A street filled with medical clinics in the Aziziyah neighbourhood in Basra.
It was a strange way for the Basra orthopaedic doctor to find out he was dead. “One of my patients came to see me for a routine check-up, something he does every two months, and he was surprised to see me – because I was still alive,” the doctor told NIQASH.
The patient had been waylaid by one of Basra’s medical brokers, salesmen who are paid by clinics in Basra to bring patients into their surgeries. The brokers – called dallaloun by the locals – wait at junctions where there are pharmacies, doctors’ surgeries and labs. They speak to passers-by and recommend the services of a doctor, who eventually pays them a cut for bringing a new patient to the clinic. The business is pressured and sometimes their sales methods are dodgy. That’s what happened to the orthopaedic doctor in question.
Sometimes the doctors make use of the ignorance of their patients and they convince them they are suffering from illness they don’t have so that they will pay more.
“One of the brokers told my patient that I had died and offered to take him elsewhere,” continues the orthopaedist, who had actually been on holiday overseas; he wanted to remain anonymous because he feared for his safety if the brokers found out he was telling tales. “But my patient wanted to check this so he went to the hospital where I also work and was told that I was not dead.”
The doctor says this phenomenon of the brokers doesn’t happen elsewhere, it is unique to Basra. Most of the medical brokers work in the Aziziyah neighbourhood in Basra, where there are a lot of medical service providers and much foot traffic.
The brokers will tell potential patients all kinds of stories: The clinic has moved. The doctor is a bad doctor and inefficient, or dangerous. They may say the doctor has retired or they will garnish a doctor’s CV, saying that the person also works as a specialist at a local hospital. Or that the doctor works for a medical committee that grants sick leave to government staff.
Abdallah Qassim, a local nurse, confirms the practice. “It’s not just doctors setting up a new practice that do this,” Qassim told NIQASH. “Even well-established doctors use brokers.”
If a patient pays the doctor, say, IQD25,000 (about US$21) for a consultation, then the doctor will keep IQD15,000 and the broker will get IQD10,000, Qassim explains. Some doctors will give all of the fee to the broker and then make money from the patient in other ways.
“Most of the people who fall victim to the brokers are poorer people who live out in the country and have come into Basra to go to the doctor,” says another Basra doctor, Abdul-Hamid Abdul-Majid. “Sometimes the doctors make use of the ignorance of their patients and they convince them they are suffering from illness they don’t have so that they will pay extra for X-rays or other tests. The doctors have agreements with the companies providing those services and they get a kick back from them. That’s how they make back the money they pay to the brokers,” he concludes.
Part of the reason that doctors are using the brokers is because of the rising cost of doing business in Basra, suggests Shawqi Sadiq, a local pharmacist. Work has halved and taxes and rents are rising.
Thanks to an increasing number of security checkpoints as well as the roads being closed to vehicles for security reasons, there are fewer potential patients coming to the area. But there are still more than a hundred medical service providers – including pharmacies, clinics, laboratories and specialists for things like X-rays – in the area.
Some of the doctors have been tempted to move away, into the Saei district where there are wider streets and more modern buildings. Often pharmacies will pay for the doctor’s space as long as the doctor prescribes certain medications that the pharmacy stocks.
Doctors should actually be prosecuted for “these shameful acts”, says Mushtaq Abu al-Hail, the head of the local medical union. “We have circulated letters telling doctors they should abide by the law, which prohibits them dealing with brokers,” al-Hail told NIQASH. “Doctors are primarily to blame for this problem,” he added. “We know the names of those using brokers and we have sent them notices to cease and desist. We are now seeking the help of local government to put a stop to this.”
At one stage, local security forces did launch a campaign to clear the streets of medical brokers after various complaints from the public. Many were arrested but were later released thanks to the influence of their tribes or families.
Meanwhile it is the evening rush hour back in Aziziyah and the brokers are quietly meandering, beginning their work. Most of them are well educated young men, glib and persuasive but certainly not kind. It seems clear that they won’t allow anyone to stop them from making a living - not even doctors who come back from the dead.