Forgotten oath

 

Two traditional protagonists are lining up to do battle once again: the government and the Government Medical Officers’ Association (GMOA), the trade union representing the vast majority of doctors in state hospitals. The issue at stake is the granting of recognition to the South Asian Institute of Technology and Medicine, more popularly known as ‘SAITM’ in Malabe.

This week the GMOA held its annual elections and re-elected its President, Dr. Anurudhdha Padeniya for a sixth consecutive year. Unlike in some previous years, Padeniya was elected uncontested. Soon after the elections, the GMOA announced that, if the government were to grant recognition to graduates of SAITM to practise medicine in Sri Lanka, it would launch strike action.

All this has a sense of déjà vu. Thirty years ago, the GMOA was at the forefront of a similar struggle to deprive the country’s first ‘private’ medical college, the North Colombo Medical College (NCMC) set up in Ragama of its degree awarding status.

That struggle added fuel to the fire of youth unrest which was simmering at the time because it coincided with the second insurrection launched by the Janatha Vimukthi Peramuna (JVP) in the late ’80s. It led to a prolonged closure of universities- which were then a hotbed of JVP activity- and ultimately resulted in the nationalisation of the NCMC which was then converted to the medical faculty of the University of Kelaniya, soon after Ranasinghe Premadasa assumed office as President.

Angst between the govt. and the GMOA

Ironically, fighting hand in hand with the GMOA to thwart the NCMC at the time was the trade union of dental surgeons, the Government Dental Officers Association (GDSA). The then general secretary of the GDSA was none other than the present Minister of Health, Rajitha Senaratne!

That the GMOA and the Minister of Health Rajitha Senaratne are at loggerheads is no secret. Never one to fight shy of controversy or keep his thoughts to himself, Senaratne has publicly berated the GMOA on many occasions. In turn, the GMOA accuses the minister of being partial to SAITM as a close family member is a student at the institution.

Much of the angst between the government and the GMOA stems from the fact that a faction of doctors led by Dr. Padeniya have wrested control of the GMOA and have been running its affairs for several years now.

Senior doctors, mostly specialists in the state sector have expressed their frustration and disappointment at this state of affairs and left the GMOA to form their own trade union, the Association of Medical Specialists (AMS). Although the AMS comprises of specialists who should, at least theoretically, wield more influence in decision making, they are vastly outnumbered by the GMOA whose ranks include doctors of all grades.

In government, there is also much hostility towards Padeniya because he publicly endorsed former President Mahinda Rajapaksa at the last presidential election and worked towards mobilising the support of GMOA members for Rajapaksa. This was referred to by Prime Minister Ranil Wickremesinghe in Parliament as well.

Trade union action

Padeniya is also opposed to the Indo-Sri Lanka Economic and Technology Cooperative Agreement (ETCA), another cause championed by the government and opposed by the forces aligned with Rajapaksa. Given these positions adopted by Padeniya, the government does not consider the GMOA to be an apolitical organisation. Indeed the conduct of the GMOA has been less than exemplary in recent times. Its most recent trade union action was to demand places in schools for the children of doctors. Carrying placards and chanting slogans, they demonstrated outside the Ministry of Education. Their activists took to social media and claimed that for the first time, a government had deprived doctors’ children of their education when in fact what they were demanding was special treatment simply because they were medical professionals. If the government yielded to their demand, every other profession would take to the street demanding special consideration too- but such logic appears to be lost on the GMOA.

That is not to say that SAITM should be given a blank cheque to register their graduates. It is headed by Dr. Neville Fernando, a former MP for Panadura who provoked the ire of former President J. R. Jayewardene. After shedding his political garb, Fernando went on to achieve great success as an entrepreneur and then set up SAITM, modelled loosely on the NCMC.

The principal bone of contention in granting recognition to SAITM graduates is the quality of its clinical training. Its teaching hospital in Malabe is a private hospital and because of that, does not attract the hordes of patients a state hospital caters to. As a result, it has been argued that the clinical exposure SAITM students are subjected to is inadequate. There is some merit in this claim.

If this is to be compared with the NCMC, the authorities that ran the NCMC, the College of General Practitioners built a teaching hospital from funds raised through its students and handed it over to the government to run as a public hospital. Therefore, there was never a short supply of patients. Had SAITM followed the same model, it could have made a better claim to recognition.

Nevertheless, the GMOA has also been instrumental in placing stumbling blocks to the progress of SAITM. The private institution cannot offer training in two specialities- Community Medicine and Forensic Medicine- and when the government made arrangements for SAITM students to obtain this training at state hospitals, the GMOA went berserk protesting against it. Therefore, the GMOA also stands exposed for its hypocrisy- insisting on maintaining standards but obstructing measures put in place to achieve just that!

SAITM graduates

Questions have also been raised about the GMOA’s commitment to ensuring the standards of medical education because each year, hundreds of Sri Lankan students travel overseas in search of a medical degree. The GMOA does not query the standards of these degrees, taking refuge in the fact that foreign graduates are required to sit a qualifying examination. Whether SAITM graduates could be required to sit such an examination is a question that surely needs to be asked.

The authority responsible for granting- or declining- registration for SAITM graduates is the Sri Lanka Medical Council, headed by Professor Carlo Fonseka. Fonseka, the uncle of Vijaya Kumaratunga and known as much for his left leaning views as for his expertise in Physiology has stated that SAITM, in its current state, cannot be granted recognition. In a strange twist of fate, Fonseka was also the person appointed to wind up the affairs of NCMC when it was nationalised in 1989.

In this tussle between the GMOA, the government and SAITM, there can be no winners. The GMOA has its credibility eroded, the government has yet another crisis to deal with and SAITM students who have toiled long and hard for a career in medicine, have been left in limbo.

The matter is now before courts, with some SAITM students seeking legal redress for their plight. A court decision may help to some extent it is clear that these stake holders need to resolve this issue with the larger interests of the country at heart rather than seeking to further their own agendas. With the futures of thousands of potential SAITM graduates at stake, there is certainly a case for the government to intervene. If they do, they must do so promptly and decisively and not allow history to repeat itself, as it did with the NCMC several decades ago.