Preventing the Preventable; Preserving healthcare services
Recent address by
Dr. Sarath Gamini De Silva
to the Galle Medical Association
It is indeed my privilege and pleasure to be given this opportunity to address the members of the Galle Medical Association (GMA). I am grateful to the President and the Council of the GMA for inviting me as the guest of honour at the inauguration ceremony of your annual academic sessions.
Coming here today is like getting back to my roots again. I was born and bred in Galle and had my entire primary and secondary education at Richmond College. Between 1982 and 1995 I was associated with the GMA in my capacity, first as a senior lecturer in medicine for two years and then for nine years as a Consultant Physician at the Teaching Hospital, Karapitiya.
I was the President of the Galle Medical Association in 1994.My colleague Prof. Ariyananda and I were the first two senior lecturers in the Dept. of Medicine, with Prof. Hettiarachchi as the head. We knew almost every student in the first few batches by name, taking a personal interest in their welfare, to make sure that they did well as doctors.
The academic and non-academic staff took it up as a personal challenge to prove that the Ruhuna Medical Faculty, though rather hastily established, was second to none in the island. Looking back, we can be happy that all did very well, most of them becoming very competent specialists in various fields, later on, and are providing an exemplary service here and abroad.
We started in the dilapidated buildings at Mahamodera and then moved into modern facilities at Karapitiya, which at that time was still a building site. The long-established Galle Clinical Society later merged with the relatively new Galle Medical Association under the presidency of the late Prof. Tommy Wickremanayake, the Dean of the Medical Faculty, at that time. This wonderful auditorium, named after him, is a tribute to the late Professor’s energy and determination to see that we had the best facilities in the Southern Province. He took me round this building site on several occasions, and I once nearly had an accidental fall trying to mount this stage, only half built at that time. Today I feel quite confident standing here on a firm foundation, a podium graced by many medical luminaries over more than 40 glorious years, in the service of medical education.
The Galle Medical Association has done justice to the ideals and aspirations of its founders. As a life member, I receive regular information of your activities. The Association is meeting amply the academic and non-academic needs of its membership. Your lecture series on beyond medicine; religious and sports activities, musical programmes, leisure trips, etc., would provide much relaxation outside the exhausting routine of medical practice. Your annual academic programme is not second to that of many professional Colleges and Associations based in Colombo or elsewhere in the country. This wide array of activities is indicative of an Association keen on providing an all-round service to its members and their families, as well as to the medical students. My congratulations to all concerned.
Your theme this year, “Preventing the Preventable,” is very timely. With the economic crisis we are experiencing, the age old saying “Prevention is better than cure” is more relevant today than ever before. Certainly, true in the case of prevention of diseases, I am concentrating today on other aspects of healthcare the doctors have overlooked and to a great extent failed to prevent their decline.
Preventing the Preventable; Preserving the Healthcare Services is my concern today.
All the remarkable achievements in the fields of communicable and non-communicable diseases, with world acclaimed health indices, are now being nullified by the economic crisis in which the healthcare services appear to be caught unawares. The shortage of drugs and other equipment, costing more and more with every passing day, has made it near impossible to give proper treatment to needy patients. I will not be surprised to hear of deaths due to lack of treatment in the near future. We already hear allegations, though authorities keep refusing to accept their responsibility, of deaths due to poor quality of drugs hastily imported to overcome shortages in a poorly planned system.
This is compounded by poor household incomes, high transport costs and other difficulties the patients experience in seeking medical care.
While most of the blame for this unfortunate situation falls on poor planning and corruption by the rulers, the medical profession, too, has failed in preventing this calamity. They have contributed by their irrational prescription habits, doing unnecessary investigations and the like, leading to a high cost in the delivery of healthcare. Irrational prescriptions contribute in a big way to multidrug resistance to antibiotics, as well. Poorly regulated private practice by doctors needs an overhaul. Exorbitant fees charged by some specialists are the talking point in the society. I need not bore you with details which should be well known to all of you by now.
We as a profession should not allow ourselves to be exploited by the profit-oriented private healthcare services and the pharmaceutical industry. The patients are compelled to pay a heavy price for our shortcomings in this regard. Thus, by our inaction in dealing with such, we have failed to prevent the gradual deterioration of the respect the society has for the profession.
Has the medical profession knowingly or unknowingly colluded with the misdeeds of the politicians? As an example, I wish the institutions, like the drug regulatory authority, NMRA, did more to prevent corruption and irregularities in the procurement of drugs. They have remained mostly silent knowing very well how their decisions regarding the registration of drugs are overruled or circumvented by politicians and administrators with ulterior motives.
Functioning of the Sri Lanka Medical Council is being looked down upon by many in the profession itself. The amendments to the Act governing the SLMC has been proposed over many years to broad base its membership to include non-medical professionals and make it more effective in its primary duties of regularizing medical practice, maintaining discipline in the profession and maintaining good standards of medical education. Politicians have so far failed to enact them. With poor standards of medical education, due to shortages in staff and other facilities in hastily established new medical schools, SLMC has been largely silent on these aspects. At present it appears that the medical trade unions and indirectly the political influence are hampering its proper functioning. As a result the SLMC remains mainly a body for holding the ERPM for foreign medical graduates and registering the medical practitioners. Our professional associations should be more involved in its affairs and add their voice for reforms.
I have been a member of the SLMC for 10 years in the past. But your chief guest as its immediate past president, who was removed from the post in a most unprofessional way by the politicians, with perhaps the connivance of our own colleagues, will be in a better position to address these issues. That action initiated by our own professional colleagues has now established a precedent for the Health Minister to have a bigger say in the SLMC affairs, seriously undermining its autonomy.
In my address to the Colombo Medical Congress a year ago, I stressed how our Professional Colleges and Associations kept a blind eye without getting involved and having their say in the administration of the health service. Even when there was an uprising asking for a system change, the medical profession remained largely silent without adding their voice. This was in stark contrast to the legal profession who stood up with the people asking for justice. By remaining ‘respectable’, confining ourselves to academic activity only, we have allowed our efforts at improving services to the public and training postgraduates to become meaningless. As a result, we are now spending tax payers’ money for training specialists for service abroad. With an unprecedented exodus of locally trained doctors and other healthcare staff, we are helping richer countries to serve their citizens better. The world-acclaimed health indices we have achieved by hard work over the years are becoming irrelevant with rampant malnutrition and other maladies affecting a significant proportion of the people.
Even the few medical men who dared to warn the authorities publicly on impending childhood malnutrition in their area had to face disciplinary action. The services of an alumnus of the Ruhuna medical faculty have been terminated as a result. Unfortunately, there is hardly any protest heard from the trade unions or other medical organizations against such action, at a time when elsewhere numerous unlawful activities and rampant corruption remain unpunished.
As much as the people are asking for all 225 in the Parliament to be thrown out, there are loud whispers in the society that the medical profession, too, is corrupt exploiting the people in various ways. There is no use in our grumbling about any shortcomings of doctors and incidents of medical negligence being highlighted in mass media regularly. Naturally, the good work done by the doctors will not be talked about with praise as that is the minimum the society expects from us.
It is high time our annual conferences and other meetings had a regular session or symposia on various aspects of the doctor in society, discussing our own faults and ways of rectifying them. All Colleges, especially those dealing with clinical disciplines coming into direct contact with the public daily, should communicate regularly with their members on these issues. They should also keep a close watch on the activities of health-related institutions like the SLMC and the NMRA already referred to, and intervene where necessary, without waiting till it is too late.
Thus, prevention in broader terms involves not only prevention of diseases but also prevention of other irregularities in the administration of health and questionable practices of our own colleagues that have a direct bearing on the health of the people. The medical profession, despite its many shortcomings, is still respected and influential. Our strong voice will be heard by the rulers, medical administrators and the general public.With these thoughts let me conclude by wishing you all a very successful and enjoyable annual sessions. I wish you all a very good evening.