EMS Around the World: Violence, Inflation Threaten Turkish Emergency Sector

The Turkish EMS sector has seen recent development despite current serious economic problems in the country and the possibility of the latest wave of COVID-19.

Despite the efforts of the state, Turkey’s official inflation rate increased to almost 80% in June, putting serious pressure on the country’s health care and EMS sectors, whose personnel’s wages continue to devalue.

Complicating the situation is that the number of coronavirus cases in Turkey increased by a factor of 8 since May 30, based on an analysis of the weekly COVID-19 infection and fatality rates. According to data from the country’s health ministry, Turkey last reported more than 57,000 new cases in a week between June 27 and July 3. The country has seen its highest numbers of active COVID-19 cases of the entire pandemic in 2022, and numbers were spiking again in early August.

Analysts expect the number of COVID cases in the country will continue to grow in coming weeks due to an ongoing influx of tourists for the summer season. That could lead to increased hospitalizations and emergency departments volumes and a new wave of criticism of the government. Health Minister Fahrettin Koca, according to some analysts, is already discredited by policies that failed to prevent mass infections and deaths during previous peaks of the pandemic.

Hospitals, Stat!

While new waves continue to threaten, the Turkish government is working to upgrade capabilities. In response to COVID-19 a number of new large-scale emergency hospitals have been built in the country.

An example of this is Yeşilköy Prof. Dr. Murat Dilmener Emergency Hospital (Yeşilköy Hospital), a hospital in Bakırköy District in Istanbul Province, which opened in late May 2020 with the participation of Turkish President Recep Tayyip Erdogan.

According to the president, in contrast to other countries that tried to solve their lack of medical facilities during the peaks of the pandemic by the building field or mobile temporary hospitals, Turkey “was able to build real hospitals in the shortest possible time (just 2 months).”

Indeed, ground was only broken on Yeşilköy Emergency Hospital on April 9, 2020, and the hospital was completed in 52 days. It was named after a physician and professor who died from COVID-19.  

In general, the Turkish government pays significant attention to the development of its health care and EMS sectors. According to data from the country’s Ministry of Health, in recent years it has invested more than US $30 billion in the development of both sectors.

At present the Turkish emergency sector consists of emergency public hospitals, university hospitals, and private hospitals. Most feature modern equipment, with nearly 35% of the doctors working in these hospitals having received Western training.

The emergency line for state ambulances in the country is 1-1-2, and more than 90% of Turkish population has it available. The emergency line is free and works 24 hours a day. Most of the country’s private ambulance companies, conversely, primarily specialize in patient transportation.

Among the main state tasks in the field of EMS are reducing the incidence of unreliable emergency response and overuse of emergency departments.

The generally good organization of the EMS sector in Turkey is mainly due to a reform completed in the early 2000s. In 2002 Turkey faced a deep crisis in its national health care system, including EMS, that generated widespread dissatisfaction among the population. At that time infant mortality stood at 26.1 per 1000 live births, and less than two-thirds of the population had health insurance, resulting in unequal care access among different population groups.

The reform was conducted within the Health Transformation Program (HTP), which involved partnerships between the state and private sector to improve the country’s hospitals and health care infrastructure. It was carried out with the support of World Bank Group and resulted in the transformation of the entire industry such that all citizens received access to quality services.

Violence Problems

Despite those successes, a number of problems continue to hinder development. One is stepped-up attacks on medical workers, including emergency doctors. Probably the most high-profile of such attacks occurred when Dr. Ekrem Karakaya, a cardiologist at one of Turkey’s largest hospitals, was murdered in July.

Karakaya was killed by the relative of a patient, resulting in a 2-day nationwide strike by Turkish health care workers. According to the Duvar English news outlet, “it is common for doctors to be targeted by either patients or their relatives in Turkey, leading medical staff to urge the government to adopt harsher measures to protect them from such violence.”¹ Karakaya’s assailant committed suicide after the murder.

Physicians and health worker organizations such as the Turkish Medical Association (TTB), the NGO Hekimsen, and Health and Social Services Workers’ Trade Union (SES) believe the government has failed to respond to the increasing attacks and must take additional measures to stop them.

According to analysts the number of acts of violence against Turkish health care workers increased from 11,942 in 2020 to 29,826 in 2021. According to a survey conducted by the TTB, 84% of physicians have been subjected to physical or verbal violence at least once in their professional lives.

Analysts also fear the beginning of a new wave of the pandemic will exacerbate the current problems. Due to the country’s complex economic situation, strikes throughout the health care sector to demand better wages and benefits have become common. Deterrent legal measures against dozens of daily incidents of violence in health institutions have been a common demand.

Reference

1. DuvaR.English. Turkish doctors go on strike after murder of cardiologist by patient. Published July 7, 2022. www.duvarenglish.com/turkish-doctors-go-on-strike-after-murder-of-cardiologist-ekrem-karakaya-by-patient-news-61006

Eugene Gerden is an international freelance writer who specializes in coverage of the global firefighting, EMS, and rescue industries. He has worked for several industry titles and can be reached at gerden.eug@gmail.com.