Jul 30, 2018

Tragedy doctoring the Health Service

JVP MP moves wants two more medical faculties, saying country has only 50 per cent of required doctors

In addition to Teaching Hospitals medical faculties need more resources and facilities to turn out quality products

Already the existing medical faculties do not have the required full-time teachers

None of the successful campaigns against diseases had doctors involved-all were by PHIs and PHMs

Can more medical doctors reverse the continuing decline in our health service? JVP member in Parliament Dr Nalinda Jayatissa has moved two private member motions to establish medical faculties at the Uva Wellassa and Moratuwa Universities, with Badulla and Nagoda Hospitals proposed as “Teaching Hospitals”. 

His argument is that Sri Lanka has only 50 per cent of the required number of medical doctors and medical faculties in State Universities can only accommodate 1,200 to 1,300 medical undergraduates each year-therefore, the need to establish two more medical faculties to increase the number of student intake.

There is something rather sneaky in his proposal to have Nagoda Hospital as the Teaching Hospital for the proposed Moratuwa Faculty. Why go that far when there are two other hospitals much closer in Panadura and Bandaragama?image 1532634920 9f4092a19a

Besides that, though a medical doctor, the JVP politician fails to understand that to produce a ‘quality’ medical professional, a Teaching Hospital is not the only necessity.

A Medical Faculty needs many more resources and facilities to turn out quality professionals.

Though the GMOA and Deans of Medical Faculties in State Universities cry foul over the SAITM Medical Faculty, they are selfishly silent on the quality of education in their own medical faculties including Rajarata, Ruhuna (Karapitiya) and Eastern University.

Most faculties don’t have permanent qualified teaching staff and are wholly dependent on “visiting” professors and lecturers from elsewhere.

The Sri Lanka Medical Council (SLMC), throttled by the GMOA mafia in decision making, has evaded this lapse and the necessity of having a permanent teaching staff in their draft on ‘minimum standards in medical education’ by allowing medical professionals in Teaching Hospitals to be counted as teaching staff.

This is one of the many reasons, the GMOA as a trade union, should be completely barred from running for positions in the SLMC and the reason, why the SLMC should be restructured anew to give it better representation from other professions and to “societal” interests.

The whole approach in shaping our health service with medical doctors and the argument that we need more medical doctors raises the vital question, “what we as a society expect from our health service?”

image 1532634934 c9f76bd570Do we want more and more patients to seek outdoor and indoor treatment in hospitals for medical doctors and specialists to have a thriving private practice?

Do we have to keep increasing the number of medical doctors to treat increasing numbers of patients? Is that what we are looking for?

The argument for more medical doctors, the JVP MP Dr Jayatissa is echoing, is one borrowed from his own ilk in the GMOA.

 If the existing number of medical doctors is 50 per cent of the required number, he should explain, why medical doctors are posted in numerous offices to attend to administrative work.

 On the Health Services, Minutes Gazetted in October 2014 that comes after the GMOA mafia endorses it, there are 324 administrative posts strictly for medical doctors.

 There are also 341 MOH positions for medical doctors. Lately, there are other stupidly unnecessary office positions created in the 25 RDHS offices with designations like MO-IT, MO - Planning and MO-Health Education, while in Colombo Hospitals, there are other posts that keep cropping up like MO-5S and MO-QC.

 These office-based positions totalling around 800 don’t need medical graduates. image 1532634948 9e62385fb7

While increasing numbers of medical doctors take over such idling administrative positions, the overall health service is on the decline.

The alarming spread of Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF) is one proof.

 The spread of dengue is mainly due to the callous disregard of the once very effective monitoring and regulating mechanism that was then under a Senior Public Health Inspector (PHI) but now controlled by medical doctors sitting in MOH Chairs.

 With medical doctors in office as MOHs, not interested in enforcing monitoring proper and regulating, there has been a dramatic increase in the incidence in most Provinces although the highest incidence of DF/DHF is seen in the Western Province (44.9% in 2007).

 In the recent past, the incidence of DF/DHF has been more marked in the NCP (4.8% in 2004 vs. 11.8% in 2007), Wayamba (10.2% in 2004 vs. 15.9% in 2007) and Sabaragamuwa (6% in 2004 vs. 12.2% in 2007) and with 35,008 cases reported in 2009 with 346 deaths, according to the Epidemiology Unit of the Health Ministry. 

With all the rhetoric available from medical officers manning decision-making and implementing positions in the health sector, during the first three months of 2018, there were 14,627 reported cases of DF/DHF.

 The result is that we have hospitals with DF/DHF patients cramped everywhere in the hospitals.

 In Sri Lanka, this needs to be stressed and emphasized with the GMOA mafia wanting to portray and project the medical profession as the sole saviour and guardian of our health services. It is a total and an absolute lie.

 It wasn’t medical doctors who worked towards lifting Sri Lanka’s health status to that of the more advanced countries.

 From hookworm to poliomyelitis, from malaria to whooping cough, smallpox and filariasis, all outbreaks and recurrences were eradicated through a well monitored and regulated community based preventive healthcare service handled by paramedical servicemen and not by medical doctors.

 PHIs played a very vital role in carrying out an islandwide awareness on personal hygiene and developing cleaner sanitation. They were responsible for creating a new generation that paid more attention to personal cleanliness and better family hygiene. It was also PHIs and the Midwives who played a very committed role in making immunization and vaccination programmes a success in the 1960s.

 In the 1980s with WHO support and guidance the anti-leprosy campaign was efficiently and successfully carried through to declare leprosy as eradicated in 1992, without medical doctors playing any significant role.

 Now that medical doctors have taken over leprosy prevention, there is once again a warning of a possible increase in leprosy cases.

 Yet, another interesting piece of news was from Moneragala, when the now hyped Gam Peraliya development programme was launched over a month ago. It was reported, 25,000 households were without proper toilets. A special allocation was set aside for their construction. Truth is, if the MOH was effectively monitoring and regulating community health in his or her area, this lack of toilets should have been remedied, long before Gam Peraliya was launched.

This also raises the question why allocations for their construction were channelled through the Divisional Secretariat (DS) and not through the MOH.

The fact is, MOH is now a wholly irrelevant position in community life even after the spread of dengue fever.

MOH is not seen or heard of even in dengue prevention campaigns that are carried through Development Officers in DS offices, LG councillors and local area Police, at times backed by the STF as well.

Therefore what we should as a society demand from our health service is a very strong preventive community healthcare system to reduce numbers admitted to hospitals.

A preventive healthcare system makes hospitals in the curative healthcare system less important. Sri Lanka’s proud status on health rankings was achieved on a comparatively very low budget that depended more on preventive health care and sanitation than on curative healthcare and medical doctors.

Preventive community health care with trained paramedics checking on households regularly is certainly not as expensive as curative health care with sophisticated hospitals, long lists of expensive medicinal drugs prescribed by medical doctors and specialists, supported by semi-professional staff like MLTs, Radiographers and Physiotherapists.

Sri Lanka needs to give more importance to preventive community health care over curative healthcare that should have a strict referral system.

We are wasting money on curative health with heavy investments going in search of the most modern and expensive health equipment to meet ever-increasing numbers of patients.

This is due to GMOA backed medical professionals holding all key positions in the health hierarchy who are not “pro-people” as they project themselves to be. 

We also need to break out of international norms and standards, where and when necessary to design programmes for our own need(s).

We should get back to the well-knit preventive healthcare service with paramedics at the community level that we had till the 70s. This can be redesigned under specially trained senior PHIs designated as “Area Community Health Officers” (ACHO) to clear out this mess. The ACHOs should also have well trained “Public Health Midwives” (PHM) in the field.

The present WHO norm of having one PHI for 10,000 persons and one PHM for 3,000 persons should be revised for a more practically valid ratio.

It is humanly impossible for a PHM to care for 3,000 pregnant mothers and infants within a month that includes home visits too.

So is it with PHIs. The present MOH who is a medical doctor can thus be repositioned as the GP in outpatient dispensaries in ACHO divisions.

A community based preventive healthcare system would help reduce the heavy cost of producing medical doctors through low-quality medical faculties proposed at public expense.

Experience during past decades proves that increasing the numbers of medical doctors produced does not in any way improve the health of people.

They only get comfortably absorbed into the thriving private sector health industry that lacks full-time medical doctors.

Thus, what JVP MP Dr Nalinda Jayatissa actually proposes is to produce more medical doctors in the private sector health industry at public expense.

 The medical profession now only feels money, not human pain.



(Except for the headline, this story, originally published by dailymirror.lk has not been edited by SLM staff)