NEWS FROM THE UAE
SOURCE : THE NATIONAL

Doctors scribble illegal sick notes

DUBAI - Mar 05: Doctors have been caught issuing thousands of illegal and fake sick notes to government employees.

The Dubai Health Authority (DHA) revoked the licences of three doctors, one of whom issued 2,500 notes in one year, after investigating claims of the illegal practice. It has also temporarily closed a private clinic.

Patients are usually charged Dh100 for each note. Most clinics do not charge workers from the private sector.

Abdulla al Falasi, director of medical licensing at the Department of Health and Medical Services, said of the doctor who issued about 2,500 notes: “This is a huge number. We began investigating and then approached the doctor to ask for the files of the patients. We found he did not have them. He was not issuing the sick notes for genuine reasons. This is fraud.”

A general medical committee and an online sick-note application process allow the DHA to monitor sick leave taken by government employees and look for doctors who issue unusually large numbers of notes.

A circular issued by the health department in January reminded all public and private sector facilities that they must use the electronic sick-note system rather than write notes manually.

That means doctors must fill in and register the sick leave application on the department’s website, where the application will be approved or rejected. The employer can check the registration number of the note online to verify that it was approved by the authority and the reasons for the sick leave are genuine.

The system also allows the authority to monitor the numbers of sick notes being issued by individual doctors or clinics and also monitor the amount of sick leave being taken.

“We watch it very, very closely. It helps employers know if their staff are cheating. We want everyone to know that is they issue the notes fraudulently or take sick leave when they should not, we will find out.”

Government employees are entitled to five days of sick leave with a doctor’s note before it is reported to the general medical committee at the health department, which scrutinises longer sick leave to spot suspect notes.

If an alarm is raised with the DHA, the committee will investigate the claims and report its findings and recommendations to another committee, which decides what action should be taken against the doctor.

Mr al Falasi said some employees were caught taking one or two sick days every few weeks.

“This will be noticed,” he said. “Employers do not want this to happen. If they are being given fake notes, we will find out.”

The committee was created last year after the DHA found government employees were using fake sick notes to take advantage of their 90-day allowance of sick leave.

According to labour laws, employees who pass their probation and have worked for more than three months are entitled to up to 90 days sick leave each year. They receive full pay for the first 15 days, half pay for the next 30 days, and no pay for the remaining time.

In October, the DHA revoked the licenses of two doctors who each signed more than 1,000 sick notes for civil servants who were not ill. The Dubai Naturalisation and Residency Department alerted the DHA of two clinics issuing fake notes after they spotted patterns in their employees’ sick leave.

Building site accident reporting ‘is flawed’

ABU DHABI - Mar 05: The reporting of accidents on construction sites is flawed, a new study says.

The problems include a lack of basic information, such as the injured person’s nationality and the machinery being used, according to the UAE University study.

The Ministry of Labour’s safety and inspections office plans next week to review how the information is collected.

“The system the ministry is using right now is kind of general,” said Noura al Kaabi, the lead researcher of the study. “The safety department is covering all kinds of occupational hazards so it’s not particular for construction. We designed a better, simplified computer database for the ministry that fits with the construction industry.”

She characterised the proposed reporting system as “a report and an investigation at the same time” because of the depth of information it allows.

“If we have a fall, you select where he falls from,” she said. “An elevated platform, a roof, an opening, a staircase or scaffolding? And then what kind of fall protection was in place – a guard rail system or safety nets? Was he pushed or was it a defective fall protection system?”

The director of the inspections department at the ministry, Muhsin Saeed, said yesterday that it has been in contact with Ms al Kaabi.

“Maybe we can mix her system and ours together,” he said.

Health and safety managers of major developers also urged the ministry to improve how it records construction accidents.

Dave Bass, of Al Naboodah Contracting Company, said that while builders were required by law to enter basic information such as the person’s name and sex, “there are also some strange questions there”.

“If you look to the labour law, there is a table that tells you one of the items you’re supposed to have within the reports is how much the guy was earning,” he said. “What on earth does that matter to an accident report?”

Andrew Broderick of Aldar Properties, one of the country’s largest developers, said that before yesterday he was unaware of any kind of form used by the ministry for occupational accidents.

“I’ve never seen this before in my life,” Mr Broderick said after receiving a faxed copy.

He said the form was inadequate for the construction industry. “I know that straight away because it asks for ‘profession or trade’, so this could be oil and gas, this could be working in a factory or a kitchen.”

Mr Broderick and Mr Bass stressed that the fundamental problem was a lack of enforcement.

“Do the little companies actually report their statistics?” he asked. “I know of some small companies of 200 or 300 people that build two or three villas at a time and they’re not reporting anything.”

Ms al Kaabi said one of the study’s objectives was to help the ministry determine which companies should be awarded contracts. Those with poor safety records could be ruled out.

The trade group Safe Build UAE recently published figures showing there were 20 fatalities last year and 690 lost-time injuries on construction sites. The most common cause of injury was falling from height, with 81 incidents.

New guidelines for treatment

ABU DHABI - Mar 05: New guidelines for treating anaemia and asthma, following an increase in the number of cases, will be in place by the end of the year. The Ministry of Health (MoH) says it is determined to ensure treatment meets international standards.

“According to our strategy, in 2008 we worked on hypertension and diabetes, but 2009 is for bronchial asthma and anaemia,” said Dr Muna al Kuwari, director of primary health care at the ministry.

The treatment of hypertension was discussed by medical professionals last month. Key personnel were invited to learn the new treatment guidelines, with plans for them to pass on the information to their own hospitals and medical clinics.

“We are educating the doctors about the disease, and even health providers and educators, according to their speciality,” Dr al Kuwari said. Now bronchial asthma is to be given the same degree of attention, due in part to the large numbers seeking treatment.

The ministry has carried out a study into the rates of the disease in Sharjah, and the results are likely to be released along with the new treatment guidelines.

Anaemia is also a concern because of the high rate of genetic blood disorders in the local population.

“We have patients suffering from thalassaemia and sickle-cell disease that we need to treat. We want to update everything so we have to look at every category of disease,” Dr al Kuwari said.

Dr Hasrat Parkar, head of family medicine at Tawam Hospital in Al Ain, welcomed the move by the ministry, which oversees health care in the northern Emirates, to standardise treatment.

“Having the guidelines is good provided they are backed up by the appropriate diagnostic treatment,” he said, agreeing that both asthma and anaemia were prevalent in the community.

The rates of bronchial asthma have increased because it has become easier to diagnose and people are being exposed to more allergens.

“Part of the reason is environmental – the last few days have been particularly dusty and sandy. Even if the instances were the same as before now we are better at diagnosing it. We are better about thinking about what could be asthma.”

Anaemia can often go unnoticed. The symptoms are a feeling of lethargy and a pallid complexion but in severe cases the condition can lead to heart failure. It is found in people with a lack of iron in their diet, and also in those with thalassaemia traits.

“Anaemia is common around the world but it is particularly common in the UAE,” Dr Parkar said.

Vitamin D warning issued by doctors

ABU DHABI - Mar 05: A lack of vitamin D is responsible for many health problems, and the only way to combat it is for people across the country to have more regular check-ups, medical professionals say.

One of the biggest contributing factors is not getting enough sun. Just a few minutes of sunlight a day can make a huge difference.

Dr Afrozul Haq analyses about 110 blood samples a day in his role as a senior clinical scientist in the department of laboratory medicine at Sheikh Khalifa Medical City.

“You name the disease, and vitamin D is playing a role,” he said. “The importance is being realised by health professionals.”

Over the past two years examining 80,000 blood samples, Dr Haq found that 65 per cent of women and 60 per cent of men had vitamin D deficiencies. Sometimes he finds levels of just 10 nanomoles per litre, compared with healthy amounts of 75 to 200 nanomoles per litre.

“It’s common in a sunny climate,” he said. “The main reason is people are concerned by the strong sun. Here there is the traditional way of clothes, the abaya, and people who are working in the office, they spend most of their time inside.”

Dalya Gomaa of Dubai, the vice president of sales and marketing at Ethos Consultancy, agreed. Ms Gomaa, who has three children, knows that although vitamin D is important, she and her family may not get enough because they are rarely outside in the sun.

Most of the time, she said, it was just too hot. “We were in Canada last summer and it was nice to go for a walk,” added Ms Gomaa, who came here from Egypt. “But here, what do you do? You go to work, you go to your car, you go to the mall.”

Vitamin D helps the body absorb calcium from food and drinks and, while it is essential for healthy bones, muscles and teeth, research in recent years indicates it is also deeply involved in most of the body’s cellular processes and affects the entire immune system.

It also serves as a glucose regulator, and low levels are usually seen in people with diabetes. Vitamin D deficiency can lead to serious health problems including depression, multiple sclerosis and heart disease. It can increase by 30 to 50 per cent the risk of developing breast, prostate and colon cancer.

A study published in the January-February issue of the medical journal Endocrine Practice involving 87 Arab women living in Dearborn, Michigan, found their conservative dress had a significant effect on their vitamin D levels. All of them had 25 per cent, or less, of the vitamin D they required, and the levels got lower in veiled women.

Raymond Hobbs, the lead author of the study and a senior staff physician in the department of internal medicine at Henry Ford Hospital in Detroit, said some levels were so low they could not even be measured.

Studies show the situation has been reflected even in the sunny Middle East, Dr Hobbs said.

“The thing I want is awareness,” he said. “The key thing is for them to get their vitamin D levels checked. Once you find out what that is, you know what to do.”

Testing for screening purposes – that is, with no medical problem prompting a doctor to ask for it – is not yet covered by most medical insurance plans.

Although vitamin D is found in some foods, such as oily fish, eggs and fortified milk, the amounts are often minimal and not sufficient to maintain the level the body needs. A person would have to eat 80 eggs or drink 20 glasses of milk a day to get the proper amounts, Dr Hobbs said.

The most effective way people can boost their levels is still regular exposure to sunlight – 10 or 20 minutes on a regular basis.

“The body is capable of making 100,000 to 200,000 units of vitamin D from moderate sun exposure,” said Dr Hobbs. “It will only make as much as is needed.”