Letters to the Editor
View(s):Our medical profession and regaining fast eroding public confidence
Last week: A deserted OPD at a state hospital
I am moved to write to you once again on the subject of the continuing fall from grace of the reputation and perception of the Medical Profession in Sri Lanka in the eyes of the general public. There are two main issues to be addressed if the confidence of the public is to be restored.
Government Medical Officers Association (GMOA)
The continued attempt by the GMOA to usurp the functions of the Sri Lanka Medical Council (SLMC) and the University Grants Commission (UGC) is unacceptable. The resulting so-called industrial action has seriously challenged the public’s right to be able to access free medical care as needed.
The total inability of the administrators and government to quickly resolve this in no uncertain terms will not win the plaudits of the general public. It is not ‘rocket science’ to point out that the role of the GMOA is to promote the legitimate rights of doctors in terms of their working conditions, remuneration and defence in the event of disciplinary action or litigation.
The SLMC should determine the eligibility of candidates for registration whether they have qualified in Belarus, Timbuktu, Manipal, or Colombo. There could be a common exam for all candidates not holding a degree from the University of Sri Lanka.
The disruption of the medical educational systems in the local universities must mean that the lost time,now nine months, will have to be repeated by the medical students to avoid a gap in their knowledge. In addition, the ‘A’ level students who are about to be admitted to the local universities to do medicine may well have to wait twiddling their thumbs. Idle minds, albeit, educated to a certain level can be dangerous in our politico-social environment. All this is against the backdrop of patients awaiting hospital care and on long waiting lists for surgical procedures to be undertaken. In many cases this would be a life-threatening situation.
While the GMOA carries out disruptive protests against private medical education the modus operandi of the authorities is to set up sequential committees or Presidential chats. While this may be a tool for prevarication, it is not helpful to patients. In the meantime the GMOA will continue to hold processions using their tax exempt SUVs waving the proverbial digit to the public purse. Surely, an affront to the taxpayer. Any reports and reviews produced that disagree with the views of the GMOA, to any extent, will be dismissed out of hand. The latest one chaired by a Minister who should be having his hand on the economic till was not even graced by the GMOA’s presence, though invited. It is clear that the GMOA will not be satisfied until the government eventually finds a committee of lily livered politicians and professionals that will rubber stamp the former’s position. The resolution of this controversy should be in the context of the right to set up private medical education in Sri Lanka rather than any particular institution.
Heart Transplant at the Kandy Teaching Hospital:
About 18 months ago following a visit from one of the heart transplant surgeons in Newcastle England, it was widely reported that the Sri Lanka Heart and Lung Transplantation Society had been established by the cardiac and thoracic surgical community in Sri Lanka. The accompanying fanfare with Ministerial and official attendance seemed to be a clear indication that resource support from the government would be ensured. The usual ‘breaking of bread’ with kiributh and kavung followed this event. No hoppers.
While there was a certain element of doubt as to the resource implications of such a venture, one supported the advancement in the specialty but ensuring that the waiting lists for routine cardiac surgery, which extend to three years, would also be addressed. In fact there is no government sector cardiac surgery north of Kandy, though a surgeon has been appointed in Jaffna since January 2016. The world literature would suggest that up to 10% of patients per year die awaiting surgical intervention. The surgery itself has 1-3% mortality from the procedure. These would be adult patients requiring coronary artery bypass surgery (CABG), which is, of proven benefit, both in terms of relief of symptoms and extending the longevity of life. A good operation, that has stood the test of time.
About a month ago the cardiac surgical centres in Colombo, were aghast when it was announced that the first heart transplant in Sri Lanka had been carried out at the Kandy Teaching Hospital. While there was acceptance that surgeons in Colombo had done much of the ‘homework’ needed for a programme rather than just doing an operation it was generally recognised that it was a progressive step. There however, remained an ‘edge’. The procedure would be carried out with the inevitable publicity to follow a ‘first’ and the programme would then fizzle away seemed to be the emerging view amongst the professionals. Such an outcome will not be to the benefit of patients.
All heart surgery requires an inclusive approach that is multi-disciplinary and has the interests of the patient at the centre. In transplantation surgery this approach is crucial since the grieving relatives of the donor who are asked to consent for the procedure to go ahead compound the anxiety of the recipient and their relatives. Donor relatives face a monumental philosophical if not a spiritual dilemma. “Our loved one is dead but the heart beats”. They have to be persuaded with compassion and sensitivity. Their consent to donate is a demonstration of human kindness though they may be unwittingly participating in a game of one up-man ship.
Having established the transplantation society there surely needs to be criterion for recipient and donor suitability. The society should be in a position to advise if not insist on the requirements and the membership of the ‘transplantation team’. Media reports suggest that the second heart transplant in Kandy initially did not take place merely because of such a failing (the operation was subsequently carried out). It may well make relatives think twice before consenting to donate. Potential recipients who may benefit will die. The confidence in the medical profession will be further eroded.
Unless the transplantation societies, through bodies such as the College of Surgeons of Sri Lanka and the SLMC take on the role of governance and self-regulation the politicians and the government will do so.
Ravi Perumalpillai Via email
No one seems to know who’s running what at the Education Ministry
The Ministry that is charged with the responsibility of forming the future generations of the country, one of the most important institutions of the Government of Sri Lanka, is seemingly being governed in a state of chaos. As per the Treasury Reports, The Ministry of Education has shown up one of the lowest rates of utilization of funds.
The top notch are too busy with outside meetings and functions that appear to take much of their time and important decisions and signing off on urgent programmes and activities are being left in abeyance and or delayed thereby. Yet, delegation of authority is not even being thought of. Nominations to attend training programmes, workshops and meetings, more often than not, get approvals only at the very last moment. Letters and responses to urgent needs take weeks to get signatures and approval and there have been instances that the letters put up for signatures have been lost or misplaced. Sometimes, files get returned without even a comment or signature.Nominations and approvals for Tender Evaluation Committees are also not done in a timely manner.
Much time is spent on issues concerning school admissions and administration of national schools, with very little time being available for issues of policy and monitoring of delivery mechanisms and innovations in education and teaching, improving curriculum and examinations, research and development. Herein lies the crux of what is affecting education quality and delivery in Sri Lanka.
Recently, interviews of 15,000 prospective candidates for 3,000 vacancies for minor staff posts, titled “Sports Advisers” for National Schools have been carried out and by staff who did not have much clue about the respective sports. Instead of filtering and reducing the numbers for interviews to economize on time, all applicants had been called for interviews that involved nearly a month’s work for numerous staff at the Ministry. Focus on these have an impact on delivering other important services on time.
The government in the meantime is losing credibility vis -a -vis the outside and among their own voter bases and the lower rungs at the Ministry are a disgruntled lot and are losing motivation. This is certainly no way to govern. Critics say, the “Marapalanaya” at least got things done, when compared to “Yahapalanaya”!
One could imagine what the plight would be if ever there is a hike of spending on education to 6% of the GDP, under this kind of management and functioning when they are even unable to utilize the present allocations properly. It can be a national disaster in waiting.
Over to you Mr President and for the Mr Prime Minister to say to those at the helm, “Disce Aut Discede” in the true Royal Spirit.
Education is too important a treasure to be left in the hands of square pegs in round holes.
Adyapana Via email
Is this the way ‘Paradise isle’ inhabitants treat foreign tourists?
On Wednesday, September 20 around 7 or 7.30 p.m., I boarded a Highway bus to Negombo from the Pettah Private Bus stand. The big bus was full so I got busy with my phone just like all others. Suddenly someone prodded me and when I looked up it was the conductor for the tickets.
A couple of minutes later, I heard the conductor shouting “Four Hundred!”, “Four Hundred!” nastily and someone from behind shouting back “No, I won’t give!” I looked back, in the row behind me, there was a young foreign couple and it was the girl who retorted. I then asked her whether she bought the ticket and she said she paid Rs. 300. I told her a ticket cost Rs.130 and they should get the balance and asked her why the conductor was demanding another Rs. 400. She pointed to their baggage – two medium-sized suitcases kept upright just behind the last row of passenger seats, on a sort of a narrow shelf. I was shocked! As the suitcases were not on two seats where some conductors charge for the seats taken, and at Rs.200 for each bag which was more than the money paid for a ticket one way to Negombo!
Then the conductor was shouting “get down!” get down!” By now we were passing the Technical College. I was alarmed, wondering as to how they could get off with their bags etc. in the middle of the journey and a foreign couple at that and at that hour! I asked him why he was charging for the baggage. He did not answer. When the young man next to me advised me “let the bus conductor and the tourist sort it out,” I protested and the girl next to him said “now when we go abroad, we don’t have to pay for our baggage.” I agreed and we continued discussing the rude behaviour of the conductor and the guy kept quiet. With an attitude like this, no wonder commuters are harassed daily by these nasty conductors and bus drivers! Going by private buses especially in Sri Lanka, with the deafening music is such an annoying experience to say the least!
Then there was this wonderful young man from Kochchikade who protested loudly and sternly that he cannot make them get down like that in the middle of the journey. Mind you, 95% were male passengers in that bus and not a single protested except this young man! It was just this young man who stood up and I salute him!
When we approached Negombo around 8.30 p.m., I had to get off one halt before the main bus terminal but as the tourists did not get down, I thought I should get down at the terminal itself lest they be harassed once again.
To my surprise, another lady too stayed on. The boy who stood up for them too got down with another boy. The young tourist couple alighted last as they had to collect their bags and before we could get to them the taxi drivers surrounded them. When we went towards the couple these taxi drivers became very hostile and were just as vicious to us as the bus conductor!
The couple’s concern now was to get a room. I suggested they go to Ethukala where there are plenty of guest houses. The taxi drivers were still shouting. Then the other lady took the phone and said she would call the police and when she was dialling, they became quiet.
This lady told the young couple that she will go to the police and also find a place for them to stay and the grateful couple went with her. When I came home, I promptly called the Ethukala Tourist Police who asked me to contact the Negombo Police. I spoke to a courteous police officer, Sergeant Gamage at the special unit who took down all details and promised to take appropriate action.
When I followed up the next day he said he had already notified the Negombo Bus Depot and informed them that the conductor in question and the driver would have to report to the Negombo Police Station. Then the following day when I called, Sgt. Gamage, he said that this bus belonged to the Katunayake Depot and that he had instructed them to ask the conductor and the driver to report to the Negombo Police station.
How can we Sri Lankans of this so-called “paradise isle” full of metta, karunawa etc. etc. allow tourists to face such an ordeal? No wonder, one sees online people warn people about travelling to Sri Lanka as they could be killed, raped, gang raped, fleeced of their precious money and belongings.
The Tourist Ministry, Tourist Police and the Private/Public Transport Ministry should take note and afford tourists, whether they be high end tourists or backpackers the necessary courtesy, security and make their stay in the country, a pleasant and memorable one.
On Saturday the 23rd morning I got a call from Sgt. Gamage to say that the conductor and the driver had reported to the Negombo Police station and an inquiry was going on.
I salute Sgt. Gamage, for following up on this complaint and am so thankful and proud that there are still such fine officers in the Police Force.
Nelum Wickramasinghe Negombo
Why doesn’t the GMOA rally its forces to rid the country of quacks?
I wish to place on record my appreciation of the GMOA of highlighting the inadequacy of clinical training for the medical students at SAITM. The GMOA has thus prevented Sediris and Saranelis from being treated by inadequately trained doctors.
The GMOA claims to have 17,000 members on roll. However, at the last council there were 40,000 “quacks” practising medicine in Sri Lanka. These quacks have neither theoretical or chemical training. What has the GMOA done in all its years of existence to stop the practice of medicine by these quacks? Absolutely nothing!
The GMOA now boasts of having the backing of the IUSF, the Bhikkhu Students Front, the parents of all medical students and a rag tag lot of various union members. This amount is a lot of manpower.
I suggest that the GMOA mobilises this huge manpower to travel the length and breadth of Sri Lanka, in order to ferret out all the quacks and hand them over to the law enforcement authorities. They should spend about 7-10 days and walk through the remotest parts of the country to save Rosalind, Anseline and Angeline from the clutches of these quacks.
I would be failing in my duty if I do not mention my former lecturer (now Prof. Carlo) in Physiology. In front of the TV cameras he said that this is his last fight and that he will not permit private medical education in Sri Lanka. Has he forgotten the case of the North Colombo Medical College set up for private medical education in Sri Lanka years ago?
Finally I would plead with the GMOA to drop its political agenda and permit the students to follow their courses at the universities.
Retd. Medical Officer Colombo
Human elephant conflict: Speaking up for the voiceless poor people
The ever present human elephant conflict is causing untold harm. On a daily basis in different parts of Sri Lanka:
a) Men, women and children are being killed by wild elephants
b) Wild elephants damage, destroy completely people’s houses, plantations and harvest
What we have to remember is that the victims are most often poor, innocent people. They are not rich. They carry on their day-to-day lives with great difficulty. They depend on their agriculture and alas this is also destroyed by elephants.
The irony is that nobody seems to care about these poor people. What I have gathered is that there are lots of people who are concerned about the elephants and their welfare but no one even writes about the plight of the people who are the victims of the elephants.
As you are aware this problem is not abating but only growing worse day by day.
I have written many letters regarding my thoughts on the plight of these poor people. As a free citizen I have the right to express my ideas on this unending conflict, but strangely none of these letters are published. This confirms my belief that the majority of Sri Lankans who are not affected by wild elephants and live in luxury do not care at all about these poor people as a lot of people think that elephants are more important than humans, that they are sacred animals etc.
B. Joseph Wattala