by dr Nagi Barakat
Since late 70s many Libyan doctors left Libya for postgraduate training in many western countries and specifically English speaking and very limited numbers went to Germany or France or Eastern Europe and settled there. Majority who complete there studies did not go back to Libya and the total number of Libyan doctors abroad, no one know it. Libyan doctors abroad never agreed to form a body that represent them as many others do. There are attempts and first was LDS in UK in Feb 2002, which did not flourish due to many reasons. Majority of them are sponsored by Libyan government for their post-graduation studies and few who did make it by themselves and I am one of them. The number of Libyan doctors who are practicing in UK and registered are 707 (2), and at least 200 are at consultant levels in different specialities and 20 general practioner. There may be other 1000 or more, they are practicing all over the world and the second most popular place is Middle East countries (Gulf States).
All Libyan doctors are a higher achiever and leading expert in there field of specialisation and very well respected from the native people where ever they provide services. Over the last 10 years, few make it back and many stories about why they went back and few left the country again. Since the revolution I only heard three at consultant level are returned to Libya from UK and one from UAE. There are many reasons why doctors do not want to go back before revolution which are:
1- Brutality of the regimen
2- No democracy and no respect to the human being in Libya and respect to the professionals
3- Corrupted health services in Libya and nothing moving forward
4- Poor patient-doctors relationship and mistrust each other
5- No real plans to develop health services and no good quality leadership with doctors leading on management
6- Family issues and education facilities to there children who are in higher education or Universities levels
7- Life style and struggle to get the basic need
8- No systems in managing, running day to day health services in Libya
9- Poor quality of the training which produce very incompetent doctors which is not there fault, it is the fault of the higher training committees at LBMS.
10- Friction between doctors in Libya and doctors coming from abroad.
These reasons and many others kept Libyan doctors not even thinking of coming back and help. There are attempts on individual basis and small groups to visit and perform teaching, training and see patients and all of these documented and known among Libyan doctors. Some done a lot and kept on going others just watching and criticising and later accusing those who done most of the work as collaborators with Gaddafi regimen. It is very easy to find an excuse not going back and help, but the reals once never been mentioned.
Incentives play a major role here and most of doctors are entrepreneur and live good quality of life as they worked hard to get to this position. This is universal and where ever you go, you find doctors earning a lot and live a good quality of life. Libyan is similar and no one can blame them as they worked hard and they are higher achiever and should be rewarded for that.
As the revolution started, many of them involved in all aspect of charitable work. From first few days of fighting in Benghazi, Musrata and western mountain, Libyan doctors from abroad went back in groups and helped in treating war wounded and saved many lives side by side with there colleagues in Libya. Myself, I have been honoured to lead on health services during the revolution till end November 2011. It was a privilege to be part of the revolution and Libyan history. We did our best to manage the crises with the help of colleagues from inside Libya and whenever possible from colleagues outside Libya (3). Unfortunately health services still suffering and many challenges are facing the new minister of health. Any help will be appreciated and the real one should settle in Libya whenever possible.
Until now, there are not many who returned to Libya and only few and some of them continue going as a visitors for few days to deliver lectures, see patients or do courses. Why they are not willing to go now?
1- No security and no stability yet in Libya, even so it start improving
2- No real plans for health services as the new MOH is having priorities which some of it targeting the Libyan doctors from abroad.
3- Schools, places for living, places for work, are not guaranteed to be found yet.
4- Salaries are very low and no real plan yet how this can be sorted
5- Children are now in universities or higher education and they do not want to disrupt them
6- Style of life, they get use on certain style of life and some of them have spent 30 years or more outside Libya and the shortest will be round 15-20 years.
7- Fear from failure as hospitals are not very will be governed by systems, standards, policies and regulations.
8- Few are may never come back
9- There is cultural of not welcoming them and only from small group who unfortunately some of them in leading positions in many hospitals in Libya who are putting many obstacles and preventing any one joining that hospital.
10- Rural hospitals are not will equipped and patient safety cannot be guaranteed nor doctors themselves
All of these and many others making them reluctant to come and work in Libya. I am sure majority of them, would love to come and work but not now as they will be not effective and will not give all what they have learned due to poor system and lack of organisation and facilities. To over come this problem a group of them has to scarify and go back and help in building systems, organisation and lead in certain areas including the training. This may take 3-5 years.
What things may encourage Libyan doctors to come back :
1- The hospital management should be given to a management companies from abroad and to run the hospitals with the help of locals aiming to create a system in each hospital leading to implement standards, policies and regulations similar to the other health services world wide
2- The incentives have to be changed and adopting payment by results will encourage the productivity and ensure good quality of patient care. Every one capable of doing this if the right management,environment and facilities are available to every doctor.
3- The appraisal process has to be implemented to all doctors, nurses and other health services employees. By doing this will guarantee good delivery of services, patient trust regained and communication will improve between all health sectors provided
4- Clear and aimed health service plan for next 5-10 years from the government, so every one are expected to deliver, participate and take part in this plan.
5- Ethic and law should be endorsed to protect patients from doctors and also protect health services employees rights
6- Structured and dedicated training programs to all juniors doctors, nurses and administrators, so they can participate and take part as well
7- Encourage and implement the roles of doctors, nurses association and membership should be compulsory
8- Help with accommodation, education of their children, family and facilitate there move to Libya on stages.
9- There should be a call for a meeting by the prime minister and the head of national general congress to all Libyan doctors and listen to there needs and work with them. This can be done in stages in Libya and invitation should be done by the head of the state Mr Ali Zidan and Dr Nurredin Dogman
10- The government should instruct all hospitals not to reject any applicant from rare subspecialties to work in any hospital of his or her choice or anyone who is been a consultant for more than 10 years in any specialities.
It is time to start thinking about Libyan patient and how much they do suffer when they go to a foreign country and how they are been treated.
It is time to save a lot of money been spent on treatment abroad and given away to our neighbouring countries whose doctors are not better than Libyan doctors who achieved a lot abroad and in Libya.
It is time to stop the miss trust between patient and doctors and work toward improving patient care at all levels.
It is time to stop corruption at ministry of health and at all hospitals. It is time to build the primary health care in Libya which will save a lot of money, time and shorten the patient journey.
The state has to decide about the health system in Libya weather it is public funded or public and private or totally private. This should happen over next five years and moving toward private funded with 40% public.
Libyan doctors are there and not far away and I am sure many of them will go back and helped there beloved Libya. Some of them are excellent in there field and some are not good which similar situation for doctors inside Libya. All are willing to help and any one who are not good, should think to train him and it is the responsibility of MOH to train him or her. We also should know, Libya is not Benghazi and Tripoli, Libyan patients are every where and where ever there is a space, people should go and help patients. I am sure the current government will work very closely with who is wanting to lead on making the distance between doctors inside and outside even closer and to work together for the seek of the Libyan patients.
Libya is free and always will be free
Dr Nagi Giumma Barakat Consultant Paediatric Neurologist-UK Ex-Minister of Health-NTC Libya
1- http://www.libyaherald.com/2013/02/02/health-data-in-libya-inadequate-and-misleading/ 2- http://wmclibya.org/wp-content/uploads/2012/01/Libya Health report.pdf 3- http://www.libyaherald.com/wp-content/uploads/2012/11/Libya-Herald-supplement-Nov2012.pdf