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Universities, Doctors and Society - Part II:

Universities and student activism

Vidya Jothi Prof. Arjuna Aluvihare, Emeritus Professor of Surgery, University of Peradeniya delivered the Sujata Jayawardena Memorial oration, organised by the Alumni Association of the University of Colombo, last December.

Interactions

Today I feel sad to see the high pig mesh railing outside the Senate House premises of the University of Colombo, and the fortification of the UGC, and worry that this physical barrier means less dialogue with the inflow and outflow of ideas, and may be a feeling that less is necessary between students (University) and establishment (Society) - a recipe for disaster. I was pleased to see none such in Peradeniya even at the VC’s residence and the Senate House (where of course such barriers would be impossible to construct). Interaction is necessary even at some risk.

Student and staff interaction with society is essential as society needs and must breed and mould ‘universities’/ training bodies and ‘universities’ must deliver societies’ expectations, society must nurture ‘universities’, society (including ‘universities’) must correct society -peacefully in keeping with status and society must respond to correction.

Doctors

What about Doctors? They are products of and nurtured by family, society and University and Prevent and Manage ill health. Society and University have obligations to facilitate maximum performance from Doctors and Doctors have obligations to Society (and University- Alma Mater). Doctors and Society (patients and others) have ‘Rights and Obligations’ in respect of each other and themselves.


Peradeniya University

In the International Human Rights documents it is clear that both groups have rights, and both need to recognize this. The other side of the ‘rights coin’ is the matter of the obligations they have to each other. Which group has priority- doctor or society? I feel the least powerful and most disadvantaged has to have priority- patients rights and doctors obligations to society should have pride of place therefore.

There are not enough doctors in Sri Lanka (judge by queues in the public and private sector); those we have are very able and skilled, are from many social strata and this input enriches the system, work in medically and physically risky situations- including lady doctors, work very hard for a relatively low formal emolument, have many ‘distractions’ in order to boost income, but sometimes display attitude, communication, turf and availability problems.

Hippocrates

Historically there are doctors’ oaths and codes of conduct- the oath of the Greek Hippocrates and that of the Arab Physician Ibn Sina are amongst the best known older ones. The current Sri Lankan one includes requirements of not with-holding services, not criticising each other or degrading the profession, and maintaining Integrity and propriety. Doctors should honour teachers, and share resources and cooperate with other health professionals.

They can expect support from Society- a fee is acceptable (a 15th Century document quotes an 11th Century doctor who advised his juniors to send a poorly dressed spy to patients houses before fixing a fee as patients tried to dress below their level of wealth hoping to reduce the doctor’s fee. )

A digression for a moment: on a recent visit to India during which there was an opportunity to visit Raipur- where there is in Prison, a Paediatrician and Community doctor who has done much grass roots and innovative work to create health facilities, recruit rural people in measures to prevent and manage malaria, TB and other problems, and raise consciousness of what can be done by people to help themselves.

He is prison for being outspoken about his perception of rights abuses of rural people by terrorists and vigilantes and consequently is accused of siding with terrorists. Here society by imprisoning him, has perhaps betrayed the doctor who is trying his very best for society in a holistic manner. Interestingly in his enforced absence some of his work is being done almost on a voluntary basis by graduates of a very prestigious Indian Medical College- the All India Institute if Medical Sciences.

Interaction

A proper interaction between society and doctors is at strain in Sri Lanka with a breakdown of mutual obligations. The recent killings of doctors in the South and East are a terrible betrayal by society of doctors.

The withdrawal of services of doctors as a mark of condolence for the killing in the South is not correct. At the risk of being accused of degrading the profession I would add that the withdrawal of services (strikes) by doctors is never correct or acceptable, and is a betrayal by doctors of their obligations: it should never happen. The same applies to the reaction to the tragic and unacceptable killing of the doctor in the East. About this type of incident one would hope a secret attempt is made to ensure that all armed parties agree to leave health services alone and not make them conflict issues, and allow them to function with safety to staff and patients.

At the same time it is tragic that the Administrative and Political authorities seem unable to act on obvious and genuine doctors’ issues without a strike or threat of it.

This is a breakdown of society’s obligation to doctors, as is the matter of inadequate provision of facilities to maximize quality output, and also inadequate pay and other facilities.

On the other hand again a rushed and excess business orientation of doctors, inadequate communication with patients, and the matter of the brain drain represent a lack of recognition by doctors of their debt to and obligations to society. Ultimately perhaps doctors’ failures and administrative failures represent a failure of the University system to communicate to its graduates the extent of their debt to society and the ways in which this debt should be honoured.

 

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