Bahraini Doctors: Canadian Accreditation for MOH Should be Revoked

Dear Sir,
We are a group of Bahraini Doctors working in both primary and secondary health care in Bahrain and we are writing this letter to you requesting your esteemed organization to revisit the accreditation certificate awarded by the “Accreditation Council of Canada” to the “Ministry of Health” in light of recent regrettable events in Bahrain. It is our believe that the accreditation was awarded based on specific criteria and standards, thoroughly review and evaluated by representatives of your organization during the accreditation process. We strongly believe that these criteria and standards have been compromised so severally during the period from mid February 2011 to date to an extent that warrants reevaluation and possibly revoking the accreditation certification.
We believe it is our ethical duty as doctors to raise this issue with you as an accreditation council as well as other bodies to protect both our and your moral standing in the service of the profession. The issue of the recent events in Bahrain and how it affected the medical profession and the provision of healthcare has been well documented by the various human rights organizations including Amnesty International, Human Rights Watch, Doctors without Borders and Physicians for Human Rights. The political backdrop is very clear but we wish to categorically emphasize that our intentions for writing this letter are purely professional as healthcare providers and are not tainted by political affiliations.
The following are only few examples of where we believe the standards of the accreditation were violated. This is only from a remote high level assessment by physicians who worked in the project for accreditation. We are sure that more compelling evidence can be established if a proper review of records and events is undertaken in the Ministry of Health during the period in question. 
According to the standards required by the “Accreditation Council of Canada” to the “Ministry of Health” in the Kingdom of Bahrain:
     1.2 There are processes for promoting consistency in the quality of        services throughout the organization

Due to the severe shortage in medical staff as a result of detained and suspended consultants primary care physicians, (surgeons: neurosurgeons, orthopedic, plastics and specialist medical physicians), nurses at various levels and other medical staff in primary and secondary care, there has been no consistency in the quality of services delivered to patients. This also means that patients will be seen by different doctors or without their medical files during consultation.

2.0 The services provided are responsive to the community’s needs

During the crisis which Bahrain passed through since mid February 2011 to date, the following incidents were against this standard stated above:

1.       Ambulances were prohibited from reaching the scene of the disaster by where the injured people needed care by Salmanya Hospital administration and later on the security forces.
2.       The paramedic staffs of the ambulances were attacked physically and assaulted verbally by the official and non official government security forces and members of the Bahrain military forces.
3.       The injured people reached the hospital and various health centers through civilian cars.
4.       A lot of injured protesters were suffering from injuries (Birdshot wounds, teargas and rubber bullets). These were not able to come to the Salmanya Hospital or other places where medical services are provided including private hospitals and clinics because they were afraid of being arrested by police and military forces. This matter has been thoroughly documented by Amnesty International, PHR and Doctors without Borders in their various reports.

Note: Incidents 1, 2 and 3 occurred during the security and military attacks on the demonstrators in Pearl Roundabout, attacks on Sitra, Nwaidrat and Budaya Health Centers.

5.       There is no easy access to the services, especially in Salmaniya for the injured people or for patients who need certain follow up for their cases. This is because a large sector of the population is exposed to attack and humiliation by the military forces and some get arrested while passing the many military check points inside and outside the vicinity of the Salmanya hospital as well as the roads leading to it. In fact, there are a number of check points with tanks and military personnel bearing weapons right in front of the hospital main gates. This is valid up to the date of this letter.
6.       All ambulance services are accompanied by security personnel from the ministry of interior, many of whom are mask and bearing weapons. The critically ill patients referred from both the health centers and home will hesitate greatly before calling the ambulance for medical assistance. Again this is well documented by the human rights organizations as well as foreign journalists who covered the events in Bahrain. It is very evident on the streets of Bahrain when an ambulance passes by. This is also valid to the date of writing this letter.

-          4.0 There is a demonstrated link between the services provided and the health of the population.

1.      During the crisis there were a lot of injured people who were wounded and had fractures and other injuries but they could not be provided with proper medical care. This is still valid today.
2.      It was well documented that many injured protestors were treated at home by relatives or volunteer medical staff in total secrecy.
3.      A lot of people had mental and psychological trauma because of the crisis and what they passed through but they were afraid to seek medical care.
4.      The medical staffs themselves who provided the care were under stress and exposed to physical and psychological assaults from the security forces that attacked the health centers and the hospitals suddenly without permission and arrest physicians and medical staff in many cases in front of patients and/or from the operating theater. Acting Minster of Health Fatima Al-Balooshi has admitted publically that Senior Surgeon Dr. Ali Al-Ekri was arrested in the operating theater.

-          10.0 The services given to the community group are documented.

The number of patients during the crisis (protesters) was huge and there was no proper documentation for the majority of them. There was a real risk to document the cases because the security forces ask about the names of these injured protesters in order to arrest them. Revealing that information is against medical ethics and patients’ right for privacy and confidentiality. Many doctors ended up not documenting the cases they treated.

-          11.0 There is a process to meet the community group’s need for follow-up service.

During and after the crisis the community groups could not get easy and safe access for their follow-up services. This is especially true at Salmanya Hospital as patients for dialysis; patients with fracture, pregnant with medical problems were not going for follow-up due to insecure access and exit to Salmaniya as tanks and military forces in and around the vicinity of the hospital occupied all the gates and the wards. They feared, with good reason, that their family members or who ever accompanies them will face the same risk.

-          One of the areas of improvement needed from the health services in Bahrain is the appropriate and competent medical emergency response capacity.

1.      The disaster plan was not activated by the central commander to deal with the crisis especially at SMC during the first and the second clearing of the Pearl Roundabout on 17 Feb 2011 and 16 March 2011 respectively.
2.      The physicians at Salmaniya who took the initiation to meet the needs to respond to the disaster were detained and accused of forming a committee to coordinate with the protesters and occupy Salmanya. There are all held incommunicado with no access to family members or layers till the date of writing this letter. Again this issue has been well documented.

There are other violations that are inconstant with the standards. A few of these are stated below:

·         The violations were directly committed by the former and current Minister of Health as well as senior hospital administrators.
·         A huge three story poster of the political leadership was erected in the vicinity of the Salmanya hospital.
·         The majority of the doctors who worked on the accreditation project alongside your evaluators have been detained, suspended or relieved of their responsibilities. Junior and inexperienced doctors have been pushed to assume their role. It has been reported publically that 20 of the 22 heads of primary care health centers have been relieved in a matter of few days.
·         Doctors who have not been detained or suspended have been interrogated by masked security officers bearing arms in both the health centers during operating hours and called in for questioning in police stations. This applies to nurses and auxiliary staff as well. As a result the moral of the health care provider’s country wide has been at an all time low.
·         Members of the security and military force doctors and other senior staff to hand posters of the political leadership every where in the hospital and health centers. They force them to undertake humiliating acts like chanting pro government slogans and kiss the posters of the leadership all the while giving them verbal abuse.
·         The Salmanya Hospital has been transformed into a military site rune by the military with constant beating and harassments of doctors, nurses and other services staff. There has been no authority or action by the Ministry of Health to protect the workers of the Ministry.
·         The elected Head and board of the Bahrain Medical Society have been suspended and detained. A pro government doctor has been appointed.
·          Many Bahraini and non-Bahrain consultants and senior physicians have fled the country putting further pressure on a dwindling resource base of specialists.
·         During the crisis a government official (Dr. Nezar Al-Baharna) was assigned the post of Ministry of Health to handle the situation. He promptly resigned because he was not able to handle the unethical demands of the government and the way it handled the medical profession.

 In conclusion, we wish to reiterate that all the above claims can easily be corroborated, verified or have already been public knowledge and documented thoroughly. As stated violations were done by Ministry of Health officials and administrators and clearly lead to the accreditation standards not being met during the crisis till date. The community has lost its trust of the medical services as a result of the handling of the matter. We firmly believe, a final assessment and judgment is left with you, that the Ministry of Health in Bahrain is not and will not be able to meet in the near future the accreditation standards required by the “Accreditation Council of Canada” and therefore the current accreditation status should be revoked.