Sunday Times 2
GMOA; intrusions and intransigence in the public health sector
View(s):By Amaranath Rajakaruna
The Government Medical Officers Association (GMOA) has taken centre stage in recent weeks in their opposition to the South Asian Institute of Technology and Medicine (SAITM) awarding medical degrees. They have unleashed their cadre in sporadic strikes throughout the island and canvassed support from the medical students, the Inter University Student’s Union, the JVP and Joint Opposition.
Government Medical Officers Association (GMOA) protest against the South Asian Institute of Technology and Medicine.
Let us see the credentials and the past activities of the GMOA in dealing with the 13 other supplementary medicine health categories recognised by the Sri Lanka Medical Council, namely nursing, pharmacists, ML sciences, physiotherapy, radiography, radiotherapy etc.
In 2002 a proposal was agreed upon after consultation with the Ministry of Higher Education, Health Ministry and the University Grants Commission to offer an allied health science degree to those categories enumerated in the preceding paragraph from those who have offered science subjects at the advanced level examination with the z score of 1.4 and above. Peradeniya was selected as the venue for those entrants who were to start the course on July 17, 2006. The GMOA protested about giving the Peradeniya faculty to the new entrants.
The Lady Hill Quarters was selected as the alternative venue. The GMOA blocked the medical faculty and no resources were allowed. The GMOA exerted pressure on the lecturers to stop giving lectures. The GMOA wrote to hospital directors of the Kandy, Peradeniya, Nawalapitiya, Kegalle and Gampola hospitals not to give clinical facilities. Medical students were instigated to picket and protest against the Dean of Medical Faculty Dr. Chula Goonasekera who thereafter assumed duties as the Dean of the Allied Health Sciences. The allied students filed a case against the dean and the vice-chancellor with the supreme court. The GMOA and medical students intervened and demanded whilst giving evidence that the four year course be reduced to three years and if done the readiness to give consent to provide clinical facilities at Kurunegala. The parties reached an agreement where the 2006, 2007 and 2008 batches were to be given four years and the rest 3+1.
Here it should be noted that Professor Carlo Fonseka, Dr. Chula Goonasekera and Mohan Samaranayake took the stand against the GMOA. The allied students won their demands in 2014 after a long struggle. Those students who entered in 2005 were recruited only in 2015 on a salary scale of a diploma holder.
Then again in January 2017 the GMOA was against giving the Sirimavo Bandaranaike Children’s Hospital for clinical facilities.
There is an anomaly compared with the other ministries in that the Health Ministry employs MBBS medical degree holders to run its administration. Attendance, rosters, signing of letters and typing of letters is handled by MBBS personnel. Even IT management is handled by medical doctors. These jobs could easily be done by IT degree holders and degree holders in management and finance who are found in abundance in this country. These medical degree holders rob these vacancies meant for degree holders in the relevant fields. The Government sometimes spends 64 lakhs of rupees per head to train these MBBS men in the field alien to them learned only in the medical field. They may very well be stationed in their learned fields where patients with ailments could be looked after to reduce the over work of doctors at the OPD centres.
Not only that, these medical degree holders, also handle the nutritional field, lactation management, health education, infection control and quality control which could easily be done by nurses with a six month training which is within the ambit of a nurses duty in other countries.
The Sri Lanka Medical Council has identified 13 other disciplines concerning health category professionals besides medical professionals.
Hierarchical management has prevented the advancement of these 13 professional categories in both learning and reaching their full potential except the medical officers (doctors). The 13 categories have been prevented independently from developing in their own academic and professional fields there by stunting their growth. This is a travesty of justice and a breach of professional ethics.
Further in the National Hospital at Colombo there are a total of 73 medical laboratory scientists working and in addition there are over 60 MBBS medical officers and eight clinical consultants in the laboratory. The presence of these medical officers creates a redundancy where they could be substituted at places where they are most needed. If the authorities place these medical men where they are most needed pertaining to their learning as medical graduates there would be no dearth of doctors in the Colombo National Hospital.
Let me also briefly touch upon the events by which the assistant medical practitioners (apothecaries) became a closed service (came to its death). AMPS who had over 10 years experience requested they be allowed to sit for the final MBBS examination some time back. This request was disallowed amidst protest by the GMOA. Then the Ministry of Health arranged Saint Petersburg University in Russia for the AMPS to follow a medical course leading up to the passing of the medical degree. A few AMPS followed the course and having passed the exams came back. The SLMC refused to recognise the St. Petersburg medical degree with the support of the GMOA where at that time the United Kingdom had already recognised this medical degree. Then these AMPS who had qualified filed a fundamental rights case where the Supreme Court held in favour of the AMPS. But nothing happened. Some of them are still working as AMPS in Government hospitals.
With the promise that the AMPS would be granted permission to sit for the MBBS examination the AMP course was declared a closed service. (death)
The demise of the AMP course signalled the end of the apothecaries era where apothecaries had single handedly operated and run Government dispensaries all over the island during the British colonial period and in the plantation sector. Apothecaries had catered to the well being of the estate worker.
From the early times doctors unions has a history of opposing when more medical students are accommodated to follow medical degree courses. In 1962 when the second medical college was started at Peradeniya, doctors went on strike. When the Rajarata Medical Campus was started the GMOA wrote to the doctors not to accept teaching appointments.
GMOA spokesman Samantha Ananda was reported to have said to the Sunday Times of March 5, 2017, regarding the trade union action of stopping work in all provinces at different times, “We are fighting to maintain the patients rights for quality care.â€
These words are laudable. But by obstructing at every turn supplementary categories in their efforts to improve themselves in their fields of study, does the GMOA believe that they could bring quality care to the health sector. A hospital is run not only by doctors but by the nurses, pharmacists, attendants, minor staff etc.. Patients rights for quality care could only be ensured by the combined efforts of a well qualified staff of every kind with a well equipped hospital. The GMOA is naïve to believe that they and they alone are well privileged and with the full control of all resources and power at their hands could barge into other fields depriving others of their independent development and that this is the answer to the, “the rights of patients for quality care” by the GMOA.
Their arrogance is manifest by Dr. Ananda’s comments in the Sunday Times, that they would step into the shoes of politicians to “safeguard” the rights of the people”. But history shows that the only method known to them of “safeguarding the rights of the people”, is indiscriminate work stoppages at the drop of a hat.
In the early 1960s a peculiar term came into medical parlance called, “channelling”. During the tenure of office of the Minister of Health Siva Obeysekera and Mr. Balasingham a non-medical man as the secretary to the ministry, doctors were given “channel” practice during off hours having completed their official duties as an ad-hoc measure to relieve the shortage of doctors. As we all know that this “channeling” has now become a permanent feature in a country where health services are supposed to be given free. A new breed of government servant evolved, the only one of its kind in Sri Lanka with ”channeling” where the doctor is employed by the state as any other government servant, is entitled to all benefits a state officer is entitled to with a right to earn money during off hours of work.
Mr. Balasingham was empathic that some tax be collected by the government from earnings of the ”channeling”. But the latest hot demand of the GMOA is that no tax should be levied against the earnings of doctors from ”channeling” and a new breed of a trade union called the GMOA came into being in Sri Lanka where they jealously fight for their “trade union rights” whilst safeguarding the privileges of not only earnings in the form of ”channeling” but also earnings from the performance of surgeries and other medical care provided to patients in private hospitals by certain categories of doctors on the pay roll of the government. Certain officials of the GMOA are highly vocal as to the exorbitant fees charged by SAITM and that medical education should not be a saleable commodity.
For once they are completely right. But their silence is deafening as to the mushrooming of private hospitals and the fact that a certain category of government doctors are the star actors who are the main attractions in the medical services offered by the private hospitals who are fully dependant on these specialised state doctors. Private hospital services would hardly survive if these categories of doctors are not available for them. So this is a fine symbiotic relationship. Remember these doctors according GMOA are the products of the free education system of Sri Lanka for which they vouch to fight to the last drop of blood; who are freely available of course for money to the rich clients of private hospitals.
The SAITM issue has its positive impact in that alternative avenues of medical education have come under discussion, the right to medical education liberated from the archaic traditional medical education set-up confined only to a selected few, an appreciation of the enjoyment of modern higher education in other disciplines of professional learning in present day Sri Lanka. The SAITM issue has given an opening to closely scrutinize the past and present activities of the main antagonist GMOA.
Medical education in Sri Lanka has also produced notable exceptions to the traditional elite in the field of medicine. To mention a few, professors, Carlo Fonseka, Arjun Aluwihare, Janaka De Silva, Nimal Senanayake, Valentine Basnayake, and also Dr. Mark Amarasinghe and Dr. Channa Ratnatunga.
Finally may I stress that this article is not an indictment against the doctors serving far and wide throughout the island in government hospitals. Our doctors are basically competent and dedicated to their profession. If not for the state providing free medical services with all medicare categories giving their support, the poor people of this country would have being left in lurch for want of medical care.
There should be continuity of free education enabling state medical colleges to flourish and more and more state medical faculties should be opened to increase the cadre of doctors. Whether many students who go abroad in pursuance of medical degrees at tremendous expense eat up scarce foreign reserves begs the question whether private medical colleges should be opened in Sri Lanka. The medical fraternity, educationists, intellectuals, social workers, policy makers and politicians should sit down and decide on the issue keeping in mind that education should not be decided by market forces but by the needs confronting the country. If the decision to open up private medical colleges is arrived at the quality of the passing out doctor should be ensured and the cost factor should be affordable. The money needed for private medical education could be provided by the state to the needy students which could be recovered once they are employed.
(The writer is an attorney-at-law.) Sunday