Prime Minister Edi Rama’s remarks at public consultation meeting with community of doctors and health workers:
Hello everyone!
Thank you for hosting this public consultation meeting to tackle a serious issue and you know that this is not a new problem. But exactly because it is an old problem, it can no longer continue to be an open issue and it can no longer continue to jeopardize peace and safety of all health professionals while delivering services to the people needing health care.
At least four incidents of blind violence against doctors and the health personnel have been reported, while an estimated 315 000 cases have been treated on time and with a high sense of responsibility by the personnel in the emergency wards of the University Hospital Centre in Tirana only, despite a number of difficulties they face in their daily work.
I am providing such figures to highlight the fact that despite of an incredibly high volume of work, the emergency medical teams have succeeded in handling and coping with the influx of patients in a 24/7 service. And despite the complications and the psychological hazard that any incident of aggression poses to the health care professionals, doctors and health workers have succeeded to resists and stay on duty without abandoning their mission and even deal with this phenomenon by raising their voice and by protesting.
I, the Ministry of Health and the whole government understand and fully support protest or march of any kind, considering it a great help in the efforts to raise public awareness about the fact that doctors are not a figure embodying the evil as they are vilified on a daily basis, especially on the social networks, which carry the whole outpouring of ignorance, aggressiveness and emptiness in relation to the true reality, which is not the reality taking totally incompatible dimensions to the reality of facts reported on screens or web portals due to the aggressors on one hand, or due to the cases when certain doctors, sector heads, nurses and other health workers are shown in a wrong position of a corrupt individual.
If we were to state that no corruption practices are to be found in our country’s health system, the we would be uttering a big lie. But, if we were to acknowledge that no corruption-free health care or service is provided in the health care centres and hospitals across the country, then we would be acknowledging even a bigger lie. The truth is that our health system is damned and blamed mainly by those who have never tried it. Meanwhile, the number of those who go through the necessary process to receive care and develop respect for doctors and nurses is growing constantly. But this fact does not make news. Handling some 315 000 health emergency cases is not reported as news. Only a handful of cases including certain doctors exposed to corruption practices are reported as news. This has cast a huge abusive cloud of prejudice and ill-judgement over doctors.
Just like it is worth mentioning that deficiencies and shortcomings in our hospital and health care service are mainly attributed to the management system rather than to the network of health personnel, whether they be doctors nurses, be sanitation workers. A management system that is not uniform throughout Albania. A management system that leaves much to be desired in certain hospitals, or in certain health centres due to mismanagement.
Today, whoever is unable to distinguish between the today’s reality and the past, he definitely needs a careful examination of his eyes at the ophthalmologist. Should it turn out his sight not impaired then he needs to consult a psychologist. This is clear. He needs to see a phycologist to help him escape from the psychosis of negativism and the evil that is being reported from TV channel to web portals in Albania. But, on the other hand, such a difference is not sufficient, because the today’s reality is completely different to the past reality at the University Hospital Centre, where a fundamental transformation has happened and continues to take place, and at every other health care centre that are being reconstructed and transformed. It is a big difference and huge gap between the today’s reality and the objective to build a uniform care service throughout the country.
Nothing can, however, justify actions that violate physical safety. Especially at this particular stage of our progress, we cannot allow violation of the physical safety becomes a normal behaviour. Assaults against doctors and medical practitioners, assaults against policemen and the attacks against the people’s representatives. We cannot accept such misbehaviour as normal as such actions question one of the cornerstones of this whole system and the entire this work we have done so far in the efforts to set limits and define one person’s freedom ends where another’s begins.
Assault because of duty is punishable pursuant to the Criminal Code. It is not something that is not stipulated by the Criminal Code, but there is a discretion loophole, allowing those who deserved to be punished escape, while those who deserve justice always lose just because of courts, which are still under a transformation process and still remain hostage to corruption. Then it is imperative for us to amend the Criminal Code again and a broad discussion is taking place within our parliamentary group, in the parliamentary committees with individuals with the right degree of expertise. The Ministry of Justice is leading this process and the assault because of duty will be included in a new impossible discretion framework that won’t allow prosecutors and judges to decide that “the assault was not really an assault,” or decide that “the assault was a premediated or not a premediated one,” and acquitting then the aggressors.
Considering the violence and threats against the medical practitioners and health workers a specific criminal offense is imperative.
In the meantime, we are drafting the amendments to define the pitch’s lines during a sports game. Whoever crosses those lines should be sent to prison, because they pose a physical threat to those carrying out their duty, be them football players or referees.
Defining the hospital’s lines and borders is also an imperative. It is no longer acceptable that hospitals resemble to train stations in the far west classic movies. We can no longer tolerate hospitals being places where nobody knows “who is who” and where there is no schedule or a timeline for those who deliver care services and those who receive such services and others who come to see the latter.
Unfortunately, I have noticed such a phenomenon anytime a tragedy happens in the process of delivering care service, with the doctor being the prime “suspect for killing the patient,” and from the individual who is the reference point for saving the people’s lives, the doctor becomes a target of attacks. This is intolerable. Doctors do not kill, but save lives and we should clearly determine, in compliance with the European standards, the nature of a doctor’s medical mistakes in the course of treatment. It is impossible to immediately launch an investigation into every unsuccessful treatment case, just like it happens all over the world, even in countries seen as the Mecca of medicine. This is not the case neither in the United States, nor in Europe and this should not be the case in Albania too. Of course, abuse or flagrant negligence should be punished. Yet it is unacceptable that the emotions of the family members or relatives of a patient, which are then turned into TV emotions just because of the desperate need to increase audience and their irresponsibility towards the public, become a reason to morally execute every doctor in Albania and persecute a doctor or a surgeon for performing an unsuccessful surgical intervention.
We can no longer tolerate and admit that a doctor personifies corruption, nurse means “a thief.” For 1001 reasons, this has also become a trend when it comes to politicians, but it can’t become a trend in describing doctors and nurses, furthermore when you see the reality. It is still a kind of a preferred sport of those who take the camera to show the system’s black holes and claim that they don’t know the reality, so “I don’t know the reality,” “the Health Minister doesn’t know the reality,” while we are dealing with this reality every single day, night, hour and minute.
Amending the Criminal Code to stipulate improper medical treatment, or medical negligence based on best international practice and standards and not on the media emotions, thus providing a safe and peaceful environment for doctors is an imperative. A special and full legal package to ensure special protection for the doctors and health workers is a must and it will create conditions to give exemplary lessons to those who would dare to threaten civil servants.
I have looked into the four incidents of aggression against doctors. I have read each description of the incidents, including fine details about what the doctor was doing, what he suggested, what he recommended to the aggressor and the feedback he received and because of which he ended up hospitalized. This is a barbarity that is inspired and instilled in an atmosphere where violence seems a democratic option, even the only democratic option that is commented and predicted by people who pretend to be opinion makers or commentators.
Today it is the right moment for us to give a two-pronged answer to this phenomenon. I notice that the President of the Physicians Order is attending the meeting. The today’s meeting represents definitely a reference point to collect opinions and ideas. Yet I notice that university officials, as well as many other protagonists of the health system are attending the meeting as they have the needed experience, as well as a kind of obligation to refer to the international practice and provide full arguments on their part. Protesting in order to raise a certain problem represents the first step. But addressing the problem by articulating and providing solutions is the next indispensable step. You can’t stick to protest only, but you should also help and assist us in the efforts to find a solution together, so that the solution is a long-lasting one and a common effort and what the parliament does then is just a direct expression of your will. This is what the power stands for; to create the needed interaction in order to achieve necessary results.
Any kind of assault because of duty will meet harsh response in the coming weeks. The same process we are working to implement regarding the State Police and other interest groups, by making a resume of the situation that needs to be tackled.
Earlier this month we hosted a round-table discussion with the Albanian Football Association representatives, since an exemplary violence, collectively admitted fatality, is taking place in sports.
I would like to put emphasis on one thing; the indispensability to materialize a new hospital regime. It is the very first point where everything begins. It is no accident that the rest of the world has set borders and walls to divide doctors and patients from the rest of people, including family members of patients, friends and relatives. It is no accident that the rest of the world has set schedules and strictest controls in hospitals, because these are phenomena that the rest of the world has already experienced and we can’t afford waiting any longer, but instead just adopt measures that the world has put in place long before us. I know it is not quite easy in terms of logistics and infrastructure, starting with the University Hospital Centre in Tirana that should definitely undergo a new infrastructure intervention to ultimately and clearly divide the neighbourhood streets and the hospital-dedicated road. We are working with the Albanian Development Fund and the University Hospital Centre under the Health Minister’s leadership and in collaboration with the Director of the University Hospital Centre in order to finalize such a project.
To conclude, I would like to highlight the issue of miserable hospital security guard services that are provided by private security guard companies.
The private policing industry in Albania is a real industry. It would shock you if you were to know the number of private policemen in Albania. It would shock you if you were to know that Albania has a private policing industry with very low standards, miserable wages, scandalous professionalism, and zero responsibility and shocking appearance and uniforms. It is supposed that private policemen should protect others, but indeed they can’t protect their own selves.
A reform is being drafted in cooperation with the Ministry of Interior to address this matter. The Minister of Interior has proposed that a State Police company is created to serve also as a transitional stage for many police officers when they retire from the active service. The company will also help to standardize the private police and enforce rigorous in order to make sure that the private police services recruit true professionals and become serious and real services.
Should there be a procedure of this state that is a big headache, the procurement procedures for the private police services are. Such procurement procedures are a show of nonsense and lack of seriousness. These procedures are cancelled 10 to 15 times. This is really weird. The same goes for the millions of euros that universities spend for private security services and private policemen who practically guard and protect nobody and nothing, and, quite the contrary, it is the university that should be on the watch for them in order to protect the university from aesthetic aggressions that cause real psychological concerns.
I regret to admit, but this is also the case in our hospitals. I have visited every hospital throughout Albania and feel myself as a protagonist in an old Albanian movie anytime I see the silhouette of a private policeman among the crowd of doctors, nurses and health workers.
I would like to emphasize that the transformation process is progressing positively. We have started to fill the huge void we inherited regarding the specialized physicians, who bring fresh positive energies and added value to the health care service and greatly reduce the tensions that are created due to this gap.
Since early 2018, some 340 young doctors have joined the health system, whereas the trash media keeps on reporting about the alleged exodus of physicians, saying that only veterinarians are staying to serve in Albania’s hospitals. But 340 young doctors, 1161 nurses have joined the country’s health system. The young physicians are specialized, whereas the nurses have been hired via the digital platform “Nurses for Albania.” Some 167 other young doctors, under a contract with the Ministry of Health and Social Protection, will join the whole team of public health throughout the country within March.
This year’s health budget is 43% higher than that of five years ago. If we are to consider health system and social protection combined, this year’s state budget is estimated more than $ 750 million. Of course, this budget includes the public-private partnerships, because, quite differently from what is being propagated and from what reaches to the people’s mind due to the lack of knowledge on such a practice, this is not money allocated by the government to the private, but instead it is money that is invested in the system. The private companies get the profit only. When we talk about hundreds of millions, we mean investment in the service and not money that was budgeted.
I believe everyone agrees that health care services have significantly improved. It suffices to mention the sterile surgical instruments and medical devices. You shouldn’t necessarily be a specialist, but it is enough to look at the Albania-Chinese friendship-era surgical pliers and screwdrivers you had still in use not long ago and compare them with the packages of new instruments to figure out that a whole new world has been opened up, all thanks to the public-private partnership that is paid by the state each year based on the investment done by the private company.
The same thing, I believe, is about to begin soon with the medical laboratories, which will mark a huge transformation, while no lab workers will be fired. Quite the contrary, the project will enhance the service capacities, increase the number of tests and improve service quality.
Violence is definitely punishable and I believe we stated it clear at this meeting and you will state it clearer as you are somehow the target of such violence, but on the other hand we should also carefully examine the aspects that need to constantly improve, because provision of health care is not excellent, let alone the fact that the service is not uniform all over Albania. The health care service has constantly improved, but it still needs a lot more other things.
If there is an excellent thing in our health care system, they are the doctors themselves, or a considerable majority of them. They are people who have attended and have acquired a good reputation in international events and practices. They are people with extraordinary long years’ experience in a miserable health system as far as conditions are concerned. So it is completely the opposite of what is painted and commented on by the whole wave of vulgarization on social networking and TV channels and web portals that target doctors as if they were the devil himself. The opposite is true.
The truth must be stated, though it would be much easier to engage in populist campaigns and assault doctors in order to win the hearts of the revolted ones, who have never been forced to receive a health service in hospitals at least once, because they are lucky enough to enjoy good health and I with them all the best of health and may they never need to go to the hospital. But they have never seen a hospital with their own eyes, or they still have in mind the hospitals they have seen here 5, 7, 10, or 15 years ago that, like it or not, were not to compare with the today’s hospitals.
Thanking you all for what you really do by taking responsibility, I personally and the government, because the hospital management is not as adequate as it should be in several hospitals across the country, the management of other mechanisms of the system is not everywhere as it should be, on the contrary there are segments in system that are still very bad, what keeps us really motivated and gives us a lot of courage every day is you and your colleagues, doctors and nurses all over Albania.
And whenever you feel bad because of the assaults against your category, comfort yourselves with thinking about the assaults against me. The assaults against me are personal ones and you see I am still alive. Not only I am alive, but, regardless of what you might have heard, I still do not need you. But it is for sure and I have the evidence, although whenever I need to see a doctor I do it always first here in our hospitals, but I am not going to tell you where and how, because fantasies would then begin again.
Fortunately, I turn out to be successful in every medical check-up and examination in the face of whatever they say and do against me. So, just recall this. Never forget what Nietzsche has said: “What does not kill you, just makes you stronger!” So, wishing all the best to your four colleagues, I would like to tell them and everyone else who comes under assaults, what doesn’t kill you, just makes you stronger. Today you are stronger than you used to be prior to assault.
