Africa, Development & Aid, Headlines, Health, Human Rights, Middle East & North Africa

Libya Faces a Health Check

TRIPOLI, Apr 7 2012 (IPS) - At a crowded corner of the Tripoli Medical Centre, people gather every morning to submit paperwork for medical treatment abroad, or worriedly scan new lists of approved names plastering the walls.

Kaltoum Alhadi bound for Italy for corrective surgery stands before a list of approved patients.  Credit: Rebecca Murray/IPS.

Kaltoum Alhadi bound for Italy for corrective surgery stands before a list of approved patients. Credit: Rebecca Murray/IPS.

Kaltoum Alhadi Marwan, 29, is one of the lucky ones. She won a visa and the go-ahead for surgery in Italy to correct a congenital bone deformity in her right leg. She is at the TMC – Tripoli’s largest hospital – to collect a cheque from the Libyan government for her airfare.

Kaltoum is a manager at a local disability clinic. But she has little faith in the quality of Libyan healthcare. “I had another deformity in my finger and had corrective surgery in Tripoli,” she says. “It was useless. It made it worse than before.”

Dr. Arbi Gomati, a UK-trained surgeon at the TMC, takes a breather during another hectic day. He is one of 11 decision makers on a committee to choose candidates for treatment abroad under the auspices of the Ministry of Health. His Tripoli group is one of three nationwide; the others are in Benghazi and Sebha. Five more are opening soon.

Dr. Gomati says since they started in November his committee reviews up to 250 patient files per day, of which an estimated 20 percent qualify. These are usually Libyans suffering from severe ailments like cancer, kidney failure, pediatric surgery and congenital heart failure. Common destinations for the pre- approved treatment are Germany, France, UK, Italy, Jordan, Egypt and Tunisia.

“In Libya we have shortages in medication,” says Dr. Gomati. “You can have an up-to-date MRI or CT scan, but no single radiologist who can look at the film or give an accurate report. Many cases we send are just because we need someone to do an intervention for radiology, that’s it.

“Because there were no health services immediately after the revolution and too many people needed them, the only way was to send people outside. But we don’t like the system and we’d like to stop it.”

Dr. Gomati’s committee is a separate entity from the transitional government’s programme to send injured rebel fighters for treatment abroad. Recent outrage over substantial abuses of the plan, to the detriment of some genuine candidates – including procedures like plastic surgery, fertility treatments, extended hospital stays and overbilling – has cost an embarrassed Libyan government an estimated 800 million dollars and forced a revision of the oversight.

Tripoli Central Hospital, an Italian-era built trauma facility in the capital’s downtown, has posters of missing people lining its emergency room walls.

“It was risky to go out, and the ER was also very unsafe – most people had guns. There was a shortage of medicine, staff and doctors,” says Dr. Ezdeen Elnaam, a young neurosurgeon who spent many nights in a row working there.

Some things are no better now. “Many days the CT scan isn’t working, or the MRI isn’t working, and we lack ultrasounds,” says his colleague, Dr. Naili Samar. “As for most of the doctors, the emphasis is on salary and not on treatment.”

“The hospitals here are terrible,” Fawzia Toshani remarks sharply. She is a media spokesperson with the health ministry, a place she’s worked for 15 years.

The health ministry just received an estimated 2.3 billion dollars in the recent government budget. “There is a problem with bureaucracy and mismanagement,” she says. “Corruption? Yes, that’s true.

“Libyan professional doctors go abroad first to study or get better money. Here the doctors get around 1000 dinars (800 dollars) a month. Patients would prefer to go to a private clinic if they had money. But that doesn’t mean you’ll get better treatment.”

Dr. Rami Ben Ahmeida, general practitioner at the private Libyan British Medical Centre, equipped with an ambulance and surgery bay, disagrees. “This place is better. It has good hygiene, better staff, and is well organised. There is no waiting list for operations, while at the government hospital you can wait up to one month.”

A two-tier health system matured under the Gaddafi regime to accommodate wealthier citizens and businesses has yielded a multitude of private facilities like the Libyan British Medical Centre.

As nurses from the Philippines bustle through the small white corridors, patients interviewed by IPS say they had health insurance through work with banks, construction and oil companies.

In post-Gaddafi Libya, as the national economy’s largely oil revenue ramps up and commercial businesses and investment start to return, the debate around a new model for Libya’s new governance, and healthcare system intensifies.

Dr. Gomati from the Tripoli Medical Centre says he would like to see medical insurance companies introduced nationwide, and encourage a public-private system. “People should pay for health services. Right now it’s costing the country money – draining money.”

“I can tell you there is a need to improve the quality of health services here, or maybe market it better,” says an official from the recently reopened U.S. embassy in Tripoli. “Libyans really do have this firm belief they cannot get appropriate health care in their country.

“But we’ve done extensive medical surveys of the facilities here, just when we were coming back and in terms of contingency planning, and there is actually very good care available here in Libya in both (government and private facilities).”

At the busy private Al Mokhtar Clinic in one of Tripoli’s more affluent neighbourhoods, Salma Gouma, supervisor for the mostly foreign nurses from the Philippines, Ukraine, Morocco, Tunisia and Algeria, says they reduce prices for poorer families.

“I don’t know why people go away for medical treatment. People don’t trust Libya, but we have done a lot of procedures correcting mistakes from Tunisian hospitals.”

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