Health care stabilising - for those who can pay

A not-so-well-kept secret has come to light in Iraq’s otherwise well-run hospitals: patients have to pay, sometimes quite a lot, to get care in what is otherwise a virtually free health-care system. That system was a fact of life under Saddam Hussein’s regime, when millions of dollars from the country’s United Nations-administered Oil-for-Food Programme were spent on health supplies, medicines and medical equipment for hospitals. Under the programme, started in December 1996, food and humanitarian supplies were sold to Iraq in exchange for its oil. In hospitals now, those who do not pay have to deal with flies, dirt, faeces on the floor in the bathrooms that might not be cleaned up for days, or even worse. Patients are often asked for extra money, starting with the doctor down to the man who wheels them out of the hospital in a wheelchair when they are discharged. Patients, doctors and nurses express varying views on whether the health care-situation is getting better or worse at the Yarmuk Hospital in central Baghdad, reputed to be one of the best in the capital, where health care was previously also heavily subsidised by the government. At Yarmuk Hospital, nursing care is now arbitrary, even when patients do pay, according to some patients. "Most people used to do their jobs fairly. Now, we’re waiting for three hours for an injection, and the nurse has left without being replaced," said Hannah Jami, 40, who was watching her daughter sleep in a ward with 12 beds, half of them occupied. Samirah Mirzan, recuperating from appendectomy in a nearby ward, said patients paid even more now than they did previously. "The doctors treat us well, but the nurses - if you pay too little money, they get angry," said the 25-year-old. "I was here before, and I had to pay money, but now it’s even more expensive." A nurse in the ward agreed that patients paid her for services, but did so because she was taking care of them so well. "We never ask our patients to pay us. The salaries were low, but now they’re good. There’s no reason to ask patients to pay money," said Suhan Sufi, 53. "But sometimes patients are generous. I work from 2 p.m. to 8 a.m. It’s a very long shift." The brother-in-law of a patient who had been shot during a robbery said he had had to pay before the ambulance would take her to the hospital. The ambulance driver told Jasim Jundi he had to pay a certain amount, about US $10, based on how far the incident happened from the hospital. "It’s like a gift from you to the ambulance driver," said Jundi, 26. "I didn’t have previous experience with this, but I was surprised." Patients might realise that they have to pay, but it was very stressful to have to continue paying for every little thing when your relative was sick, said Majid Qaddum, 30, a security guard at the hospital. One of the worst things was the lack of staff in the wards, he said: a single nurse in charge of an entire ward of maybe 72 people might be unable to properly take care of all of the emergency cases. "It gets very tense in here. Families don’t want to pay the nurses," Qaddum said. "People get very excited when their relatives are sick. The patients get angry." Medicines were still very reasonably priced, patients said. Under the former regime, patients were charged a nominal sum, between about 50 cents and $1 for all forms of medication, and that had not changed, doctors told IRIN. Doctors at Yarmuk said patients paid half of what they used to for initial admission to the hospital – about $25, or 10 percent of a monthly salary for public sector employees. The temporary US-appointed Governing Council had made the decision to drop the price, said Dr Salman Hamid Ali. "But patients still have to put up money for admission up front, as insurance, but we dropped the price by 50 percent to help people more," he added. However, a doctor who operates his own clinic at the hospital predicted that the system would deteriorate before it got any better than it was now, especially if it was privatised under a free market economy, as the US-led administration has suggested will happen. Public and private hospitals used to get all their medical supplies free of charge under the Oil-for-Food Programme, said Wadih al-Ja'di. Now, doctors were having to buy medicines and supplies like sutures and plastic gloves on the black market, he said. "If you have a free market with these low salaries, God knows what will happen," Al-Ja'di said. "Privatisation is only good in a stable economy." Salman Hamid Ali agreed. "If hospitals are privatised, the prices will go way up and supplies will become too expensive on the commercial market," he said. "Patients could die before they could pay – their salaries are too low."