What ails the health sector!

The hard working Sri Lankan doctors are being regularly exposed to criticism in the press by expatriate medical men. Although only a few returnees indulge in this exercise, their writings get prominence in the press painting a bad and unfair picture about the doctors in this country. Though an eminent cardiologist is leading among them, this article is a response to a letter of Dr. Ayesha Muthuveloe that appeared in a weekly of March 5. Unfortunately these good Samaritans have ignored the basic lesson we were taught in clinical medicine; that no proper diagnosis can be made on current clinical features alone without understanding the background to the illness.

I must stress at the outset that the majority of Sri Lankan doctors working abroad are well meaning people. They have done well bringing honour to the motherland, at times reaching the pinnacle in the health service of the respective countries. They have been instrumental in finding placements for our post graduate trainees in the best centres in their countries.

These expatriates are valuable resource persons for various educational activities for doctors here. In addition they donate entire hospitals, equip them, provide scholarships to needy students, and indulge in various charitable activities to help the countrymen back home. Our fellowship has been for mutual benefit. For this we are ever so grateful to them. They do not waste time criticizing the way the doctors work here.

Sri Lankan health service

Let me explain how I understand the background of those few who have turned part time preachers trying to rectify anomalies in the Sri Lankan health service. Most, if not all, of them have received free education here but left the country for greener pastures. At least some of them left in anger when they could not be happy with the working conditions here.

Having served those prosperous societies with all the facilities, yet often treated as second class citizens, they have accumulated enough wealth at a relatively leisurely pace. Their mistakes have been well covered by insurance. They have educated their off spring in good schools. They are now earning healthy pensions which leave them with no need to work any further. During this period when they were “missing”, their kith and kin at home were looked after by doctors in Sri Lanka.

They, lacking recognition after retirement in those countries, return home with their rather easily earned lucre and acquire a luxury living.

With guilt pricking their conscience, they even offer free services to poor locals. They occupy penthouses in the best parts of Colombo. From those heights, they survey their other acquisitions down below. In doing so, some of them happen to see among others, Sri Lankan doctors trying hard from dawn till late at night to make a reasonable living. This is when they feel like delivering sermons from their high pedestals.

Social problems

Having explained the background of the ones delivering sermons, let me now give the background of the “patient” they are trying to cure, or more aptly, to kill.

The doctor in Sri Lanka, as everyone else, starts his life after a struggle by their parents to get admitted to a school. They know that in most instances, their parents had to forge documents, go behind politicians and pay huge bribes even to school authorities to get in. In school they see some of their own teachers neglecting school work giving private tuition till late at night charging huge fees, often from their own students in the school. They are witnesses to many instances of favouritism whereby one has to please the teacher by irregular means to get good marks at exams or to get a place in a sports team.

Private practice

Having gone through a system of education with no fun, leisure or any input on ethical issues, they enter the university. Here they are exposed to all elements with social problems which I need not elaborate here. The turmoil in the university system ensures that the young doctor passing out could be quite skeptical about the values in society.

The doctor is then expected to serve in any part of the country, quite rightly, but provided with poor facilities for patient care and a decent living. He sees all around him, much less educated people including dirty politicians (yes, I mean very dirty, except for a very few) at all levels enjoying luxury living at public expense and by fraudulent means. He can see much injustice, whereby obvious wrong doers are never punished due to political patronage. He has to earn enough money to buy a reasonable dwelling, a decent car and educate his children often at great cost. Thus it is naïve to expect a doctor in such circumstances to behave as a Good Samaritan doing his best for patient care, neglecting his own family responsibilities. No wonder this malady affects the rest of the public service as well.

It is really praiseworthy that the majority of Sri Lankan doctors choose to remain in Sri Lanka or return home after post graduate studies abroad despite being offered lucrative permanent jobs overseas. They do a yeoman service out of humanitarian concerns and the love for the motherland. Their services maintaining a high standard of health care with limited resources go unnoticed or are taken for granted by everyone.

I do not for a moment condone the questionable activities of a few doctors that bring disrepute to the profession. Doing private practice during hospital working hours, spending only two to three minutes for a consultation in their rush to see twenty patients in one hour, some charging exorbitant fees for their service and the alleged unholy alliance with the suppliers of pharmaceutical products and appliances, are all practices that should be condemned by all. Unfortunately the authorities who have all the powers to apprehend such wrong doers appear to be unconcerned.

It is high time those owning and operating the private hospitals understood the essential difference between providing health care to the sick and their all other business activities.

Humanitarian considerations should take priority over profit motive. It should be noted that providing healthcare is perhaps the only instance where the “salesman” (doctor or hospital) decides what the “customer” (patient) should buy! Hence there is a heavy moral responsibility on our part to ensure that our actions are not discoloured by financial considerations.

Thus it is worthwhile for the doctors who have recently returned after many years abroad, or make casual visits to avoid the miserable winters back home, to plead with the corrupt authorities to provide a better life for all citizens including the doctors.

They would do well to understand that the doctor is a product of the society that nurture them.