who is sick? - EDITORIAL

onflict after conflict, conflicts within conflicts and diseases within diseases for the past few months among doctors, nurses, midwives and other paramedical personnel, have plunged Sri   Lanka’s life-or-death Public Health Services into a shameful shamble.

The number one priority in the Public Health Service should be the well-being of millions of suffering patients, many of them from the poverty-stricken classes and some of them the poorest of the poor. Thus the in-fighting, strikes, threats of strikes, sudden walkouts and work-to-rule protests by doctors and other paramedical personnel have turned hospitals into hellholes if not graveyards. Instead of looking at and critisising the symptoms only, we need to diagnose the root cause or causes of this Public Health Service scandal.

Most independent health analysts believe one of the main causes is the declining budgetary allocation which now ranges between 1.7 and 2 per cent of the Gross Domestic Product (GDP) which itself  is now often bloated or spin-doctored. That is why enlightened countries like our South Asian neighbour Bhutan—which has become fully vegetarian and allows only organic agriculture—has scrapped GDP figures and measures only the Gross Domestic Happiness rates.

Largely because of the declining and grossly inadequate budgetary allocation—while billions are busted on showpiece projects or plundered by high level corruption—the human and technological resources in public hospitals are like sticking plaster compared to the marvels of modern technology provided at some private hospitals at a high cost. Indeed, the costs are so high, that if a middle class patient is warded for a week or two for a major surgery the family is likely to go bankrupt or become paupers.

Another result of the inadequate budgetary allocation is that the salaries and allowances given to doctors, nurses and other paramedical personnel are less than quarter or what they could earn in the private health sector. Thus in a free market society driven by greed and selfishness, the temptation is to hang the Hippocratic Oath and do medical business in the private sector.

That is why we have often lamented that medicine was once a sacred vocation—but to a large extent the vocation is dead and buried and today it is a big-money profession or a business, with a few inspiring exceptions.

In recent months the public service nurses have been asking that they be trained as midwives also, saying they could then help in the labour rooms of maternity hospitals—a sacred place where babies are born. But the Midwives’ Association is opposing this move, claiming the nurses were trying to deprive the Midwives of their work opportunities.

This dispute has led to strikes and work to rule protests with both unions accusing each other of resorting even to violence and lockouts or locking up each other in hospital rooms. Whatever the causes, it is disgraceful behaviour and dangerous, also because the lives of pregnant mothers and unborn babies are at stake.
Even among the nurses there is rivalry between the Public Service United Nurses’ Union led by the Ven. Muruttettuwe Ananda Thera and the Government Nursing Officers’ Association (GNOA) led by senior trade unionist Saman Rathnapriya.

Into this medical muddle and melee, has come the Government Medical Officers’ Association (GMOA) which itself is suffering from divisions as seen at last Saturday’s Annual General Meeting while some paramedics accuse the GMOA of thinking it
is almighty.

Indeed Ven. Muruththetuwe Ananda Thera has charged that Health Minister Maithripala Sirisena was not so much a Health Minister but more a minister of doctors because he was giving into the demands of
the GMOA.

We are not taking the side of doctors or any other paramedics but we are making a preferential option for the poor innocent and suffering patients. If their well-being is not given priority then indeed it is a clear sign that our society is sick and terribly sick.