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Illegal grab of A’pura hospital
Patients hit by devolution malaise; central government makes no effort to take control of hospital
By Santhush Fernando and Nalaka Nonis
Once a busy hospital bustling with wounded soldiers, today Anuradhapura General Hospital itself cuts a sorry figure of a wounded person - nay a wounded victim of haphazard devolution of power.

The affairs at the hospital epitomize the follies of a devolution system that was imposed on the people and not evolved within. Sixteen years after the provincial council system was introduced as a means of solving Sri Lanka's ethnic question, the system as an administrative mechanism is found wanting in many respects.

The 1348-bed Anuradhapura hospital, the third biggest hospital in Sri Lanka after the National Hospital and the Kandy General Hospital, is a classic example to prove this.
Health is a devolved subject under the provincial council system, but the control of at least one major hospital of a province, with the only exception being the Anuradhapura hospital in the North Central Province, has been retained by the central government.

During the height of the government's military campaign, the Anuradhapura hospital acted as the frontline hospital. There was no shortage of medicine, equipment or medical personnel then, but there were allegations of corruption and irregularities.
An official in charge of the hospital said they had been petitioning authorities since 1994, asking the central government to take over the hospital. Petitions were sent to President D. B. Wijetunga and President Chandrika Kumaratunga. But the authorities did not act till 2000.

On April 7, 2000, the cabinet agreed to take over the hospital and accordingly, the hospital was vested in the central government Health Ministry through the publication of a Gazette Extraordinary on October17, 2000. Prior to this, the Ministry of Health by its circular, MHF/40/2000, dated July 13, 2000, announced the takeover of the hospital, along with two main hospitals in Badulla and Ampara.

Another circular dated July 24, 2000 stipulated that the Anuradhapura Hospital was to be allocated Rs. 18 million per month by the Central Government with effect from July 26, 2000. An account bearing A/C no. 220806081 was opened on August 1, 2000, at the High Grade Branch of the Bank of Ceylon, Anuradhapura with the initial deposit being Rs. 2.5 million for recurrent and urgent expenditure.

But the central government control did not last even a week. The powerful PA Chief Minister, Berty Premalal Dissanayake, is alleged to have struck back. He is reported to have summoned Dr. W. Atapattu, the then Medical Superintendent of the hospital, and told him that it was the provincial council, which was in control of the hospital and he should take orders from him. The chief minister is said to have reprimanded the medical superintendent when he pointed out that the hospital was under the central government.

He acted in this manner because it was the PA that was running the central government, an insider said. The insider said that the chief minister had exceeded his powers in not recognizing the takeover as valid and legal, and it was nothing but political thuggery. Dr. Atapattu then complained to the Health Ministry secretary, but did not even receive an acknowledgement. On the contrary, the doctor is said to have received death threats, the insider said.

The Thirteenth Amendment to the 1978 Constitution provides that an institution vested in the provincial council cannot be taken over by the Central Government without the approval of the relevant provincial council. But in terms of the Public Security Act, the President can take over any institution in the interest of national security. This was stressed by the Supreme Court in a case filed after the central government takeover of the Kegalle Hospital.

Dr. D. L. Waidyaratne, a Judicial Medical Officer, said the Provincial Council’s financial position was not sound to maintain the hospital. He said the hospital needed at least Rs. 500 million a year, but this year the hospital had received only Rs. 60 million so far, though in previous years, it had received about Rs. 125 million from the Provincial Council.

In spite of this newspaper highlighting the sad state of affairs of the hospital in a recent report, neither the provincial authorities, nor the central government has taken any meaningful action to rectify the hospital's maladies. The new building which was opened by President Kumaratunga is in an abandoned state with its beds disappearing. Hospital authorities claim the beds are removed and sent to other hospitals. There is no proper audit to check this claim or any financial irregularities.

The Intensive Care Unit roof is still leaking and there seems to be no effort to repair it. The maternity ward is a sorry sight with two mothers and two babies sharing one bed as the photograph on this page shows.

In the face of dwindling resources and shortage of essential drugs, medical equipment and staff, serious patients – not only from the Anuradhapura district, but also from the neighbouring districts – are sent to Colombo or hospitals in other provinces. Patients and the staff say they expect the central government to act immediately, before the hospital becomes another ruin in this city of ruins.

What the patients say
Nineteen-year-old patient Saman Kumara from Rajanganaya said that although the hospital staff were doing their bit, the lack of facilities had made their task difficult. He said he was infected with a viral flu but had to share his bed with another patients.

Another patient, Nihal Siripala from Padaviya, said he had been diagnosed with dengue and had been treated at the hospital for 10 days. He said the ward was full of flies and not clean and when it rained the roof leaked. A woman patient who identified herself as Siriyalatha said she had come from Polonnaruwa for her confinement but was facing much inconvenience because she had to share a bed with another woman who had also given birth to a child.

What medical officers say
Senior surgeon Dr. Mahanama Gunasekara said the hospital had enough doctors but it lacked supporting staff and facilities.

"There are neurosurgeons, ENT specialists, orthopaedic surgeons, eye surgeons and specialists in the fields of Oral Maxillo Facial (OMF), Oncosurgery and Forensic Science, but they were unable to do their job because facilities such as clinic space and operating theatres and basic material required for surgery were either inadequate or non-existent. The problem is worsened because the hospital does not have enough nurses," he said.

Dr. Gunasekera said even interns find it a waste of time as they do not gain enough experience during their stay here because not many operations were taking place in the hospital. Dr. D. L. Waidyaratne, the hospital's JMO, said that it was not only the living who had to undergo hardship here but also the dead because only four of the hospital morgue's eight freezers work.

He said there were instances when two bodies were put together in one freezer and sometimes bodies were kept on the floor. Consultant Physician Dr. Wasantha Dissanayake said the deterioration began with the signing of the ceasefire agreement as the hospital lost its frontline status with no casualties.

He said that the Intensive Care Unit was in a horrible condition as the roofs leaked while sewage water from the toilets seeped into the room. Neurosurgeon Dr. Prasanna Gunasena said that already an action committee had been appointed by the Government Medical Officers' Association to look into this matter. He said that it would lodge a formal complaint to the Bribery Commission and the Auditor General regarding alleged misappropriation or misuse of public funds.

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