With the looming introduction of a National Health Scheme, THEO PANAYIDES meets a doctor who revolutionised medicine on the island in the late 70s by introducing private services. He now looks back and rues how it has become so tied up with money
Dr Lakis Anastassiades winds up our interview with a brief tour of the Cardiovascular Diagnostic Centre in Nicosia, which he co-founded with two other cardiologists in 1977. In the corridor we run into another doctor, one of his colleagues at the Centre, and Lakis mentions that we’ve been talking (partly) about Gesy, the national health scheme that’s due to be implemented in a few weeks. The response is immediate and heated, the other doctor railing against the proposed scheme’s “Soviet-style” provisions – a sign of the controversy Gesy is igniting among the medical community. Lakis himself offers only a mild rejoinder, keeping things civil – though in fact he’s very pro-Gesy, and has come out on Facebook to chide the Cyprus Medical Association (CyMA) for being against it.
It’s a moment that typifies the man, holding – though not necessarily masking – his strong beliefs behind a pleasant demeanour. Lakis is 75 and decidedly twinkly, his bedside manner seemingly extending to life in general. He’s compact, rather “overweight” by his own admission, and very jolly. He laughs more than once during the interview, and not just laughs but laughs uproariously, literally throwing his head back – not just when something is funny but especially when it’s not, as if consciously to lighten the mood. ‘How did you find the money to open this clinic, back in the 70s?’ I ask, prompting wild merriment. “It’s funny,” he gasps between chuckles: “The government, or the Medical Association, does not give any help to the young doctors! You come, and you’re on your own.”
Simply put, he found his own money – and made quite a splash, along with his two colleagues. “Yes, we made a splash,” he affirms. “Three doctors, American doctors, it was unheard-of in those days… And three cardiologists together, it made an impact, yes”. At the time, there were only eight (!) cardiologists in the whole of Cyprus, and the few private doctors on the island almost always worked alone, never in clinics. Lakis knows this because his CV includes a magnum opus called Kyprion Iatron Erga (‘The Works of Cypriot Doctors’), a history of medicine in Cyprus from 1950-2015 – an insanely detailed, 888-page doorstop that took five years to write, a period (from 2010 to 2015) during which he also ran his practice and taught at the University of Nicosia medical school. He’s also, at various times, co-written a book on nutrition, stood (unsuccessfully) as a member of Parliament, and helped create the first proper hospital in the National Guard. The manner may be jolly, but the life was (and remains) very active; he’s involved in public affairs – including, inevitably, Gesy – and talks, more than once, of making “a contribution”.
This is all a bit old-fashioned nowadays. We speak, coincidentally, on the same day that high-school students staged a two-period walkout, refusing to go to class in protest against the education ministry’s plans to implement twice-yearly exams. These exam-shy students faced no sanctions – unlike 13-year-old Lakis and his English School classmates who staged a similar protest in a very different Cyprus, on the day of Eoka fighter Michalis Karaolis’ execution in 1956. The headmaster and PE master corralled some 50 young patriots and gave them “two sticks, we used to call it ‘sticks’, you had to bend over a chair and they struck you two times”. Lakis didn’t tell his dad – a teacher at the English School – about the incident, but his mum (also a teacher) was helping the boy take his shower that night and “saw two black [lines] on my buttocks,” he recalls, laughing uproariously. “She said ‘Goodness, what happened to you?’,” goes on Lakis, rocking with laughter.
The contrast is instructive, students now protesting over too much work and students then protesting in the service of a higher ideal – and medicine, too, has changed in the decades since young Lakis tagged along behind his dentist uncle (“He was my idol, I would say”) on the uncle’s trips to far-flung villages, and even in the (slightly fewer) decades since he first started practising himself. “Medicine has become more mechanised, because of the modern equipment,” he relates, “and of course this has also changed the character of the doctor… Everything becomes mechanical, ‘Oh you come, you do this test’ – and I can tell you that a doctor now may manage a patient without even touching him!” No surprise that a man with his fulsome manner should fixate on that touchy-feely detail, the fact that his own generation always began with a physical examination whereas now “you do an electrocardiogram, you do a chest X-ray, you do an echo; you know everything about him, so you don’t have to touch him”. Nothing has been lost per se (if anything, it’s much more efficient now) – yet something, perhaps, has been lost, that sense of intimacy which helped doctors in perceiving their job as more than just a job.
The word we’re looking for is ‘vocation’ – and Lakis doesn’t use that word himself, too diplomatic to imply that young doctors lack dedication, but it does sound like he sacrificed a lot in pursuit of medicine. “Family time,” he says by way of example. “My two kids grew up, and I don’t remember anything from their childhood.” (Both are now in their 40s, his son a gastroenterologist in Singapore, his daughter in Human Resources.) “I used to leave at six in the morning, come back at midnight”.
Why so many hours?
“Because we had to take care of our patients. We had a lot of work! Finishing the office, then you go to the clinics to see the patients. Your patient had a heart attack, you have to stay with him. Long hours.” He was used to it, having worked 100-hour weeks during his training at the prestigious Baylor College of Medicine in Houston – he’d previously studied in Israel, under a WHO scholarship – including one memorable stint when he didn’t go home for three days. All told, Lakis lived abroad for 14 years, incidentally missing the Turkish invasion (he followed it on TV in the States, heart-in-mouth since his family actually come from Kyrenia). When he returned, in 1976, he felt “completely cut off from Cyprus” and wasn’t really planning to stay – “but when I came and saw this disaster here, people living in camps, my whole family displaced, I had second thoughts. I thought ‘What am I going to do in the US, just sit there and work and make money? Here, people need help’.” It was, as he says, “a contribution”.
We shouldn’t oversell the idealism. For one thing, meeting his wife (also a doctor, in the state sector) was a big factor in deciding to stay. For another, it’s not like Lakis wasn’t making money in Cyprus too, as a US-trained cardiologist – and it wasn’t just the money, it was also a case of presiding over “a new era”, overseeing the transformation from public to private medicine. At the Centre, he and his colleagues introduced now-familiar tools like ultrasound examinations and exercise (a.k.a. stress) tests, importing the equipment themselves; on the island as a whole, a system was built up from scratch. “It was an exciting era, from the medical aspect. We had to do things for the first time in Cyprus. Organise seminars, invite foreign guests, foreign doctors”. He was president of the Cyprus Cardiology Society, liaising with colleagues from all over Europe. Medical associations were set up for various specialties – the same associations which are now lining up against Gesy.
Was there already talk of starting a national health service in the 80s?
“Oh yes!” replies Lakis, reaching for a copy of his book – and there, on page 781, is a press clipping from 1982, lamenting that “political interests, in the run-up to Presidential elections” were impeding the progress of a national scheme, which had been due to come into effect at the end of 1981! Plus ça change, it appears.
Everyone was against a scheme in those days, he recalls, politicians siding with the pharmaceutical and insurance companies which stood (and stand) to lose money. “So the doctors were fighting alone for Gesy. And now, 40 years later, the only ones against Gesy are the doctors! This is unheard-of”. He shakes his head: “I’m mad at my colleagues for one thing. They have been pushing for a national health system for 40 years. They were the pioneers, the doctors. They managed to get it through Parliament, to make a law for Gesy” – but now, in the wake of that triumph, the current CyMA leadership has turned against the scheme. “This is not serious… You cannot go back and say ‘No, I don’t play now because I didn’t get what I want’.”
The main stumbling-block is the government’s insistence that doctors won’t be able to practise privately, on the side, after joining Gesy – and we talk about that, though none of Lakis’ arguments are entirely conclusive. First, he points out that negotiations were always conducted on the basis of no private practice – “All the studies throughout the years were without private, because all government and private doctors would be the same. This is a philosophy. You accepted it” – so doctors can hardly demand it now. (Then again, it may be that those doing the negotiating were more ideologically pure than the bulk of their colleagues.) Then he calls for the system to be implemented anyway – if only to avoid another 40 years of bickering – and corrections to be made as needed. But surely it’d be quite hard to change such a central component, once the parts were up and running?
Other countries offer only limited guidance. In the UK, for instance, ordinary GPs must abide by the system but consultants “can have a few hours of private,” says Lakis – but most private doctors are indeed consultants (i.e. specialists) in Cyprus, so that doesn’t solve the main dispute. The crux of the matter lies perhaps in Lakis’ explanation of why we can’t have it both ways: “If you tell everybody ‘You are free to do private practice’, am I stupid to come and work for the system for peanuts, and not close my office and open it later, private?”.
‘Peanuts’? But doctors in Gesy will apparently be getting some €135,000 a year, probably more. That doesn’t sound so bad.
“It doesn’t sound to you, and it doesn’t sound to any European doctor,” he replies, chuckling grimly. “That’s why we’ll have many Greek nationals coming to Cyprus to work. But we’ve learned to live with much more”. A surgeon now may earn €3-4,000 per operation, often operating twice a day, three times a week: that’s €24,000 a week, just for surgeries – never mind the patients he sees at €50 a pop, and MRIs and CT scans and so on. Doctors have become businessmen, laments Lakis. You can’t always blame them, since they’ve had to invest in building clinics and need to recoup that investment. “It’s the ugly side of medicine – which shouldn’t really be like that. I don’t know, do I look socialist?” he adds playfully – and does another of his head-thrown-back roars of laughter, breaking the tension.
I don’t know. Are you?
“No!” he protests, still laughing hard. In fact, when he stood for Parliament (in 1981) it was with centre-right Disy, one of the two youngest candidates on the party ballot: the other was another Anastasiades, that one from Limassol rather than Kyrenia. “The one from Kyrenia flopped, the one from Limassol continued and became president,” jokes Lakis. “We are close friends,” he adds, “we are good friends. But Anastasiades was born a politician. I was not!”
Is that true? You have to wonder, given the very political talents of this rather smooth operator: his ability to cultivate a convivial atmosphere (the laugh helps), his sociable nature, his dynamism. He’s still active now, in his 70s; in April he’s off to Accra, capital of Ghana, for a meeting of “authorised physicians”, a position he holds in Cyprus for several countries including Canada, the US and Australia. (Basically, he’s the doctor who gives the medical all-clear for those seeking visas to those countries.) Then again, he may be a touch too wide-eyed for a politician. It’s unlikely that a politician would’ve spent five years on such a quixotic project as his history of medicine in Cyprus.
His true position – speaking of the history of medicine – may be slightly more ironic. Lakis is a part (indeed, an important part) of a generation of doctors who revolutionised private medicine on the island, did so with enthusiasm and the best intentions – but may also have created a monster, making the practice more mechanical and vastly more lucrative. The result is a system that’s become alienated from patients, and far too attached to money – and has now turned against the scheme he himself once championed, as a CyMA member in the 90s.
‘Does being a doctor change the way you view life?’ I ask Dr Lakis Anastassiades, and he nods fervently, thinking back to his 50 years of virtuously inserting himself in the lives of others, checking and examining and trying to save patients – especially, perhaps, to those hard, inevitable moments when he failed to save them. “Throughout your life, you philosophise,” he tells me. “You become a philosopher, gradually. Yes. Seeing the patient dying in front of you, watching him dying – because you give up, you tried everything to resuscitate him, he doesn’t respond, and then you watch him and see all the process of death. How he opens up his mouth, and you imagine –” he sighs – “How many times I thought: ‘Oh, now the soul is coming out of the body!’.” Lakis shakes his head in wonder: “It’s a feeling that cannot be described. You have to feel it as a doctor”. So much for medicine being just a business.