Doctors Write Prescription for Improvement of Medical Services in Sudan
25 August, 2014KHARTOUM (SUDANOW)—Several Sudanese physicians acquired prominence in fields of medical treatment and discoveries inside and outside the country. Besides the outstanding pioneers in this field, the most recent list of honor includes Sudanese Senior Surgeon Al-Rasheed Saeed of Britain’s Luton & Dunstable Hospital who discovered an advanced technology, the first of its kind in Europe, for treatment of elbow fractures which prevail among children and Professor Mustafa Abd Alla Salih, a Sudanese pediatrician in Saudi Arabia, who discovered an inherited gene that causes the most dangerous polio, in addition to several medical discoveries he has achieved in collaboration with scientists in America and Britain.
The migration of tens of thousands of Sudanese doctors in the past few years also indicates a steady confidence by foreign countries in the Sudanese doctor. For instance, in Britain there are 1582 Sudanese physicians serving there as registered doctors, in addition to others serving in Saudi Arabia, the United Arab Emirates and Libya.
In contrast, complaints have of late escalated within the Sudan about shortcomings in the health services and about growing medical mistakes, despite the remarkably growing numbers of medicine graduates and increasing numbers of hospitals and equipment. What are the reasons of those complaints, then?
The tumors specialist in the National Council for Tumors and Radiation Treatment of Khartoum, Dr. Kamal Hamad Mohamed, said “Unfortunately, the Salvation government has opened numerous colleges, including 23 schools of medicine in different parts of the Sudan, but the number of the staff specialists is very limited, hence the result was a great number of graduates but of an awful standard that was reflected in the poor medical services”.
“In the 1970s, there was only one school of medicine in the University of Khartoum – followed by faculties in the Islamic University of Omdurman, Juba and Gezira- and the number of the graduates from that school ranged between 20-21 doctors of a high and honorable academic standard as opined by external examiners who used to come from the United Kingdom for the purpose at that time. But now the numbers of the students increased and the schools of medicine redoubled in addition to another increase in the special admission students, permitting many students with low Sudan school certificate grades to enroll in those schools.”
While it underlines confidence in the capacity of the Sudanese doctor, the migration of the doctors has an adverse impact on the academic standards in the faculties of medicine and the training of the new doctors. There are now great numbers of doctors undergoing training compared to the small number of their instructors, affecting the standards of the trainees and the service alike. Moreover, the internal training requires numerous training aids the larger part of which is not available internally. Those doctors, after specialization, should be sent abroad for short periods for training on modern devices relevant to their fields of specialization but such scholarships are not available at the present time for lack of funding by the state.
Dr. Hamad attributes the immigration of the teachers of medicine in the last two years to several reasons, noticeably including meager salaries as the professor of medicine in the University of Khartoum gets a monthly pay that is not more than 400 US dollars, the lack of funding for scientific research and absence of a suitable atmosphere for scientific research as the doctor needs to be tranquil and not pre-occupied with other burdens.
“After graduation in 1997, I used to get 74 pounds in a monthly salary from which I used to pay the expenses of my brothers. But now the doctor is paid 500 pounds a month which is not adequate for his own living and cannot help his family and, therefore has to work in private institutions,” said Hamad. “In the past, the doctor enjoys scholarships in Europe, scientific secondments, paid leave for obtaining a PHD and accommodation, while the salaries of the doctors and university staff are among the highest in the state and, moreover, the doctor participates in international scientific conferences,” he added.
In view of the unavailability of all facilities at the present time, the professors resorted to the private business so that they can meet the costs of living, medical treatment and education of their children. Although it is presumed that the private business is usually in the evenings, rather than mornings, most of the doctors began to work in the private clinics in the morning. Such practices cannot be terminated through deterrent laws but through improvement of the conditions of service and salaries as most of them can leave the government employment and give full time to the private business because one day’s income in a private clinic is equal to a government monthly salary. For this reason, radical solutions must be found for the roots and causes of this problem, rather than solving it with laws, said Hamad.
He concluded by suggesting solutions to the decline in the health services, including reconsideration of the number of the faculties of medicine by cutting down their number and merging them together as most of the graduates do not find jobs. Dr. Hamad also suggested an increase in the number of professors, making use of training agreements with countries of the world and “most important, improvement of the professors’ service conditions for minimizing immigration and provision of funds for scientific research without which we cannot achieve any success in the medical field.”
Dr. Ahmed Ali, a cardiologist in the Sha’ab (People’s) Hospital of Khartoum, noted that the education and health services are less than the sovereignty services as the state has no control and supervision over the health services. Moreover, he went on, there is the problem of unavailability of life-saving drugs and vaccines in hospitals, while the Ministry of Health has in each state a minister, enjoying privileges, and a number of health centers; has that minister been questioned about the situation of diseases and drugs? 
Regarding the situation of the hospitals, Dr. Ali said: “The dormitories are dirty, the offices of the specialists are worse, the lighting is poor and the sections are not rehabilitated. Above all that, the specialist works in two shifts, morning and evening, in the government hospital during the morning and in the private clinic in the evening. This is why the doctors migrate abroad because they get tired of running from the hospital to the private clinic because the salary is too small to meet the cost of living. In Saudi Arabia, for instance, the doctor serves a morning shift and gets three times his ay in the Sudan.”
Speaking about the services provided in the public health centers, Dr. Ali said the public sector cannot afford bearing the medical services to all people and, therefore, the private sector serves as complementary. But now the private sector has become the main actor and the patient seeks the suitable treatment that retains his dignity, and the poor has to sell his house and other property to treat himself and his children. The well-to-do people pay for their comfort, Ali said, adding: “We want the private sector to be complementary, rather than the main medical actor; what happens now is the contrary as most of the medical service is provided by the private sector.”
Dr. Umaimah Hashim, a micro-biology and clinical specialist, said: “I have relished the medical profession ever since my childhood because it is a humane job and I feel satisfied and happy for treating patients. I studied hard so as to obtain high marks and I succeeded in this and studied medicine. But this wish faces many obstacles as there is a wide gap between wishes and the reality we are living in. For a doctor, in order to study and become a specialist has to undergo training and study for four years at his own expense in the Medical Specialties Council. But after he specializes, the doctor does not find a job because there are no opportunities of employment in the hospitals and the doctors are unemployed and may either work in private clinics or travel abroad. He may be offered a government job in a state hospital where it will be difficult for him to continue there. The doctors, therefore, are at a loss between their previous wishes and the suffering and hardships they confront and they are, therefore, forced to travel abroad, leaving their families and relations behind.”
Dr. Anas al-Bedawe (a physician) holds a different opinion saying:”The majority of the Sudanese patients go for treatment abroad for a lack of trust between the Sudanese doctor and the patient. Directives on the kind of a disease and its treatment should be set for the doctor to abide by and in case of disrespecting those directives he/she must stand trial.” 
Some people find excuses for the doctors while others mourn the honorable defunct medical service of the past. Dr. Mohamed Hassan Saeed, a university teacher, said: “Medicine is a humane profession, some people called doctors as angels of mercy, but now the situation has changed and the profession has now become like any other economic job subject to the profit-and-loss standards. This is due, first of all, to the present economic situation which caused deterioration of the medical services in the government hospitals and centers, confining the first-class medical services in the private hospitals and clinics.”
Dr. Saeed said: “It is unfair to blame the doctors alone because everything has changed. In the past the medical cadet used to get semi-free education with all educational services available. The study of medicine has now become highly expensive and the graduated doctors tend to compensate by imposing high rates for treatment of the patients. On the other hand, the medical treatment services have horribly declined for several reasons, remarkably including negligence of the governmental health institutions, absence of supervision and shortage of the medical staff as a result of immigration by those personnel abroad for improvement of their economic conditions.”
In order to reform the medical situation, Dr. Saeed suggested a number of measures to be taken, including improvement of the conditions of the health facilities, particularly the governmental ones, provision of a suitable environment for the doctors and other health personnel and improvement of their economic and social status and restoration of trust in the Sudanese doctor who was renowned for qualification and experience.
For his part, journalist Yusuf al-Jalal opines that the profession of medicine has become an unmistakably business of investment which he said, nevertheless, is beneficial to people because, in view of the deterioration of the medical services in the government facilities, this investment assists the doctors to establish private institutions where excellent services are provided, although he said this may be afforded only by financially capable people.
Jalal described the medical treatment abroad as “only an inferiority complex because there are now patients who come to the Sudan from 17 neighbouring countries for treatment in such Sudanese hospitals as Royal Care and Dream, while the financially capable Sudanese patients travel to Jordan and Egypt for treatment.”
It is not a problem of doctors but is one of diagnosis and the state must establish modern laboratories that restore the trust of the Sudanese national, Jalal said. He called for correction of a mistake in the policy of admission as, he noted, students with low grades are accepted in the scientific laboratories compared with the very high grades required for acceptance in the faculties of medicine.
Expressing another viewpoint, Hajjah Amnah Ahmed said: “In the past, we rarely go to the doctor, people were healthy and diseases were few. When we get ill we treat ourselves with indigenous medicines and if a person did not recover he went to doctors who were very few and were brilliant and one visit to the doctor would be enough for the patient to recover. But today diseases became numerous and varied, there are now diseases which we did not hear about in the past, like heart, blood pressure and cancer and a medicine prescribed by one doctor is different from the medicine written by another doctor. The diseases have now increased and we do not know whether the increase was due to failure by the doctors to treat them or to our diet and the way of life we are leading.”
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