Right of Reply
Read with much interest a response to my article of July 27, 2018, in particular and to most other articles of mine on the health sector and medical profession in the DM, titled “Do away with Medical Officers of Health? A response to Kusal Perera” by Dr. Ramya Kumar, an academic in the Medical Faculty of the University of Jaffna. Appreciate very much the initiative to engage in discussion on this very vital topic that most have kept away to date.
Reading through Dr. Ramya Kumar’s response, I feel there is some misreading of what I have been arguing and making observations on, and that needs brief clarifications and explanations.
1) Dr. Kumar says in “yet another article” I have been “slamming the medical profession”, implying I have always been “slamming the medical profession”. In conclusion, Dr. Kumar says “I urge Perera to separate his contempt for the medical profession and the Government Medical Officers’ Association(GMOA) from his analysis of the public health sector…..”
I have always been holding the GMOA leadership as a “medical mafia”. I would continue to do so, until and unless the GMOA leadership changes course to play a responsible, civilized role within the health sector and in society. As for the medical profession, yes, I do say, it is no more the “noble profession” it was. As a “profession” the medical profession has over the past decades given up its moral and ethical standards and is no more different to all other corrupt professions; the legal, accounting, engineering, the academia etc. Yet I do accept there are very good medical doctors as very good lawyers, engineers, accountants, academics et al. Where I hold “good doctors” at fault is on their silence and their reluctance to stand up to the GMOA mafia. My “criticism of the medical profession and the private practise is valid” says Dr. Kumar.
2) Yet Dr. Kumar says “…his writings are confused and often unsubstantiated”. A point made is that, my “antipathy to the medical profession” led me to “undermine the students’ call to protect ‘free’ education”. I was thus supporting the government’s effort to privatize medical education says Dr. Kumar, “taking a questionable position on SAITM”.
Glad Dr. Kumar raised this issue of “free education” along with “private medical education”. My position on “free education” had nothing to do with simplified sloganizing of “free education” by not only the students, but by the academics and the GMOA too. “Free education” in the anti SAITM protests was only a popular cover for the very sectarian demand by GMOA.
My position on “free education” is based on “Sessional Papers No.43 of 1944”, commonly known as “Kannangara Reforms”. Sadly, most in the “anti-SAITM” campaign did not know what this “Sessional Paper” is about and those gullible students brought on to Colombo streets have not even seen a copy of it. In June 1944, when it was adopted by the State Council, there were over 1,100 private schools managed by Missionaries and the Buddhist Theosophical Society along with State owned “government” schools. “Kannangara Reforms” never ever proposed to “nationalize” these private schools. It never proposed education “free of charge”. It allowed even government schools to levy “facilities fees”. Private schools that could not afford a well paid tutorial staff was “assisted by government”. All schools levied fees, with government schools not making it compulsory.
“Free education” was NOT “free of charge” education as these students and Dr. Kumar would want to believe.Today we have more than 44 totally private schools (including Chundikuli Girls’ School) within our national education system, even after PM Bandaranaike’s government in 1962 nationalized a vast majority of assisted and private schools. Pupils in these private schools are taught the same curriculum and the same syllabi. They sit the same G.C.E O/L and A/L exams with all other students from government schools and compete for admissions to all faculties in State universities.
Free education and private medical education issues raised as ‘matters of life and death’ have no relevance and validity in the context of present day education
The call against private medical education Dr. Ramya Kumar stands with, has no validity with eight medical faculty Deans sitting in the SLMC accepting and registering private medical colleges and universities for Sri Lankan students to graduate as medical doctors with only the ERPM (another tuition industry monopolised by medical doctors) required to practise medicine and join government service. Is it where the private medical college is located that decides “privatizing of medical education”? If private medical education is opposed on principle, why wasn’t the KDA fee levying medical faculty opposed along with SAITM?
Free education and private medical education issues raised as ‘matters of life and death’ have no relevance and validity in the context of present day education where everything has been com-modified with absolutely no protests from any quarter during the last 30 years and more. Private companies own “International schools” that have yet to be opposed by this fake “Free education” campaigners. Nor do they question, the massive private tuition industry that makes a mockery of Kannangara Reforms that established a “national education system”, accepted the “right to education” with equal opportunities on a level playing field. The role of the State was to create that opportunity for the majority who could not afford such education to their children.
Let’s also not forget,those who fight to safeguard “free education” never speak nor oppose fee levying courses in their own universities and the academia that sympathized and supported student campaigns never avoided teaching in these fee levying courses for extra income. They also ignore all foreign university degrees offered and privately tutored here and professional degrees and diplomas from private institutes and organizations held valid in local employment.
There always was a market-based education sector that had expanded without limits within the ‘free market economy’ and without any opposition from “free education” campaigners.
3) The present role of the position ‘MOH’ and that of the medical doctors holding that position needs serious dialogue. Dr. Kumar’s details as to why and how the British colonial rulers came to establish a Medical Officer Health (MOH) post in preventive healthcare is accepted and is history.The 50’s and the 60’s, was when even politicians were honourable men and women unlike today. Not only the MOH, everyone else in the health service from top to bottom were duty conscious and discharged their duties honestly. The whole public sector was that then. Monitoring of field work then came under an OIC who was a Senior PHI in the MOH division. This responsibility was brought under the MOH from around 1964.
My assumption, Medical Doctors of “today” as MOH have failed miserably in their discharge of duties, with spread of Dengue used as one example is based not only on numbers I quoted, but on pathetically degenerated professionalism and politics of the GMOA that results in medical officers as MOH neglecting their duties and responsibilities. The claim by Dr. Kumar that “They oversee service delivery at the community level, including maternal and child health, family planning, and communicable and non-communicable disease prevention, while carrying out medical consultations at maternal and child health clinics” is therefore the point of contention. Except attending maternal and child health clinics, MOH is an almost absent officer in all else. They are comfortable remote controlling all monitoring work from their offices. May be Jaffna is different, as noted by Dr. Kumar.
Rapid and unplanned urbanisation mentioned as reason for recent spread of dengue, is only half true with MOH rarely seen or heard in most anti dengue campaigns carried out with police personnel, Local Government Councillors and DS office personnel. It is a fact that dengue cannot be successfully controlled without community support and participation. It is also a fact, community support and participation have to be mobilized by MOH and his staff. That is what goes missing with medical doctors as MOH. Their ego with the “tie and the stethoscope” do not allow them in the field as the PHI and the Public Family Health Officers (Mid wives) do.
True the post of MOH is no glamourous post for medical doctors. But that gives them enough time for PP in their own area, especially in rural society. And in Colombo and suburbs that provides them an added reason to demand “National schools” for their children.
As for my proposal to shift medical doctors posted as MOH to area GP work, does not in anyway reflect “Colombo dinner table talk”. That also does not replace the medical doctor with para medics in curative health. Instead it provides people with a government GP in their own area, they now have to pay for, unless they go to a government hospital, where the OPD often doesn’t run for more than three hours a day. Well trained para-medics for community preventive healthcare, is one I borrowed from J.H.L Cumpston (Director General, Health Services of Australia) who was commissioned by then Ceylon government and whose Report in 1950 explains the rational for it. Yet it was only a proposal, and is open for dialogue, without doubt.