Outcry! Doctors strike while dengue spreads | Sunday Observer

Outcry! Doctors strike while dengue spreads

The deadly dengue menace, spreading like wildfire in Sri Lanka in epidemic proportions, does not seem to release its grip anytime soon. Now, with an indefinite doctors’ strike called by the Government Medical Officers Association (GMOA), apparently to settle a score with the Health Minister Dr Rajitha Senaratne over SAITM, there are fears that its consequences would cause a ‘death spiral’ . This is despite assurances by the GMOA big wigs that they will not let dengue units in hospitals go defunct due to their trade union action. The strike is expected to leave a chain reaction that will affect the care of dengue patients and other emergency services.

Public anger was apparent during the first two days of the strike. Rendered helpless by the lightning strike called by doctors on Thursday, they were seen thrashing the Government, health authorities, hospital staff and the doctors. With the unresolved garbage issue adding fuel to fire, independent observers said the defunct local government bodies which have washed their hands off garbage collection was another reason for the unprecedented spread of the disease this year.

Dr Fernando said, according to his observations he did not believe dengue cases have gone up due to the increase in mosquito population or increase in mosquito bites.

In 2015, there were 29,000 reported cases of dengue, while 55,000 cases were recorded in 2016. So far this year nearly 70,000 cases have been identified, which is an alarming situation.

“However, I don’t believe there was an unprecedented increase in mosquito population this year than in previous years to justify the above figures,” Dr. Fernando observed.

He was of the view that the current outbreak may not be linked to the increase in their population. There is a probability that a relapse of Serotype 2 Dengue may have increased the number of patients. Serotype 2 has returned to Sri Lanka after a few years, and it can be safely presumed the immunity for that type among people has diminished by now. This may be a reason for the high number of cases and deaths reported this year.

According to WHO, there are 4 distinct, but closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4). Recovery from infection by one provides lifelong immunity against that particular serotype. However, cross-immunity to the other serotypes after recovery is only partial and temporary. Subsequent infections by other serotypes increase the risk of developing severe dengue/DHF.)

“Having said that”, Dr.Fernando said, “I believe it is necessary that we concentrate on destroying the breeding grounds to lower the chances of mosquito bites.”

He said, the cleaning of breeding grounds will not be easy,”If you destroy one place the mosquitoes will find another breeding site.” It would be a never ending battle.

Dr. Fernando who is internationally recognized for his outstanding contribution to reduce dengue related deaths, locally as well as internationally said, the health sector needed a creative preventive strategy that could concentrate on ways to avoid mosquito bites.

The use of mosquito repellent is a key in this strategy. Dengue mosquitoes are believed to roam between 6 am -8 am and between 4 pm – 6.30 pm. Public awareness and their part in the whole process is vital in combatting the dengue menace.

“I presume the death rate could have been high due to overcrowding in hospitals too. The patients who develop severe dengue either go undetected or are detected ‘too late’ to manage their condition effectively,” he said adding, “Our clinical management is good but we are lagging behind in crowd management in hospitals.”

The Health authorities have also decided to restrict hospital admissions, to help identify critical cases in time, so that they can minimize deaths.“We will advice the patients to stay home, under close observation and seek hospital admission as and when critical signs develop,” he said.

There is a shortage of doctors and medical staff too in dengue units, Dr. Fernando said.

Consultant Pediatrician and Head of Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever (CCMDDHF) in Negombo

Dr.Lakkumar Fernando

Dr. Samaraweera said, the Bacillus thuringiensis subspecies israelensis (Bti) produced with Cuban technology to fight the spread of dengue is still in use here and the bacteria is now imported from China. The Health Ministry is also exploring the possibility of producing local Bti, after a tie-up with a private company, Bio Power Lanka. The imported bacteria are mostly used in places such as, construction sites. The Bti is not used to destroy dengue larvae in discarded items, like yoghurt cups, etc because the solution is too expensive. “People must learn proper garbage disposal, because we cannot waste the expensive Bti spray on trash piles,” she said.

The National Dengue Eradication Unit (NDEU) is overseeing and coordinating all dengue prevention campaigns islandwide. The Unit is in the process of testing a new Bacterium known as ‘Wolbachia’ from Australia to combat the dengue menace at present.

It is a natural bacterium present in 60% of all species of insects around us. The Australian government will offer the technology but the Sri Lankan government is required to purchase the expensive product. The pilot project, expected to be funded by the Australian Government will be implemented in the near future.

Dr. Samaraweera denied the allegation that the authorities had been dragging their feet over anti-dengue fumigation campaigns, and leading to the current surge of mosquito borne deadly diseases. “A decision has been taken recently to fumigate only places where dengue cases are reported. There would not be any random fumigation campaigns hereafter,” she said, without offering further explanation.

So, when the hospitals tip off the NDEU of a new, reported case of infection, the respective MOH office will be directed to fumigate the particular house or building and its surroundings. She said the Unit uses ‘Pest Guard’, a World Health Organization approved chemical for fumigation. Dr. Samaraweera added, the fumigation is effective only for a period of 30 minutes implying that it was pointless to go for random fumigation in housing schemes, etc.

Community Specialist at the National Dengue Control Unit

Dr. Priscilla Samaraweera

Medical Supplies Division Director Dr. P.W.C. Panapitiya said, the Thai made Dextran 40 special saline drip required exclusively for patients detected with fatal Dengue Haemorrhagic fever (DHA) was now in hospitals and there was no shortage, as of Friday.

He said, they stopped the stock of Indian manufactured Saline being used in hospitals since it caused a reaction in certain patients. “We have got down ample stocks from Thailand now and it has been distributed to hospitals,” Dr. Panapitiya told the Sunday Observer, on Friday.

Earlier this month the Government Medical Officers Association (GMOA) charged that there was a shortage of Dextran 40 and the Health Ministry was delaying the import of new stocks. The Health Minister denied the allegation accusing that the GMOA was spreading falsehoods. In mid June the government announced that sufficient stocks of Dextran 40 had arrived from Thailand and the GMOA praised the Health Minister for the prompt action.

Medical Supplies Division Director

Dr. P.W.C. Panapitiya

The GMOA had its General Committee meeting on Thursday. The General Committee represented the whole country and more than 200 representatives were present. They mainly focused on the brutal attack at the Health Ministry premises and the Government not giving a permanent solution to the SAITM issue. Therefore, we unanimously decided, now is the time to go for a continuous trade union action asking the Government to implement the five point suggestions that we had given with the consent of university students, University Teachers’ Association, Deans, the GMOA and parents. Our main demands are: to stop recruitments, degree awarding and abide by the Supreme Court decision, and the compliance certificate which is a must for a degree awarding status of a medical school, which is not given by SAITM, The Health Minister should tell the Supreme Court this is not a qualified institution to give medical degrees. We also ask that SAITM students be given a solution and examine whether they have the qualifications to be a doctor. If so, we can decide through a committee in the future. We don’t want to chase them out or send them home. But there should be a minimum qualification and we ask the Government to gazette the minimum standards of medical education in the country. After that the Government can decide whether they are going for private medical education or not. At present, SAITM is a fraudulent institution which should be nationalised. That is our argument and all the parties agree to that. The actual situation was understood by the Prime Minister. He was informed the SLMC is not willing to compromise on the standards of medical education in the country. We also gave our proposals to the President, because as the former Health Minister he knows the true situation of this fraudulent institution. Only Health Minister Dr.Rajitha Senaratne stood by this fraudulent institution and we don’t know what the reason is. He is the only person who safeguards this institution. That is why we ask the President and the Prime Minister who are willing to improve the standards of medical education, and not the Health Minister. So we request the President and the Prime Minister to resolve this matter as it would not be a benefit to the doctors but to the public.

Asked whether the GMOA could justify their strike when the country is faced with an acute dengue epidemic, Dr.Zoysa said because of the dengue, they decided to consider it as an emergency and treat all dengue patients as well as fever patients. This is a failure of the management of the Health Ministry. However, the public can’t be made to suffer, so we asked all hospitals to open a new fever corner. Anybody having fever can go to the hospitals for treatment. Actually, we want to settle our trade union action. Unfortunately, the Government is not willing to give a settlement.. There was nobody to listen to the IUSF and medical students, nor did they get an opportunity to meet the Higher Education Minister.

That is why they went to the Health Ministry to meet the Minister. If the Minister had met them, such an incident would not have happened. There should be a person to listen to the grievances of the students.

GMOA Secretary

Dr. Naveen de Zoysa

The Colombo Municipal Council (CMC) awarded garbage collection earlier, without proper monitoring. Now, we have set up a Task Force to do proper monitoring of the garbage and try to work on a system where there is more accountability, with regard to payments as well, because there are issues and numerous complaints as regards payments.

The President as well as I raised this issue, and we are trying to implement a proper monitoring mechanism in respect to payments to local bodies on garbage collection. It becomes worse where the private sector is involved. Asked whether the situation is aggravated due to the non-functioning of local bodies, Minister Musthapha said if there were elected members, obviously , it would have been better because more accountability can be ensured to the people. But, we can’t attribute the issue to local government members not being there, because the actual fact is that the delimitation process had not been done properly. So, nobody can point an accusing finger at us.

Provincial Councils and Local Government

Minister Faiszer Musthapha

The Government will take unprecedented action against the ongoing wildcat strike launched by the GMOA when the whole country is facing a dire dengue crisis. The people condemn this indefinite strike by the GMOA. We have to query whether the striking doctors are human as they resorted to a trade union action at a time when the country is engulfed by dengue.

Addressing a media briefing at the Government Information Department attended by all top Health Ministry officials on Thursday (June 22), Dr.Senaratne said, the Inter University Students’ Federation (IUSF), medical students and the representatives of a particular political party forcibly entered the Health Ministry premises and caused a huge damage to state property.

The Front Line Socialist Party leaders were instrumental in giving instructions to the students. All CCTV visuals of this attack are available. The damage caused to Ministry property by anti-SAITM demonstrators amounts to millions of rupees. Legal action will be taken against all those who caused damage to the Ministry property. Causing more than Rs. 25,000 damage to public property is a non-bailable offence.

The iron gate of one of the floors has been broken while the national flag had been pulled down and the protesters had attempted to hoist their own flag. However, this attempt by the demonstrators had been prevented due to the intervention of Ministry officials. When some elderly Ministry employees asked the demonstrators not to damage Ministry property, they had pulled them up by their collars. As shown by the visuals, none of the leaders who incited the students to gatecrash into the Ministry building had even a minor injury.

They only led the mob attack from outside and ultimately only university students who entered the Ministry premises became victims. The Ministry Secretary had asked the security forces not to enter the premises until all Ministry employees had vacated the building. The demonstrators however didn’t allow the employees to leave the premises. Amid various difficulties, finally they were able to leave the building. In fact, they had to be in the custody of the demonstrators for a few hours.

All institutional heads of the Health Ministry condemned the attack at a meeting on Thursday (June 22). In addition, all trade unions of the Ministry too condemned the attack.

However, the GMOA as planned, resorted to strike action on Thursday (June 22) because according to the court ruling given, the medical students have decided to attend lectures with effect from June 26.

Under the circumstances, the GMOA wants to sabotage it and further keep them by force under their jackboot, by organising the anti-SAITM protest. In the hurly burly, the GMOA wanted a dead body and display it, to prevent the students from attending lectures. That is why they compelled the students to “invade” the Health Ministry.

The IUSF or medical students didn’t have any idea of gatecrashing the Ministry. As the protestors refused to leave the Ministry building, the Police had to intervene to remove them. However, both security services personnel and students sustained injuries when the demonstrators attempted to assault the Police. Some of the injured were hospitalised while some had obtained outdoor medical treatments. One STF person is undergoing treatment at the ICU.

The anti-SAITM protestors have caused a massive damage to Ministry property. A large number of doors, windows and even the finger print machines have been damaged. The irony of the fact is that after they attacked the Health Ministry, demonstrators who suffered injuries were admitted to the Colombo National Hospital, which is also governed by the Health Ministry.

The GMOA doctors also come under the purview of the Health Ministry and their salaries are paid by the Ministry. The GMOA levels various allegations against the spread of dengue but their doctors are responsible for this. It is the GMOA doctors who should speak about dengue prevention programs and submit reports to us.

The GMOA somehow had planned to launch the strike action, but all other trade unions rallied round to condemn the unruly behaviour of the IUSF members. All trade union leaders who met me extended their fullest support and condemned the attack.

Health Minister

Dr. Rajitha Senaratne