By Dr. Nagi Barakat,
On Aug. 20, 2013, Libyans celebrated the second anniversary of the liberation of Libya’s capital Tripoli. That day in 2011 had been a difficult one and after breaking fast in Tripoli everyone had a mission. Tripoli residents came out and with the help of rebels from Zintan, Zawia, Ghariyan, eastern Libya, and then later from Misurata Tripoli was liberated.
I was in charge of the Ministry of Health at the time so I contacted a number of colleagues in Tripoli in order to deal with the crisis. My first contact was with Dr. Khaled Elmaghbub from the childrens hospital in Tripoli whom I asked to establish a medical crisis committee and to report back to me on the hospitals in Tripoli whenever possible.
After the liberation of Tripoli I visited field hospitals in Tajora and Souk Al Jumma and saw the work being done by Tripoli residents, both by doctors and ordinary people. Those days of the revolution were tough yet beautiful, everyone fought against a common enemy, nobody worried about petty affairs – we all knew who the enemy was and we were united in the fight to overthrow Gaddhafi
Two years on, and after a successful revolution, that momentum has been thwarted by the militias and not a lot of real progress has been made. Everyone is pointing the finger of blame at someone else; some are accusing Qatar, others the Islamic Brotherhood or the secularists, liberals, federalists etc… but we forget that the problem is in us.
We had established two MoH crisis committees during the revolution one for Benghazi and one for Tripoli, and these were operational before the announcement of liberation on 23/10/2011. A lot of work and organization went into them and we served tirelessly for the supply of medicines, blood transfusion, deportation of the wounded, treating patients, vaccinations and helping to release any bottlenecks and obstacles in many cities.
The committee members reached to the far south and contributed significantly in preventing a health disaster in Libya during the revolution. After the liberation of Libya, everything was handed over to the newly appointed minister Dr. Fatma al-Hamroush. The first thing al-Hamroush did was to dismantle both committees and start from scratch all over again!
New names and faces arrived who never been on the stage before the liberation of all Libya, but with little or no experience to build on, they set the country’s health service onto the path of chaos where nothing was achieved and it was doomed to become the worst period ever in the management of health services in Libya.
Some went further and said it was even worse than in Gaddafi’s era in spite of all the money that was available, and the goodwill of the general public.
The next Minister of Health to arrive is the current minister Dr. Noureddine Dougman who, without any further consideration, continued on the same path as his predecessor. I was against his appointment from the start as I felt his leadership and decision-making skills were very weak as I had experienced working with him while he was a member of the crisis medical committee in Benghazi.
Many colleagues asked me to support him and they assured me he would be happy to meet with me and listen to my suggestions. I did meet with him in January 2013 and we shared many ideas. I advised him to have a list of priorities and the high-ups on the list would be medicines, equipment, emergency medical care and inviting visiting doctors to help with difficult cases.
I put forward proposals for cardiac surgery, plastic surgery and neurosurgery and six neuro-rehab centres in Libya. Treatment in Libya is far more cost-effective as each 10 patients treated in Libya will save the Ministry of Health £500,000.
I also suggested a few names that would be helpful for him in his tasks at the ministry, but he ignored this. Dr Dougman and the third deputy to PM in Libya (Elgadi) asked me and Dr Nuerrdin Erabi to nominate advisors to Dougman which we did and explained clearly the responsibilities of these advisors. The minister of health ignored this as well.
However, the worst decision ever made by Dougman was to take back the treatment of the war wounded from their dedicated ministry to be a part of the MoH. He also endorsed the centralization of everything back to Tripoli and wanted to take over everything by himself without using any of his deputies.
After a few meetings with him and various discussions, it became clear that he just had ideas and notions about what he wanted to see happen, but no tangible plans or priorities.
What should be done about the health services and to save it from catastrophic events?
1- To reinstate or establish the crisis committees in Benghazi, and Tripoli which were operating during the liberation as the country is still in crisis.
2- There should be three deputies to the Minister of Health:
a. One to lead the eastern part of medical crisis committee and look after the eastern and southern regions’ medical needs in Libya.
b. The second for the western and middle regions.
c. The third to help the minister at the Ministry of Health on a day to day basis.
3- The existing or the new Minister of Health should have charisma, leadership and experience in dealing with crisis. He/she should set up priorities for the whole of his/her period of leadership, which should include short term plans to be implemented over 6 months and a long term plan which should be continued even when transitioning from one minister to another, without starting again from scratch.
4- The polyclinics in Libya should all be activated and the current lead on primary health care should be replaced as he is inexperienced and has been twice rejected from MOH positions.
5- The European Union committee should be transparent, effective and accountable at all times. They should include more experienced people than what they have and from all Libya rather than just Tripoli and Benghazi and the two inexperienced people who have no idea about health services in Libya, and are neither strategists nor managers.
6- The priorities should include, supply of medicine, equipment, emergency care including child birth and accident and emergency departments.
7- There should be 3 centres that will look after complicated cases and continue to care for the war wounded to save money. This can be operated by visiting experienced doctors – Libyans or non-Libyans and managed by a foreign team/s with Libyan help.
8- Building capacities and human resources is very important and to develop a long-term program to improve and develop hospitals, medical education and training for all health services employees and medical colleges.
We hope that the Prime Minister and the General National Congress will pay attention to this vital sector and service. The performance of the Minister of Health is very poor after 7 months in the office in spite of there being a lot of money to use and support from PM and GNC. It is about time to re-evaluate performance and if he is doing well, should be supported but if he is a failure should be substituted very quickly and someone else be appointed with clear vision and deliverable plans.
The new Minister of Health should be given all the support he/she needs and scrutinize progress on a regular basis with advisors and deputies to support him/ her.
Finally, we must continue to be honest and faithful to Libya and put aside all our differences, completely leave them behind, so that we can concentrate on making a decent future for our country and people.
Yet what is happening these days make me sad and frustrated. Those who were key players in the process of change have now been marginalized and excluded, with obstacles placed ahead of them to block their way and contributions, and even with trumped up accusations of corruption and theft being thrown at them!
What nation on earth treats its honourable revolutionaries and others who risked their lives and contributed so importantly to its people’s victory in this way? They are not expecting rewards but at least some recognition and respect for their contributions, and inclusion in the process of moving forward.
Hatred and exclusion is flourishing in Libya against these honorable people – but even more so against each other. Although Tripoli and Libya were liberated from the tyrant and we have started moving forward in small steps, many want to lead Libya into a dark tunnel; but this tunnel must be demolished so that Libyans can begin to see the light of day again.
The writer is ex-Minister of Health under the National Transitional Council. He contributed this article to The Tripoli Post. He can be reached at: email@example.com