Dr. Ekram Karakaya was murdered on Wednesday, in Turkey. Five bullets from the gun of Hacı Mehmet Akçay put an end to the life of Karaykaya, a cardiologist at Konya City Hospital in the central part of the country, after which the presumed assailant committed suicide.
The reason was apparently the murderer’s anger over the death of his mother, who was Karakaya’s patient. As is fitting, Turkish President Recep Tayyip Erdogan sent condolences to Karakaya’s family and pledged that the government would do everything it could to prevent violence in hospitals. At the same time, Turkey’s communications authority banned publication of all details of the killing. It is unclear why, because the perpetrator is known and is already dead.
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Doctors have their own explanation. They believe the government wants to calm people down without taking any concrete steps, and is trying to conceal the security failures that are so common in hospitals or to "anaesthetize" people vis-à-vis the issue of violence there.
Physicians and other health-care professionals are all too familiar with government promises, which they have heard for years, and they know what they are worth. In a report published by Turkey's Union of Health Care and Social Service Workers, in 2021 alone there were 190 cases of violence involving 364 assailants and some 316 health-care workers; most of the attacks were perpetrated by family members of patients. According to the report, only 11.3 percent of the assailants were arrested, the rest were released or not found.
Immediately after the Karakaya’s murder became known, the Turkish Medical Association declared a general strike of all medical workers, which went on for two days. Non-essential operations were cancelled, appointments were postponed, medical facilities went on emergency footing and at many hospitals, doctors staged silent protests demanding that the government step up to protect their lives.
But it is not only the violence that has brought doctors to the streets. For them, this is an opportunity to tell the media about the harsh conditions they suffer at hospitals and about their meager, barely-above-minimum-wage salaries, whose purchasing power has plummeted by dozens of percentage points due to inflation, which is approaching 80 percent. For example, one couple who are both physicians say they cannot maintain a normal family life because each is posted to a hospital in a different city, and they insist that the Health Ministry makes no effort to find them jobs closer together.
When doctors threatened to strike at hospitals in the past because of wage conditions, Erdogan told them: “Do what you want. Your places will be filled by excellent graduates from medical schools.” This time too, the president's coalition partner, Devlet Bahceli, head of the Nationalist Movement Party, came down hard on the strikers, accusing them of spearheading an illegal action for “separatist” purposes; he even called them supporters of terror. Bahceli, like Erdogan, has a great deal to say in particular against the medical association, which has levelled harsh criticism at the government for its health policy. Close associates of the party leader have in the past even suggested disbanding the association.
Thousands of doctors in all fields, of all ages and levels of experience, have already reached the conclusion that they cannot face off against the system or expect better working conditions and wages – and they have emigrated.
There are no precise statistics on how many have left Turkey, but when doctors ask their employers for recommendations and acknowledgement of their professional achievements, they are already marked as potential emigrants. According to the medical association, in 2021, 1,405 doctors requested such recommendations, and this year, the number is expected to reach 2,500 – or more than seven doctors every day.
At a time when Turkey’s public health system is gradually being destroyed from within, private health care – especially what's called medical tourism – is flourishing. According to figures from the country's health and tourism ministries, during the first quarter of this year, some 285,000 medical tourists arrived in Turkey for treatment, bringing some $332 million into the country's coffers. It is estimated that by the end of the year, income from this branch alone will top $3 billion.
About a decade ago, Ankara recognized the importance of medical tourism and encouraged the establishment of private hospitals and private treatment wings in government-owned hospitals. These facilities receive tax breaks and certain exemptions from customs payments. Some of them also operate as travel agencies that offer medical tourism packages including flights and transfers to hospitals, accommodations in luxury hotels, personal caregivers who accompany patients and speak their language, and even visits to tourist sites during their recuperation.
The web pages of certain specialists – for example, those doing hair transplants and plastic surgery – detail the types of operations involved and the physician’s training, provide impressive photos of clinics and medical equipment, and offer a comparative price list to Western countries. For example, one popular site notes that a hair transplant (depending on the type and extent of treatment needed) costs between $3,000 and $7,000 in Turkey, a fraction of the cost in the United Kingdm or Germany. Such a clinic is required by law to be licensed by the Turkish Health Ministry, but hundreds of clinics operate without authorization, proper guarantees or insurance. One of the implications of this burgeoning industry is that many doctors, including long-time specialists in other fields, are moving to this lucrative field, leaving younger physicians to deal with the public health care system and the threats to their lives.