Health sector in crisis:

Causes and possible remedies

Of all the crises that affect us, the most damaging is that in the medical sector. Pictures of poor elders turned away from empty clinics due to sudden strikes by nurses, attendants and (quite deplorably) doctors are heart-breaking.

Now doctors including consultants are leaving the country in droves, supposedly seeking more lucrative employment in richer countries. It is unfair, and possibly erroneous, to suggest that money is the only or main motivating force. It takes much more than financial considerations to drive them to leave their country of birth.

It is clear that many of our countrymen working abroad have reached stellar heights in their chosen fields. It seems that our young men and women are no less talented than the best there is. Thus, it is not likely that the lure of creature comforts and money alone are the main driving forces, or that they are betraying the investment of State money and time, to equip them educationally. The argument that they should acknowledge their debt to the nation in some way is reasonable.

There are much more compelling reasons for their risking their own future and that of their children in virtually unfamiliar conditions. I believe that the causes of their discontent have to be identified and rectified so that our growing society will measure up to their expectations.

It is true that health and education are nominally provided free by the State, but equally true that their quality is far below acceptable standards.

Sadly, in our society, politics takes precedence over everything else. That it emits an overpowering stench on all that it touches is clear. It is a largely parasitic creature, whose roots have sunk into a totally subservient heart. That it has done so successfully is tribute to a virile and evergreen menace. Thus, our stupidly malleable society has been deceived to loudly demand a timely holding of elections and a New Constitution.

This false delusion of “Power to the people” deflects attention from much more compelling and real issues like for example, escalation of crime, drug addiction and widespread malnutrition of children.

Rather than asserting that emigrating citizens are disloyal ingrates, it would be far more productive to identify and where possible to eliminate, or at least to reduce the underlying causes that encourage emigration.

Firstly, the discontent that is dramatised by the alarming departure of medical talent, is much more widespread among all professionals, be they teachers, researchers, academics or engineers, as well as others with specialised training and experience. They are invaluable assets, which our country cannot afford to lose.

Given the all- pervasive nature of politics in our country, ii is but fair that comparison focus on this sector as setting standards for others. Parliament becomes the “Gold Standard” or a factor of reference as the base. By any measure, the stark difference between the rewards for politics far surpasses those of any other. This huge aberration, if allowed unchecked, will lead to irreversible decline and eventual collapse.

The enormous disparity between rewards for Parliamentary representation are so blatant that they could never have escaped the notice by the beneficiaries of this ridiculous reality. A few need emphasis.

Costs and (no) returns.

Each member of Parliament is estimated to cost the Exchequer about one million Rupees per month. In reply to a Member’s query, it was revealed that the total cost of maintaining a previous incumbent of the Presidency, was around twenty million per day.. Little wonder that in the quest for this bonanza, the aspirants would resort to even the most despicable crime, to lay their grasping hands on this unconscionable reward. Talk of “value for money”.

Dereliction of Duty.

Parliament assembles for 100 to 120 days per year. This works out at less than a two-day week. Even with this low demand, the empty seats are scandalous. Often, even the quorum is not met. The front row of seats (ruling party seniors and Cabinet) are bare. It was once explained (without a semblance of shame) that no less than 18 Ministers were abroad. One wonders how the rest of the World survives in their absence. One may also question why our taxpayers should pay for the upkeep of other Countries, while neglecting their own. Generally, the proceedings, of Parliament are rich in ritual and poor in substance.

Quite often, the House adjourns, even after just about ten minutes for lack of a quorum or even inability to control a rowdy display. It is interesting to know whether members draw their “sitting allowance”.

Pensions:

While most public officers get entitled to a graded pension after more than twenty years of service, and this too a miserable percentage of their last salary, an MP after just five years (just a single term), qualifies for a lifetime pension possibly drawing 100% of his emoluments as pension for life, and for the wife too. A retiring (or dying or being chased out) President is entitled to a full salary, a house, staff and security as before. The same applies for the surviving spouse. Not bad is it?

In my personal case, after serving the State for more than fifty years, I do not draw one cent as pension. Is it any wonder that I have a great respect and love for politicians living or dead?

I have deliberately focused on the undue prominence and costs of duping ourselves on the relevance and importance of an essentially divisive activity. The media must take much of the blame for this societal scourge. Personalities of doubtful competence – even to the extent of crudity – are lionised by undue prominence. It seems as if nothing else matters. Events, achievements and personalities outside of politics do not seem to be worthy of attention.

This situation has perhaps, defined much public behaviour – such as this of massive emigration. It is human nature to be exhilarated by peers as worthy of praise. It is painful to be ignored or condemned to anonymity.

The low priority accorded to science and professionalism in general manifests in several ways and bodes ill for development, and adversely impacts on sustainability and future progress.

The impact of science on a country’s progress, is well illustrated by countries like Germany, UK and other European countries and Japan and more recently by China and South Korea. The South Korean example is perhaps the most relevant to us. The management of companies with significant technological content, like Samsung, is a striking example, where young and recently qualified scientists are at the helm of management.

As an indication of the Government’s serious interest, a massive multi-storied building was built to house their nascent Science Academy. The total cost was more than USD 5 mn and borne entirely by the government. The floor area is vastly in excess of immediate needs. The academy was empowered to rent out or lease some of its premises and use the proceeds to meet their immediate needs. This is in a country which not so long ago was in severe economic distress.

In contrast, The Sri Lanka Association for the Advancement of Science (SLAAS) and The National Academy for Sciences in Sri Lanka (NASSL) are together allocated just about a million Sri Lanka Rupees as an Annual Grant, and this too not paid to the two Associations in several years. It is hoped that The State Institutes for Health (MRI), Industries (ITI) and The Government Analysts and Meteorology Departments are treated better.

Contrast this with the expenditure borne for Parliament and other political institutions and and it will be easy to see where state priorities seem to lie.

Actually, the medical sector has a march over others. This is the contentious issue of private practice being allowed outside of official working hours. All are aware how this contentious facility is prone to abuse. The State service suffers deprivation and providers of private services thrive. The same applies to the education field as well, private tutors easily siphon quality education to private tuition centres fed easily by willful neglect of legitimate duties.

In my opinion this is one of the most damaging political stunts since 1956.The perpetrators of this crime took pains to see that their own children were shipped abroad to be educated in English, thereby improving their employability, locally and also in most parts of the World.

At the time of this disastrous change, (during the watch of our greatest PM), the Minister of Education was Mr Badi-uddin Mohamed Former Principal of Zahira College, Gampola. Under the Act, Muslim children could choose their medium of instruction, while those of Tamil or Sinhala parentage were compelled to choose the language of their parents. Muslim children mostly chose English. The consequences are plain to see and are bound to be aggravated with time,

To me, the Language/Swabasha/Sinhala only Act, has been an unmitigated disaster. The abandonment of English as the medium of instruction has blasted the career prospects for our children, isolating them from a vast treasure of information and thereby employability. Perhaps most parents would not wish this to happen to their children. Hence the incentive to relocate. This change has handicapped a whole generation and will affect others yet to come. It was political jugglery at its worst and will remain a monument to a nation’s stupidity.

Media coverage reveals a massive escalation of crime. Unsolved killings, robberies, drug-related crimes and smuggling. The numbers and quantities and cash seizures are mind boggling. Sociologists have a role in determining the extent to which proceeds and prevalence of law infringements results in a social and class upheaval. The Middle Class is facing extinction and take-over by a less educated and more vicious segment of society. The elders among us may recall “The Turf Club Robbery” which made media headlines for months. The amount involved was some four lakhs and one murder. In today’s context, this would barely qualify as petty crime.

Corruption which has penetrated all sectors of society, is alarming and very justifiably concern parents and would constitute an important incentive for re-location.

The problem of drug addiction among the young is truly alarming. If unchecked, it will escalate sufficiently to throttle our entire social fabric.

Consequently, it is cynically believed that one can be believed. This has very far-reaching impacts. Choosing to ignore such trends is a recipe for disaster. A feeling of powerlessness is a recipe for disaster.

These are, I believe, factors that motivate emigration rather than the mere quest for monetary gain and creature comforts.

More politics and legal reforms alone are unlikely to be effective and adequate.

Dr. Upatissa Pethiyagoda