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by Kusal Perera

The agony of waiting patients

There is a lucrative private sector medical care service that has sprung up in cities alongside the Government health service. And it has become quite conspicuous with many innovative schemes offered and seemingly new technology introduced. Yet, work stoppages or strikes during the past decade by medical doctors in government hospitals have become socially unbearable, very painful and intolerable.

While the private sector caters the urban population in general, a heavy majority in society still depends and has to depend on the State for their health care. Even if the affluent in society would want a well paid for medical care service from the private sector, there are only 974 beds (in 27 private hospitals located in the Western Province - 12, Southern Province - 7, Central Province - 3, North Western Province - 3, Eastern Province - 1 and Uva Province - 1) for something like 51,400 in-patients cared for by 86 permanent doctors according to the year 2002 Central Bank report. And the same report says, these private hospitals are serviced by 583 visiting and 86 part-time doctors. This is apart from specialist - doctor channelling in them that adds support to the existence of private hospitals.

It is therefore obvious that the survival of these private sector hospitals too, though catering to the affluent in society, are dependent on Government medical doctors availing themselves of the right to do private practice, while they are duty bound to look after those who turn up at Government hospitals and dispensaries. And the lot they have to look after is very much more deprived of life necessities than most human beings. Just think of 1.9 million families who receive allowances from the Department of Poor Relief (DPR) under the income supplementary programme because their monthly income is less than Rs. 1500. That is not the total below a very low poverty line.

In addition to Samurdhi relief recipients, there were 83,171 families receiving nutrition allowances at end 2002. Another 145,777 families received assistance under the Samurdhi Dry Ration Scheme. All in all 2.23 million families have to depend totally on the Government health services, if one dares to discount others earning something a little more than Rs. 1500, as those who could afford a paid service. These millions are those who cannot ever think of a private sector medical care service.

Within the Government health service, 605 hospitals with 59,781 beds have 7,459 medical doctors attending on around 4,015,000 in-patients and around 43,329,000 out-patients annually. Medical doctors can never on their own handle this patient - traffic and therefore the support of 1,295 Assistant Medical Practitioners (AMP) cannot be discounted in any way. Add to this the 16,000 plus nurses and 7,000 attendants who are also indispensable in a medical care system, which the doctors should not feel ashamed to acknowledge and accept. For all of them and others involved in providing medical care and for all health inputs, the recurrent cost borne by the State through public taxes and funds, amounted to Rs. 20,233,000 in year 2002 (all figures in this article from year 2002 CB report) for which capital expenditure too should be added. This is the general scenario on which the behaviour of medical doctors should be assessed and conclusions be drawn.

If their parents did not force them to choose the medical profession, no one else in this world ever forced them to choose the medical profession and remain in Government service. Therefore their reasons for choosing the medical profession being totally irrelevant within the health care system, these Government medical doctors should accept the fact that they are wholly responsible for at least 4,000,000 human lives annually, leaving aside the millions who turn up as out-patients. Therefore the few who run the GMOA should work out their approaches in redressing any grievance and anomaly in their profession giving high credence to the cardinal rule that human lives are much more worth than any of their demands, together with their inflated egos. For the medical doctors are and they have to be, different from all other service providers in this society.

Nevertheless, these factors and conditions do not in any way deny the medical profession the right to rectify the anomalies in their service. But what is being stressed is that when a dignified profession responsible for enormous numbers of human life has to decide on curtailing their services for whatever reason, there has to be a civilised and a responsible manner in handling the situation. Now, taking the explanations and excuses so far given by those few who lead the GMOA, for their continued strike action is that a salary increase given to the Registered and Assistant Medical Practitioners who are also providing an auxiliary service in Government hospitals and central dispensaries, has resulted in narrowing the wages gap between the two services thus reducing the status of doctors within the health care system. This argument in a way suggests that any salary increase given to any trade or service in the health sector should invariably give the doctors a right to a salary increase. This argument has no justification.

Why should salary structures of two services within the same sector always have a fairly large gap between the maximum salary of one service after 20-25 years of experience and of the initial salary of the other, which in this case is the inexperienced, just out of internship doctors'? And it is worse to say that these raw medical recruits should be given a pride of place when structuring salaries over those providing similar service and with a very long period of experience.

There is yet another moral issue that comes up when medical doctors claim status and a hierarchical position in the health system. Let's leave their demand in repairing this so called anomaly aside for now: the 40% and more salary increase they claim to rectify their so called anomaly. First and foremost, the present leadership as we know, are not a constitutionally elected body that has a right to decide on such principle matters. They are only a temporary group still maintaining power as no doctor challenges their right to be at the head of the GMOA. And why there is this ad hoc group clinging to power is also interesting. Doctors who claim a higher status have been rigging their own elections for office-bearers at their GMOA conference resulting in factional fighting among doctors. And the judiciary therefore decided to declare that conference null and void on an application made to the courts. That in fact is how disciplined and honourable the doctors are. And it is therefore no wonder this ad hoc leadership behaves this way in holding 4,000,000 human lives to ransom. One could turn round and ask, who is more sinister and savage? Is it the LTTE that's waging war demanding a Tamil Eelam after 35 years of political negotiations for equitable status within a single nation failed, or these GMOA leaders, who care little to negotiate, for they could in a moment's notice deliver a death threat to over 4,000,000 human lives and wouldn't care less? LTTE would look much saner than the present GMOA, no doubt.

The worst is, however educated the medical profession is, it has lost the power of reason and the culture of refined professionalism to that of gaining quick, easy and stubborn redress at the cost of human lives, the GMOA spokesman claim would any way die. They have lost track of the basic ethics of trade unionism too. Not even the lowest grades of unskilled, uneducated labour resort to strike action after immediate notice of their grievances. The best traditions of trade unionism not only lobby and pressure the employer to negotiate on the demands presented through many rounds of compromised and alternate proposals, they also canvass the support of their own membership from grass roots level up and that of other trade unions, before a final decision is taken on work stoppage. The campaign launched by the Bank Employees' Union against privatisation of State banks is one such recent example of disciplined and broad based trade union action with responsibility.

The Bank Employees' Union has taken their case to the public and every branch office display to their customers through posters and banners the reason why the union opposes privatisation of State banks. They come on to the streets to picket publicly, not only to pressure the Government, but also to exhibit their strength and impact on society.

Can the GMOA say they have also gone through such responsible and civilised actions before the decision to strike was announced? Can the GMOA say they have been canvassing the support of other health sector trade unions? Can they say they have been canvassing the support of the public who come to their hospitals and whose lives they are holding to ransom in winning their demand? It's not only the Government and the Health Minister who should know the reasons and justifiability of the demands put forward by the medical doctors. The public has a right to know the reasons too, for it is their lives the doctors are playing with. And the public should be convinced the doctors have a decent, justifiable case to fight for. Unfortunately, the doctors have a very sensitive human prey at hand that could be used to molest any Government to succumb to their demands and an hyper ego that does not allow them to stand in public with their demands.

This unfortunately is a sad situation. The doctors are not alone after all in this selfish, inhuman mind set. The other professions too should take part of the blame and the responsibility for allowing the GMOA to hold the public to ransom this easy and casually. For these other professions have continued to give recognition and a pride of place within the Organisation of Professional Associations (OPA) to the doctors, despite the inhuman arrogance and unprofessional behaviour the GMOA has been displaying repeatedly over many years. May I therefore ask how professionally disciplined the OPA is, to allow a temporary, unconstitutional body of a member organisation to go on delivering "death threats" on human life in order to win a mere salary increase that is far from justified? How honourable and dignified is it for professionals and their associations to just turn a blind eye on these vulgar behaviour of their own kind? Shouldn't they lead society to sanity?

Time is more than ripe to tell the medical doctors they should stop bludgeoning poor Hippocrates. Tell the doctors they have crossed the line of social tolerance. And for their own good and for the upkeep of a once noble profession, time has come to ask for a legal, a political forum with due powers and includes representatives of civil society organisations and trade unions (for instance, a representative each from the Bar Association, Editors' Guild, Bank Employees' Union, University Academia, Commercial and Industrial Chambers etc.) that could arbitrate between contending health sector trade unions and the Government on issues and conflicts that involve two or more services in the health sector, before any trade union action is resorted to by the unions. This legal forum could be fashioned similar to that of a Public Complaints Commission or to that of a regulatory commission like the "Fair Prices Commission". The structure and powers of such a body could be discussed in all public platforms before it is legally constituted.

But the fact remains, the medical profession cannot and should not be allowed to hold the public to ransom to gain their petty demands. And its time the civil society takes up the responsibility of sorting out its own issues through democratic structures as those who claim to be responsible professionals do not behave that way. In short, its time to save Hippocrates in the name of humanity.

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