315 healthcare workers were victims of violence in eight months
Sebnem Korur Fincanci, Chair of the Central Council of the Turkish Medical Association (TTB), Gizem Pehlivan, a medical doctor who emigrated to Australia due to poor conditions in Turkey, and Helin Cakir, a member of the central executive of the TTB's medical students' branch, spoke to GercekNews about the causes of violence in healthcare, the deteriorating quality of medical education and the reasons for emigration.
"When the perpetrators of violence are not punished, it is a punishment for those who are harmed"
TMA Central Council President Sebnem Korur Fincanci pointed out that violence in Turkey occurs not only in health facilities, but also in many other areas: "Gender-based violence has increased. The practice of impunity plays a very important role in this. When the perpetrators of violence are not punished, it is a punishment for those who are harmed," she said, stressing that this impunity leads to violence.
Fincanci noted, "They act with the sense that they are protected and can get away with the violence they perpetrate. When we look at violence in healthcare, we find that there is a very high rate of verbal and psychological violence. We would like to see reports of violence in health care shared on a regular basis so that we can see in which areas it is most prevalent, what the characteristics of the perpetrators of violence are, and what types of violence there are so that we can take appropriate action."
315 healthcare workers were victims of violence in the first eight months of 2022
According to the Union of Health Care Workers (Saglik-Sen), 316 health care workers were victims of violence perpetrated by 364 assailants in 2021. Of the 190 incidents of violence, 162 were both verbal and physical, 22 were verbal, 5 were bullying, and 1 was harassment.
146 incidents of violence occurred in hospitals, 13 incidents in family health centers, and 31 incidents in the field. In these incidents, 92 physicians, 59 nurses, 50 security guards, 46 helpline workers, and 69 other health care professionals became victims. 135 assailants were arrested and released.
No action was taken against 124 assailants, while 41 assailants were arrested, 61 assailants were subject to a judicial investigation, and three assailants were fined.
In comparison, in the first eight months of 2022, there were 165 cases of violence in the healthcare sector, in which 315 healthcare workers were victims of violence by 387 attackers. While no effective investigations were carried out against the attackers who inflicted verbal, physical and psychological violence on them, Dr. Ekrem Karakaya was killed by an attacker.
What is the WHITE CODE?
The WHITE CODE is an emergency management instrument designed to prevent violence against healthcare professionals. It was created to take the necessary safety measures by providing appropriate interventions and external security forces when healthcare workers are exposed to violent incidents, and to analyze the incidents in order to take specific actions for the healthcare facility in question.
"The ministry maintains the data from the WHITE CODE, but does not share it"
Fincanci pointed out that preventive measures should be taken to prevent violence in health care and emphasized that such measures can only be effective if you are able to identify all the characteristics of violence.
"Since the Ministry of Health started compiling the WHITE CODE data on reports of violence, we have asked to access this data, however, the Ministry protects this information and does not share it," Fincanci stated, emphasizing that they could only access the 2020 data.
Fincanci explained, "From the data we were able to access, we were able to identify who among health care professionals was most affected by violence. Physicians were at the top of the list of those who were exposed to violence. We find that verbal violence was the most common. And we see violence more often in public hospital emergency rooms."
"Public authority is the direct perpetrator of violence"
Fincanci added: "Especially during the outbreak of the pandemic, the failure of the health system became visible in practice and turned into violence. This was because the health authorities preferred to fight the pandemic in hospitals instead of slowing the spread with public health measures. Accessibility to health services declined. What had accumulated in the system was like boiling water in a closed container. The pandemic process caused it to become unbearable, and the lid burst from the pressure that had built up inside.
Fincanci explained that the root causes of the violence are the inflated demand for health and inadequate health policies, and criticized the performance system imposed on physicians as follows:
"More patients and more procedures mean that the time the patient spends with the doctor is shortened. As time is shortened, communication between patient and physician deteriorates. In such a health care system that leads to an increase in violence, the physician can no longer anticipate when he or she will be exposed to violence."
Fincanci pointed out that the Ministry of Health's Communications Department (SABIM), established in 2004, has also become a separate area of violence: "Although the complaints that patients and their relatives file with SABIM involve verbal abuse and insults, an investigation can still be opened against the health personnel. If there is a complaint, an investigation shall be conducted, but the transformation of a possible investigation into bullying of health personnel as a threat is also an act of violence by the public authority. In this respect, the public authority is the direct perpetrator of violence."
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7% answered "yes" and 81% answered "no" to the question of whether the training they receive is effective
With cases of violence in the healthcare sector increasing by the day, medical students are worried about their future. Not only are they receiving an unqualified education, but they are being victimized by violence even before they enter the profession.
According to the survey conducted by TMA's Medical Students Branch to raise awareness and make their voices heard about the working conditions of doctors, 7% answered "yes" and 81% answered "no" to the question of whether the training they receive is sufficient and effective.
According to the results of the same survey, 67% of interns reported that they were subjected to mobbing. 49% of them stated that they were harassed by interns,13% by their professors, and 11% by other healthcare professionals. To the question "Have you ever experienced violence from patients or family members?" 62% answered yes while 37% answered no.
Helin Cakir from the Central Board of TMA Medical Students Branch stated that as medical students, they are concerned about their future and emphasized that students are among the most affected by the economic crisis in the country needing to maintain their school essentials, course materials, and livelihood activities.
"We want to receive qualified medical education"
Cakir went on to say, "In the picture announced under the label of 'white reform,' there is an item concerning interns, but although it was recently announced that they will receive the minimum wage, this good news has also turned out to be empty. After the health care system has been trampled on in such a way, the measures to be taken are not such 'good news' as they are nothing more than attempts to get through the day."
Stating that it is the current policies on healthcare that fuel violence in the health sector, Cakir expressed the problems and demands of medical students in the following sentences:
"In the last 15 years, 48 medical faculties have been opened, which amounts to about ten thousand students for medical faculties. Our friends listen to the lectures standing up, there is one microscope for almost five students while some faculties do not have microscopes at all. There are more and more faculties and less and less qualified education."
In stating "We want to receive qualified medical education. We are not only medical staff, but also university students. While a stethoscope costs between one to two thousand TL, the government scholarship we receive is 850 TL per month under these economic difficulties. We demand a free education and a working life where violence is not tolerated," Cakir stressed that they want to be recompensed for their work.
The number of physicians who obtained a certificate of good conduct in seven months amounted to 1402
The current conditions of the healthcare system, the high cost of living, and the poor quality of life are driving healthcare professionals and medical students from Turkey to move and work abroad. Healthcare professionals who used to study abroad to get ahead academically are now looking for opportunities to go abroad for good.
Fincanci pointed out that health professionals in Turkey feel insecure and do not see their future in Turkey: "In the early 2010s, the number of applications for a certificate of good conduct to go abroad was quite low. Then suddenly it started to increase exponentially. In the last three or four years, we have seen an increase from 100s to 1000s. This year, the number has multiplied even more, and the figures for the first half of the year have already reached last year's total."
Meanwhile, the TTB announced that the number of physicians who obtained documents to go abroad in the first seven months of 2022 amounted to 1402. The Union informed that in July alone, 231 physicians applied for a "certificate of good conduct."
Cakir reflected, " If the number of our young colleagues going abroad has increased so dramatically, if the majority of medical students are willing to move abroad, if the German courses are more in demand now than the Medical Specialty Examination (TUS) courses, and if even the medical school is not favored lately by the students taking the university exams in this country, then this is a clear indication of the destruction of the health care system."
“Turkey lost a doctor while Australia gained one”
Dr. Gizem Pehlivan, who has settled in Australia on a specialist physician visa, shared that she decided to leave Turkey when she was a medical student and explained her process of moving abroad as follows:
"The main reasons were problems with living in Turkey. When I was a doctor for no more than three months at the beginning of my career, I had to work alone during the pandemic. I suffered from severe depression and it was not possible to access therapy. The process of moving abroad accelerated even faster as health policies became inextricable, my colleagues were subjected to mobbing every day, and injustice was at an all-time high."
Pehlivan stated that she had made a post on social media when she was admitted to Australia and was subsequently subject to lynching, and went on to say, "I shared a photo before I left that read, 'Turkey lost a doctor while Australia gained one.' Some of the responses were positive, but the most were angry and insulting messages because I was leaving the country. I was criticized not only for the reason of my departure, but was also reproved for my piercing, my hair and my weight. I have no plans to return to Turkey," she concluded, stressing that she is happy with the city where she lives and with her job.
*Rozerin Yuksel was born and went to school in Istanbul before studying journalism at Onsekiz Mart University. Her studies focused on rights-based journalism and new media during her university years and she participated in various social responsibility projects.