Bargaining With Illness: Patients Call the Shots at Egypt's Teaching Hospitals

Tuesday 4 April 201708:51 am
If it’s true that an apple a day keeps the doctor away, then Omar Badr* wants nothing to do with apples. For him, his illness is his only source of income. At almost 65, Badr has never had any stable work. He acquired some handiwork skills, allowing him to fix people’s various wares, but has otherwise only worked irregular jobs. Residing with his family in Cairo, he lives day to day, doing his best to feed his four sons and 15 grandchildren, whose fathers have been unable to find work. In his old age, and due to over-exertion, Badr has developed various illnesses, including diabetes, renal failure, as well as an auto-immune illness. While seeking free-of-cost treatment in public hospitals, he discovered an opportunity to make a little money from his illness. [h2]Mutually Beneficial Trade-Offs[/h2] At teaching and university hospitals, patients place themselves at the disposal of university students, allowing them to study their cases and diagnose them. In doing so, the patients discovered an opportunity, exploiting the desperation of students who would  do anything to pass their examinations, including pay in cash. The examinations in Egyptian medical schools include testing students on their ability to correctly diagnose patients based on the volunteering patient’s description. Over time, the patients acquire a degree of expertise with regards to their scientific diagnoses, after hearing them scores of times from the doctors and students. In turn, they begin bargaining with the new students to give them the correct diagnosis, in exchange for some cash. At the beginning, the students would give them small amounts of cash out of pity, but eventually, they began paying the patients off if they were unable to arrive at the correct diagnoses. In more recent days, Badr has the ultimate power to decide how much he would like to charge for the correct diagnosis, along with many others like him. Mona*, a fifth-year medical student at Ain Shams University, says the phenomenon of underprivileged patients charging students is just business as usual. “We need them in all the practical departments, whether those associated with the university or the ones we learn about in private tuitions,” she tells Raseef22. She further affirms that students require the patients’ “assistance” in examinations, saying: “They have learned the scientific diagnoses for their conditions better than any student, given the number of times they have heard them from professors.” According to her own experience, Mona divides these patients into two camps; the full-time patients, who have the time to stay at the hospital 24/7, and those who live outside of Cairo, and therefore cannot dedicate all their time to this “profession”. In many cases, treating such patients requires only a simple, straightforward procedure, but the patients refuse the treatment, hoping to squeeze the source of income for as long as possible. Patients earn about 500 Egyptian pounds ($27) per week—the equivalent of an average public servant’s salary—fluctuating in accordance with the rates they set. In reality, the 500 pounds are just enough to meet Badr’s family’s basic requirements for food and other needs. Yet, nonetheless, such patients think of the income as an indispensable blessing. [h2]Private Tuitions[/h2] After teaching hours, once these patients leave the hospitals, finding no more students to bargain with, they move on to private training circuits, in which professors charge students for training. In these circuits, the patients’ payment is almost doubled, charging 30 Egyptian pounds from 30 students in each tuition. Given that the patient’s presence is crucial, the professor must ensure that his/her payment is worthwhile. [h2]No Haggling Allowed[/h2] Heba*, a medical student at Helwan University, says that during practical examinations, patients do not only help by providing the correct diagnoses—at times, the patients will undertake the examinations for the students themselves. Having acquired the expertise to describe their conditions with a great deal of precision, Heba notes that “we are no longer surprised to find a smattering of English words in the patient’s answers to questions, having heard these words from the professors previously, as well as medical terms that we as students find to be complicated”. During the practical examinations, the professor leaves the room, allowing the student and the patient some alone time. Should a student insist that they do not wish for the patients’ assistance, the latter may retaliate by providing them with incorrect symptoms, to ensure that the student cannot properly diagnose him/her alone. However, in Badr’s case, he is sensitive toward the students’ socio-economic status, and given that some of them also come from low-income families, he provides a discount, asking for 50 to 100 Egyptian pounds to help them. However, other patients refuse to bargain or haggle over prices. Another medical student, Hoda, learned this the hard way, when she bargained with a patient who asked her for 100 pounds to answer her questions. Hoda later learned that the patient had agreed to a lower price, but then gave her wrong answers, seeking to knock off the same percentage off her overall grade that Hoda had knocked off the price. Moreover, Mahmoud Salah, a student at Helwan University, recalls that one patient asked a student for the gold ring she was wearing. She threatened to give her incorrect information about her condition if she refused, ensuring that the student couldn’t even rely on her own skills to arrive at the correct conclusion. The student was forced to accept, but henceforth, students ensured that they wouldn’t attend examinations with jewelry. [h2]Qualified Doctors?[/h2] In a country where the medical profession continues to be the most esteemed traditionally, about 12,000 medical students graduate every year. It is nearly impossible to discern the students passed on their own skills from those who received the patients’ assistance, and in turn whether they are truly capable of diagnosing illnesses. Salah and his colleagues know that this exchange system between students and patients is educationally counterproductive, but patients have imposed their dominance, making it nearly impossible to escape their demands. Moreover, he notes that the overwhelming majority are more concerned with the short-term target of passing their exams, preferring to worry about the repercussions later. As for the patients, the majority of them are destitute, crushed by untenable economic conditions, amid skyrocketing prices and overwhelmingly low wages. Thus, they are left bargaining with their health as a last resort to earn some cash. “Nobody would sanction this kind of work,” Badr tells Raseef22, however noting that he has no choice. He has no wish to recover, noting that the only true comfort would be in a quiet death that would absolve him of his suffering and responsibilities.
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