For the past two weeks, many patients have been turned away from hospitals. The sick- young and old, pregnant or with broken limbs all have had to bear up or seek private medical treatment since nearly 90 percent of the government medical officers were on strike. The health sector was, and at the time of writing still is, virtually paralyzed- saved only by the work of a few non striking doctors and Assistant Medical Practitioners at dispensaries. Emergency services were, of course , attended to. But what was classified as an emergency- a broken limb? A heart patient suffering a cardiac failure? A pregnant women who needed a cesarean? A child with food poisoning? Hospital administrators say that doctors decide on what could be called an emergency situation on the criterion of it being life threatening. Most administrators said that they are satisfied with the emergency work of the striking doctors.
But it is the masses, the vast majority of the sick, elderly and disabled who have had to suffer through this strike - through no fault of their own. The daily wage earning tax payers of this country, whose contributions support the entire health sector- Minister, doctors and all- have been unfairly thrown into a health crisis and great inconvenience with little warning. Although our inquiries did not reveal any very serious incident during the strike period, many doctors were witness to extreme hardship that patients had to undergo. Sick children , pregnant women in labour and even accident victims were mostly attended to by nurses or attendants, who were also under a lot of pressure.
Therefore the questions arise- Is it ethical for doctors- under the Hippocratic Oath to serve the sick- to resort to strike action on the issue of a post intern-merit list?. Is it fair for a Minister- under oath to serve the public- to let the strike action drag on without attempting to negotiate a settlement?
Ò Why do people talk of ethics only when doctors are on strike?, one professional ( not a doctor) questioned. It is probably because doctors are regarded as demi-gods in our society. Their work has been put on a pedestal as the noblest profession ever. Therefore the question of ethics invariably will arise. There is no running away from it.
But the issue is certainly not one sided. The Minister and the other government officials running the health sector too need ethics. It is quite obvious that the suffering of the public has not moved a single health sector official to action- to seek means to resolve the conflict. It had to be the President of the country to intervene and attempt to seek dialogue with the aggrieved parties. Reports indicate that this is the third time that the GMOA has resorted to strike action and the 23rd health sector strike during the time of Minister A. H. M. Fowzie. A very dismal overview of the unhealthy patterns that have developed within this all important ministry.
The present controversy began when the Health Minister A.H.M. Fowzie attempted to alter the post-intern merit list of doctors to give ten Cuban-educated Muslim interns, preferred postings among some 472 interns who came into government service in April. All interns are placed on a merit list according to predetermined criteria. Their placing on the list will be the order of their seniority right throughout their careers. These ten Muslim doctors had gone through medical college in Cuba, supposedly obtaining government scholarships . But there are no records of these ten scholarships, awarded during the time when A. C. S. Hameed was Foreign Minister, within the government. Therefore their rightful placing is at the bottom of the merit list, where all foreign scholars who went abroad through private means are placed. At the beginning of their internship these ten doctors were placed at the lower rungs of the list. But by a Ministry directive they had been suddenly moved up more than a hundred places and assigned to good hospitals, when their internship ended.
The President, faced with an immovable Health Minister, appointed a retired Supreme Court Judge O. S. M. Seneviratne to look into the matter when the GMOA discussions with Presidential Secretary K. Balapatabendi failed to bring results. The commission was still sitting at the time of writing this article.
Ò Doctors too need to fight for their rights GMOA official Dr. J. Fernando said. Ò We tried our best to avoid strike action but the other party (ministry) forced us to resort to trade unionism
Ò Most people think that the issue about merit lists is not important enough to cripple the health services said Dr. Charitha Fonseka, another GMOA official. He explained that the union resorted to this severe step because the decision to alter the merit list would have severe repercussions on the careers of all doctors. A merit list prepared by the Higher Education Ministry more than a decade ago cannot be altered on the whims of one minister, the GMOA said.
Some private practitioners, who are not involved in the strike , were quite supportive of the GMOAs trade union action. Although most ventured to give their opinion and comments on the strike they did not wish to be quoted by name, an indication that whatever differences they may harbour, the doctors generally wish to seem united in a cause.
We see that there is no other way to resolve conflicts that are arising in the health sector one private general practitioner told The Sunday times
You can shout as much as you want, but the Minister can simply ignore and work to his rules. Therefore, I believe the GMOA is justified in its strike
When asked if it could be considered ethical for doctors to go on strike- (the question most irate members of the public pose), he said, In that context it is not right. Strikes are never the ideal solution. No one will really support strikers. But it is impossible for doctors to strike without the patients being affected .The ministry let a problem that could easily have been resolved by negotiations, get out of hand . If they only agreed to meet and discuss, this could have been averted
Another private practitioner, a member of the Independent Medical Practitioners Association agreed- Ò The government made no effort to curb the strike action. The fighting is going on at a very personal level now. Both parties do not wish to compromise. To safeguard the rights of doctors, it looks as if striking is the only course of action left
These private practitioners agreed that this entire problem could have been amicably settled by the two parties if more attention was paid to solution by amicable give-and -take settlement. Our clinics are full of patients who have been turned away from state hospitals one said. Ò We treat these patients free of charge
Director of Badulla General Hospital said that he is satisfied with the emergency procedures adopted by the doctors on strike. Routine hospital work is not being done, but serious cases are attended to by the doctors. There have been no incidents He said that the doctors had a right to resort to strike action . If the government lays down regulations it should adhere to these regulations. This is the first time a merit list has been altered like this. Unfortunately the doctors have had to recourse to trade union action
But within the profession there were some dissenting viewpoints also.
Ò Doctors should not strike. Not only doctors but professionals engaged in essential services should not strike. One must exercise restraint and learn the art of negotiation and compromise. These are the qualities which differentiate humans from animals. The GMOA strikes too frequently- how can we take them seriously? It cannot be considered ethical for doctors to neglect their patients for so long unless a very, very grievous injustice has been done to them
Director, Ratnapura General Hospital Dr. S. Narayan said, The GMOA is on strike for some medical interns who are not even in their association. I myself have been a member of the GMOA for some 30 years. I fail to see the reason for this strike- we are only trying to help a group of doctors who are mostly non- members. This is a problem which should have been easily resolved at Ministry level. The GMOA should not have walked out and resorted to strike The doctor said that although emergency services are being attended to, other patients like those with diabetes, pressure and asthma etc., who need their monthly/weekly quota of medicine are terribly inconvenienced. He said that he as an administrator cannot strike along with the rest of the GMOA.
Prof. Colvin Guneratne, President of the Sri Lanka Medical Association said that the council or membership of the association has not taken a collective decision on the issue of ethics. But speaking on a personal basis, he said that professional trade unions like those involved in the medical field should not take to strike action, save in the most exceptional circumstances. The public have a right to expect members of such professions to lay claim to be called noble and learned and have superior skills of communication, negotiation, conflict resolution and diplomacy. Therefore, people are likely to perceive their frequent trade union action as one that has the potential to seriously harm or kill innocent patients or the community at large, not as a sign of strength but as a sad stigma of intellectual and moral weakness
The Hospital Secretary of Asha Central Hospital speaking out on the strike said, Ò Doctors trained and educated by public funds have no right to strike against this same public. It is the poor who will suffer. If some injustice has been done it is up to the courts to resolve it. As a responsible citizen of this country I think it is totally unfair on the public to deprive them of health services for a simple reason like this.
Both Asha Central and Nawaloka Hospital said that government consultants are not coming for channel services at their hospitals and patients who wish to channel these doctors cannot do so. But this is the only effect the strike has had on the private hospitals.
Another school of thought is that the entire medical profession has been compromised by the attitude and practices of today's medical officers. Private practising, channel services by government doctors, and the increasing emphasis on money-making in the profession as opposed to old -school professional devotion to service has ruined the medical profession and reduced its popularity and credibility among the public, some doctors feel. Some even said that present day medical school education does not instill the idea that the profession is a noble service in its students- hence the emphasis on rupees and cents instead of quality service to all and the crumbling of traditional medical ethics.
This question of ethics is a difficult one. The GMOA continuously defends their stand-
as being the only option available to them We asked for an interview with the minister. Sent at least three letters to him. But he retaliated in anger and refused to meet us Dr. Ananda Samarasekera , Chairman GMOA said. The manner in which the minister acted in regard to the problem of the merit list is totally unjust. Can we as professionals tolerate this kind of thing?
The GMOA said that as a trade union it could not go to court on a rights issue. Therefore the only course of action - in order to safeguard the careers of many doctors- was to resort to strikes. We have to protect the interest of our membership
The GMOA accused the government of using a vague idea of ethics to try dissuade them from their demands. One third of our membership is working ( emergencies). Doctors are the only people who work when they strike
Because this debate could continue endlessly, we focus again on the patients. An aged women who has run out of her diabetes pills which she has to take daily, a mother with a baby who has suddenly begun to throw up his food, a young man with a broken ankle, an old man with a particularly bad cold- people who cannot afford even the basic medicines from as city pharmacy, people who travel sometimes the entire day to get treatment-what do they think? Do they agree that the GMOAs problems merit such a strike? Do they think the minister s right in ignoring their plight?
The answers, most certainly, would be in the negative. It would be interesting for the doctors to put themselves in shoes of suffering patients and their relatives. Don't they have rights too?
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