Deutsche Welle, 6 january 2013
When it
comes to corrupt doctors, the question is not whether, but to what extent.
German doctors sometimes pocket gifts from pharmaceutical companies. In
Zimbabwe, patients who can't afford care are often left to die.
According
to the German medical professional code, it's forbidden for a doctor to accept
gifts in exchange for services. But in practice, an established doctor in
Germany need not worry about being punished if he or she accepts a gift from a
pharmaceutical company. The German penal code currently lacks the necessary
legislation to deal with such infractions, and they are only rarely punished in
German occupational courts.
Nevertheless,
in comparison to other countries, Germany's healthcare system has relatively
good checks and balances. Elsewhere, especially in countries where doctors are
chronically underpaid, corruption is the rule, not the exception. It is also
far more likely to impact on those suffering from illnesses, often resulting in
avoidable deaths.
Widespread
corruption in Zimbabwe
Joost
Butenop works as a doctor in Zimbabwe, Pakistan and Malaysia. In Transparency
International's latest Corruption Perceptions Index Germany ranks 13th, while
Zimbabwe comes in at 163 out of 174.
 |
| In Zimbabwe, patients even have to buy the scalpels for their operations |
"One
can only accuse the system, not the individual doctors," Butenop said in
an interview with DW. "When doctors and nurses aren't paid regularly but
turn up for work anyway, they of course want to ensure a source of income - and
they let the patients pay for that."
Before an
operation in Zimbabwe, Butenop says, a patient's family has to purchase not
only the medicine but also infusion devices, disinfection chemicals, even
scalpels. Those who do not have the means to do so will not receive even the
most vital medical intervention. Butenop explains that monies earmarked for the
healthcare sector are siphoned off in advance by the government.
There's a
good reason, he says, why doctors in developing countries like Zimbabwe don't
receive money from pharmaceutical companies. "Their target group is
extremely small, because the consumer has to pay cash to get the medicine. I
don't believe the pharmaceutical industry sees a market there," he says..
Even if
doctors were to provide financial aid to assist patients in purchasing such
medicine, patients would still resort to unbranded alternatives, Butenop says.
Dangers of
cheap medicines
The
situation is similar in Uganda. "The biggest problem there is getting
medical care at all," Widha Moses of Transparency International Uganda
(TIU) told DW. "Medical personnel don't provide the services they
should."
 |
| Ugandan patients are often given cheaper, ineffective medicines |
Doctors and nurses are often hours late or don't show up at all, according to TIU's 2012 study, because their salaries are so low. When they do show up, they often don't prescribe the necessary medication, or they provide patients with cheap, defective drugs in order to make a profit.
"The
people who are responsible for selling medicines ignore advice as to which
kinds of medicine they should sell, and in what doses," Moses said.
"Doctors buy low-quality medicines because they can pocket the
difference."
In order to
fight corruption, TIU trains volunteers like Moses to ensure that physicians
provide proper information to their patients, and prescribe the right
medication. They also work with local politicians, and have formed committees
to create checks and procedures for the provision of medicine.
Public and
private healthcare overlap in Peru
In Peru,
the mix of public hospitals and private clinics breeds corruption.
"Doctors in public clinics earn so little that most of them also have a
private clinic," says Samuel Rotta, the deputy director and a 10-year
veteran of Proética, the Peruvian chapter of Transparency International.
"Doctors who see patients at public clinics automatically transfer those
patients to a friend's private clinic - and expect him to do the same. You
scratch my back, I'll scratch yours."
 |
| Peruvian public doctors will refer patients to each other's private clinics |
Peru's medical administration is also riddled with corruption. As there aren't enough hospital beds for patients, available beds are sold in advance. In fact, the process begins even earlier. "In order to get an appointment with a doctor at all you have to bribe the assistants working on reception," Rotta says.
Even though
bribery is rampant, Rotta still has hope for his country. "The good news
is that public health officials are aware of it and are trying to do something
about it," he says.
Bribery
scandal in Croatia
South-eastern
Europe is currently embroiled in a similar scandal - one that has dragged
Germany with it into the spotlight. For years, some 350 doctors in Croatia were
receiving kickbacks in exchange for prescribing medicine manufactured by the
Farmal pharmaceutical company. That exchange ended abruptly when it came to
light in November 2012.
Now, all 30
employees in Farmal's management and sales department have been arrested,
according to "Apotheke Adhoc," a source of pharmaceutical news in
Germany.
Farmal has
close ties to Germany: 96 percent of the company is owned by the Bavarian
pharmaceutical producer, Dermapharm. When DW contacted Dermapharm in early
January, no one was available for comment.
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