Northern Emirates nurses who can’t afford medical treatment for themselves
Mini Issac knew something was wrong when her husband’s handwriting became shaky. Then he struggled to put on his socks.
“All of a sudden this sickness came,” Ms Issac says. “It was just like a dark cloud coming in.”
When the illness was eventually diagnosed as Parkinson’s disease seven years ago, her husband lost his job as an accounts manager.
His wife, along with other Ministry of Health nurses in the Northern Emirates, have health cards issued by the ministry, but they do not have full medical insurance for themselves or their dependents.
Ms Issac, who has worked at a Ras Al Khaimah government hospital since 1994, cares for her husband with informal advice from doctors, between shifts and frequent trips to India to buy medication.
“It’s a lifelong disease,” she says. “Day by day it’s getting worse and we don’t have any insurance. I’ve been working here for the past 20 years and no benefits have been given for health care for such a long time. Once you become unhealthy, nobody will accept you.
“We are in the healthcare field but when it’s our time to get sick everything is taken from us.”
Nurses want full insurance, like the Abu Dhabi model of mandatory coverage, to be extended across the country.
The Abu Dhabi Government requires that all workers in the emirate and their dependents be given health insurance by their sponsor.
“No doubt it would serve all and take out the burden,” says Obaid Al Khadeem, director of Fujairah Hospital. “Most of them do not have private health insurance. They are just playing it by ear.”
In the Northern Emirates, nurses earn an average monthly salary of between Dh6,000 and Dh8,000, which includes transport, food, schooling and return airfare.
They say the rising cost of medical treatment means the government health card they were offered on arriving in the UAE no longer covers their expenses.
The cost of private insurance varies with age, location and medical history. For a healthy, 30-year-old male in the Northern Emirates a basic annual insurance plan is about Dh2,200 with Alliance Insurance, and Dh3,000 with Daman.
“We are hoping for this insurance coverage like this one in Abu Dhabi,” says Mr Al Khadeem. “I am sure that the situation is known and of course it has been discussed, and I hope that it will materialise.
“It has to be done by the concerned authority. Health should be the number one priority on everybody’s mind.”
Newly arrived nurses are often unaware that there are different policies on health coverage in different emirates.
“Even if we are sick we will not go to hospital because we cannot pay,” says Antonette Escobal, a nursing supervisor at Saif Obaidullah Hospital in RAK.
Ms Escobal lifts her trouser leg to show a six-inch burn, the result of dropping a pot of boiling chicken sauce a few days earlier.
“I did not go [to hospital] because I’d have to pay Dh300,” she says.
Ms Escobal tries to avoid hospitals. After a Dh30,000 thyroidectomy she discharged herself early to minimise costs, a common practice among those with little or no insurance.
In other cases, nurses have continued to work when they were ill or recovering from surgery because they fear money will be deducted from their salary.
Pregnant nurses and the wives of male nurses have been known to discharge themselves hours after giving birth, regardless of possible complications.
Deliveries, which are no longer covered, cost between Dh5,000 and Dh8,000, while a bed in an RAK ward costs Dh300 to Dh500.
While much of the national debate about mandatory insurance has revolved around labourers, many educated, low-salary white-collar professionals would also benefit.
Nurses work physically demanding, long shifts and are continuously exposed to disease.
“I take care of myself by myself,” says a Palestinian-Jordanian nurse who works at a government hospital RAK and did not wish to give his name.
“As a nurse we know from experience what to take. So we buy from the pharmacy directly, so many times.
“My children have problems with their eyes. They need glasses, they need to be examined but I cannot take them. My wife she has some gynaecological problems and I cannot take her. For myself, alhamdulillah, I’m still alive.
“Really, health is the most important thing. We are working with patients who have infectious diseases, hepatitis, HIV and so many diseases but we cannot take treatment ourselves.”
If a bill cannot be paid, it is deducted from benefits at the end of service.
“One day they had a conference in Abu Dhabi and I asked about this health insurance,” he says. “She told me, ‘everybody has health insurance’. In Abu Dhabi they don’t know that we don’t have health insurance here.”
The ministry is aware of the situation, says Dr Yasser Al Nuaimi, director of the RAK Medical District, which falls under the Ministry of Health.
“I believe it is coming soon, it has to come,” says Dr Al Nuaimi. “I think for the Northern Emirates that is going to happen in a very short time. It cannot happen in one and not in another.”
The ministry had recently requested details of employees’ dependents, he added.
An option is to travel overseas for treatment and medication. Ms Issac pays a monthly average of 7,000 Indian rupees (Dh417) for her husband’s medication. He has not had formal medical advice in a year.
Ms Issac, 45, has taken sick leave twice in 19 years, once for chickenpox and once when she had hypothyroidism diagnosed and travelled to India for treatment.
Nurses are paid on contract, cannot claim overtime and are prevented from taking part-time work elsewhere, even though the UAE is experiencing a nursing shortage.
The ratio of 4.1 nurses and midwives for every 1,000 people in 2010 is lower than Qatar, Oman and Kuwait. That compares with 10.1 nurses for each 1,000 population in the UK, 15.7 in Ireland and 24.0 in Finland.
“They should just give us the opportunity to work somewhere else,” says Ms Issac. “We don’t need anybody else’s money. I don’t even like to take help from our relatives.
“We came to this country decently. It’s not like we came here because we didn’t have anything. We had.”
Ms Escobal, 40, had full medical coverage when she arrived in 1997 from the Philippines to work in the male cardio unit.
After her Sudanese husband died from a stroke last year at the age of 45, Ms Escobal transferred her daughters, aged 10, 11 and 14, to a Sharjah school because she could no longer afford education at English-language schools in RAK.
“My children are still at school so I need this job,” says Ms Escobal. “If I go to other countries again and look for another job, I will start over.”
Returning to India is not an option for Ms Issac whose husband and children, aged 13 and 16, have Malaysian citizenship.
“I just wait,” she says. “I have faith that God will not leave me alone for my 21 years of very sincere work, with nothing I ever did wrong.
“In the long run, now I’m trying to make my husband as independent as he can be. I will ask him to do things on his own. In the long run, maybe he will be in a wheelchair.
“After 21 years of hard work we are not achieving anything. I only realise this now.”
If full insurance is given to nurses, it may only come after a law is passed that requires mandatory insurance for all workers.
A federal law for mandatory insurance for workers across the country was drafted last year, after similar draft laws were considered in 2004 and 2007.
Last November, Sheikh Mohammed bin Rashid, Vice President and Ruler of Dubai, passed a Health Insurance Law requiring mandatory health insurance for all workers in Dubai from 2016. It will also cover employees’ spouses and children who live in the emirate.
It is estimated that 2 million people in Dubai are uninsured. Abu Dhabi introduced mandatory health care for all workers in 2006, with 98 of people cent insured within five years.
The Ministry of Health did not respond to repeated requests for information.
Hospital administrators have voiced support for the nurses. They warned that growing costs will affect all hospital staff.
“It’s really not only nurses, doctors, it’s everybody,” says Reem Uy, director of nursing at Saif Obaidullah Hospital. “Can you imagine the company cleaners are earning Dh700, Dh800, and if they get sick, what will happen to them?
“It is really a must to give these people insurance, just like what Abu Dhabi is having. Health is very important. What is the use of coming here and working if you get sick and you die?”
Published: January 14, 2014 04:00 AM