Khalid Ali: Angels or demons? When doctors become perpetrators

Sand Cliffs (Faleze de nisip)
Director: Dan Pita
Showing at the Curzon Mayfair cinema, London, on 3 July 2010 as part of the Romanian Film Festival in London, 2-4 July 2010
Rating: ***

Links between doctors and corrupt government members have been previously explored in films such as The Last King of Scotland (Review BMJ 2007;334:100, doi:10.1136/bmj.39085.675856.59). In that film a young Scottish doctor (James McAvoy) collaborated with the Ugandan dictator Idi Amin in supporting breaches of human rights and genocide in return for sharing of power and living a luxurious life.

The Romanian film Sand Cliffs explores a similar theme. Shown in Romania in 1983 for a few days before being banned by the late dictator Nicolai Ceausescu, the film was a clear denouncement of the oppressive Romanian regime. The central character is a cardiothoracic surgeon, Dr Hristea (played by Victor Rebebgiuc), who is spending a summer holiday with his partner and a friend. Peace and tranquillity are shattered when a thief steals Dr Hristea’s radio and camera. The surgeon witnesses the theft and runs after the thief but does not catch him.

The next morning an innocent carpenter wandering at the seafront is accused of the theft. The surgeon insists vehemently that it was the same man he saw walking away with his goods. Although Dr Hristea’s partner and his friend are not convinced of the thief’s identity, the surgeon bullies them into providing a statement against the innocent carpenter. Dr Hristea becomes an integral part of building the case against the poor man. Police officers in charge of the investigation support the surgeon’s bullying behaviour to get a confession out of the “presumed” thief. Signs of blatant corruption appear when the chief police investigator allows Dr Hristea to interrogate the carpenter in return for seeing the police officer’s wife who has kidney problems.
The net of lies and oppression tightens around the carpenter’s neck. After being coaxed into admitting guilt, he finally succumbs. Following the innocent man’s imprisonment, the surgeon is rewarded for his assistance with the interrogation by being appointed the principal director of his hospital. Bullying behaviour and mercilessness towards the innocent man are seen as “excellent leadership skills.” Thereafter feelings of guilt and doubt haunt the surgeon for the rest of his life, while the carpenter struggles to rebuild his life after leaving prison.

Healthcare professionals collaborating with oppressive regimes is not just a fictional story from 80’s Romania. The role of the German doctors in the Nazi genocide is a vivid example of doctors assisting in “crimes against humanity.” Recent events from African countries such as Sudan showed us that basic human rights of doctors seeking better pay can be met with brutal resistance. This heavy handed government approach is supported by some doctors in the Ministry of Health. The BMA has recently condemned the ill treatment of striking doctors in Khartoum (BMJ 2010; 340: c3225).

Social justice and basic human rights are all integral components of healthy living. Consequently the remit of doctors’ responsibilities should strive to protect those values in their patients, and not just concentrate on their physical ailments.

However the portrayal of doctors as partners in an oppressive regime does not make all doctors villains. Machiavellian principles exist in all walks of life and in all professions. Until the day there is true freedom of speech, some medical doctors will continue to violate the human rights of other human beings including fellow doctors. Dr Hristea’s friend states “if we remain silent in the face of aggression, then we deserve our fate.”

Khalid Ali is a senior lecturer in geriatrics, Brighton and Sussex Medical School