Sri Lanka's premier hospital needs urgent remedies
Operation Jayewardenepura
By our medical correspondent
Even his bitterest critics would agree that the Sri Jayewardenepura Hospital (SJH), barely a kilometre away from the nation's Parliament, is one of the greatest legacies bequeathed to the nation by the late President J.R. Jayewardene. During a visit to Japan, the Sri Lankan elder statesman was asked what his country wished to have as a gift. He queried Japanese leaders what the bed strength of the largest hospital they gifted to any country was. When told it was a 1000 bed hospital, he asked that a 1001 bed hospital be set up in Sri Lanka.

That was how the Rs 860 million rupee, 260,000 square feet, 1001 bed hospital in 27 acres of sprawling land in Kotte was built, equipped and donated by the Government of Japan. Since its opening on September 17, 1984, hundreds of thousands of Sri Lankans have been its beneficiaries. Those are not United National Party members alone but those of all political persuasions and outside them. Thousands of soldiers who survived the 18 year long separatist war still pay tribute to the dedicated doctors at the SJH.

One of the late President Jayewardene's greatest ambitions was to ensure that the SJH remains a model hospital not only in Sri Lanka but in the entire continent of Asia. He ensured that an Act of Parliament (No 54 of 1983) was passed to create an autonomous board to run the hospital. Its first Chairman, Dr. Rienzie Peiris and one of his senior men, Dr. Narme Wickremasinghe, administered the hospital with great efficiency, with discipline being one of the important hallmarks. Over the years, the SJH earned the reputation of being the nation's foremost medical institution. Various groups have taken it upon themselves to run the day to day activities at the SJH. Men and women of a ragtag firm tasked with security responsibilities are harassing patients and visitors. Officials tasked with administrative responsibilities are either unaware or are too frightened to intervene due to trade union reprisals. They seldom visit wards to see prevailing conditions or talk to staff there.

A cartel of attendants, the most privileged among the employees, much more than the MPs in the Parliamentary Complex overlooking the SJH, get all three meals - breakfast, lunch and dinner - for Rs. 75 a month, free uniforms and free medical treatment for their immediate family (and brothers-in-law too), are also having a free run. The only language they speak and understand is a santhosam or money. They will not budge without periodic instalments. That is in a hospital which now has an occupancy of 65 per cent though the employees, at 1200, outnumber the bed strength.

Here is the first person account of a patient who entered Class One of the SJH last week for urgent surgery. This ward, with 17 individually air -conditioned rooms, was once considered the best in Sri Lanka and was most sought after. The conditions there reflect the state of affairs in the hospital. "The first hurdle is at the main gate. After a few questions and examination of clothes brought in a polythene bag, I arrive at the main entrance to the hospital building with my wife and another, who, to use the SJH parlance, is a 'standby person,' or one allowed to stay in the Class One room with the patient. This is a privilege allowed to those paying Rs. 1750 per day for room and food. Charges for drugs, technical services and fee for doctors are additional.

"A private security guard insists only two persons are allowed to enter. Since my wife and the 'standby person' are ahead of me, he signals them to enter through one of two doors that remain open. Then he places his arm across to touch the door that is shut. I am blocked. I plead that I am seeking admission to Class One by paying money but the security guard is adamant. Only two persons could enter. I tell my wife and 'standby person' to go ahead with admission formalities while I explore means of gaining entry. If I fail, I tell my wife, she could leave the hospital so I may enter the ward.

"I walk to the car park and ask a security guard whether any of his senior officers are on duty. He directs me to the main gate and asks that I speak to the Officer-in-Charge. Inside a room there, a person in a blue shirt is busy reading a Sunday Sinhala newspaper. He raises his head and asks me 'what do you want ?' I tell him my story but he says that only two could enter.

"Just as I turn around to walk towards the hospital building to request my wife to leave, I come face to face with another security officer. He delivers a bottle of Coca Cola with a straw to the man reading the newspaper, presumably a 'senior.' He then walks behind me and asks whether I have any problem. After I relate my tale for the second time, he acts differently. He asks a security guard to escort me to the main building and ensure I am allowed entry.

"The men of the security service have come under severe criticism for terrorising patients. Most of the victims are those from the poorer sections of society. Many complain of being harassed or treated rudely. They say the guards lack compassion and humanness. The relative of one patient related his experience to me. "A security guard prevented a vehicle bringing a patient in a seriously ill condition from parking near the foyer to be transferred to a trolley. He was ordered to park on the road, some 40 feet away. The relative asked 'do you expect me to throw the patient from there to a trolley ?' He argued his way to park near the foyer and transfer the patient to a trolley. Some security guards prevented vehicles with authorised passes from entering the premises. They were ordered to be parked outside.

"Poor patients arriving in three-wheelers are ordered to stop at the gate and forced to walk all the way to a clinic, some 100 metres away. A son and daughter carry their aged mother with her arms placed around their necks. Another limped on one leg whilst placing his arm on another's neck. Each security guard appeared to be giving his or her own orders. One father, who was among those coming to a clinic to obtain treatment for a daughter was told to stay outside the gate. Only two were allowed in. The old man had boarded a bus at 4 a.m. from Horana and was the only one who knew his daughter's illness well.

"Firms to provide security at the SJH are picked after tenders are called. The lowest bidder is given the award. It does not always mean the lowest bidder is the highest performer. "It is no secret that dubious security outfits often hire cheap labour - uneducated rural youth - for a pittance to skim off profits from security contracts. There have also been allegations of some security firms engaging criminals and deserters from the armed forces. Apart from recognising a business registration, the SJH has no other laid down criteria to ensure reputed, professional, well known security firms are engaged. Nor does it obtain security clearance from intelligence agencies (or even the Labour Department) about the men who run dubious security firms.

"Due to the good-heartedness of one security officer, I now enter the hospital building to join my wife and 'standby person.' They had completed admission formalities. However, we are told, my medical file already available at the SJH, is in the Stores. We sit on a bench and wait for 50 minutes until it arrives. Then a helper walks the three of us to Class One Ward. That is two hours and 10 minutes after we had arrived at the SJH. At a desk near the Nurses Station, we complete more formalities. I sign giving my consent to surgery and am given a room number.

"We walk towards the room. I take delight that the worst is over and look forward to relax before surgery the next morning. I was wrong. My room is near a dark corridor. The light bulb there has fused and was not replaced during the five days of my stay. It is only after I enter the room that I realise I am in for worst things. "I walk into the toilet to find it stinks. I feel faint. A half full metal urinal (usually used by patients in bed) lay on a ledge. The odour is most foul. On the ground, in one corner of the toilet, lay a pile of blood soaked cotton balls and medicinal plaster. The tiled walls are dirty. The shower tap does not work.

It had to be manipulated in different directions before a slow trickle of water comes out. That is no easy task. Though there had been hot water in the years past, there is none now. There is a gaping hole in the ceiling. "Walking into the bedroom, I see the walls are dirty with dark patches. There are cobwebs in some corners. The bed is covered with used linen, with dark patches-stains from medicine and sweat. On the ground pieces of bread crumbs lay strewn. There are ants all over including in the bedside cupboard. Pieces of broken cobwebs hang out.

" I am told that janitorial services are no longer carried out by hospital staff. A contract had been given to a private firm. I meet the cleaner tasked for Class One and pay him Rs 100. There is a hive of activity. The toilet is cleaned with disinfectants. The floor is made spotlessly clean. So is my room. I am assured by the person, in a yellow T-shirt emblazoned with the logo and name of the janitorial firm, that he would be available for any help. He visits me at least four times a day. I had to pay a santhosam every day to ensure the room was in a hygienic condition. It was worth the money.

"I was, however, unsuccessful that evening in persuading an attendant to change the bed sheets. I phoned my wife to bring coloured bed sheets (white is not allowed). I use them and go for surgery the following morning. "When I return, the sheets have been changed. The morning soft drink arrives - thambili water for me and a highly diluted fruit cordial for the 'standby person.' The two tumblers are carried in each hand, held at the top, by a female attendant. Her finger prints are all over the tumblers.

The rice and curry lunch is good and could match a meal in a countryside rest house. But two successive dinners could not be enjoyed. "Service from the attendants came only after they were also paid periodic santhosams. Yet, it was not as easy as having the toilet and room cleaned. One morning, at 5 a.m. I asked one of them for a cup of tea. It arrived at 8.35 a.m. That was after four reminders and complaints to a nurse. When I asked an attendant, he replied tersely that there was no water. I later found his claim was not true. By making the request, I had actually interrupted a group of attendants who were gossiping seated on ß a set of chairs meant for visitors.
"A more shocking development came in the medication. After my surgery, my Consultant Surgeon had recommended antibiotic injections for my wounds to heal. On two occasions they were not administered to me. When my wife reminded a member of the nursing staff, she admitted someone had forgotten to do so. Imagine someone forgetting to administer an injection to a patient whose life may be at
stake ?

"One morning, the Welfare Officer of the Hospital visited my room to inquire how their service was. I related my experience. The next morning I had a visitor - Dr. H.H.R. Samarasinghe, now Chairman of Sri Jayewardenepura Hospital. A reputed physician, he had served long years at the SJH as a Physician..

"He was apologetic about the shortcomings and said the board of directors had just taken a decision to obtain stocks of new bed linen. He said he was doing his best to improve conditions and declared that the private security firm had been hired by the SJH long before he assumed office as Chairman.

Dr. Samarasinghe may have inherited the unenviable task of cleaning out the Augean stables. If this is so, he needs to have all the support he can get. As one hospital official admits, the attendants are a powerful lot with a strong trade union. 'They can even prevent a patient from being prescribed a tablet. They are so powerful and will go on strike on any issue,' he points out. No sooner Dr. Samarasinghe leaves my room, an attendant walks in to interview me. He asks me why Dr. Samarasinghe visited me and what he said. He also wants to know whether I had made any complaints. I tell him politely that I had known Dr. Samarasinghe.

"Despite the deeply deteriorating situation, many patients still regard Sri Jayewar-denepura Hospital the best. The reason - it has some of the nation's most qualified and reputed Consultant Physicians and Surgeons in addition to other specialists and doctors. Though they are aware of what is going on, they are both embarrassed and concerned.

"I also learn that some of the bureaucrats assigned to supervise the day to day working of the SJH do not visit any ward or identify shortcomings." That is how one of the nation's premier medical institutions has turned out to be. Unless Health Minister P. Dayaratne, moves in to help positively, where help is needed, worsening conditions will only force an exodus of talent from the SJH. In fact one foreign private hospital, opening a branch in Colombo this month, has already made very attractive offers to many of them. The cash rewards are treble and quadruple of what they receive now.

The billion dollar question is whether the Health Ministry will move in boldly to restore the prestige of the Sri Jayewardenepura Hospital.

Peace drive in a three-wheeler
When Norway's Deputy Foreign Minister Vidar Helgesen went to address the Foreign Correspondents' Association of Sri Lanka, he was confronted by a three-wheeler.
Not the type weaving in and out of Colombo traffic with would-be suicide drivers at the handle bars, but a wooden replica of the Indian-made Bajaj.

The FCA gifted the miniature Bajaj as a symbol of the peace process in Sri Lanka. The contraption depends on Indian support to keep it in running condition, very much like the peace process in the island. The rear wheels were compared to the Sri Lankan government and the Tamil Tigers - they must work together and not independently. Guided by a single wheel, Norway, in front, the three wheeler gives a bumpy and a risky ride.

Having accepted the somewhat unusual gift, Mr. Helgesen remarked that he thought the front wheel was the Sri Lankan President guiding the process along.
But, if that was the case, a foreign correspondent whispered, the threewheeler would be usually late.

Only the previous day, Mr. Helgesen had to kick his heels waiting for a morning meeting with the President which eventually took place, as widely expected, much later in the afternoon. Mr. Helgesen addressed the FCA, a day before he left Sri Lanka last Sunday. He said the peace process was moving "amazingly" and thought the speed was probably too fast - something other motorists and passengers often complain about the hree-wheel taxis on Colombo roads.

He wanted both sides to spend more time on preparing an agenda for the crucial political talks ahead. He said he would keep the three-wheeler on his desk to remind him of his peace mission.

Jaffna: a boom with a difference
Our Jaffna Correspondent
The opening of the A9 highway leading to Jaffna has prompted thousands of people including Sinhalese and Muslims from the south to make sight-seeing visits to the Jaffna peninsula over the past week. Many of the visitors are making special visits to LTTE chief Velupillai Prabhakaran's ancestral home at Valvettithurai, not failing to take photographs of the place.

Other places of interest have been Kandarodai, a historic place where Buddhist have been living. The site has many temples of archeological value. The Nallur Murugandy temple and the Keerimalai beach are among other attractions. Among the visitors from the south are people on goodwill missions trying to build up better relations between Sinhalese and Tamils.

Most of the visitors from the south told The Sunday Times, their visit to the north would not have taken place if not for the ceasefire agreement between the government and the LTTE. Some who had come to set their sights on establishing business contacts and even starting business in the north, said, "we in the south would be glad if the produce from the north and east could be sent to the south, so that the spiralling cost of living will come down in the south."

A Pettah businessman said if the glut of onions, paddy, and even fish which is available in abundance in the north and east could be sent to Colombo this would be a big boon for those in the south. He had come to establish contact with someone who could supply fish, bananas and grapes. Fishermen in the north are now breathing a sigh of relief as they can go fishing with fewer restrictions.

Those in the north are optimistic that if the current trend of people coming from the south and those from the north visiting the south continues without a hitch, the country will also prosper once again. Palmyrah toddy has been in demand since visitors have begun arriving while other Palmyrah and coconut products are also selling fast. Hundreds of Muslims who have returned to Jaffna are busy setting up their businesses establishments while some are trying to rebuild their houses and bring back their families.

Due to the increase of travellers, inns, bars and restaurants are expanding their facilities and services. They are expecting more business in the coming few months.

Dr. Corea said product endorsement had to be left to highly professional, competent and independent bodies like the Sri Lanka Standards Institute. He said that when the Sri Lanka Dental Association gave a recommendation to commercial products which were directly linked to dental matters it created a conflict of interest, credibility crisis and ethical issues.

Dr. Corea said product endorsement was a matter of advertising which was strictly prohibited under medical ethics. Furthermore the SLDA was known to have a relationship or financial dealings with one of the toothpaste companies. However SLDA president Dr. T. Krishnarasa defended the recommendations given by his association to three commercial products. He said that the SLDA specialists had done a series of clinical tests on these products and spent up to 5 million rupees on the analysis before endorsing these products.

He said several other manufacturers had also given samples of their products for endorsement but the SLDA after analysis had declined to do so. Dr. Krishnarasa said there were up to 40 varieties of toothpaste marketed in Sri Lanka and the SLDA could not vouch for the efficacy of those products except the two it had analysed and endorsed. He claimed that the two toothpastes endorsed contained substances which helped prevent dental caries and gum ailments. As a result the percentage of people suffering from such ailments had come down from 68% in 1982 to less than 50% today.

Dr. Krishnarasa said the product endorsement had been made by the SLDA in 1995 and he wondered why questions were being raised seven years later. The suggestion appeared to be that rival manufactures whose products had not been endorsed were provoking the questions.

Another patients' rights and ethics campaigner Dr. Joel Fernando asked the SLDA president how much the two toothpaste companies had paid the SLDA for recommending their products. Dr. Fernando also asked for detailed accounts on how the SLDA spent the 5 million rupees it claimed to have spent on the toothpaste research and what it did from the profits it made out of this endorsement project.
Dr. Fernando pointed out that if the SLDA was venturing into the public area of consumer protection it must be fully transparent and accountable to the public.

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