 Hi everyone and welcome to another episode of the People's Health Dispatch. Today we are here with the president of the Turkish Medical Association, Shabdan Korur, and the Turkish Medical Association has been driving a wave of protests and strikes for almost a year now, a bit less than a year, and they have been raising issues related to both salaries but also working conditions and violence in the workplace. So we are here to talk more to Shabdan and to learn more about what's happening with doctors and other health workers in Turkey. Welcome Shabdan. Thank you. Thank you for the invitation actually. And so just to begin with, you know, very recently there has been a new protest and a new strike in Turkey and this was sparked by a recent murder of a cardiologist in central Anatolia. And so of course the Turkish Medical Association, the TMA, has been warning about the rise of violence against health workers for some time. But still we are seeing that, you know, action from the policymakers is missing. So to begin with, can you tell us a bit more about how this problem of violence against health workers became so prominent and also what are some of the solutions that the association you see and would like to see happening? It's a long time since we struggle against this violence at the workplace, particularly the healthcare workers just are subjected to violence and the numbers are escalating recently. When we just check the numbers of white codes, which means that this is a reporting mechanism of violence at the workplace. It was around 17,000 in 2019 and it had dropped to around 11,000 in 2020 because of people to the hospitals and healthcare centers have also dropped around 35% in that period because of the COVID-19 cases. But in 2021, there was a dramatically increased numbers of white codes, which is nearly 30,000. So it has been three times more than the previous year. What is the reason of this escalation of the cases, violence cases? If we ask this question, we have to just consider the health policy of the government for 20 years, actually, because there was a so-called revolution in the health policy according to the government, AKP government, but it was actually unfortunately a deterioration of the healthcare system in the country because they have just ignored preventive healthcare systems and just shifted all the general practitioners as family physicians while they were just appointed on contract phases. And without the regional coverage of these family physicians to their region where they just work in the region, they can have some patients or people from different cities, for example. And if it is not regionally based, then you can't have a preventive medicine practice in that region properly. And also while they are just appointed in a contract basis, also they do not have other healthcare professionals who have to work with them. Either they have to hire some healthcare professionals themselves or they have to be alone. But preventive medicine means a work of a team with social workers, nurses, midwives, and the environmental technicians, etc. But there is no system in this context. So without any preventive healthcare system, then all the people were forwarded to the hospitals, to the second step of the healthcare system. And then there are too many people just being admitted to the hospitals while some of these people, actually most of these people tend to use the emergency departments. Last year the numbers is more than 120 million applications to these emergency departments. It is nonsense. More than the population of the country needs emergency healthcare. It is not the truth, of course, but people use these emergency departments as outpatient clinics actually. So we have to keep in mind that they in a way provoked a demand for healthcare system. I wouldn't call this a solicitation, a milder word for this. This is a provocation. So with this provocation, people, when they cannot find a solution for their healthcare problems, then meet with the healthcare professionals in front of them. They do not consider the Ministry of Health, they do not consider the health authorities and the political authorities of the country. But they just feel the anger against the healthcare professionals against the physicians, unfortunately. Then the violence escalates in this kind of a healthcare system. So this is the problem of the healthcare system in the country, which they have called a revolution, but it was a deterioration of the system actually. And we have to keep in mind that we cannot prevent violence with some security measures, actually. We have to just think broader than security measures, broader than some legal reforms or amendments in the law. So there are serious problems. We have to change the health policies. We have to just prioritize the preventive healthcare and build preventive healthcare centers with a big team preventing illnesses and protecting environments. So in order to prevent people to be ill at the end. And of course, the violence is not the only problem that the health workers are facing right now. The Turkish Medical Association actually has been organizing quite so it has organized a number of strikes and number of protests since 2021. And this is also related to the very low salaries that you are seeing in the health sector, but also to the inflation that we know that the country has been going through. So could you tell us a bit more about how working conditions in the sector are currently looking like and what is the medical association actually pushing to do? Unfortunately the workload is also increasing in the last years because of this provocation of demand for healthcare system. And this workload in a way was just accepted by the healthcare professionals because their low salaries were compensated by performance payments. But these performance payments were unstable. And they never knew whether they would just earn the same amount on the upcoming months or so. So this obscure situation was the reason of anxiety for the healthcare professionals. And also they considered the situation, the workload as they are being devaluated in the system. This was probably the target of the government to devaluate the healthcare professionals. Instead of being the subjects of the healthcare system, just providing healthcare to people and having the rights, then when they devaluate the health professionals, they are just turned to objects without any rights at all, even without being called human being cinema. So in this context, with the salaries lowering all the time and the inflation just rising constantly, they just became poor and poor in those years. And of course this situation, hardworking and also very qualitative healthcare providing didn't make them earn more in the system. They had to just have the quality in front of quality because of the performance payments. Then they were unhappy. They were too tired. They were worried about their future. And this caused a burnout for all the healthcare professionals at the end. And we had to just struggle for our rights as a medical association, as a professional organization. But of course, struggling for the rights cannot be alone for the professional organization. So we just joined forces with all the unions and all professional organizations of the unhealth care system, with nurses, with dentists, with veterinary physicians, etc. And all these groups also joined to this struggle. And we had several different types of protests. For example, marching from Istanbul to Ankara, stopping every few cities and protesting there, having demonstrations, and also trying to make the public join us. Because they also had a serious problem of access to healthcare. Because of this burnout physicians, for example, physicians either resign or try to travel abroad for better conditions. So in many cities, there are lack of some specialties. We do not have hand surgeons in some cities. For example, the pathology department of a city is closed because there is no body in that department. So this means that we have to raise our voice and make it heard by the authorities. Is it hurt a bit? Because they have to at least promise that they will just promote the situation. But we didn't see any result yet. So we continue to struggle. And we are decided to continue the struggle till we can have all our rights. But it is not easy, we know, because the health policy has to change. The health care system has to be changed. And also the economic system had to be changed at the end. You also mentioned something that I wanted to ask for the end, actually referring to the many health workers who have been living Turkey because of the worsening conditions in the health sector. And I believe that the latest number that you came out with was more than 700 physicians living Turkey in 2022 alone. So I'm sure that you explained so well what kind of impact this had on the care that was provided. And I just wanted to ask, is there any site of this trend ending or being stopped by some something happening in the health system? Not at all. And the number was 1171 at the end of June. So the first half is more than 1000. It was 1405 in 2021. So this trend would not end. It is not only the health care professionals, it is not only the physicians, actually well educated people try to leave the country because they consider that they are devaluated. This is the problem. Educated people are devaluated by the government. And many people are criminalized by the government. Particularly the health care workers, health care professionals are criminalized recently together with their professional organizations and unions. Because we struggle for our rights, which is a common situation. How can we just sit silently and accept our fate? This is not a fate. This is the policy that they force us just to accommodate ourselves, but we cannot accommodate ourselves with such kind of slavery conditions. So many physicians try to leave the country, but not only this situation. Also, just recently the results of the university entrance examinations have been announced. And I can see on the social media that many of the physicians ask these young people not to choose medical faculties because the conditions are so harsh for them. So they are not only living, but also we are not sure about our future, whether people would like to be physicians or not. Even if being a physician is taking care of another person before yourself, it is not an easy situation if you are also devaluated for just sacrificing your life, sacrificing your ambitions for working in a condition which working is too hard, too long, and without any payment for your work, for your labor. So the situation for the future is not so enlightening and bright at all. Thank you for sharing that. And of course, we at the People's Health Dispatch will continue to follow the work of the Turkish Medical Association. And we do hope that the actions that you do will get so much traction that actually the government is pushed to act. And thank you for being our voice and also hope we will talk on how the improvements are just moving forward.