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State doctors lose patience
Govt. says no money to meet GMOA's salary-hike demand as patients's right to healthcare is buried in crippling strike
By Faraza Farook
Caught in the chronic tug-of-war between the Government Medical Officers Association and the Ministry of Health are thousands of poor patients, for whom free healthcare is a life and death matter.

Minister helpless
Health Minister P. Dayaratne says there was very little he could do and asks the doctors to postpone their strike until the next cabinet meeting.

"We are with the doctors," he said last week adding, "but we may have to wait till the Finance Ministry approves the proposal of the cabinet sub committee because it's a large sum. We are negotiating with them."

On the demand that doctors working in the North and East be continued to be paid the inconvenience allowance, Minister Dayaratne said the Government cannot pay this because there was no war in the country.

"The circular states that the payment would be made until the end of a war or for a maximum of two years.

ccordingly, we stopped payment in January 2002. If we continue this allowance, then all public servants will demand a special payment even in the absence of war.

Although the GMOA suspended the four-day crippling strike on midnight Friday as a mark of respect for the Poson Poya Day yesterday, many patients fear that they will be once again pushed to difficulties if the two sides fail to reach a compromise by tomorrow morning -- a deadline the state doctors have set for the government.
The GMOA action committee would meet tomorrow morning to take a decision based on the government's response to its demands.

Although emergency services and children and maternity units were not affected by the strike, the Out Patients' Departments were the worst hit in all hospitals. In some hospitals, the OPD patients were turned away. Other hospitals obtained the services of Registered and Assistant Medical Officers to attend to the patients, who felt their right to healthcare had been buried by both the doctors and the government. One patient said that some patients might not seem to be serious, but their cases could become serious as a result of the delay in medication.

Besides the OPDs, regular clinics and routine surgeries were also affected by the strike. Thousands of patients who came for the clinics from 3 in the morning were turned away by the hospital staff. Some left the clinic, cursing the strike, the doctors and the government, but a desperate few stayed back, hoping the strike would end any moment and doctors would return to work.

The National Hospital, which generally carries out 75-80 surgeries a day had confined operations to emergency cases only. On the positive side, the National Hospital did not stop admitting new patients or patients who were transferred from other hospitals, according to Director Dr. Hector Weerasinghe.

No more compromise, says GMOA
The Government Medical Officers Association (GMOA), which suspended its strike over the weekend in view of the Poson Poya Day, says it has compromised enough and given all the time the Health Ministry needed to sort out the issue.

"Since 1988, we pointed out the anomaly being created. But the authorities did not heed our protests," Dr. Rohan Gunawardene, media spokesman of the GMOA Interim Committee said.

He said the salary of a Grade II doctor and a Special Grade AMO/RMO had a 12% difference before 1988. However, gradual increases in the salaries of RMO/AMOs had placed an MBBS-qualified doctor's salary 30 percent below the salary of an RMO/AMO.

Having gone through the tedious process of five years of university education and a year of internship to earn an MBBS degree, the state doctors feel that it is unfair to place the salary of AMO/RMOs who follow a three year course on a higher scale.

The basic salary, Dr. Gunawardene said, was vital in determining administrative posts and responsibilities. For instance, the appointment of an inquiring officer was determined according to the salary.

Dr. Gunawardene said the GMOA had come down in its demands by fifty percent and have been lenient with the Ministry giving them sufficient time to resolve the issue.

"On April 8 we came to a compromised solution proposed by the Cabinet Sub Committee. In one such compromise the Sub Committee said that although the anomaly would be rectified from 1993, the arrears would be paid only from 1997.

We also agreed to a proposal that 50% of the arrears would be paid in installments over six years starting from 2004," he said. GMOA's interim President Dr. Kumar Weerasekera said the trade union was forced to take action due to the government's failure to sort the matter out on a priority basis.

He said Health Ministry Secretary Dr. Reggie Perera in a letter dated May 7 assured the GMOA that the Cabinet Sub Committee would present its recommendations at the "very next Cabinet meeting", but no progress had been made although more than a month had lapsed.

"At every discussion we are told that it will be taken up at the next Cabinet meeting. Even during Wednesday's meeting with Health Ministry officials, we were asked to call off the strike as the issue would be taken up at the next cabinet meeting," said Dr. Weerasekera who also asked, "How many more Cabinet meetings do they want us to wait if they couldn't do it all this time?"

The GMOA chief said the strike would be called off only if they received a concrete assurance that the anomaly would be rectified before a definite date. While the rectification of the salary anomaly is the main demand, the GMOA wants the inconvenience allowance paid to docros working in the North and East to be continued.

The GMOA claimed that the doctors were still living in harsh conditions with poor accommodation and transport facilities in spite of a ceasefire.

The Sunday Times learns that the number of patients transferred from the strike-hit provincial hospitals to the National Hospital had increased during the four days of trade union action by doctors.

The trade union action began on Tuesday but it was only confined to Teaching and General hospitals. On Wednesday, doctors in Base hospitals joined the strike while peripheral hospitals doctors expressed their support the following day. It was only doctors at the Lady Ridgeway Children's Hospital and the Cancer Institute at Maharagama who did not join the strike for obvious reasons.

Despite image-tarnishing allegations that doctors hold patients to ransom to win their demands and they now concentrate more on private practice, the GMOA went ahead with an islandwide indefinite strike claiming that it had been forced to take trade union action due to what it called the Health Ministry's inaction.

The doctors say they will come back to work only if the Government gives a written assurance that the salary anomaly would be rectified within a definite timeframe. The doctors claim that there exists a big anomaly between the salaries of doctors and RMO/AMOs from 1988. They say as a result of the Health Ministry's myopic action, the crisis over the salary anomaly aggravated in 1993 and by last year the disparity had widened, in favour of RMO/AMOs.

However, the Society of Registerd and Assistant Medical Officers (SRAMO) disputed this claim saying that as a result of adjustments and increments effected last year, the difference was only 7 percent.

Meanwhile, Health Minister P. Dayaratne says he acknowledges that there exists a problem of salary anomaly but he could do very little because the Treasury has no money. The GMOA, scoffing at the Minister's remarks, asks how the ministry got money when it wanted to rectify the salary anomaly of RMOs last year.

A Cabinet Sub Committee has estimated that Rs. 550 million would be required annually to meet the the salary hike and more than one billion rupees for the arrears demand of the 11,000 state doctors. Minister Dayaratne claimed that he was pursuing the matter with Treasury officials and was trying to get them to reconcile to the Sub Committee's recommendations.

Former Health Minister John Seneviratne told The Sunday Times that a request for a salary hike for doctors was postponed pending the Devendra Commission report. "The report was pending at the time and I promised to consider an increase following the report. But, the new government misinterpreted the report recommendation claiming it had suggested the retrenchment of the people in service," Mr. Seneviratne said.

Nimal Siripala de Silva who succeeded him as health minister during the PA regime, alleged gross mismanagement on the part of the Government. "The government had created an anomaly without taking into consideration the cumulative impact on other groups in the health sector."

Irrespective of who created the anomaly, the problem remains unsolved and the patients left with no choice get battered by the indifference the doctors and the government show towards the patient's right to healthcare.
The GMOA asks the Ministry to resolve the issue at its earliest while the Ministry in turn requests the doctors to be patient. In either case, both say, "For the sake of patients!"

Ban strikes by doctors, says patients' group The National Association for the Rights of Patients yesterday strongly condemned the latest strike by doctors as an act of blatant, irresponsibility towards poor suffering patients.

A spokesperson for NARP which includes several patients rights and civic action groups said they would draw up a petition signed by thousands of patients asking the government to ban strikes by doctors and nurses and other health sector staff. He said the doctors might have a legitimate grievance regarding salaries and the government should work out a process of arbitration through the Commissioner of Labour instead of allowing doctors to inject more agony into the plight of patients.

The spokesperson said the health minister had agreed that doctors would get an extra salary which would cost about 550 million rupees in public funds in addition to 1,000 million rupees for payment of arrears. With so much being given from public funds the people had a right to insist that they would no longer be subjected to the torture of strikes by doctors and other health staff.

The Govt. Medical Officers' Association which launched a strike last Tuesday suspended the strike for the Poson weekend but warned of further action from tomorrow if a circular was not issued on the 40% pay hike.

NARP will hold an action committee meeting on Saturday June 21 at the Community Center No. 15, Quarry Road Dehiwala, to plan out further action. Meanwhile, in a powerful act of judicial activism and involvement, Chief Justice Sarath N de Silva has told the government that it was elected in trust to protect the rights of people and not of big global companies.

The Chief Justice was commenting in a Fundamental Rights case filed by AIDS crusader Dr. Kamalika Abeyratne who has complained that the new bill to be introduced soon would deny millions of Sri Lankans the right to get quality drugs at affordable prices. Dr. (Mrs) Abeyratne, herself an AIDS victim after an infected blood transfusion said the new code of Intellectual Bill would give priority to the patent rights of global companies and thus enable them to exploit or plunder unsuspecting patients. The Chief Justice said the supreme Court's observations on this bill would be made known to the President and the Speaker.

'Professional jealousy,' charges SRAMO
The Society of Registered and Assistant Medical Officers (SRAMO) has accused the GMOA of being agitated over 'professional jealousy'. Claiming that the disparity was a mere 7.1 percent, the SRAMO said it would oppose any attempt to increase the doctors' salary beyond that.

While the GMOA charged that the AMOs/RMOs were ahead of them in terms of salaries despite being lower in the ladder, K.M. Zahir, National Organiser for SRAMO said it was purely professional jealousy that made the graduate doctors underestimate their work.

He said it was unreasonable for the doctors to compare a Grade II medical officer's salary with the income of a Special Grade RMO/AMO. "Unlike graduate doctors who reach Grade II within two years, an AMO/RMO has to work for 25 years to get to the special grade. So it is unfair to compare the two," he said.

SRAMO President Mahinda Liyanage said whatever increments they had received were through the Salaries Commission and not through political influence.
According to the SRAMO chief, the Salaries Commission based on the B.C. Perera Commission recommendations effected the 1997 increment.

The latest increment was given this year based on the Kodagoda Commission recommendations. Accordingly, AMOs/RMOs, nurses and paramedical staff got a 7.1% increase following a series of trade union actions.

Let them suffer
Despite the doctors' strike, patients continued to come to hospitals. Some of them were unaware of the strike while others came there in desperation. Whether it be minor ailments or just after care, for several patients who made exhausting trips from far off places, the trade union action was nothing but unfair.

Abdul Wahid (44) was distraught and disappointed to find that his niece would not be treated due to the strike. "We didn't know there was a strike. Had I known, I would not have come," a disgruntled Wahid said.

A fisherman from Muttur in the Eastern Province, Wahid accompanied niece Nihara (30), her 11-year-old daughter and his brother to the National Hospital in Colombo on Friday. "We left home last night (Thursday) to make it to the hospital early. We had to travel eight miles by boat and then take a train to Colombo. But now, we're told to go home."

Earning a meager income of Rs. 200 a day, Wahid had saved some money to make this trip over the past ten days. His niece suffering from head pain had been asked to attend the clinic on June 13 with medical reports.

"It's with great difficulty that I collected this money. Some days, we went without food and had to skip meals to save for this trip," he said. Nihara had come with blood tests and an X-ray, but there was no doctor to see her reports. "I don't know what to do," said Nihara, a mother of four children. "We need money if we're to stay in Colombo till the strike comes to an end. But if we stay in Colombo, we will lose our daily income to feed our children at home."

The Wahid household does not have a television or a radio. His income does not permit him to buy newspaper. Thus he was cut off from news on decisions taken in air-conditioned rooms in Colombo by doctors or health officials.

Wahid and the family were not alone. We met several others who had come to the National Hospital from far off places like Polonnaruwa and Anuradhapura. To hear their sorry plight, there were no doctors or officials. Don't Wahid and others have a right to healthcare?

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