There are over 40,000 'Quacks' in the country, but little is done to curb their practice, reports Feizal Samath...

Doctors who kill not heal

A senior Sri Lankan doctor was driving to Kandy from Colombo one day when a young boy crossed the road in the path of the oncoming car and was hit.

The boy looked okay but the doctor suggested to parents and other villagers who had gathered around, that he should be taken to a government hospital to be medically checked as a precautionary measure.

"But the parents insisted that the boy should be taken to their doctor nearby. That man turned out to be a quack. But since they insisted and I was alone, I went along to the 'doctor' who examined the boy and declared him okay, after which I paid his fee," said Dr. Ananda Samara-sekera, former president of the Government Medical Officers' Association (GMOA).

Dr. Samarasekera related this incident two weeks ago when the country's medical profession practising allopathy or western medicine met to discuss a growing crisis situation - the proliferation of quacks across the island.

Health Minister Nimal Siripala de Silva said recently that the government would be unable in the future to offer jobs to graduates who come out of the country's six medical colleges - as has been the practice in the past - as all cadres had been filled up.

A shortage in funds allocated to the government's health sector to recruit more doctors plus the inability of the private sector to absorb the large number of doctors who pass out from state-run colleges annually have complicated the situation.

The crisis, since June, has triggered a string of demonstrations by unemployed medical graduates and their parents demanding that the government provide jobs to budding doctors and also take action against quacks who have made inroads into the private medical profession.

Shivantha Fernandopulle, a spokesman for the Medical Faculty Students' Union of the Colombo University says the government is encouraging new doctors to enter the private sector instead of seeking government jobs that are not there.

"But the private sector is still unorganised and there is a fear that if we go into the private sector, we may also be identified as quacks who pose off as registered doctors," he said.

There are more than 40,000 quacks operating in the country posing off as medical doctors and little is being done about them, according to Duncan Bujawansa, president of the Independent Medical Practitioners Association (IMPA), which has for the past 30 years canvassed the authorities on this issue.

Compared to the number of quacks, there are about 7,000 qualified medical doctors practising in the government and private sectors, according to official figures. Quacks are often ex-employees of private doctors, retired hospital attendants, dispensers and sometime medical students. Their small clinics mostly in rural and impoverished areas are filled with patients.

The number of doctors for every 1,000 persons in Sri Lanka's population at 0.25 per 1000 is low compared to the world average of 1.6 per 1000 and 1.2 in East Asia and the Pacific, according to a World Bank study in 1999.

Sri Lanka's health budget as a percentage of gross domestic product (GDP) was also low at 1.9 percent in 1995 compared to 5.6 percent in India, 5.0 percent in Nepal and 2.4 percent in Bangladesh, the same study showed.

Mr. Bujawansa says illegal practitioners are helped by the fact that pharmacies and drug stores in Sri Lanka often sell drugs over the counter and don't need a prescription by a registered doctor. "We must define these pharmacies also as quacks."

He said quacks were a danger to society as they performed illegal practices like abortions and other small operations, issued bogus death certificates and helped to cover up deaths under suspicious circumstances. Strong drugs were also prescribed as quick remedies to patients which were harmful in the long run, he added.

At the discussion, organized by the Sri Lanka Medical Association (SLMA), it was revealed that one quack had issued 36 death certificates in a year when qualified doctors on average don't issue more than five death certificates per year.

Police and lawyers say there are no teeth in the law against illegal practitioners. Fines and jail terms are small and patients are reluctant to give evidence against them.

Most people including doctors concede that action against quacks should run parallel to expanding the private sector in rural villages. "People come to depend on these illegal practitioners and illegal clinics because they don't have a choice. You can't just take them away unless they are replaced by qualified doctors of which there is a shortage," says Dr. Samarasekera.

"It is a practical problem that we are facing." Michael Attygalle, director of the legal department of the police, says they find it difficult to take action against quacks as they are popular with and respected by the people. They also had powerful political patronage, he said.

Mr. Bujawansa, whose association is most at risk because more quacks mean less business for the legitimate profession, says however that under no circumstances can the existence of quacks be justified.

"It is legally wrong and dangerous to public health."

He said the medical profession also had to be blamed since some members were known to practice under bogus doctors who ran medical clinics. "Our profession is partly responsible for this situation," he said adding that the IMPA had written to some of its members when this was discovered.

Bujawansa cited the case of a consultation clinic run by a quack on the Colombo-Katunayake highway. Top specialists used this clinic for their consultations during the afternoons and evenings while for the rest of the day the quack who ran it, practised his own medicine on patients.

The Sri Lanka Medical Council was due to meet with the Attorney General and his officials last week to seek ways of strengthening laws pertaining to quacks. There were no details of this meeting.

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