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Q&A with Minister of Health Dr Rekawt Rashid

SUN, 5 AUG 2012 17:16 | Rudaw

In this interview with Rudaw, Kurdistan Region’s Minister of Health Dr Rekawt Rashid says that most people, including the government aren’t satisfied with the healthcare system. Dr Rashid says his ministry has plans to reform the health system by improving relations between doctor and patient, follow up on hospital performance, close down unlicensed pharmacies and stop the import of fake medicine into the Kurdistan Region.

Rudaw: Are you satisfied with the health care system in the Kurdistan Region?

Dr Rashid: I am not satisfied enough with the health care system.

Rudaw: Are you satisfied with the administration in hospitals and doctor-patient relations, which people often criticize?

Dr Rashid: I don’t think people are criticizing doctors for having bad relations with them, but people disapprove of the fact that they cannot get the doctors they need. Some patients come to us with the criticism that a young doctor has treated them at the emergency department. We have begun to find solutions for these problems. We have agreed that a special doctor must be present at hospitals at night, which the head of the government has also approved. I think patients have problems with younger doctors because they don’t have much experience in the field.

Rudaw: Your predecessor said that the health care system was similar to the one that existed during the Ottoman Empire. As a doctor, then manager and now as the minister of health, would you say he made a correct comparison?

Dr Rashid: I was not alive during the Ottoman Empire, but what I can tell you is that no one is satisfied with the health care system. Patients, doctors, the government, the opposition and the media are unhappy with it. Therefore, there is no doubt that it needs to change. But, that change cannot happen overnight. We need reform first, and we can do it because we are not a poor country.

Several problems need fixing right away though. For instance, pharmaceutical medicines are pouring into the country and nobody knows where they’ve actually come from or what they are. The way those medicines are spread around is bad. People should only be able to buy medicine with a prescription.

Prior to having injections, patients must have a blood test to see if they are fit for the injection required, yet nothing like that takes place. On the other hand, medicines are not given to patients in a healthy way and are not received from a healthy place either.

In the previous cabinet, the government did try to tackle these issues. We toughened border checkpoints and now many trucks that try to bring fake medicine to the Kurdistan Region are arrested. We have doctors at every checkpoint that check the medicine and decide whether it can enter Kurdistan or not. People are saying there isn’t much medicine in the country anymore, but that is because we have pharmacists checking it at the checkpoints and if they do not meet our medical requirements, the tax numbers are incorrect or they are bad quality, then they refuse to let them enter Kurdistan.

This was the first step that we took to tackle the issue of bad medicine entering the region. The next step is to get an international company on board that can check medicine as well as organize the market. We want the medicine that comes into Kurdistan to have the name of a professional company on it as well as the price, because some companies put 100 percent interest on the medicine and that is a taboo, really. So far, we have received 40 proposals and we will be looking at which company is best for Kurdistan because the quality control we have is unable to organize the market properly.

Another dilemma is how the private sector is mixed up with the public sector. We have doctors in the private sector who work only two hours a week, while others in the public sector work only five hours a week. In the UK, doctors receive about £6,000 a month but that is because they work 50 hours a week. So, splitting up the private and public sector is also on our agenda.

We do not have proper nursing care here either. Patients who have gone to Lebanon or other countries come back and say the nurses took care of them properly. Most of them say that, in those countries, nurses help them wash, bring them food and even cut their nails. Now that is proper nursing. In contrast, here the nurses are only put in IV drips or inject patients and that’s it, but that is not proper nursing.

Rudaw: Since you became minister, what decisions have you made in the government?

Dr Rashid: Several days ago, we made some important decisions and the prime minister was helpful and signed all the proposals. One of them was to open the surgery department from 1:00 p.m. until the evening. Previously, the problem was late dates for surgeries, because the department was only open between 8:30 a.m. until 12:30 p.m. and, for example, if a child needed operation, he would be told to wait for another two years.

We have also decided that the government should provide 80 percent of the cost for operations. So, if a patient has to pay 200,000 Iraqi dinars, he would only pay 40,000 dinars. We will open an advisory clinic too, where doctors can see patients for a very cheap price, fewer than 3,000 Iraqi dinars. We will also provide overtime payment for nightshift specialists -- 120,000 dinars for each night they stay.

Rudaw: You talked about getting better quality medicine to Kurdistan and that is the government’s agenda too. However, people still think you have not done much as there is a lot of poor quality medicine in the market.

Dr Rashid: That is not true. We have taken many steps and, though they are still out there, it is better than it used to be. You cannot make a bad system better in just three months when it has been in place for over 21 years.

I have taken two important steps. First, I have made the decision that medicine can never enter the Kurdistan Region unless it has been checked by quality control and has been permitted by the Ministry of Health. For that, we have toughened the checkpoints. I have personally met with border security forces at the checkpoints between Kurdistan and Iran, Turkey and Iraq and they have been really helpful.

“You cannot make a bad system better in just three months when it has been in place for over 21 years.”

The second step was that on June 1 we decided to set up an audit committee to monitor private pharmacies across the region. The committee will begin work on Aug. 1 and I will personally be involved in the monitoring of the pharmacies. If we find poor quality medicine or expired drugs, we will collect them and burn them. But it will not end there; those responsible for selling these medicines will be arrested and sentenced.

Rudaw: The Kurdistan Regional Government (KRG) reform committee recently told Rudaw that three government officials were behind the smuggling of fake medicine to the region. How does the head of the government perceive the matter and what is your position on that issue?

Dr Rashid: We also heard about that in the news. We know there are formal companies that bring those medicines to Kurdistan, but apparently they are registered under the names of pharmacists. That may just be word of mouth, because like everyone else I heard it from your newspaper so I don’t have any information about that. It is not important who brings the medicine. What matters most is that it is good quality and legally permitted to enter the region.

Rudaw: Recently, poor quality syringes led to the death of a woman in Sulaimani and a child in Erbil. As the minister of health, how did you feel after hearing the news?

Dr Rashid: It was not poor quality syringes. The people died from an allergy to the injections, although the incidents are inseparable from the problems that exist in the health care system. To my knowledge, the woman had an injection at the hands of an illegal medical worker two weeks prior to her death, and then she had an allergic reaction but did not inform anyone. The medicine in the syringe had expired, but that medical worker shouldn’t have injected anyone in the first place. Moreover, the patient was not tested to see whether she was allergic to the typhoid flu vaccine, yet still was injected with it and that led to her death.

Rudaw: Your predecessor vowed to close down all the local pharmacies in neighbourhoods -- many of which are run illegally by unofficial nurses -- but they are still open. Will you shut them down?

Dr Rashid: There are 4,000 illegal pharmacies across the Kurdistan Region. If they aren’t closed, we will continue to have problems. We will try our best to find solutions to this dilemma, though it’s not easy.

Rudaw: Is it possible for cardiology departments to not have specialist doctors at all times?

Dr Rashid: It is impossible for the cardiology department to not have a specialist. We have proposed that specialist doctors must be present in that department 24/7. The head of the government has also agreed. The process is now with the Ministry of Finance. We are waiting for the files to be returned, and then specialists will be present there all the time.

Rudaw: You have a budget to computerize the health system, yet pen and paper are still being used. When is the computer system going to be installed?

Dr Rashid: We have started. We have done a lot of work on it, but it also needs a lot of time to be.

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