A few miles north of Cairo’s Tahrir Square, Manshiyet al-Bakri Hospital is an unremarkable concrete building. Around a thousand outpatients pass through here every day, mostly drawn from the northern Cairo suburb of Heliopolis.
At first sight, nine months after the fall of Mubarak, Manshiyet al-Bakri Hospital seems little changed by the revolution.
The clinics bustle with doctors, nurses and patients. Porters and clerical workers jostle in crowds in the corridors.
But on my visit last month I saw signs of a deepening revolution. I met Dr Mohammed Shafiq, founder member and president of the hospital’s independent union. “We set up the union right after the fall of Mubarak,” he said.
“I started up a petition for better conditions for the doctors and the nurses,” he explained. “Everyone wanted to sign, so eventually I thought, ‘Why not? Why don’t we set up a union to represent everyone?’”
At the entrance to the hospital, Shafiq introduced me to Fatma, an admin worker who represents temporary staff on the union council.
The new union’s first major battle was to get rid of the old director.
Fatma told me, “We put forward an official complaint to the president of the union council because of the degree of corruption as the director had no experience—he was weak. A weak management leads to corruption.
“So we took a vote, and the majority view was that the director was not welcome among us.”
The staff chose his replacement in a democratic election organised by the union. “I was one of the scrutineers, looking after the ballot boxes,” Fatma said, smiling at the memory.
The election of the director is a sign of a deeper shift in workers’ confidence and consciousness. Shafiq took me to the director’s office. “Meet Dr Usama, the deputy director,” he said.
I asked Dr Usama what he thinks of Manshiyet al-Bakri’s experiment in revolutionary democracy, and to my surprise his face lit up.
“In order to improve service in the hospital there has to be democracy. If there is democracy, it exposes things that are going wrong more clearly.
“If there is democracy, everyone will speak up and say what’s wrong in the hospital, and they won’t be afraid.”
I asked him about the challenges. “You know the circumstances we’re living in,” he said. “The situation is rather chaotic.”
As we left the office, Fatma cornered Dr Usama. “You forgot to tell her something important,” she called to him. “Tell her the how the Ministry of Health wanted to transfer you back to your old hospital—and we organised a campaign to keep you here. You’re only here because of us.”
She took me to one of the clinics on the ground floor. “I’m a temporary admin worker,” she said. “I’m on a contract which is renewed every 55 days. We don’t get any holidays.”
The union has really started to change things for the better. Fatma said, “We’re pushing to get health insurance and we hope we’ll solve this problem very soon. There were a lot of people who didn’t have a contract and we fixed that.”
Being a union rep has given her more confidence to stand up to bullying managers. “I had a problem with the director of the finance department. The union made an official complaint to the management.” In the past she would have probably put up with the abuse.
“The manager was disciplined. He is director grade and has been in the hospital for more than 25 years. I’ve only been here a year. The union made my voice louder and imposed the will of the majority on management.”
We called in on another member of the union committee, Adel Abdel-Fattah, director of the administration. He sees the extension of democracy within the hospital as the union’s key gain. “All the staff, at every level, are involved,” he said. “Democracy has helped us to improve services. Collectively we come to the right decisions—this is the best way to run an administration.”
Upstairs in the clinic, Shafiq agreed. “The difference we make may be small in some months and big in other months. Maybe you can change the management here, or in another hospital maybe you can fix an elevator, or have better meals for the patients or the nurses.
“But every hospital that has a trade union, or is founding a trade union, has seen a profound difference in how the staff perceive themselves, the management, their hospital and how they think that healthcare should be provided.”
Seven other hospitals in Cairo have now founded their own independent unions on the model of Manshiyet al-Bakri. The seven unions are now coordinating and taking steps to form a federation of hospital unions.
These gains from below have not been won easily. “The leaders of the independent unions are being fought fiercely by management and the Ministry of Health.
“The concept that hospital workers have a say in how the hospital should be run, in using their collective power, is very annoying to those at the top.”
Nor are the enemies of the independent union only to be found in the Ministry of Health, it seems. As we talk, another doctor interrupts: “Have you got permission to be here? You must get permission from the military before you come into the hospital.”
A doctor is glowering over us. “Go on, then. Call them!” shouts Shafiq. “He got rich in the Gulf,” he explains. “Now he thinks the revolution is destroying the country.”