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28th February 1999

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Second Opinion

GMOA strikes: make it the last resort, not the first!

Last week, for two days, several hospitals in the Central Province were crippled by a strike by the Government Medical Officers Association (GMOA) and other health sector employees.

The issue at stake was the alleged abduction of an employee of the Dickoya Hospital by a parliamentarian. The strike was settled only after the parliamentarian appeared in court.

This may not be the greatest "victory" in the annals of the GMOA, but the incident allows us the opportunity to focus on the issue of strike action by a trade union of professionals dealing with life and death.

Now, no one can say that a parliamentarian - or even a minister or even the president - has a right to abduct public servants on duty and hand them over to the police after allegedly assaulting them, literally taking the law into their own hands. As correctly pointed out by the GMOA president, the proper course of action would have been to lodge a complaint with the police and let the latter take action.

But, with all due respect to the rights of employees and trade unions in the health sector, the question must also be posed as to whether these unions can "strike" over every isolated incident? Certainly, the present controversy was not part of a larger conspiracy, for example, to destabilise the GMOA!

Ultimately, those who suffer are patients. And, these are the patients seeking refuge in state healthcare, perhaps not because they wish to, but because they do not have the means to access healthcare in the private sector.

It maybe counter-argued that if the GMOA and the other health sector trade unions were to adopt a more humanitarian attitude towards strike action, they may never be able to resort to a strike and therefore they may never be able to win even their legitimate demands.

Sadly, though, this may be true. Governments, both at the Central and Provincial level are notorious for ignoring such demands. They are also notorious for allowing various nefarious irregularities in the day-to-day administration of the health services in tenders, transfers, appointments and the like.

Then, they are also notorious for not acting when such actions lead to protest - until strike action is resorted to.

Indeed, the GMOA has won several creditable "victories" by resorting to strike action - initiating an inquiry into saline imports by the government and having the doctors' "Merit List" revised are two recent examples and all credit must go to them for pursuing such causes at the risk of public antipathy, simply because they believed what they were doing was right.

But that should not blind the GMOA and other trade unions in the health sector to what suffering and anguish they may be causing by their strikes.

Certainly they are entitled to use trade union action as a last resort in a crisis.

But whether it should be the first option - though it may be the most effective - is a different matter, and the recent incident is a case in point.

A worker was allegedly abducted, and perhaps allegedly assaulted, though he was still in a fit condition to talk to TV interviewers, clearly. But whether this was a matter of national or regional importance to cripple the services of the Dickoya, Matale, Nawalapitiya hospitals - and later the Teaching Hospitals at Kandy and Peradeniya - is a moot point.

Such actions will not help the GMOA's public image nor will it help restore public confidence in doctors. And this is despite the fact that if not for the strike, the parliamentarian may have escaped scot free!

This is what trade unions in the health sector must learn. They may win their demands, but the public admonishes them rather than admiring them.

Smoking: Ways to start stopping

Smoking is perceived by many as the lesser of the two evils - as opposed to alcohol. And, many are unaware that smoking very significantly increases the risk of heart disease because the habit has traditionally been associated with lung cancer. So, here are some facts which you may have never known....

* What does tobacco smoke contain?

Nicotine, mostly, which is a poison that increases the possibility of blood clots blocking the vessels to the heart. This is how it may cause heart disease. In addition, of course, it may produce changes in the lungs, causing lung cancer.

* How much at risk is a smoker?

That will of course depend on the amount of cigarettes you smoke. 'Heavy' smokers - those smoking over 20 cigarettes a day - are three times more likely to die before the age of 55 than non smokers.

* How harmful is passive smoking?

Passive smoking is breathing the sidestream smoke which emanates from the lighted end of the cigarette. As this smoke does not pass through a filter it is more harmful than the "mainstream" smoke. Passive smoking is a significant cause of Asthma in children whose parents smoke at home.

* Can a heavy smoker give up?

Yes, a heavy smoker can give up the habit completely, instead of 'cutting down' on the number of cigarettes. Initially, there will be what are called 'withdrawal symptoms' - irritability, restlessness and craving for a cigarette - but they will subside at most within a few weeks.

But how can one 'start' to stop?

A few tips would be helpful:-

  • Choose a day to stop - such as New Year's Day or your Birthday and stop completely on that day.
  • Tell everyone - family, friends, colleagues at work - that you are stopping. That will make you think twice before resuming the habit.
  • Identify times when you particularly crave for a cigarette. Plan an alternative activity for that time. Read a newspaper, if you must, when you are in the toilet if that is your favourite place for a cigarette.
  • Cigarettes are expensive. Every week calculate how much you have saved by 'kicking' the habit. Deposit that money in a special bank account. Watching that money grow will be an added incentive.
  • If you still cannot manage to quit, seek specialised help from a doctor. There are special methods to help give up the habit.

Of sibling rivalry

My elder child is jealous. This is of-ten a complaint of mothers when a second child is born. The older child, until then behaving very normally, reacts to the arrival of the younger sibling and the attention the latter gets, by becoming jealous and sometimes, trying to hurt the younger child.

This is called "sibling rivalry". How do you cope with it?

There are several techniques that parents can use to limit this "battle" and help the older child adjust to the idea of sharing their home with a new baby:

*During pregnancy and after the birth of the new baby, try to maintain many of the small rituals the older children have grown up with such as bedtime stories. The more parents can continue with these routines, the less affected the older child will feel.

*One way to help older children identify with their younger sibling is to remind them what they were like as infants. Go over their baby pictures with them and tell them what they did when they were babies. Ask them how they think their new sibling will behave.

*Involve older children in setting up the baby's room. It is often useful to get them some new but inexpensive toys as well. Then, have the child select his or her own baby toys or clothes to give to the baby. This way, the older child feels less rejected.

*When the mother goes to hospital to give birth explain to the older child that when she returns, it will be with a baby who is small and therefore needs more attention;

*If the older child attempts to breast feed, do not reject him or her at once. Explain, if possible, that the baby's need is greater, or try giving some other food which is liked by the older child.

* Children, specially those under four years cannot relate well to the changes around them that occur with the arrival of the baby. Talking and reassuring them that they will not lose out on love and attention is also important.

A pain in the mouth!

Mouth ulcers, also known as aphthous ulcers are small sores which usually appear on the inside of the lips or cheeks. They can also be found underneath or on the edge of the tongue. They form quickly - almost overnight! - and can be very painful.

Mouth ulcers tend to heal in about five to seven days. But they can also be effectively treated and even prevented from forming.

Such ulcers can form by damaging the inside of the mouth with very hot or acidic food and drink, by betel chewing, by accidentally biting the inside of the lip, by brushing your teeth and gums too hard, by using poorly fitting dentures, by some treatments for cancer and by a variety of drugs.

Lack of iron, Folic Acid, or being too stressed may also make some people more likely to get mouth ulcers.

Anyone can get mouth ulcers but they are more common in young adults and students.

Some women get them just before their period. And surprisingly, you may get mouth ulcers if other people in your family also get them!

Most mouth ulcers will heal by themselves but that has not prevented the pharmaceutical industry from trying some remedies for those who want quick relief. They include pastes, mouthwashes, gels and mouth paints.

But, perhaps more than these, good self care will help the ulcer heal faster and also prevent a recurrence.

You may suck on ice to help reduce the pain of the ulcers. Rinsing your mouth with warm (not hot!) salt water maintains a clean environment for the ulcer to heal quickly.

Teeth should be brushed as usual, but not too vigorously.

Avoid, by all means, spicy foods or very hot food or drinks. Instead, drink plenty of water. If your mouth ulcers are very painful use a pain reliever before eating.

And remember, mouth ulcers may just be an isolated sore or even an indicator of more sinister illness. This doesn't mean you should be alarmed when you next get a mouth ulcer but it is good to watch for telltale signs of other illness.

These include ulcers that last for three weeks or more, those that have not healed with treatment, ulcers that are larger than one centimetre across, ulcers that bleed, those that occur every one to two weeks.

Special attention. Perhaps a visit to the dentist or doctor is also recommended if the ulcers occur with a sore throat, if they are painless and if they occur with a rash on the face or body.

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