By Golnaz Mahdavi
May 6, 2021
In recent days, news of the alleged suicides of three young doctors at Iran University of Medical Sciences tore through social media and horrified many observers.
With the cases now being investigated, other medical students have spoken out about their experiences of constant strain, exploitation and isolation working under the Iranian Ministry of Health. IranWire spoke to three health workers about the difficulties they have faced both before and during the coronavirus pandemic.
The sudden deaths of three young doctors in the residency stage of their training shocked Iran this week. All three are reported to have been suicides by those close to them, although what conclusions the Iranian authorities come to has yet to be seen.
The first was a young doctor named Amin Abdirad, a third-year radiology resident who was awarded top grades in his 2018 specialists’ exam. He also had thyroid cancer, but friends insist it was not this that took his life.
The second is Azin Kamali, also a third-year radiology student at Iran University of Medical Sciences. The third was Sara Heidari-Moghaddam, an ear, nose and throat (ENT) surgeon in residency, who had lost her husband, Dr. Navid Masjedi, in February this year.
Iranian media has dubbed the three tragic incidents, which took place fewer than ten days apart, “serial deaths”. In a report published on Tuesday, May 4, Rokna News Agency speculated about the cause.
It quoted Mohammad Sharifi Moghaddam, secretary of the trade union Iranian Nursing House, as saying that the deaths might have been caused by drug abuse because of the pressures that resident doctors are under.
But Hossein Kermanpour, the public relations officer of the Iranian Medical Association, told Rokna that “accurate information has not yet been collated… Investigations into the deaths are ongoing. The investigations will probably be summed up today and the final results will be announced by noon tomorrow.”
At the time of writing, the Medical Council of the Islamic Republic of Iran had yet to announce the three students’ definitive causes of death.
Meanwhile, a number of Iranian physicians took to Twitter to criticize what they called the Ministry of Health’s policy of “forced labor”, drawing on their own painful experiences of long hours, low wages and annual exams throughout their residency placements.
Ali Nikjou, a member of the Central Council of the Islamic Association of Iranian Medical Society, was one of the doctors who spoke out. The psychiatrist described the deaths as a “painful tragedy”, adding: “The national assets of this country are either gone, crumpled in the corners, or endure life with more difficulty than ever and end their lives in this tragic way. Death is no longer our business these days; it has become our life.”
Elham Moadeli, an assistant gynaecologist, wrote sympathetically of her own suicidal thoughts in residency. “It was as if I had fallen into a well,” she said, “that was so deep and black that no light from life could reach it, and no rope could reconnect me to life outside. My only thought was to plunge in a car down to the bottom of the valley.”
Resident Doctors Working Back-to-Back Shifts Miles from Home
IranWire spoke to three doctors about their own observations of residency in Iran. Ahmad is a medical student at Hormozgan University of Medical Sciences, in a province racked by widespread deprivation and high rates of coronavirus infection in 2020 and 2021.
“The situation is very difficult, especially now with the pandemic,” he said. “I heard that these doctors were radiology residents. Imagine working 30-hour long shifts with no breaks, having to give chest x-rays to patient after patient. As far as I know, residents are also paid a little less than two million tomans [US$83], which is barely enough to live on.”
Shifts at the Ministry of Health’s university hospitals, he said, can sometimes last from morning until the afternoon of the next day. “There’s no energy left for a person to think about their mental health.”
At Ahmad’s university, some interns and residents take drugs such as Ritalin – a stimulant used to treat hyperactivity in children – to stay alert and make it through long stints on the wards, and also to study for exams. But Ahmad said he was not convinced by the overdose hypothesis because “doctors know how much to consume”.
Naghmeh is an gynaecological surgical assistant, now in her last year of training. She said her hobbies have “diminished” in that time and her last years of specialization were “really tough”: “Imagine being on 20 night shifts in one month. Senior-year residents and teachers treat us in a humiliating manner, and the salary is just enough to cover the transportation.”
Radiology, she said, had comparatively fewer shifts and better rates of pay after graduation – at least until Covid-19 struck. “We don’t yet know what the continuous x-rays and coronavirus will end up doing to residents.”
In a bid to address address regional healthcare inequalities, the Ministry of Health often requires students with the University of Medical Sciences to move to other cities for their residency period. Though a worthy goal, this has the knock-on effect that many students end up adrift in towns far from their friends and families, and currently lack a clear vision for when they might be able to go home.
“The coronavirus pandemic has prevented some from seeing their families for a long time,” Naghmeh said, “due to restrictions or the fear of transmission of the disease to their families. Add that feeling of homesickness to all the hard work at this time.”
Wealthy Residents Pay for Poorer Ones to Take on Work
Behrouz studied general medicine at the University of Tehran and after working in cities around Tehran for a few years, he emigrated to Berlin, Germany to complete his specialization. “I finished last year,” he said. “The situation was very difficult at that time. But apparently it’s even more difficult now.
“Everyone looks at residency or internship as a transition period and wants it to end as soon as possible. During my 18-month internship, I had 36-hour shifts once every three days. You couldn’t usually sleep, and the full day I was at home, I had to rest.
“What made it worse was that the children of the rich could sell their shifts. Those who had money paid up so that others who needed it could stand guard at night instead. Because of this, the interns who had no money had to stay in the hospital for more seven or eight more shifts a month. The internship itself did not generate much income.”
The young GP said that while he was studying at least, 10 percent of places at Iran’s medical colleges were reserved for the children of war veterans and Basij members.
“This quota was not only for the entrance exam, but for the specialist courses,” he said. “Alongside the ideological ‘superiority’ and power that gave them, the university even provided special support for these people.”
The residency period in Iran generally lasts for four to five years, during which students are not allowed to transfer elsewhere. “Residents,” Behrouz said, “especially in orthopaedics and neurology, had very heavy shifts. It was well known at the University of Tehran that they could only leave the hospital in the evenings for one week out of every month, and aside from that they would have to live in the hospital the whole time.
“Giving up a residency is not easy. You have to pay back the debt and you are not allowed to take the specialist exam again for a certain period of time. Residents must also enter into long commitments to work for the Ministry of Health [afterwards], usually three times the length of their residency.”
Comparing his experience of training in Iran with that of Germany, Behrouz said: “The situation is different in Germany. Here the resident has no obligation to the hospital or health system and is trained by a professor of his or her choice. The income here is enough to make a decent living, and he or she has the right to leave, and is not legally permitted to stay on a shift for more than 16 hours. Meanwhile in Iran, we had 36-hour shifts.”
Behrouz also recounted the story of a friend of his, who attempted suicide as a resident by throwing himself from a height. “Fortunately,” he said, “it was not successful, but he had a lot of fractures.
“We often heard at that time that somebody had committed suicide. Now I read the news and I fully understand why.”