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Raed Arafat speaking at TEDxBucuresti

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It means that I have to sit here I’m sorry that I’m dressed like a Martian, if I take the words of my foregoer And it’s true that dressed like this among you I look like a Martian I didn’t have time to go home and change my clothes But being involved in an activity where sometimes I’m dealing with extra-terrestrial beings that don’t have a clue about what’s happening on Earth, you need to be dressed like Martian so that they believe you when you talk to them. So it’s normal that I’m wearing these Martian clothes It’s difficult to talk in 20 minutes about what’ve done and how we’ve done things to be with the SMURD (public emergency intervention system) where we are now. Because this is the topic – how we were able to go so far First, it not really a "do it yourself" action because this was not an action of just one person This was a project done by several people who during the years got involved either by supporting our cause or believing in it or by working inside this system, many of them as volunteers, without any financial reward just to see that an idea will take shape. This idea was based on just one principle – to do things better and see that more lives are being saved. We had a simple running principle – there were no private benefits involved, we were not planning to make a business out of it – but it was very difficult – and it still is to make people believe that a public service that has become a state owned public service can function at better parameters that a private service. This simple idea, that we started doing something or that I started doing something and other people joined without having any private benefit was the major issue and people are still asking the same question, even today: why? What is he up to? What does he have to hide? Our society has troubles believing that a person or a group of people can do something without having a hidden petty private benefit, without planning to get rich or without thinking about themselves first and not to the people they are going to serve. I liked a lot the last presentation – there is nothing more beautiful that doing something for the others, than helping the people around. If you haven’t tried this so far, you should. There is no feeling comparable to the feeling that you’ve saved somebody’s life. Of course, the people working in such a system have to be paid accordingly, they have to be appreciated and respected by the others. That’s normal. But, ever since this system was created it was based on volunteers – students and even pupils and it also has nurses and doctors that work much more then the money they get. If they were only after the money, they wouldn’t work long hours, they wouldn’t complete extra tasks. But these people do it with pleasure, because they want to see this system functioning. Ghandi once said: “First, they ignore you, then they laugh at you, then they fight you, then you win”. [Laughter] So, lets take it like this: in what stage are we right now with the SMURD? When we started in Cluj, all this Ghandi code evolved very fast. From ignoring us to fighting with us it all went rapidly. And we didn’t win the battle there. There we lost, because the SMURD team in the 90s in Cluj didn’t have the chance to prove what we can accomplish. And I don’t talk about myself here, but about the entire team that wanted to do something there. In Cluj there was a union, called the Free Trade Union, who tried and succeeded to block starting the SMURD project in Cluj after 6 months of fight. At the beginning I had an equipped car and I told them I wanted to work inside the existing emergency system. But they ignored me, it was not something important for them. When the ambulance came, you could see them laughing at it, because there was something new, it was an VW with two flashers, painted, with things written on it. When I went out on duty with it and they saw that I can get there in 6 minutes when in the 90s the normal ambulance would come in 50 minutes, or even an hour, or two, three, this is when the battle started. The thing is to have somebody to believe in you. And at that time in Cluj there was nobody to believe in what I was doing. There was only one person who believed 100% in what I was doing, but it was not powerful enough to support me. And then after 6 months they told me: You are allowed to go on duty but only with the supervision of the nurses from the official ambulance system that would check if what you do is correct. And then I asked: You mean that if I, as ER resident, get to a case in a few minutes and I am with my colleagues that can help me, I have to sit and wait for an ambulance with a nurse to come and supervise me? They said: yes. Interesting, I said. I had somebody working at the Ministry who believed in that project and made a provision for the project to start right away. But this man, called Radu Dop, resigned after one week. In this week, we advanced a lot, after his resignation we went back on an even worse position than before. I think I still have the letter I’ve sent to the lady running the Medical State Administration in Cluj where I was writing her that given the conditions I’ve decided to move the project in Targu Mures. This happened after I visited regularly an observed very carefully Targu Mures during one month. I found there a very enthusiastic and young person – young even if he was 50, because you don’t determine if somebody is young by his or her age, but by the vision that person has, and by the way she or he understands novelty and you accept it. He was the ex boss of the ER department in Targu Mures hospital who understood correctly what I wanted to do and he accepted. I was afraid to move there, because it seemed to pretty. Even if I liked the way he was seing the matter, I went there 2 times to ask once more: Are you really sure that we can do it? Yes. I arrived in Targu Mures, we started, and the Ghandi phases started all over But this time it was much slower. The mistake was that in the beginning I was ignored. But the people have learned with us. They’ve learned that things can be different and that we can really help the patient. I don’t want to show you here what were the signs that people were making when we were passing through town with the flasher and the siren. Maybe you remember that in Romania in the 80s the ambulances were not allowed to use the siren and this mentality was still in place in the 90s. The siren is disturbing. The siren creates panic. The siren doesn’t need to go on, except when is really necessary and when it was really necessary only if the patient was somebody important, or if the patient was a friend of somebody important Otherwise the ambulance was supposed to be something like a taxi even when it was on duty. These things changed over the years. In the beginning of 90s it really was like this And when in Targu Mures they started to hear sirens that were strident and loud, the first reactions were: “Can’t you turn the volume down a little bit? Or “Do you really have to use it? Is it really such a complicated case that you need to use the siren and the flasher?” And we were saying: “Yes, we’re going to somebody that might have had a heart attack or somebody that has lost consciousness, or we go to a car accident. And they were saying: “But this siren is too loud. You have to turn the volume down”. It was a fight that lasted for a few months. I remember how they put one of the policemen to stop me I was right at the beginning as a foreign citizen in Romania working on this project. He stopped me, I was with the Opel, which had the flasher and the sirens and everything, and he stopped me to tell me that he heard that I am using the flasher and the sirens to go to ladies. I was very enraged in the sense that for us this was an offence. Our statistics was already 90 cases, I remember even now. I went and talk to professor Chereanu, telling him that this is an offence and I told him that we should make the statistics and show it to the police. And we’ve made a chart with all the 90 cases, and we showed accidents, and people that lost consciousness, and then asked them: "How can you say that we are playing with the siren?" Since then we started to have a very good relationship with the police in Targu Mures. In fact, they stopped us because somebody made a complaint against us. From someone inside the medical system, who said that we were playing with the siren and the flasher. This was an idea that was very new for Romania, even if people were watching movies; they were not used to what we see now on TV. Maybe if the ER series was on TV back then, maybe if there were movies with firemen on, the things wouldn’t have been so strange. And we go further. Which is the biggest problem of somebody who has an initiative? It is the limit where he or she is ready to drop this initiative. If your limit is small the project has no chances. If your limit is up, and you resist and you don’t care what the others say about you and what they try to do to you the chances that the project succeeds are much better. At the beginning they ignored the situation and then they saw that the population started to be interested. The time flies. Can’t we turn back the time? When the people started to appreciate what we were doing there was a major resistance from some people from the medical world, and especially among our colleagues from the ambulance service In Targu Mures we also started together with them. But something was disturbing for them. And in a movie I’ve heard this: “first thing look and see whom you are upsetting”. When you know whom you’re upsetting, you know where the resistance and the kicks are coming from. A wave of resistance and kicks started indeed against this initiative. I remember that during one year I was on duty with volunteer students and with nurses from the hospital and from the university. How we received an ambulance as a gift, first we had the small car and then we got an ambulance from Germany that was 13 year and it was for us a huge joy that we finally had an ambulance equipped for ER. I was driving this ambulance, then when I was arriving to the patient I was the doctor, after this we were taking the patient with us in the car and the student and the nurse were taking care of him and I was supervising by looking in the mirror, I was driving the ambulance back to the hospital. In the first phase, the Manager of the Medical State Administration was very much against us because of different reasons – he was a big "patriot" and in his view an Arab shouldn’t come to Romania to teach us ER and even if people were telling him that I studied in Romania and that I’ve learned what I knew in Romania, he stayed with the same idea. Or at least he did not have any other reason to attack me except this which is the reason of the petty people in my view. When you attack somebody’s origin, when you pick on personal aspects that have no connection to the profession in order to disqualify this person professionally is the most pitiful thing a person can do. And this person attacked us for years in row, until 1996 with fights, with attempts to stop our activity. In 1991 the most important success was that we convinced other people to support us, not only the ER specialist I was telling you about but also some very powerful people which – you might laugh – they were the military firefighters. Then we had the help of a general that was in Bucharest and a colonel in Targu Mures that I’ve met and ask if he doesn’t want to cooperate with us. We were already active for one year and I told him: look, in France and in Germany, all over the place, it is the firefighters who do this job. Over the time we had an attempt to cooperate with the Red Cross. but the ex-president of the Red Cross put a stop to the project after a cooperation of 6 months that we had following a German model. He got angry because I appeared on TV without asking for his permission. No problem, the firefighters accepted and they proved to be a really professional partner. They said: we work together for 6 months and then we send a team to assess the situation. If the assessment team considers that the experiment is successful, we continue, if not, we separate in good terms and that’s it and we cooperate only on duty at the place of the accident. Exactly after 6 months, when I have already forgotten the whole deal, a team arrived from Bucharest to evaluate us, they went out with us at the interventions I still remember how the Chief Doctor from the Firefighter Forces came with me for 3 days at every intervention and we really had complicated cases with kids and adults and he had the chance to see how we’re working. He was a very open minded person and he went back and wrote a positive report recommending that we continue our activity. And I can say that this was the birth of SMURD: Mobile Emergency Service for Resuscitation and Extrication The fights that went on after this were in fact only battles that we had to win. And the war did not stop yet. We fight with the mentality, with those that can have private benefits out of this, those that can’t understand how this system started and functions now in half the country. And here I have to say that each person that gave us a hand has to be praised be it a politician, or not, a young voluntary or somebody that came an participated in 2 interventions. All these people had their role, bigger or smaller, in making this system work. We can ask ourselves what is happening now. I say it one more time: I didn’t do it by myself as says the title of the conference. We all did it. There were some elements that convinced the politicians that this thing has to work and it’s necessary to exist. There 2 elements. First it was the mass media and we were heavily criticized for this. Everybody was asking – why are we on TV? They accused us that we make propaganda. In my view, the fact that SMURD became known at the national level, protected us from those who wanted to destroy us. Not so many people know how many attempts to stop us really were. In 1997 we had a deal with a big company to donate a huge amount to open SMURD in Bucharest but this deal was destroyed by a person in a high position who requested this company to donate half of the amount to a football club. And the company gave up the donation completely and we lost the chance to start the SMURD in Bucharest in 97. 2001 we have another project – at national level – and somebody else came and destroyed 98% of our project with just a signature. Only Mures County was saved from the entire project. How? Unexpectedly, the entire population of Targu Mures all the trade unions and people from all factories threatened the authorities of the County that they will go out on the streets if the cars that were supposed to come for SMURD will be given to another institution. Of course, this thing did not happen – I even asked them not to do this but the Head of the County talked to the person that was trying to block us and told him: If you don’t want to lose your job because of the Mures County, I suggest you allow the project to function here. The intention back then was to destroy SMURD completely as a brand and as an institution. An official decision came saying that we are not allowed to write anything else on the intervention cars except Ambulance.We were not allowed to write firefighting forces or SMURD or anything like that. So they really wanted to eliminate us from Romania. But they did not succeed. And they accepted to let SMURD function in Targu Mures, hoping that they will close it in the other counties where we were functioning already Oradea, Cluj, Craiova. But they were not able. Why? It was because the population had a strong consciousness about this service and about its necessity. And it was not only the population. If somebody wanted to destroy SMURD there were other people from the same political party who said: “Stop, what you’re trying to do is wrong, this service functions well”. This system gained a reputation and the population voted for it indirectly by contributing with 2% of their incomes for funding us, by supporting us in various ways. In Mures in 98 they received some cars at the Ambulance service – everybody was happy. And we asked them to give us one of the cars - as the SMURD car was already 20 years old and is already forth hand or third hand. They said: NO. We don’t give any car to SMURD. And then I had this crazy courage - even if many of my colleagues were against this - they thought that is weird to ask many from the ordinary people to buy a car. In their view this was begging. And I was saying: No, we asked them to get involved. That’s different. We had the objective to collect money for the first SMURD intervention car. We went out on the street. We got help from political parties, schools, people that I’ve never known before, various organizations. We started to collect money door to door in order to buy this new car. The target in 98 was 180.000 German Marks, meaning 100.000 USD. We did it in 3 months. We collected 100.000 USD from door to door, out in the streets. I remember that I also joined the campaign in Reghin, there were high school students helping us, we had some sorts of invoices – we even requested for a fiscal control because I was expecting people to attack us. They said that we will steal the money and run away with it. So we requested the fiscal authorities to check on us. I was there with high school students, the cars – who wanted gave us some money – I don’t remember which was the amount set on our donation invoice, but it was a small amount. And you could see the people asking for 3 or 4 invoices or even 5. So, when we finished the campaign in Targu Mures, we had 183.000 German Marks. We promised the population that, if we collect the money, we will have the car by December. And we found a car used for only 10.000 kilometers, it was not brand new, but it was a demo car that was send at fairs an exhibitions. We got it with a discount. When we brought it it was a festivity in the entire town. The mayor, the county authorities, the population really waited for the car to arrive. This was the proof that what we were doing was right. Thanks to the simple people. I remember that one day a retired man came to the ER and he said my pension is only 5000 lei but I want to give you something, I want to know that I made my contribution to this car. And he took out a small amount of money and gave it to us, so that he makes his contribution. One cannot expect more than this. This is the ultimate proof. Where are we now? We are in a stage where we got the second vote of confidence for SMURD from the 2% campaign. And the war continues. This year we were attacked for the 2% campaign but this time not by the Ambulance system who keeps bugging us. In my new position as state secretary in the Health Ministry I made the best I could to make the Ambulance system more competitive and to set up a cooperation with SMURD – and Bucharest is a great example of how the Ambulance and SMURD can really cooperate. The fact that in Bucharest SMURD has 35 000 interventions a year and it cooperates well with the Ambulance is a success story in Romania and it’s a real surprise for me aswell. This is due to several people that worked together for this. But when the NGOs attack you which you think that have a more open minded staff and you see that even in such an environment there are petty people it’s over the limits. The first attack on the internet forums had a very tough title: SMURD commits fraud and the main issue was that a public services uses money that are supposed to go to the NGOs. But in fact this money is collected by an NGO which has as a purpose supporting SMURD just like any public hospital has maybe an NGO raising funds to support the activity of the hospital. It’s a normal thing; there is no interdiction for this. But which is the most disturbing aspects, where our society has to change?... What percentage of the population really donates the 2% tax? 15%. 85% of this money stays with the state and are not used by any NGO. What is upsetting for me is that instead of fighting with those who keep these 85% blocked, you attack those who use that 15%. You’d better go and convince the other 85% of the population to believe in your cause and get more money for extra activities. This is what usually happens when you direct your mentality towards a negative aspect instead of focusing on a positive thinking. Go talk to the people! We had a commercial on a TV station. After the TV stations went on air with it, representatives from 5 NGOs called to criticize them the SMURD commercial. And the answer of the TV stations was: "Did you ever asked us to help you and broadcast your commercial and we said no?" "You didn’t come for our help. You didn’t do anything. Why are you upset that we broadcast their commercial?" After this a company that offers Ambulance services makes a complaint against us to the National Broadcast Authority that the SMURD commercials are advertising for SMURD. Why? Because our commercial was saying that our mission is to keep people alive and because the commercial says: "Our mission is to keep you alive. We are among the best ones." The advertising agency worked on our project pro bono. We didn’t pay any money. And when they came with the commercial to show it to us the first time, there it said: "We are the best!" And I said: No, this is not correct. "We are among the best ones." We cannot deny that others are very good too. And this was interpreted as SMURD advertising for itself. So, we had to stop the commercial, take out this slogan and go back on air. I don’t want to keep you much longer. I could talk for hours ahead, but I just want to tell you this. In order to succeed in a project you need leadership, as I was saying before, you need people that believe in what you are doing and in you as a person and they believe in the future of your project. Your project has to be useful indeed and not something that only looks useful but finally has no impact. I tell you just one thing: how do we change people’s mentality? A few years ago I still believed that on each ambulance you need a doctor. But I discovered slowly that this is not possible. And moreover, there’s a waste of resources that you can’t afford. Going all over the world, I saw that in some countries they have no doctor on ambulance. Going to France and learning about their system, I saw that the firefighters are the base there and that they have first aid training and the doctor come only at the complicated cases. The rest is handled by them. I came to try to implement this in Romania and here in Romania we have an eternal dilemma: Who was first: the hen or the egg or the cock? Meaning that any initiative that is not mentioned in the law is illegal. [Laughter] [Applause] This thing always functions the same. And then, we wanted to take some actions that would save more lives but this would be illegal. After I arrived at the Ministry I was able to give legal support to initiatives started in 99. So, finally, in Targu Mures, the firefighters were allowed to offer the first aid with the help of the intelligent defibrillators. In Germany you will see defibrillator put on the walls of the train station or in the airport. The same in the US. If any of you see somebody having a heart attack can intervene after reading the directions. And in Romania my colleagues were asking: "How can you let a fireman do this?" And I was asking: "But is the Romanian fireman stupider then the German or the American one?" They all have education and there are courses that can tech you to save lives. The proof is that in Bucharest they can do it. And now, also in the rest of the country. And finally the mentality has changed for better. There were even funny aspects – a colleague was in a day care hospital and he heard a story about a diallogue between two eldery men. You all know that people tend to abuse the Ambulance system, by calling them to give them prescriptions or other small things. And one of the old men asked the other: "Why are you here?" "For a prescription". And the other said: "Why didn’t you call the Ambulance"? The first one replied: "'Cause this Arafat guy made the firemen drive the Ambulances, they don’t give you prescriptions". This is true. [Laughter] They were calling us saying that they have a pain in their chest, we thought that it has heart attack we were sending the firemen in 3 or 5 minutes to give them first aid and when he was there, all they wanted was a prescription. But there was no doctor with the crew to do it. The fireman in 3-5 minutes. The fireman was saying: If you want, I can take you to the hospital and if you don’t want to please sign here. It happened the first time, the second time and then they’ve learned to go to the hospital as they should. And this is a changed in mentality for the better and a change of the system. Are we out of danger? No. There are many things happening around us, that are colored and presented in a certain manner. Now there is a huge battle on roll. There are many commercial entities that want to become part of the public ER system or to be in competition with the public ER system. And for me this seems the most dangerous thing that can happen to a public ER system, because you transform a humanitarian system that has as purpose to help and save its citizens in a thing that has a commercial purpose, and where the focus is on the profit. All these aspects shouldn’t be connected with offering first aid, which is the duty of a state. The Romanian law stipulates that is the duty of the state to protect the lives of all its citizens. The private companies were allowed to cover a few medical services but it seems that this is not enough, that they want more. They want to step on the ground of the public services. And then I ask myself: Can a country as Romania afford to have the public system competed by the private system and be taken over by it, as it happened in a few countries that now cannot go back to the old way? I don’t think we can afford this. We receive all sorts of complains, especially from a certain company – I don’t want to mention names – and they ask for a free market, open to competition in the ER system. Should we accept something like this? I don’t know. When I see that already a few have made the same request already, I start to wonder what is behind this. Should we turn the ER system into a commercial activity? Is this a space for commercial competition or is this a sacred service which a state gives to you whenever you need it, regardless of the color of your skin, the color of your eyes, the things you have accomplished, your age, your place of origin, whose son are you. If a state cannot insure its citizens that their lives will be saved when needed, then why did those citizens paid taxes for? Ensuring these rights to your citizens is a basis of a civilized state. When this turns into a cheap commercial competition it means that we make a fundamental mistake towards our citizens. At the first glace, this can bring benefits, but the previous experiences run across the entire world show that it is not like this. And we need to learn from the others. Not everything that flies is edible and not everything is done in the name of a free market is correct. And these are real dangers for the patients and for a system that is supposed to serve its patients. And there are also voices complaining that the public system gets too much money. What does this mean? This sudden interest for the public system began only when they saw that the state started to invest money in the public system. As long as the public system had no funding there was no interest in that area. At the certain moment the citizens will have to say if this is good or bad and this is very difficult because you need to be well informed to have a correct opinion Anyhow, what I can say in the end is that what they didn’t know when they started harassing me is that with each harassment my limit goes upper and upper and the chances to quit get smaller. In some people the harassment unleashes stubbornness. Especially when you see the reason of the harassment. If you believe in what you are doing and you have a vision of what you are doing and you see that people are doing the same as you – this can turn into an encouragement. For me this was the biggest encouragement. – to talk to people from other countries that were doing what I was doing here with my colleagues. We need to learn from the others. In France, when the firefighters entered the emergency system, somebody placed a coffin in front of the house of the commander of the firemen to show him what would happen if he continues. There were fight there as well, but this happened 35 or even 40 years ago. We went through these phases much faster. Most of the times I hope we can avoid those phases that in other places proved to be problematic, inefficient or even wrong. We need to get over this phases fast and get to these ones proven to be correct by the others. So, we will see where we will end. And, one more time, if something is successful, the success is due to those who believe in the idea, to those that take it further and to those who dream it further. There is a saying in English language that says: When others ask me why, I keep dreaming and I say why not? Any project is doable if you believe in it. Thank you. [Applause]

Video Details

Duration: 39 minutes and 30 seconds
Country: Romania
Language: English
Genre: None
Producer: Hydra Society, TEDxBucuresti
Views: 2,516
Posted by: tedxvideo on Jul 12, 2009

Raed Arafat is a Palestinian doctor that lives in Romania for 20 years now. He set up from the scratch a public emergency intervention system at amazing standards that saves everyday hundreds of lives. He is a local hero and an excellent speaker. He put lots of energy and hope into the audience.

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