Go Away! We No Treat Sick People Here.

The latest hot topic happening in the medical world of Sudan is the recent closure of Khartoum Paediatric Hospital Jaafar Ibnaouf’s emergency room and transforming the hospital into a tertiary specialised referral hospital. This post isn’t about the injustice of this decision, because you don’t need a blog post to talk about that when it’s so obvious. I know Dr Jaafar Ibnaouf personally, and remember him visiting when my grandfather was sick back in November. He told me the ministry is trying to close down his hospital so that they can move the centre elsewhere (meaning their own personal hospitals). I know Dr J has a long history with this government and ministry, with a tug of war at the centre of which is his hospital. He built it to provide free healthcare, the government took it away and made it paid. After floundering around for a few years and the hospital almost collapsing, they gave it back to him, and it became free again. Of course, like all healthcare facilities in the country, it has been suffering from lack of funding and poor management issues, and children have been dying. That’s been happening all over the country, and not just to children but renal failure patients dying because dialysis machines are not enough, surgical patients dying from overwhelming infections due to dirty operating rooms, women dying in labour, etc.

I work in the ministry, in a small part of the training directorate. One of my bosses is a consultant, a previous undersecretary for the ministry of health, who came into power with Albashir back in 89 and who is a very influential, very high-ranking, and very dangerous man in the NCP. Interestingly, all the projects he is currently working on concern fixing the failing health system in Sudan, and he talks about the government as ‘those people’. So I asked him what he thinks about the close of Dr J’s hospital. He looked confused and didn’t know what I was talking about. I asked him if he hadn’t even heard of the closure? Because that would be weird, he has very close ties to the ministry and something like this would be known to him before most people in the country. He said, he kept hearing talk about closing the hospital, but it was just talk. As in, there had been no actual feasibility study, no data collected about the patient load on the hospital, no alternate options for where those patients would go to, no situational analysis, nothing. It was just talk. The minister for health in Khartoum wanted to close down the hospital, just because he wanted to close down the hospital.

I was shocked. I mean, I always knew there was a personal element to this whole closure thing, but I didn’t think that even the minister for health could actually go ahead and close down an entire emergency room, especially one as large and popular as Dr J’s, ‘just because he wanted to’. Ok then, isn’t this minister accountable to anyone? Mafi zol bis2alo?? He could just go ahead and close whatever hospital he likes? What about the federal minister for health? He’s higher than him isn’t he? Yes, he is, but there’s no accountability line. The minister for health is accountable ‘only’ to the president and his vices. So then, why doesn’t the president and/or his vices question the minister on this actions? There are several answers to that, one of which is obvious from the allocation of the defence budget 3 times as large as health and education. But mainly it’s as simple a reason as because the president and his vices are not doctors. Apparently, non-medical professionals don’t really get involved in ‘health issues’ because they don’t speak medical jargon, they don’t know what health statistics are, and they would pretty much rather leave it to the experts. When it comes to health issues, the president and his vices, and pretty much ALL non-medical politicians, don’t get involved because they are intimidated by doctors. Remember, this is coming from someone who was the undersecretary for health: a position actually more powerful than the minister. Furthermore, the context of things has a large, or actually the largest, role to play. Everyone in Sudan is family. Arch enemies in politics still gather in homes when a family member dies, and get invited to each other’s weddings. In any social event you’d find Alsadig Alamhdi, Albashir and Malik Aggar sitting next to each other and chitchatting. Business and personal relationships are inseparable. It is not the national policy and constitution that rules all, it is ‘akhoy wu akhok’. The consultant remembers a story where one of the state ministers had actually breached the constitution, and a heated discussion had taken place in the federal ministerial office. Someone then stated that this should go to the supreme court, since breaches of constitution are actually a federal crime and should be judged there. The minister then said: la la yaaaakh, ma7kamat shino? With the general understanding that, courts are 3eib wu ne7na ma 7alab wala 3arab 3ashan namshi alma7kama!! Aji yakhwani?!?!? Notice that these are STATE MINISTERS having this discussion. Unlike other countries where national policies go to parliament and once approved become actual laws that EVERYONE must abide to, in Sudan, national policy is something on a piece of paper, that may or may not even exist, that no one really knows about, and no one actually cares about. Therefore, when the minister takes it into his head to settle a personal grudge with a paediatrician who built an entire hospital from scratch on his OWN piece of land and pledged it for free health care for children whose families pick and leave everything behind them in their poverty-stricken villages and come to Khartoum to save their children, and that minister finds that the best way to settle such a grudge is to close down the hospital and turn people away from the door, that minister is accountable to no one but God whom he obviously doesn’t care much for. Not even the president will ask that minister what he’s doing, and people can shout and raise banners and slogans and do whatever they want, but actually, nothing will happen.

I wonder how a country like Sudan can function at all with this kind of mentality and ‘context’ ruling everything and everyone. I wonder if there will ever be a time when those people in-charge actually have respect for the constitution, treat the people they rule like actual people, and who believe that there will be a Day when they will be called forward, naked and shivering, and asked about what they have done. Does the minister, the president and his vices, the government, and everyone else, actually stop to consider Who they’re accountable to?