina and Ihab Taher resigned as the Doctors Syndicate’s assistant secretary general and secretary general respectively on Tuesday night, pointing to a litany of hurdles that have stalled health reform, and a generally “low ceiling” for trade union freedoms as the reason for their decisions.

The criticism that Mina and Taher leveled at the steering committee they are leaving behind points to the political divide that other doctors who spoke to Mada Masr echoed. “[The remaining leadership has] a different style, which we may not agree with and whose effectiveness we’re not convinced of, but that some people find to be more suitable for the current period.”

While doctors Mada Masr spoke to center their accounts of the syndicate’s decreasing clout on the undermining of the momentum that welled up in 2016 through continued capitaluation to the Health Ministry — the syndicate head met with the minister as recently as a day before the May 11 general assembly meeting — some medical professionals pose that the present political context may not be suitable for a return to collective action.

Support, but is it enough?

On the same day Awad was attacked at the Sahel Teaching Hospital, a patient in the public Nasser General Hospital in Shubra assaulted doctor Mohamed Abdel Fattah. According to the Doctors Syndicate website, Abdel Fattah walked away from the incident with a laceration to his scalp, and the hospital administration reported damage to the facility.  

Awad has undergone surgery since he was assaulted and says he is recovering. “The four attackers were issued four-day detention orders on Saturday, following a legal complaint that the hospital and I filed,” he tells Mada Masr.

The syndicate has provided public and legal support to doctors who have been attacked while at work. Since he started his position as the legal consultant for the syndicate in 2014, Mohamed Shawky, the syndicate’s lawyer, has been involved in a number of assault cases. However, there are no official statistics available on the number of doctors who have been assaulted, he tells Mada Masr.

In one such show of support, the syndicate entered as a claimant in Nasser General Hospital assault case, in which four people accused of attacking the doctor have been detained pending further investigations. The syndicate will also be a claimant in Awad’s case, along with the other injured doctors and the Sahel Teaching Hospital. The syndicate has also been involved in the case of Mohamed Hassan, a 10th of Ramadan Health Insurance Hospital physician who was sentenced to one year in prison and dismissed from his position by a Sharqiya court on May 9. While his prison sentence was suspended following the May 14 payment of LE5,000 bail, the syndicate had already filed an appeal earlier that month, the next court session for which is set for July 5, Shawky tells Mada Masr.

Although the syndicate has consistently pursued legal action against those accused of assaulting medical personnel, it does not seem to have stemmed the prevalence of such attacks. Former Doctors Syndicate Assistant Secretary General Mona Mina tells Mada Masr that the assaults are not new. However, the increased frequency of incidents is due to the weakness of Egypt’s health system, which Mina attributes to the state’s low budget allocation to the health sector. Mina also points to what she calls “an ongoing media campaign against doctors and nurses” as another reason behind the increasing number of assaults on doctors.

Ahmed Farouk, a former syndicate board member and an oral and maxillofacial surgeon, believes that as long as doctors are paid low salaries, and as long as the services provided are poor due to a shortage in medical supplies, assaults will continue to occur. “Patients do not have access to those really responsible for Egypt’s health problems, but they are able to reach doctors,” he says.

According to Mina, “It is easy to use doctors as a scapegoat for the serious inefficiency and poor planning present throughout the health sector, which eventually leads to the provision of poor services.” Consequently, she says, stress is placed on patients unable to access adequate medical care, who then resort to violence against doctors.

Protecting doctors on duty

“I went to the Sahel Teaching Hospital late last evening and no one asked me where I was going or what I was there to do. Without security personnel protecting hospitals, anything could happen,” Shawky says.

In a health sector defined by recurring incidents of medical negligence, poor service quality in public hospitals and exorbitantly high costs at private clinics and hospitals, tension over medical treatment has become the norm.

“We are held accountable in cases of negligence, but when it comes to protection, which is necessary for us to be able to help people, no one cares. We go to hospitals unsure whether or not we will return to our homes safe at the end of the day,” Awad adds.

“The Ministry of Health should be responsible for securing hospitals. It should coordinate this with the Interior Ministry, but employees of the Interior Ministry themselves attack doctors,” gastroenterologist Mohamed Hassan Ali, who works in a public hospital, tells Mada Masr.

Ali adds that Health Minister Ahmed Rady sees himself as a representative of the government, not the doctors, and therefore does not offer support to doctors who have been assaulted.

For Ali and Awad, the solution lies in increasing the penalties for those who assault hospital staff or damage any of its property. According to Mina, the syndicate submitted draft legislation to Parliament, which included an article imposing penalties on those who attack hospital staff or property in 2016. Although intended to be added as part of the penal code, this article was never even debated, according to Mina.

The proposed amendment stipulates penalties of one to three years in prison, as well as a fine of between LE10,000 and LE100,000 in cases of attacks on hospital property; and one to 10 years in prison, as well as a fine worth between LE5,000 to LE20,000 in cases of attacks on hospital personnel, depending on the number of personnel injured, as well as the extent of their injuries.

“This amendment could be passed easily to prevent attacks on doctors and hospitals. The penalties for such incidents reaches 15 years in some countries, which is also a means to protect the rights of patients to receive treatment in a stable and quiet atmosphere,” Mina says.  

What went wrong?

Thinking back to February 2016, Farouk describes the scene as “similar to Tahrir Square, when the crowds blocked the street. It was a Friday. Doctors brought newspapers to lay down and pray on. Even though the scene was impressive, I was not optimistic, as I was communicating with the syndicate’s board, and they lacked a clear vision.”

During the last Doctors Syndicate general assembly meeting on May 11, doctors who spoke to Mada Masr previously, as well as those who addressed the assembly during the meeting, expressed their disappointment. Some believed the issue to be beyond the syndicate’s purview, while others directly criticized the syndicate’s performance. Syndicate head Hussein Khairy came under fire for his meeting with the minister of health the day before, and some went as far as calling for the syndicate’s board to resign.

Sayed Mohamed, a doctor from Sharqiya, told Mada Masr that he was shocked at the doctors’ low turnout, explaining that this was the result of their “disillusionment” with the idea of the syndicate as a vehicle for securing their rights.

“An administrative court issued a ruling ordering compensation to be paid to doctors who contract an illness while on the job [in November 2015], but the Health Ministry never implemented it. People are disillusioned by the prospect of anything happening,” Mohamed said. “In previous general assemblies, there was not enough room for all the doctors present in both the main hall and other rooms at the syndicate,” he added.

Another doctor from Damanhour, Ahmed al-Shimy, told Mada Masr that he does not see a solution. “The government is against doctors,” he said. “In the end, the Doctors Syndicate, as well as other professional syndicates, don’t hold much sway. They cannot force their will on state institutions.”

Ali is one of the doctors who blames the syndicate for its weak response to doctor assaults. He attended the May 11 meeting, but left when disputes broke out.

“The syndicate is not radical, it is reformist,” Farouk says. According to the former syndicate board member, “They do not have other options because taking radical stances would lead to prison. The government has also placed pressure on the syndicate, threatening escalation against doctors in 2016.  Now, we are dealing with the repercussions of 2016’s failure. Then, we failed to effectively use the strong, large crowd in order to formulate a powerful response. Doctors have since refrained from participating in such movements again.”

“The syndicate has always prefered negotiations over radical actions. It concedes to the conservative current, which is headed by Khairy, who helped foil the 2016 movement. At the time, Khairy said that, in the interest of serving patients, doctors should not strike. This idea garnered acceptance among doctors,” Ali says.

Mina refrained from blaming the syndicate in the comments she made to Mada Masr before resigning. Although she understands the fear and disappointment that has grown among doctors, Mina still believes that more should have attended the May 11 meeting to support their colleagues and voice their demands.

“The 2016 incident will be hard to repeat, as the ceiling for syndicate freedoms has decreased since then. The question also relates to the public atmosphere. However, there is always room to show support and solidarity. Collective action always reflects strength, even if its just in the form of stickers in hospitals, flyers distributed to patients or symbolic demonstrations in protest of some attacks,” Mina says. While some doctors are cautious about work stoppages, she adds, “Collective action does not necessarily have to take the form of a strike.”

Hadeer El-Mahdawy 

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