By Anonymous (MD)
Over the past month, especially in the last week, Ethiopian health professionals have been protesting and demanding fair pay, better working conditions, and improved living standards. In a country deeply divided along ethnic lines, where agreement is often hard to achieve, this movement has been surprisingly successful. It has not only made the public aware of the terrible state of Ethiopia’s healthcare system but has also brought health professionals together across ethnic and religious lines—something rarely seen in other issues.
This movement has also revealed an unexpected betrayal within the ranks of health professionals. While mid-career and junior residents, interns, nurses, and other healthcare workers have bravely joined the fight for dignity and fairness, some of the senior medical doctors have remained noticeably silent. These seniors, who should be leading the effort, have either stayed on the sidelines or actively discouraged their struggling junior colleagues. Their absence is a painful betrayal of responsibility and principle. It’s crucial to acknowledge, however, that this observation isn’t a blanket condemnation. There are indeed senior professionals of integrity who have stood in solidarity with their juniors, even to the point of resignation.
This piece is not a plea for senior doctors to join the strike; rather, it serves as a call to reveal the reasons behind their silence and to inform both the public and health professionals of the underlying truth. Their refusal to participate stems not from integrity, but from selfish interests that benefit a few at the expense of the majority and the public healthcare system.
Here are the main reasons why these senior doctors have avoided the movement:
- Owning Lucrative Private Business:
- Most of these senior doctors own their own private hospitals or clinics so that they can make adequate business from private medical settings. They do not have the financial and living challenges the other professionals faced with.
- Using Public Hospitals for Personal Gain:
- For these seniors, public hospitals are little more than free referral centers for difficult cases they cannot handle in their private clinics. They take advantage of the resources available at the public hospitals to leverage their personal benefit. For example, advanced and complex cases, like surgical procedures which could not be managed at their private clinic, would be brought to public hospitals to use the facilities for free.
- Minimal Time in Public Hospitals:
- Most seniors normally do not regularly present at public hospitals. They normally work at public hospitals a maximum of 1 or 2 days a week and only 3-4 hours each day they are present (which means they work in public hospitals on average 6-8 hours a week). Their low public hospital salaries do not matter to them because they earn far more from their private clinics.
- Own Free Government Houses:
- Many senior doctors enjoy benefits that starkly contrast with the struggles of their junior colleagues. Most have been provided with housing by the hospitals, yet they also have their own one or two houses in Addis Ababa. While living in with no cost at government houses meant for the low-income groups, they rent out their own houses. For instance, senior doctors at Tikur Anbessa and St. Paul’s Hospitals occupy government apartment houses at best locations like Bole Road, Arat Kilo, Piassa, Sar Bet, Mekanisa, Jemo, etc. while simultaneously profiting from renting their own houses. Some even rent out the hospital condominium houses to third parties. Worse still, some senior couples submit fake divorce certificates to secure two hospital houses—living in one while renting out the other. This blatant misuse of resources occurs while the majority of health professionals struggle to meet their basic needs, highlighting a deep-seated injustice within the healthcare incentive system.
- Own Government Cars:
- Many senior doctors often use the hospital’s vehicles despite having their own cars, showcasing a troubling sense of entitlement.
- Own Projects:
- When projects from international organizations or donor agencies are came, they often benefit a select few senior doctors who have cultivated networks of nepotism. These individuals frequently secure lucrative incomes from projects, sometimes earning millions of birr each month. Meanwhile, the majority of mid-career and junior physicians remain unaware of these opportunities, sidelined by a system that favors personal connections over equitable access. This entrenched favoritism not only undermines morale but also exacerbates the disparities within the healthcare system.
- Academic Titles Without Real Contribution:
- Public hospitals are often used by seniors to gain academic titles like “professor.” These titles, often earned through questionable methods, are treated as badges of status rather than a sign of meaningful work in healthcare.
- Normalized Unethical Practices:
- Some senior doctors exploit their positions at public hospitals to direct patients to their private businesses, often by frequently closing hospital laboratory or imaging services and then instructing patients to go to their private facilities or those that offer them a 20-30% commission. Some private referral diagnostic centers even provide additional incentives like arranging for seniors in public hospitals vacations to resorts such as Kuriftu Resort. This unethical practice extends to their private settings, where treatment is determined by a patient’s financial capacity rather than medical necessity, leading to instances like unnecessary C-sections for financially capable women or excessive laboratory investigations solely to inflate costs.
The reluctance of senior doctors to join the movement is no surprise, given their deep involvement in these unethical practices. They are happy with the way things are because it allows them to prosper while the public healthcare system and their colleagues suffer. These individuals are not leaders or role models; they are corrupt people who take advantage of the system for their own gain. Let us call them what they are: corrupt and selfish. The fight for a fair and dignified healthcare system in Ethiopia must continue, and the public must understand how these few so called “seniors” are part of the problem.
The author is a medical professional working in a public hospital in Addis Ababa. With firsthand knowledge of the incentive system, he is willing to cooperate with any further serious investigation into the misuse of incentives in public health facilities.
Editor’s Note : Views in the article do not necessarily reflect the views of borkena.com
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