Menacing public health: Dengue or GMOA? | Sunday Observer

Menacing public health: Dengue or GMOA?

Sri Lankans, today, would be forgiven if they wonder which of the two ‘plagues’ menaces public health more: dengue or the GMOA? Today, they seem to be the most frequent infliction on the people’s health. Bouts of dengue are interspersed with bouts of sudden work stoppages by government doctors throughout the whole country.

The on-off ‘strike’ status of the Government Medical Officers’ Association (GMOA) is such that it waxes and wanes every few weeks or months, just like the frequent dengue epidemics. The awful irony is that the one should be tackling the other!

If dengue causes severe illness to thousands and several score deaths islandwide, the government doctors’ strikes affect virtually the whole population, if not directly fatally, possibly in slow death. Since the general health of the nation rests on the effective functioning of the public health system, work stoppage by the government doctor cadre directly affects that efficient delivery in the administration of health – including treating dengue – for the entire population. While there have been instances of deaths of patients indirectly due to the doctors’ work stoppage, it is the slowing down of the delivery of treatment to all public sector patients, whether surgery, regular treatment to combat disease and medical care for numerous health conditions like pregnancy, infancy and old age.

If the law’s delay, delays justice, delays in medical care can quicken death or permanent maiming. A legal case usually involves individuals or a few interested parties. Medical care and health administration involves the entire population, often immediately affecting whole categories of patients: pregnancies, post-natal care, infants, epidemic victims, malnutrition, and numerous other categories of patients of all ages and genders.

Thus, when government doctors stop work, the nation’s health is affected. How serious the effect depends on how long the work stoppage, how frequently such stoppages occur and, how much notice is given to enable contingency planning (if such is possible when the whole relevant cadre is not available).

In the past twelve months, Sri Lankans have lost count of the number of strikes, partial or full-scale, by government doctors led by the GMOA. Worse, most of these work stoppages have been sudden or, at most, with just a few days’ notice. ‘Wildcat’ is the term most suited to describe these sudden work stoppages by a large section of the most respected professions.

When the national health system is paralyzed frequently – every few weeks, literally – there is systemic slow down. Imagine the delays in treatment for millions of Sri Lankans. How much is the disruption of health administration and supervision resulting in worsened inefficiencies, slackness of services and treatment delivery?

As pointed out earlier, in these columns and, in many other commentaries throughout the new media, the main issue that has prompted all these GMOA strikes, namely, the SAITM issue, has long been negotiated and debated (ad nauseam, some would say) and, a few weeks ago, broadly settled, at least in terms of consensus over the broad commitments for action, if not in actual implementation.

The scope of the broad understanding between the Government and the relevant technical and administrative authorities on the SAITM issue has been announced. That it broadly fits the requirements of national medical education output, training standards, award of qualifications, and, the management of current student batches, has been acknowledged by most concerned parties, including the SAITM investors, as well as parents.

Then, why is just one professional sub-sector, namely, the government health sector doctors, causing such an uproar, indeed menacing public health?

In the first place, unlike the university students and the national higher education administrators – such as, the medical faculties – the government sector doctors represent only one segment of the country’s medical professional cadre, albeit the largest segment. It is that numerical factor and, the critical positioning of this sub-cadre in the all-important public health system, that has led to this misuse of labour union power. Their key role in providing immediate medical services to the bulk of the population has given government doctors their trade union power: they can cripple public health services at will.

The body that represents the whole cadre of doctors, and does so through a wholly formalised process of internal election and functional protocols, is the Sri Lanka Medical Associate (SLMA). Equally or more decisive is the apex professional body, the Sri Lanka Medical Council.

The Medical Council has, necessarily, been a key actor in the SAITM imbroglio and has played a valuable role in ensuring that the complex issue is being resolved comprehensively. Along with the Health and Higher Education Ministries, the University Grants Commission, the combined university medical faculties, the Medical Council has collaborated in the broad settlement plan.

All that the GMOA has done is to tag on a new ‘demand’ that is not part of the multi-stakeholder understanding already arrived at: namely, that SAITM be nationalised.

Why should any private educational institution be nationalised if it is ready to function according to agreed standards and conditions? Just as much as the health services have expanded vastly, thanks to the private hospital sector, it is long past time that the higher education sector is also similarly guided towards expansion in accordance with carefully set national standards.

We need more, not less, private medical colleges. What has been lacking and, will now be implemented, is the proper regulation of private sector education – in this case, medical education.

The government doctors should now focus on dengue rather than on SAITM – unless they or, some lurking political disrupters behind them, have other reasons for causing this mayhem.