JEDDAH, 11 November 2002 — The structure of any edifice is only as strong as its foundations. At the King Faisal Specialist Hospital and Research Center in Jeddah, everything depends on the support and continued application of the nursing and medical staff.

So when a senior administrator is reported to have said at a staff meeting that most of the staff were working at the hospital "because they were unable to get jobs elsewhere," it is hardly going to encourage the continued support on which the institution is built.

The administration was immediately galvanized into a state of verbosity and denial. "We have scoured the world looking for the most talented and dedicated personnel that will allow us to be reach our goal of being a medical center of internationally recognized quality," said Dr. Tariq Linjawi, chief operating officer in a recent newsletter addressed to staff.

"You are the best, and we have invested considerably in order to bring you together. Your presence and dedication are crucial for us to be successful." The last bit is surely right, but "methinks he doth protest too much!"

The speaker may have taken comfort from the fact that many of the staff cannot get jobs elsewhere through no fault of their own. They neither have the money to leave nor, if they have, will they get a "No Objection Certificate". The latter will not be given as if they do leave, they will be seen as having broken their contract. "We cannot issue letters of no objection to individuals who are considering breaking contracts during this difficult period," Dr. Linjawi added.

The staff has not been regularly paid and has suffered every kind of difficulty and uncertainty. The senior management has of course been paid; they are paid from Riyadh, rather than from the local budget.

The administration, 186 in executive management in a 236-bed hospital, is, according to an experienced expatriate, "a ratio unheard of in any hospital this size." Apparently they don’t see non-payment or late payment of salaries as a breach of contract on their part. They do though expect the situation to continue into January 2003, having begun in September 2002, according to Dr. Sultan Bahabri, chief executive officer who said so in an interview in early October.

According to sources at the hospital, the organization can afford to have the management living in the most expensive compound in Jeddah for about SR200,000 per annum, introduce a new computer system at a cost of millions, attend expensive retreats and foreign conferences and order desks for SR80,000 each (80,000 — it’s not a misprint) while writing memos on photocopy paper directing economies.

Several rooms in one unit were refurbished at great expense. The consultant objected to the wallpaper, so it was "re-refurbished." Phone bills, deducted from salaries at source have, according to the compound manager where nursing staff live, not been paid for six months. Single male staff no longer live on a compound; apparently that compound has not been paid and men now live in an "economical" hotel.

The staff does receive certain benefits. For example, a letter to their creditors explaining that this internationally-recognized institution cannot pay the salaries and also offering a free five-minute international phone call to those with suffering families.

And of course the free ice cream sundaes ("with your favorite topping") on the lawn in company with the administrators and served by the managers. The opportunity for assault with a deadly dessert must have been tempting. Luckily it’s near the emergency room — that is if there’s anyone paid to staff it.

Many specialists have been attracted to the hospital. The salaries are too low to attract the very best because they do not compete with the signing bonuses, step increases and other perks offered by the sister hospital in Riyadh. Neither do the terms and conditions compete with those offered by major US institutions.

The lack of cash has a similar effect further down the line in the qualified nurses and support staff. The quality of medical and surgical staff is remarkably high, certainly in the top 25 percent of hospitals anywhere. Add to that the unreliable payment of salaries and the downstream family and personal financial problems that stem from that and a situation develops that could easily threaten the quality of patient care.

The hospital is backed, says the management, by the Ministry of Health, but has to find 30 percent of its income from private health care. This means that it has to pay from cash flow. If the cash doesn’t flow, for example if patients and hospital clients do not pay their bills for any reason, then there is simply no cash to flow. The staff has been asked to raise output by 20 percent and reduce cost by 20 percent. Quite how you increase output of patients is not clear — they are unwell people, not manufactured production units.

Reducing cost should be easy. Lowering the administration/bed ratio, half a dozen desks and a cheaper compound for managers would achieve that — followed by the simple commercial practice of suing debtors for outstanding dues.

One senior member of staff was candid. "There are some excellent people in management here. However, they lack the skills to handle a 1,000-person team. They see only what they want to see so there is a discontinuity between the reality of the situation and the vision of the administrators. It’s counter-productive; there is little understanding of the actual needs of the units and too great a concern for public image."

That would account for both the wallpaper and the hiring of a PhD for a laboratory even though the lab told the administration he was not needed.

Dr. Sultan Bahabri said recently, "The loyalty of the staff is very strong." With the lack of salary and the refusal of "No Objection Certificates" their options are certainly limited. It might be that they are still here because they cannot go anywhere else. That sounds familiar — but with a slightly different spin on it from the frustrated remarks by Dr. Linjawi.

On Saturday, Arab News received this announcement by Dr. Linjawi: "On a less happy note, I’m very sorry to inform you that payment of salaries will be delayed again. This is not to be unexpected. We are doing everything we can to expedite salary payment but I’m not able to predict a date for payment at this time. The quality of care has improved over the last period. The standard of patient care has not been affected. Patient care is an entirely different issue and should not be confused."

Medical men might apply their surgical technique to cut to the core of this case. Patient care involves nursing and medical staff; staff cost money.

No staff, no patient care. That’s not too confusing, is it?