Ashamed of private practice Doctor returns consultation fee - Dr. Lucian Jayasuriya recalls

Dr. Lucian Jayasuriya former Additional Secretary, Ministry of Health, writing in the recent issue of the Ceylon Medical Journal recalls the incident which happened to him in Ittapana in 1965, which made him feel ashamed of private practice and returned the Rs. 15 (the then) consultation fee which he took from a poor man, and gave up private practice thereafter.

Since the article gives an insight into the difference in thinking of doctors at that time, and now in relation to the profession, and makes interesting reading we are re-producing it here.

Of the incident he writes:

"After doing a postmortem I was walking along a footpath with a labourer, when I was accosted by a man who insisted that I drink some young coconut water from him in his hut. It had only a bed and no chairs.

This was the man who had 'channelled' me to see his infant son with cyanotic heart disease. I was ashamed that I had taken Rs. 15 at that time. I handed over his money and decided not to do private practice again and kept to it."

It was my first appointment

I was a District Medical Officer (DMO), Ittapana from April 1963 to April 1965. It was my first appointment after internship. I went on a reconnaissance before assuming duties. Ittapana was a poor village. There was a 50-bed hospital.

The DMO's quarters was in the premises. I met an Assistant Medical Practitioner (AMP). He discouraged me. He told me, "Doctor why do you want to come to this dry place?"

The AMPs did not have quarters. One lived near the hospital. The other lived further away. From 5 p.m. till 8 a.m., when a patient came for admission, or when a patient in the hospital needed attention, a labourer had to call the AMP.

There was a delay in attending to patients even when I was in my quarters. I changed the procedure. I told them that when I am in the quarters I can be called directly. Initially the AMPs did not like it. They thought that I was trying to make money.

Except for every other weekend I was in the quarters. I handed over my quarters to an AMP whenever I left station. I had no vehicle. Although the Department of Health wanted me to buy a car I could not afford one. My salary was Rs. 630 and I had no vehicle.

I was in a pensive mood when a relative of mine living in Ittapana visited me. He asked me what my problem was and I told him. In a few days he camp up with a solution. He found a car which could take me wherever I wanted, whenever I wanted. I had to pay the owner-driver 40 cents a mile.

The government paid me only 25 cents a mile (hired car rate). For every mile I travelled on official work I lost 15 cents. But I was happy because I was able to do my work.

I did a ward round in the morning, afternoon and night. I also saw out-patients. The two AMPs were good workers. One is now having a good private practice in the deep south.

The news of good patient care spread quickly. Numbers in the indoor and outdoor increased. The hospital which had an average bed occupancy of 10 when I took over was now having floor patients.

Orders MP out

The local Members of Parliament (MP) was from the government party. His supporters were becoming a nuisance. They were in and out of the hospital at any time they wanted.

The hospital staff were scared of them. One evening I asked them to get out of the hospital. I told them that they could come only during visiting hours. They were very angry. They told me that they will teach me a lesson.

A few weeks later when I happened to meet the SHS, he asked me why I threw out the MP's supporters. The MP had sent a petition against me to the Minister.

It had come down the normal channels for my report. I told him the story. He supported me. The MP also did not proceed further because he found that Ittapana hospital was functioning well.

AMPs good friends

The AMPs were now good friends of mine. We had regular contract bridge sessions at my quarters. There were a number of government surveyors in Ittapana. They had taught us bridge. The sessions were generally from 5.30 p.m. to 8.30 p.m. - till the last bus.

On one occasion there were floods. The hospital, which was on the higher ground, became an island. We were marooned for a week. For one week the diet contractor gave us only rice and dhal.

I did medico-legal work for the Welipenna police area. I had a good relationship with the Police. Occasionally they brought convicts for medical examination. Once the Police had broken a man's tooth.

The Officer-in-Charge said, "Doctor, isn't it simple hurt?" I posted the Police Ticket saying, grievous hurt - fracture tooth. Afterwards the Police avoided me.

Private practice granted

DMOs were not allowed private practice. Although some practised, I did not. The Government Medical Officers' Association went on demanding the right of private practice.

Practice was granted to medical officers in charge of stations, where a qualified medical officer in full time private practice was not available within a radius of three miles.

So I was eligible for private practice. I gave notice that I will see patients after working hours. The approved fee was Rs. 15, Rs. 5 for the government and Rs. 10 to me.

In the first month the nearby ayurvedic doctor sent me two patients. I remitted Rs. 10 to the SHS. I got a call from the Accountant at the Office of the SHS. He said, "Doctor you are the only one doing private practice in the Kalutara district!" In fact I was the only one who had sent the mandatory Rs. 5 per patient to the SHS!

Ittapana had two telephones. But the telephones rarely worked. I had no ambulance.

The theory was that I could get an ambulance from Kalutara or Pimbura hospitals (each about 20 miles away). Most of the time the telephone did not work, nor an ambulance was available. I had to transfer patients by a hired car. I had to pay first.

The SHS office took time to reimburse me. The transfers were mostly obstructed labour and post-partum haemorrhage. Sometimes I went with the patients to Kalutara hospital.

This year's theme at SLMA annual sessions :

'Sustained advocacy for better healthcare'

The Sri Lanka Medical Association's 118th annual sessions will commence on March 23 at the Ceylon Intercontinental Hotel, Colombo under the theme 'sustained advocacy for better healthcare.'

The chief guest at this 5-day sessions is President of the British Medical Association Prof. Sir Charles George. He will also deliver this year's S.C. Paul oration on - Tackling Coronary Heart Disease - Lessons from the National Service Framework in England.

This year's SLMA oration is to be delivered by Prof. S.N. Wickremasinghe (Emeritus Professor of Haematology Imperial College University of London), on 'The use of functions of the Bone Marrow'.

The President of the Indian Medical Association Dr. Manjul Joshipura who is also due to attend the sessions will speak on Emergency Medical Response to Disasters.

Among the papers to be presented at the 5-day symposium are surgery - Best medical treatment for surgery by Dr. Wendy Brown Australia.

Thirty-two resource persons from abroad are due to participate at this annual sessions.

The welcome speech at the inauguration will be made by President SLMA Prof. A.H. Sheriffdeen.

Beware a multi-drug resistant TB is emerging

Consultant Chest Physician of the Welisara Chest Hospital Dr. W.V. Senaratne in a press statement released to mark the World T.B. day refers to a warning given by the WHO that a 'multi-drug resistant TB is emerging in the world, which will be extremely difficult and expensive to treat.'

In this statement issued at a seminar held to mark the TB day. (Monday March 14) at the Health Education Bureau in Colombo, he points out that already TB is the number one killer of the infectious diseases in the world.

According to estimates one third of the world population are TB infected, and annually eight million more people are getting infected with this disease and if action is not taken by all concerned to check the emergence of the MDR-TB, the results would be disastrous since 75 per cent of the TB cases are in the developing world that's where we have a greater responsibility.

Another disturbing aspect of this problem in this part of the world is that the large majority of the patients, about 75 per cent are in the economically productive age group of (15-50) years.

The statement emphasises also the following points:

* 80 per cent of TB deaths are in the developing world.

* Some conditions make an infected person more prone to develop - diabetes, malnutrition and even HIV (AIDS).

Sea slug helps man to get over forgetting

Scientists in America have developed a sea slug based Memory Pill to stall the gradual memory loss as we age, and thus keep the memory from ageing.

Newwsweek Magazine of December 13, 2004 carries this story in an article by Maty Carmichael headed - 'The quest for memory drugs'.

According to this article probably the Memory Pill based on the sea slug has already undergone all the trials and expected to be in the market within the next two years (by 2007).

According to the article, the Sea Slug Memory Pill Research Team has been headed by Noble Laureate Kandel working in the Colombia University Medical Centre. The researchers have found that the memory molecules of the Sea Slug aren't that different from some of those in the human brain.

With this discovery, they had pursued further, done more research and had succeeded in producing the new Sea Slug Memory Pill to plug the memory loses of the ageing.

According to the Newsweek article, at the moment, there are some memory boosting drugs alternative medical drugs with dubious effectiveness.

The article goes on to say that the workable alternative medicine in this field has been dozens of books containing mental gymnastics, such as crossword puzzles to keep the brains working, eating fish which has Omega-3 fatty acids to keep the blood vessels in the brain cleared of blocks, thus enabling their optimum functioning. But none of those could completely halt 'Mild congenitive impartment' in adults.