How the Ministers of Dudley Senanayake’s National Government handled the gentlemen Medical Officers in 1967 - exactly 50 years ago. There was no strike, only ‘Work-to Rule’ campaign that paralysed the entire health services islandwide causing untold misery for two weeks from June 23 to July 8, 1967. However, the bitter lessons that the health authorities learnt was a blessing in disguise.
In March 1967, Dr. (Miss) S. I. Malalagama, a medical officer attached to the Lady Ridgeway (children’s hospital) in Borella treated a child for a throat ailment at the OPD. The medical officer was alleged to have advised against the parents’ wish to take the child back home with necessary instructions on medication. Earlier the health department administrators had made verbal request to OPD doctors that they must minimize admission of patients by persuading patients who sought admission in order to ease the congestion. The parents, as the story related, took the child to a private medical institution for consulting a specialist, where the child was diagnosed with diphtheria (a serious bacterial infection that affects the mucous membranes of throat nose). Someone had lodged a complaint with the health authorities, who after a preliminary inquiry, decided to interdict the medical officer concerned for ‘negligence of duty’, on the grounds that an error of diagnosis and inadequate treatment. Hospitals were without basic facilities and drugs. At the OPD, 19 doctors had to share a single thermometer!
Dr. R. P. Jayewardene, President of the GMOA who was also the brother of JR Jayewardene, the Minister of State, emphasized that the strike weapon should be the last resort after all other methods had failed to achieve their demands
The economy was in bad shape following nine years of mishandling by the two Bandaranaike governments of 1956-1964. A seven-party alliance headed by the UNP took over the reins in March 1965 promising ‘sun and moon’ but failed to make available a few clinical thermometers to the leading children’s hospital in the city until March 1967, when the unfortunate episode occurred. Dr. R. P. Jayewardene, President of the GMOA who was also the brother of JR Jayewardene, the Minister of State, emphasized that the strike weapon should be the last resort after all other methods had failed to achieve their demands. He further stated that the time would not be far off when that strike weapon would have to be put into use; that would be when the govt would make an attempt to reduce the salaries/perks of medical officers. He continued, “when our doctors try to do a job under trying conditions, it results in interdictions.” The GMOA were determined to bring the administration of hospitals to confusion.
19 OPD Doctors shared a single thermometer!
The GMOA contested the findings of the Health Department. One of the charges listed in the ‘show cause’ letter said, there was proof as per diagnostic papers that she had not checked and recorded the body temperature of the 6-year-old. However, the professionals of the GMOA did not act hastily, but made their own investigations into the matter and found the doctor was not guilty and that she had followed the procedures and taken all necessary precautions to treat the child as per the medical guidelines and good practices. The gentlemen of GMOA sought an appointment with the Health Department officials who reported the matter to higher authorities for disciplinary action against Dr. Malalagama, but washed their hands off like the present day bureaucrats; saying the matter was before the PSC and that it was beyond their purview. The Minister of Health M. D. H. Jayawardene was out of the country, hence the GMOA met the Parliamentary Secretary to the Minister, (how the deputy minister was then known) Ms. Wimala Kannangara who did not like to interfere with the PSC’s ruling knowing well that the senior public servants would not tolerate even an honest politician in the discharge of their sacred duty.
The first few patients received best attention and were extremely happy, while for the others it was a disappointment waiting for hours in long queues; and yet a large number had to return empty-handed
History of GMOA agitations
Inspired by the London-based Medico-Political Union established in 1914, which was later renamed the Medical Practitioners’ Union in 1922. Dr. Ludovyck of the Kandy Hospital formed the Government Medical Officers Association (GMOA), Kandy in 1926. It was initially restricted to the central region, and the purpose was for demanding salary revisions, travelling allowances or quarters for its members. The expanded provincial unit that covered the rest of the island too was re-named GMOA and it was registered in 1949 as a trade union. For the first time since GMOA’s inauguration, the union launched their first strike at a time that doctors in any part of the world had ever dreamt of a such line of action. The outcome was triumphant and the Sirimavo Bandaranaike Govt granted an increase in salaries and a restricted form of private practice (channelling) too. All this before the consumerist oriented open economy and changes in the political culture that affected the value system. There was some level of corruption, but suppression of opposition, money laundering, the mafia etc never heard of.
Coming back to June 1967; the general membership of the union [not just the executive committee] met on June 21, and following a lengthy discussion agreed to launch a ‘Work-to-Rule’ (W2R) campaign in all Government Hospitals, had the talks fail. Work to rule means doctors at the OPD would take their time to make full clinical examination of all patients who come before them and make a full record of those findings in their notes before taking up the next patient.
Work-to-rule campaign launched
On June 25, 1967, the work-to-rule campaign began as a sequel to the interdiction of Dr. Malalagama of LRH who along with her other 18 colleagues shared one thermometer in examining an average of 950 patients a day. The very first day of W2R recorded a drop of 60 % of examinations, causing disappointment to over 500 parents of sick children that included poorest of the poor. President of GMOA stated that, for any other grievances which they might have against the administration, they should find other avenues or methods by which they could express their disappointment and protest. The first few patients received best attention and were extremely happy, while for the others it was a disappointment waiting for hours in long queues; and yet a large number had to return empty-handed.
For the first time since GMOA’s inauguration, the union launched their first strike at a time that doctors in any part of the world had ever dreamt of a such line of action!
In the absence of PM Dudley Senanayake, the GMOA met the acting Head of State, JR Jayewardene on June 26, who told the delegation led by his own brother that the case against Dr. Malalagama would be expedited and taken up on the next day, and warned that they should not take it too far. Union decided to continue with the TU action in spite of restlessness and misbehaviour by crowds at most of the city hospitals. By the 28th, overcrowding in wards became a severe problem for the authorities when the doctors admitted most patients quite unnecessarily. W2R continued for the sixth day without hope of an immediate settlement while congestion in all hospitals had reached unwieldy proportions. M. D. H. Jayeawardene, the Health Minister on his return summoned a delegation of the GMOA as the TU had rejected the Health Director’s request for a second meeting, saying, “we will in future talk only with the Minister”. The GMOA in a statement to the media said that the child patient concerned was very much alive and that proved the diagnosis of the MO was correct.
DR. MALALAGAMA’S AFFIDAVIT
Dr. Malagama, in March, handed over an affidavit to the ministry alleging unfair treatment and other irregularities and the manner in which the investigation was conducted by the Medical Superintendent and the Health Department officials, which the Director of Health Services wanted her to withdraw (following talks with GMOA) before considering her re-instatement to which the GMOA and the officer concerned agreed. She made a written withdrawal which was totally unacceptable to the Ministry Secretary C. Balasingham, as it included two conditions stating, ‘subject to withdrawal of interdiction’ and ‘no further action be taken against her on any other matter’. The department described the conditions as ‘vague and far too wide’. The executive committee of GMOA met in an emergency session and appointed an action committee headed by Dr. R. P. Jayewardene who would meet daily and review the W2R situation in all hospitals and send out to the outstations its members to brief and step up the campaign. Intensified and extended to all specialized clinics in general hospitals, the W2R caused mayhem as the 7th day approached making the poor patient to suffer unthinkable misery. The adjourned inquiry on Dr. Malalagama was resumed on July 2. As the TU action reached its eighth day, the doctors at the OPD were faced with a stiff problem. Patients resisted refusing to use the conch for examination, as the linen on them were filthy and had not been replaced for weeks though 50 to 60 patients a day, and mostly barefooted had soiled them. Doctors lamented, ‘but we have to W2R and examine them thoroughly otherwise we would get interdicted for negligence of duty. In the meantime, elementary hygiene was disregarded at LRH, an irate patient refused to place the child on a dirty couch, cursed the nation’s medical services and administration and took the child away. Patients crowded on hospital floors complained of being bitten by rats and were receiving treatment for rat bites. Frayed tempers and unending queues at OPDs, with mothers hugging sick children in the hot sun became a common sight.
On the 11th day, the Association of Medical Specialists intervened. Dr. P. R. Anthonysz, led a team of members who met the Minister and the President of GMOA and warned the warring parties on severe inconvenience caused in hospitals. Dr. R.P.Jayewardene assured them that they were keen to revert to normalcy, but the people would have to bear with them for a little longer and that all that GMOA asked was. the assurance that no action against Dr. Malalagama for the affidavit. Dr. Anthonysz said, “In the struggle between the sick giant; the Health Dept. and another giant; the GMOA, it is the patient who would ultimately suffer. The lives of large mass of people were involved in the struggle.”
In a another fanatical move, Dr. V. T. Herath Guneratne, Director of Health sent a circular to all MOs asking them to submit updates as per the format already distributed earlier or face salary suspension. The PSC inquiry lasted 12 hrs on its last sitting on July 4, where the father of the child patient involved in the controversy, named D. S. Anthonypillai giving evidence said that no doctor outside LRH wanted his child admitted to a hospital and that the private practitioner they consulted wanted them to go to LRH for a throat swab of the child. He was happy that Dr. Malalagama ordered a swab even before he mentioned this to her, which report indicated a negative result. On the 13th day of W2R, the General Nurses Union and Medical Specialists Association decided to give their wholehearted support to the GMOA and decried the action of administration for having interdicted the doctor.
On the 15th day of TU action; on July 8, the inquiring officer of Public Services Commission, Dr. J. V. Arulanandan reported that the charges against the MO has not being proved. The PSC recommended the immediate re-instatement of Dr. (Ms) S. I. Malalagama.
THE CURRENT SCENARIO
The current scenario involving the GMOA along with Health and Higher Education is much more complex an issue with utter selfishness, personal interests, jealousies, vituperative politics, conflict of interests, money, corruption, business, inter-party and intra-party conflicts with Ministers making divers comments with no direction or control; JVP, other Marxists, and the JO fishing in troubled waters, all combined to bring disaster to ‘Free’ health services. Let’s not talk, it’s a waste of time. When Parliament met on July 8, and during vote of thanks to Throne Speech, Pieter Keuneman, the Communist Party Chief and Opposition MP accused the GMOA of creating mayhem at hospitals where the poor had to suffer. He did not side with the doctors and blame the govt. He said, “…I understand that large numbers of patients at the OPD are not being treated. They are deliberately trying to create a situation to bring pressure on the govt for certain purposes…there is an open flouting of authority by the doctors - why is the government not taking any serious action on the matter” (Hansard - 8/7/1967 - folio-68/69).
FIVE DECADES AGO-BOGUS PRESTIGE
JR’s brother’s involvement forced the government to stay out. What a sorry mess this whole affair was! The health ministry was trying to maintain a bogus prestige and the GMOA wielding the big stick. They brought credit neither to the Health Ministry nor to the GMOA, and in the ultimate analysis brought them both into disrepute. It was an administrative blunder of the highest magnitude. The interdiction was wrong, and should have been revoked immediately. That was the only matter that concerned the members of the GMOA. Dr. Malalagama’s behaviour in submitting an affidavit is quite another topic, which was between her and the Department and was not relevant or connected to the issue and did not concern the GMOA. The situation that, “…you unconditionally withdraw your affidavit, and we will withdraw your interdiction” was itself a condemnation of the interdiction and would be a comic interlude, where if not for the fact that thousands of poor and helpless patients had to bear endless suffering, if not death!