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20th May 2001
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Re-turning the wheel at KGH

By Carl Muller
Too often have the members of the medical profession been looked upon with a kind of impertinent disdain. The public, being treated, warded, the victims of disease and all its ills, have also been fed, rightly or wrongly, with anti-doctor attitudes that are so easily swallowed. This is easily spread too, for we all know how easy it is to complain. After all, what is a sick, ailing public if not a sort of potter's wheel? In health and fitness, the wheel turns well. Then, heir to the ills of bad public health systems, bad irrigation, broken-down and corrupted facilities and public utilities; the scourge of Imagemosquitoes, pollution and festering garbage dumps, grossly blackened watercourses and chemically-laden foods - the wheel slows, stops. Sick, tired, diseased, they lay their desolation at the doctor's door. And yet, another wheel turns within them - the wheel of discrimination. 

The doctor does not give a man disease. His task is to cure. He will do all he can and he also knows that he can fail. In this picture, no one really considers cause and circumstance. What made the wheel to stop turning? What makes the fungus enter the tree to fill it, rot it? Instead there is new and urgent focus: doctor, surgeon, nurse, attendant, dispenser, patient... and this is all that begins to matter. 

This is why I considered the meeting of the Kandy General Hospital Committee at the Le Kandyan Hotel on May 4, a revelation of sorts. Who tells us what the true face of the doctor is? Politicization has wreaked its own havoc among our medical systems; trade unionism has done its damnedest. The public; the sick, told of doctors' strikes, nurses' strikes, feel that they are in the line of fire. They also see and swallow the insensitivity and indifference of attendants and nurses, ambulance men and janitors. They can lie abed and chant litanies of complaints. All this has become so commonplace that we begin to wonder where the disease truly is. Is it the system? The politics of the whole boiling? The trade union tactics? The treatment? Is it that patients feel they are being dehumanized? Are the patients mere ciphers in a game of bureaucratic pitch and toss? 

Some of the finest doctors and professionals I knew were at this General Hospital Committee meeting headed by Dr. Nihal Karunarathne. What were they really confronting? What real support did they receive? What made them the targets, and why? 

At first, it all seemed routine but suddenly I had to know why the RDA needed to be contacted so urgently, why building contractors were stalling in their final work on the new hospital units; why the new buildings were being inundated with road and drain water, why plumbing had been done in such a slipshod manner that upper floor toilets caused huge water seepage at ground floor level. It is all so sorry a mess and the Committee needed to drive home to the urban authorities the fact that they couldn't go on functioning, ostrich-like, but had to come awake and do something! The new hospital complex is still unable to function. Why? It is so easy to say that it is a doctors' white elephant but the truth is that there is little co-operation or action from the urban authorities and the other mechanisms that are supposed to pitch in and ensure that the hospital functions well. 

Even the President wished that the new units begin services immediately. In fact, it was all planned for May - the armed services and police units, the children's wards, the cardiology unit... yet somehow, problems keep surfacing. The pace of work is slow. More toilets need to be built. Water pollution has become a major nuisance. Rainwater rushes down the Hantane road, drains spill over furiously; the pavements are so broken up that everything is awash in wet weather and the water finds its way into the clearing where the new units proudly rise. Must the local authorities wait until they are formally informed of the mess? What sort of responsibility and responsiveness do we see? Kandy keeps having its recurrent urban nightmares while, doubtless, in their own sleepy hollows, urban authorities slumber. 

The Committee was indignant. It had worked, toiled, collected so much, devised ways and means of elevating the Kandy General Hospital to be a proud part of the island's hospital system. As one doctor said: "God knows we care. We care a lot. No one really, truly knows how much we care. But we face problems the public knows little about." 

This is true. A sick man, is never a selfless man. He is immersed in his own pain and is ready to blame everyone around him. Listen... and be surprised. Why isn't the Cardiology Unit at strength? More toilets are needed. Doctors don't build toilets, do they? The unit is fully functional but one necessary piece of equipment is still needed. Doctors have sent personnel to be trained at Sri Jayewardenepura Hospital. All nurses have been fully trained but there are hitches. The cardiac surgeon who has been appointed is still not in harness - a bit of bureaucratic legerdemain. Doctors fear that if the unit does not function as planned a new danger could arise - the trained staff may leave, take new jobs in private hospitals. 

"We will go ahead even with the limited facilities now available and the minimum number of toilets," it was resolved and overwhelmingly accepted. Yes, yes, yes. we can begin with minor operations. We must look after our patients!" 

When it came to the dispensation of drugs, the Committee had much to say. "What's the position today? We give patients drugs, pills, capsules to take away. Sometimes there is up to Rs. 1,000 worth of such drugs - and the patient is given these in small envelopes or, as we have seen, in a twisted paper "gotta". This is absurd!" 

Of course it is. What value will a patient place on a bunch of paper-wrapped pills? He will put it in his shirt pocket, go home, find that the 'gotta' is damp with sweat, the pills inside grown soggy. 

"This has got to stop. We need our patients to understand and appreciate the value of the drugs they receive. And another thing, the name of the drug is never written on the envelopes. What is the position? If the patient is in need of more of the same drug and he is in another part of the country, will he tell the doctor, 'In Kandy I got some yellow pills'. How does any doctor identify 'some yellow pills' in an emergency?" 

It was agreed that henceforth all drugs be given to patients in self-adhesive polythene bags. The bag would also hold a card detailing the name of the drug and instructions on use. "This was done earlier with much success. In fact, 98 percent of the patients brought back the polythene bags on their next visit. Some even brought back the pills and capsules that remained, enabling us to return these to our stocks. It meant a saving on drugs too." 

It was also good to learn that three sub-committees are functioning too - going into all aspects of the hospital working and better yet, many more things to be done. 

A society for the provision of free drugs and medicines to the needy, with Hilmy Suleiman as Chairman. Messrs. Dinapala Ltd., of Kandy has already contributed a million rupees and is an active society member.

Mr. Suleiman said, "We will begin activities when we have collected between Rs.10 and 15 million. Drugs can be pretty expensive. We need to have a considerable sum of money, banked and earning interest in order to keep up the flow of drugs to the poor." 

A society will also be formed for the maintenance of the new hospital units. Everything from janitorial services upwards will soon be set in place. 

A national tissue typing laboratory is to be set up. Tissue typing is a prerequisite for the performance of organ transplants. The government has promised Rs. 10 million and the service will be non-fee levying. Three million rupees are still required for equipment, while all personnel have already been trained. 

Later, I began to think about our doctors and what the Kandy General Hospital means to them. The Committee wants the hospital to be the finest ever - decidedly. 

Before I left, I spoke with Samantha Gunarathne, Manager of Le Kandyan. "Don't run away with the idea that the Committee is living it up with meetings here," he said. "We are a part of the 'Caring Plan' too. We give them all services free and even transport the Committee to the hotel and back at no cost. We stand behind the Committee and help as much as we can. And we are prepared to do more. After all a hotel is people, so is a hospital." 

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