Egypt’s doctors mull strike

CAIRO, Egypt – Enter the lounge in the Nile Hospital, take a seat on a ripped leather couch, swipe at the cigarette smoke and listen to a litany of complaints on the cruel economics of health care from doctors whose salaries are as low as $63 a month and who live with their parents.

The travails of doctors mirror the larger shortcomings of a government struggling to provide medical care in a country where about 45 percent of the population lives in poverty. Physicians across the nation complain of long hours, shrinking respect for their craft, lack of medicine and broken equipment. One gynecologist said his public hospital is so broke that he buys his own rubber gloves rather than wearing ones that have been washed for reuse.

“You get 10 extra pounds (about $1.80) if you work a 24-hour shift,” said Mohammed Farahat, an orthopedic specialist. “But to buy your dinner during that shift costs you 15 pounds. So you’re thinking, what good does it do?”

Egypt’s doctors have been protesting for weeks and have set a March deadline for a nationwide strike. Their battle is the latest ripple of labor unrest that in recent months has sparked demonstrations by textile workers, university professors, pharmacists, train conductors and real estate tax collectors. High inflation, flat wages and anger at the government of President Hosni Mubarak are increasingly agitating both the educated and working classes in a moderate Arab state that is one of America’s closest Middle East allies.

The Doctors Union is demanding an immediate minimum monthly salary of $180 for 93,000 physicians working directly for the state. No salary at the Nile Hospital in northwest Cairo exceeds that, including the pay for surgeons, Farahat said.

The starting monthly pay for doctors can be as low as $23. The Egyptian Health Ministry said it will gradually increase pay based on performance, but that its budget, like those of many government agencies, is too strapped to meet the union’s demands.

“We sympathize with doctors,” said Abdel Rahman Shahin, a ministry spokesman. “The state should finance (higher pay), but the state has a lot of obligations.” He added that with phased-in performance bonuses, “at least there is some change doctors will feel” by the end of the year.

Many doctors view the proposal as a paltry attempt to correct years of low salaries that are now quickly eaten up by a surge in inflation that has increased prices as much as 50 percent for food and other commodities over the last two years. The crisis has also reminded doctors that despite years of education and training, their salaries are slightly higher than that of government accountants, who earn about $35 a month, and less than many university professors.

“Life is very difficult, but people expect you, as a doctor, to have a car, spend generously and leave huge tips,” said Ahmed Sobhi, an internist at Nile Hospital who earns less than $65 a month. “The reality is my small salary. My wife and I and new daughter live in an apartment owned by my father. We never go to the movies. Our only entertainment is to watch TV.”

The physicians’ stature and sense of professional entitlement have been tested by a state health care system burdened by bureaucracy and debt. Most doctors moonlight by rotating shifts at different hospitals and private clinics. This accumulates into strings of sleepless nights but can earn an extra $90 a month. Many doctors leave Egypt for richer Persian Gulf oil countries, where hospital salaries are many times higher.

“This is causing a brain drain,” said Farahat, who sat puffy-eyed in scrubs and a lab coat. “I have doctor friends who have moved abroad, and I’m thinking of going to Saudi Arabia, Kuwait or the United Arab Emirates. The problem is that in 10 to 15 years, if all the doctors leave, there will be no one left to teach a younger generation of Egyptian physicians.”

It is a sensitive time for doctors to be contemplating a strike. Mubarak and his ruling National Democratic Party are under pressure from labor groups demanding better wages and from opposition organizations, such as the Muslim Brotherhood, pushing for political reforms. Calls for change have highlighted the widening anger the poor have for an upper class they regard as corrupt and aloof to the nation’s problems.

But many physicians feel that, although they still command a degree of respect in society, they are part of a vanishing middle class. “We have two classes today in Egypt – the capitalists and the poor,” said Farahat. “We have no middle class anymore. Given such conditions there must be labor strikes.”