Hippocratic Oath versus currency that pays the bills

ACCORDING to online journals, the Hippocratic Oath is an oath historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific ethical standards. The Oath is the earliest expression of medical ethics in the Western world, establishing several principles of medical ethics which remain of paramount significance today.

These include the principles of medical confidentiality (non-harming or inflicting the least harm possible to reach a beneficial outcome). Although the ancient text is only of historic and symbolic value, swearing a modified form of the Oath remains a rite of passage for medical graduates in many countries. Hippocrates, the writer of the original Oath, is often called the father of medicine in Western culture. The original oath was written in Ionic Greek, between the third and fifth centuries BCE. Dr Thirumoorthy of the Singapore Medical Association, writes that the Hippocratic Oath applies across the world to the field of medical care, but he brings to the fore some challenges it is facing in modern day, that of financial considerations and privacy of information (this which he attributes to the digital era).

"Several lines in the pledge are easy to recognise as part of contemporary professional and clinical ethics. Make the health of my patient my first consideration — fits in well with the principle of primacy of patient welfare and the importance of managing conflicts of interest (especially financial conflicts). The principle demands accepting that the interest of the patient be held above that of the clinician and other third parties, and is an essential component of building trust in the doctor-patient relationship.

"Respecting the secrets which are confided in me — lends easily to the principle of upholding medical confidentiality. This was easier to uphold when a single family physician was responsible for the majority of a patient's medical care. In present day medicine, when the average elderly patient may have more than three medical co-morbidities managed by multiple teams and both healthcare professionals and patients zipping in and out of hospitals, it is a challenging task to maintain medical confidentiality and privacy. With electronic medical records that are accessible to many, and the rise of public interest and interest of medical payers (managed care and medical insurance), this principle has been diluted with many ethical and legal exceptions."

As the country grappled with the industrial action by some medical practitioners, particularly doctors, many pundits have been quick to refer to the Hippocrates Oath, and zeroing in on the promise that doctors made or should have made upon joining the profession, that is to "make the health of my patient my first consideration". At face value, that would suggest doctors and other medical practitioners responded to a "calling" or are driven by passion to give medical care to fellow citizens. At face value, it would suggest doctors should never consider going on strike as doing so would endanger the lives of their patients, whom they vowed to protect and put first.

At face value, it would appear doctors have thrown out of the window all the tenants of the Oath, as they seek to push for financial gains. But maybe that is far from it, as one medical doctor, Dr Benson Mudiwa put it on an online article early last year when doctors made similar demands.

"There has been much bickering, misinformation and public backlash to the striking doctors. It is evident that the public is unaware of what doctors are fighting for, and how they need to support this fight, as it is not for selfish aggrandisement on the doctors' part, it's far from that, but rather an attempt to reduce the rot happening to the healthcare of Zimbabwe. It is easy to be disillusioned by just looking at the surface and apportioning blame to these hard working doctors, it is easy to throw in phrases like "your profession is a calling, negotiate while at work", or "you are no longer upholding the Hippocratic Oath", but it suffices to say that "calling" is not a currency that can be used to pay bills like electricity, water, neither can "calling" be used to buy groceries and pay school fees. Also, those quoting the Hippocratic Oath, unfortunately have no idea what it says or means, thus making their assertions conjectural fallacy. Doctors' demands are simple and reasonable, far below the minimum Sadc requirements for any health professional, and the Government of Zimbabwe can surely meet the demands. If other Sadc countries like Lesotho and Swaziland, with far less resources and a smaller GDP can prioritise their health and grant these, Zimbabwe can also do it."

Doctors downed tools on March 1 after petitioning Government to address their issues which include salary review, allowance payments, jobs for those who finish their studies, loan scheme and provisions of medicine and equipment in hospitals. In response, Government last week announced it had reviewed allowances for the health sector, opened avenues for employment and established a vehicle loan scheme. Doctors had a number of meetings with the Health Ministry before meeting then Acting President General Constantino Chiwenga (Retired) and Vice-President Kembo Mohadi, where further agreements were made.

The Zimbabwe Hospitals Doctors' Association and the Government on Wednesday reached an agreement on the salary negotiations. The agreement was reached after a meeting was held between consultants representing doctors and then Acting President, General Chiwenga (Retired), who was accompanied by Vice-President Mohadi.

According to a statement by ZHDA, Vice-President Chiwenga promised the doctors, among other benefits, an increment of on-call allowances from $1,50 to $5 per hour, an increase in rural and medical allowances, to withdraw its statement advising cessation of salaries and ensure that there is no victimisation of doctors. It was also agreed that the loan facility will be functional soon.

"Consultants informed the ZHDA executive that they had met Acting President Chiwenga and VP Mohadi and they resolved to immediately rescind the letter advising cessation of salaries. This means that every doctor on industrial action is to get their full salary. The Acting President also promised to increase our on call allowances from $1,50 to $5 per hour, while there is a road map to ultimately increase it to $10 per hour. This means that from the current $360 per month of on call, interns are set to earn $800 per month of on call allowance," said ZHDA.

ZHDA spokesperson, Dr Mxolisi Ngwenya, told our sister paper, Chronicle that they consulted their members, who said they are waiting to see the promises in writing.

What has also been of public debate has been the money that junior doctors get per month. This was after pictures of striking doctors went viral on social media with one placard saying they earn $329.

However, in an article published by newly launched website Zimfact, after factoring in other allowances, junior doctors earn much more than that. And the figures published were before some upward adjustments agreed on last week.

According to the report, the basic salary was $329, housing allowance $250, transport allowance $100, medical allowance $49, rural allowance $15, on call allowance $1,50 per hour. According to the doctors' association, doctors have about 160 hours or more on call (overtime) in a month but the Government has been paying for less than 80 hours and the housing allowance was only given to doctors who do not have accommodation within the medical institutions that they work in, according to Zimfact.