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 I felt their love for Libya and their profession superseded any glitches in the system.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
|Prof Saleh El-Gadi
||Date: 28/01/2012 21:28:52
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