Our medical profession and regaining fast eroding public confidence
Iam moved to write to you once again on the subject of the continuing fall from grace of the reputation and perception of the Medical Profession in Sri Lanka in the eyes of the general public. There are two main issues to be addressed if the confidence of the public is to be restored.
Government Medical Officers Association (GMOA)
The continued attempt by the GMOA to usurp the functions of the Sri Lanka Medical Council (SLMC) and the University Grants Commission (UGC) is unacceptable. The resulting so-called industrial action has seriously challenged the public’s right to be able to access free medical care as needed.
The total inability of the administrators and government to quickly resolve this in no uncertain terms will not win the plaudits of the general public. It is not ‘rocket science’ to point out that the role of the GMOA is to promote the legitimate rights of doctors in terms of their working conditions, remuneration and defence in the event of disciplinary action or litigation.
The SLMC should determine the eligibility of candidates for registration whether they have qualified in Belarus, Timbuktu, Manipal, or Colombo. There could be a common exam for all candidates not holding a degree from the University of Sri Lanka.
The disruption of the medical educational systems in the local universities must mean that the lost time,now nine months, will have to be repeated by the medical students to avoid a gap in their knowledge. In addition, the ‘A’ level students who are about to be admitted to the local universities to do medicine may well have to wait twiddling their thumbs. Idle minds, albeit, educated to a certain level can be dangerous in our politico-social environment. All this is against the backdrop of patients awaiting hospital care and on long waiting lists for surgical procedures to be undertaken. In many cases this would be a lifethreatening situation.
While the GMOA carries out disruptive protests against private medical education the modus operandi of the authorities is to set up sequential committees or Presidential chats. While this may be a tool for prevarication, it is not helpful to patients. In the meantime the GMOA will continue to hold processions using their tax exempt SUVs waving the proverbial digit to the public purse. Surely, an affront to the taxpayer. Any reports and reviews produced that disagree with the views of the GMOA, to any extent, will be dismissed out of hand. The latest one chaired by a Minister who should be having his hand on the economic till was not even graced by the GMOA’s presence, though invited. It is clear that the GMOA will not be satisfied until the government eventually finds a committee of lily livered politicians and professionals that will rubber stamp the former’s position. The resolution of this controversy should be in the context of the right to set up private medical education in Sri Lanka rather than any particular institution.
Heart Transplant at the Kandy Teaching Hospital:
About 18 months ago following a visit from one of the heart transplant surgeons in Newcastle England, it was widely reported that the Sri Lanka Heart and Lung Transplantation Society had been established by the cardiac and thoracic surgical commu- nity in Sri Lanka. The accompanying fanfare with Ministerial and official attendance seemed to be a clear indication that resource support from the government would be ensured. The usual ‘breaking of bread’ with kiributh and kavung followed this event. No hoppers.
While there was a certain element of doubt as to the resource implications of such a venture, one supported the advancement in the specialty but ensuring that the waiting lists for routine cardiac surgery, which extend to three years, would also be addressed. In fact there is no government sector cardiac surgery north of Kandy, though a surgeon has been appointed in Jaffna since January 2016. The world literature would suggest that up to 10% of patients per year die awaiting surgical intervention. The surgery itself has 1-3% mortality from the procedure. These would be adult patients requiring coronary artery bypass surgery (CABG), which is, of proven benefit, both in terms of relief of symptoms and extending the longevity of life. A good operation, that has stood the test of time.
About a month ago the cardiac surgical centres in Colombo, were aghast when it was announced that the first heart transplant in Sri Lanka had been carried out at the Kandy Teaching Hospital. While there was acceptance that surgeons in Colombo had done much of the ‘homework’ needed for a programme rather than just doing an operation it was generally recognised that it was a progressive step. There however, remained an ‘edge’. The procedure would be carried out with the inevitable publicity to follow a ‘first’ and the programme would then fizzle away seemed to be the emerging view amongst the professionals. Such an outcome will not be to the benefit of patients.
All heart surgery requires an inclusive approach that is multi-disciplinary and has the interests of the patient at the centre. In transplantation surgery this approach is crucial since the grieving relatives of the donor who are asked to consent for the procedure to go ahead compound the anxiety of the recipient and their relatives. Donor relatives face a monumental philosophical if not a spiritual dilemma. “Our loved one is dead but the heart beats”. They have to be persuaded with compassion and sensitivity. Their consent to donate is a demonstration of human kindness though they may be unwittingly participating in a game of one up-man ship.
Having established the transplantation society there surely needs to be criterion for recipient and donor suitability. The society should be in a position to advise if not insist on the requirements and the membership of the ‘transplantation team’. Media reports suggest that the second heart transplant in Kandy initially did not take place merely because of such a failing (the operation was subsequently carried out). It may well make relatives think twice before consenting to donate. Potential recipients who may benefit will die. The confidence in the medical profession will be further eroded.
Unless the transplantation societies, through bodies such as the College of Surgeons of Sri Lanka and the SLMC take on the role of governance and self-regulation the politicians and the government will do so. Ravi Perumalpillai Via email