Columns

I n view of the severe dearth of medical drugs prevailing in government hospitals, the Association of Medical Specialists wrote to Health Minister Nalinda Jayatissa on Friday, placing in his court three questions.

As believers of the maxim ‘prevention is better than cure’, they sought clarification from the minister in advance to prevent themselves from being remanded at a later date and meeting the same fate as a specialist neurosurgeon of the Sri Jayewardenepura Hospital, Dr. Maheshi Wijeratne, has met today.

The three questions were pertinent for any specialist doctor intent on upholding the highest standards of a profession sworn to the Hippocratic code to ask for his or her own protection should a conflict arise between Ministry rules and the best interest of the patient according to medical practices and ethics, what should prevail?

With a severe drug shortage existing in government hospitals, leaving their medical chests woefully bare, specialists were impaled on the horns of the dilemma, whether to prescribe drugs to patients, advising them to buy it from pharmacies outside, or send them home with only a diagnosis of their complaint, denying them the cure.

HEALTH MINISTER: Permissible

They worried that if they dared prescribe to the patients to obtain drugs from outside pharmacies, whether it may possibly incriminate them and lead them to face corruption charges and a spell in prison, leaving an indelible blotch on their reputations.

They further asked that even if they were allowed to tell the patient to buy the prescribed drug from outside, whether they could also tell the patients where to buy them. Furthermore, they inquired whether prescriptions could be given to patients to get medical tests, unavailable at government hospitals, done at private laboratories, and, if allowed, from which lab?

Of course, these medical specialists could have avoided all this bureaucratic hassle by simply informing patients who come to government hospitals for treatment that, in their capacity as government-employed specialists, they were debarred from prescribing drugs to be bought from outside pharmacies.

However, they could tell their patients that, if they so wished, they could visit them at the private hospitals where they channelled, and by paying the prescribed consultation fee of approximately 2000 or 3000 bucks, they could have their malady diagnosed, medical tests taken to confirm it, and remedial drugs that meet international quality standards administered.

The patients, of course, would have to pay a price for all the services and medicines that cost the earth, received at these private medical institutes. Had they first gone to a government hospital, which they probably did, they would have received, as of right, the same medical package absolutely free.

Presumably they were alarmed by the arrest of top neurosurgeon Dr. Maheshi Wijeratne on charges of corruption for allegedly requesting patients awaiting delicate brain operations to be done by her at Sri Jayewardenepura Hospital to purchase essential surgical items such as EVDs and VP shunts, required for neurosurgical procedures, from a specified company, in spite of them being available in government hospitals at a lesser price.

But whether it conformed in quality to the highest standards that complicated brain operation demanded for surgery to be successfully performed is yet unknown. The offence is alleged to have occurred during the nation’s bankrupt years of 2022 and ‘23, when Sri Lanka had to depend on an Indian credit line for food, fuel and medicines brought down from India alone.

Their professional colleague’s arrest and remand forced the Association of Medical Specialists to seek safeguards to protect its members from meeting the same fate that befell Dr. Maheshi Wijeratne. They sought from Health Minister Dr. Nalinda Jayatissa an immediate assurance, whether it was permissible or not to ask patients to buy certain drugs from pharmacies outside. Furthermore, they asked him whether it was permissible to name a particular pharmacy from which to buy the drugs.

The specialists received clearance to prescribe drugs from outside when, at Tuesday’s weekly Cabinet briefing, Cabinet spokesman and Health Minister Dr. Nalinda Jayatissa gave a most pragmatic and professionally satisfying reply.

Health Minister Dr. Jayatissa declared, “The ministry cannot supply all the drugs and medical tools that different doctors and specialist surgeons may want to treat patients or operate on them.”

He continued, “If there is a small difference from the ones supplied by the ministry to the ones they require, and it is not available in hospitals, they can ask patients to bring it from outside pharmacies. If patients or their families are not aware exactly which pharmacy may have it, the doctor or surgeon or anyone else is free to tell them at which pharmacy it will be available.”

It’s a frank answer that accepts reality: the sad, sorry state presently existing at government hospitals. That’ll do nicely for the moment. In the gloomy backdrop of a prolonged drought of essential drugs, it is one that sends a ray of relief to physicians and specialists that, at least, they can prescribe medicines to their patients to buy from outside pharmacies, and rather than send patients on a pharmacy crawl, searching for the prescribed drugs, they, the doctors, can freely direct them to a named pharmacy and ask them to buy it from there, without the fear of landing in prison on corruption charges and being crucified on social media.

At least for those who can afford to pay, they are not sent away from hospitals empty-handed but with a valid prescription to buy the panacea for their ills. But for those who can barely find the bus fare to come to hospital, the Health Ministry message seems to say, ‘Hard luck’.

And the shortages at government hospitals are not confined to drugs alone but also extend to hospital equipment. On Friday, civil activist Dr. Chamal Sanjeewa told the media that in many government hospitals, patients are asked to buy important medical items like artificial knee transplant equipment and other surgical tools from private companies, as hospitals often do not have them in stock.

Dr. Sanjeewa, the President of the Trade Union Congress of Doctors for Civil Rights, said patients have to pay more than Rs. 350,000 to buy artificial knee equipment from private pharmaceutical companies. After the payment is made, the company staff bring the equipment into the operating theatre for the operation.

Those who have the money walk out of the hospital. Those who don’t have to be carried.

But isn’t it a far cry from the utopian ideal of a free healthcare system that our forebears devised to provide for this country’s citizens when it gained independence from the British yoke?

Free healthcare is not a free gift but an evolving covenant between the people and the state. The people are entitled through the payment of taxes, indirect or direct, to an equal free measure from the bowl of mankind’s greatest blessing, health. The return for the state: a healthy labour force, one that is indispensable for the economy to boom.

Of course, to meet exigencies that may arise at certain times, deviations from this noble concept may perforce have to be taken. Expediencies, though they may appear immoral or improper and even cause hardship to some, may be resorted to to overcome tidal waves of economic challenges.

That expedient measures to ride out hard times cannot be disputed. The snag is that expedient measures taken to ride the storm often become legitimate practice, the order of the day, even after the tempest has cleared and the sun has emerged from its eclipse to shine again.

The inescapable duty of any government is to ensure state-run hospitals are amply stocked with essential drugs and medical accessories at all times to enable physicians and specialists not only to physically examine patients but also to administer the relevant high-quality medicine to bring them back to health.

While singing hosannas to Lanka’s free health care system, the minister cannot leave the medicine larder bare and blame doctors for asking patients to bring their own medicines from pharmacies, even accusing them of corruption, if allegations arise that they take commissions from known pharmacies.

An artist without his canvas, a sculptor without his marble, a surgeon without his scalpel, and a physician without his bag of medicines, all their skills are rendered useless and will lie dead if denied their canvas, marble, scalpel, and medicines to make them come alive.

One cannot give a man bad tools to work with and later blame him if he messes up the job.

It is not only the economy that has made many in the top tier of the medical profession leave Lanka’s hospital wards. It is the glaring lack of medicines and proper facilities, preventing them from giving of their best to ease another’s pain or triumph in saving another’s life, with the triumph being its own reward, that has made them take flight and leave these island shores for more satisfying hospital chores abroad.

Until and unless drugs and medical equipment are available at government hospitals in full measure, ending the need to bring them from outside, bringing charges against doctors or surgeons for prescribing medicines and surgical tools to be brought by patients from outside pharmacies, and launching witch hunts to find those who do, will quicken the flight of the remaining handful of the cleverest and topmost specialists and surgeons from Lankan hospitals to more fulfilling jobs abroad.

Trump’s shining hourIt was Trump’s shining hour. A shining hour that would shine all week long. And he did not fail to show the world that he knew it.Last Sunday, by the time the world awoke, Iran’s Fordow uranium enrichment plant lay obliterated beyond repair for years to come. Operation Midnight Hammer had dealt a lethal blow to Iran’s nuclear ambitions and denied Iran’s Supreme Leader Ayatollah the sceptre of his power. On a dark, moonless night, ten B2 Stealth bombers took off from their airbase in Missouri, US. Three flew west as decoys. Seven flew east, heading towards Iran, their ultimate target destination. They were accompanied by 120 other planes, including dozens and dozens of refuelling bombers to keep the planes flying non-stop on their 37-hour flight. The mission also includes reconnoitre  planes and fighter jets to protect the B2 bombers from ground-to-air missile attacks. At 2.30 am Lankan time last Sunday night, the fleet of bombers enter Iranian airspace. They are not met by any Iranian plane, nor are ballistic missiles launched against the fleet. With complete dominance over the skies, the 7 B2 Stealth bombers, each carrying two 30,000-pound penetrator bombs, drop their payloads of 14 ‘bunker busters’ over the Fordow site. US PRESIDENT TRUMP: Israel’s hero and NATO’s Daddy Simultaneously, two dozen cruise missiles, fired from US submarines based nearby at sea, land on two other nuclear sites, destroying them completely. Within 30 minutes after the attack began, American bombers leave Iranian airspace with no one injured or killed, and with the mission accomplished. As the smoke of destruction slowly drifted to the Iranian sky, US President Trump delivered an address to the nation from the White House. He said, “If Iran dared to retaliate, it would meet the full force and might of the United States.” He vows complete destruction of Iran’s other strategic sites. Iran cannot afford to take Trump’s threats lightly or call his bluff. He means business. He is in no mood to be trifled with. On Monday night, the Ayatollah’s expected revenge attack takes place. Iran fires a symbolic 14 missiles on America’s largest military base in the Middle East, situated in Qatar, to equal the 14 bunker busters dropped on Fordow the previous night. No damage is caused or done. It turns out to be a real ‘pus vedilla’. Two hours before the impending attack, Qatar receives advance notice of it. On Tuesday morn, the offer for a truce is made to Trump. Provided Israel does not attack Iran, Iran will not attack it either. Trump accepts it. The guns fall silent, and tenuous peace exists in the Middle East. But if Trump expected a retaliation, it has come not from Iran but from Democrats back home. Drooling with envy and blistering with hate, the Democrats’ media, led by CNN, have sought at every turn to belittle Trump’s achievement by claiming that despite the attacks on Fordow, it can be restored in a few months, though none can say for certain until a physical assessment is made. The International Atomic Energy Agency Director General Grossi told his 35-nation Board of Governors, ‘No one, including the IAEA, is in a position to have fully assessed the underground damage at Fordow. But it probably caused “very significant” damage.’ But he didn’t rest on his desert laurels; he won the Netherlands’s tulip too. For long he had pressed NATO members to contribute 2 or 3 per cent of each state’s GDP to the defence of Europe, instead of America footing the bill alone. Since taking office last year, he had asked for 5 per cent. Even before stepping down from Air Force One, NATO members handed it in a vase. He had become NATO’ darling, the daddy of them all. Back home, the US Supreme Court seemed to expand his powers when it questioned the right of lesser courts to hear cases against his executive orders. On Friday he had brokered a deal between Congo and Rwanda to end the thirty-year war. He has already ended the India-Pakistan flare-up. “I told them”, Trump said, “until you settle this, America will not trade with either of you. The settled.” The Democrats have downgraded their country’s outstanding military triumph, simply to deny Trump his well-deserved shining week of triumphs.