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Towards an Efficient Healthcare Policy: Observations from My Notebook on Healthcare Services in Libya
13/01/2012 23:06:00
Libyan doctors treat an injured anti-Gaddafi fighter at a hospital in the town of Ras Lanouf, eastern Libya, on March 9, 2011.(AP)

By Dr. Elmahdi A. Elkhammas
(Columbus, Ohio, USA)

What I am sharing with the reader is a collection of notes written over the last few months for my own use. My memory is not the only source for these. Some are from Skype conversations, some from chats and others from Facebook discussions with colleagues.

Even though I have been in surgical practice away from Libya for over a quarter of a century, I have always admired my colleagues who remained there. I felt their love for Libya and their profession superseded any glitches in the system.

During the last 5-7 years, many attempts have surfaced to introduce the terms “Libyan doctors inside” and “Libyan doctors abroad” to separate Libyan healthcare professionals (LHP) into two somewhat competing camps. I have resented this and voiced my opinion all along. I still feel the same way.

To me the LHP is the same if he /she is practicing in Tripoli, Benghazi, Ras Ejdair, Assalloum, or in any other foreign country. What is important is what he/she is offering to Libya, the profession, their patients, their colleagues and so on.

A few years ago (2007, The national day for the Libyan physician), I wrote an editorial asking for initiation of a national day for Libyan doctors. I really feel that Libyan doctors are intelligent, hard working, and are very productive under often-difficult circumstances. The clinical and managerial skills of Libyan doctors inside are what have kept Libyan citizens healthy for the last 42 years.

They also understand that medical education has deteriorated over the years with the opening of many colleges that lack adequate training tools. Despite this, Libyan doctors are scoring very well on their qualification examinations and are performing quite well both inside our home country and abroad.

We are aware that medical tourism in Tunisia, Jordan and other countries in recent years have been the result of a poorly functioning health system and not the lack of good Libyan doctors. We also know individual Libyan doctors who obtained all their medical training in Libya who went on to excel beyond any expectations. I have several examples if anyone is interested.

Having said this I would like to go back to my notes.

1. It is with tremendous pride that I acknowledge how the Libyan medical students, interns, residents and consultants ran to the fighting fields and front lines to participate in treating the wounded during the liberation of Libya. City by city you find Libyan healthcare professionals from different places, inside and outside Libya, working with each other with respect and ultimate professionalism. They were able to build field hospitals in no time. They saved many lives. They tended to dozens of those injured and saved many extremities. Some of them were even held as prisoners of war, tortured, and some were killed as a result of torture. Their colleagues never backed off. They kept pressing and doing the impossible to help. Some who could not travel sponsored fundraising activities, and sent monetary aid to their colleagues inside. Medical equipment, ambulances, medicines, and relief organizations were delivered on very short notice. Such young and talented people deserve attention and recognition. They need someone to remind them of a brighter future for their career. They are not asking for a lot. They just want to live as decent human beings. They are asking for basic needs. A home, transportation, education, a well-functioning health system, security, and food on the table are all basic needs and not ambitions. Their ambition is to learn more inside their home country and abroad. It is important to travel and observe other doctors in practice. You learn a lot that way. Having well regarded training programs will be very worthwhile and provide a long-term satisfying experience.

2. They need to hear a unifying voice. Libyan politicians need to understand the relationship between a good health system and the economy of the country. Healthy citizens are more productive than sick ones. I guess this fact is obvious but I could not resist mentioning it. Healthy Libyans report less sick days and spend less money abroad seeking diagnosis and treatment. So it is vital to our country for our politicians to address the healthcare workers and listen to their needs and concerns.

3. The Libyan Board of Medical Specialties. This is a real entity and a very important institution for Libyan Medicine and its future. It has played a major role for over two decades. It may have been misused and abused in the past. It may have been used for political and personal gains but we are in a new era. It cannot last without strong leadership and significant attention from our officials. The leadership of such an institution is vital for our young doctors as well as for the health system as a whole. The leadership has an abundance of work needing to be done to enhance the different boards and make them functional again with better outcomes and quality. A dialogue should be opened between the doctors, the ministry of health, the ministry of higher education and the LBMS leadership to shape future training. All Libyan physicians have a stake in this. The board should include physicians from inside and abroad. Ideally this would occur within the next eight months and continue for the long-term. A long healthy discussion then will lead to selecting the best design and role for this institution. There are several similar institutions internationally. Familiarity with those is a must before deciding on a final organizational structure. Keeping the “no decision” action will help no one. It will harm Libyan citizens in the long run.

4. Libyan board of medical specialties should open its doors to frank discussions about its role in the future and about relations with other international boards as well as different auditing systems and consulting services. The LBMS and other Libyan medical associations abroad have a national duty to bring the unity of Libyan doctors to life again. This particular point is bothering me a lot. I placed it as a separate item and often repeated it in my notes. Following the liberation of the country, this issue becomes high on the list of priorities to assist with gaining the Libyan citizen’s vote of confidence in the new health system.

5. The confidence and trust among Libyan physicians, patients and the health system has eroded. I do not think regaining such a trust has been given adequate priority. How to do that is a topic for discussion in itself. It deserves several multidisciplinary task group meetings. I do feel having the Libyan physicians in all locations on the same page will expedite this process.

6. Family Medicine. I’ve been thinking about this for at least two years how Libya should proceed. I remember when doctors were sent to Egypt for six-month training sessions in family medicine. We all knew that six months was not enough. We also knew that Egypt was not always the best place for family medicine training. Possibly we should grandfather a few doctors as family medicine specialists so they may collaborate with colleagues both in Libya and overseas to develop this important specialty. We can link to a large group of family physicians both in Canada and the UK.

7. Task forces: in talking to my colleagues from different cities and countries, one message is often repeated; no one minister of health in Libya can do it alone. It is a heavy burden, and collaboration is the solution. I hear many colleagues saying multiple task forces are essential for the ministry to perform over the next six months as well as into the future, I hear the message that there is a need for an advisory board. This is self-explanatory. I also hear the need to have a specific task force that would mimic one such as that of Abraham Flexner report in 1910. For anyone unfamiliar with that, it had a major impact on medical education in the United States. The impact of Dr Flexner’s report is still felt today 100 years after its publication (N Engl J Med 2006; 355:1339-1344). I think the current minister of health is in a good position to take advantage of the current post liberation momentum to seek the help of others in determining different task forces, committees, and advisory boards.

8. Communication between healthcare workers and the ministry of health, again this leads back to TRANSPARENCY. Physicians in general do not like to remain in the dark. They like involvement and open discussions. They would love a weekly report from the ministry of health. Even if the steps are modest or with little continual progress. As long as they know what to expect, they can live with it. So it would be nice if the spokesperson for the ministry of health gave a 10-minute weekly update. This would go far to streamline the ministry and its constituency and get everyone on board for any changes.

9. Building a health service: Do we need to build a new one or do we reform our exiting one? We have a lot of good healthcare workers who show outstanding individual efforts. However, there is no clear path or system that allows for individual efforts to merge so that we can accomplish improved outcomes as a group. At this point it would seem the action should focus on enhancing current services. Meanwhile, a study group separately should be working for strategic planning and a long-term agenda for a health service that is well designed and appropriate for the 21st century. What we ultimately need is a structure that is going to allow our system to grow and flourish, and that fits the Libyan culture. I do agree we do not have to re-invent the wheel. But we must remember that not all the already-made wheels will fit our present model. So having the right task force committee to look into that and interact with professionals in designing and maintaining health services is mandatory.

10. Several physician groups are working abroad extending their hands to help their colleagues and their country. I would like to commend their efforts during the revolution and now. However, due to time differences and lack of experience with teamwork, this has made their efforts not entirely clear and without a focused message. I understand the message of love for their colleagues and for their country. I think with time and patience, such efforts will stabilize and become more productive. One of the seniors abroad said: “We always say the correct things but we fail to execute it.” I do agree with that statement. I hope our ability to communicate and execute our goals will increase with time. A forum does exist and welcomes all interested in the healthcare services in Libya to participate and express their opinions.

11. Ethics. I do think it is in the heart of the situation. Having a group working on introducing medical ethics on a larger scale is a necessity and not luxury. It will lead to producing better patient care, better training, better healthcare laws, improved patients’ rights and the overall extension of the right behavior in the profession of healthcare.

I know the above notes may not be very clearly connected. Libya and healthcare are two common factors among these scattered notes. I think that each one deserves a better discussion on its own merit. Please feel free to dissect and elaborate.

Elmahdi A. Elkhammas, FACS and Professor of Clinical Surgery, Division of Transplantation, at the Ohio State University, Columbus, Ohio, USA. He contributed this article to The Tripoli Post. He can be reached at: elmahdi.Elkhammas@osumc.edu


زملائي ..
هناك امر خطير يدبر بالخفاء الان في كواليس الصحة و هو اعطاء صحة الليبيين لشركات يقال عنها للخدمات الطبية و هي ابعد ما تكون عن ذلك. القذافي عطل النظام الصحي في ليبيا و اجبر الليبين على طلب التشخيص و العلاج في الخارج و لمساعدة اقتصاد تلك الدول. اليوم الوزارة تهب صحة الليبيين للاجانب يتحكمون فيه حسب مصالحهم.
لا ادري اذا كان هذا الموضوع قد درس جيدا و مدى جدواه .
الوزارة تحاول اعادة الشركة المسماه دينوس الى مركز بنغازي الطبي و نحن نعلم جيدا ان تلك الشركة هي من مو روثات الفساد للنظام السابق. هذه الشركة صصمت خصيصا لمركز بنغازي الطبي و ليس لها اي مشروع لا في فرنسا و لا في اي دولة في العالم اضف الى ذلك ان و زارة الصحة الفرنسية لا تعلم عنها شيئا.
ارجو من السيدة الوزيرة دراسة ملف هذه الشركة جيدا و غيرها من الشركات قبل تسليم رقاب الليبيين مرة اخرى لمصاصي الدماء و الفاسدين.
اللهم فاشهد اني بلغت
Excellent article doctor we need experts as yourself here in Libya to handle our health care. You have been helping us before the revolution before anyone had the courage to do so. thank you for everything.
Well said professor ,all the points are extremely vital , what dragged my attention most is wither we have to reform vss rebuild the health care system, its to rebuild and invent a new health care system as the one which seems proving medical serves are totally corrupted and based on a fragile foundations (if there were any), to have a help from our colleagues abroad is a good thing to start with, once they reach a point a knowledge that can add much to the system
وزارة متعددة الادرات(ادرات مفعلةتشتغل مش على الورق) بناس يفهموا وا في تخصص الإدارة الطبية +ميزانية (مش مليار ولا اتنين لان ميزانية مركز طبى متخصص متوسطها نص مليار سنوي(يصل إلى مليا رو أكثر في بعض الدول) -تشكيل نظام صحى يشمل الطب العام او طب العائلة منضم بالتسجيل ويغطى استشارات الأولية الباطنة العامة والجراحة العامة والأطفال ونساء ولادة وتطعيم صحة عامة مدرسية وغيرها ويشمل أيضا عدد كافي من العيادات بجميع تخصصاتها مش عيادة مقطوع عليها لمياه وفيها دواء كحة وحرارة بس !!!!!!! شن بيديرلك الدكتور ولا الممرض -كم عدد مرضى الضغط -السكري القلب الأزمة-االحسساسية الغدد وجراحة بأنواعها اوووووو فى ليبيا كم يوجد من عيادات ومراكز متخصصه فى علاج هذه الحالات قليل بل نسبة لعدد السكان -كم يوجد اخصائى قلب فى البيضاء مثلا وكم يوجد اخصائى صدر فى درنة وكم يوجد اخصائى جراحة مسالك فى سبها وكم يوجد جراح صدر او اعصاب او اوعية دموية كم يوجد اخصا ئئ ج عظام فى ليبيا كلها وكم اخصائى طب مختبرات وعلم امراض وميكروبيولوجى ووووووو وكم اختار الاجابة( لا يوجد –ولا 1ولا -4-ولا20-ولا 30) !قلييييييييييل اجدعها تخصص فيه ّ50 على مستوى ليبيا- العدد هذا تلقاه فى مركز طبى متخصص واحد فى الخارج- بعد سياسة الاستغناء عن الأجانب وقلة الإيفاد الى الخارج كم عدد أسرة العناية المتوفرة يوميا لجلطات القلب والدماغ و اللازمة والصرع ولتسمم وال الالتهابات وووووووووو التى تحدث على مدار الساعة لاابنائنا وأمهاتنا و ا لآبائنا في المستشفيات في بنغازي درنة وطرابلس المستشفيات اجدعها واحد فيه 10 اسرة عناية كم اخصائى فى الطب الحرج(العناية) فى ليبيا وكم يستطيع ان يفعلوا العناصر الطبية فى ضل هذا النقص الرهيب فى الاسرة التحاليل الادوية- فى مستشفى عام واحد فى مدينة كيف طرابلس يتردد علية يوميا 1000- 2000 من اى منطقة فى ليبيا!1كم تحليل دم ابو 5- دينارولا 10مش قسطرة وففحوصات ملونة ال ناسينهااذا كان ميزانية المستشف 5ولا20 مليون هذا بخلاف الولادات العمليات صدر وبطن وحوادث ودخول يوميا فى مستشفى 200 ولا 400 سرير وغيره من الاشياء الضرورية والتى تحفض الحياة ومهمة لا تقدر بمال من 100-3000-100000 ديناركم ثمن وصفة مضاد حيوى ولا علاج اساسى لبعض الاورام عفاكم الله لكل حالة لن نستطيع تقييم الخدمة فى عدم وجود تخصصات كاملة مهمة طب الطوارى طب اسعاف نضام تحويل مرضى تحاليل واشعة فى نفس المكان استشاريين معامل طبية وهندسة ومعدات وانضمة تجهيز ومراقبة ادوية تحضير محاليل وصيانة اجهزة واحصائيات وارقام بالاحتياجات والاستهلاك والتخزين الاطباء احيانا كثيرة يطبعو فى المستندات واوراق المتابعة ووالوصفات بروحهم و وووووو تاهيل تمريض فى مرة سمعتو على دورة لفنيين ولا التمريض فى الخارج لليبيين! طب العسكرى طب شيخوخة االحسساسية اعادة التاهيل التقيف الصحى التسجيل واتوثيق وعدم تكرار الفحوصات المكلفة قسطرة تندار بكم @تكتب على ورقة تضيع تانى يوم وووووووووووووووونريد نضام صحى فية عدد كافى من المستشفيات مش1 فى البيضاء كلها ولا4في مدينة كيف بنغازىفيها مليون نسمة (تحتاج لى 15000 سرير طبى ) ولا مركز سكر واحد فى طرابلس الى فيها 160000 مريض بالسكر 13-16%من عدد السكان عدد الاطباء فى طرابلس كلها لايكفى علاج مرض السكر بمضاعفاته المتعددة هذا م نحتاجه لتطبيق المعايير واعطاء المريض حقه من العناية التي يستحقها واوووووووو وومن لذلك نترحم على الشهداء إلى غيرو الانظام ونعالج الجرحىونرقى بالتعليم بسرعة ونوفد ّّّّ- سنويا400 طبيب سنويا للخارج ونجهز نضام صحى كامل وبلاستعانة بالخارج بسرعة لان عندنا مجموعة خدمات متفرقة ومحدودة برغم بعض الكفاءات تحتاج الى نضام لكي تنجز والاا تضل النتائج محدودة ولالالالالالالاتكفى لان الوقت مهم والقرمة لاتفيد!

اولويات لازم من البدء فيها ولو بنسبة 20 % كل سنة لكى تكمل بعد 5 سنوات
1- تسجيل الليبين لتقديم الخدمات بمهنية مبنية على إحصائيات دقيقة وعادلة يتم متابعتها وتقييمها ويتم التأكد ان كل ليبى مسجل فى مركز رعاية أولية يقوم بتنسيق الخدمات الصحية لة ونظام إحالة الى مستشفيات تخصصية يضمن استمرارية العناية بالحالات المزمنة وسجلات طبية تضمن متابعة دقيقة للفحوصات والاستشارات والأدوية المقدمة للمريض
2- تجهيز مراكز صحية وربطها بمستشفيات تخصصية بألية خدمية تضمن خدمة المريض وتدريب أطقم الرعاية الصحية الأولية
3-ربط المستشفيات التخصصية بالمستشفيات والمراكز الطبية الجامعية لضمان الإشراف العلمى والتدريب الطبى المستمر
4-نظام إسعاف طارئ يشمل النقل للمستشفيات والعناية الطبية الطارئة فى العيادات الطبية الخارجية بكافة التخصصات والعناية المركزة داخل المستشفيات ونقل الحالات بين المراكز الطبية
5-نظام تسجيل ومتابعة للادوية من دخولها للدولة للتخزين للتوزيع للصرف للتجديد الروشتات وللتخلص منها لما تكون غير صالحة
6-تاهيل عدد مناسب من التمريض والفنيين الطبيين علاج طبيعى تاهيل مختبرات اجهزة طبية إداريين صحيين اعلام صحى
7-تعليم طبى مستمر
8-تطبيق القانون بخصوص حقوق العاملين الطبيين وواجباتهم
9- دراسات بحثية ومراجعة لتطبيق المعايير الجودة والطب حسب البرهان والمعايير الدولية
10-انشاء هيئة للتامين الطبى بمعايير دولية لتغطية خدمات الطبية الخاصة لمن يرغب
11-تشجيع الاستثمار الخاص ومراقبة جودته
12-إنشاء اتحادات للعاملين الطبيين للرقى بالخدمات ومراقبة شروط الخدمة وضمان الالتزام بالمعايير الاخلاقية والعلمية فى العمل
13-تطوير التدريس الجامعي والدراسات العلياء لكافة العاملين الطبيين

ملاحضات للبدء فى تحديث الصحة ولمساعدة الأطباء للرجوع إلى ارض الوطن
----إلى أن يتم استحداث نظام صحي عام مكتمل خلال السنوات القادمة هناك العديد من الخيارات لمن يرغب فى الرجوع ومشاركة زملائه حسب قدرته من تقديم خدمة مميزة إلى تدريب كوادر إلى مشاركة أدارة مؤسسات القطاع وتطويرها
نظرا لوجود كفاءات في الجامعات تكون بداية لتطوير القطاع
----- إنشاء هيئة تدريب طبية تكون نواتها المستشفيات التعليمية نموذجية(اختيار عدد معين من المستشفيات مبدئيا تتبع الجامعات إشرافيا في المدن ذات الكثافة السكانية) تتكون من أقسام طبية تحت إشراف أعضاء هيئة التدريس ويتم مشاركة الإخوان في الخارج استحداث خدمات أو استكمال النواقص الموجودة حاليا ل(فيه تخصصات ليست موجودة حتى في مايسمى كادر(نكتة)!!!! الان الذى يحتاج الى مراجعةومعظم التخصصات ناقصة
تخصصات تعليم طبي** – أبحاث طبية*
تخصصات التخدير* –العناية الفائقة* –طب الطوارئ**-طب المناعة**- –طب شيخوخة **–الأمراض المعدية –المعامل المايكرو والباثولجى*—معامل طبية بأقسامها*-السجلات الطبية-التمريض-أدارة طبية* –صيانة أجهزة طبية* -
الجراحات التخصصية وبأنواعها* الأشعة التخصصية بأنواعها*-الصيدلة السريرية** وأطقم الطبية المساعدة-أعادة تأهيل**
(* ترمز ا ى تخصصات بها نقص شديد و** غير موجود)

يتبع هذه عيادات تخصصية .
تكون هذه المستشفيات نموذج لتقديم رعاية طبية جيدة ومراكز لتدريب كوادر طبية مختلف التخصصات من تمريض –فنيين-أطباء –أدارة طبية (دورات - دبلومات وورش عمل......الخ)
-----يتم استحداث وحدات ومراكز رعاية صحية نموذجية (خدمات وتدريب كوادر)بالاستعانة بكفاءات من الداخل والخارج تكون نواة لتخريج كوادر ويمكن التسريع فى البرنامج بإرسال بعثات فى هل المجال للخارج للمتميزين وللذين تسمح ظروفهم لذلك من الكوادر الموجودة حاليا فى العيادات العامة(والى ماتسمحله ظروفه يدرب محليا فى الوحدات النموذجية).
- ---- نظام جديد للخدمات الصحية الأولية بتأهيل على مراحل بسجلات وتقسيمات أدارية وووو.
- ----إنشاء جامعات طبية خاصة بدعم من الحكومة او-مركز تدريب تأهيل طبية فى مختلف التخصصات الطبية والطبية المساعدة ويشارك فيها كل من يرغب من الداخل والخارج بالية منظمة ولوائح تنظيمية بدون إرباك للخدمات الصحية.
- ----انشاء مستشفيات خاصة
- -----إنشاء هيئة للتامين الطبي بمستشفياتها وعياداتها الخاصة بها وأنظمتها ولوائحها ومرتباته الخاصة بها
- ------إنشاء مستشفيات او مركز صحية تتبع مؤسسات فى الدولة-مثل مستشفيات عسكرية-لاستكمال ومتابعة علاج وتاهيل الجرحى اوتتبع قطاعات صناعية ذات طبيعة مهنية كيف الصناعات النفطية الاسمنت وغيرة لان هذة الخدمات ناقصة أو لا توجد .
- طبعا ايجاد البيئة المناسبة للعمل والتطويره تحتاج إرادة سياسية وموارد وتدرج في التطبيق على مراحل وتطوير للوائح مبنى على استشارات ودراسات أولية والاستعانة بخبرات وتجارب مماثلة لتحديد الأولويات مما ذكر
- وكذلك نحتاج إلى تداركا الإجحاف الكبير فى رواتب التخصصات الدقيقة فى قانون الرواتب مثلا يعامل الأطباء لعند شريحة تخصص الباط نة العامة وليس هناك علاوات او تمييز للتخصصات الباطنة المختلفة المهام يعنى استشارى باطنة عامة نفس راتب استشارى قلب يقوم بالعمل فى عناية القلب ويدير لفحوصات القلبية (ايكو قسطرة وووووو)ونفس مرتب استشارى الجهاز الهضمى وووو استشارى الباطنة كيف جراحة العظام والجوادث!!!!!!! فكل تخصص لة خصصوصيتة ومهامة الروتينية والجراحية والحرجة و مسئوليتة ووووو
- يجب ان تتم معاملة الأطقم الطبية حسب المهام المكلف بها سواء كان ليبى من داخل او خارج او اجنبى .
لابد من إعادة النظر في المكافئات عندما يقوم طبيبان بمهمة مثل امتحان او دورة ا وظيفة فى مستشفى يعطى الاجنبى مكافئة شكل والليبي شكل الا اذا كان دار مهمة اوعمل يختلف ولا تقنية تختلف وكم مرة صار نقص في كادر معين في منطقة ما ولا امتحان اذا تم الاستعانة بكادر ليبى (من منطقة اخرى او من الخارج)او أجانب كان يحدث اجحاف لليبين (من الداخل او الخارج) مقارنة بالاجانب يعنى ممكن الاجنبى ينصرف له تذاكر اقامة ومواصلات والليبين مش برانية!!!!
-انا مع اخوتناالاطباء فى الداخل و الخارج لإيجاد آلية معينة لدعم الكوادر الطبية والطبية المساعدة بمختلف التخصصات فى السكن والبدل المواصلات بدل مؤتمرات طبية وإعادة الاستقرار نظرا لطبيعة العمل نوعية المسئولية والمناوبات التعرض للعدوى وووووو

- هذه ملاحظاتي المتواضعة والتى يشوبها النقص فى بعض التخصصات نظرا لعملى فى ليبيا فى مجال التعليم الطبى وكاستشارى بقسم الباطنة .

Thank you so much for your comments. I do agree that Libyan healthcare professionals inside Libyan and their colleagues abroad have to join hands and help each other directing the health service in Libya to a better future. I know for sure that we have a lot of colleagues inside Libya who can serve as as a group of advisers. They know the politics of Libyan medical culture and Libyan society. They can also help selecting who can work with them from inside and outside. For the next 4-5 months we need teams to triage the issues into urgent vs long-term issue and attempt solutions accordingly.
Dear Mahdi,
Thank you very much for your thoughts and your continuous concern and support for the healthcare in Libya. I very much share your admiration for our colleagues who remained inside and serviced the Libyan people often in difficult circumstances. I also pay tribute to all those who rushed to do whatever they can to help the wounded.
The points you raised are valid and very important. I think the Libyan healthcare system needs major reform starting with what sort of healthcare system the Libyan people wish to have. This is not just technical question, but political and social choice. A mixture of experts in the field from inside and outside the country helped with a reputable western think-tank as an adviser should lead the way into a major national debate involving all the healthcare workers and the Libya people to choose the healthcare system that best services and respond to the Libyan people heath needs. At the present time there are so many pressing issues for the transitional government. As a transitional non elected government, it might not be appropriate for the government to start radical reform, but the government can still do a lot. I am very concerned that the quality agenda in the healthcare seems to be not a top priority. Clinical Governance and Clinical Audit are not being practiced in the Libyan healthcare institutions. Irrespective of the resources or even the training these are vital to ensure a safe and good quality healthcare system which always capable to check, correct and improve itself on a continuous basis. The current administration can also start the reform of the care of the emergency medical loop: the ambulance service, the A&E departments and the Intensive Care Units. Service that is professional, capable and responsive like any other in a Western country in the 21st Century. To try to persuade the top officials of the old regime I used to tell them that no matter how much money or power you do poses if you have RTA or a heart attack it’s the local acute medical care which determine whether you live or die. Primary healthcare services which is going to be essential irrespective of the healthcare system which we as Libyans untimely going to have. Nursing training is another top priority. It should well planed and executed probably by Arab nursing training bodies because of the language barrier but the training has to be accredited by reputable Western Nursing accreditation bodies and there are some of these courses around.
In whatever we do we must very carefully, systemically and professional examine, conduct and involve the healthcare community in Libya in the decision making and only implement reforms that is very carefully selected, well consulted and implemented to reputable Western accredited standard. Change of the medical culture into more respectable medical professionalism and ethics is vital not only to improve healthcare but this an essential requirement towards regaining the Libyan patients trust and confidence towards our Drs, Nurses and our Healthcare system. We should introduce and improve recruitment of Drs and nurse. This will raise awareness, improve ethics and professionalism, standards rise and training improves.
What concerns me most at the present is the fear of introducing abstract reform changes that is not carefully considered as part of overall strategy particularly taking into account the very transitional nature of the current government.
Prof Saleh El-Gadi, MPH, FRCP, FRCPI, Dip GU Med
I have worked in Libya. All told by you are correct. Indian Specialists could offer the helping hand if the Govt of Libya calls on Ind Govt. and also to establish PRIVATE Indian Teaching Hospitals in Libya. INSHA ALLAH only when elections and post elec violence cease !!

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